Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_10-cv-02385/USCOURTS-casd-3_10-cv-02385-0/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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10cv2385 1

UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF CALIFORNIA

COLLEEN STUART,

Plaintiff,

v.

MICHAEL J. ASTRUE, 

Commissioner of Social

Security,

Defendant.

 

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Civil No. 10-2385-WQH(WVG)

REPORT AND RECOMMENDATION 

DENYING PLAINTIFF’S MOTION FOR

SUMMARY JUDGMENT (DOC. # 10) 

GRANTING DEFENDANT’S 

MOTION FOR SUMMARY JUDGMENT

(DOC. # 11)

On November 18, 2010, Plaintiff Colleen Stuart (hereafter

“Plaintiff”), filed a Complaint for Judicial Review and Remedy On

Administrative Decision Under The Social Security Act [42 U.S.C.

§405(g)]. On January 18, 2011, Defendant Michael J. Astrue

(hereafter “Defendant”), filed an Answer and the Administrative

Record (hereafter “Tr.”), pertaining to this case. On March 28,

2011, Plaintiff filed a Motion for Summary Judgment. On April 11,

2011, Defendant filed an Opposition to Plaintiff’s Motion for

Summary Judgment and a Cross-Motion for Summary Judgment.

The Court, having reviewed Plaintiff’s Motion for Summary

Judgment, Defendant’s Opposition to Plaintiff’s Motion for Summary

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10cv2385 2

Judgment, Defendant’s Cross-Motion for Summary Judgment and the

administrative record filed by Defendant, hereby finds that

Plaintiff Is not entitled to the relief requested and therefore

RECOMMENDS that Plaintiff’s Motion for Summary Judgment be DENIED

and Defendant’s Motion for Summary Judgment be GRANTED.

 I

 PROCEDURAL HISTORY

On February 27, 2007, Plaintiff filed applications for 

Supplemental Security benefits and Disability Insurance Benefits,

alleging that she was disabled since February 20, 2006. (Tr. 16,

118-130). Plaintiff alleged that she became unable to work because

of herniated discs in her back, shoulder pain, lower back pain,

right side neck pain, shoulder and arm pain, right side body pain,

numbness in her right foot, and depression. (Tr. 33, 473, 493). 

The Commissioner of Social Security denied her application

initially and upon reconsideration. (Tr. 63-72). On November 14,

2007, Plaintiff requested a hearing before an Administrative Law

Judge (hereafter “ALJ”). (Tr. 76). On June 25, 2009, Plaintiff

appeared before Larry B. Parker, the ALJ, at a hearing with counsel.

The hearing was continued. (Tr. 24-28).

 On August 17, 2009, Plaintiff again appeared and testified

before ALJ Parker. (Tr. 31-58). On September 25, 2009, ALJ Parker

found that Plaintiff was not disabled. (Tr. 13). On August 20, 2010,

the Appeals Council denied Plaintiff’s request for review of the

ALJ’s decision. (Tr. 5-8). On September 21, 2010, the Appeals

Council again denied Plaintiff’s request for review and the ALJ’s

decision became the final decision of the Commissioner of Social

Security. (Tr. 1-4). 

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1/ The dates of Plaintiff’s reported employment in each job varies by

report. (See Tr. 172, 193, 212).

2/ In 2003, doctors recommended that Plaintiff have surgery to

alleviate the pain in her neck. Plaintiff did not undergo the

surgery on her neck because she is “claustrophobic” and did not want

to wear a neck brace.(Tr. 40).

10cv2385 3

 II

 STATEMENT OF FACTS

Plaintiff was born on April 16, 1950. She completed two years

of education after high school. (Tr. 32). Plaintiff worked as a

medical assistant until 1995, an airline ticket salesperson from

January 1998 to January 2000, a timeshare salesperson at various

companies from January 2000 to October 2005, and an education

consultant from October 2004 to February 2006.1/ (Tr. 33, 185, 193).

In 2001, Plaintiff ‘blew out’ her knee and hurt her neck when

she fell down a set of stairs.2/

 (Tr. 39). In 2004, Plaintiff

purportedly suffered a lower back injury in a motor vehicle

accident. (Tr. 36). In 2009, Plaintiff had knee surgery. (Tr. 52).

Plaintiff claims she became unable to work on February 20,

2006. (Tr.33). Plaintiff used this date as her disability onset date

because it is when her California State Disability Insurance (SDI)

payments ended. (Tr. 36). Plaintiff alleges degenerative disc

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3/ Degenerative Disc Disease (“DDD”) is not really a disease but a term

used to describe the normal changes in spinal discs as a person

ages. It is when spinal discs break down (or degenerate). It can

take place throughout the spine, but it most often occurs in the

discs in the lower back (lumbar region) and the neck (cervical

region). The changes in discs can result in back or neck pain,

osteoarthritis, herniated disc, and spinal stenosis (narrowing of

the spinal canal). DDD may be caused by age-related changes such as

loss of fluid in spinal discs or tiny tears or cracks in the outer

layer of the disc. These changes are most likely to occur in

smokers, people who do heavy lifting, and obese people. DDD can also

be caused by a sudden injury leading to a herniated disc (an

abnormal bulge or breaking open of a spinal disc). DDD may result in

back or neck pain and where the pain occurs depends on the location

of the affected disc. The pain often gets worse with movements such

as bending over, reaching up, or twisting. See

http://www.webmd.com/back-pain/tc/degenerative-disc-disease-topic.

4/ Degenerative Joint Disease (also called osteoarthritis)is a type of

arthritis that is caused by inflammation, breakdown, and eventual

loss of the cartilage of the joints. Osteoarthritis is the most

common type of arthritis and usually affects the hands, feet, spine,

and large weight-bearing joints, such as the hips and knees. See

http://www.medterms.com/script/main/art.asp?articlekey=2932.

5/ “Of or relating to or near the small of the back and the back part

of the pelvis b etween the hips.” See

http://www.thefreedictionary.com/Lumosacral. No definition was found

for “Lubosacral Degenerative Disc Disease.” It appears as though

Plaintiff is referring to lubosacral merely as the location/one of

the locations of Plaintiff’s alleged DDD.

6/ Radiculopathy refers to nerve irritation caused by damage to the

disc between the vertebrae. This occurs because of degeneration of

the outer ring of the disc or because of traumatic injury, or both.

Weakness of the outer ring leads to bulging and herniation. When

nerves are irritated in the neck from degenerative disc disease, the

condition is referred to as “cervical radiculopathy,” which can

cause painful burning or tingling sensations in the arms. When

nerves are irritated in the low back from degenerative disc disease,

the condition is called “lumbar radioculopathy,” which often causes

“sciatica” pain that shoots down to a lower extremity. See

www.medicinenet.com/degenerative_disc/page 2.htm

10cv2385 4

disease3/

 (hereafter “DDD”), degenerative joint disease4/, back,

shoulder, neck, foot, and right leg pain, lumbosacral5/ DDD,

radiculopathy6/, and depression, an affective disorder. (Tr. 33).

Plaintiff has seen several psychologists since her divorce in

1986. (Tr. 40). She has also seen numerous psychiatrists. (Tr. 42).

Plaintiff claims that she does very little all day; although she

occasionally drives her mother to the Commissary, where they shop

together using electric carts. (Tr. 46). Plaintiff claims that she

does not do any household cleaning but does do some cooking.

Plaintiff claims that she no longer has hobbies and is not a

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7/ “Lumbar” refers to five lumbar vertebrae situated in the spinal

column. The five lumbar vertebrae are represented by symbols L1

through L5. The five vertebrae are situated in the part of the back

and sides between the lowest ribs and pelvis. See

http:/www.thefreedictionary.com/lumbar;http://www.medterms.com/scr

ipt/main/art.asp?articlekey=18053.

10cv2385 5

‘typist’ on the computer. (Tr. 47-48). However, Plaintiff was able

to care for sick and aging family members for a period of time. (Tr.

308).

Subsequent to her disability onset date of February 20, 2006,

Plaintiff received state disability benefits for one year. From

April 7, 2007 to July 19, 2007, she worked approximately 30 hours

per week selling timeshares. Plaintiff was fired for losing her

temper. (Tr. 33-36). The ALJ found that for purposes of a disability

determination, this particular employment was not “substantial

gainful activity.” Rather, it was “an unsuccessful work attempt.”

(Tr. 18).

A. Dr. Thomas Waltz, Orthopedist

On April 8, 2002, Plaintiff first visited Dr. Waltz. She

complained of neck and arm pain as the result of a fall. Plaintiff

worked in sales at the time and had undergone previous operations on

her knees. Plaintiff told Dr. Waltz that the pain had been

progressive since her fall.(Tr. 272). Further, Plaintiff complained

of lower back pain that had been present since the 1980's. 

On physical examination, Dr. Waltz concluded that Plaintiff

walked on her heels and toes normally, had a good range of motion in

her neck, and her lumbar7/ scan showed no particular abnormality. Dr.

Waltz also discussed with Plaintiff the possibility of surgery for

her neck pain, should medication not alleviate it. (Tr. 272-273).

On April 26, 2005, Dr. Linda Falconio, Plaintiff’s primary care

physician, referred Plaintiff to Dr. Waltz for a consultation.

Plaintiff reported to Dr. Thomas Waltz that she had pain between her

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8/ Degenerative arthritis is also known as Degenerative Joint Disease

and osteoartritis.

9/ “Intractable Pain” refers to pain that is not easily relieved or

cured. See http://www.merriam-webster.com/medlineplus/intractable.

10/ “Cervical” is of or relating to a neck or cervix. See

http://www.merriam-webster.com/medlineplus/cervical. 

11/ Magnetic Resonance Imaging (MRI) if a noninvasive diagnostic

technique that produces computerized images or internal body

tissue.Se ewww.merriamwebster.com/medlineplus/magnetic+resonance+imaging.

12/ Loss of disc height is a symptom of Degenerative Disc Disease. See

http://www.medicinenet.com/degenerative_disc/article.htm.

13/ A “disc bulge” is also known as a herniated disc. A herniated disc

is when the softer central portion of a disc ruptures through the

surrounding outer ring, possibly causing pain at the level of the

disc herniation. A herniated disc is a symptom of Degenerative Disc

Disease.See http://www.medicinenet.com/degenerative_disc/article.htm

14/ “Facet joints” are joints that stack the vertebrae. See

http://www.medicinenet.com/degenerative_disc/article.htm.

15/ Refers to Lumbar 5, and Sacral 1 discs in the spine. “Sacral” refers

to the “sacrum,” the triangular bone at the base of the spine. See

http://medical-dictionary.thefreedictionary.com/sacrum. Basically,

Plaintiff has mild DDD in her lower back.

10cv2385 6

shoulder blades and pain in her lower back that was radiating into

her legs. She explained that the pain was aggravated by a car

accident in 2004. (Tr. 270).

Dr. Waltz found that Plaintiff appeared to have some 

degenerative arthritis,8/ intractable9/ pain syndrome, and a recent

cervical10/ and lumbar strain. He recommended that she try medication

at bedtime and to have a lumbar MRI11/ scan. (Tr. 270-271).

On May 11, 2005, Plaintiff had an MRI of her lumbar spine. The

MRI found that Plaintiff’s alignment of her lumbar spine was within

normal limits with very mild loss of disc height12/ at L4-5 and a

mild disc diffuse bulge13/ at this level. Plaintiff also had mild to

moderate facet14/ degenerative joint disease at L5-S1.15/(Tr. 266).

B. Linda Falconio, M.D., Plaintiff’s Primary Care Physician

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16/ Chronic refers to long duration, frequent recurrence over a long

time and often by slowly progressing seriousness. See

http://www.merriam-webster.com/medlineplus/chronic.

