Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_03-cv-04581/USCOURTS-cand-3_03-cv-04581-0/pdf.json

Nature of Suit Code: 865
Nature of Suit: Social Security - RSI (405(g))
Cause of Action: 42:205 Denial Social Security Benefits

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United States District Court

For the Northern District of California

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United States District Court

For the Northern District of California

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

CYNTHIA SANCHEZ,

Plaintiff,

 v

JO ANNE B BARNHART, Commissioner

of Social Security,

Defendant.

 /

No C 03-4581 VRW

 ORDER

Plaintiff Cynthia Sanchez brings this action under 42 USC

section 405(g), challenging the final decision of the Social

Security Administration (SSA) denying her disability benefits from

the period beginning January 26, 2000. Plaintiff claims disability

based on orthopedic and neurological conditions. Now before the

court are the parties' cross-motions for summary judgment. The

court GRANTS plaintiff’s motion and DENIES the government’s motion.

\\

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I

A

Plaintiff was born on July 26, 1949. She alleges that

she has been unable to work since January 26, 2000 due to physical

ailments. Her work history includes experience as a secretary and

administrative secretary. From 1986 until the onset of her alleged

disability, she held both positions at the Monterey County Office

of Education. Her primary duties there included recording and

transcribing meeting minutes, maintaining records and answering the

telephone. Administrative Record, Doc #14 (AR) at 42, 56. 

Plaintiff has a high school diploma and has taken college course

work but did not receive a college degree. Id at 42.

Plaintiff first sought treatment for work-related

injuries in 1994, at which time she complained of right lateral

forearm pain due to repetitive keyboard use and was diagnosed with

repetitive motion syndrome. AR 135. In April of 1996 she saw Dr

John P Colman, an orthopedic specialist acting as agreed medical

examiner (AME), whose findings included overuse syndrome involving

the right shoulder girdle and upper extremity related to repetitive

computer activities. AR 129. Dr Colman found plaintiff’s symptoms

to be “consistent with a myofascial pain syndrome or fibrositis

[fibromyalgia].” Id. He also noted that previous

electrodiagnostic testing and x-rays had been unremarkable. Id. 

In December of the same year, x-rays taken at Salinas Urgent Care

indicated early degenerative disc disease at C6-7, with some

anterior osteophytic spurring, but otherwise unremarkable results. 

AR 133.

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On July 26, 1997, Dr Colman examined plaintiff again and

concluded that her disability had reached a permanent and

stationary status. AR 130. He stated that her residual disability

left her with the equivalent of 25% of her pre-injury capacity for

lifting, pushing, pulling, grasping, pinching, holding, torquing or

performing other activities of comparable physical effort as well

as activities requiring finger dexterity with the right dominant

upper extremity.

From 1996 through 1999, plaintiff sought intermittent

treatment for her symptoms from one Dr Galicia, whose first-hand

impressions are not included in the administrative record. But the

reports of the other physicians show that, in 1998, Dr Galicia

diagnosed plaintiff with acute right lateral epicondylitis with a

prior history of cervical trapezius myofascial pain syndrome. AR

130. In January of 1999, Dr Galicia reported that plaintiff was

responding well to occupational hand therapy but still complained

of right lateral elbow pain. Id. Dr Galicia prescribed the antiinflammatory drug Daypro as well as physical therapy.

In 1999 Dr Galicia moved his practice to the other side

of Salinas, making it difficult for plaintiff to continue seeing

him. AR 131. She was referred to Dr Warren Nishimoto, a family

physician and osteopath. Id. According to Dr Nishimoto, plaintiff

reported “increasing right hand numbness and weakness,” although

the Tinel’s and Phalen’s tests (used to assist in determining

whether a patient suffers from carpal tunnel syndrome) were

negative. Id. Dr Nishimoto also noted cervical lesions. Id. He

prescribed muscle-relaxant medication and treated the lesions with

osteopathic manipulation. Id, AR 252.

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In January of 2000, Dr Colman, again acting as AME,

examined plaintiff and analyzed an MRI of her cervical spine. He

noted degenerative disc space narrowing at C5-6 and C6-7 with

slight impaction of the inferior plate at C6 as well as mild

arthritic changes at C4-5 and C7-T1. AR 124. There was no sign of

cord or nerve root compression, no herniation and no stenosis. Id.

At the examination, plaintiff reported increasing muscle

stiffness and tightness over her right shoulder girdle, across the

neck and upper back extending toward left upper extremity; symptoms

of muscle tightness and cramping that can spread down to her lower

back; frequent tightness or cramping in thighs when she tries to go

to bed at night; problems sleeping; and problems opening jars. AR

131-32. She stated that it was becoming harder and harder to

perform her regular job duties. Id at 132.

Dr Colman found “trigger point” tenderness over

plaintiff’s paraspinous muscles in the cervical thoracic, midthoracic spine and lumbar areas, with the greatest tenderness over

the cervical thoracic area and specifically over the trapezius

areas bilaterally. AR 132-33. He also found increased tenderness

over the lateral elbow area and lateral epicondylar region, with

some mild tenderness in the same area on the left, as well as

trigger point tenderness over the paraspinous muscles in the midthoracic area and near the lumbrosacral junction. Id.

