Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_14-cv-00851/USCOURTS-azd-2_14-cv-00851-0/pdf.json

Nature of Suit Code: 863
Nature of Suit: Social Security - DIWC/DIWW (405(g))
Cause of Action: 42:405 Review of HHS Decision (SSID)

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WO 

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Tammy Rene Swing, 

Plaintiff, 

v. 

Carolyn W. Colvin, 

Defendant.

No. CV-14-00851-PHX-BSB

ORDER 

 Tammy Rene Swing (Plaintiff) seeks judicial review of the final decision of the 

Commissioner of Social Security (the Commissioner) denying her application for benefits 

under the Social Security Act (the Act). The parties have consented to proceed before a 

United States Magistrate Judge pursuant to 28 U.S.C. § 636(b) and have filed briefs in 

accordance with Local Rule of Civil Procedure 16.1. For the following reasons, the 

Court reverses the Commissioner’s decision and remands for further proceedings. 

I. Procedural Background 

 On October 21, 2011, Plaintiff filed applications for a period of disability and 

disability insurance benefits and supplemental security income under Titles II and XVI of 

the Act. (Tr. 15.)1

 Plaintiff alleged that she had been disabled since March 31, 2010. 

(Id.) After the Social Security Administration (SSA) denied Plaintiff’s initial 

 

1

 Citations to “Tr.” are to the certified administrative transcript of record. (Doc. 13.) 

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applications and her request for reconsideration, she requested a hearing before an 

administrative law judge (ALJ). After conducting a hearing, the ALJ issued a decision 

finding Plaintiff not disabled under the Act. (Tr. 15-27.) This decision became the final 

decision of the Commissioner when the Social Security Administration Appeals Council 

denied Plaintiff’s request for review. (Tr. 1-6); see 20 C.F.R. § 404.981 (explaining the 

effect of a disposition by the Appeals Council.) Plaintiff now seeks judicial review of 

this decision pursuant to 42 U.S.C. § 405(g). 

II. Administrative Record 

 The record before the Court establishes the following history of diagnosis and 

treatment related to Plaintiff’s alleged impairments. The record also includes opinions 

from State Agency Physicians who examined Plaintiff or reviewed the records related to 

her impairments, but who did not provide treatment. 

A. Medical Treatment Evidence 

 The record reflects that from 2010 through 2013, Plaintiff was diagnosed with 

fibromyalgia and received regular treatment for fibromyalgia and related symptoms from 

Dr. Viji Mahadevan (Tr. 515-43), Dr. Sherif Nasef (Tr. 545-53), Dr. Ehab Farouk 

Abdulab (Tr. 702-05, 718-20), Dr. Ronald Burns (Tr. 955-60), Dr. Andy Le, and 

providers at Sun Pain Management. (Tr. 1054, 1318-23.) 

 During a November 2010 appointment with Dr. Mahadevan, Plaintiff reported that 

she tried to ride her bike, swim, or walk daily to maintain her weight. (Tr. 541.) 

Dr. Mahadevan recommended that Plaintiff continue with aquatherapy. (Tr. 538, 543, 

547.) 

 In 2011, Dr. Abdulab referred Plaintiff to a neurologist for her headaches. 

(Tr. 693-94.) Neurologist Jatin Shah, M.D., treated Plaintiff for chronic headaches in 

2011 and 2012. (Tr. 633-37, 639-42.) Dr. Shah observed photophobia and phonophobia. 

(Tr. 633 (noting that Plaintiff was “lying in a dark room when [Dr. Shah] went to 

examine her because of the headache”), 639 (noting that noise and light bothered Plaintiff 

during an attempted EMG).) Dr. Shah prescribed medication (Tr. 633-37, 639-42), and 

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prescribed occipital injections in 2011. (Tr. 634.) Plaintiff sought emergency room 

treatment for headaches several times during 2010 and 2011. (Tr. 1147-50, 1159, 1170, 

1180, 1193.) 

 Plaintiff was also treated for degenerative disc disease of the cervical and lumbar 

spine. A July 20, 2011 MRI of Plaintiff’s cervical spine showed C5 to C7 spondylosis 

and arthropathy causing neural foraminal and central stenosis. (Tr. 643-44.) During 

appointments with Dr. Abdulab in 2011 and 2012, Plaintiff reported low back pain 

(Tr. 689, 700, 703, 704, 718) and neck pain (Tr. 690-91, 693-94, 703, 704). Plaintiff’s 

back pain was treated with pain medication, including Percocet and hydrocodone, and 

lumbar trigger point injections. (Tr. 689, 690-93, 718, 955-56.) Plaintiff was referred to 

physical therapy for her neck and back pain. (Tr. 572-78, 697, 700, 935.) In May 2011, 

Dr. Abdulab noted that physical therapy was not helping. (Tr. 697.) On January 25, 

2012, Dr. Abdulab stated that Plaintiff had “failed” physical therapy. (Tr. 700.) A 

January 26, 2012 discharge summary completed by the physical therapist notes that 

Plaintiff’s compliance was poor, explaining that she attended sixty percent or less of her 

scheduled appointments. (Tr. 578.) 

 In 2011, Dr. Mahadevan also treated Plaintiff for pain and swelling in her knees 

and ankle. (Tr. 520, 533, 538, 542.) A March 2011 MRI of Plaintiff’s right knee 

revealed chondromalacia along the medial patellar facet. (Tr. 555.) 

 Plaintiff also received treatment for pain and numbness in her upper extremities. 

(Tr. 641-42.) In 2011, motor and sensory nerve studies and an EMG revealed “early 

evidence” of carpal tunnel syndrome. (Tr. 641-42.) Nerve studies and an EMG in 2013 

revealed “very early evidence of carpal tunnel syndrome in right upper extremity.” 

(Tr. 1315-16.) On May 11, 2012, Dr. Shah administered a “left carpal tunnel injection.” 

(Tr. 631-32 (left wrist injected with bupivacaine and depomedrol).) Treatment notes 

from Sun Pain Management in 2012 indicate that Plaintiff had a weak grip in her right 

and left upper extremities and that she wore a brace on her left wrist. (Tr. 935-38, 1338-

39.) 

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B. Medical Opinion Evidence 

 1. Michael D. Rabara, Psy.D. 

 As part of the Agency’s consideration of Plaintiff’s applications for benefits, on 

June 25, 2012, Michael D. Rabara, Psy.D, examined Plaintiff. (Tr. 657-62.) Plaintiff 

reported fibromyalgia, migraines, irritable bowel syndrome, sore knees, carpal tunnel 

syndrome, and neck pain. (Tr. 657.) The referral from the Agency indicated that 

Plaintiff also had short-term memory loss. (Id.) Dr. Rabara administered psychological 

tests including the WAIS-IV, WMS-IV, and the Trail Making Test. (Id.) He diagnosed 

depressive disorder with anxious features, pain disorder associated with psychological 

factors and fibromyalgia, and borderline intellectual functioning. (Tr. 661.) 

 Dr. Rabara noted that Plaintiff’s “effort was questionable” on psychological 

testing. (Tr. 660.) With regard to the WAIS-IV intelligence test, Dr. Rabara stated that 

Plaintiff’s scores were provided “only for reference” because their “validity is uncertain 

secondary to questionable effort.” (Id.) Dr. Rabara explained: 

Her demeanor during the interview was polite and compliant, but there was a sense that she was overemphasizing her 

various symptoms and limitations. However, this is difficult 

to judge without any supporting medical records, but it may be relevant that she exhibited a number of overt pain 

behaviors throughout the exam. During the testing, she frequently complained about the perceived difficulty of the various tasks presented to her and sometimes seemed to give 

up very easily. She also seemed to be calling attention to her various pain complaints. Her effort seemed variable at best, 

but on the Rey 15 Item Memory Test, she recalled only 1 item in the correct position. She then included 10 items not in the 

original stimuli and in and positions that had a vertical, rather 

than horizontal sequence of the original design. Such an error is very atypical and suggestive of intentionally poor effort. 

(Id.) 

 Dr. Rabara stated that although Plaintiff seemed to experience genuine depression 

and anxiety, she had not apparently sought behavioral health treatment and some of her 

claims seemed “vague.” (Tr. 661.) Dr. Rabara found that Plaintiff’s test scores seemed 

“much lower than what her reported education and work history suggest.” (Id.) 

Dr. Rabara estimated that Plaintiff had “borderline to low average cognitive skills,” but 

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noted that “her current scores were much worse and some highly atypical errors on a 

screening measure of effort make her overall effort very questionable.” (Id.) 