17/ Duragesic is a skin patch containing fentanyl, a narcotic (opioid)

pain medicine. The Duragesic skin patch is used to treat moderate to

severe chronic pain. Duragesic is not for treating mild or

occasional pain or pain from surgery. See

http://www.drugs.com/search/php?searchterm=Duragesic=patches.

18/ Norco is a prescription medication containing acetaminophen(a less

potent pain reliever that increases the effects of hydrocodone) and

hydrocodone (a narcotic pain reliever). Norco is used to relieve

moderate to severe pain. See http://www.drugs.com/norco/html.

10cv2385 7

Plaintiff began to visit Dr. Falconio in December 2004 for

primary care after her motor vehicle accident. (Tr. 187).

On June 16, 2005, Plaintiff was extremely stressed over her

finances, employment issues, and problems at home with her son. On

this date, Dr. Falconio noted that Plaintiff’s recent (2004) auto

accident exacerbated her chronic16/

 back pain and that Plaintiff had

continued problems with numbness in her legs, likely due to her

spinal cord problems. Dr. Falconio reported that Duragesic patches17/

improved the control of Plaintiff’s pain until her recent (at the

time) move, when she did a lot of lifting and packing. (TR. 322). 

On January 11, 2006, Plaintiff visited Dr. Falconio,

complaining of problems at work. Dr. Falconio noted much improvement

in Plaintiff’s back pain with the use of a Duragesic and occasional

use of Norco18/ medication. (Tr. 316).

On March 13, 2006, Dr. Falconio reported that Plaintiff was

fired from her job after missing a mandatory meeting due to fatigue

from her pain medications. Dr. Falconio reported that Plaintiff was

beginning to suffer from muscle ticks, had no appetite, was on

numerous pain medications, and her Duragesic patches were wearing

off quickly (in less than 72 hours). Further, Dr. Falconio reported

that Plaintiff could not sit, walk, or stand for an extended period

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19/ Foot-drop is a dropping of the front of the foot due to weakness or

paralysis of a anterior muscles of the lower leg. Foot drop results

in what is called a steppage gait in which the advancing foot is

lifted high in order that the toes may clear the ground. Foot-drop

can be caused by a number of conditions, including injury to muscles

in the foot, or nerves to these muscles. See

http://www.medterms.com/script/main/art.asp?articlekey=22480.

20/ Early satiety is feeling full sooner than normal or after eating

less than usual. See http://www.drugs.com/enc/satiety-early.html.

21/ A neuroma is a growth that arises in nerve cells. A Morton’s Neuroma

is a swollen, inflamed nerve located between the bones at the ball

of the foot. http://www.medicinenet.com/mortons_neuroma/article.htm.

10cv2385 8

of time, she had foot-drop 19/

 on her right foot, she had leg pains,

and Plaintiff reported that she was not sure what she could do for

a job. Dr. Falconio reported that Plaintiff told her that she had

applied for unemployment, but was not sure that she would receive

it. Dr. Falconio gave Plaintiff a form for disability. (Tr. 311).

On June 23, 2006, Plaintiff visited Dr. Falconio. Plaintiff

reported that she had numbness and pain on the bottom of both of her

feet, and that she could not stand, or sit for an extended period of

time. Plaintiff also reported that she was taking care of her father

who had Alzheimer’s Disease, and was visiting him at least once

every two days. Dr. Falconio noted that Plaintiff had weight loss

due to early satiety,20/ that she had chronic pain, financial stress,

severe low back pain (LBP), spinal disease, chronic pain syndrome,

probable Bilateral Morton’s Neuroma21/, and continued stress from

caring for her sick parents and troubled son. (Tr. 308).

On September 25, 2006, Plaintiff visited Dr. Falconio. Dr.

Falconio reported that Plaintiff was still in a lot of pain and

under a “tremendous amount” of stress with her son. Dr. Falconio

reported that Plaintiff must extend her disability for six more

months. (Tr. 304).

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22/ Sciatica is pain resulting from irritation of the sciatic nerve,

typically felt from the low back to behind the thigh and radiating

down below the knee. Sciatica can result from a herniated disc or

any irritation or inflamation of this nerve. See

http://www.medterms.com/script/main/art.asp?articlekey=5418.

23/ Xanax is in a group of drugs called benzodiazepines. It affects

chemicals in the brain that may become unbalanced and cause anxiety.

Xanax is used to treat anxiety disorders, panic disorders, and

anxiety caused by depression. See http://www.drugs.com/xanax.html.

24/ Soma is a muscle relaxer that works by blocking pain sensations

between the nerves and the brain. Soma is used together with rest

and physical therapy to treat injuries and other painful

musculoskeletal conditions. See www.drugs.com/soma/html. 

10cv2385 9

On April 23, 2007, Dr. Falconio opined that Plaintiff had

chronic anxiety, chronic back pain, sciatica,22/ increasing problems

with the use of her right leg, and multiple stresses from her

finances. Dr. Falconio reported that Plaintiff was waiting to

receive long-term disability. Plaintiff was given re-fills on

various medications, including Xanax23/

 and Soma.24/ (Tr. 646-648).

On October 2, 2007, Plaintiff’s chart noted that Plaintiff

“cannot sit, walk, or do much of anything, her life is really bad

due to her pain.” Furthermore, it was noted that (1) Plaintiff has

a discolored buttocks due to tissue injury from the use of heating

pads to control pain, (2) she needed an MRI of her spine,(3) she was

trying to work but needed a letter regarding a drug test,(4) she

still could not feel her foot, since her motor vehicle accident in

2004, (5) she could not go to dinner or the movies, (6) she could

not stand or walk for more than 10 minutes, (7) she rarely had upper

back problems but her lower back was “really a problem now,” (8) her

bowel function was impaired due to her spine problems and nerve

injury,(9) she had chronic anxiety and panic, (10) she had

progressive weight gain from inability to be active, and (11) she

had chronic bladder problems due to all the pressure and pain. An

order was given for Plaintiff to have a brain MRI and she was given

a re-fill on her Xanax. (Tr. 642, 644).

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10cv2385 10

On March 17, 2008, Plaintiff’s chart noted that she had been

living with her mother in a retirement facility since her father

passed away in January 2008. Plaintiff reported that disability

“turned her down right away.” Dr. Falconio reported that Plaintiff

“just can’t work due to the pain and drugs. She has no comfortable

position to sit. Her legs get numb in the car.” Dr. Falconio further

reported that Plaintiff had stress with the recent death of her

father, had permanent disability and chronic anxiety, and that her

pain medications would be increased. (Tr. 635, 637).

On January 20, 2009, Dr. Falconio reported that Plaintiff was

limping and using a cane. Plaintiff stated that she would need to

have her knee replaced but was not sure when the surgery would take

place. Dr. Falconio noted that Plaintiff “is doing ok otherwise.”

(Tr. 632).

On April 22, 2009, Plaintiff visited Dr. Falconio for pre-knee

operation and other concerns. The Patient Chart indicated that

Plaintiff was planning on a total knee replacement that week with

Dr. Hackley. Plaintiff reported several months of chest pressure

radiating to her neck and jaw, and occasional radiation to her arm.

The chart indicated that Plaintiff “has severe DDD in neck and

spine, nerve damage on her right side, and a bit of drop foot.” 

Plaintiff blamed her reported foot spasms on being “shoved by

a police woman” on April 18, 2009. The chart further indicated that

Plaintiff was under stress because she was taking care of her

mother. Her mother was in her 80's, and had dementia and night

terrors. Additionally, Plaintiff’s son was out of jail on bail and

was allegedly being harassed by the police. (Tr. 625-626).

Dr. Falconio advised Plaintiff to cancel her surgery.

Plaintiff declined pain medications, stating that she just needed to

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28 25/ Atrophy refers to a decrease in size or a wasting away of a body

part or tissue. www.nlm.nih.gov/medlineplus/mplusdictionary.html.

10cv2385 11

talk about the incident with her son. Notes in Plaintiff’s chart

also indicated that Plaintiff’s foot spasms may be caused by her

disc disease and abnormal gait, but labs tests were ordered in order

to rule-out other possible causes. (Tr. 628).

On June 15, 2009, Dr. Falconio completed a “Spinal Residual

Functional Capacity Questionnaire” with regard to Plaintiff. Dr.

Falconio noted that (1) Plaintiff has chronic pain with tenderness,

muscle spasm, lack of coordination, atrophy,25/ and reduced grip

strength, but Plaintiff has no significant limitation of motion, (2)

Plaintiff has depression, anxiety, and irritability, which affect

her physical condition, (3) Plaintiff is incapable of even “low

stress” jobs because of her chronic pain, drowsiness, and

irritability, (4) Plaintiff can only walk one-half of a city block

without rest or severe pain, she can only sit for 15 minutes without

getting up, and she can only stand for 20 minutes at one time, (5)

in an eight hour work day, Plaintiff can sit and stand or walk for

less than two hours, (6) at work, Plaintiff would need to shift

positions at will, (7) Plaintiff should carry less than 10 pounds

rarely, (8) Plaintiff should rarely move her head, twist, and climb

stairs, (9) Plaintiff should never stoop, crouch, or climb ladders,

(10) Plaintiff cannot use her right hand at all and can only use her

left hand 10 percent of an eight-hour working day, (11) Plaintiff is

likely to miss more than four days per month of work. Based on all

of her observations, Dr. Falconio opined that Plaintiff is capable

of “less than sedentary work.” (Tr. 677-682).

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On March 17, 2010, Dr. Falconio wrote a letter recommending

Plaintiff’s use of a service dog due to her chronic pain, spinal

disease, severe depression, and situational stress. (Tr. 731).

On June 2, 2010, Dr. Falconio filled out the “Mental Work

Restriction Questionnaire” on behalf of Plaintiff. Dr. Falconio

reported that Plaintiff had depression, a stress disorder, anxiety,

and panic, as found by her psychologist, Dr. Angelina Hood. Dr.

Falconio further noted that Plaintiff had mostly “severe”

impairments in the area of engaging in various work activities,

including tasks such as remembering procedures, maintaining

attention for two hours, making simple decisions, accepting

instructions, and responding to criticism. Dr. Falconio further

reported that Plaintiff had a “poor” prognosis. (Tr. 734-735).

Dr. Falconio also filled out an “Evaluation Form for Mental

Disorders” on behalf of Plaintiff. Dr. Falconio noted several

illnesses and social history, including incapacitation from working,

chronic pain, and anger issues. The doctor reported that Plaintiff

had difficulty accomplishing daily tasks, had a lot of disagreements

with neighbors, had poor coping abilities with stress, that

Plaintiff worked poorly with others, and that she had previously

been terminated from jobs. (Tr. 737-740).

C. Angelina Hood, Ph.D., Plaintiff’s Psychologist

Plaintiff first visited Dr. Hood in 2001 for depression,

therapy and medication. (Tr. 187).

 On June 22, 2009, Dr. Hood filled out a “Mental Impairment

Questionnaire” about Plaintiff. With regard to employment, Dr. Hood

opined that there are several areas where Plaintiff had no useful

ability to function, including (1) maintaining attention for two

hours, (2) maintaining regular attendance, (3) working in proximity

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26/ Plaintiff and Defendant consistently and mistakenly refer to Dr.

Michael Sebahar as Michael “Sebahak.” The correct spelling is

“Sebahar.”

10cv2385 13

with others without being distracted, (4) completing a normal

workday without psychologically based symptoms and an unreasonable

number of rest periods, (5) getting along with co-workers, (6)

dealing with normal work day stress, and (7) dealing with stress of

semi-skilled and skilled work. (Tr. 691-692).

