Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-4_08-cv-00674/USCOURTS-azd-4_08-cv-00674-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:1383 Review of HHS Decision

---

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Bryan Crumly, 

 Plaintiff, 

vs.

Michael J. Astrue, Commissioner of 

Social Security, 

 Defendant. 

)

)

)

)

)

)

)

)

)

)

)

No. CV-08-674-TUC-RCC-CRP

REPORT AND RECOMMENDATION

Plaintiff brought this action pursuant to 42 U.S.C. § 405(g), seeking judicial review of

a final decision by the Commissioner of Social Security (“Commissioner”). The

Commissioner denied Plaintiff’s application for Supplemental Security Income (“SSI”) under

Title XVI of the Social Security Act. 42 U.S.C. §§ 1382. Plaintiff requests this Court remand

without a hearing for an award of benefits or, in the alternative, remand for further

administrative proceedings. (Doc 10). Plaintiff alleges: (1) the Administrative Law Judge

(“ALJ”) erred in failing to evaluate treating physician Dr. Barnett’s opinion about Plaintiff’s

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 1 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 2 -

sensitivity to loud noises or general opinion that Plaintiff is chronically disabled; (2) the ALJ

erred in giving little credit to the lay witness testimony of Plaintiff’s mother; (3) the ALJ

erred in failing to evaluate Plaintiff’s sensitivity to light; (4) the ALJ erred in evaluating the

absence of treatment for organic brain damage; and (5) the ALJ erred in evaluating Plaintiff’s

activities. (Doc 10). The Commissioner contests Plaintiff’s allegations. (Doc 11). Plaintiff

replied to the Commissioner’s response. (Doc 12). Based on the pleadings of the parties and

the administrative record submitted to the Court, the Magistrate Judge recommends that the

District Court, after its independent review, GRANT Plaintiff’s Motion for Summary

Judgment and REMAND this case to resolve the errors. (Doc 10).

I. FACTUAL AND PROCEDURAL HISTORY

On May 31, 2005, Plaintiff applied for supplemental security income (“SSI”) alleging

disability beginning May 1, 2005. (Administrative Record (“AR”) 55). The claim was

denied initially on July 12, 2005 (based on insufficiency of evidence), and upon

reconsideration on April 20, 2006. (AR 65, 72). Plaintiff then requested an administrative

hearing which was held on March 21, 2007. (AR 85; Transcript at AR 9-48). After the ALJ

denied Plaintiff’s application for disability, Plaintiff appealed the decision. The Appeals

Council denied Plaintiff’s request for review on October 30, 2008 (AR 1) and Plaintiff

subsequently filed the pending federal action. (Doc 1).

Plaintiff was born on December 30, 1972, making him 32 years old when he filed his

application for SSI and 34 years old when the ALJ issued his decision. (AR 15, 64, 99).

Plaintiff finished high school with generally low grades (AR 181-187) and two years of

junior college without receiving a diploma. (AR 16). Plaintiff worked in various manual

labor jobs, including as a fast food worker and construction laborer. (AR 118-119, 148-152).

Earnings records show Plaintiff has never earned more than $5300.00 annually. (AR 110).

In his most recent earnings, Plaintiff earned $1984.78 in 1995; in 1996, he earned $3913.00;

and in 1997, he earned $895.63. (AR 110). Plaintiff has not earned income in over a decade.

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 2 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 3 -

(AR 110). His earnings records show no income since 1997. (AR 110). The ALJ found

Plaintiff had no past relevant work based on his lack of earnings. (AR 63).

A. Plaintiff’s Headaches

The record shows Plaintiff’s alleged disability derives most significantly from chronic

headaches. At step two in the social security disability framework, the ALJ found Plaintiff

suffered from severe impairments of headaches; organic brain damage; and substance abuse

disorder. (AR 57). Plaintiff contends the headaches are the result of multiple head traumas.

Plaintiff’s treating physician, Dr. Brad Barnett, and Plaintiff’s neurologist, Dr. David

Lippincott, both found Plaintiff suffered from chronic headaches associated with closed head

injury/head trauma which resulted in organic brain syndrome. (AR 333, 314). Plaintiff

reported to examining psychologist Jill Caffrey, Ph.D. and testified at the administrative

hearing about four separate incidents in which he suffered injuries to his head including

incidents in 1987, 1993, 1994, and 1999. (AR 280, 24-25). The record contains documents

relevant to three of those four alleged incidents, with no record for the alleged injury in 1994.

(AR199; 243; 320-325).

Plaintiff and his mother allege physical abuse by Plaintiff’s father when Plaintiff was

a child. In a modification of custody order from an Iowa state court in 1987, the judge found

Plaintiff’s father physically struck Plaintiff on the head on at least two occasions after

Plaintiff broke school rules. (AR 190). The Court modified the custody arrangement, giving

custody to Plaintiff’s mother, in part, because of the allegations of physical abuse. (AR 199,

202). At the administrative hearing, Plaintiff testified that his father’s physical abuse resulted

in neurological trauma and that he went to the hospital. (AR 24). The custody modification

order does not address whether Plaintiff needed medical treatment.

In September 1993, Plaintiff self-reported that he was hit on the head with a hammer.

(AR 243). Doctors described a “contused scalp and small laceration.” (AR 243). Plaintiff

was “alert and oriented” with normal cranial and cerebellar functions. (AR 243). The cut

on Plaintiff’s head was a four inch wound that was closed with staples behind his ear. (AR

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 3 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

1

 At the administrative hearing, Plaintiff also alleged another incident in which he had 150

to 180 staples placed in his head. (AR 24). There is no evidence in the record of this

incident.

- 4 -

242). A Brain CT scan revealed no brain injury - the findings were “routine brain CT

performed without contrast” and impression was “left scalp soft tissue swelling but no

intracranial hemorrhage or fracture.” (AR 253). At the evidentiary hearing, Plaintiff testified

that he needed 160 to 180 staples in the back of his head as a result of the injury. (AR 24).

It is unclear from the record how many staples were needed to close the four inch wound on

Plaintiff’s scalp described by doctors as a small laceration. The record does state that the

staples were removed from behind Plaintiff’s left ear, with minimal bleeding and without

difficulty. (AR 242).1

In November 1999, Tucson fire department records show that Plaintiff was involved

in an assault. (AR 311-312). At the emergency department, doctors diagnosed him with a

broken finger and laceration on his elbow. (AR 320). Plaintiff tested negative for any signs

of head trauma; although, Plaintiff did suffer superficial lacerations to his scalp. (AR 320-

321). Plaintiff initially stated that he was assaulted with a “mag light” but later said it may

have been a glass bottle. (AR 320, 324- 325).

Medical records show Plaintiff has sought treatment for chronic headaches and that

medical professionals observed characteristics common to organic brain damage and the

associated chronic headaches. Plaintiff’s examining doctor, Denny Peck, Ph.D., described

Plaintiff as behaving “like a recalcitrant, inappropriate, immature child with adolescent

authority problems.” (AR 354). Dr. Peck found Plaintiff’s behavior “definitive because this

behavior is routinely seen with closed head traumas and while distressing for people who

have to interact with [Plaintiff] is ‘normal’ brain damage behavior.” (AR 354). In treatment

notes, Plaintiff’s treating physician observed similar behavior and found Plaintiff

“functioning at perhaps a teenage level”; described Plaintiff, in another visit, as “of

borderline intelligence”; and, in another visit as “acts rather young for his age.” (AR 334,

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 4 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 5 -

333). The record also shows Plaintiff missed appointments to repack peri-rectal abscesses

and lost the prescription for antibiotics. (AR 332). Plaintiff also failed to initially set up an

appointment with the neurologist to whom his treating physician referred him and missed

numerous appointments with his chiropractor. (AR 334, 309). 

Plaintiff has consistently complained of chronic headaches. At the administrative

hearing, Plaintiff told the ALJ that he has headaches every day but that the severity changes.

(AR 22). In an undated Headache Questionnaire, Plaintiff stated he had headaches on a daily

basis but that the headaches vary in intensity. (AR 172). Plaintiff began seeing his treating

physician in January 1999 for complaints of chronic headaches. (AR 334). Neurologist Dr.

Lippincott noted in March 1999 that Plaintiff “continues to have headaches on a daily basis.”

(AR 313). In December 1999, Plaintiff complained to treating physician Dr. Barnett of

headaches twice a week. (AR 333). Later, in August 2002, Plaintiff saw Dr. Barnett

complaining of intermittent headaches that “have been flaring up recently.” (AR 264). The

treatment notes show Plaintiff saw Dr. Barnett in October and December of 2002 and July

2005 complaining of chronic headaches. (AR 263, 262).

Plaintiff provided evidence that different environmental factors can induce and/or

aggravate his headaches. Plaintiff told the ALJ that stress; bright lights and noises make his

headaches worse. (AR 22). Plaintiff testified that bright light like sunlight triggers his

headaches. (AR 25). When asked by his attorney whether the lights at the hearing bothered

him, Plaintiff said “[y]es, fluorescent usually bothers me, unless it’s really soft.” (AR 25).

Plaintiff stated that he uses dark (black out) curtains to block out the light in his home. (AR

25). Plaintiff further testified that loud noises, screeching, whining, and babies crying give

him headaches. (AR 26). In an undated Adult Disability Report, Plaintiff stated that bright

lights and stress intensify headaches. (AR 117). He also testified that he has temper and

memory problems as well as a constant ringing in his ears. (AR 26-27, 28). 

Plaintiff’s mother also described light and noise as triggers to Plaintiff’s headaches.

(AR 129). At the evidentiary hearing, Plaintiff’s mother stated that Plaintiff keeps his home

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 5 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

2

Butalbital is prescribed as a packaged drug containing caffeine and acetaminophen or aspirin

and sometimes, codeine. See The American Society of Health-System Pharmacists, Inc.,

United States National Library of Medicine, Medline Plus,

http:www.nlm.nih.gov/medlineplus/druginfo/meds/a601009.html, (Last Reviewed September

1, 2008). A copy of this web page is attached to this report and recommendation. The record

does not clarify which form of the medication Plaintiff takes.