 2. Adriana Tarazon Weyer, Ph.D. 

 On December 14, 2012, state agency consultant Dr. Weyer examined Plaintiff for 

her benefits applications. (Tr. 1085.) She used several examination procedures including 

a psychological survey, WAIS-IV, Bender Gestalt Test, WMS-IV, Trail Making Test, 

and the CTONI-2. (Id.) Dr. Weyer diagnosed major depressive disorder. (Tr. 1088.) 

 Dr. Weyer noted that Plaintiff displayed “no significant memory or attention 

problems” during the interview and put forth “good effort” on observation. (Tr. 1088.) 

However, Dr. Weyer noted that Plaintiff “appeared to be putting forth less than optimal 

effort” during testing. (Id.) For instance, she “responded very quickly at times and gave 

up easily on more difficult tasks.” (Id.) 

 Dr. Weyer administered the CTONI-2, a nonverbal measure of intelligence. (Id.) 

Dr. Weyer stated that Plaintiff “earned an IQ of 65,” but was “observed to give up easily 

on more difficult tasks and provide very quick responses at this point.” (Id.) Dr. Weyer 

opined that Plaintiff’s IQ score “may reflect lack of optimal effort and therefore is likely 

an underestimation of her actual abilities.” (Id.) Dr. Weyer concluded that Plaintiff’s 

effort on intelligence testing “was questionable.” (Tr. 1088.) She also stated that, 

although Plaintiff seemed to have some level of cognitive impairment, her scores on 

testing were “difficult to interpret due to [Plaintiff’s] perceived lack of effort during 

testing.” (Id.) 

 Dr. Weyer completed a Psychological/Psychiatric Medical Source Statement. 

(Tr. 1090.) She opined that Plaintiff may perform better with supervision, including 

explanation of tasks, extra time to complete tasks, and redirection as needed. (Id.) 

Dr. Weyer also found that Plaintiff may have “moderate difficulties on tasks requiring an 

ability to complete a normal workday and workweek without interruptions from 

psychologically based symptoms.” (Id.) 

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 3. Ronald Burns, M.D. 

 On May 30, 2013, treating physician Dr. Burns completed a medical assessment of 

ability to do work related physical activities. (Tr. 1310.) He opined that Plaintiff could 

sit for thirty minutes continuously for a total of two hours in an eight-hour day. (Id.) He 

opined that she could stand or walk for thirty minutes continuously and for less than an 

hour total during an eight-hour day. (Id.) To support these limitations, he explained that 

Plaintiff needed “frequent rest periods.” (Id.) 

 Dr. Burns found Plaintiff limited to lifting ten pounds occasionally. (Id.) He also 

opined that Plaintiff should never stoop, squat, crawl, or climb, and that she was limited 

to occasional reaching and gross or fine manipulation with her right and left upper 

extremities. (Tr. 1310-11.) He further found that Plaintiff should avoid unprotected 

heights, moving machinery, and occupational driving. (Id.) He also found that Plaintiff’s 

pain and fatigue were moderately severe and would cause her to be “off task” eleven to 

fifteen percent of the time. (Tr. 1312.) 

 4. State Agency Reviewing Physicians

 a. Ramona Bates, M.D. 

On May 9, 2012, state agency consultant Dr. Bates reviewed the medical record. 

(Tr. 620.) She noted Plaintiff’s diagnoses of fibromyalgia, chronic neck and back pain, 

and headaches. (Id.) She assessed exertional limitations consistent with light work. 

(Tr. 621, 628.) 

 b. Paula Lynch, M.D.

 On July 18, 2012, state agency medical consultant Dr. Lynch reviewed the 

medical records and found “insufficient evidence” of mental impairments. (Tr. 665, 677, 

679.) Dr. Lynch opined that the available medical evidence was insufficient to establish 

mental impairment status or function relevant to a date last insured of March 31, 2010. 

(Tr. 677, 679.) 

/ / / 

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 c. Susan Daugherty, Ph.D. 

 On January 16, 2013, Susan Daugherty, Ph.D., reviewed Plaintiff’s medical 

records. (Tr. 1102-15.) Dr. Daugherty noted that Plaintiff had mild restriction in 

activities of daily living, moderate difficulties maintaining social functioning, and 

moderate difficulties maintaining concentration, persistence, or pace. (Tr. 1112.) She 

concluded that Plaintiff could perform work “where interpersonal contact is incidental to 

the work performed, e.g. assembly work; complexity of tasks is learned and performed by 

rote, few variables, little judgment; supervision required is simple, direct and concrete 

(unskilled).” (Tr. 1100-01.) 

III. The Administrative Hearing

 Plaintiff was in her early forties at the time of the administrative hearing and the 

ALJ’s decision. (Tr. 16, 201.) She had the equivalent of a high school education. 

(Tr. 45, 658.) She took community college course, but did not earn a degree. (Tr. 45, 

658, 1086.) Plaintiff had past relevant work as a custodian, warehouse worker, and 

machine operator. (Tr. 47, 58-59, 258, 301-08, 332-45.) She testified that she was 

unable to work due to her impairments and symptoms of impairments including daily 

headaches, fibromyalgia, carpal tunnel syndrome, and back and neck pain. (Tr. 47, 50.) 

She testified that her pain medications caused drowsiness and that cortisone injections 

and a TENS unit aggravated, rather than relieved, her pain. (Tr. 50, 57, 60.) She stated 

that she wore wrist splints for carpal tunnel syndrome and frequently dropped things. 

(Tr. 57, 60.) She also testified that she has problems with memory and concentration. 

(Tr. 63.) The vocational expert testified that an individual with the limitations identified 

in the ALJ’s residual functional capacity (RFC) could not perform Plaintiff’s past 

relevant work, but could perform other work that existed in significant number in the 

national economy.2

 (Tr. 20-21, 70-71.) 

IV. The ALJ’s Decision

 

2

 As set forth below in Section IV.B, the ALJ found that Plaintiff had the RFC to 

“perform light work as defined in 20 CFR 404.1567(b) and 416.967(b), subject to” several limitations. (Tr. 20-21.) 

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 A claimant is considered disabled under the Social Security Act if she is unable 

“to engage in 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.” 42 

U.S.C. § 423(d)(1)(A); see also 42 U.S.C. § 1382c(a)(3)(A) (nearly identical standard for 

supplemental security income disability insurance benefits). To determine whether a 

claimant is disabled, the ALJ uses a five-step sequential evaluation process. See 20 

C.F.R. §§ 404.1520, 416.920. 

A. The Five Step Sequential Evaluation Process 

 In the first two steps, a claimant seeking disability benefits must initially 

demonstrate (1) that she is not presently engaged in a substantial gainful activity, and 

(2) that her medically determinable impairment or combinations of impairments is severe. 

20 C.F.R. §§ 404.1520(b) and (c), 416.920(b) and (c). If a claimant meets steps one and 

two, there are two ways in which she may be found disabled at steps three through five. 

At step three, she may prove that her impairment or combination of impairments meets or 

equals an impairment in the Listing of Impairments found in Appendix 1 to Subpart P of 

20 C.F.R. Part 404. 20 C.F.R. § 404.1520(a)(4)(iii). 20 C.F.R. §§ 404.1520(d), 

416.920(d). If so, the claimant is presumptively disabled. If not, the ALJ determines the 

claimant’s RFC. 20 C.F.R. §§ 404.1520(e), 416.920(e). At step four, the ALJ 

determines whether a claimant’s RFC precludes her from performing her past relevant 

work. 20 C.F.R. §§ 404.1520(f), 416.920(f). If the claimant establishes this prima facie 

case, the burden shifts to the government at step five to establish that the claimant can 

perform other jobs that exist in significant number in the national economy, considering 

the claimant’s RFC, age, work experience, and education. 20 C.F.R. §§ 404.1520(g), 

416.920(g). If the government does not meet this burden, then the claimant is considered 

disabled within the meaning of the Act. 

/ / / 

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 B. The ALJ’s Application of the Five Step Evaluation Process

 Applying the five-step sequential evaluation process, the ALJ found that Plaintiff 

had not engaged in substantial gainful activity since the alleged disability onset date, 

March 31, 2010. (Tr. 17.) At step two, the ALJ found that Plaintiff had the following 

medically determinable impairments: “fibromyalgia, chronic headaches, chronic bilateral 

knee and ankle pain, gastroesophageal reflux disease (GERD), degenerative disc disease 

of the cervical and lumbar spine, depressive disorder not otherwise specified (NOS), 

organic mental disorder not otherwise specified (NOS), and intellectual disability (20 

C.F.R. 404.1520(c) and 416.920(c)).” (Id.) The ALJ found that Plaintiff did not have an 

impairment or combination of impairments that significantly limited (or was expected to 

significantly limit) her ability to perform basic work-related activities for twelve 

consecutive months. (Tr. 18.) The ALJ found that Plaintiff had the RFC to “perform 

light work as defined in 20 CFR 404.1567(b) and 416.967(b), subject to” several 

limitations. (Tr. 20.) The ALJ clarified that Plaintiff could perform work when 

“interpersonal contact is incidental to work performed; complexity of tasks is learned and 

performed by rote, with few variables, and little judgment; and supervision is simple, 

direct, and concrete.” (Tr. 20-21; see Tr. 1100.) The ALJ found that Plaintiff could not 

perform her past relevant work, but she could perform other work that existed in 

significant number in the national economy. (Tr. 25-26.) He concluded that Plaintiff had 

not been under a disability as defined in the Act from March 31, 2010 through the date of 

his decision. (Tr. 27.) Therefore, the ALJ denied Plaintiff’s applications for a period of 

disability and disability insurance benefits and supplemental security income. (Id.) 