Furthermore, Dr. Hood opined that Plaintiff possessed numerous

symptoms, including (1) physical and emotional limitations, (2)

irritation and moodiness with her physical problems, limiting her

ability to work with, and interact with others, (3) that Plaintiff’s

psychiatric condition exacerbated Plaintiff’s experience of pain and

other physical symptoms, and (4) that Plaintiff has anxiety,

depression, elation, irritability, anger, frustration, and sadness.

Dr. Hood opined that Plaintiff has chronic pain, is depressed,

and has a pain disorder. Dr. Hood further opined that Plaintiff’s

problem areas include occupational, economic, and social

environmental issues. (Tr. 689-698).

D. Michael Sebahar26/, M.D., Plaintiff’s Pain Management

 Physician

Plaintiff began visiting Dr. Sebahar on May 10, 2005, for pain

management, medications, examinations, and testing. (Tr. 187, 262,

468). Plaintiff complained of pain in her lower back, neck, and

upper mid-back region. She described “stabbing pain,” radiating down

her calf, with numbness in her right foot, and “stabbing” pain

radiating down her arm to her elbow and right breast. Plaintiff told

Dr. Sebahar that her neck pain began a few days after a fall in

2001, when she also injured her left knee. Plaintiff claimed that

her pain worsened after her motor vehicle accident on December 4,

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27/ Dorsum refers to the upper surface of an appendage or part. See

http://www.merriam-webster.com/medlineplus/dorsum.

28/ Fentanyl is a narcotic (opioid) pain medication. The Fentanyl Patch

should be used only for long-term or chronic pain requiring

continuous around-the-clock narcotic pain relief that is not helped

by other less powerful pain medicines or less frequent dosing. See

http://www.drugs.com/cdi/fentanyl-patch.html.

29/ Epidural steroid injections (ESI) are minimally invasive procedures

used to treat pain in the neck, arms, back, and legs caused by

inflamed nerves. Injections in the lumbar (low back) region are low

risk while injections in the thoracic (mid back) and cervical (neck)

region have risk of injury to the spinal cord. See

http://www.drugs.com/clinical_trials/study-shows-no-

(continued)

standardized-approach-epidural-steroid-injections-back-pain6666.html.

30/ Refers to the sacrum which is the large bone at the base of the

spine. It is located in the vertebral column, between the lumbar

vertebra (upper) and the coccyx (lower). See

http://www.medterms.com/script/main/art.asp?articlekey=7936.

31/ Spondylosis is the degeneration of the disc spaces between the

vertebrae. The finding of this in the spine is commonly associated

with osteoarthritis (degenerative joint disease). See

http://www.medterms.com/script/main/art.asp?articlekey=13959.

10cv2385 14

2004 and that the pain fluctuated in intensity between her back and

her neck. Further, Plaintiff reported numbness in her right toes and

the dorsum27/ of her foot. (Tr. 468).

Dr. Sebahar noted that anti-depressants increased Plaintiff’s

pain and that she received only slight relief from muscle relaxants,

opioids, heat, and ice. Dr. Sebahar started Plaintiff on extended

release Fentanyl Patches28/

 and noted that she was adverse to lumbar

epidural steriod injections29/ and to cervical epidural steroid

injections. Dr. Sebahar assessed Plaintiff with having (1)

Lumbar/Sacral30/

 Radiculopathy, (2) Cervical Radioculopathy, (3) DDD,

lumbar, (4) DDD, cervical, (5) Spondylosis,31/ lumbarsacral and (6)

Spondylosis, cervical. (Tr. 466, 468).

On June 8, 2005, Plaintiff visited Dr. Sebahar. Dr. Sebahar

reported that Plaintiff was “very pleased” with the results of the

fentanyl pain patch, and noted that Plaintiff also used Norco daily,

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32/ Inversion therapy is a method of treating back pain by diminishing

the influence of gravity, reducing compression of the vertebrae and

discs and allowing the muscles and ligaments that encase the spine

to relax. An inversion table allows the user to lie on his or her

back in an inverted position so as to eliminate some or all

gravitational compression, depending on how far back one’s body is

positioned. See http:///www.losethebackpain.com/inversionep950.html.

33/ Lyrica is an anti-epileptic drug, also called an anti-convulsant. It

works by slowing down impulses in the brain that cause seizures.

Lyrica also affects chemicals in the brain that send pain signals

10cv2385 15

along with some use of Soma. Dr. Sebahar increased the dosage of

Plaintiff’s fentanyl patch. (Tr. 464-465).

On July 6, 2005, Plaintiff visited Dr. Sebahar. Plaintiff

reported a new occurrence of “right drop foot,” which she allegedly

noticed that day. Dr. Sebahar reported that Plaintiff had not

received her epidural steroid injections due to her high deductible.

Furthermore, Dr. Sebahar noted that Plaintiff was currently

litigating a motor vehicle accident that allegedly had caused her

lower back problems. (Tr. 460).

On October 6, 2005, Plaintiff reported that her son had beat

her up, increasing her pain. Dr. Sebahar urged Plaintiff to consider

attending Alanon or CoDependents Anonymous. Plaintiff was to

continue her current medications. (Tr. 445-446).

On December 1, 2005, Plaintiff told Dr. Sebahar that she gotten

a restraining order against her son. (Tr. 439-440).

On December 29, 2005, Plaintiff visited Dr. Sebahar. She

reported that her pain greatly intensified due to more activity when

she moved. Plaintiff reported numbness and tingling in both feet and

both radiating and non-radiating pain in her back. Furthermore,

Plaintiff stated that she could not stand for long periods of time.

Plaintiff reported that she bought an inversion machine32/ which

helped to relieve her pain. (Tr. 432, 438).

On January 26, 2006, Plaintiff visited Dr. Sebahar. Plaintiff

was given samples of Lyrica33/ in an attempt to help with the

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across the nervous system. See http://wwww.drugs.com/lyrica.html.

34/ Neuropathic pain is chronic pain resulting from injury to the

nervous system. It can be related to the central nervous system (the

brain and spinal cord) or the peripheral nervous system (nerves

outside of the brain and spinal cord). Symptoms of neuropathic pain

include shooting and burning pain, and tingling and numbness. See

http://www.medicinenet.com/neuropathic pain/article.htm.

10cv2385 16

neuropathic34/

 pain in her feet. Plaintiff’s fentanyl was continued

and she was “doing well in this regard.” (Tr. 427, 395).

On February 22, 2006, Plaintiff reported that she was under a

lot of stress at work because they were not accommodating her

medical condition. Plaintiff decided that she wanted to proceed with

steroid injections for her pain. (Tr. 397, 402).

On March 22, 2006, Plaintiff reported that she had lost her job

and was under a lot of stress. Plaintiff reported no changes in her

symptoms and she was stable on her current medication regimen. (Tr.

403, 408).

On April 19, 2006, Plaintiff’s chart noted numbness in

Plaintiff’s right toes and dorsum of her foot, and intermittent

weakness in Plaintiff’s right leg. Dr. Sebahar further reported that

Plaintiff’s primary care physician, Dr. Linda Falconio, was placing

Plaintiff on disability, and that Plaintiff was stable on her

current medications. (Tr. 409, 413).

On May 17, 2006, Dr. Sebahar noted that Plaintiff had begun to

change her fentanyl patches before 72 hours had elapsed in order to

prevent withdrawal symptoms. (Tr. 414, 418).

On July 13, 2006, Dr. Sebahar reported that (1) Plaintiff had

tingling in her feet, especially while she was sitting,(2) that her

pain had increased due to an attack by her son, (3) that her

fentanyl patch was working, but her lower back pain was still

worsening,(4) that Plaintiff was taking three to four Norco per day

as her pain increased, and (5) that Plaintiff’s previous injections

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10cv2385 17

did not provide any relief. Plaintiff was to continue her

medications with a slight increase in Norco to combat the increase

in pain. (Tr. 419).

On September 8, 2006, Plaintiff reported that she had been

under a lot of stress at home and that her pain had increased so

that she was taking about four Norco per day. Plaintiff reported

that her back pain was greatly increased. (Tr. 361). On October 6,

2006, and November 2, 2006, Plaintiff visited Dr. Sebahar with no

major changes. (Tr. 366, 370, 371, 375).

On December 4, 2006, Plaintiff reported that she had still not

had an MRI and that she had noticed more back pain and stiffness at

night. (Tr. 376, 380).

On January 3, 2007, Plaintiff reported that she has been sick

and less active, thus improving her back pain. Plaintiff’s

medications were continued. (Tr. 385). On January 31, 2007, February

28, 2007, and March 26, 2007, Plaintiff visited Dr. Sebahar with no

major changes. (Tr. 353,358,390).

On April 23, 2007, Plaintiff reported that her pain increased

more in April, along with an increase of numbness in her right leg.

(Tr. 350).

On June 17, 2009, Dr. Sebahar completed a “Spinal Residual

Functional Capacity Questionnaire.” Dr. Sebahar’s Questionnaire is

consistent with the findings of Plaintiff’s functional and

exertional abilities as detailed in Dr. Falconio’s Questionnaire.

Based on his observations, Dr. Sebahar opined that Plaintiff is

limited to “less than Sedentary Work.” (Tr. 683-688).

E. A.W. Lizarraras, State Agency Medical Consultant

On May 15, 2007, Dr. Lizarraras conducted a “Physical Residual

Functional Capacity Assessment” with regard to Plaintiff. The

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10cv2385 18

examination concluded that Plaintiff had some exertional and

postural limitations. The examination concluded that Plaintiff is

able to (1) frequently lift and carry 10 pounds, (2) stand or walk

2 hours of an 8 hour workday, (3) sit about six hours of an 8 hour

workday, (4) perform unlimited pushing/pulling, (5) occasionally;

climb a ramp or stairs, balance, stoop, kneel, crouch, and crawl,

but never climb ladders, ropes, or scaffolds. (Tr. 470-471).

Furthermore, it was found that Plaintiff is limited by physical

problems but does not need reminders, she is able to cook and do

some chores, she is able to drive, shop, handle money, pay bills,

read for enjoyment, sightsee, dine out, walk at the beach, and she

is not in need of a companion. Plaintiff can walk 15-20 minutes

without rest. (Tr. 473-474). Significant objective findings include

MRI scans from June, 2003, and June, 2005, and various medical

appointments and diagnoses. (Tr. 474).

Ultimately, Dr. Lizarraras concluded that Plaintiff’s

allegations are partially credible for back and neck pain, and for

Plaintiff’s limitations as to prolonged standing and sitting. Dr.

Lizarraras reported that Plaintiff appeared to be capable of

sedentary work. (Tr. 469-474).

 On May 17, 2007, Dr. Lizarraras created a “Psychiatric Review

Technique” with regard to Plaintiff. The report covered

approximately the time period from Plaintiff’s reported disability

from February 20, 2006 to May 17, 2007. It was found that

Plaintiff’s allegations of depression were only partially credible,

based on subjective and objective evidence. Furthermore, Plaintiff

did not appear to have a severe impairment. (Tr. 475- 485).

F. Coastal Pain and Spinal Diagnostic

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10cv2385 19

Unless otherwise stated, all of Plaintiff’s visits to Coastal

Pain and Spinal Diagnostic (hereafter “CPSD”) were with Kelly

Geurink, Physician’s Assistant (hereafter “PA”).

On May 17, 2007, Plaintiff visited CPSD. At this time,

Plaintiff was currently taking fentanyl and Norco for her pain.