Dr Colman stated that plaintiff’s disability was

“permanent and stationary.” AR 125. Due to the “natural

progression of the disease,” he considered plaintiff’s upper

extremity disability to be equivalent to 50% loss of pre-injury

capacity for lifting, pushing, pulling, grasping, pinching,

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holding, torquing and performing other activities of comparable

physical effort as well as activities requiring fingertip dexterity

with the right dominant upper extremity. Id. Dr Colman concluded

that plaintiff was now a “qualified injured worker” for retraining

purposes. Id.

Plaintiff saw Dr Nishimoto as her treating physician

approximately every two to four weeks from December 1999 through

January 2002. AR 152-55. Throughout that period, Dr Nishimoto’s

diagnoses included neuropathy, id at 252, muscle spasms, id at 248,

and generally pain in the right hand through to the neck. He also

noted fibromyalgia as a “presenting complaint.” Id at 249. Dr

Nishimoto prescribed various pain-relieving and muscle-relaxing

medications, including Robaxin, id at 254, Valium, id at 246,

Arthrotec, id at 183, Depomedral, id at 167, Vioxx, id at 165,

Effexor, id at 161, and Soma. Id at 45. Non-medicative treatment

included yoga, id at 231, exercise classes, osteopathic

manipulation, id at 230, water and stretching classes, id at 226,

and electrode-induced muscle stimulation. Id at 217.

On December 17, 1999, Dr Nishimoto stated that plaintiff

was not able to perform her usual work. One week later he approved

a return to her full-duty work schedule, considering her condition

not to be permanent and stationary. Id at 251. At the start of

February 2000, however, he authorized vocational rehabilitation, id

at 241, and at the end of that month he issued a disability

certificate due to “continued back and neck pains.” Id at 239. On

May 1, 2000, he assessed plaintiff to be “totally disabled” from

performing any occupation but able to stand for eight hours and

lift 25 pounds. Id at 230.

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Plaintiff showed some improvement in response to various

treatments until she slipped and fell at a Target store on June 3,

2000. AR 225. The following day she reported pain in her right

wrist, right leg, neck, shoulder and lower back. Id. On June 19,

2000, Dr Nishimoto approved a one-month disability certificate, id

at 223, which he later extended until the end of August of that

year, noting “condition unchanged.” Id at 219. On July 7, 2000,

Dr Nishimoto reported plaintiff’s condition as permanent and

stationary to the State of California. Id at 214. At that time he

stated that plaintiff was not able to perform her usual line of

work but would be able to perform another, unspecified line of

work. Id at 215.

Accordingly, plaintiff began taking real estate courses

on September 6, 2000, AR 201, but she stopped taking them a few

months later as her symptoms worsened, leaving her unable to grip a

pen for a length of time sufficient to complete the forms and tests

required for obtaining a realtor’s license. Id at 41. On January

30, 2001, plaintiff’s symptoms again worsened after she fell down a

small flight of stairs and landed on her right hand. Id at 185.

On February 7, 2001, plaintiff visited the consultative

neurologist Dr Dale A Helman for an EMG nerve conduction study and

needle examination. AR 139. The results of both tests were

unremarkable, with no evidence of significant neuropathy or

radiculopathy (compression of the nerve roots in the cervical or

lumbar spine). Id. She then saw Dr Helman for a neurological

examination on December 12, 2001 (with an allegation of “repetitive

use — neuropathy”). Id at 135-38. At the examination, plaintiff

reported severe, relatively constant pain and numbness radiating

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from the right upper extremity proximally to her arm and neck

region, as well as some weakness in the right upper extremity. Id

at 135. Dr Helman’s review of the MRI scan of the cervical spine

showed evidence of degenerative changes at the middle and lower

levels but nothing he considered “surgical.” Id at 136. He

diagnosed plaintiff with repetitive motion syndrome, “most likely

tendinitis or something very similar that involves chronic stress

to the soft tissues.” Id at 137. In his opinion, her disability

should “encompass any activity that involves repetitively using her

upper extremities or hands.” Id. Dr Helman concluded that the

restrictions will remain in place until plaintiff’s symptoms

improve, “if they ever do[.]” Id.

On January 29, 2002, plaintiff’s treating physician Dr

Nishimoto summarized his impressions over the preceding years and

assessed plaintiff’s then-current condition. AR 153. He stated

that she continued to suffer from cervical, thoracic and lumbar

strain. Id. Plaintiff could “do very minimal things at home

before that activity will aggravate her condition, forcing her to

stop.” Id. Dr Nishimoto stated that plaintiff’s condition was

permanent and stationary and that she would be kept “off work.” 

Id. Finally, he noted that plaintiff had tried vocational therapy

but that it only exacerbated her symptoms. Id.

Plaintiff’s last examination described in the

administrative record was performed by Dr Ian MacMorran, orthopedic

surgeon acting as consultative physician, on August 24, 2002. At

the examination, plaintiff reported pain, numbness and cramping in

her right hand, arm and shoulder, radiating to her neck, left arm,

back and lower back. AR 262-63. She also reported frequent

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headaches. Id at 263. Due to these symptoms, plaintiff claimed

that she was unable to perform routine daily tasks such as

shopping, writing, vacuuming and folding laundry. Id at 262-63. 

She further stated that she was unable to sit for more than fifteen

minutes without pain, to stand or walk for more than one or two

hours at a time, and to sleep without difficulty. Id at 263. To

attempt to alleviate the pain, she was taking stretching classes

and walking as much as her symptoms allowed. Id at 264.