V. Standard of Review 

 The district court has the “power to enter, upon the pleadings and transcript of 

record, a judgment affirming, modifying, or reversing the decision of the Commissioner, 

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

court reviews the Commissioner’s final decision under the substantial evidence standard 

and must affirm the Commissioner’s decision if it is supported by substantial evidence 

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and it is free from legal error. Smolen v. Chater, 80 F.3d 1273, 1279 (9th Cir. 1996); 

Ryan v. Comm’r of Soc. Sec. Admin., 528 F.3d 1194, 1198 (9th Cir. 2008). Even if the 

ALJ erred, however, “[a] decision of the ALJ will not be reversed for errors that are 

harmless.” Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir. 2005). 

 Substantial evidence means more than a mere scintilla, but less than a 

preponderance; it is “such relevant evidence as a reasonable mind might accept as 

adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 401 (1971) 

(citations omitted); see also Webb v Barnhart, 433 F.3d 683, 686 (9th Cir. 2005). In 

determining whether substantial evidence supports a decision, the court considers the 

record as a whole and “may not affirm simply by isolating a specific quantum of 

supporting evidence.” Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007) (internal 

quotation and citation omitted). The ALJ is responsible for resolving conflicts in 

testimony, determining credibility, and resolving ambiguities. See Andrews v. Shalala, 

53 F.3d 1035, 1039 (9th Cir. 1995). “When the evidence before the ALJ is subject to 

more than one rational interpretation, [the court] must defer to the ALJ’s conclusion.” 

Batson v. Comm’r of Soc. Sec. Admin., 359 F.3d 1190, 1198 (9th Cir. 2004) (citing 

Andrews, 53 F.3d at 1041). 

VI. Plaintiff’s Claims 

 Plaintiff raises the following claims: (1) the ALJ erred by rejecting the opinion of 

treating physician Dr. Burns and by rejecting opinions on two headaches questionnaires; 

(2) the ALJ erred by concluding that Plaintiff’s impairments did not meet or equal Listing 

12.05C; (3) the ALJ erred by assessing an RFC that did not include all of the limitations 

that Dr. Weyer identified; and (4) the ALJ erred by discounting Plaintiff’s subjective 

complaints. (Doc. 14.) The Court considers these claims below, first addressing claim 

one, then addressing claim four, claim two, and claim three. 

A. Weight Assigned to Medical Source Opinions

 Plaintiff argues that the ALJ erred in weighing the medical source opinion 

evidence. (Doc. 14 at 7.) In weighing medical source opinion evidence, the Ninth 

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Circuit distinguishes between three types of physicians: (1) treating physicians, who treat 

the claimant; (2) examining physicians, who examine but do not treat the claimant; and 

(3) non-examining physicians, who neither treat nor examine the claimant. Lester v. 

Chater, 81 F.3d 821, 830 (9th Cir. 1995). Generally, more weight is given to a treating 

physician’s opinion. Id. The ALJ must provide clear and convincing reasons supported 

by substantial evidence for rejecting a treating or an examining physician’s 

uncontradicted opinion. Id.; Reddick v. Chater, 157 F.3d 715, 725 (9th Cir. 1998). An 

ALJ may reject the controverted opinion of a treating or an examining physician by 

providing specific and legitimate reasons that are supported by substantial evidence in the 

record. Bayliss v. Barnhart, 427 F.3d 1211, 1216 (9th Cir. 2005); Reddick, 157 F.3d at 

725. 

 Opinions from non-examining medical sources are entitled to less weight than 

opinions from treating or examining physicians. Lester, 81 F.3d at 831. Although an 

ALJ generally gives more weight to an examining physician’s opinion than to a nonexamining physician’s opinion, a non-examining physician’s opinion may nonetheless 

constitute substantial evidence if it is consistent with other independent evidence in the 

record. Thomas v. Barnhart, 278 F.3d 947, 957 (9th Cir. 2002). When evaluating 

medical opinion evidence, the ALJ may consider “the amount of relevant evidence that 

supports the opinion and the quality of the explanation provided; the consistency of the 

medical opinion with the record as a whole; [and] the specialty of the physician providing 

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

 1. Weight Assigned to Dr. Burns’ Opinion 

Dr. Burns found Plaintiff limited to sitting two hours per day and standing or 

walking less than one hour per day. (Tr. 1310-12.) He found Plaintiff limited to lifting 

ten pounds occasionally, occasional gross or fine manipulation with her upper 

extremities, and also assessed postural limitations. (Id.) He also concluded that Plaintiff 

would be off task eleven to fifteen percent of the time due to pain and fatigue. (Id.) The 

ALJ assigned Dr. Burns’ opinion no weight because the ALJ concluded that his opinions 

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were inconsistent with his treatment notes and with the medical record that indicated that 

Plaintiff was stable on medication.3

 (Tr. 24.) The ALJ also found Dr. Burns’ opinions 

inconsistent with evidence in the record indicating that Plaintiff could walk, swim, and 

ride a bicycle. (Id.) 

 The ALJ properly assigned Dr. Burns’ opinion no weight by providing specific 

and legitimate reasons, which are supported by substantial evidence in the record. See

Bayliss, 427 F.3d at 1216. The ALJ discussed the medical record (Tr. 23-25) and 

properly discounted Dr. Burns’ opinions as inconsistent with the record and his treatment 

notes. (Tr. 24); see Batson, 359 F.3d at 1195 (an ALJ may discredit treating physicians’ 

opinions that are unsupported by the record as a whole or by objective medical findings). 

 First, in October 2012, Plaintiff reported to Dr. Burns at Sun Pain Management 

that her pain was a level eight to ten and he administered a series of trigger point 

injections in her lumbar spine. (Tr. 955-56.) In December 2012, Plaintiff reported that 

her pain level was six. (Tr. 1336-37.) Another treatment note from Sun Pain 

Management describes Plaintiff’s pain as stable with medications. (Tr. 1318.) Plaintiff 

reported her pain level as between five and ten and reported injections had decreased her 

symptoms and pain. (Id.) In January 2013, Plaintiff reported that her pain was at level 

four to six with medication. (Tr. 1333.) She was considered stable, with no change in 

medications “due to optimal pain control and meeting opioid goals.” (Tr. 1335.) In July 

2013, Plaintiff’s pain was at a level five without medication, and she received series of 

trigger point injections. (Tr. 1321-23.) She remained stable in August 2013 with no 

change in medication “due to optimal pain control and meeting opioid goals.” (Tr. 1318-

20.) Thus, substantial evidence in the record supports the ALJ’s determination that the 

limitations Dr. Burns assessed were inconsistent with the medical record. Although the 

 

3

 The ALJ also rejected Dr. Burns’ opinion because he was not a specialist in orthopedics. (Tr. 24.) Plaintiff argues that this is not relevant to the assessment of the 

doctor’s opinion. (Doc. 14 at 8-9.) The Commissioner states that she does not rely on this reason to support the ALJ’s disability determination. (Doc. 16 at 10 n.3.) Additionally, a specialist’s opinion is not required to support a finding of disability. See

20 C.F.R. § 404.1527. 

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record could be interpreted more favorably to Plaintiff, the Court “must uphold the ALJ’s 

decision where the evidence is susceptible to more than one rational interpretation.” 

Magallanes v. Bowen, 881 F.2d 747, 750 (9th Cir. 1989); see Batson, 359 F.3d at 1198. 

 Second, the ALJ also found that the limitations Dr. Burns identified were 

inconsistent with records showing that Plaintiff walked, swam, and rode a bicycle. 