- 6 -

dark and prefers only 40 watt light bulbs. (AR 35). She testified that she “painted all the

walls like a dark brown for him to keep it so it wasn’t so bright for him. And then I got him

the blackout curtains. He hardly turns on his lights.” (AR 35). 

To treat his chronic headaches, Plaintiff takes some form of the medication butalbital.2

In his first visit with his treating physician in January 1999, Plaintiff reported that he took

butalbital in the past for his headaches. (AR 334). Plaintiff reported to neurologist Dr.

Lippincott, in March 1999, that he takes butalbital for his headaches frequently, but not more

than six to eight times per week. (AR 313). In his treatment notes, treating physician Dr.

Barnett, consistently remarked that Plaintiff takes butalbital for his headaches. (AR 333-334,

262-264). Plaintiff told Dr. Barnett that his headaches improve “as long as [I] take[]

Butalbital and Elavil as prescribed.” (AR 333). Plaintiff reported to Dr. Barnett in July 2005

that he continued to use Butalbital for his headaches. (AR 262).

Based on the evidence in the record, Plaintiff does have significant side effects from

the medication butalbital. One of Plaintiff’s ongoing side effects from the medication is

irregular sleeping patterns. At the administrative hearing, Plaintiff described an occasion on

which he took the medication at 11:00 p.m. and did not wake up until 1:00 p.m or 3:00 p.m.

the following day. (AR 26). In the undated Adult Function Report, Plaintiff reported

“sometimes I sleep for 12 - 20 hours straight[;] sometimes I can’t sleep for 36+ hours[;] meds

affect my sleep cycles” (AR 133). In the December 2005 Function Report, Plaintiff

described it as “my sleeping pattern is irratic [sic] sometimes I’ve been known to sleep 15-20

hours when under meds.” (AR 155). Responding to a question about whether Plaintiff’s

condition affects his ability to sleep, Plaintiff’s mother stated “[h]e sleeps up to 24hrs straight

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 6 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 7 -

or can’t sleep at all.” (AR 125). In the headache evaluation form, Plaintiff claimed that he

has no warnings of the oncoming headaches and that they cause irregular sleeping patterns

and nausea. (AR 172).

Plaintiff’s ability to drive and overall ability to function on his own is also dependent

on whether he takes butalbital. Plaintiff stated that his ability to drive, ability to follow

directions and interact with people depends on whether he is on the medication. (AR 137,

117). At the evidentiary hearing, Plaintiff testified that he cannot drive due to his

medications (AR 16). He testified that he put less than 500 miles on his car in the last two

years. (AR 21). Plaintiff did state he drives himself to doctor appointments and to the

grocery store when he does not have headaches. (AR 21). Plaintiff stated that he drives

himself, except when he is on the medication. (AR 135). When asked by the ALJ at the

administrative hearing if there was anything Plaintiff could take to alleviate his headaches,

Plaintiff said “[m]y medicine usually works, but it makes me pass out. I get nauseous

sometimes when I take it...” (AR 22).

When on the medication for his headaches, Plaintiff’s mother stated that Plaintiff is

forgetful, does not want to be around people and his temper flares. (AR 127, 129).

Plaintiff’s mother stated that Plaintiff needs assistance when his head hurts and he takes his

medicine. (AR 128). Plaintiff’s mother described the effect of his medication, “Bryan is

depress [sic] he wants to be left alone + [sic] doesn’t like to leave his house. He get angry

when his head hurts. When on medication he forgets things + [sic] can sleep 20 to 24 hours

straight.” (AR 131). When asked on the disability function report about how well Plaintiff

can follow written and spoken instructions, Plaintiff’s mother responded “not at all on

medicine.” (AR 129). 

The office manager for First Chiropractic where Plaintiff received treatments for over

ten years stated that Plaintiff would arrive for care and “his mental state would be groggy and

somewhat disoriented.” (AR 309). When office staff inquired into his grogginess, Plaintiff

would state he “had not slept well and had taken medication.” (AR 309). The office

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 7 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 8 -

manager further stated “[o]n some occasions he would be totally mentally clear and

conversant (on a couple of visits he had even picked up candy for the staff), but typically he

was groggy and sullen.” (AR 309).

Plaintiff’s daily activities are limited by his headaches. Plaintiff stated he played

Dungeons and Dragons every Friday unless his head hurts and he takes his medication. (AR

136). At the administrative hearing, the ALJ asked Plaintiff how often his mother came to

his house to see him and Plaintiff responded that it depended on his headaches. (AR 20-21).

He said “[d]epending on my – if I have a headache, how bad my headaches are, whether or

not I can drive. It varies.” (AR 21). The ALJ also asked Plaintiff if he drove and Plaintiff

testified that he drove “very little” but would drive to doctor’s appointments and get

groceries “when [his] head is okay.” (AR 21). Plaintiff stated that he feels antisocial and

tries to stay away from people when his head hurts. (AR 137). At the administrative

hearing, Plaintiff answered “yes” when the ALJ asked if he spent most of his time at home

by himself. (AR 20). Plaintiff’s mother testified to Plaintiff’s limited activities. She stated

“I try to get him to go out once a week, which I’m lucky if I get to get him out of the house

once a month.” (AR 32). Plaintiff’s mother further testified that she used to get him out of

the house once a month but that “[l]ately it’s been real hard to get him out. I’d say about

three months in between.” (AR 34). The ALJ did not ask Plaintiff how often Plaintiff has

headaches that are so severe that he must take medication and limit his activities.

Plaintiff’s daily activities when he does not have a severe headache requiring

medication are less limited. When asked about his daily activities during the administrative

hearing, Plaintiff stated that he read, played Dungeons and Dragons and computer games,

watched television and listened to the radio. (AR 18). When completing an Adult Function

Report in December 2005, Plaintiff described his daily routine as “[d]epends on the day[,]

usually wake up[,] shower[,] clean then eat. Once every 2 weeks I go grocery shopping.

Most day [sic] I watch tv or play video games or listen to the radio. I eat about 2 times a

day[,] sometimes 3[,] then I go to bed & do it all over again the next day.” (AR 154). In the

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 8 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 9 -

same Function Report, Plaintiff responded that he was able to watch tv, play video games and

listen to the radio everyday with “fairly good results”. (AR 158). He also described

sweeping, mopping and doing laundry indoors and weedwacking outdoors; he stated these

things take 1 -2 hours a day. (AR 156). In another undated Adult Function Report, Plaintiff

described his Sunday activities as “laundry all day and sweep [and] mop floors after

breakfast[;] watch tv, cook, read, play Nintendo/pc games & take medicine when head hurts.”

(AR 132). 

Plaintiff’s mother stated that Plaintiff’s daily activities include reading, cooking food,

watching television and doing a little house cleaning. (AR 124). Plaintiff’s mother stated

he only does activities like reading, watching television and computer games when his head

is not hurting. (AR 128). Plaintiff’s mother also stated that “depression makes [Plaintiff] not

take [a bath]” and not care for his personal hygiene. (AR 125). Also, “[d]epression makes

him want to be isolated ...” (AR 125). Plaintiff’s mother stated that Plaintiff goes out once

or twice a month. (AR 127). She also stated that she spends two to four hours a week with

Plaintiff - taking him to get groceries and going out to eat. (AR 124; 32). When his head

does not hurt, Plaintiff has game night once a week and he goes out to get his own groceries.

(AR 127-128). Plaintiff testified at the administrative hearing that his mother lives around

the block but that he does not go over to see his mother unless she needs him to do some

chore for her or she brings him groceries when he has headaches. (AR 20-21). When asked

if Plaintiff experienced changes in his social activities due to his conditions, Plaintiff’s

mother answered “yes[;] personal hygiene [sic], doesn’t want to leave his house + doesn’t

want to be around people.” (AR 129). 

B. Plaintiff’s Alcohol and Drug Use

Plaintiff’s reports regarding his alcohol and marijuana use are inconsistent in the

record. In an interview with Dr. Denny Peck, a psychologist hired by Plaintiff, Plaintiff

stated he drank only on holidays or birthdays and limited his intake to one beer. (AR 349).

At the administrative hearing, Plaintiff reported that he had not had a drink in six weeks or

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 9 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 10 -

six months. (AR 31). He explained to the ALJ that the last time he drank was when his

friends stopped by for the night and he had three or four beers. (AR 31). When asked when

the last time was that he had marijuana, Plaintiff said it was the same time as the beer, when

his friends came over. (AR 31). Earlier in the hearing, the ALJ asked Plaintiff if he was still

using marijuana; Plaintiff responded “[o]nly if someone offers it to me.” (AR 19). In the

treatment notes of his treating physician, Dr. Barnett noted moderate alcohol intake and

moderate marijuana use in July 2005. (AR 263). When examined by Dr. Jill Caffrey in

April 2006, Plaintiff told her that he last used drugs about 10 to 12 years ago. (AR 281). 

C. Treating Physician’s Notes and Opinions

Plaintiff’s treating physician, Dr. Bradley Barnett, has opined that Plaintiff is disabled.

Dr. Barnett treated Plaintiff with some consistency between January 1999 and July 2005.

There are gaps in the treatment records, with no treatment notes between January 2000 to

July 2002 and January 2003 to June 2005. The following is a summary of Dr. Barnett’s

treatment notes for Plaintiff: 

January 1999 - In the first visit, Plaintiff’s main complaint was chronic

headaches. (AR 334). Plaintiff’s mother wrote Dr. Barnett a letter explaining

that Plaintiff was almost beaten to death by his father. (AR 334). Plaintiff

presented to Dr. Barnett as alert and cooperative but functioning at a teenage

level. (AR 334). 

March 1999 - Dr. Barnett opined that Plaintiff is of borderline intelligence. 

(AR 334). Dr. Barnett noted that Plaintiff had missed two appointments and

failed to follow up with a neurologist to whom Dr. Barnett had referred him.

July 1999 - Plaintiff saw Dr. Barnett for follow up on his headaches. (AR

333). He reported that his headaches had improved as long as he takes

Butalbital and Elavil as prescribed. (AR 333). Dr. Barnett observed that

Plaintiff was alert and cooperative and the neurologic exam was normal. (AR

333). Dr. Barnett recommended continuing the same medication, discussed a

healthy lifestyle with Plaintiff and recommended regular exercise and weight

management. (AR 333).