Dr MacMorran found spinous process tenderness in the

lower cervical region, cervical paraspinal muscle spasms and

tenderness posteriorly at the right and left. AR 267. He noted a

20% loss of overall range of cervical-spine motion compared to

normal. Id. Dr MacMorran also found thoracic paraspinal muscle

tenderness posteriorly on the right and left as well as paraspinal

tenderness in the lower lumbar area, but no spinous process

tenderness in the mid- and lower thoracic and lower lumbar regions. 

Id. According to his report, plaintiff could squat all the way

down and rise to the standing position with slight right knee pain

and had a normal gait. Id. His diagnoses included fibromyalgia,

bilateral carpal tunnel syndrome, lateral epicondylitis and

bilateral shoulder sprain. Id at 271. Dr MacMorran assessed that

plaintiff’s disability was caused by “elements of cumulative trauma

and also by the disease process of fibromyalgia.” Id at 274. He

considered her to be “burdened with the problem of chronic pain for

the rest of her life” and stated that “she is unable to do any

types of work, sitting, standing, or walking for at least twelve

months.” Id. He concluded that plaintiff was “precluded from all

types of work in the competitive job market.” Id.

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B

On September 27, 2001, plaintiff filed an application for

disability insurance benefits with the SSA, listing her disability

onset date as January 26, 2000. AR 78-80. She based her claim on

repetitive use syndrome and neuropathy, which were causing pain,

stiffness, numbness and spasms. Id at 90. The SSA denied the

application on December 20, 2001, stating that “[t]hough you have

discomfort, the evidence shows you are still able to move about and

to use your arms, hands and legs in a satisfactory manner,” and

concluding that “you have the ability to perform [the work of an

administrative secretary].” Id at 64. Plaintiff then filed a

request for reconsideration, which the SSA denied. Id at 68, 70-

73. Following her husband’s death on April 10, 2002, plaintiff

filed an application for widow’s insurance benefits (based on

disability) on June 3, 2002. Id at 282.

On March 14, 2002, plaintiff filed a request for a

hearing before an administrative law judge (ALJ). AR 74. The

hearing, which involved issues common to both the primary and the

widow’s benefits applications, took place in Monterey, California,

on October 7, 2002. Id at 37. Plaintiff, her attorney and a

vocational expert (VE) were present. Id.

At the hearing, plaintiff testified that Dr Nishimoto had

diagnosed her with repetitive use syndrome and fibromyalgia, which

were worsening over the years. AR 44. She testified to continuous

numbness in her hands and right arm, frequent cramping in her

shoulders and neck, frequent pain and tightness from her neck down

into her lower back, pain often reaching from her back into her

legs, and spasms throughout her body. Id at 44-48. Due to these

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symptoms, plaintiff further testified to the inability to sit or

stand for more than one half-hour at a time; to perform any

repetitive motion without pain, such as brushing her teeth, picking

up a fork or blow-drying her hair — in fact, she had selected a

short hairstyle for that reason; to hold a newspaper or book at

eye-level; to bend forward at the waist without pain; to lift, push

or pull heavy items; to turn a round doorknob; to write monthly

statements and checks without spasms and pain; to rotate her neck

sufficiently to permit her to drive safely; to cook for herself on

more than rare occasions; to handle heavier laundry such as

blankets and sheets; to fall asleep reliably and to sleep

continuously through the night. Id. At the time of the hearing,

plaintiff was taking Vioxx, Soma, Effexor and Tylenol, which she

testified impaired her thought processes and made driving even more

difficult. Id at 45, 52.

The ALJ then posed a hypothetical question to the VE that

assumed an individual with the residual functional capacity (RFC)

for light exertional work activity and only the following

additional limitations: no repetitive keyboarding and no

repetitive use of the right hand, but occasional ability to pinch,

hold, torque, push, pull and grasp with the right upper extremity. 

Id at 56. The VE stated that such an individual would not be able

to perform the work of administrative secretary — plaintiff’s

previous occupation — and that the job skills plaintiff possesses

would not transfer to any positions matching the hypothetical RFC

and further limitations. Id at 56-57.

The VE was able to identify just one position that a

person with this hypothetical profile could perform: school bus

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In this section of her decision, the ALJ actually specified an exertional

capacity for sedentary — not light exertional — work. But based on the testimony

of the VE and the table that the ALJ cites from Appendix 2 of Subpart P, she

apparently meant to refer to light exertional work. Because the disposition of this

matter does not depend on that distinction, the court is not remanding the matter

to the ALJ for clarification.

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monitor, of which there are approximately 22,600 positions in

California. Id at 57. Under questioning by the ALJ and

plaintiff’s attorney, the VE stated that this job involves

monitoring the conduct of students on school buses to maintain

discipline and safety; assisting in loading and unloading the bus;

riding the bus to prevent altercations between students;

disembarking from the bus at railroad crossings; and participating

in bus safety drills. Id at 58. He testified that it “can be an

eight-hour a day job,” but “[s]ometimes it’s less,” and that it

would require sitting and/or standing for more than one half-hour

at a time. Id at 59-60.

In her decision issued on November 6, 2002, the ALJ

denied plaintiff’s application for disability benefits. Id at 30. 