(Tr. 22.) Substantial evidence in the record supports that ALJ’s determination. In a 

November 23, 2010, treatment note, Dr. Mahadevan indicated that Plaintiff rode her 

bicycle every day and swam or walked several times per week. (Tr. 541.) Physical 

therapy notes from April 2011 indicate that Plaintiff continued to ride her bicycle and 

walked about thirty minutes per day. (Tr. 1214, 1218, 1220.) A treatment note in 

November 2011 indicates Plaintiff rode her bicycle and walked, and that she had some 

swelling in her knee after walking but not much after bicycling. (Tr. 652.) On October 

12, 2012, Plaintiff reported riding her bicycle and “do[ing] some more things” without 

increased pain. (Tr. 894.) 

 Plaintiff asserts that evidence of her physical activities does not detract from her 

claim of disability because her doctors encouraged exercise and she “failed” physical 

therapy “many times.” (Doc. 14 at 9-10 (citing Tr. 578, 697, 700).) The May 2011 and 

January 25, 2012 treatment notes that Plaintiff cites state that she “failed” physical 

therapy and that physical therapy was “not helping.” (Tr. 697, 700.) However, as the 

ALJ noted, evidence in the record also indicates that Plaintiff had poor compliance with 

physical therapy. For instance, a January 24, 2012 treatment note from Plaintiff’s 

physical therapist states that Plaintiff would “greatly benefit” from continued therapy two 

to three times per week for an additional four weeks. (Tr. 575.) A January 26, 2012 

treatment note states that Plaintiff’s physician had discharged her from physical therapy. 

(Tr. 578.) The therapist described Plaintiff’s compliance with therapy as poor because 

she attended less than sixty percent of her scheduled appointments. (Id.) A March 2013 

treatment notes states that Plaintiff had poor compliance with her home exercise program. 

(Tr. 22, 1288.) Although there is evidence that Plaintiff “failed” physical therapy, there 

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is also substantial evidence to support the ALJ’s conclusion that Plaintiff did not comply 

with physical therapy. See Batson, 359 F.3d at 1197-98 (stating that “[w]hen the 

evidence before the ALJ is subject to more than one rational interpretation, [the court] 

must defer to the ALJ’s conclusion.”). 

 Third, the ALJ rejected Dr. Burns’ opinion because he found it less persuasive 

than the opinions of the state agency medical consultants and less consistent with the 

record as a whole. (Tr. 24.) A nonexamining doctor’s opinion may amount to substantial 

evidence “when it is consistent with other independent evidence in the record.” 

Tonapetyan, 242 F.3d at 1149. On May 9, 2012, state agency medical consultant 

Dr. Bates reviewed the medical records and considered the objective evidence, including 

X-rays, an MRI, and EMG. (Tr. 627.) She opined that Plaintiff was capable of doing 

light work. (Tr. 620-29.) Jim Takach, M.D., reviewed the medical evidence on January 

15, 2013, and affirmed Dr. Bates’ opinion. (Tr. 1097.) 

 Plaintiff argues that Dr. Bates’ inaccurately summarized the evidence because she 

stated that Plaintiff did not receive epidural injections. (Doc. 14 at 11.) Dr. Bates 

completed her review of the record on May 9, 2012. She noted that, in 2011, Plaintiff’s 

insurance company had denied Plaintiff epidural injections and that she was scheduled 

for physical therapy and Percocet. (Tr. 627.) A July 2011 treatment notes supports 

Dr. Bates’ description of the record. (Tr. 523.) Plaintiff also argues that the ALJ erred in 

relying on Dr. Bates’ opinion because she is a plastic surgeon. (Doc. 14 at 10-11.) 

Dr. Bates’ specialty as a plastic surgeon did not preclude the ALJ from relying on her 

opinion to support his disability determination. See Crane v. Shalala, 76 F.3d 251, 254 

(9th Cir. 1996) (a licensed physician who was not a psychiatrist was qualified to state a 

medical opinion on claimant’s mental state). 

 For these reasons, the Court concludes that the ALJ did not err in assigning no 

weight to Dr. Burns’ opinions and substantial evidence supports the ALJ’s reasons for 

discounting his opinion. 

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2. Weight Assigned to Headache Questionnaires 

 a. May 4, 2012 Headache Questionnaire 

 A May 4, 2012 headache questionnaire states that Plaintiff had daily headaches 

that lasted all day. (Tr. 619.) The questionnaire also states that headaches interfered with 

Plaintiff’s ability to work and that Plaintiff could not work. (Id.) The ALJ assigned no 

weight to this opinion. (Tr. 25.) He explained that the opinion on the questionnaire was 

subjective, conclusory, and lacked explanation. (Id.) The ALJ also noted that the 

signature was illegible. (Id.) Plaintiff asserts that if the ALJ found the signature illegible, 

he was required to further develop the record. (Doc. 14 at 11.) The Court disagrees. 

 An ALJ’s “duty to develop the record further is triggered only when there is 

ambiguous evidence or when the record is inadequate to allow for proper evaluation of 

the evidence.” Mayes v. Massanari, 276 F.3d 453, 459-60 (9th Cir. 2001) (internal 

citation omitted). Here, the record as a whole was not ambiguous or inadequate. The 

lack of a legible signature on the May 4, 2012 opinion did not make it ambiguous. 

 As the ALJ found, the statement that Plaintiff had daily headaches that lasted the 

entire day was most likely based on her subjective complaints. (Tr. 619.) Because the 

ALJ properly discredited Plaintiff’s subjective complaints as discussed in Section VI.B 

below, the ALJ did not err in this regard. See Bray, 554 F.3d at 1228 (9th Cir. 2009) 

(ALJ properly discounts a physician’s opinion that is based solely upon claimant’s selfreporting if ALJ concludes that claimant’s self-reporting is not credible); see also Thomas 

v. Barnhart, 278 F.3d 947, 957 (9th Cir. 2002) (rejecting physician’s opinion in part 

because it was based on claimant’s subjective complaints, not on new objective findings); 

Tonapetyan, 242 F.3d at 1149 (medical opinion premised on subjective complaints may 

be disregarded when record supports ALJ in discounting claimant’s credibility). 

 Additionally, as the ALJ noted, the opinion that Plaintiff’s headaches would 

“interfere with [her] ability to work” and that she could not work, was conclusory. 

(Tr. 25, 619.) The opinion did not include any specific work-related limitations, but 

generally concluded that Plaintiff could not work. An ALJ need not accept a treating 

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physician’s opinion which is “brief and conclusory in form with little in the way of 

clinical findings to support [its] conclusion.” Young v. Heckler, 803 F.2d 963, 968 (9th 

Cir. 1986). The Court concludes that the ALJ did not err in assigning no weight to the 

May 4, 2012 opinion as conclusory. 

 b. Dr. Shah’s Headache Questionnaire 

 The ALJ also gave no weight to a headache questionnaire that treating neurologist 

Dr. Shah completed in May 2013. (Tr. 25, 1317.) Dr. Shah stated that Plaintiff had 

“mixed type” headaches that lasted “for days.” (Tr. 1317.) He stated that Plaintiff’s 

headaches caused pain at a level “ten” and that they interfered with her concentration, 

attention, memory, and capacity to work. (Id.) He opined that Plaintiff’s headaches 

would cause an “undetermined” amount of absences from work monthly. (Id.) The ALJ 

rejected Dr. Shah’s opinion because he found the opinion subjective, unspecific, and 

unsupported by Dr. Shah’s treatment notes. (Tr. 24-25.) 

 As the ALJ noted, Dr. Shah’s opinion did not indicate to what extent Plaintiff’s 

headaches would cause her to be off task. (Tr. 24.) Additionally, although Dr. Shah 

opined that Plaintiff’s headaches would interfere with her concentration, attention, and 

memory, he did not quantify those limitations. See Young, 803 F.2d at 968. 

Additionally, because the ALJ properly discredited Plaintiff’s subjective complaints as 

discussed in Section VI.B below, the ALJ did not err in discounting Dr. Shah’s opinion 

because it was based on Plaintiff’s subjective complaints. See Bray, 554 F.3d at 1228. 

 Finally, substantial evidence in the record supports the ALJ’s conclusion that 

Dr. Shah’s treatment notes did not support his opinion. Plaintiff cites several of 

Dr. Shah’s treatment notes as supporting his 2013 opinion on the headache questionnaire. 

(Doc. 14 (citing Tr. 633, 634, 638, 639).) On February 2011, Dr. Shah saw Plaintiff for 

headaches. (Tr. 639-40.) He noted that Plaintiff was sensitive to light and noise during 

an attempted EMG. (Tr. 639.) On examination, Plaintiff was alert, oriented, could move 

her upper and lower extremities, had full strength, normal reflexes, normal coordination 

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and gait, and normal sensory responses. (Tr. 640.) Dr. Shah noted that a CT scan was 

normal, and that Plaintiff agreed to have an EMG. (Id.) 

