Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_11-cv-02561/USCOURTS-azd-2_11-cv-02561-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:405 Review of HHS Decision (SSID)

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 Citations to “Tr.” are to the administrative transcript, which appears at docket 12. 

WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Delores Jane Clark, 

Plaintiff, 

vs.

Michael J. Astrue, Commissioner of the

Social Security Administration, 

Defendant. 

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No. CV-11-2561-PHX-BSB

ORDER

Delores Jane Clark (Plaintiff) seeks judicial review under 42 U.S.C. § 405(g) of the

final decision of the Commissioner of Social Security (the Commissioner), denying her

application for supplemental security income benefits under the Social Security Act. The

parties have consented to proceed before a United States Magistrate Judge pursuant to 28 U.S.C.

§ 636(b) and have filed briefs in accordance with Local Rule of Civil Procedure 16.1. For the

following reasons, the Court remands this matter for further proceedings. 

I. Procedural Background

 In June 2007, Plaintiff filed an application for supplemental security income, 42

U.S.C. §§ 1381-83f, under Title XVI of the Social Security Act, alleging disability with an onset

date of March 2003. (Tr. 18.1

) After the Social Security Administration denied Plaintiff’s

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

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

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 The ALJ erroneously identified Dr. Tsingine as “Dr. George Tsung.” (Tr. 21.) 

3

 Because the administrative record is not in chronological order, citations to pages in

chronological order are not in numerical order. 

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Plaintiff not disabled under the Social Security Act. (Tr. 30-58.) This decision became the final

decision of the Commissioner of Social Security when the Social Security Administration

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

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

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

II. Medical Record

As set forth in the parties’ briefing, Plaintiff’s application for benefits is based on her

spondyloarthritis (arthritis of the spine) and obesity. The record before the Court establishes

the following chronology of treatment and diagnosis.

A. Treating Physicians at Phoenix Indian Medical Center 

Between June 4, 2007 and July 20, 2009, Plaintiff received treatment at the Phoenix

Indian Medical Center (PIMC) from Georgia L. Tsingine, M.D.,2

 a primary care physician, Lisa

M. Sumner, M.D., a rheumatologist, and Neil Irick, M.D., a pain management specialist . She

was diagnosed with and received treatment for seronegative spondyloarthritis (arthritis of the

spine), obesity, and chronic foot dermatitis and cellulitis. (Tr. 222-475, 603-04, 647-649, 669-

694, 709-716, 731-752, 767-792, 799-806, 813-828, 835-836, 853-856, 879-884, 895-910, 919-

934, 955-970, 987-994, 1003-1062, 1075-1136, 1145-1152, 1163-1172, 1185-1188, 1197-1200,

564-565.3

) 

Plaintiff tested positive for elevated sedimentation rates and C-reactive protein.

(Tr. 489, 488, 486, 484, 483, 482, 337.) Plaintiff’s PIMC treatment notes indicate that she had

persistent severe pain in her back, neck, shoulders, knees and hips, recurring infections on her

feet, numbness and swelling of the feet, cellulitis, difficulty sleeping, and wrist pain. (Tr. 465,

457, 433, 425, 427, 413, 401, 383, 377, 353, 297, 291, 227, 267, 237, 230, 225-26.) Plaintiff

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was prescribed medications including sulfasalazine, MS Contin (morphine), and Percocet.

(Tr. 235, 237, 267, 270, 647.) 

On May 30, 2008, Dr. Sumner noted that Plaintiff presented “with disabling pain but

unclear if this is completely the result of her arthritis. She does appear to have a chronic pain

syndrome that makes it difficult to work.” (Tr. 453.) On March 3, 2009, Dr. Sumner wrote a

one paragraph letter directed “[t]o whom it may concern,” stating that she treats Plaintiff in the

rheumatology clinic for spondyloarthritis and that Plaintiff’s “arthritis in her back and

joints . . . causes considerable pain and disability,” “limits her ability to work[,] and often makes

it difficult for her to get out of bed in the morning.” (Tr. 689.) Dr. Sumner further noted that

she discontinued some of Plaintiff’s medications because of a skin infection, and that her

condition was “not well controlled and she suffers chronic pain in her back, hips, ankles, neck

and knees.” (Id.) 

On July 20, 2009, Dr. Tsingine completed a “Medical Assessment of Ability to Do

Work Related Activities” and found that Plaintiff had significant physical functional limitations.