She concluded that, while plaintiff does have medically

determinable “severe” impairments, she also possesses the RFC for a

wide range of light exertional work further limited to no

repetitive keyboarding and no repetitive use/manipulation of the

right hand. Id at 29. Based on this RFC and plaintiff’s age,

education and work experience, the ALJ also found that Rule No

202.14 in Table No 2 of Appendix 2, Subpart P, Regulations No 4

would support a conclusion of “not disabled.” Id at 30, 20 CFR

§ 1569. The ALJ further noted that the VE identified significant

numbers of jobs that an individual with plaintiff’s limitations and

vocational profile could still perform.1

 AR 30.

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The ALJ reached these conclusions by finding plaintiff’s

contentions regarding subjective pain and the associated

limitations to be “not entirely credible.” Id at 27. She stated

that the frequency, severity and duration of plaintiff’s alleged

back, neck and upper extremity pain were “not consistent with the

treating medical records.” Id. The ALJ also noted that

plaintiff’s EMG and nerve conduction study had been unremarkable,

with no evidence of significant neuropathy or radiculopathy. Id. 

In addition, she found that plaintiff’s medical treatment had been

“routine and not particularly aggressive,” and that there were “no

continuous side effects of medication.” Id. Regarding plaintiff’s

claim of fibromyalgia and the associated pain in her fingers,

hands, arms, shoulders, neck and back, the ALJ stated that “[i]n

the absence of medical evidence to support such allegations, I

cannot give weight to this testimony.” Id.

In reaching her conclusions, the ALJ gave minimal weight

to the opinions of plaintiff’s treating physician, Dr Nishimoto,

who had assessed plaintiff as temporarily disabled at various times

and ultimately restricted her from working. Id at 26. According

to the ALJ, “the minimally abnormal objective medical findings

simply do not support such an extreme assessment.” Id. She noted

that Dr Nishimoto’s records did not reveal detailed examinations of

or physical findings related to plaintiff’s musculoskeletal

structure, nor did they contain any laboratory tests, such as

x-rays or MRI scans, that would support his opinions. Id.

The ALJ also gave minimal weight to the assessment of Dr

MacMorran, the consultative orthopedic surgeon. Id at 27. Dr

MacMorran had diagnosed plaintiff with fibromyalgia, bilateral

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carpal tunnel syndrome, lateral epicondylitis, and bilateral

shoulder strain. Id at 26-27. He stated that plaintiff’s back and

neck conditions prevent any type of lifting, bending, stooping,

pulling or pushing activities, and that plaintiff was unable to

stand for more than five minutes, sit for more than thirty minutes,

and grasp/open doorknobs. Id at 27. He concluded that plaintiff

was precluded from all types of work in the competitive job market. 

Id. Again, the ALJ responded that “the objective medical findings

simply do not support such an extreme assessment.” Id. Moreover,

she stated, Dr MacMorran had only examined plaintiff on one

occasion, giving rise to no longitudinal physician-patient

relationship. Id. Specifically regarding the diagnosis of

fibromyalgia, the ALJ stated that, “in light of the absence of

significant treatment, this diagnosis and the attendant residual

functional capacity is found to be not persuasive.” Id. She went

on to note that Dr MacMorran had found no spinous process

tenderness in the mid and lower thoracic and lower lumbar regions,

although he did find paraspinal muscle tenderness posteriorly on

the right and left. Id. The ALJ also stated that, when examined

by Dr MacMorran, plaintiff had a normal gait, was able to squat all

the way down and rise to the standing position with slight knee

pain, and had full range of motion of the shoulders, elbows,

wrists, forearms, and knees. Id.

The ALJ based her conclusions regarding plaintiff’s

alleged disability on the assessment of the consultative

neurologist Dr Helman, who had examined plaintiff twice. Id at 25. 

She noted that Dr Helman’s impressions included “repetitive motion

syndrome, most likely tendinitis or something very similar that

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involves chronic stress to the soft tissues,” resulting in a work

restriction from “any activity that involves the repetitive use of

the upper extremities or her hands.” Id. But the ALJ also noted

that Dr Helman’s neurological, sensory and cervical spine

examinations of plaintiff were normal. Id. Accordingly, she

concluded that “the findings and assessment of Dr Herman [sic]

allow for a wide range of light work.” Id.

The ALJ also reviewed the assessment of the orthopedic

specialist Dr Colman, who had examined plaintiff and her records as

an AME in both 1996 and 2000. Id at 25, 127, 129. She did not,

however, specify the weight that she gave to his assessment, nor

did she mention his impression of myofascial pain syndrome and

fibrositis (fibromyalgia) in the 1996 examination. Id at 25, 129.

On January 7, 2003, plaintiff requested review of the

ALJ’s decision. Id at 11. On August 8, 2003, the Appeals Council

denied plaintiff’s request for review, and the ALJ’s decision

became final. Id at 4. On October 9, 2003, plaintiff commenced

the instant action for judicial review of the final decision.