December 1999 - While at the doctor’s office for another medical issue,

Plaintiff stated that he has headaches a couple times a week. (AR 333).

Plaintiff stated he did not feel any worse headaches, although he did suffer

from frequent headaches. (AR 333). Plaintiff denied dizziness, visual changes

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 10 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 11 -

or other neurological impairments. (AR 333). The impression of Plaintiff by

medical staff was that he “acts rather young for his age” (AR 333).

August 2002 - Plaintiff saw Dr. Barnett for a follow up on his headaches. (AR

264). Dr. Barnett stated that Plaintiff gets [headaches] intermittently but they

have been flaring up recently. Patient has a history of multiple closed head

injuries and uses butalbital for his headaches. Denies any vision change,

vomiting, weakness, numbness or other new changes in his neurologic status.

(AR 264). Plaintiff was again alert and cooperative and his neurologic exam

was normal. (AR 264). Dr. Barnett noted the chronic headaches and stated

weight gain may be part of worsening headaches. “He is followed by

neurology. I have asked him to reduce his salt and caffeine intake, keep a

diary of his headaches and come back in 6 weeks. He will call me sooner if

he has any new neurologic symptoms at all; or he can follow-up with his

neurologist.” Dr. Barnett also filled the butalbital prescription and opined that

some of headaches were migraines. (AR 264).

October 2002 - Plaintiff had appointment for chronic headaches. Dr. Barnett

noted history of multiple head injuries which result in the headaches. Dr.

Barnett filled out disability paperwork, opined that Plaintiff was chronically

disabled. (AR 263). Plaintiff presented as alert and cooperative. Dr. Barnett

noted that Plaintiff will try Inderal. (AR 263).

December 2002 - Dr. Barnett opines that Plaintiff has organic brain syndrome

(OBS) from multiple closed head injuries. (AR 263). He notes that Plaintiff

tried Inderal but could not tolerate it. (AR 263). “He continues to have fairly

frequent headaches.” (AR 263). Plaintiff presented as alert and cooperative

with a neurologic exam that was “[n]on focal and grossly norm”. (AR 263).

 For treatment, Dr. Barnett stated “[a]s far as the headaches, he will call if they

worsen, if he develops new neurologic [symptoms] or other complaints.” (AR

263).

July 2005 - Dr. Barnett notes that he had not seen Plaintiff in several years.

(AR 262). Plaintiff on butalbital. Plaintiff would like to be on anti-depressant.

Just feels lack of energy. Plaintiff reported smoking one to two packs of

cigarettes a day, moderate alcohol intake and moderate marijuana use. (AR

262). Plaintiff reported headaches/depression/anxiety. Dr. Barnett’s in office

neurologic exam is normal. (AR 262).

In October 2002 and then again, in October 2004, Dr. Barnett completed disability

paperwork, stating Plaintiff was disabled. (AR 263, 328). The administrative record

contains the October 2004 paperwork. (AR 328). On it, Dr. Barnett completed an Arizona

General Assistance Disability form in which he opined that Plaintiff had a medical incapacity

of dementia rendering him unable to perform substantial gainful activity. (AR 328). Dr.

Barnett has also requested special housing for Plaintiff to avoid loud noises. In a July 2003

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 11 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 12 -

letter to an unnamed person dealing with housing, Dr. Barnett requested his patient be

allowed to “rent living space from his parents so that he can avoid loud noises and other

distractions.” (AR 327). 

At the evidentiary hearing, Plaintiff’s attorney stated that there were updated medical

records from Dr. Barnett but that she had not received them yet from his office. (AR 13).

The ALJ left the record open so that Plaintiff could supplement the record with those medical

records. (AR 13, 47). In his decision denying benefits, the ALJ noted a lack of ongoing

medical care and stated that while he left the record open for Plaintiff to submit additional

medical records, none were submitted. (AR 61).

In the spring of 1999, Plaintiff’s treating physician had him neurologically evaluated.

Dr. David Lippincott, D.O. completed the neurological evaluation of Plaintiff. Plaintiff

presented to Dr. Lippincott as alert and oriented. Plaintiff complained of daily headaches.

(AR 313). Plaintiff reported that he took amitriptyline 50 mg everyday and butalbital

frequently (but not more than six to eight times per week). (AR 313). Dr. Lippincott found

no new neurologic symptoms and found Plaintiff to be in generally good health. (AR 313).

His impression was Plaintiff suffers from “chronic daily headache associated with a closed

head injury”. (AR 313). Dr. Lippincott recommended “continu[ing] present medication,

MRI, PT...” (AR 314). An April 1999 MR Brain Scan returned a result of normal. (AR

239).

D. Examining Psychologist’s Report and Reviewing Physician’s Report

In April 2006, Dr. Jill Caffrey, Ph.D. examined Plaintiff on behalf of the

Commissioner. (AR 280-283). She noted that Plaintiff took butalbital for headaches as

needed. (AR 280). She did not inquire into how frequently Plaintiff experiences headaches

requiring medication and therefore, did not determine how frequently Plaintiff takes

butalbital. (AR 280-283). Plaintiff reported to Dr. Caffrey that his headaches depend on

stress and also told her that depression is an issue for him. (AR 280). Plaintiff told Dr.

Caffrey that he was anxious in public and “antisocial” with his headaches. (AR 280). 

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 12 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 13 -

Plaintiff presented to Dr. Caffrey as slightly overweight, some personal hygiene

issues, but an affect in full range and mood euthymic. (AR 281). Dr. Caffrey stated “[g]iven

his self-report, I found Mr. Crumly more interpersonally appropriate than I expected.” (AR

283). Dr. Caffrey noted that Plaintiff fully cooperated and made good effort but that he did

the requested work at a high rate of speed with marked impulsivity. (AR 281).

On the Wechsler Adult Intelligence Scale (WAIS), an intelligence quotient test,

Plaintiff performed in the average range. (AR 281). Plaintiff also completed a Beck

Depression Inventory on which he received a 28, suggesting depressive symptomatology.

Dr. Caffrey opined that Plaintiff would not be able to manage his own benefits. (AR 283).

Dr. Caffrey did not expound on why she believed Plaintiff would be unable to manage his

own benefits. (AR 283).

After examining Plaintiff and completing her own report, Dr. Caffrey completed a

Medical Source Statement on Plaintiff’s ability to do mental work related activities. (AR

285-290). Dr. Caffrey found Plaintiff did have conditions including dysthymia and

headaches that would impose limitations for twelve continuous months. (AR 285). Dr.

Caffrey found five moderate limitations:

- ability to maintain attention and concentration for extended periods; 

- ability to perform activities within a schedule, maintain regular attendance,

and be punctual within customary tolerances; 

- ability to sustain an ordinary routine without special supervision; 

- ability to maintain socially appropriate behavior and to adhere to basic

standards of neatness and cleanliness; 

- ability to set realistic goals or make plans independently of others.

(AR 285-290). She found nine mild limitations in:

- ability to understand and remember detailed instructions; 

- ability to work in coordination with or proximity to others without being

distracted by them; 

- ability to make simple work related decisions; 

- ability to complete normal workday and workweek without interruptions

from psychologically based symptoms and to perform at a consistent pace

without an unreasonable number and length of rest periods; 

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 13 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 14 -

- ability to interact appropriately with the general public; 

- ability to accept instructions and respond appropriately to criticism from

supervisors; 

- ability to get along with coworkers or peers without distracting them or

exhibiting behavioral extremes; 

- ability to respond appropriately to changes in the work setting; 

- ability to be aware of normal hazards and take appropriate precautions.

(AR 285-290). Dr. Caffrey did not state and it does not appear that she considered any effect

of the medication butalbital on Plaintiff’s potential limitations. (AR 280-290).

In April 2006, Dr. Jack Marks, a reviewing physician for the Commissioner, found

the same five moderate limitations as Dr. Caffrey when reviewing Plaintiff’s file. (AR 291-

293). Dr. Marks acknowledged Dr. Caffrey’s WAIS testing of Plaintiff and found “claimant

is capable of low stress routine tasks with limited interpersonal demand.” (AR 291-293).

On a Psychiatric Review Technique form, Dr. Marks noted Plaintiff experienced affective

disorder and substance addiction. (AR 295). Dr. Marks found Plaintiff had dysthymia (per

CE) with symptoms of decreased energy. (AR 298).

E. Plaintiff’s Examining Doctors

Plaintiff hired Dr. Denny Peck, Ph.D. and Dr. Thomas McCabe, Ph.D. to complete

a comprehensive disability evaluation of Plaintiff. The evaluation included two clinical

interviews, a collateral interview with his mother, a Minnesota Multiphasic Personality

Inventory-2 test and a review of medical file. (AR 348-356). Dr. Peck completed the clinical

interviews and Dr. McCabe conducted the testing. (AR 348).

Dr. Peck interviewed Plaintiff and found he presented as “ an overgrown complaining,

unhappy, disheveled individual who has difficulty answering direct questions.” (AR 354).

Dr. Peck opined that Plaintiff was combative and defensive when he perceived criticism.

Plaintiff had difficultly answering questions and needed to be constantly refocused. (AR

348). 

Drs. Peck and McCabe evaluated Plaintiff’s ability to work in “an isolated work place

away from others” and found “[t]he medications, documented by his physician in the file and

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 14 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 15 -

[by Plaintiff], headaches, documented in the file, by [Plaintiff] and collateral interview,

working memory deficit, as documented by CE testing, and inability to respond to demands,

as documented in the MMPI-2 definitive interpretation above, clearly substantiate the severe

impairments even in a restricted, isolated environment.” (AR 355). In support of their own

conclusions, Drs. Peck and McCabe noted treating physician Dr. Barnett’s diagnoses of

organic brain syndrome secondary to closed head injuries and his opinion that Plaintiff was

disabled as well as Dr. Caffrey’s opinion that Plaintiff was incapable of handling his own

benefits. (AR 355).

In the Psychiatric Review Technique Form, Drs. McCabe and Peck found marked and

extreme limitations in the following:

- Marked to extreme on restriction of daily activities (Doctors noted that

Plaintiff withdrawals, fatigue, sleep problems, daily headaches). (AR 343).