 On May 4, 2012, Plaintiff saw Dr. Shah for a follow-up appointment. (Tr. 633.) 

Dr. Shah noted that when he entered the examination room, Plaintiff was lying in the 

dark because of her headache. (Id.) Dr. Shah noted that an EMG and an EEG were 

normal. (Tr. 633, 638.) On examination, Plaintiff was alert, oriented, could move her 

upper and lower extremities, had full strength, normal reflexes, normal coordination and 

gait, and normal sensory responses. (Tr. 640.) 

 Although the record indicates that Plaintiff received ongoing treatment for 

headaches and could be interpreted more favorably to Plaintiff, substantial evidence in 

the record supports the ALJ’s conclusion that Dr. Shah’s opinion was not supported by 

his treatment notes. See Batson, 359 F.3d at 1197-98 (stating that “[w]hen the evidence 

before the ALJ is subject to more than one rational interpretation, [the court] must defer 

to the ALJ’s conclusion.”). The ALJ did not err in assigning no weight to Dr. Shah’s 

headache questionnaire and his reasons for doing so are supported by substantial 

evidence in the record. 

B. The ALJ’s Credibility Determination 

 Plaintiff also asserts that the ALJ erred by discrediting her symptom testimony 

without providing clear and convincing reasons. (Doc. 14 at 17.) An ALJ engages in a 

two-step analysis to determine whether a claimant’s testimony regarding her pain or other 

symptoms is credible. See Treichler v. Comm’r of Soc. Sec., 775 F.3d 1090, 1102 (9th 

Cir. 2014); see also Garrison v. Colvin, 759 F.3d 995, 1014-15 (9th Cir. 2014) (citing 

Lingenfelter v. Astrue, 504 F.3d 1028, 1035-36 (9th Cir. 2007)). 

 “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 or other symptoms alleged.’” Lingenfelter, 504 F.3d at 1036 (quoting 

Bunnell v. Sullivan, 947 F.2d 341, 344 (9th Cir. 1991) (en banc)). The claimant is not 

required to show objective medical evidence of the pain itself or of a causal relationship 

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between the impairment and the symptom. Smolen, 80 F.3d at 1282. Instead, the 

claimant must only show that an objectively verifiable impairment “could reasonably be 

expected” to produce his pain. Lingenfelter, 504 F.3d at 1036 (quoting Smolen, 80 F.3d 

at 1282); see also Carmickle v. Comm’r of Soc. Sec., 533 F.3d at 1160B61 (9th Cir. 2008) 

(“requiring that the medical impairment ‘could reasonably be expected to produce’ pain 

or another symptom . . . requires only that the causal relationship be a reasonable 

inference, not a medically proven phenomenon”). 

 Second, if a claimant shows that she suffers from an underlying medical 

impairment that could reasonably be expected to produce her pain or other symptoms, the 

ALJ must “evaluate the intensity and persistence of [the] symptoms” to determine how 

the symptoms, including pain, limit the claimant’s ability to work. See 20 

C.F.R. § 404.1529(c)(1). In making this evaluation, the ALJ may consider the objective 

medical evidence, the claimant’s daily activities, the location, duration, frequency, and 

intensity of the claimant’s pain or other symptoms, precipitating and aggravating factors, 

medication taken, and treatments for relief of pain or other symptoms. See 20 

C.F.R. § 404.1529(c); Bunnell, 947 F.2d at 346. 

 At this second evaluative step, the ALJ may reject a claimant’s testimony 

regarding the severity of her symptoms only if the ALJ “makes a finding of malingering 

based on affirmative evidence,” Lingenfelter, 504 F.3d at 1036 (quoting Robbins v. Soc. 

Sec. Admin., 466 F.3d 880, 883 (9th Cir. 2006)), or if the ALJ offers “clear and 

convincing reasons” for finding the claimant not credible.4

 Carmickle, 533 F.3d at 1160 

(quoting Lingenfelter, 504 F.3d at 1036). Because the ALJ did not specifically find 

evidence of malingering, the ALJ was required to provide clear and convincing reasons 

for concluding that Plaintiff’s subjective complaints were not wholly credible.5

 

 

4

 The Ninth Circuit has rejected the Commissioner’s argument (Doc. 16 at 6) that a lesser standard than “clear and convincing” should apply. See Garrison, 759 F.3d at 

1015 n.18. 

5

 The ALJ stated that Plaintiff’s performance and behavior during mental status examinations was “evidence of possible malingering,” but he did not discredit Plaintiff’s 

testimony on that basis. (Tr. 23.) 

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 1. Inconsistency between Reported Activities and Testimony 

The ALJ discounted Plaintiff’s symptom testimony because the medical record 

included a range of activities that were “at odds with what Plaintiff alleged in her hearing 

testimony.” (Doc. 21.) As discussed below, this is a clear and convincing reason for 

discounting Plaintiff’s credibility that is supported by substantial evidence in the record. 

 As part of the overall disability analysis, and in weighing various allegations and 

opinions, the ALJ must consider whether there are any inconsistencies in the evidence, 

such as Plaintiff’s inconsistent statements. See 20 C.F.R. § 404.1529(c)(4) (stating that 

an ALJ must consider “whether there are any inconsistencies in the evidence.”); SSR 96-

7p, 1996 WL 374186, at *5 (stating that a strong indicator of the credibility an 

individual’s statements is their consistency, both internally and with other information in 

the record). Thus, the ALJ properly considered inconsistencies between Plaintiff’s 

hearing testimony and the medical record. 

 At the administrative hearing, Plaintiff testified that about four to five years before 

the September 2013 hearing, or in 2008 and 2009, she rode her bike every day. (Tr. 66.) 

She also testified that in 2010 she told Dr. Mahadevan that she was not riding her bike 

every day. (Id.) She said she tried to get out once a week or a few times a month. (Id.) 

However, on a November 23, 2010 treatment note, Dr. Mahadevan noted that Plaintiff 

reported that she rode her bike every day. (Tr. 541.) Thus, Plaintiff’s hearing testimony 

was inconsistent with Dr. Mahadevan’s treatment note. 

 Plaintiff also testified that she rode her bike before she had slip and fall in 

November 2010. (Tr. 57-58, 66.) Then she stated that she had not ridden her bike. 

(Tr. 66.) However, as the ALJ noted (Tr. 21 (citing Admin. Hrg. Ex. 7F at 29)), a March 

2011 treatment note indicates that Plaintiff was active, riding a bicycle, walking, and 

lifting. (Tr. 1026.) Additionally, as the ALJ noted, physical therapy records from April 

2011 indicate that Plaintiff rode her bike and walked about thirty minutes a day. (Tr. 21-

22, 1214.) Additionally, primary care records from November 8, 2011, report that 

Plaintiff rode a bike, walked, and exercised. (Tr. 22, 652.) 

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 Because Plaintiff gave conflicting testimony about her ability to ride her bike and 

testimony that conflicted with several medical records, the ALJ properly found Plaintiff’s 

credibility diminished on this basis. See Thomas v. Barnhart, 278 F.3d 947, 958-59 (9th 

Cir. 2002) (inconsistencies in a claimant’s testimony weigh against her credibility). 

 2. Social Isolation 

 The ALJ also discounted Plaintiff’s credibility because he found her “complaints 

of social isolation” inconsistent with her report, “during the same therapy appointment,” 

that she went to a baby shower. (Tr. 22.) He also noted that Plaintiff referred to friends 

in other counseling records. (Tr. 22 (citing Admin. Hrg. Exs. 51F at 37, 41, 49).)6

 

 Plaintiff argues that she did not testify that she was socially isolated, but testified 

that she did not “have many friends” and did not “get out much.” (Doc. 14 at 18 (citing 

Tr. 57).) The ALJ, however, did not discredit Plaintiff based on an inconsistency 

between her hearing testimony and the record. Rather, he discredited her based on 

internal inconsistencies in several treatment notes. (Tr. 22.) As discussed below, the 

treatment notes that the ALJ cited do not support the conclusion that Plaintiff gave 

contradictory reports regarding her level of social interaction. 

 The ALJ cites a July 22, 2013 treatment note, which indicates that an objective of 

Plaintiff’s treatment at Phoenix Interfaith Counseling was to “increase positive 

communication and social interaction.” (Tr. 1417.) During that same appointment, 

Plaintiff reported that she had recently attended a baby shower where she interacted with 

people. (Id.) However, the treatment note indicates that Plaintiff had difficulty with her 

anger and communication style and that she “resisted” asking people certain questions at 

the baby shower. (Id.) Thus, it is unclear whether Plaintiff was socially isolated or 

whether she had difficulty engaging in positive social interaction. The other treatment 

notes the ALJ cites do not specifically include reports of social isolation. (Tr. 1405, 

1409.) The August 21, 2013 treatment note states that Plaintiff reported “avoidance 

behaviors,” but does not describe the specific behaviors and does not specifically refer to 

 

6

 These administrative hearing exhibits appear at Tr. 1405, 1409, and 1417. 