II

The court's jurisdiction is limited to determining

whether the SSA's denial of benefits is supported by substantial

evidence in the administrative record. 42 USC § 405(g). A

district court may overturn a decision to deny benefits only if the

decision is not supported by substantial evidence or if the

decision is based on legal error. See Andrews v Shalala, 53 F3d

1035, 1039 (9th Cir 1995); Magallanes v Bowen, 881 F2d 747, 750

(9th Cir 1989). The Ninth Circuit defines "substantial evidence"

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as "more than a mere scintilla but less than a preponderance; it is

such relevant evidence as a reasonable mind might accept as

adequate to support a conclusion." Andrews, 53 F3d at 1039. 

Determinations of credibility, resolution of conflicts in medical

testimony and all other ambiguities are to be resolved by the ALJ. 

See id; Magallanes, 881 F2d at 750. The decision of the ALJ will

be upheld if the evidence is "susceptible to more than one rational

interpretation." Andrews, 53 F3d at 1040.

“Disabled” is defined as “unable to do any substantial

gainful activity by reason of any medically determinable physical

or mental impairment which can be expected to result in death or

which has lasted or can be expected to last for a continuous period

of not less than 12 months.” 20 CFR § 404.1527. 

To determine whether a claimant is disabled and entitled

to benefits, the SSA conducts a five-step sequential inquiry. 20

CFR § 404.1520; 20 CFR § 416.920. Under the first step, the ALJ

considers whether the claimant is currently employed in substantial

gainful activity. If not, the second step examines whether the

claimant has a “severe impairment” that significantly affects his

or her ability to conduct basic work activities. In step three,

the ALJ determines whether the claimant has a condition which

“meets” or “equals” the conditions outlined in the Listings of

Impairments in Par 404, Subpart P, Appendix 1. 20 CFR § 404.1520. 

If the claimant does not have such a condition, step four asks

whether the claimant can perform her past relevant work. If not,

in step five the ALJ considers whether the claimant has the ability

to perform other work which exists in substantial numbers in the

national economy. 20 CFR §§ 404.1520(b)-(f); §§ 404.920(b)-(f).

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In steps four and five, the ALJ makes her determination

based on the claimant’s residual functional capacity (RFC). An RFC

is the “maximum remaining ability to do sustained work activities

in an ordinary work setting on a regular and continuing basis[.]” 

Social Security Ruling (SSR) 96-8p [emphasis in original]. A

“regular and continuing basis,” according to the SSA’s own

interpretation of the Act and regulations, means eight hours a day,

five days a week, or an equivalent work schedule. Id. Moreover,

the regulations themselves require a claimant to demonstrate the

inability to perform work on a “sustained basis.” 20 CFR §

404.1512(a). Accordingly, the adjudicator must determine which

work activities a claimant can perform eight hours a day, five days

a week or an equivalent work schedule, taking into account her

functional limitations.

In this circuit, cases distinguish among the opinions of

three types of physicians: (1) treating physicians; (2) nontreating examining physicians; and (3) those who neither examine

nor treat the claimant. Lester v Chater, 81 F3d 821, 830 (9th Cir

1995). As a general rule, more weight is given to the opinion of a

treating source than a non-treating one. Id. Where the treating

doctor’s opinion is not contradicted by another doctor, it may be

rejected only for “clear and convincing reasons.” Baxter v

Sullivan, 923 F2d 1391, 1396 (9th Cir 1991). Even if the treating

doctor’s opinion is contradicted by another doctor, the ALJ may not

reject this opinion without providing “specific and legitimate

reasons.” Murray v Heckler, 722 F2d 499, 502 (9th Cir 1983).

Plaintiff makes three general arguments in support of

this appeal. First, she points to a discrepancy in the ALJ’s

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determination of plaintiff’s RFC: in her decision, the ALJ first

found that “[plaintiff] has the residual functional capacity for a

wide range of light exertional work,” AR 29, only to base her

conclusions in the subsequent paragraph “on an exertional capacity

for sedentary work,” id at 30; plaintiff argues that this court

should not affirm such irreconcilable findings. Doc. # 23-1, Pl br

at 16-17. Second, plaintiff asserts that the ALJ improperly relied

on a part-time occupation — school bus monitor — as the basis for

meeting defendant’s burden of proof at step five. Id at 17-19. 

Finally, plaintiff argues that the ALJ improperly rejected evidence

of plaintiff’s subjective complaints in determining her RFC for

performing other work. Id at 19-22.

After a careful review of the entire administrative

record, the court concludes that this case must be remanded to the

SSA because (1) the ALJ failed to make proper findings in support

of her decision that plaintiff’s pain complaints were not credible;

and (2) the ALJ impermissibly discounted the assessment of 

plaintiff’s treating physician. In light of these conclusions, it

is unnecessary for the court to address plaintiff’s remaining

contentions.

A

Reduced to its essence, this case turns on the apparent

disparity between plaintiff’s subjective pain symptoms and the

underlying medical signs and findings. The Social Security Act

directly addresses such cases: 

An individual’s statement as to pain or other symptoms

shall not alone be conclusive evidence of disability as

defined in this section; there must be medical signs and

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findings, established by medically acceptable clinical or

laboratory diagnostic techniques, which show the existence

of a medical impairment that results from anatomical,

physiological, or psychological abnormalities which could

reasonably be expected to produce the pain or other

symptoms alleged and which, when considered with all

evidence required to be furnished under this paragraph

* * * would lead to a conclusion that the individual is

under a disability.

42 USC § 423(d)(5)(A). See also 20 CFR § 404.1529(b) (symptoms

such as pain, fatigue, shortness of breath, weakness and

nervousness will not be found to affect ability to do basic work

activities absent medical signs or laboratory findings showing a

medically determinable impairment). 