Plaintiff reported that on May 7, 2007, she was “riding a shuttle

that was driving out of control and caused [her] to be jolted,”

increasing her original back pain and causing mid-back pain. The PA

re-filled Plaintiff’s medication and she was referred to Dr. Waltz

in Tahoe, where Plaintiff was residing at the time of this

appointment. (Tr. 519-522).

On June 7, 2007, Plaintiff visited CPSD where she reported that

she had residual numbness in her right foot and increased back,

neck, and arm pain. Plaintiff was referred to a neurologist and

informed that epidural injections may benefit her, but Plaintiff

preferred to wait on the injections until she saw Dr. Waltz. (Tr.

524-526).

On July 12, 2007, Plaintiff visited CPSD where she reported

residual numbness in her right foot and increased back and muscle

spasms. The PA noted that Plaintiff was stable on her medication

regimen but was using a heating pad regularly to manage her pain.

(Tr. 527-529).

On August 9, 2007, Plaintiff visited CPSD where she reported

residual numbness in her right foot. However, she reported that her

muscle spasms had improved since moving back from Tahoe. (Tr. 530-

532). 

On September 6, 2007, Plaintiff visited CPDS where she reported

difficulty sitting for prolonged periods and that her pain

medications were not helping to manage her chronic pain. Plaintiff

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35/ Breakthrough pain is a transient increase in pain intensity that

occurs in patients with stable, baseline persistent pain. See

http://www.medical-

(continued)

dictionary.thefreedictionary.com/breakthrough+pain.

36/ Percocet contains a combination of oxycodone (narcotic pain

reliever) and acetaminophen (a less potent pain reliever that

increases the effects of oxycodone). Percocet is used to relieve

moderate to severe pain. See http://www.drugs.com/percocet.html.

37/ Paresthesia is an abnormal sensation of the skin, such as numbness,

tingling, prickling, burning, or creeping on the skin that has no

objective cause.

www.medterms.com/script/main/art/asp?articlekey=4780.

10cv2385 20

reported more stiffness and back pain in the mornings. The PA refilled Plaintiff’s prescriptions. (Tr. 533-535).

On October 4, 2007, Plaintiff reported that she was still

having difficulty sitting for prolonged periods and that her pain

had continued to increase greatly. She also reported more numbness

and tingling in her right foot, and severe back pain. Plaintiff

reported that her quality of life decreased due to her pain, that

the Norco was helping less for breakthrough pain35/, and that the

pain was constant. (Tr. 537). The PA decreased Plaintiff’s Norco,

continued her fentanyl, and started her on a limited number of

Percocet36/ in an attempt to better control Plaintiff’s pain. (Tr.

537-539).

On October 31, 2007, Plaintiff reported more parethesia37/ in

her lower legs and more neck pain and numbness in three fingers of

her right hand. Plaintiff reported that she was using her heating

pad consistently and that her primary care physician, Dr. Falconio,

was planning to order an MRI. The PA increased Plaintiff’s Percocet,

continued her fentanyl, and stopped the Norco since Plaintiff was on

Norco for a long time, and had developed a tolerance to it. (Tr.

540- 542). 

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38/ Radicular pain is the manifestation of pressure of damage to nerve

roots. See http://www.spinaldisorders.com/radicular-pain.htm

39/ Oxycodone is a narcotic pain reliever similar to morphine. It is

used to treat moderate to severe pain. See

http://www.drugs.com/oxycodone.html.

10cv2385 21

On November 28, 2007, Plaintiff reported that she was still

having difficulty sitting for prolonged periods of time, and that

her pain had continued to increase greatly. Plaintiff reported that

Lyrica was helping with the numbness in her right hand but that the

quality of her life was affected due to her pain. The PA continued

Plaintiff’s Percocet and fentanyl, and gave her Lyrica samples to

continue since Plaintiff had noted improvement in her neuropathic

pain. (Tr. 543-545).

On December 26, 2007, Plaintiff reported that she had noticed

more pain, including radicular pain38/

 in both legs. She reported

that the Lyrica helped with her neuropathic pain but had too many

side effects, such as severe pain in her hands and difficulty with

motor skills. Plaintiff reported that her pain level was increasing.

The PA continued Plaintiff’s Percocet and fentanyl, discontinued the

Lyrica, and started Plaintiff on Duragesic patches to avoid

escalating her oral medications. (Tr. 546-548).

On January 3, 2008, Plaintiff called CPSD reporting that her

joints were sore and her hands were very “puffy” with finger

numbness and tingling. (Tr. 549).

On January 21, 2008, Plaintiff reported that both of her legs

were going numb intermittently and that she was using her heating

pad daily. The PA continued Plaintiff’s Duragesic patch and started

Plaintiff on oxycodone39/. (Tr. 550-552).

On February 14, 2008, Plaintiff reported that she still has

difficulty sitting for prolonged periods but she is able to continue

her daily activities on her current dose of medications. Plaintiff

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40/ Lumbar Spinal Stenosis (Spinal Stenosis)is a condition whereby

either the spinal canal (central stenosis) or vertebral foramen

(foraminal stenosis) becomes narrowed. If the narrowing is

substantial, it causes compression of the nerves, which causes the

painful symptoms of spinal stenosis. See

http://www.medicinenet.com/lumbar_stenosis/article.htm.

41/ Compression relating to the nervous system. See http://medicaldictionary.thefreedictionary.com/neural.

42/ Refers to the chest area. The thorax runs between the abdomen and

neck is encased in the ribs. See http://medicaldictionary.thefreedictionary.com/thoracic.

43/ Morphine is in a group of drugs called narcotic pain relievers.

Morphine is used to treat moderate to severe pain. See

http://www.drugs.com/mtm/msir.html.

10cv2385 22

reported that she moved again and her pain level remained stable.

The PA continued Plaintiff’s oxycodone, fentanyl, and Duragesic

patch. (Tr. 553-554).

On March 13, 2008, Plaintiff reported that her current

medication regimen was managing her pain and that she was able to

continue her daily activities. However, Plaintiff stated that her

lower back pain had increased more. (Tr. 556-557). 

On March 26, 2008, Dr. Falconio requested that Plaintiff have

an MRI. Plaintiff’s MRI revealed minimal disc degeneration and no

spinal stenosis40/

 or neural compression41/, concluding that the MRI

was an otherwise ordinary lumbar spine MRI. (Tr. 620).

On April 9, 2008, Plaintiff reported that her right foot was

going numb more often. (Tr. 559-560).

On April 29, 2008, Plaintiff reported that she had a severe

increase in pain in her mid back, with more pain on the right side.

Plaintiff reported that she discovered this pain while bending over

to put on socks. Plaintiff reported that she could barely stand up,

still had numbness in her right foot, and had been using more

oxycodone. The PA noted that Plaintiff did have a spasm on her right

thoracic42/ muscles, and most likely had a muscle sprain or strain.

She gave Plaintiff some MSIR (morphine)43/ to use in addition to the

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44/ Toradol is in a group of drugs called nonsteroidal anti-inflammatory

drugs (NSAIDs). It works by reducing hormones that cause

inflammation and pain in the body. It is used short-term to treat

moderate to severe pain. See http://www.drugs.com/toradol.html.

45/ Zanaflex is a short-acting muscle relaxer. It works by blocking

nerve impulses (pain sensations) that are sent to the brain.

Zanaflex is used to treat spasticity by temporarily relaxing muscle

tone. See http://www.drugs.com/zanaflex.html.

46/ Valium belongs to a group of drugs called benzodiazepines. It

affects chemicals in the brain that may become unbalanced and cause

anxiety. Valium is used to treat anxiety disorders, alcohol

withdrawal symptoms, or muscle spasms. See

http://drugs.com/valium/html.

10cv2385 23

oxycodone, and a Toradol injection,44/ for Plaintiff’s pain. (Tr.

562- 564).

On May 7, 2008, Plaintiff went to CPSD for medication refills

and reported that her severe back pain had nearly resolved, but that

she still had constant low back pain with occasional numbness in her

right leg and foot. Plaintiff reported that her activity level had

increased, leading to more pain. The PA discontinued the MSIR,

increased the oxycodone, and continued the fentanyl and Duragesic.

(Tr.566-568).

On June 3, 2008, Plaintiff went to CPSD for medication refills.

She reported that she was feeling better and that her current

regimen was working well to keep her pain controlled. However,

Plaintiff reported more pain in the right ball of her foot. (Tr.

569-571).

On July 1, 2008, Plaintiff reported that she “threw out her

back” again, and that she was having spasms along her lumbar spine,

with increased pain. Plaintiff reported that her pain was slowly

resolving and she believed that her increased spasms were from

pushing her mother in a wheelchair. Plaintiff reported minimal

relief with Zanaflex45/

 (prescribed by Dr. Falconio). The PA refilled

Plaintiff’s prescriptions and started her on Valium46/ for use with

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10cv2385 24

her spasms and anxiety. Plaintiff was to discontinue Zanaflex and

Xanax. (Tr. 572-574).

On July 24, 3008, Plaintiff reported that her back pain was

stable but that she was still using her heating pad consistently on

her low back for pain control. Plaintiff reported that the Valium

“worked great” for spasms and anxiety. The PA refilled Plaintiff’s

prescriptions but stopped her Valium, reporting that the Plaintiff

could not be on Valium and Xanax and that she was still receiving

Xanax from her primary care physician. (Tr. 576-578).

On August 20, 2008, Plaintiff reported that her back pain was

“flaring” due to a dog jumping on her. The PA re-filled Plaintiff’s

prescriptions and “took over” Plaintiff’s prescriptions for Zanaflex

and Xanax, which were originally prescribed through Linda Falconio.

(Tr. 580-582).

On September 17, 2008, Plaintiff reported that her pain level

was higher and that she had another “severe flare up of back pain.”

Plaintiff also reported pain in her left knee. The PA re-filled

Plaintiff’s Zanaflex, oxycodone, Xanax, fentanyl, and Duragesic

patch. (Tr. 584-586).

On October 13, 2008, Plaintiff reported that her pain level

increased. On October 5, Plaintiff reported that she slipped on a

wet floor, heard a “pop,” and twisted her knee. She also reported

flaring back pain. The PA re-filled Plaintiff’s prescriptions and

referred her to Dr. Hackley, an orthopedist with Torrey Pines

Orthopedic Group, for Plaintiff’s knee pain. (Tr. 587-590).

On November 5, 2008, Plaintiff reported that her back pain was

still severe and that she “throws out her back” more often.

Plaintiff further reported that she had significant knee pain and

was seeing an orthopedic doctor for treatment. (Tr. 591-593).

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47/ A torn meniscus is damage to the cartilage within the knee. A torn

meniscus occurs because of trauma caused by forceful twisting or

hyper-flexing of the knee joint. Symptoms of a torn meniscus include

pain, swelling, popping, and giving way of the knee. See

http://www/medicinenet.com/torn_meniscus/article.htm.

10cv2385 25

On December 1, 2008, Plaintiff reported that she was moving and

that her back pain was “flaring greatly” due to lifting boxes. (Tr.

594-596).

On January 20, 2009, Plaintiff visited CPSD, reporting a

meniscal tear47/ in her left knee and stating that she was planning

to have knee surgery in the near future. (Tr. 601-603). On February

13, 2009, and March 9, 2009, Plaintiff had follow-up appointments.

(Tr. 604-609). 

On April 1, 2009, Plaintiff reported an increase in her back

pain and spasms. She reported that her right leg continued to have

severe paresthesia and that she still had a meniscal tear in her

left knee, and planned to have surgery. Plaintiff also reported poor

sleep at night due to the pain, along with difficulty walking,

standing, and sitting for prolonged periods of time. The PA refilled Plaintiff’s prescriptions and increased her Xanax to help

with the spasms and anxiety. (Tr. 610- 612).