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social isolation. (Tr. 1405.) The September 10, 2013 treatment note again indicates that 

counselling had a goal of “increase[ing] positive communication and social interaction.” 

(Tr. 1409.) Plaintiff discussed having friends, but said they did not keep clean houses 

and reported leaving a friend’s home due to bug bites. (Tr. 1409.) 

 These treatment notes do not support the ALJ’s conclusion that Plaintiff gave 

contradictory statements amount being socially isolated. These treatment notes do not 

state that Plaintiff reported “social isolation,” and during these counseling sessions 

Plaintiff reported limitations in social functioning that were consistent with the behavior 

she reported. Accordingly, the record does not support the ALJ’s determination that 

Plaintiff gave contradictory statements about being socially isolated. 

 3. Non-Compliance with Treatment and Poor Effort 

 The ALJ next found that Plaintiff was noncompliant with treatment. (Tr. 22.) An 

“individual’s statements may be less credible if . . . the medical reports or records show 

that the individual is not following the treatment as prescribed and there are no good 

reasons for this failure.” SSR 96-7p, 1996 WL 374186, at *7. 

 The ALJ noted that Plaintiff did not comply with her home exercise program and 

that she canceled or failed to attend behavioral health counseling appointments. (Tr. 22-

23.) Substantial evidence in the record supports this determination. (Tr. 1268, 1394, 

1395-99, 1401-02, 1410, 1412, 1425-26, 1430, 1432.) Plaintiff asserts that she stopped 

attending counseling appointments because she thought there were bed bugs at the clinic. 

(Doc. 14 at 19, Tr. 1395, 1398.) However, she also attributed the bug bites to a friend’s 

home. (Tr. 1409.) 

 In addition to reflecting that Plaintiff had poor attendance at behavioral health 

appointments, the record reflects that Plaintiff had poor compliance with physical 

therapy. (Tr. 22, 580, 575, 1288.) The ALJ also discounted Plaintiff’s credibility 

because she gave a poor effort on WAIS-IV tests during two consultative examinations 

and made errors that were so atypical the examining physician thought Plaintiff’s effort 

was intentionally poor. (Tr. 22 (citing Admin. Hrg. Ex. 18F at 3).) Plaintiff argues that 

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she suffers from anxiety and depression, suggesting that those issues excused her poor 

performance on the intelligence tests. (Doc. 14 at 19.) However, as the ALJ noted, 

Dr. Rabara and Dr. Weyer believed her poor efforts were intentional. (Tr. 22, 660-61, 

1088-89.) 

 Plaintiff’s poor compliance with treatment and medical testing is a clear and 

convincing reason to support the ALJ’s adverse credibility determination and that reason 

is supported by substantial evidence in the record. See Lingenfelter v. Astrue, 504 F.3d 

1028, 1040 (9th Cir. 2007) (whether the claimant failed to follow, without adequate 

explanation, a prescribed course of treatment may be considered in assessing claimant’s 

credibility). 

 Although the Court does not accept all of the ALJ’s reasons in support of his 

adverse credibility determination, the ALJ provided sufficient legally sufficient reasons 

that are supported by substantial evidence in support of his credibility determination and, 

therefore, the Court affirms that determination. See Batson, 359 F.3d at 1197 (stating that 

the court may affirm an ALJ’s overall credibility conclusion even when not all of the 

ALJ’s reasons are upheld); Tonapetyan v. Halter, 242 F.3d 1144, 1148 (9th Cir. 2001) 

(stating that “[e]ven if we discount some of the ALJ’s observations of [the claimant’s] 

inconsistent statements and behavior . . . we are still left with substantial evidence to 

support the ALJ’s credibility determination.”). 

C. Plaintiff’s Impairments do not Meet Listing 12.05C

 Plaintiff argues that the ALJ erred at step three of the sequential evaluation 

process by finding that her impairments did not meet the criteria of Listing 12.05C. 

(Doc. 14 at 13.) As discussed below, the Court concludes that the ALJ did not err at step 

three. 

 Conditions contained in the Listing of Impairments (Listings) are considered so 

severe that “they are irrebuttably presumed disabling, without any specific finding as to 

the claimant’s ability to perform his past relevant work or any other jobs.” Lester, 81 

F.3d at 828. The Listings were “designed to operate as a presumption of disability that 

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makes further inquiry unnecessary.” Sullivan v. Zebley, 493 U.S. 521, 532 (1990). If a 

claimant shows that her impairment or combination of impairments meets or equals a 

Listing, she will be found presumptively disabled. 20 C.F.R. §§ 416.925-416.926. 

 Plaintiff contends that the evidence establishes that her IQ between 60 and 70 in 

combination with her other impairments meets Listing 12.05C, and thus the ALJ erred at 

step three. (Doc. 14 at 13.) The Commissioner disputes this assertion (Doc. 16 at 15), 

and Plaintiff’s reply does not address the Commissioner’s arguments on this issue. 

(Doc. 17.) To be considered disabled under Listing 12.05C, Plaintiff must show the 

following: 

12.05 Intellectual Disability: Intellectual disability refers to significantly subaverage general intellectual functioning with deficits in adaptive functioning initially manifested during the developmental period; i.e., the evidence demonstrates or 

supports onset of the impairments before age 22. 

The required level of severity for this disorder is met when 

the requirements in A, B, C, or D are satisfied. 

* * * 

C. A valid verbal, performance, or full scale IQ of 60 through 70 and a physical or other mental impairment imposing an additional and significant work-related limitation of 

function[.] 

20 C.F.R. Part 404, Subpt. P, App. 1 § 12.05.C. 

 The introductory paragraph of Listing 12.05 defines intellectual disability as 

“significantly subaverage general intellectual functioning with deficits in adaptive 

functioning” beginning before the age of twenty two. Id. § 12.05. This diagnostic 

description is separate from the specific criteria measuring the severity of the mental 

impairment. See 20 C.F.R. § 416.925(c)(3) (“We will find that your impairment(s) meets 

the requirements of a listing when it satisfies all of the criteria of that listing, including 

any relevant criteria in the introduction, and meets the duration requirement . . . .”). The 

relevant severity prong requires a “valid verbal, performance, or full scale IQ of 60 

through 70 and a physical or other mental impairment imposing an additional and 

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significant work-related limitation of function.” 20 C.F.R. pt. 404, subpt. P, app. 1, 

§ 12.05(C). 

 Therefore, to meet the requirements of Listing 12.05C, a claimant must (1) satisfy 

the diagnostic description of intellectual disability, (2) meet the temporal requirement, 

(3) have a valid verbal, performance, or full scale IQ of 60 through 70, and (4) have a 

physical or mental impairment that imposes an additional and significant work-related 

limitation of function. See Randall v. Astrue, 570 F.3d 651, 659-60 (5th Cir. 2009) 

(construing Listing 12.05 as requiring claimants to satisfy the diagnostic description’s 

substantive requirements independently of the severity criteria); Brooks v. Barnhart, 167 

Fed. App’x 598, 600 (9th Cir. 2006) (finding IQ scores were likely invalid but noting that 

“[i]n any event, the scores, alone, are insufficient to establish a severe impairment” and 

record did not show significantly subaverage intellectual functioning). 

 The ALJ determined that Plaintiff did not satisfy the criteria of Listing 12.05C, in 

part, because her recent IQ scores were invalid. (Tr. at 20.) An ALJ has the authority to 

determine whether an IQ score is valid. See Thresher v. Astrue, 283 Fed. App’x 473, 475 

(9th Cir. 2008) (stating that “an ALJ can decide that an IQ score is invalid.”). To support 

his conclusion that Plaintiff’s IQ scores were invalid, the ALJ noted that although 

Plaintiff had full scale IQ scores of 63 and 65 on WAIS-IV tests, the consultative 

examining psychologists’ reports indicate that those results likely underestimated 

Plaintiff’s abilities due to her poor effort during testing. (Tr. 20.) “[S]ince the results of 

intelligence tests are only part of the overall assessment, the narrative report that 

accompanies the test results should comment on whether the IQ scores are considered 

valid and consistent with the developmental history and the degree of functional 

limitation.” 20 C.F.R. pt. 404, subpt. P, app. 1, § 12.00(D)(6)(a). 