- Marked difficulties in maintaining social functioning (Doctors noted that

Plaintiff does not go out much). (AR 343).

- Marked and extreme difficulties maintaining concentration, persistence, or

pace (Doctors referenced WAIS III, medications).

- Doctors also noted three episodes of decompensation each of extended

duration. (AR 343).

On the Mental Work Tolerance Recommendations, Drs. McCabe and Peck found

Plaintiff suffered marked or extreme limitations in the following:

- Markedly limited in ability to understand and remember detailed instructions

(Doctors noted the memory testing; multiple head injuries; headaches and

narcotic medication Plaintiff was taking). (AR 344).

- Markedly limited in ability to carry out detailed instructions (Based on

Plaintiff’s memory impairment; multiple head injuries, medications). (AR

344).

- Markedly limited in ability to maintain attention and concentration for

extended periods (Due to Plaintiff’s memory impairments). (AR 345).

- Markedly limited in ability to perform activities within a schedule, maintain

regular attendance, and be punctual. (Based on Plaintiff’s severe sleep

problems; malaise and fatigue; severe headaches related to head injuries.) (AR

345).

- Markedly limited in ability to sustain an ordinary routine without special

supervision (As evidenced by Plaintiff’s multiple impairments requiring

supervision or he would sleep all day.) (AR 345).

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 15 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 16 -

- Markedly limited in ability to work in coordination with or proximity to

others without being distracted by them. (Plaintiff’s inability to function

around people without being distracted).

- Markedly limited in ability to complete a workday and workweek without

interruptions from psychologically based symptoms and to perform at a

consistent pace without more than the normal rest periods. (Supported by

Plaintiff’s headaches, medication; fatigue; isolation/withdrawal). (AR 345).

- Markedly limited in ability to accept instructions and respond appropriately

to criticism from supervisors. (Plaintiff responds to everyone as though they

were his father who beat him and criticized him). (AR 346).

-Markedly limited in ability to maintain socially appropriate behavior and to

adhere to basic standards of neatness and cleanliness (Based on collateral

interview with mother. Plaintiff does not shower unless he has to and is not

neat). (AR 346).

- Markedly limited in ability to set realistic goals or make plans independently

of others. (Plaintiff has no direction and would sleep all day). (AR 346).

After evaluating Plaintiff, Drs. Peck and McCabe completed a Psychiatric Review

Technique form and found Plaintiff met or exceeded the criteria for four different disorders

as listed in the social security guidelines. (AR 338). They found Plaintiff met or exceeded

the listings for 12.02 (organic mental disorder), 12.04 (affective disorders), 12.08

(personality disorders). (AR 338). They opined Plaintiff exhibited memory impairment,

perceptual or thinking disturbances, disturbance in mood thus, meeting or exceeding listing

12.02. (AR 339). They opined Plaintiff exhibited emotional withdrawal and/or isolation

with paranoid ideation (all related to organic brain injury) thus, meeting or exceeding listing

12.03. (AR 340). For 12.04, they found Plaintiff suffered from depressive syndrome

supported by (pervasive loss of interest in almost all activities; sleep disturbance; decreased

energy; feelings of worthlessness; difficulty concentrating or thinking; thoughts of suicide

(but not plan and would not act on it); paranoid thinking. (AR 341). For 12.08, they noted

Plaintiff suffered from oddities of thought, perception, speech and behavior; persistent

disturbances of mood or affect. (AR 342). 

In choosing not to offer a hypothetical to the vocational expert based on the

limitations identified by Drs. Peck and McCabe, the ALJ stated that if the examining doctors’

conclusions were taken into account, Plaintiff would meet a listing and be disabled at step

three in the social security framework. (AR 41).

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 16 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 17 -

F. The Conclusions of the Vocational Experts

At the administrative hearing held on March 21, 2007, the ALJ requested the

testimony of Staci Schonbrun, a vocational expert. (AR 37). The ALJ initially asked Ms.

Schonbrun to consider three hypotheticals regarding Plaintiff’s ability to work. (AR 39).

The first hypothetical profiled the five moderate limitations identified by Dr. Caffrey. (AR

39). The second hypothetical was based on Dr. Marks’ review of Plaintiff’s record and was

essentially the same as the hypothetical based on the limitations identified by Dr. Caffrey.

(AR 40-41). The ALJ began to outline a third hypothetical based on the limitations identified

by Plaintiff’s examining physicians, Drs. McCabe and Peck but then noted that if the medical

evidence supported the physicians’ conclusions, Plaintiff would meet one of the disability

listings in step three of the evaluation process. (AR 41). Thus, Ms. Schonbrun considered

only the moderate limitations identified by Dr. Caffrey and reiterated by Dr. Marks. (AR 41-

42).

Based on the limitations identified by Drs. Caffrey and Marks, including the five

moderate limitations, Ms. Schonbrun opined that Plaintiff could sustain three jobs: a janitor,

a night cleaner, or a dishwasher. (AR 42-43). Plaintiff’s attorney asked Ms. Schonbrun what

“moderately limited” meant to her, specifically she asked if “moderately limited” meant that

Plaintiff could not perform based on his limitations thirty percent of the time, would he still

be able to work. (AR 44). Ms. Schonbrun answered yes, Plaintiff could work with moderate

limitations that impeded him in those areas thirty percent of the time but that the result would

be different if those limitations impeded him fifty percent of the time. (AR 44). On

questioning by Plaintiff’s attorney, Ms. Schonbrun also acknowledged that all three jobs

involved working in fluorescent light. (AR 44-45). Ms. Schonbrun was not asked about the

level of noise in the three jobs. Nor was Ms. Schonbrun asked about the effect of missing

a certain amount of work due to headaches as the ALJ did not determine how frequently

Plaintiff has severe headaches requiring medication.

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 17 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 18 -

After the administrative hearing, Plaintiff requested David Goguen, another vocational

expert, evaluate his ability to work. Mr. Goguen reviewed Plaintiff’s record including the

medical reports, Plaintiff’s statements, Plaintiff’s mother’s statements, and he listened to the

recording of the administrative hearing. (AR 204). Mr. Goguen also interviewed Plaintiff.

(AR 204). In his report, Mr. Goguen summarized the reports from Plaintiff’s examining

doctors, Drs. McCabe and Peck, as well as the Commissioner’s examining doctor, Dr.

Caffrey, and the reviewing doctor, Dr. Marks. (AR 205-206).

Mr. Goguen focused on the five moderate limitations identified by Drs. Caffrey and

Marks and chose not to address in detail the limitations identified by Drs. Peck and McCabe

as the ALJ found Plaintiff would meet a listing if he followed the conclusions of those

doctors. (AR 210-211). Mr. Goguen opined that the number of moderate limitations

identified by Drs. Caffrey and Marks made it unlikely that Plaintiff could maintain

employment. (AR 213). Mr. Goguen stated “[o]bviously greater limitations within the

moderate range and the more moderate limitations that exist for a worker then the more likely

it is that such a person would not reasonably be able to successfully meet the basic mental

demands of competitive, remunerative, unskilled work.” (AR 211). Mr. Goguen pointed out

that critical to performing unskilled work is the ability to maintain attention for extended

periods of two-hour segments and the ability to maintain regular attendance and be punctual

within customary tolerances. (AR 213). Mr. Goguen opined that Plaintiff’s multiple

moderate limitations including the limitation to maintain a schedule could prevent him from

successfully maintaining gainful employment in unskilled work. (AR 213). Mr. Goguen

also noted that Plaintiff’s moderate limitation in his ability to maintain regular attendance and

be punctual within customary tolerances is a strict tolerance for unskilled work, meaning

there is less flexibility of attendance and punctuality. (AR 213).

G. The ALJ’s Conclusions

Subsequent to the administrative hearing, on August 24, 2007, the ALJ Peter J. Baum

issued his opinion that Plaintiff was not disabled at step five because he could perform a

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 18 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 19 -

significant number of unskilled jobs. (AR 52-64). In his opinion at step two in the analysis,

the ALJ did find that Plaintiff suffered from severe impairments of headaches, organic brain

damage and substance use disorder. (AR 57). The ALJ also found Plaintiff’s residual

functional capacity was limited by Plaintiff’s moderate limitations in the ability to sustain

attention and concentration for extended periods, perform activities within a schedule,

maintain regular attendance, be punctual within customary tolerances, sustain an ordinary

routine without special supervision, maintain socially appropriate behavior, adhere to basic

standards of neatness and cleanliness, and set realistic goals or make plans independently of

others. (AR 58). The ALJ found Plaintiff limited to unskilled work and also found that

Plaintiff would work best in an environment requiring only brief, intermittent contact with

the public or coworkers and that due to his medication, he should avoid working around

hazards. (AR 58).

Regarding Plaintiff’s headaches, the ALJ acknowledged Plaintiff is significantly

affected by his headaches. The ALJ stated:

headaches vary in severity and are made worse with stress, noise, and bright

lights. Warnings for prescribed medicine include not driving or using

machinery. As a result, he is unable to perform the construction work he used

to do, as he used power tools on that job. Although the headache medicine

works, it often causes him to sleep excessively and become nauseated, side

effects he has reported to his physician. In addition to his headaches and

adverse side effects from prescribed medication, he has had multiple head

injuries resulting in memory problems so severe that he must often be

reminded to do even routine daily chores and tasks. He has a driver’s license

but drives infrequently and only if he does not have a headache. He socializes

infrequently even with his mother who lives just a block away. When he is

around more than five to eight people, he sweats profusely and, at times,

becomes angry.

(AR 59-60). Although the ALJ noted the significance of Plaintiff’s headaches, he did not

inquiry into how frequently Plaintiff has severe headaches that require he take butalbital to

control them.

In reaching his decision, the ALJ found the record did not support Plaintiff’s

complaints about the severity and persistence of Plaintiff’s alleged symptoms. (AR 59-60).