On April 22, 2009, Plaintiff reported a “spike in pain” due to

an incident with police. Plaintiff claims she was “shoved,” causing

her low back and right leg pain to flare, and causing more pain

along the entire right side of her body. Plaintiff also reported an

upcoming knee surgery. The PA re-filled Plaintiff’s prescriptions

and gave her MSIR for post-operation pain for after Plaintiff’s knee

surgery. (Tr. 614-616).

On May 19, 2009, Plaintiff reported that she had undergone knee

surgery, improving her knee pain greatly. However, Plaintiff

reported the same back pain complaints and right foot parathesia.

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Plaintiff also reported that her neck pain improved since her last

visit. The PA re-filled Plaintiff’s prescriptions and discontinued

the MSIR (Tr. 617-619).

G. Torrey Pines Orthopedic Medical Group

On October 23, 2008, Plaintiff visited Dr. David Hackley at

Torrey Pines Orthopedic Medical Group (hereafter “TPOMG”), pursuant

to a referral from Dr. Sebahar. Plaintiff complained of soreness in

her knee after an alleged fall on her washroom floor. Dr. Hackley

conducted x-rays and found a left knee strain, but no meniscus tear.

Plaintiff requested an MRI scan. (Tr. 711-712).

On November 25, 2008, Plaintiff had an MRI scan. The results

conveyed a suspicion of a meniscus tear. (Tr. 671, 721-722).

On January 5, 2009, Plaintiff visited Dr. Hackley at TPOMG for

a physical examination. The doctor reported that Plaintiff was to

proceed with a left knee surgery. (Tr. 665- 667, 710, 725-726).

On April 22, 2009, Plaintiff visited Dr. Thunder at TPOMG

complaining of neck pain, mid-shoulder pain, and some low back pain

(LBP), the symptoms of which were exacerbated by an altercation with

police. Dr. Thunder took x-rays and found a lumbar, thoracic, and

cervical strain, recommending rest and activity modification. (Tr.

664, 709).

On April 30, 2009, Dr. Hackley performed a left knee surgery on

Plaintiff. (Tr. 662-663, 723-724). On May 6, 2009, Plaintiff had her

one-week post-knee operation appointment at TPOMG. Dr. Hackley

reported that Plaintiff was healing nicely and had minimal swelling.

(Tr. 661, 708).

On June 10, 2009, Plaintiff visited Dr. Thunder at TPOMG.

Plaintiff reported an injury to her low back from leaning forward,

and numbness and tingling in her feet. An x-ray showed normal

alignment of the lumbar spine and minimal degenerative changes. The

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48/ Effusion is the accumulation or escape of fluid in various spaces of

the body, including the knee. See http://medicaldictionary.thefreedictionary.com/effusion. 

49/

 In the transcript of Plaintiff’s hearing before the Administrative

Law Judge, Dr. Weilepp is incorrectly referred to as “Dr. Wyla.” 

10cv2385 27

chart indicated that Plaintiff had a low back strain. The doctor

acknowledged that Plaintiff was on several pain medications and gave

her a prescription for Toradol for acute back strain. (Tr. 659, 706,

713).

Also on June 10, 2009, Plaintiff had a post-knee operation

appointment at TPOMG with Dr. Hackley. A physical examination

revealed that Plaintiff had an excellent range of motion of her left

knee, that she had no effusion48/, and she had no significant joint

line tenderness. (Tr. 660, 707).

On August 4, 2009, Plaintiff had a follow-up appointment with

Dr. Hackley about her left knee. Plaintiff reported that her knee

was doing fine but that she recently moved homes and was having

symptoms in her back. Dr. Hackley reported that he would not

recommend any more physical therapy for Plaintiff’s left knee, but

that he would see her for her back pain. (Tr. 705).

H. Dr. George W. Weilepp49/, Medical Expert

On August 17, 2009, at the hearing held before the

Administrative Law Judge, Dr. Weilepp testified as a medical expert

to assess the medical evidence of Plaintiff’s record. (Tr. 29, 48).

Dr. Weilepp opined that Plaintiff has a combination of impairments

that is “severe” when all of her impairments are taken together. He

reasoned that Plaintiff has a pain issue and that is why she has

stopped working. He also indicated that Plaintiff has had knee

problems. (Tr. 52-53). 

Dr. Weilepp opined that the duration of an eight hour day is a

problem for patients who manage their pain with a lot of chemicals.

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10cv2385 28

However, Plaintiff did not have any major complications with the

chemicals or her prior surgeries. (Tr. 53-54). Dr. Weilepp

determined that whether Plaintiff can sustain an eight-hour work day

is difficult to ascertain by only looking at medical records. (Tr.

54)

From looking at the records, Dr. Weilepp concluded that he

would allow Plaintiff to perform sedentary activity. Furthermore, he

stated that Plaintiff was able to drive, and probably did not need

to be re-trained. 

Dr. Weilepp reasoned that “continuous activity” in the upper

extremities is a problem with pain patients like Plaintiff, but

“frequent activity” is usually agreeable. He did not know why

Plaintiff’s prognosis from three of her main treating physicians was

“fair to poor” and “poor,” and did not know whether Plaintiff could

work full time. (Tr. 54).

I. Mr. Kilcher, Vocational Expert

At the hearing before the Administrative Law Judge, Mr.

Kilcher, a vocational expert, discussed Plaintiff’s prior employment

classifications: (1) Plaintiff was a telemarketer, classified at the

sedentary level and semi-skilled Specific Vocational Preparation

(hereafter “SVP”) of (3),(2) Plaintiff was a women’s clothing

salesperson, classified at the light level and semi-skilled (SVP of

3), (3) Plaintiff was a jewelry salesperson, classified at the light

level and skilled (SVP of 5), (4) Plaintiff worked in airline

sales, classified at the sedentary level and semi-skilled (SVP of

4), (5) Plaintiff was a timeshare salesperson, classified at the

light level and skilled (SVP of 5), and (6) Plaintiff worked as an

educational consultant, classified at the sedentary level and

skilled (SVP of 8).

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10cv2385 29

 III

 SUMMARY OF APPLICABLE LAW

Title II of the Social Security Act (hereafter “Act”), as

amended, provides for the payment of insurance benefits to persons

who have contributed to the program and who suffer from physical or

mental disability. [42 U.S.C. § 423(a)(1)(D)]. Title XVI of the Act

provides for the payment of disability benefits to indigent persons

under the Supplemental Security Income (SSI) program. [§ 1382(a)].

Both titles for the Act define “disability” as the “inability to

engage in any substantial gainful activity by reason of any

medically determinable physical or mental impairment which can be

expected to last for a continuous period of not less than 12

months...” Id. The Act further provides that an individual: 

Shall be determined to be under a disability only if

his physical or mental impairment or impairments are

of such severity that he is not only unable to do his

previous work but cannot, considering his age,

education, and work experience, engage in any other

kind of substantial gainful work which exists in the

national ecomony, regardless of whether such work

exists in the immediate rea in which he lives, or

whether a specific job vacancy exists for him, or

whether he would be hired if he applied for work. Id.

The Secretary of the Social Security Administration has

established a five-step sequential evaluation process for

determining whether a person is disabled. [20 C.F.R. §§ 404.1520,

416.920. Step one determines whether the claimant is engaged in

“substantial gainful activity.” If he is, disability benefits are

denied. [20 C.F.R. §§ 404.1520(b), 416.920(b)]. If he is not, the

decision maker proceeds to step two, which determines whether the

claimant has a medically severe impairment or combination of

impairments. That determination is governed by the “severity

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10cv2385 30

regulation” at issue in this case. The severity regulation provides

in relevant part:

If you do not have any impairment or combination of

impairments which significantly limits your physical

or mental ability to do basic work activities, we will

find that you do not have a severe impairment and are,

therefore, not disabled. We will not consider your

age, education, and work experience. [§§ 404.1520(c),

416.920(c)].

The ability to do basic work activities is defined as “the

abilities and aptitudes necessary to do most jobs.” [20 C.F.R. §§

404.1521(b), 416.921(b)]. Such abilities and aptitudes include

“[p]hysica functions such as walking, standing, sitting, lifting,

pushing, pulling, reaching, carrying, or handling;” “[c]apacities

for seeing, hearing, and speaking;” “[u]nderstanding, carrying out,

and remembering simple instructions;” “[u]se of judgment;”

“[r]esponding appropriately to supervision, co-workers, and usual

work situations;” and “[d]ealing with changes in a routine work

setting.” Id.

If the claimant does not have a severe impairment or

combination of impairments, the disability claim is denied. 

If the impairment is severe, the evaluation proceeds to the

third step, which determines whether the impairment is equivalent to

one of a number of listed impairments that the Secretary

acknowledges are so severe as to preclude substantial gainful

activity. [20 C.F.R. §§ 404.1520(d), 416.920(d)]. If the impairment

meets of equals one of the listed impairments, the claimant is

conclusively presumed to be disabled. 

If the impairment is not one that is conclusively presumed to

be disabling, the evaluation proceeds to the fourth step, which

determines whether the impairment prevents the claimant from

preforming work he has performed in the past. If the claimant is

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10cv2385 31

able to perform his previous work, he is not disabled. [20 C.F.R. §§

404.1520(e), 416.920(e)]. If the claimant cannot perform his

previous work, the fifth and final step of the process determines

whether he is able to perform other work in the national economy in

view of his age, education, and work experience. The claimant is

entitled to disability benefits only if he is not able to perform

other work. [20 C.F.R. §§ 404.1520(f), 416.920(f)].

 IV

 ALJ’S FINDINGS

The ALJ made the following pertinent

findings:

1. [Plaintiff] meets the insured status requirements

of the Social Security Act through March 31, 2010. 

2. [Plaintiff] has not engaged in substantial gainful

activity since February 20, 2006, the alleged onset

date.

After the alleged onset date, the [Plaintiff] worked

at Club Sunterra from May 4, 2007, to July 19, 2007,

on a schedule of 30 hours per week. She stopped due to

her medical condition. She was compensated based on a

commission basis. Her length of work fell short of

substantial gainful activity and that work was

considered an unsuccessful work attempt.

3. [Plaintiff] has the following severe impairments:

degenerative disc disease of the lumbar spine, pain in

the back, neck, shoulders, knees, and right leg and

foot; depressive disorder. 

[Plaintiff] has a history of chronic upper and low

back pain with radioculopathy, down the right leg and

associated with numbness and tingling in the right

foot. She has been diagnosed with degenerative disc

disease of the lumbar spine. An MRI scan of the lumbar

spine in May 2005 showed mild to moderate degenerative

changes at L5-S1. An MRI scan of the lumbar spine in

March 2008 showed minimal L4-5 and L5-S1 degenerative

changes with no stenosis or neural compression. An Xray of the lumbar spine in June 2009 showed normal

alignment and minimal degenerative changes. 

[Plaintiff] has a history of pain in the neck and

shoulders. An MRI of the cervical spine in 2003 showed

disc osteophyte formation with effacement of the right

hemicord at C5-6 with no evidence of stenosis.

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10cv2385 32

[Plaintiff] has knee pain. She sustained a left knee

meniscal tear and underwent a clincially successful

repair. She has reported significant improvement in

pain and that she had full range of motion of the knee

joint. 

The record establishes a depressive disorder NOS with

anxiety features. While she has reported some anxiety

or an agitated mood, exams show that she has been

oriented in all spheres with a normal mood and affect.