(Tr. 217-19.) She noted that Plaintiff could lift no more than ten pounds, stand and/or walk less

than two hours in an eight-hour day, and sit less than six hours in an eight-hour day, “less than

[two hours] continuous[ly].” (Tr. 217.) In support of her conclusion, Dr. Tsingine explained

that Plaintiff “has chronic pain limiting standing, sitting, lifting, pushing and pulling. Pain in

neck, shoulder, back . . . .” (Tr. 217.) Dr. Tsingine also completed a pain assessment and found

that Plaintiff had severe pain, and was “[e]xtremely impaired due to pain which precludes ability

to function,” constantly interferes with attention and concentration, and often resulted in failure

to complete tasks in a timely manner. (Tr. 220-21.) Dr. Tsingine explained that she, Dr. Irick

and Dr. Sumner regularly provide treatment and medication to Plaintiff. Dr. Tsingine noted that

Plaintiff was diagnosed with “hypertension, chronic pain syndrome, morbid obesity and

seronegative spondyloarthritis with involvement of pain . . . knee, shoulders, neck, and back

joints.” (Tr. 222.) 

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B. Agency Examining and Non-Examining Physicians 

On August 21, 2007, agency consulting examining physician, David Rand, M.D.,

examined Plaintiff. (Tr. 201-204.) Plaintiff reported a history of a back disorder resulting in

pain and physical limitations for which she took medication. (Tr. 201-202.) On examination,

Dr. Rand noted that Plaintiff was obese and had a limited range of motion in her lumbar spine,

but had full cervical spine range of motion, “normal” joints in her upper and lower extremities

without “erythema” or “deformities,” normal muscle strength, normal sensation, and bilaterally

equal reflexes. (Tr. 202-203.) Dr. Rand concluded that Plaintiff could lift twenty pounds

occasionally and ten pounds frequently, walk, sit, and stand for six hours, perform postural

movements occasionally with the exception of using ropes, ladders, or scaffolds, and frequently

use her upper extremities bilaterally, but should avoid heights and moving machinery. (Tr. 203-

204.) Dr. Rand’s report states that “no x-rays or records are available,” and that his diagnosis

was based on Plaintiff’s reported history and his examination of Plaintiff. (Tr. 204.)

In October 2007, state agency physician M. Miller, M.D., reviewed the medical record

and completed a Physical Residual Functional Capacity Assessment. (Tr. 208-15.) Dr. Miller

determined that Plaintiff retained the physical residual functional capacity to lift and/or carry

twenty pounds occasionally and ten pounds frequently, stand and/or walk and sit about six hours

in an eight-hour day, push and/or pull within her lifting capacity, and climb ramps and stairs,

balance, stoop, kneel, crouch, and crawl occasionally. (Tr. 209-212.) He also found that

Plaintiff could perform work that did not require climbing ladders, ropes, or scaffolds or

concentrated exposure to temperature extremes or hazards such as machinery or heights, and

that Plaintiff had no manipulative, visual, communicative, or other environmental limitations.

(Tr. 209-212.) 

On February 28, 2008, Thomas Glodek, M.D., completed a “Case Analysis” stating

that, “[a]fter a complete review of the file, the prior decision is affirmed.” (Tr. 216.)

Dr. Glodek did not explain his decision or identify the records he reviewed. 

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 Past relevant work is work “done within the last 15 years [that] lasted long enough for

you to learn to do it, and was substantial gainful activity.” 20 C.F.R. § 416.965(a). 

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III. Administrative Hearing Testimony

At the time of the administrative hearing, Plaintiff was in her forties and had an

eleventh grade education. (Tr. 54, 122, 131.) Although Plaintiff held various short-term jobs,

she did not have any past “relevant work” as defined in 20 C.F.R. § 416.965(a).4

 (Tr. 54.)

Plaintiff testified at the administrative hearing that she experienced pain from arthritis in her

hips, back, neck, and shoulders. (Tr. 41-42.) She also testified that she took MS Contin

(morphine) and Percocet daily for pain (Tr. 44-45), and that she suffered from fatigue and rested

for about one-and-one-half hours during the day. (Tr. 48.) 

Vocational expert, David Janus, also testified. The ALJ asked the vocational expert

what work a person could perform if you assume “a person . . . capable of doing light exertional

work, wouldn’t have to lift more than 20 pounds occasionally and up to ten pounds on a more

frequent basis . . . . postural limitations [including] no crawling or crouching or climbing or

squatting or kneeling, and . . . no use of feet for pushing or pulling of foot or leg controls. Add

a sit/stand option so the employee could alternate between sitting and standing and still perform

the job duties.” (Tr. 55.) The vocational expert responded that a person with those limitations

could perform work as an assembler, parking lot cashier, and packer. (Id.) In response to a

hypothetical including the limitations that Dr. Tsingine assessed (Tr. 220-222), the vocational

expert testified that sustained work would be precluded. (Tr. 57.) 