The law governing the ALJ’s responsibilities in cases

involving excess pain is well-developed in this circuit. “Excess

pain” is “pain at a level above that supported by medical

findings.” Chavez v Department of Health and Human Services, 103

F3d 849 (9th Cir 1996). If a claimant is able to produce objective

medical evidence of an underlying impairment, an ALJ may not reject

his subjective complaints based solely on lack of objective medical

evidence to corroborate the alleged severity of pain. Moisa v

Barnhart, 367 F3d 882, 885 (9th Cir 2004). If the ALJ finds the 

claimant’s pain testimony not to be credible, the ALJ “must

specifically make findings that support this conclusion.” Id. 

Absent “affirmative evidence that the claimant is malingering,” the

ALJ must provide clear and convincing reasons for rejecting the

claimant’s testimony regard the severity of symptoms. Id. 

At no time during the period under consideration has the

record been entirely devoid of medical signs and findings that

could account for some degree of pain. According to the medical

reports in the administrative records, plaintiff was variously

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diagnosed with repetitive motion syndrome, myofascial pain

syndrome, degenerative disc disease, lateral epicondylitis, mild

arthritic changes, neuropathy and fibromyalgia throughout the

period from 1994 to shortly before the hearing in 2002. The ALJ

identified no “affirmative evidence that the claimant is

malingering” and was therefore required to provide clear and

convincing reasons for rejecting plaintiff’s testimony regarding

the severity of her pain. The ALJ did not do so, but merely

concluded that all the doctors who examined plaintiff were unable

to identify clinical findings that could account for the degree of

plaintiff’s pain. Indeed, the ALJ’s determination that plaintiff

was “not entirely credible” turned entirely on the absence of

corroborating medical findings. This is a legally insufficient

basis for rejecting a claimant’s subjective complaints of pain. 

“If an adjudicator could reject a claim for disability simply

because a claimant fails to produce medical evidence supporting the

severity of the pain, there would be no reason for an adjudicator

to consider anything other than medical findings.” Bunnell v

Sullivan, 947 F2d 341, 347 (9th Cir 1991).

“Clear and convincing reasons” for rejecting plaintiff’s

testimony regarding subjective pain must accordingly go beyond a

mere discrepancy between the objective medical findings and the

alleged severity of pain. Once a medically determinable basis that

could cause the alleged pain has been established, 20 CFR § 1529(c)

describes the kinds of evidence that the adjudicator must consider

in addition to the medical evidence when assessing a claimant’s

credibility:

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(1) The individual’s daily activities;

(2) The location, duration, frequency and intensity of the

individual’s pain or other symptoms;

(3) Factors that precipitate or aggravate the symptoms;

(4) The type, dosage, effectiveness, and side effects of

any medication the individual takes or has taken to

alleviate pain or other symptoms;

(5) Treatment, other than medication, the individual

receives or has received for relief of pain or other

symptoms;

(6) Any measures other than treatment the individual uses

or has used to relieve pain or other symptoms (e g,

lying flat on his or her back, standing for 15 to 20

minutes every hour, or sleeping on a board); and

(7) Any other factors concerning the individual’s

functional limitations and restrictions due to pain or

other symptoms

Not only did the ALJ fail to consider many of these factors, but

this court’s consideration of them provides clear and convincing

reasons to find plaintiff’s claims to be credible — just the

opposite of the ALJ’s finding.

First, plaintiff’s uncontradicted testimony established

that she significantly restricted her daily activities in response

to her pain. She had difficulty grasping a fork, brushing her

teeth and blow-drying her hair — the latter even leading her to

keep her hair short. AR 47, 51. Plaintiff could only perform

limited shopping and, due to her medication and inability to rotate

her neck, driving. Id at 52-54. After selling her home for

financial reasons, she moved into a house with hardwood floors that

she would not need to vacuum. Id at 53. Plaintiff testified that

she cooked infrequently, and that her pain so disrupted her sleep

that she could not plan her activities for subsequent days. Id.

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In addition, the location, duration, frequency and

intensity of plaintiff’s pain show a consistent pattern of

worsening and spreading over the years, with piecemeal improvement

in response to treatment but frequent aggravation caused by falls

or particular movements. The pain that started primarily in her

right hand and arm slowly spread into her shoulders and neck, and

from there into her left arm, lower back and even legs. 

Medication, along with periods of rest and physical therapy, helped

to slow the long-term progression of the symptoms. AR 185, 221. 

But a sudden pulling motion, a fall down stairs and a fall at a

department store all aggravated her symptoms and accelerated their

spread. Id at 130, 185, 225. And according to plaintiff’s

uncontradicted testimony, even sitting or standing for more than

thirty minutes at a time exacerbated her spasms and pain. AR 49.

Plaintiff took pain relievers and muscle relaxers on a

continual basis, including Robaxin, Daypro, Vioxx, Valium, Soma,

Effexor and Tylenol. AR 25, 45. She responded to unpleasant side

effects — such as upset stomach — by switching medications, but

testified to continued side effects of impaired thought processes

and lethargy. AR 27, 45. Moreover, in addition to medication,

plaintiff underwent treatments such as physical therapy, stretching

classes, osteopathic manipulation and muscle stimulation (for which

she even rented a muscle-stimulation device). Id at 130, 226, 217,

206. And in her uncontradicted testimony, plaintiff described

other symptom-relieving measures such as daily walks to maintain

muscle flexibility; lying down to alleviate daily headaches; and

moving about after no more than thirty minutes of sitting in order

to prevent and alleviate muscle spasms. Id at 46, 49.