4. [Plaintiff] does not have an impairment or

combination of impairments that meets or medically

equals one of the listed impairments in 20 CFR Part

404, Subpart P, Appendix 1.

I find that the [Plaintiff’s] medically determinable

impairments, alone or in combination, do not meet or

medically equal any listing in Appendix 1, Subpart P,

Regulations No. 4 and No. 16. No physician has opined

that [Plaintiff’s] condition meets or equals any

listing and the state agency program physicians opined

that it does not. 

5. After careful consideration of the entire record,

the undersigned finds that the [Plaintiff] has the

residual functional capacity to perform sedentary work

as defined in 20 CFR 404.1567(a) and 416.967(a) except

for occasional bending, stooping, crouching, crawling,

kneeling, balancing, and climbing stairs and ramps; no

climbing ladders, ropes, or scaffolds; in light of her

pain, she is limited to work with detailed but

uncomplicated instructions that is performed up to

moderate stress work environment. 

In making this finding, the undersigned had considered

all symptoms and the extent to which these symptoms

can reasonably be accepted as consistent with the

objective medical evidence and other evidence, based

on the requirements of 20 CFR 404.1529 and 416.929 and

SSRs 96-4p and 96-7p. The undersigned as also

considered opinion evidence in accordance with the

requirements of 20 CFR 404.1527 and 416.927 and SSRs

96-2p, 96-5p, 96-6p, and 06-3p.

The [Plaintiff] has alleged disability due to back

pain, neck pain, shoulder pain, arm pain, right leg

pain, and bilateral leg and foot numbness. 

After careful consideration of the evidence, the

undersigned finds that the [Plaintiff’s] medically

determinable impairments could reasonably be expected

to cause the alleged symptoms: however, the

[Plaintiff’s] statements concerning the intensity,

persistence and limiting effects of these symptoms are

not credible to extent they are inconsistent with the

above residual functional capacity assessment. 

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10cv2385 33

While the [Plaintiff’s] allegations of disability are

inconsistent with her ability to care for others, she

was able to care for her father who suffered from

Alzheimer’s disease and visited him at least every two

days until he died in 2007. She has been able to care

for her disabled mother who is wheel-chair bound and

is dependent on oxygen therapy. She also cares for her

son who is autistic. 

The weight of the objective evidence does not support

the claims of the [Plaintiff’s] disabling limitations

to the degree alleged. Physical exams do not support

more restrictive than sedentary level work with

postural restrictions. While progress notes show

muscle spasms in the right side of her low back,

straight leg raise testing has been negative. She has

some diminished range of motion in the thoracic spine

and lumbar spine. Despite her neck pain and upper

extremity pain, she has a full range of motion of her

neck and upper extremities. She has been

neurologically intact. While it was noted in March

2006 that she had a right foot drop, she has

satisfactory ability to heel and toe walk. Exams of

her lower extremities show no significant crepitus or

any instability, swelling, or warmth.

[Plaintiff] has not generally received the type of

medical treatment one would expect for a totally

disabled individual. Other than a left knee surgery

for repair of a torn meniscus, the [Plaintiff’s]

course of treatment since her alleged disability onset

date has generally reflected a conservative approach.

The record does not show that the [Plaintiff] requires

any special accommodations (e.g., special breaks or

positions) to relieve her pain or other symptoms. 

In contrast to the allegations of the [Plaintiff’s]

disabling fatigue and weakness, she does not exhibit

any significant atrophy, loss of strength, or

difficulty moving that are indicative of severe and

disabling pain.

Although the [Plaintiff] has been prescribed and has

taken appropriate medications for the alleged

impairments, which weighs in her favor, the objective

medical evidence shows that the medications have been

relatively effective in controlling the [Plaintiff’s]

symptoms. Moreover, the [Plaintiff] has not alleged

any side effects for the use of medications.

While the [Plaintiff] has had weight loss and

complained of poor sleep due to chronic pain, there is

not evidence of cognitive deficits due to pain or

depression. 

Consequently, the [Plaintiff’s] allegations are not

credible to establish a more restrictive residual

functional capacity than that found above. 

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10cv2385 34

As for the opinion evidence, I have considered the

opinion of Michael Sebahak (sic.), M.D., dated March

1, 2007, in which he stated that the [Plaintiff] was

incapable of performing her regular and customary work

from March 1, 2006 to March 1, 2008. I have given

little weight to this opinion of disability. By

regulation, opinions that the [Plaintiff] is

“disabled” or “unable to work” are not entitled to any

special significance, even when offered by a treating

physician. [20 C.F.R. §§ 404.1527(e)(3),

416.927(e)(3)] and [Social Security Ruling 96-5p]. Dr

Sebahak’s (sic.)opinion failed to indicate any

specific functional limits. His opinion is based on

the [Plaintiff’s] subjective claims and is not

supported by objective findings indicating that the

[Plaintiff] is more restricted than sedentary level

work with postural restrictions. 

I have considered the opinion of Linda Falconio, M.D.,

contained in an assessment dated June 15, 2009. Dr.

Falconio filled out the pre-printed form and indicated

that the [Plaintiff] was incapable of doing even low

stress jobs; was limited to sitting for 15 minutes at

a time and less than 2 hours total in an 8 hour

workday; standing for 20 minutes at a time and for

less than 2 hours total in an 8 hour workday; and

expected that the [Plaintiff] would be absent from

work more than 4 days per month. I give little weight

to Dr. Falconio’s opinion. As in the case of Dr.

Ssebahak (sic.), Dr. Falconio’s opinion is too extreme

and not supported by the clinical findings or

diagnostic studies documented by her and other

treating sources.

I have considered the opinion of Angelina Hood, PhD.,

contained in an assessment dated June 22, 2009. Dr.

Hood filled out the pre-printed form and opined that

in every major mental functional domain, the

[Plaintiff] had such extreme limits that she ranged

between “unable to meet competitive standards” to “no

useful ability to function.” She further indicated

that the [Plaintiff] had marked difficulties in the

ability to maintain her activities of daily living,

maintain social functioning, and maintain

concentration, persistence, and pace. She also

expected that the [Plaintiff] would be absent from

work more than 4 days per month. I give little weight

to Dr. Hood’s opinion. Her opinion is too extreme.

Indeed, it even conflicts with the [Plaintiff’s]

reported activities of daily living that show that she

can do a wide range of activities even with her

physical and mental difficulties. Indeed, she was able

to care for her disabled father before his death in

2007 and continues to care for her disabled mother and

autistic child. Dr. Hood’s opinion concerning the

[Plaintiff’s] mental limits is not supported by the

clinical findings documented by her as the

[Plaintiff’s] only mental health treating source.

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10cv2385 35

There is no mental status exam or psychological

testing. It appears that Dr. Hood has premised her

opinion on the [Plaintiff’s] subjective complaints.

On the other hand, I have given significant weight to

the medical expert who had the opportunity to review

the entire record. He took into consideration the

[Plaintiff’s] pain that reasonably flowed from her

combined severe impairments. 

In sum, the above residual functional capacity

assessment is supported by the medical expert. The

undersigned also took into consideration the

[Plaintiff’s] pain and mental symptoms in limiting her

to work with detailed but uncomplicated tasks with

exposure to no more than minimum stress levels. 

6. [Plaintiff] is capable of performing past relevant

work as a time share salesperson, telemarketer, and an

airline sales agent. This work does not require the

performance of work-related activities precluded by

the [Plaintiff’s] residual functional capacity.

I took testimony from the vocational expert regarding

the classification of the [Plaintiff’s] past work, and

the ability of someone with the [Plaintiff’s] residual

functional capacity to perform the exertional and

nonexertional requirements of such work, both as

actually done and as generally done in the national

economy.

I specifically asked the vocational expert to note and

explain disagreements, if any, with the provisions of

the Dictionary of Occupational Titles (DOT), and the

vocational expert did not indicate any such

disagreement.

After reviewing the documentary record and hearing the

[Plaintiff’s] detailed explanation of her past

relevant work, the vocational expert classified that

work as follows: telemarketer (DOT No. 299.357-

014)(sedentary/semi-skilled); sales person, women’s

clothing (DOT No. 261.325-066)(light/semi skilled);

sales person, jewelry (DOT No. 279.357-

058)(light/skilled); airlines sales agent (DOT No.

238-367-018)(sedentary/sv-4); sales, time share (DOT

No. 250.357-018)(light/skilled); and education

consultant (DOT No. 099.167-014)(sedentary/skilled).

The vocational expert further testified that the

[Plaintiff] actually performed her past work in the

same was as it is generally done in the national

economy.

Hypothetically assuming the [Plaintiff’s] residual

functional capacity as found above, the vocational

expert opined that the [Plaintiff] is able to perform

her past relevant work as time share salesperson,

telemarketer, and airline sales agent, both as

actually done and as generally done in the national

economy. I accept the testimony of the vocational

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10cv2385 36

expert and so find. Since the [Plaintiff] can return

to past relevant work, she is not under a “disability,” as defined in the Social Security Act.

7. [Plaintiff] has not been under a disability, as

defined in the Social Security Act, from February 20,

2006, through the date of this decision. (citations to

exhibits omitted except where noted).

 V

 STANDARD OF REVIEW

A district court may only disturb the Commissioner’s final

decision “if it is based on legal error or if the fact findings are

not supported by substantial evidence.” Sprague v. Bowen, 812 F. 2d

1226, 1229 (9th Cir. 1987); see Villa v. Heckler, 797 F.2d 794, 796

(9th Cir. 1986). The court cannot affirm the Commissioner’s final

decision simply by isolating a certain amount of supporting

evidence. Rather, the court must examine the administrative record

as a whole. Gonzalez v. Sullivan, 914 F.2d 1197, 1200 (9th Cir.

1990). Yet, the Commissioner’s findings are not subject to reversal

because substantial evidence exists in the record to support a

different conclusion. See, e.g., Mullen v. Brown, 800 F.2d 535, 545

(6th Cir. 1986). “Substantial evidence, considering the entire

record, is relevant evidence which a reasonable person might accept

as adequate to support a conclusion.” Mathews v. Shalala, 10 F.3d

678, 679 (9th Cir. 1993); see Thompson v. Schweiker, 665 F.2d 936,

939 (9th Cir. 1982). The Commissioner’s decision must be set aside,

even if supported by substantial evidence, if improper legal

standards were applied in reaching that decision. See, e.g., Benitez

v. Califano, 573 F.2d 653, 655 (9th Cir. 1978).

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10cv2385 37

 VI

THE ALJ PROPERLY EVALUATED THE OPINIONS OF

 PLAINTIFF’S TREATING PHYSICIANS

Plaintiff argues that the ALJ incorrectly afforded controlling

weight to the non-examining medical expert’s opinions and that the

ALJ should have afforded controlling weight to Plaintiff’s treating

physicians. Specifically, Plaintiff argues that controlling weight

should have been given to the opinions of Dr. Angelina Hood, Dr.

Linda Falconio, and Dr. Michael Sebahar (Plaintiff’s psychologist,

primary care physician, and pain management specialist,

respectively). 

Defendant argues that Plaintiff does not make a sufficient

challenge because she fails to explain what error, or errors, the

ALJ allegedly made, or how the evidence contradicts the ALJ’s

findings in any way. 

“Although a treating physician’s opinion is generally afforded

the greatest weight in disability cases, it is not binding on an ALJ

with respect to the existence of an impairment or the ultimate

determination of disability.” McLeod v. Astrue, 640 F.3d 881, 884

(9th Cir. 2011), quoting Mayes v. Massanari, 276 F.3d 453, 459-460

(9th Cir. 2001); see also Lester v. Chater, 81 F.3d 821, 830 (9th

Cir. 1995). Furthermore, “[t]he ALJ may disregard the treating

physician’s opinion whether or not that opinion is contradicted.”