IV. The ALJ’s Decision

A claimant is considered disabled under the Social Security Act if he is unable “to

engage in any substantial gainful activity by reason of any medically determinable physical or

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

expected to last for a continuous period of not less than 12 months.” 42 U.S.C. § 423(d)(1)(A);

see also 42 U.S.C. § 1382c(a)(3)(A) (nearly identical standard for supplemental security income

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disability insurance benefits). To determine whether a claimant is disabled, the ALJ uses a fivestep sequential evaluation process. See 20 C.F.R. §§ 404.1520, 416.920. 

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

(1) that he is not presently engaged in a substantial gainful activity, and (2) that his disability

is severe. 20 C.F.R. § 404.1520(a)-(c). If a claimant meets steps one and two, he may be found

disabled in two ways at steps three and four. At step three, he may prove that his impairment

or combination of impairments meets or equals an impairment in the Listing of Impairments

found in Appendix 1 to Subpart P of 20 C.F.R. pt. 404. 20 C.F.R. § 404.1520(a)(4)(iii). If so,

the claimant is presumptively disabled. If not, the ALJ proceeds to step four. At step four, a

claimant must prove that his residual functional capacity (RFC) precludes him from performing

his past work. 20 C.F.R. § 404.1520(a)(4)(iv). If the claimant establishes this prima facie case,

the burden shifts to the government at step five to establish that the claimant can perform other

jobs that exist in significant number in the national economy, considering the claimant’s RFC,

age, work experience, and education. If the government does not meet this burden, then the

claimant is considered disabled within the meaning of the Social Security Act. 

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

not engaged in substantial gainful activity during the relevant period. (Tr. 20.) At step two, the

ALJ found that Plaintiff had “spondyloarthritis and morbid obesity,” “which are severe when

considered in combination.” (Id.) At the third step, the ALJ found that the severity of

Plaintiff’s impairments did not meet or medically equal the criteria of an impairment listed in

20 C.F.R. Part 404, Subpart P, Appendix 1. (Id.) At step four, the ALJ concluded that Plaintiff

retains “the residual functional capacity to perform light work with restrictions as defined in 20

C.F.R. § 416.967(b). She requires a sit/stand option and should do no crawling, climbing,

squatting, kneeling, and no pushing or pulling with her lower extremities.” (Tr. 21.) The ALJ

concluded that Plaintiff had no past relevant work as defined in 20 C.F.R. § 416.965. (Tr. 22.)

At step five, the ALJ found that considering Plaintiff’s age, education, work experience and

RFC, she could perform “jobs that exist in significant numbers in the national economy.”

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(Tr. 23.) The ALJ concluded that Plaintiff was not disabled within the meaning of the Social

Security Act. (Id.) 

V. Standard of Review 

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

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

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

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

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

is free from legal error. Smolen v. Chater, 80 F.3d 1273, 1279 (9th Cir. 1996); Ryan v. Comm’r

of Soc. Sec. Admin., 528 F.3d 1194, 1198 (9th Cir. 2008). 

Even if the ALJ erred, however, “[a] decision of the ALJ will not be reversed for

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

evidence means more than a mere scintilla, but less than a preponderance; it is “such relevant

evidence as a reasonable mind might accept as adequate to support a conclusion.” Richardson

v. Perales, 402 U.S. 389, 401 (1971) (citations omitted); see also Webb v Barnhart, 433 F.3d

683, 686 (9th Cir. 2005). 

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

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

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

omitted). The court also may not “affirm the ALJ’s . . . decision based on evidence that the ALJ

did not discuss.” Connett v. Barnhart, 340 F.3d 871, 874 (9th Cir. 2003); see also SEC

v. Chenery Corp., 332 U.S. 194, 196 (1947) (emphasizing the fundamental rule of

administrative law that a reviewing court “must judge the propriety of [administrative] action

solely by the grounds invoked by the agency” and stating that if “those grounds are inadequate

or improper, the court is powerless to affirm the administrative action by substituting what it

considers to be a more adequate or proper basis.”). 

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 For example, the Commissioner cites “a plethora . . . of favorable objective findings”

(Doc. 24 at 12) such as “normal strength, sensation and reflexes and absence of spinal

tenderness.” (Doc. 24 at 4-5, 8-9, 12, 20-21.) The Commissioner also argues that the

medication Plaintiff took for pain was effective and that an “impairment which can reasonably

be alleviated by treatment cannot serve as a basis for a finding of disability.” (Doc. 24 at 9.)