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 19 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 20 -

The ALJ found Plaintiff not entirely credible and gave little weight to Plaintiff’s mother’s

lay witness testimony because the testimonies were not supported by the other evidence in

the record. (AR 61-62). The ALJ also found that much of the medical evidence predated

Plaintiff’s alleged onset date of May 1, 2005, including most of the treatment notes and

opinions from treating physician Dr. Barnett. (AR 60). The ALJ addressed the medical

evidence presented by the Commissioner’s examining and reviewing physicians and by

Plaintiff’s examining doctors but did not address the medical opinions nor much of the

medical evidence offered from Plaintiff’s treating physician, Dr. Barnett. (AR 60-62). Also,

the ALJ gave the opinions of examining doctors Peck and McCabe little weight because their

opinions were based, in part, on Plaintiff’s testimony which the ALJ found not entirely

credible and because the ALJ found Plaintiff did not seek ongoing medical care or take

psychotropic medication regularly. (AR 62). The ALJ further gave substantial weight to the

opinion of Drs. Caffrey and Marks but did not acknowledge that Dr. Caffrey opined Plaintiff

would not be able to manage his own benefits. (AR 62).

II. ANALYSIS

A. Standard of review

The Commissioner’s determination of Plaintiff’s disability must be affirmed if it is

supported by substantial evidence and the Commissioner applied the correct legal standards.

Hoopai v. Astrue, 499 F.3d 1071, 1074 (9th Cir.2007) (internal citation omitted). The court

may overturn the decision to deny benefits only if the decision “contains legal error or is not

supported by substantial evidence.” Orn v. Astrue, 495 F.3d 625, 630 (9th Cir.2007)

(internal citation omitted). Substantial evidence is “such relevant evidence as a reasonable

mind might accept as adequate to support a conclusion.” Id. (internal citation omitted). The

“evidence must be more than a mere scintilla but not necessarily a preponderance.” Bayliss

v. Barnhart, 427 F.3d 1211, 1214 fn. 1 (9th Cir.2005) (internal citation omitted). Where

there is more than one rational interpretation for the evidence, and the evidence can support

either affirming or reversing the ALJ's conclusion, the reviewing court “may not substitute

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 20 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 21 -

[its] judgment for that of the ALJ” and the ALJ’s decision should be upheld. Burch v.

Barnhart., 400 F.3d 676, 679 (9th Cir.2005) (internal citation omitted). 

The Social Security Regulations establish a five-step sequential evaluation process for

determining whether a claimant is disabled. 20 C.F.R. § 416.920; see also Heckler v.

Campbell, 461 U.S. 458, 460-462 (1983). The claimant bears the burden of proof in steps

one through four. Thomas v. Barnhart, 278 F.3d 947, 955 (9th Cir.2002). To establish

disability, the claimant must show he (1) is not working; (2) has a severe physical or mental

impairment; (3) the impairment meets or equals the requirements of a listed impairment; or

(4) claimant’s residual functional capacity (“RFC”) precludes him from performing his past

work. Hoopai, 499 F.3d at 1074-1075 (internal citations omitted). At step five, the

Commissioner bears the burden of proof and must show that the claimant has the RFC to

perform other work that exists in substantial numbers inn the national economy. Id. at 1074.

If the Commissioner conclusively finds the claimant “disabled” or “not disabled” at any point

in the five-step process, he does not proceed to the next step.

A step five determination is made on the basis of four factors: the claimant’s RFC,

age, education and work experience. Id. “To assist in the step-five determination, the Social

Security Administration established the Medical-Vocational Guidelines (the grids), which

consist of a matrix of [the four factors] and set forth rules that identify whether jobs requiring

a specific combination of these factors exist in significant numbers in the national economy.”

Hoopai, 499 F.3d at 1075 (internal citation omitted). “When the grids match the claimant’s

qualifications, the guidelines direct a conclusion as to whether work exists that the claimant

could perform.” Hoopai, 499 F.3d at 1075 (internal citation omitted). “When the grids do

not match the claimant’s qualifications, the ALJ can either (1) use the grids as a framework

and make a determination of what work exists that the claimant can perform, see SSR 83-14,

or (2) rely on a vocational expert when the claimant has significant non-exertional

limitations.” Hoopai, 499 F.3d at 1075 (internal citation omitted). 

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 21 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 22 -

B. Discussion of Alleged Errors

1. The ALJ failed to evaluate treating physician Dr. Barnett’s opinion about Plaintiff’s

sensitivity to loud noises or general opinion that Plaintiff is chronically disabled

Plaintiff asserts the ALJ erred in not providing clear and convincing reasons for

rejecting the opinion of Plaintiff’s treating physician, Dr. Barnett, that Plaintiff had

sensitivity to loud noises and that Plaintiff was “chronically disabled.” (Doc 10-2, p 4). The

Commissioner contends the ALJ was permitted to disregard Dr. Barnett’s opinions because

they were offered prior to Plaintiff’s alleged date of disability; the opinion that Plaintiff is

disabled is a determination that the ALJ ultimately makes; and, it is harmless error if the ALJ

should have incorporated Plaintiff’s alleged noise sensitivity into the hypotheticals offered

to the vocational expert at the administrative hearing. (Doc 11, pp 3-4).

In Lester v. Chater, the Ninth Circuit outlined the standard for reviewing the

opinions of physicians:

Cases in this circuit distinguish among the opinions of three types of

physicians: (1) those who treat the claimant (treating physicians); (2) those

who examine but do not treat the claimant (examining physicians); and (3)

those who neither examine nor treat the claimant (nonexamining physicians).

As a general rule, more weight should be given to the opinion of a treating

source than to the opinion of doctors who do not treat the claimant. At least

where the treating doctor's opinion is not contradicted by another doctor, it

may be rejected only for “clear and convincing” reasons. [...] Even if the

treating doctor's opinion is contradicted by another doctor, the Commissioner

may not reject this opinion without providing “specific and legitimate reasons”

supported by substantial evidence in the record for so doing.

Lester v. Chater, 81 F.3d 821, 830 (9th Cir.1995) (internal citations and references omitted).

The federal regulations provide, as a general rule, that more weight is given to treating

physicians’ opinions as opposed to non-treating physicians. 20 C.F.R. § 416.927(d). More

weight is given to treating physicians because “these sources are likely to be the medical

professionals most able to provide a detailed, longitudinal picture of [Plaintiff’s] medical

impairment(s) ...” 20 C.F.R. § 416.927(d). In determining the weight of a treating

physician’s opinions, the regulations require the SSA to consider the length of the treatment

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 22 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 23 -

relationship and frequency of examination; the nature and extent of the treatment

relationship; the supportability of the physician’s opinions; the consistency of the opinion

with the record; and any specialization of the physician and other factors. 20 C.F.R. §

416.927(d)(2). 

Specific to doctors opinions on matters reserved to the Commissioner, such as an

ultimate decision on disability, the Social Security Regulations provide “opinions from any

medical source about issues reserved to the Commissioner must never be ignored, and that

the notice of the determination or decision must explain the consideration given to the

treating source’s opinion(s).” SSR 96-5p, see also 20 C.F.R. § 416.927(e). With that said,

opinions from medical sources about issues reserved to the Commissioner are never entitled

to controlling weight or special significance. SSR 96-5p.

In the case before this Court, the ALJ did not consider Dr. Barnett’s treatment notes

or opinions. Instead, the ALJ discounted the medical evidence from Dr. Barnett as pre-dating

Plaintiff’s alleged onset date of May 1, 2005. It is insignificant that much of medical

evidence from Dr. Barnett predates May 2005. Plaintiff’s alleged disability derives mainly

from chronic headaches secondary to his organic brain damage. The ALJ does not dispute

that Plaintiff experiences the headaches secondary to brain damage. At step two, the ALJ

found severe impairments of headaches and organic brain damage. These impairments are

not temporary or transient medical conditions. Dr. Barnett’s treatment notes from January

1999 through July 2005 and his opinions about Plaintiff’s disability and noise sensitivity

directly relate to the severity and persistency of these ongoing medical impairments,

specifically the chronic headaches. The ALJ erred in discounting, without reason, the

medical evidence and opinions from Dr. Barnett. This medical evidence by itself is an

important consideration in determining Plaintiff’s alleged disability.

The medical evidence also provides significant support for Plaintiff’s credibility and

his mother’s credibility as to the severity of his symptoms. Dr. Barnett’s treatment notes are

evidence of the consistency and severity with which Plaintiff experienced the headaches. 

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 23 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 24 -

They show that Plaintiff saw Dr. Barnett over a six year period with some consistency

complaining of chronic headaches. Dr. Barnett diagnosed Plaintiff with organic brain

damage and with chronic headaches secondary to the brain damage. He prescribed butalbital

to Plaintiff for the headaches as well as other medications that worked less effectively. From

the treatment notes it is evident that Dr. Barnett treated Plaintiff’s complaint of chronic

headaches seriously and found those headaches to be a serious ailment. 

The ALJ also erred in failing to evaluate Dr. Barnett’s opinion, offered twice, that

Plaintiff is disabled. After treating Plaintiff for the chronic headaches for over a year and a

half, in October 2002, Dr. Barnett completed a state disability form opining that Plaintiff is

chronically disabled. (AR 263). The record also contains another disability form completed

by Dr. Barnett in October 2004, in which Dr. Barnett opined that Plaintiff is disabled. (AR

328). Under the regulations, the ALJ was not required to give Dr. Barnett’s opinion about

Plaintiff’s disability controlling weight or special significance. The ALJ, however, could not

ignore this opinion. The ALJ was obligated to address this opinion and explain the

consideration he gave it. 

The ALJ also erred in failing to address Dr. Barnett’s opinion that Plaintiff was

sensitive to loud noises. In the a July 2003 letter, to an unnamed person dealing with

housing, Dr. Barnett requested his patient be allowed to “rent living space from his parents

so that he can avoid loud noises and other distractions.” (AR 327). The treatment notes do

not reflect that Plaintiff had a sensitivity to loud noises but Plaintiff did testify at the

administrative hearing that loud noises exacerbate his headaches and he also noted this

sensitivity in other parts of the record. The letter written by Dr. Barnett in July 2003, is

evidence that Plaintiff is sensitive to loud noises and supports Plaintiff’s own testimony about

this fact. In his decision, the ALJ noted that Plaintiff’s headaches are made worse with

“stress, noise, and bright lights” but the ALJ did not address how that information effected

his ultimate decision on Plaintiff’s disability and significantly, how it effected Plaintiff’s

ability to perform the jobs identified by the vocational expert at the administrative hearing.