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

However, when the treating doctor’s opinion is contradicted by

another physician, including an examining physician or a nonexamining physician, the Commissioner must provide ‘specific and

legitimate reasons’ in the record for rejecting a treating

physician’s opinion, supported by substantial evidence. Lester, 81

F.3d at 830.

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Specific and legitimate reasons are established when the ALJ

“[sets] out a detailed and thorough summary of the facts and

conflicting clinical evidence, stating his interpretation thereof,

and making findings.” Magallanes, 881 F.2d at 751. The ALJ must not

only offer his conclusions, but he also must “set forth his own

interpretations and explain why they, rather than the doctors’, are

correct.” Orn v. Astrue, 495 F.3d 625, 631 (9th Cir. 2007), quoting

Embrey v. Bowen, 849 F.2d 418, 421-422 (9th Cir. 1988); See Hutchens

v. Astrue, 2009 WL 1762570 at *2 (9th Cir. 2011)(the ALJ’s

observation that the opinions of the treating doctors were

inconsistent with claimant’s daily activities was a ‘specific and

legitimate’ reason for giving them little weight); See EdwardsAlexander v. Astrue, 336 Fed.Appx. 634, 637 (9th Cir. 2009)(the ALJ

improperly discounted the opinions of claimant’s treating physicians

by merely listing the inconsistencies between the doctors’

assessments); See McCoy v. Astrue, 405 Fed.Appx. 222 at *1 (9th Cir.

2010)(“[t]he ALJ’s statements regarding the medical evidence as it

related to the conflicting medical opinions provided a specific and

legitimate explanation for rejecting the treating physician’s

conclusions.”).

The ALJ may discount a treating physician’s opinion if it is

presented in the form of a check list and does not have supportive

objective evidence, and is contradicted by other statements and

assessments of claimant’s medical condition. Batson v. Comm. of

Social Security, 359 F.3d 1190, 1195 (9th Cir. 2004).

Since Plaintiff argues that the opinions of three of her

primary treating physicians were contradicted by the opinions of

both the state agency examining physician and the state agency

reviewing physician, the ‘specific and legitimate standard’ applies

here.

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10cv2385 39

Plaintiff’s relevant treating physicians include Doctors

Angelina Hood, Linda Falconio, and Michael Sebahar. Drs. Falconio

and Sebahar each completed Functional Capacity Questionnaires, and

Dr. Hood completed a Mental Impairment Questionnaire on Plaintiff’s

behalf. 

Plaintiff was examined by Dr. A.W. Lizarraras, a state agency

medical consultant, and a Physical Residual Functional Capacity

Assessment (hereafter “RFC”) was completed on behalf of Plaintiff.

(Tr. 469-474). Plaintiff was also examined by a state agency

physician, Dr. H. Amado, and a Psychiatric Review Technique

(hereafter “PST”) was completed on behalf of Plaintiff. (Tr. 475-

486). 

Dr. Weilepp, a non-examining medical expert, and Mr. Kilcher,

a vocational expert, testified as to Plaintiff’s condition at her

hearing with the ALJ. (Tr. 52-57).

1. Dr. Angelina Hood

The ALJ specifically addressed and legitimately discounted Dr.

Hood’s opinions. He provided multiple reasons for doing so;

including (1) a lack of supporting objective evidence, (2) the

inconsistencies between Plaintiff’s admitted daily activities and

her alleged restricted abilities, (3) the inconsistencies between

Plaintiff’s ability to care for her ailing parents, and her alleged

restricted abilities, (4) Dr. Hood’s report was merely a pre-printed

questionnaire with no supporting objective tests, and (5) Dr. Hood’s

opinion seems to be premised on Plaintiff’s subjective complaints.

(Tr. 21).

The reasons provided by the ALJ are sufficient as substantial

and legitimate reasons for discounting Dr. Hood’s testimony.

Batson, 359 F.3d at 1195. 

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10cv2385 40

2. Drs. Falconio and Sebahar

As to Dr. Falconio and Dr. Sebahar, the ALJ specifically

addressed and legitimately discounted the doctors’ opinions. The ALJ

noted that both doctors’ assertions are too severe and are not

supported by the clinical findings or diagnostic studies documented

by the other physicians. (Tr. 21).

In forming his own opinions, the ALJ relied heavily on the nonexamining physician, Dr. Weilepp, who testified at Plaintiff’s

hearing. The ALJ described in detail the reasoning behind not giving

controlling weight to the opinions of Plaintiff’s treating

physicians. The ALJ noted: (1) Plaintiff’s ability to care for

others, (2) the weight of the objective evidence in the record,

including Plaintiff’s physical exams, (3) Plaintiff’s medical

treatment, (4) the effectiveness of controlling Plaintiff’s symptoms

with medications, and (5) Plaintiff’s own descriptions and testimony

of her daily activities and capabilities. (Tr. 19-22). By setting

forth a detailed summary of the facts and conflicting clinical

evidence, and offering reasons for his conclusions, the ALJ provided

adequate specific and legitimate reasons for rejecting the opinions

of Plaintiff’s treating physicians. Magallanes, 881 F.2d at 751;

Orn, 495 F.3d at 631.

3. Substantial Evidence Supports the ALJ’s Finding

Plaintiff argues that as a non-examining witness, Dr. Weilepp’s

opinions do not constitute ‘substantial evidence’ to support

discounting or rejecting the opinions of her treating physicians. 

‘Substantial evidence’ exists “when an examining physician

provides independent clinical findings that differ from the findings

of the treating physician.” Orn, 495 F.3d at 631. “Independent

clinical findings can be either a diagnosis different from that

offered by another physician and supported by substantial evidence,

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10cv2385 41

or findings based on objective tests that treating physicians have

not considered.” (quotations omitted). Id. at 631.

“The opinion of a nonexamining physician cannot by itself

constitute substantial evidence that justifies the rejection of the

opinion of either an examining physician or a treating physician.”

Lester, 81 F. 3d at 831 (emphasis added); see also Orn, 495 F.3d at

632.

In this case, the ALJ based his rejection of the opinions of

Plaintiff’s treating physicians upon a review of the entire record,

including objective testing evidence, Plaintiff’s subjective

complaints, reports from all treating physicians, and reports from

examining physicians. The ALJ did not, as Plaintiff contends, rely

solely on the opinion of Dr. Weilepp. The ALJ’s Findings merely

state that the ALJ gave significant weight to Dr. Weilepp’s opinion

and that Plaintiff’s RFC Assessment is supported by Dr. Weilepp’s

findings. (Tr. 19-22). The ALJ based his rejection of Plaintiff’s

treating physicians on the entire record, which includes various

reports from numerous doctors. Therefore, there is ‘substantial

evidence’ to support the ALJ’s rejection of the opinions of

Plaintiff’s treating physicians.

Since the ALJ had specific and legitimate reasons for

discounting and rejecting the opinions of Plaintiff’s treating

physicians, and they were based on substantial evidence, the ALJ

rightfully discounted and rejected the opinions of Plaintiff’s

treating physicians. The Court RECOMMENDS that Plaintiff’s Motion

for Summary Judgment in this regard be DENIED and that Defendant’s

Motion for Summary Judgment be GRANTED.

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10cv2385 42

 VII

 THE ALJ WAS NOT REQUIRED TO POSE A

 HYPOTHETICAL QUESTION TO THE VOCATIONAL EXPERT

Plaintiff argues that the ALJ failed to provide a complete

hypothetical question to the vocational expert. Defendant responds

that neither regulations nor case law required the ALJ to pose a

hypothetical question to the vocational expert with regard to

Plaintiff. Defendant is correct.

The Social Security Administration has a five step sequential

process for determining whether a claimant has proved he or she is

disabled. In steps one through four, the burden is on the claimant

to demonstrate a severe impairment and an inability to perform past

work. At the fourth step, the ALJ assesses a claimant’s RFC and

determines whether he or she can perform any past relevant work. If

the ALJ determines that the claimant is able to perform her past

relevant work, then the claimant is not considered disabled for

purposes of receiving disability benefits. See 20 C.F.R. § 404.1520.

If a claimant does show that she can not return to her previous

job, the burden of proof shifts to the defendant to show that the

claimant can do other kinds of work, [the “fifth step” of the

sequential process]. If there is no reliable evidence of a

claimant’s ability to perform specific jobs, Defendant and/or the

ALJ must use a vocational expert to provide the evidence. Embrey v.

Bowen, 849 F.2d 418, 422 (9th Cir. 1988). 

However, when a claimant fails to show that he or she is unable

to return to his or her previous job, the burden of proof remains

with the claimant and the vocational expert’s testimony is useful,

but not required. Mathews v. Shalala, 10 F.3d 678, 681 (9th Cir.

1993), See also Awad v. Astrue, 2009 WL 2242356 at *7 (C.D.Cal. July

27, 2009).

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50/ The article ranks the top eight “high stress jobs.” According to the

author, retail sales is the number one most stressful job. The

article can be found at http://www.careerbuilder.com/Article/CB1005-Job-Search-Strategies-8-High-Stress-Jobs. 

10cv2385 43

In this case, the ALJ expressly found that as to step four of

the sequential evaluation, Plaintiff is capable of performing her

past relevant work and is not disabled. He subsequently omitted the

use of hypothetical questions to the vocational expert, but he still

consulted one. (Tr. 22, 57). 

 Although the vocational expert was not provided a

hypothetical question by the ALJ, he did rate each of Plaintiff’s

past jobs according to the Dictionary of Occupational Titles

(hereafter “DOT”), and opined that Plaintiff’s RFC is compatible

with her past work. The ALJ agreed. (Tr. 19, 22, 55-57). See 20

C.F.R. § 404.1560(b)(2);20 C.F.R. § 404.1520(f); Pinto v. Massanari,

249 F.3d 840, 845 (9th Cir. 2001)(holding that “the best source for

how a job is generally performed is usually the Dictionary of

Occupational Titles” and that the ALJ must find a relation between

claimant’s RFC and past relevant work); Mondragon v. Astrue, 364

Fed.Appx. 346, 349 (9th Cir. 2010)(re-affirming the holding in

Pinto, 249 F.3d 840); see also Clark v. Astrue, 2011 WL 1792702

(E.D. Wash. May 10, 2011).

Plaintiff argues that she cannot perform her past relevant

work. Plaintiff primarily relies on an internet article found on

CareerBuilder.com,50/ which discusses the alleged severe stress levels

associated with retail sales. This evidence is simply not enough to

meet Plaintiff’s burden. A single internet article is insufficient

to suggest otherwise. The ALJ found that at work, Plaintiff is able

to engage in moderate stress levels. (Tr. 19). Plaintiff has not

provided sufficient evidence to suggest that she cannot.

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10cv2385 44

 “The claimant establishes a prima facie case of disability by

showing that a physical or mental impairment prevents him from

performing his previous occupation. Martinex v. Heckler, 807 F.2d

771, 773 (9th Cir. 1986).

Other than briefly describing her impairments at her hearing

with the ALJ, and stating in her brief that her previous jobs

“involve high stress,” Plaintiff has failed to prove or even to

specifically address why she is unable to perform the duties of her

previous occupations. To the contrary, Plaintiff did provide some

evidence of her ability to engage in somewhat strenuous tasks, such

as caring for sick family members, grocery shopping, and engaging in

light cooking. 