 Dr. Rabara stated that Plaintiff’s scores on the WAIS-IV intelligence test were 

provided “only for reference” because their “validity is uncertain secondary to 

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questionable effort.”7 (Tr. 660.) Dr. Rabara estimated that Plaintiff had borderline to low 

average cognitive skills, but “her current scores were much worse and some highly 

atypical errors on a screening measure of effort make her overall effort very 

questionable.” (Tr. 661.) Dr. Rabara referred to one error as “very atypical and 

suggestive of intentionally poor effort.” (Tr. 660.) 

 Similarly, state agency consultant Dr. Weyer examined Plaintiff and stated that 

although she “earned an IQ of 65,” she was “observed to give up easily on more difficult 

tasks and provide very quick responses at this point.” (Tr. 1088.) Dr. Weyer found that 

Plaintiff’s score “may reflect lack of optimal effort and therefore is likely an 

underestimation of her actual abilities.” (Id.) Dr. Weyer concluded that while Plaintiff 

seemed to have some level of cognitive impairment, her scores were “difficult to interpret 

due to a perceived lack of effort during testing.”8

 (Tr. 1089.) 

 Dr. Rabara’s and Dr. Weyer’s opinions are substantial evidence in support of the 

ALJ’s conclusion that Plaintiff did not have valid full scale IQ scores of 60 through 70, 

and thus did not meet the severity prong which requires a “valid verbal, performance, or 

full scale IQ of 60 through 70 and a physical or other mental impairment imposing an 

additional and significant work-related limitation of function.” 20 C.F.R. pt. 404, subpt. 

P, app. 1, § 12.05(C). Even if Plaintiff had valid full scale IQ scores of 60 through 70, 

the ALJ properly determined that Plaintiff did not satisfy Listing 12.05C because, as the 

ALJ noted, she was thirty-nine at the alleged disability onset date, and there is no 

evidence that intellectual disability was a severe impairment before Petitioner reached 

 

7

 The ALJ gave significant weight to Dr. Rabara’s opinion. (Tr. 25.) Plaintiff does not challenge the ALJ’s assessment of this opinion or the opinion itself. (Doc. 14 at 13-15). 

8

 In the body of her report, Dr. Weyer states that “[c]urrent testing is considered to be an accurate indicator of claimant’s current level of functioning.” (Tr. 1088.) However, she concludes that “[o]n intelligence testing, claimant’s effort was 

questionable. Her IQ on the CTONI-2 fell in the extremely low range. On the MMSE, she scored 20/30, demonstrating some degree of cognitive impairment. However, these scores are difficult to interpret due to claimant’s perceived lack of effort during testing.” (Tr. 1089.) Considering Dr. Weyer’s conclusion that Plaintiff’s lack of effort made her 

test scores difficult to interpret, the ALJ did not err in concluding that the intelligence test scores that Dr. Weyer reported were not valid full scale IQ scores. 

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age twenty two. (Tr. 20); see 20 C.F.R. pt. 404, subpt. P, app. 1, Listing 12.05.9 The 

record reflects that Plaintiff did not have a history of special education classes, she earned 

a GED, and she completed some community college courses. (Tr. 45, 257-58, 658, 

1086.) She also worked as a custodian, warehouse worker, and maintenance worker for a 

number of years and reported that her job duties included ordering parts, maintaining 

inventory, and using a computer. (Tr. 47, 58-59, 249-50, 257-58, 301-08, 338-45, 658.) 

As Dr. Rabara noted, Plaintiff’s test scores seemed “much lower than what her reported 

education and work history suggest.” (Tr. 661.) 

 In conclusion, the ALJ did not err in finding that Plaintiff did not satisfy the 

criteria of Listing 12.05C and substantial evidence supports his determination that 

Plaintiff did not have any adaptive functioning deficits before age twenty two and that 

she did not have a valid full scale IQ score between 60 and 70. Accordingly, the ALJ did 

not err at step three of the sequential evaluation process. 

D. The ALJ’s Assessment oF Plaintiff’s RFC 

 1. Limitations identified in Dr. Weyer’s Opinion 

 In 2012, Dr. Weyer completed a medical source statement. (Tr. 1090.) She 

opined that Plaintiff was mildly limited in some areas of understanding, memory, and 

adaption. (Id.) In areas of sustained concentration and persistence, Dr. Weyer opined 

that Plaintiff “may perform better when she is receiving supervision, including 

explanation of tasks, extra time to complete tasks, and redirection as needed.” (Id.) She 

also found that Plaintiff “may present with moderate difficulties on tasks requiring an 

ability to complete a normal workday or workweek without interruption from 

psychologically based symptoms.” (Id.) The ALJ assigned this opinion “significant 

weight.” (Tr. 24 (citing Admin. Hrg. Ex. 31F).) He specifically noted that Dr. Weyer 

opined that Plaintiff would have “moderate difficulties in sustained concentration and 

 

9

 Plaintiff’s discussion of Listing 12.05C does not address the temporal requirement contained in the introductory paragraph of Listing 12.05, which defines 

intellectual disability as “significantly subaverage general intellectual functioning with deficits in adaptive functioning” beginning before the age of twenty two. (Doc. 14 at 13- 15); see 20 C.F.R. Part 404, Subpt. P, App. 1 § 12.05. 

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persistence.” (Tr. 24.) He did not specifically reject any portion of Dr Weyer’s opinion. 

(Id.) 

 Plaintiff argues that although the ALJ assigned significant weight to Dr. Weyer’s 

opinions, the ALJ failed to include in the RFC Dr. Weyer’s specific opinions that 

Plaintiff had moderate limitations of concentration and persistence (moderate difficulties 

completing tasks requiring an ability to complete a normal workday and workweek), and 

her opinion that Plaintiff would perform best with extra time to complete tasks. (Doc. 14 

at 16.) Thus, Plaintiff argues that the ALJ erred in formulating the RFC.10 (Id.) 

 The Commissioner responds that Dr. Weyer’s opinions were equivocal because 

she used the word “may” before describing Plaintiff’s limitations. (Doc. 16 at 18.) The 

ALJ gave Dr. Weyer’s opinion significant weight and did not find her opinions 

equivocal. (Tr. 24.) Accordingly, the Court does not address the Commissioner’s 

suggestion that Dr. Weyer’s opinions should be discounted because they were equivocal. 

See Bray v. Comm’r Soc. Sec. Admin., 554 F.3d 1219, 1225-26 (9th Cir. 2009) (The 

court’s review is limited to “reasons and factual findings offered by the ALJ — not post 

hoc rationalizations that attempt to intuit what the adjudicator may have been thinking.”). 

 Here, the ALJ specifically accepted Dr. Weyer’s opinions that Plaintiff had 

“moderate difficulties in sustained concentration and persistence.” (Tr. 24.) Although 

the ALJ did not specifically mention Dr. Weyer’s opinion that Plaintiff needed extra time 

to complete tasks, she assigned Dr. Weyer’s opinion “significant weight” and did not 

reject any portion of her opinion. (Id.) However, the RFC only limited Plaintiff to jobs 

where “interpersonal contact is incidental to work performed; complexity of tasks is 

learned and performed by rote, with few variables, and little judgment; and supervision is 

simple, direct, and concrete.” (Tr. 21.) The Court agrees with Plaintiff that this RFC did 

 

10 Plaintiff also argues that the ALJ erred by assessing an RFC that did not include Dr. Weyer’s opinion that Plaintiff would perform better when receiving supervision and redirection. (Doc. 14 at 16.) The ALJ’s RFC assessment accounted for these limitations 

by limiting Plaintiff to work where the “complexity of tasks is learned and performed by rote, with few variables, and little judgment, and supervision is simple, direct, and concrete.” (Tr. 21.) 

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not account for moderate limitations in concentration and persistence or the need for 

extra time to complete tasks. 

 In a similar case, Brink v. Comm’r. of Soc. Sec. Admin., 343 Fed. App’x 211, 212 

(9th Cir. 2009), the ALJ accepted evidence that the claimant had moderate difficulty with 

concentration, persistence, or pace, but posed hypothetical questions to the vocational 

expert based on an RFC that “referenced only ‘simple, repetitive work,’ without 

including limitations on concentration, persistence, and pace.” The Ninth Circuit found 

that the ALJ erred and remanded the case so the ALJ could clarify his hypothetical and 

determine whether the claimant could perform gainful employment in the national 

economy. Id. at 212-13. See also Bentancourt v. Astrue, 2010 WL 4916604, at *3-4 

(C.D. Cal. Nov. 27, 2010) (when the ALJ accepted medical evidence of the plaintiff’s 

limitations in maintaining concentration, persistence, or pace, a hypothetical question to 

the vocational expert including the plaintiff’s restriction to “simple, repetitive work,” but 

excluding the plaintiff’s difficulties with concentration, persistence, or pace resulted in a 

vocational expert’s conclusion that was “based on an incomplete hypothetical question 

and unsupported by substantial evidence.”); Melton v. Astrue, 2010 WL 3853195, at *8 

(D. Or. 2010), aff’d., 442 Fed. App’x 339 (9th Cir. 2011) (the ALJ erred in her 

assessment of the plaintiff’s RFC when the assessment included the plaintiff’s restriction 

to simple, repetitive tasks, but did not include the plaintiff’s mild-to-moderate limitations 

in maintaining concentration, persistence, or pace). 