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 24 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 25 -

The ALJ should have evaluated Dr. Barnett’s opinion requesting that Plaintiff avoid loud

noises.

The ALJ erred in failing to evaluate the opinions of Dr. Barnett. The record contains

fairly extensive treatment notes from Dr. Barnett, two opinions from Dr. Barnett about

Plaintiff’s alleged disability, and an opinion about Plaintiff’s sensitivity to loud noises. The

ALJ was obligated to evaluate this evidence and then provide, at a minimum, specific and

legitimate reasons for dismissing these opinions. 

2. The ALJ erred in evaluating Plaintiff’s mother’s statements

Plaintiff asserts that the ALJ erroneously rejected the lay-witness statements of

Plaintiff’s mother. Commissioner argues the ALJ gave germane reasons for discounting

Plaintiff’s mother’s testimony as it is inconsistent with the objective evidence in the record.

Lay testimony as to a claimant's symptoms is competent evidence that an ALJ must

take into account, unless he or she expressly determines to disregard such testimony and

gives reasons germane to each witness for doing so. Nguyen v. Chater, 100 F.3d 1462, 1467

(9th Cir.1996) (citing Dodrill v. Shalala, 12 F.3d 915, 918-19 (9th Cir.1993)). Lay witnesses

including friends and family members of a claimant are in a position to observe a claimant’s

symptoms and daily activities. Dodrill, 12 F.3d at 918-919. “An eyewitness can often tell

whether someone is suffering or merely malingering.” Id. at 919. An ALJ can properly

reject lay witness statements when there are inconsistencies between the statements and

medical evidence and also when the statements describe symptoms that are not documented

in claimant’s medical records. Bayliss v. Barnhart, 427 F.3d 1211, 1218 (9th Cir.2005);

Lewis v. Apfel, 236 F.3d 503, 511-512 (9th Cir.2001). 

In this case, the ALJ gave Plaintiff’s mother’s testimony little weight. The ALJ noted

that Plaintiff’s mother testified that Plaintiff “had a problem with anger, finds it difficult to

be around people, and must be reminded constantly to do routine tasks, such as getting the

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 25 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 26 -

mail, taking out the trash, and handling his personal hygiene care.” (AR 60). In giving

Plaintiff’s mother’s testimony little weight, the ALJ stated:

The undersigned has evaluated and considered the written statement and oral testimony by

the claimant’s mother. She commented on his variable sleep pattern, poor grooming due to

depression, and a preference to be alone. However, she also noted that her son engaged in

a variety of daily activities including reading, shopping, cooking simple meals on a daily

basis, and socializing weekly on “game night” (Exhibit 3F). 

(AR 62). 

The ALJ’s decision to give the mother’s testimony little weight is in error. The ALJ

suggested Plaintiff’s mother gave conflicting testimony because she described Plaintiff as

not very functional with erratic sleeping, poor grooming and depression but then described

him as engaging in a variety of daily activities. This testimony is not conflicting if viewed

in its proper context. The proper context is whether or not Plaintiff is experiencing a severe

headache and in need of medication. When on the medication for his headaches, Plaintiff’s

mother describes him as forgetful, anti-social with a temper that flares. (AR 127, 129). She

must assist him when he takes the medication. (AR 128). Plaintiff’s mother described the

effect of his medication, “Bryan is depress [sic] he wants to be left alone + [sic] doesn’t like

to leave his house. He get angry when his head hurts. When on medication he forgets things

+ [sic] can sleep 20 to 24 hours straight.” (AR 131). She also described Plaintiff as unable

to follow written and spoken instructions when medicated. (AR 129). In contrast, but not

conflict, Plaintiff’s mother describes Plaintiff as more self-sufficient when he does not have

a headache and is not taking medication. During those times, Plaintiff is able to read, watch

television, cook, do some limited grocery shopping. 

The other evidence in the record, including the medical evidence from Dr. Barnett,

supports Plaintiff’s mother’s statements about the effect of severe headaches on Plaintiff.

The ALJ erred in giving Plaintiff’s mother’s testimony little weight because it was allegedly

in conflict with itself. In fact, Plaintiff’s mother’s testimony is supported by the substantial

evidence in the record. All the evidence suggests that when Plaintiff is not experiencing

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 26 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 27 -

headaches, he is able to function on his own but he is not functional when he has a severe

headache and takes his medication.

3. The ALJ erred in evaluating Plaintiff’s sensitivity to light

Plaintiff contends that the ALJ failed to evaluate Plaintiff’s light sensitivity. (Doc 10-

2, p 8). The record contains multiple references to Plaintiff’s alleged light sensitivity.

Plaintiff states that light induces and aggravates his headaches. At the evidentiary hearing,

Plaintiff testified that bright lights make his headaches worse and the sunlight triggers his

headaches. (AR 22, 25). Plaintiff also testified that fluorescent light, unless it is a soft light

also bothers him and that he uses dark (black out) curtains to keep light out of his home. (AR

25). In an undated Adult Disability Report Plaintiff also stated that bright lights aggravate

his headaches. (AR 117). At the evidentiary hearing, Plaintiff’s mother stated that Plaintiff

keeps his home dark and prefers only 40 watt light bulbs. (AR 35). She testified that she

“painted all the walls like a dark brown for him to keep it so it wasn’t so bright for him. And

then I got him the blackout curtains. He hardly turns on his lights.” (AR 35). 

Plaintiff argues the ALJ should have included his light sensitivity as a limiting factor

in the hypotheticals given to the vocational expert. In his decision, the ALJ noted that noise

was a factor which worsened Plaintiff’s headaches. (AR 60). Yet, the ALJ did not ask the

vocational expert about the effect of light sensitivity on Plaintiff’s ability to work the three

identified jobs. When asked by Plaintiff’s attorney about the light involved in the three

identified jobs, the vocational expert testified at the administrative hearings that all three of

the jobs could require exposure to fluorescent light. (AR 44). 

The Commissioner contends the ALJ properly found Plaintiff not entirely credible

regarding his symptoms and that the ALJ was not required to specifically address Plaintiff’s

alleged light sensitivity. (Doc 11, p 6). The Commissioner further argues that the ALJ

considered Plaintiff’s daily activities, including “a considerable amount of time [] watching

television and/or using the computer” as objective evidence discrediting Plaintiff’s subjective

complaints. (Doc 11, p 8; AR 62). 

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 27 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 28 -

It is true the ALJ detailed Plaintiff’s daily activities and rejected the severity of

Plaintiff’s complaints based on his “somewhat normal level of daily activity and interaction”,

but the ALJ did not specifically reject Plaintiff’s credibility as to the light sensitivity. 

To make a credibility determination of a claimant, an ALJ must give “specific reasons

for the finding on credibility, supported by the evidence in the case record, and must be

sufficiently specific to make clear to the individual and to any subsequent reviewers the

weight the adjudicator gave to the individual’s statements and the reasons for that weight.”

SSR 96-7p (explaining the regulatory framework for evaluating credibility as found in 20

C.F.R. § 416.929(c)). “Once the claimant produces medical evidence of an underlying

impairment, the Commissioner may not discredit the claimant's testimony as to subjective

symptoms merely because they are unsupported by objective evidence. [...] Unless there is

affirmative evidence showing that the claimant is malingering, the Commissioner's reasons

for rejecting the claimant's testimony must be ‘clear and convincing’.” Lester, 81 F.3d at 834

(internal citations omitted). General findings are insufficient; rather, the ALJ must identify

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

Dodrill, 12 F.3d at 918.

Plaintiff’s alleged sensitivity to light is significant evidence. The record shows

Plaintiff consistently complained of light inducing and/or aggravating his headaches. The

ALJ acknowledged that light increased the severity of Plaintiff’s headaches. The light

sensitivity is directly related to Plaintiff’s chronic headaches, an impairment that the ALJ

found severe at step two in the evaluation. The ALJ should have specifically addressed

Plaintiff’s light sensitivity and why it was or was not credible. If it was credible, the ALJ

should have included light sensitivity as a limitation in his hypotheticals to the vocational

expert.

4. The ALJ erred in evaluating Plaintiff’s medical treatment

Plaintiff argues the ALJ erred in finding that Plaintiff failed to seek consistent medical

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 28 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 29 -

treatment for his impairment and in using that determination to weigh against Plaintiff’s

credibility and against the evaluations of Drs. Peck and McCabe. (Doc 10-2 , p 9). The

Commissioner contends the ALJ properly found Plaintiff did not seek treatment consistent

with the alleged severity of his symptoms, not treatment for organic brain damage. (Doc 11,

p 6). In his decision, the ALJ stated “[t]he severity of [Plaintiff’s] subjective complaints is

not supported by his lack of ongoing treatment and psychotropic medication.” (AR 61). The

ALJ further stated:

Although the claimant testified to severe, unremitting symptoms, the record

reflects that he has had little in the way of ongoing medical care seeking relief

from his symptoms. While the record shows a history of alleged frequent

headaches, the claimant has not seen any physician on a regular basis for

ongoing treatment, despite having medical coverage through a State-funded

program. The most recent record from the treating physician was in July 2005

(Exhibit 6F) . . . Although his attorney requested that the record remain open

in order to submit update medical evidence from the treating physician, none

was forthcoming. Had his symptoms been as debilitating and severe as he has

alleged it is likely that the claimant would have sought treatment to a much

greater degree than is evidenced in the record.

(AR 61).

Substantial evidence does not support the ALJ’s finding on this issue. The record

shows that Plaintiff did seek treatment for his chronic headaches and did consistently take

medication for those headaches. Plaintiff somewhat consistently sought treatment from his

treating physician, Dr. Barnett, from January 1999 through, at least, July 2005. (AR 333-

334; 262-264). The record contains no treatment notes between January 2000 to July 2002

and January 2003 to June 2005 and no medical records after July 2005, even though Plaintiff

was given the opportunity to supplement the record. While there are breaks in treatment, Dr.