Since Plaintiff has failed to meet her burden of proof by

showing that she is unable to return to her previous work, the ALJ

did not err by neglecting to pose a hypothetical to the vocational

expert. Furthermore, the ALJ correctly found that Plaintiff is

capable of performing her past relevant work; specifically as a

telemarketer and an airline sales agent. Further, Plaintiff’s

restrictions as determined by the ALJ are compatible with the

requirements of these occupations, as defined in the DOT. (Tr. 19).

See DOT code 299.357-014, DOT code 238.367-018. For the reasons

stated, the Court RECOMMENDS Plaintiff’s Motion for Summary Judgment

be DENIED and Defendant’s Motion for Summary Judgment be GRANTED. 

 VIII

THE ALJ PROVIDED A VALID BASIS FOR DISCREDITING PLAINTIFF

Plaintiff argues that the ALJ failed to offer clear and

convincing reasons to reject Plaintiff’s symptom testimony. Further,

Plaintiff contends that it is improper for the ALJ to reject

Plaintiff’s subjective complaints of chronic pain and fatigue. 

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10cv2385 45

Defendant contends that the ALJ provided a valid basis for

finding Plaintiff not fully credible as to her symptomology, and

that the ALJ’s reasons are supported by substantial evidence. 

“In evaluating the credibility of pain testimony after a

claimant produces objective medical evidence of an underlying

impairment, the ALJ may not reject a claimant’s subjective

complaints based solely on a lack of medical evidence to fully

corroborate the alleged severity of pain.” Burch v. Barnhart, 400

F.3d 676, 680 (9th Cir. 2005)(emphasis added).

When making such a credibility determination, the ALJ must

engage in a two-step process:

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 of other symptoms alleged...The

claimant is not required to show that her impairment

could reasonably be expected to cause the severity of

the symptom she has alleged; she need only know that

it could reasonably cause some degree of the

symptom...If the claimant meets the first test and

there is no evidence of malingering, the ALJ can only

reject the claimant’s testimony about the severity of

the symptoms if he gives specific, clear and

convincing reasons for the rejection.

Vasquez v. Astrue, 572 F.3d 586, 591 (9th Cir. 2009)(quotations

and citations omitted); see also Lingenfelter v. Astrue, 504 F.3d

1028, 1036 (9th Cir. 2007). “The ALJ must specify what testimony is

not credible and identify the evidence that undermines the

claimant’s complaints-[g]eneral findings are insufficient.” Burch,

400 F.3d at 680. (quotations omitted).

In an ALJ’s credibility determination, the ALJ is permitted to

consider various factors, including Plaintiff’s daily living

activities, objective medical findings, lack of consistent

treatment, and lack of treatment or evaluation. Id. at 681; see also

20 C.F.R. § 404.1529.

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10cv2385 46

In this case, Plaintiff complained, inter alia, of severe

muscle cramping, numbness, limited standing and walking abilities,

adverse side-effects from her medications, and moodiness from her

chronic pain.

 The ALJ found that “the claimant’s medically determinable

impairments could reasonably be expected to cause [her] alleged

symptoms.” (Tr. 20). This satisfied the first prong of the ALJ’s

inquiry regarding the credibility of Plaintiff’s complaints.

However, the ALJ refuted Plaintiff’s credibility, stating, “the

claimant’s statements concerning the intensity, persistence and

limiting effects of these symptoms are not credible.” (Tr. 20).

Since the ALJ did not allege any evidence that the Plaintiff may be

malingering, he must provide clear and convincing evidence in

support of his adverse credibility finding.

The ALJ made several specific findings in support of his

conclusion that Plaintiff was not fully credible. 

First, the ALJ found that Plaintiff’s allegations of a

disability were inconsistent with her ability to care for others.

Plaintiff was able to care for her father who had Alzeheimer’s

disease, Plaintiff was able to care for her mother who was wheelchair bound, and Plaintiff was able to care for her autistic son.

(Tr. 20). See Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989)(it is

reasonable for the ALJ to conclude that a claimant is able to work

if she is able to perform household chores and other activities);

see also Morgan v. Apfel, 169 F.3d 595, 600 (9th Cir.

1999)(claimant’s ability to fix meals, do laundry, work in the yard,

and occasionally care for a friend’s child serves as evidence of a

claimant’s ability to work). This reason is valid to support the

ALJ’s adverse credibility finding.

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10cv2385 47

Second, the ALJ found that the objective evidence in the record

does not support Plaintiff’s limitations to the degree asserted. The

ALJ provides several objective medical findings to support this

contention. (Tr. 20). See Rollins v. Massanari, 261 F.3d 853, 857

(9th Cir. 2001)(“although subjective pain testimony cannot be

rejected on the sole ground that it is not fully corroborated by

objective medical evidence, the medical evidence is still a relevant

factor in determining the severity of the claimant’s pain and its

disabling effects.”). This reason is valid to support the ALJ’s

adverse credibility finding.

Third, the ALJ found that although the Plaintiff was

prescribed, and took, appropriate medications for her alleged

impairments, the objective evidence showed that the medications were

effective, with few side-effects. See Warre v. Commissioner of

Social Sec. Admin, 439 F.3d 1001, 1006 (9th Cir.

2006)(“[i]mpairments that can be controlled effectively with

medication are not disabling for purposes of determining eligibility

for SSI benefits.”). This reason is valid to support the ALJ’s

adverse credibility finding.

Fourth, the ALJ determined that Plaintiff has not received the

type of medical care that one would ordinarily receive for her

asserted limitations. The ALJ indicates that Plaintiff has undergone

only a left knee surgery since her alleged onset date, reflecting a

‘conservative treatment approach.’ See Parra v. Astrue, 481 F.3d 742

(9th Cir. 2007)(noting that evidence of conservative treatment is

sufficient to discount the severity of a claimant’s disability

claim.).

Plaintiff argues that her pain regimen consisted of more than

merely ‘conservative treatment.’ Regardless, a resolution to this

contention is irrelevant. Even if the ALJ erroneously classified

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10cv2385 48

Plaintiff’s treatment to be ‘conservative,’ this classification

would consist of harmless error. 

1. Harmless Error and Plaintiff’s Credibility

“So long as there remains substantial evidence supporting the

ALJ’s conclusions on... credibility and the error does not negate

the validity of the ALJ’s ultimate [credibility] conclusion, such is

deemed harmless and does not warrant reversal.” Carmickle v. Comm’r,

Soc. Sec. Admin., 533 F.3d 1155, 1162 (9th Cir. 2008)(quotations

omitted); See also Batson, 359 F.3d at 1195-1197 (applying harmless

error standard where one of the ALJ’s several reasons supporting an

adverse credibility finding was held invalid); Stout v. Comm’r, Soc.

Sec. Admin., 454 F.3d 1050, 1054-1055 (9th Cir. 2006)(harmless error

applied where ALJ expressly discredited testimony but erred in doing

so).

The ALJ provided various additional reasons supporting his

credibility determination. This sole alleged error does not negate

the ALJ’s ultimate credibility finding. Therefore, his purportedly

erroneous finding that Plaintiff’s treatment was ‘conservative,’ was

not erroneous, and even if deemed erroneous, was harmless error. 

The ALJ provided sufficient, specific, clear, and convincing

reasons for rejecting Plaintiff’s subjective pain testimony.

Therefore, he made an appropriate credibility determination as to

Plaintiff.

2. Harmless Error and Third Party Lay-Witness Testimony

Plaintiff further argues that the ALJ erred when he failed to

mention the statement of Plaintiff’s son, Aaron Aufderheide. (Tr.

155-162). Plaintiff alleges that Mr. Aufderheide’s statements

supported her subjective complaints, and a failure to assess his

statements resulted in harmful error. 

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10cv2385 49

The burden is on the Plaintiff to show how the alleged error

caused harm. Shinseki v. Sanders, 556 U.S. 396 (2009); McLeod v.

Astrue, 640 F.3d 881 (9th Cir. 2011)(the Ninth Circuit applies the

Sanders harmless error rule to social security cases). 

The ALJ is required to consider observations by non-medical

sources about how impairments affect a claimant’s ability to work

“where a claimant alleges pain or other symptoms that are not

supported by medical evidence in the file.” Smolen v. Chater, 80

F.3d 1273, 1288 (1996)(quotations omitted).

“When an ALJ discounts the testimony of lay witnesses, he must

give reasons that are germane to each witness.” Valentine v. Comm’r

Soc. Sec. Admin., 574 F.3d 685, 694 (9th Cir. 2009), quoting Dodrill

v. Shalala, 12 F.3d 915, 919 (9th Cir. 1993). Should an ALJ neglect

to address lay witness testimony, “a reviewing court cannot consider

the error harmless unless it can confidently conclude that no

reasonable ALJ, when fully crediting the testimony [of a lay

witness], could have reached a different disability determination.”

Stout, 454 F.3d at 1056.

When a third party report is largely duplicative of Plaintiff’s

own testimony, an ALJ is not said to have “rejected” the report

simply because it fails to discuss the third party report in its

decision, and the error is harmless. Zerba v. Comm’r Soc. Sec.

Admin., 279 Fed. Appx. 438, 440 (9th Cir. 2008); Lopez v. Astrue,

2011 WL 379321 at *15 (D. AZ. 2011); see also Smith v. Astrue, 2010

WL 4530154 at *11 (E.D. Cal. 2010); Noziska v. Astrue, 2010 WL

3123257 at *9 (D. MT. 2010).

As a preliminary matter, Mr. Aufderheide’s report was not

testimony and was not signed under penalty of perjury. Therefore,

the standards applicable to testimony do not apply to his statement.

Smith, supra, at *11.

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10cv2385 50

Further, Mr. Aufderheide’s report is largely duplicative of the

subjective complaints provided by Plaintiff herself. Since the ALJ

properly evaluated Plaintiff’s subjective complaints, and Mr.

Aufderheide’s report reiterates the same complaints, any error by

the ALJ in failing to specifically reject Mr, Aufderheide’s report

was harmless error. Smith, supra, at *11 [citing Curry v. Sullivan,

925 F.2d 1127 (9th Cir. 2001)]; Noziska, 2010 WL 3123257 at *9. Had

Mr. Aufderheide’s report been evaluated by the ALJ, the ALJ’s

determination as to Plaintiff’s lack of disability would have been

unchanged. Robbins v. Soc. Sec. Admin., 466 F.3d 880, 885 (9th Cir.

2006).

Therefore, the ALJ appropriately evaluated Plaintiff’s

subjective testimony and any error that he made with regard to

Plaintiff’s credibility or lay witness information was harmless.

For the aforementioned reasons, the Court RECOMMENDS

Plaintiff’s Motion for Summary Judgment be DENIED and Defendant’s

Motion for Summary Judgment be GRANTED. 

 IX

 CONCLUSION AND RECOMMENDATION

After a review of the record in this matter, the undersigned

Magistrate Judge RECOMMENDS that the Plaintiff’s Motion for Summary

Judgment be DENIED and Defendant’s Motion for Summary Judgment be

GRANTED.

This Report and Recommendation of the undersigned Magistrate

Judge is submitted to the United States District Judge assigned to

this case, pursuant to the provision of 28 U.S.C. § 636(b)(1).

IT IS ORDERED that no later than August 31, 2011,any party to

this action may file written objections with the Court and serve a

copy on all parties. The document should be captioned “Objections to

Report and Recommendation.”

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10cv2385 51

IT IS FURTHER ORDERED that any reply to the objections shall be

filed with the Court and served on all parties no later than

September 14, 2011. The parties are advised that failure to file

objections within the specified time may waive the right to raise

those objections on appeal of the Court’s order. Martinez v. Ylst,

951 F.2d 1153 (9th Cir. 1991).

DATED: August 3, 2011

 Hon. William V. Gallo

 U.S. Magistrate Judge

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