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The final factor that 20 CFR § 1529(c) lists for

determining a disability claimant’s credibility is a catch-all

consideration: “Other factors concerning [claimant’s] functional

limitations and restrictions due to pain or other symptoms.” As

the ALJ noted, medical examinations demonstrated that plaintiff had

a full range of motion of the lumbar and thoracic spine, as well as

the hips; had a normal gait; was able to squat all the way down and

rise to a standing position with slight knee pain; and had full

range of motion of the shoulders, elbows, wrists, forearms and

knees. AR 25, 27. But these findings miss the point. Plaintiff

never asserted an inability to perform any of these motions in

isolated instances; instead, she claimed an inability to perform or

refrain from performing certain motions repetitively, or on a

sustained and predictable basis, without significant pain and

spasms.

Further reinforcing plaintiff’s credibility is the fact

that none of her examining physicians expressed any disbelief of

her symptoms, or even raised the possibility that she might be

exaggerating. Dr Nishimoto, plaintiff’s treating physician,

declared her to be totally disabled at various times and ultimately

restricted her from work — despite what the ALJ characterizes as

“minimally normal objective medical findings.” AR 26. The

consultative examiner Dr MacMorran concluded that plaintiff was

“precluded from all types of work in the competitive job market,”

again despite the ALJ’s view of the objective medical findings. Id

at 274. And Dr Colman, the orthopedic specialist who examined

plaintiff twice as an AME, concluded that her symptoms were most

consistent with myofascial pain syndrome or fibrositis

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(fibromyalgia), and that she would no longer be able to perform her

then-current job. Id at 125, 129. Even Dr Helman, the neurologist

on whose assessment the ALJ relies most, based his conclusions

solely on his objective findings and made no comment regarding

plaintiff’s credibility. See id at 135-38.

The ALJ’s refusal to credit plaintiff’s pain testimony is

especially troubling in light of the multiple diagnoses of

fibromyalgia, a condition that can account for the degree of pain

plaintiff testified to experiencing. Fibromyalgia, previously

called fibrositis, is “a rheumatic disease that causes inflammation

of the fibrous connective tissue components of muscles, tendons,

ligaments, and other tissue.” Benecke v Barnhart, 379 F3d 587,

589-90 (9th Cir 2004). Common symptoms include 

chronic pain throughout the body, multiple tender

points, fatigue, stiffness, and a pattern of sleep

disturbance that can exacerbate the cycle of pain and

fatigue associated with this disease. Fibromyalgia's

cause is unknown, there is no cure, and it is

poorly-understood within much of the medical

community. The disease is diagnosed entirely on the

basis of patients' reports of pain and other

symptoms. The American College of Rheumatology

issued a set of agreed-upon diagnostic criteria in

1990, but to date there are no laboratory tests to

confirm the diagnosis.

Id at 590. 

Dr Colman, acting in his capacity of AME, first diagnosed

plaintiff with fibromyalgia (then known as fibrositis) in 1996. AR

129. The administrative record does not contain the first-hand

impressions of Dr Galicia, plaintiff’s treating position before

1999. But Dr MacMorran, who reviewed plaintiff’s medical records in

2002, noted that “[d]uring [the period from 1996 to 2000], Ms

Sanchez had a diagnosis of myofascial pain syndrome and also

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fibromyalgia.” Id at 262. Dr Nishimoto, who became plaintiff’s

treating physician in 1999, lists fibromyalgia as a “presenting

complaint” — one that he did not contest — in January of 2000. Id

at 249. And in 2002, Dr MacMorran concluded that “[t]he disability

of Ms Sanchez is caused by elements of cumulative trauma and also by

the disease process of fibromyalgia.” Id at 274.

This medical evidence, however, is not as strong as it

could be. None of these records sets forth in any detail the basis

for a fibromyalgia diagnosis. It does not appear, moreover, that

plaintiff was ever referred to a rheumatologist for follow-up by a

physician in the relevant field of specialty. Nonetheless, there is

no contradictory evidence in the record stating that plaintiff did

not have fibromyalgia. The ALJ’s own rejection of this diagnosis is

based on “the absence of medical evidence” as well as the “lack of

significant treatment[.]” Id at 27. But as noted above, a

diagnosis of fibromyalgia relies on patient’s reported symptoms as

opposed to objective medical evidence. Benecke, 379 F3d at 590. 

And plaintiff had been seeing physicians for her symptoms at least

intermittently from 1994 through 1999, AR 125-30, and every two to

four weeks from the end of 1999 to the start of 2002, during which

times she underwent continuous medicative and non-medicative

treatment. Id at 125-30, 152-250. This evidence may not

conclusively support a diagnosis of fibromyalgia, but it does

nothing to contradict the fibromyalgia diagnoses that various

physicians made — which in turn tend to reinforce the credibility of

plaintiff’s testimony.