Barnett’s treatment notes show that Plaintiff consistently complained of chronic headaches

and that Dr. Barnett found Plaintiff’s complaints valid. Dr. Barnett prescribed medications

and completed two disability reports opining that Plaintiff was disabled due to his organic

brain damage and resulting chronic headaches. Plaintiff consistently took the barbiturate

butalbital for his severe headaches and reported to the neurologist that he took that

medication as much as six to eight times a week. The ALJ erred in weighing Plaintiff’s

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 29 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 30 -

alleged lack of treatment against Plaintiff’s credibility and against the findings of Plaintiff’s

examining physicians Drs. Peck and McCabe. 

5. The ALJ erred in evaluating Plaintiff’s daily activities

Plaintiff asserts that ALJ erred in determining Plaintiff not entirely credible as to

the severity of his symptoms because his daily activities were “somewhat normal.” ((Doc

10-2, p 11; AR 62). The Commissioner argues the ALJ correctly considered Plaintiff’s

multiple reports of watching television and playing video games as evidence weighing

against Plaintiff’s complaints of light sensitivity and other alleged severe symptoms

associated with his organic brain damage and chronic headaches. (Doc 11, p 8).

As one of many factors, an ALJ may consider a claimant’s daily activities when

weighing the claimant’s credibility. Thomas v. Barnhart, 278 F.3d 947, 958-959 (9th

Cir.2002). Daily activities that show a claimant is able to perform household chores and

other activities similar to tasks involved in a type of job can weigh against a Plaintiff’s

credibility about the severity of his symptoms. Fair v. Bowen, 885 F.2d 597, 603 (9th

Cir.1989). Such reasoning, however, has its limits. Home activities may “not [be] easily

transferable to what may be the more grueling environment of the workplace, where it might

be impossible to periodically rest or taken medication.” Id. 

In this case, the ALJ erred in finding Plaintiff’s daily activities did not support the

alleged severity of his symptoms. The ALJ focused on Plaintiff’s daily activities as

described by Plaintiff and his mother when Plaintiff does not have headaches. Without a

severe headache, Plaintiff’s activities included watching television, playing video games,

doing chores, going grocery shopping once or twice a week, etc. (AR 18, 124, 154, 156,

158). The problem with focusing on these activities is that Plaintiff seems to do none of

them when he has a severe headache and takes his medication. Plaintiff stated that his ability

to drive, ability to follow directions and interact with people depends on whether he is on the

medication. (AR 137, 117). Plaintiff cannot drive himself places when he is taking the

medication for his headaches. (AR 16, 135). Responding to a question about whether he

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 30 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 31 -

needed someone to accompany him when he goes places, Plaintiff stated “only when

medicated.” (AR 136). When on the medication for his headaches, Plaintiff’s mother stated

that Plaintiff is forgetful and his temper flares. (AR 129). Plaintiff’s mother stated that

Plaintiff needs assistance when his head hurts and he takes his medicine. (AR 128). 

In considering the treatment notes of Dr. Barnett and Plaintiff’s self-reporting of his

headaches, it appears that Plaintiff’s daily activities depend on the severity of his headaches

and that Plaintiff appears to have severe headaches with frequency. Substantial evidence

does not support the ALJ’s decision. The ALJ erred in finding Plaintiff not entirely credible

based on his daily activities. 

C. Remedy

A federal court can affirm, modify, or reverse, with or without remand, a social

security case. 42 U.S.C. § 405(g). When it may be necessary to obtain a vocational expert’s

testimony about the effect of additional limitations on a claimant’s ability to work, remand

is appropriate. See Varney II, 572 F.3d at 597 (In cases “where the testimony of the

vocational expert has failed to address a claimant’s limitations as established by improperly

discredited evidence” the case should be “remanded for further proceedings rather than

payment of benefits” citing Harman v. Apfel, 211 F.3d 1172, 1178-79 (9th Cir. 2000)). A

reviewing court will not reverse an ALJ’s decision for harmless error, which exists when it

is clear from the record that “the ALJ’s error was ‘inconsequential to the ultimate

nondisability determination.’” Robbins v. Soc. Sec. Admin., 466 F.3d 880, 885 (9th Cir.2006),

quoting Stout v. Comm’r. Soc. Sec. Admin., 454 F.3d 1050, 1055-1056 (9th Cir.2006). The

errors in this case were not inconsequential. 

In this case, the ALJ erred in (1) failing to evaluate the medical evidence and opinions

of Plaintiff’s treating physician, Dr. Barnett; (2) in giving little weight to Plaintiff’s mother’s

testimony; (3) in evaluating Plaintiff’s sensitivity to light; (4) in evaluating Plaintiff’s

medical treatment; and (5) in evaluating Plaintiff’s daily activities. None of these errors was

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 31 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 32 -

harmless. These errors require this Court to remand the case back to the ALJ. This Court

will address the remedies for each of the errors infra.

To remedy the ALJ’s failure to consider Dr. Barnett’s medical evidence, Plaintiff

argues Dr. Barnett’s opinions should be credited as a matter of law. There are two remedies

where the ALJ fails to provide adequate reasons for rejecting the opinions of a treating or

examining physician. The general rule, found in the Lester line of cases and cited by

Plaintiff, is that “[courts] credit that opinion as a matter of law.” Lester v. Chater, 81 F.3d

821, 834 (9th Cir.1996); Pitzer v. Sullivan, 908 F.2d 502, 506 (9th Cir.1990); Hammock v.

Bowen, 879 F.2d 498, 502 (9th Cir.1989). There is, however, a Ninth Circuit split in

authority as to whether the ‘credit-as-true’ rule is mandatory or discretionary. Vasquez v.

Astrue, 572 F.3d 586, 593 (9th Cir.2009) (recognizing but declining to address the split in

authority on whether the credit-as-true rule is mandatory or discretionary in context of a

claimant’s subjective pain testimony). The Ninth Circuit specifically chose not to address

the issue of whether courts must apply the credit-as-true rule in cases where outstanding

issues remain before a proper disability determination can be made. Vasquez, 572 F.3d at

593. Another approach found in McAllister v. Sullivan, 888 F.2d 599, 603 (9th Cir.1989),

holds a court may remand to allow the ALJ to provide the requisite specific and legitimate

reasons for disregarding the opinion. 

In this case, outstanding issues remain before a disability determination can be made.

The Court should not credit-as-true Dr. Barnett’s opinions. Dr. Barnett opined that Plaintiff

is disabled and significant treatment notes as well as other evidence in the record including

Plaintiff’s ongoing use of butalbital provide support for that position. However, there were

some significant breaks in treatment with Dr. Barnett and it is unclear how frequently

Plaintiff experiences headaches so severe he must take butalbital. Also, the ultimate decision

on disability is reserved to the Commissioner. The ALJ erred in failing to evaluate the

opinions of Dr. Barnett but further proceedings are appropriate. There may be evidence in

the record to which the ALJ can point to provide the requisite specific and legitimate reasons

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 32 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

3

See The American Society of Health-System Pharmacists, Inc., United States National

Library of Medicine, Medline Plus,

http:www.nlm.nih.gov/medlineplus/druginfo/meds/a601009.html, (Last Reviewed

September 1, 2008). A copy of this web page is attached to this report and

recommendation.

- 33 -

for disregarding the opinions of Dr. Barnett. Then again, there may not. In any event, the

ALJ is in a better position than this court to perform the task. Remand is the appropriate

remedy. 

On remand, the ALJ must consider Dr. Barnett’s treatment notes and then either

accept his opinions or provide specific and legitimate reasons for rejecting Dr. Barnett’s

extensive treatment notes, Dr. Barnett’s opinion that Plaintiff is disabled and his opinion that

Plaintiff is sensitive to loud noises. These opinions must be considered together with the

other substantial evidence in the record. The Court notes other evidence that the ALJ should

specifically consider with Dr. Barnett’s opinions including, Dr. Caffrey’s opinion that

Plaintiff cannot manage his own benefits, Drs. Peck and McCabe’s opinion that Plaintiff was

severely impaired, Mr. Goguen’s opinion that Plaintiff’s multiple moderate limitations

foreclosed on Plaintiff’s ability to work and the letter from Plaintiff’s chiropractor office

manager that Plaintiff appeared significantly impaired by his medication on many visits and

missed multiple appointments. The testimony of Plaintiff and his mother should be

considered as well. 

The Court also recommends the ALJ be required to consider the effects of the

medication taken by Plaintiff. Plaintiff’s regular use of the medication butalbital is welldocumented in Dr. Barnett’s treatment notes. Yet, no discussion of the medication side

effects nor the frequency with which Plaintiff takes this medication was discussed in the

denial of disability. Butalbital is a barbiturate that causes significant side effects including

but not limited to: drowsiness, upset stomach, vomiting, stomach pain, depression,

lightheadedness, confusion.3

 “Butalbital can result in intoxication that is clinically

indistinguishable from that produced by alcohol. Symptoms include sluggishness,

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 33 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

4

 Stephen D. Silberstein, M.D. & Douglas C. McCrory, M.D., Butalbital in the Treatment of

Headache: History, Pharmacology, and Efficacy, Headache. 2001 Nov-Dec; 41(10):953-967

at 955, Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, PA

19107.

- 34 -

incoordination, difficulty thinking, poor memory, slowness of speech and comprehension,

faulty judgment, disinhibition of sexual and aggressive impulses, decreased attention,

emotional lability, and an exaggeration of basic personality traits.”4

 The Court notes Dr.

Caffrey did not account for the effects of medication when she identified the five moderate

limitations Plaintiff had. In contrast, in identifying multiple severe limitations, Drs. Peck and

McCabe noted Plaintiff’s intake of medication to control the symptoms of his headaches. 

Regarding the ALJ’s second error, Plaintiff’s mother’s testimony was given little

weight as “not supported by the objective evidence.” (AR 62). The entire record seems very

consistent with her testimony that Plaintiff has good days and days when he is incapacitated,

particularly the most unbiased information in the record, the letter from the receptionist at

the chiropractor.