 Here, as in Brink, the ALJ accepted Dr. Weyer’s opinions that Plaintiff had 

moderate limitations in concentration and persistence and that she needed extra time to 

complete tasks.11 (Tr. 24.) However, the ALJ did not include these limitations in the 

RFC. (Compare Tr. 21 with Tr. 1090.) Accordingly, the ALJ erred in formulating the 

RFC. That error was not harmless because the vocational expert’s testimony ─ upon 

 

11 Dr. Weyer specifically opined that Plaintiff “may present with moderate difficulties on tasks requiring an ability to complete a normal workday or workweek without interruption from psychologically based symptoms.” (Tr. 1090.) The ALJ apparently summarized Dr. Weyer’s opinion as finding that Plaintiff had “moderate difficulties in sustained concentration and persistence.” (Tr. 24.) 

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which the ALJ relied to determine that Plaintiff could not perform her past relevant work, 

but could perform other work that existed in significant number in the national economy 

(Tr. 25-27, 70-71) ─ was based on a hypothetical question that described an RFC that did 

not include all of the limitations that Dr. Weyer identified in her opinion and which the 

ALJ assigned significant weight.12 See Stout v. Comm’r of Soc. Sec., 454 F.3d 1050, 

1055 (9th Cir. 2006) (an ALJ’s error is harmless when it is “irrelevant to the ALJ's 

ultimate disability conclusion.”); Andrews v. Shalala, 53 F.3d 1035, 1044 (9th Cir. 1995) 

(for the vocational expert’s testimony to constitute substantial evidence, the hypothetical 

question posed must “consider all of the claimant’s limitations”). As discussed in Section 

VII below, the Court remands this matter for further proceedings to address this error. 

 2. Limitations in Dr. Daugherty’s Narrative of her Opinion 

 Plaintiff also argues that the ALJ erred by assessing an RFC that did not include 

the moderate limitations identified in Dr. Daugherty’s January 16, 2013 opinion. 

(Doc. 14 at 17.) In 2013, Dr. Daugherty completed a Mental RFC Assessment form. 

(Tr. 1098-1101.) Section I of the RFC assessment is entitled Summary Conclusions. 

(Tr. 1098-1100.) Dr. Daugherty marked “X” next to statements included in Section I 

(Section I of the worksheet) to indicate that Plaintiff was moderately limited in her 

abilities to carry out detailed instructions, maintain attention and concentration for 

extended periods, sustain an ordinary routine without special supervision, complete a 

normal workday or workweek without interruption from psychologically-based 

symptoms, perform at a consistent pace without an unreasonable number and length of 

rest periods, to accept instruction and respond appropriately to criticism, respond 

 

12 The ALJ asked the vocational expert to assume an individual of Plaintiff’s “age, education, and work experience who is able to perform work at the light exertional level,” and where “interpersonal contact is incidental to work performed, complexity of tasks is 

learned and performed by rote with few variables and little judgment required. Supervision is simple, direct, and concrete.” (Tr. 70.) The vocational expert testified that a person with those limitations could not perform Plaintiff’s past relevant work, but could 

perform other work that existed in significant number in the national economy. (Tr. 70- 71.) 

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appropriately to changes in the work setting, and the ability to set realistic goals or make 

plans independently of others.13 (Id.) 

 Section III of the RFC form is entitled Functional Capacity Assessment. 

(Tr. 1100.) In Section III, Dr. Daugherty summarized the limitations she noted in Section 

I into her opinion that Plaintiff “is able to perform work where interpersonal contact is 

incidental to work performed, e.g. assembly work: complexity of the tasks is learned and 

performed by rote, few variables, little judgment; supervision required is simple, direct 

and concrete (unskilled).” (Id.) The ALJ’s RFC includes this specific summary of 

Plaintiff’s limitations. (Compare Tr. 20-21 with Tr. 1100-01.) 

Plaintiff argues that Dr. Daugherty’s Section III summary of Plaintiff’s limitations 

is inconsistent with the specific limitations she marked on Section I of the RFC form. 

(Doc. 14 at 16-17.) Plaintiff finds it “strange[]” that Dr. Daugherty’s narrative has “less 

severe limitations” than the worksheet she completed. (Doc. 14 at 16-17 (citing 

Tr. 1100-01).) Plaintiff appears to argue that the ALJ erred by failing to include in the 

RFC the specific limitations that Dr. Daugherty noted in Section I of the RFC assessment 

form. (Doc. 14 at 17.) 

 The Court finds that the ALJ sufficiently accounted for the limitations 

Dr. Daugherty identified by incorporating Dr. Daugherty’s summary of those limitations 

into Plaintiff’s RFC. (Tr. 20-21.) As the Commissioner notes (Doc. 16 at 18), the 

Agency’s Program Operations Manual System (POMS) directs the ALJ to focus on the 

narrative portion of the mental RFC assessment form that is contained in Section III of 

the form, rather than the worksheet included in Section I. POMS DI 25020.010 at B.1.14 

The POMS explains that the purpose of Section I “is chiefly to have a worksheet to 

ensure that the [examining doctor] considered each of these pertinent mental activities 

 

13 Rather than marking the worksheet that appeared in the Summary Conclusions section of the RFC form (Section I) on the same pages on which the worksheet appeared, Dr. Daugherty apparently reproduced that content from the RFC form and included it on 

a different page of the form. (Tr. 1098-100.) 

14 https://secure.ssa.gov/aaps10/poms.nsf (last visited Apr. 1, 2015). 

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and the claimant’s . . . limitation for sustaining these activities over a normal workday 

and workweek on an ongoing, appropriate, and independent basis.” POMS DI 25020.010 

at B.1. The POMS specifies, “[i]t is the narrative written by the psychiatrist or 

psychologist in section III (“Functional Capacity Assessment”) . . . that adjudicators 

are to use as the assessment of RFC”. Id. The POMS also specifies that 

“[a]djudicators must take the RFC assessment in section III and decide what significance 

the elements discussed in this RFC assessment have in terms of the person’s ability to 

meet the mental demands of past work or other work.” Id. 

 The record reflects that the ALJ complied with the POMS and properly accounted 

for Dr. Daugherty’s opinion in his assessment of Plaintiff’s RFC. (Compare Tr. 1100-10 

with Tr. 20-21.) The RFC that the ALJ assessed included Dr. Daugherty’s entire 

summary of Plaintiff’s mental limitations. (Id.) Thus, the ALJ did not err with regards to 

Dr. Daugherty’s opinion. 

VII. Remand for Further Proceedings

 As set forth in Section VI.D.1 above, the ALJ erred by adopting Dr. Weyer’s 

assessment that Plaintiff had moderate limitations of concentration and persistence and 

the need for extra time to complete tasks, but not including those limitations in Plaintiff’s 

RFC. Accordingly, the Court remands to the ALJ because additional proceedings are 

necessary to allow the ALJ to include these limitations in the RFC and to pose an 

accurate hypothetical question to the vocational expert to properly assess whether 

Plaintiff is able to perform work that exists in the national economy and whether she is 

disabled under the Act.15 

 Therefore, the Court reverses and remands this matter to the ALJ for the further 

proceedings in accordance with this Order. See Garrison v. Colvin, 759 F.3d 995, 1020 

n.26 (9th Cir. 2014) (noting that remand for further proceedings is appropriate when there 

are outstanding issues that must be resolved before a determination of disability can be 

 

15 During the administrative hearing, neither the ALJ nor Plaintiff’s counsel posed a hypothetical question to the ALJ that included all of the limitations that Dr. Weyer identified. (Tr. 69-74.) 

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made); Harman v. Apfel, 211 F.3d 1172, 1173-74 (9th Cir. 2000) (stating that the 

decision to remand for further development of the record or for an award of benefits is 

discretionary, and remand is appropriate when there are outstanding issues to be resolved 

before a disability determination can be made). 

 Accordingly, 

IT IS ORDERED that the Commissioner’s disability determination is reversed 

and this matter is remanded for further proceedings consistent with the Order. 

IT IS FURTHER ORDERED that the Clerk of Court shall enter judgment in 

favor of Plaintiff and terminate this matter. 

 Dated this 1st day of April, 2015. 

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