In sum, the ALJ failed to provide “clear and convincing”

reasons that tend to undermine plaintiff’s credibility, which the

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available evidence actually tends to support. Accordingly, it was

legal error for the ALJ to disregard plaintiff’s testimony regarding

her subjective pain and functional limitations.

B

The ALJ also erred in discounting the assessment of the

treating physician, Dr Nishimoto, who found plaintiff to be totally

temporarily disabled at various times and ultimately restricted her

from work in January 2002. AR 26, 153. The adjudicator is

generally to give more weight to the opinions of a treating

physician than to the opinions of other physicians who may or may

not have also examined the claimant. Lester, 81 F3d at 830. The

Commissioner is required to give weight not only to the treating

doctor’s clinical findings and interpretation of test results, “but

also to his subjective judgments.” Id at 832-33 (citing Embrey v

Bowen, 849 F2d 418, 422 (9th Cir 1988)). The treating physician’s

continuing relationship with the claimant makes him “especially

qualified * * * to form an overall conclusion as to functional

capacities and limitations[.]” Id at 833.

Where the treating doctor’s opinion is not contradicted by

another doctor, the adjudicator may reject it only for “clear and

convincing” reasons. Id at 830 (citing Baxter v Sullivan, 923 F2d

1391, 1396 [9th Cir 1991]). If the treating doctor’s opinion is

contradicted by another doctor, the adjudicator may not reject it

without providing “specific and legitimate reasons” supported by

substantial evidence in the record. Id (citing Murray v Heckler,

722 F2d 499, 502 [9th Cir 1983]). In this case, Dr Nishimoto’s

opinion — which restricted plaintiff from work — is contradicted by

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the opinion of Dr Helman, the consultative neurologist. After

examining plaintiff and conducting an EMG nerve conduction study of

her upper extremities, Dr Helman concluded that plaintiff’s

disability “should encompass any activity that involves repetitively

using her upper extremities or hands,” thus allowing for the

possibility of non-repetitive, light exertional work. AR 137. 

Accordingly, the ALJ must provide specific and legitimate reasons,

supported by substantial evidence in the record, for rejecting Dr

Nishimoto’s conclusion. See Lester, 81 F3d at 830.

The ALJ gave the following reasons for rejecting Dr

Nishimoto’s conclusion:

The minimally abnormal objective medical findings

simply do not support such an extreme assessment. Dr

Nishimoto’s records are devoid of any description of

detailed examinations of or physical findings related

to the claimant’s musculoskeletal structure that

would support such assessments. Nor do Dr Nishimoto’s

records contain any laboratory tests, i e, x-rays,

MRI scans which would support his opinions * * *.

AR 26. The ALJ thus provided specific reasons for her findings,

but she rejected Dr Nishimoto’s opinion for essentially the same

reason that she discounts plaintiff’s credibility: the lack of

medically determinable findings that would account for the severity

of the symptoms and functional limitations that plaintiff

described — a severity that Drs Nishimoto, MacMorran and Colman

credited without question. And where, as here, a claimant’s

symptom testimony had been shown to be credible, disbelief alone

does not supply the substantial evidence required to support the

specific reasons that the ALJ gives: “[s]heer disbelief is no

substitute for substantial evidence.” Benecke, 379 F3d at 594.

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Accordingly, it was error for the ALJ to give only

minimal weight to the conclusions of plaintiff’s treating

physician.

III

Having determined that the ALJ committed legal errors

requiring reversal, the court must now determine the proper remedy. 

42 USC section 405(g) provides: “The court shall have power to

enter, upon the pleadings and transcript of the record, a judgment

affirming, modifying, or reversing the decision of the [SSA], with

or without remanding the cause for a rehearing.” In the normal

case in which the ALJ is determined to have committed legal errors,

a district court will remand the case for redetermination applying

the correct legal standard or for enhancement of the record if

appropriate. Benecke, 379 F3d at 593. Where the record has been

fully developed and further administrative proceedings would serve

no useful purpose, however, the district court should remand for an

immediate award of benefits. Id.

Where, as here, the ALJ improperly rejects the claimant’s

testimony regarding her limitations, and the claimant would be

disabled if the testimony were credited, remand for the purpose of

having the ALJ make findings regarding that testimony is

inappropriate. Lester, 81 F3d at 834. Furthermore, where the ALJ

improperly rejects the opinion of a treating or examining

physician, that opinion is credited “as a matter of law.” Id.

Thus crediting the disregarded evidence, and taking into

account the evidence in the record as a whole, the court finds that

plaintiff is unable to perform any type of physical activity on a

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sustained or repetitive basis. Accordingly, the court concludes: 

(1) plaintiff was disabled throughout the period for which she

seeks benefits by pain caused by her physical ailments; (2) that

considering the extent of plaintiff’s functional limitations, she

would not be able to perform her past work or any other work

available in substantial numbers in the national economy; and (3)

there is no reason to augment the record in this matter nor to

delay further the resolution of a benefits application that has

already been pending for nearly six years. The plaintiff is

entitled to an award of benefits. 

Having resolved this matter for the reasons stated above,

the court finds it unnecessary to consider the other arguments that

plaintiff has advanced.

This matter is remanded to the SSA for payment of

benefits to plaintiff. The clerk is directed to close the file and

terminate all pending motions. 

IT IS SO ORDERED.

 

VAUGHN R WALKER

United States District Chief Judge

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