On remand, the ALJ must consider Plaintiff’s mother’s testimony in light of the other

evidence in the record including, Dr. Barnett’s medical evidence, the opinion of Dr. Caffrey

that Plaintiff cannot manage his own benefits, and the opinions of Drs. Peck and McCabe as

to Plaintiff’s limitations while on medication. Dr. Barnett’s treatment notes show that

Plaintiff suffered from chronic headaches on a twice-a-week to daily basis. Dr. Barnett

prescribed the barbiturate butalbital to alleviate the symptoms of these headaches. While not

acknowledging Plaintiff takes medication, Dr. Caffrey opined that Plaintiff could not manage

his own benefits. Drs. Peck and McCabe found multiple severe limitations and noted the

significance of Plaintiff’s medication. This evidence supports Plaintiff’s mother’s testimony

that Plaintiff is not functional, is anti-social, and requires assistance when he has a severe

headache and takes his medication. Plaintiff’s mother’s testimony about his daily activities

when he does not have a headache should be considered in the context of how often Plaintiff

has a severe headache requiring medication. 

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 34 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 35 -

Third, the ALJ must provide clear and convincing reasons for discounting Plaintiff’s

credibility about his sensitivity to light or accept his testimony on the matter. Both Plaintiff

and his mother provided detailed testimony about Plaintiff’s sensitivity to light. If the ALJ

credits Plaintiff’s sensitivity, that photosensitivity should then be a limitation presented to

a vocational expert to determine Plaintiff’s ability to work.

Fourth, the ALJ places great weight on the lack of continued treatment. There is no

indication in the record that organic brain damage is curable. The record is clear that the

only relief Plaintiff has ever obtained comes from the barbiturate butalbital. He tried three

different anti-depressants, but in each instance could not continue with the medication

because of adverse side effects. We might speculate that Plaintiff could try safer or better

treatment options, but the record is clear that Plaintiff has determined what he believed is his

best treatment option for chronic debilitative headaches. Continuing with the same course

of treatment for thirteen years is not a lack of seeking treatment.

On remand the ALJ cannot discredit Plaintiff’s testimony, his mother’s testimony, or

the opinions of his examining physicians by stating that Plaintiff has not sought treatment

appropriate for his alleged symptoms. The record shows Plaintiff has seen a treating

physician complaining consistently of chronic headaches, Plaintiff has taken a barbiturate

regularly to combat the symptoms of his headaches, and Plaintiff has not worked since 1997.

All this evidence shows effort on the part of Plaintiff to address his organic brain damage and

the secondary chronic headaches. On remand, the ALJ may require or the Plaintiff may on

his own, provide supplementary medical records or other evidence to show if and how

Plaintiff is addressing the symptoms of his impairments.

Fifth, Plaintiff’s activities must be assessed in the proper context on remand. The

record shows that Plaintiff’s activities, ability to interact with others, and overall ability to

function are directly linked to whether or not he has a severe headache that requires

medication. 

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 35 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 36 -

As discussed supra. the ALJ should clarify how frequently Plaintiff has severe

headaches requiring medication. The ALJ must consider the evidence provided by Plaintiff

and Plaintiff’s mother regarding Plaintiff’s inability to be functional when he has the

headaches and takes the medication. The ALJ must also consider the other evidence in the

record including the letter from the chiropractor’s office stating that Plaintiff often showed

up for his appointments under the influence of medication, Drs. Peck and McCabe’s opinions

about Plaintiff’s severe limitations due, in part, to his medicated state, and Mr. Goguen’s

opinion that Plaintiff’s multiple moderate limitations made him unable to work.

Finally, the Magistrate Judge recommends the ALJ be required to consider other

evidence in the record which generally supports Plaintiff’s position on all five of the alleged

errors. For instance, the ALJ gave “substantial weight” to Dr. Caffrey’s opinion and little

weight to the opinion of Drs. Peck and McCabe “based on the less than credible information

and history by the claimant.” (AR 62). This is based on the dichotomy between Dr. Caffrey,

who found Plaintiff more interpersonally appropriate than expected (AR 60), whereas Peck

and McCabe described Plaintiff as “an overgrown complaining, unhappy, disheveled

individual who has difficulty answering direct questions.” (AR 354). The record is clear

that Plaintiff has good days and bad days. The issue is how many bad days compared to

good days. It is error to credit one expert’s opinion over the other based primarily on

different presentation, particularly where the negative presentation is more consistent with

the record as a whole and the ALJ’s finding that Plaintiff would best work in an environment

“requiring brief, superficial, and intermittent contact with co-workers and the general

public.” (AR 58). Furthermore, the inconsistency in Dr. Caffrey’s test results is never

explained and Dr. Caffrey never considers the side effects of Plaintiff’s medication.

Conversely, the report of Drs. Peck and McCabe is much more detailed and includes more

references to the medical record.

Also concerning to this Court, the ALJ adopts Dr. Schonbrun’s opinion over Dr.

Goguen’s report, even through Dr. Schonbrun identified dishwasher as a possible job, a job

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 36 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 37 -

so obviously inappropriate because of noise, machinery, light, confined space and contact

with people that the Commissioner no longer suggests in his briefing that dishwasher is an

appropriate job. Dr. Goguen’s opinion that five moderate limitations must be considered as

a composite, not independently, in terms of the potential impact on successful chance for

employment was given little weight by the ALJ.

Finally, the ALJ gave no consideration to Dr. Caffrey’s conclusion that Plaintiff could

not manage his own benefits. This troubling conclusion requires consideration by the ALJ

on remand. Also, the ALJ gave conclusive weight to the opinions of Dr. Caffrey and Dr.

Schonbrun, except Dr. Caffrey’s conclusion that Plaintiff cannot handle his benefits, and

little weight to all evidence introduced by Plaintiff. The record does not support those factual

determinations.

III. RECOMMENDATION

The Magistrate Judge recommends that the District Court, after its independent

review, GRANT Plaintiff’s motion and REMAND this case with the instructions outlined

under the remedy section of this report and recommendation. The ALJ’s decision is not

supported by substantial evidence and free of legal error.

Pursuant to 28 U.S.C. § 636(b), any party may serve and file written objections

within fourteen (14) days of being served with a copy of the report and recommendation. 

If objections are not timely filed, they may be deemed waived. The parties are advised

that any objections filed are to be identified with the following case number: CV 08-674-

RCC.

DATED this 15th day of June, 2010.

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 37 of 41
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

- 38 -

ATTACHMENT ONE

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 38 of 41
Acetaminophen, Butalbital, and Caffeine (Print Version): MedlinePlus Drug Information

 

Drug Information: Acetaminophen, Butalbital, and Caffeine

URL of this page: http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601009.html

(a set a mee' noe fen) (byoo tal' bi tal) (kaf' een) 

Why is this medication prescribed?

This combination of drugs is used to relieve tension headaches.

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

How should this medicine be used?

The combination of acetaminophen, butalbital, and caffeine comes as a capsule and tablet to take by mouth. It usually is taken 

every 4 hours as needed. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to 

explain any part you do not understand. Take acetaminophen, butalbital, and caffeine exactly as directed. Do not take more 

than six tablets or capsules in 1 day. If you think that you need more to relieve your symptoms, call your doctor.

This medication can be habit-forming. Do not take a larger dose, take it more often, or for a longer period than your doctor tells 

you to.

What special precautions should I follow?

Before taking acetaminophen, butalbital, and caffeine,

● tell your doctor and pharmacist if you are allergic to acetaminophen, butalbital, caffeine, or any other drugs. 

● tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially 

anticoagulants ('blood thinners') such as warfarin (Coumadin), antidepressants, antihistamines, pain medications, 

sedatives, sleeping pills, tranquilizers, and vitamins. Many nonprescription pain relievers contain acetaminophen. Too 

much of this drug can be harmful. 

● tell your doctor if you have or have ever had liver disease, porphyria, or depression. 

● tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while 

taking this medication, call your doctor. 

● you should know that this drug may make you drowsy. Do not drive a car or operate machinery until you know how this 

drug affects you. 

● remember that alcohol can add to the drowsiness caused by this drug. 

What special dietary instructions should I follow?

Acetaminophen, butalbital, and caffeine may cause an upset stomach. Take this medicine with food or milk.

http://www.nlm.nih.gov/medlineplus/print/druginfo/meds/a601009.html (1 of 3) [6/15/2010 2:51:10 PM]

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 39 of 41
Acetaminophen, Butalbital, and Caffeine (Print Version): MedlinePlus Drug Information

What should I do if I forget a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and 

continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

Acetaminophen, butalbital, and caffeine may cause side effects. Tell your doctor if any of these symptoms are severe or do not 

go away: 

● drowsiness 

● upset stomach 

● vomiting 

● stomach pain 

● depression 

● lightheadedness 

● confusion 

If you experience any of the following symptoms, call your doctor immediately: 

● skin rash 

● itching 

● difficulty breathing 

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) 

MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch] or by phone [1-800-332-1088].

What storage conditions are needed for this medicine?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature, away 

from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to 

your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call 

local emergency services at 911.

What other information should I know?

Keep all appointments with your doctor.

Do not let anyone else take your medication. This medication is a controlled substance. Prescriptions may be refilled only a 

limited number of times; ask your pharmacist if you have any questions.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are 

taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you 

each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of

emergencies.

http://www.nlm.nih.gov/medlineplus/print/druginfo/meds/a601009.html (2 of 3) [6/15/2010 2:51:10 PM]

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 40 of 41
Acetaminophen, Butalbital, and Caffeine (Print Version): MedlinePlus Drug Information

Brand name(s):

● Amaphen® 

● Anoquan® 

● Butace® 

● Endolor® 

● Esgic® 

● Fioricet® 

● Medigesic® 

● Repan® 

Last Reviewed - 09/01/2008

American Society of Health-System Pharmacists, Inc. Disclaimer - http://www.nlm.nih.gov/medlineplus/ashpdisclaimer.html

AHFS® Consumer Medication Information. © Copyright, 2010. The American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, 

Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP. 

http://www.nlm.nih.gov/medlineplus/print/druginfo/meds/a601009.html (3 of 3) [6/15/2010 2:51:10 PM]

Case 4:08-cv-00674-RCC Document 13 Filed 06/15/10 Page 41 of 41