The ALJ did not advance that rationale in support of his determination. (Tr. 18-22.) 

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The ALJ is responsible for resolving conflicts in testimony, determining credibility,

and resolving ambiguities. See Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir. 1995). “When

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

defer to the ALJ’s conclusion.” Batson v. Comm’r of Soc. Sec. Admin., 359 F.3d 1190, 1198

(9th Cir. 2004) (citing Andrews, 53 F.3d at 1041). 

VI. Discussion

Plaintiff asserts that the ALJ erred by (1) rejecting the treating physicians’

assessments, (2) assigning significant weight to Dr. Rand’s report, which was based on a “onetime agency examination,” and (3) rejecting Plaintiff’s symptom testimony without providing

clear and convincing reasons for doing so. Plaintiff asks the Court to remand her case for a

determination of benefits. (Doc. 20.) In response, the Commissioner argues that the ALJ’s

decision is free from legal error and is supported by substantial evidence in the record.

(Doc. 24.) The Commissioner’s response, however, includes rationale and citations to the

medical record in support of the ALJ’s determination that the ALJ did not make or discuss in

his opinion.5

 This Court’s review is limited to “reasons and factual findings offered by the

ALJ — not post hoc rationalizations that attempt to intuit what the adjudicator may have been

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

Accordingly, the Court limits its analysis to the rationale and facts upon which the ALJ relied

in determining that Plaintiff was not disabled. See Connett, 340 F.3d at 874. 

A. Weighing Medical Source Evidence

In weighing medical source evidence, the Ninth Circuit distinguishes between three

types of physicians: (1) treating physicians, who treat the claimant; (2) examining physicians,

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who examine but do not treat the claimant; and (3) non-examining physicians, who neither treat

nor examine the claimant. Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995). Generally, more

weight is given to a treating physician’s opinion. Id. The ALJ must provide clear and

convincing reasons supported by substantial evidence for rejecting a treating or an examining

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

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

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

record. Bayliss v. Barnhart, 427 F.3d 1211, 1216 (9th Cir. 2005); Reddick, 157 F.3d at 725. 

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

or examining physicians. See Hill v. Astrue, 698 F.3d 1153, 1160 (9th Cir. 2012) (citing Lester,

81 F.3d at 831). However, an ALJ must evaluate the opinions from such sources and explain

the weight given to them. Social Security Ruling (SSR) 96-6p, 1996 WL 374180, at *2.

Although an ALJ generally gives more weight to an examining physician’s opinion than to a

non-examining physician’s opinion, a non-examining physician’s opinion may nonetheless

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

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

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

the quality of the explanation provided; the consistency of the medical opinion with the record

as a whole; [and] the specialty of the physician providing the opinion.” Orn, 495 F.3d at 631.

B. The ALJ’s Rationale for Rejecting the Treating Physicians’ Opinions

Plaintiff argues that the ALJ erred by rejecting the assessments of treating physicians

Dr. Tsingine and Dr. Sumner in favor of the opinion of examining physician Dr. Rand. The

ALJ stated that he “gave no weight to” Dr. Sumner’s March 10, 2009 assessment that Plaintiff

was “totally disabled.” (Tr. 21, 689.) The ALJ also stated that he “gave no weight to”

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 Respondents are correct that the ALJ is not bound by a physician’s opinion on the

ultimate issue of disability. See Magallenes v. Bowen, 881 F.2d 747, 751 (9th Cir. 1989) (a

treating physician’s opinion is not necessarily conclusive as to the ultimate issue of disability).

7

 The Court need not determine whether the more demanding “clear and convincing”

standard applies because the ALJ failed to meet the lesser “specific and legitimate” standard.

 

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Dr. Tsingine’s July 2009 Medical Source Statement that found Plaintiff “totally disabled.”6

(Tr. 21, 220-21.) In contrast, the ALJ gave “significant weight” to examining physician

Dr. Rand’s assessment that Plaintiff could perform “light exertion with postural and

environmental limitations.” (Doc. 21, 201-04.) The ALJ explained that the treating physicians’

opinions (1) were “inconsistent with the objective findings or the record as a whole,” and

(2) “appear[ed to be] based almost wholly upon the claimant’s subjective complaints without

any independent corroborative objective medical evidence.” (Tr. 21.) Plaintiff argues that the

ALJ was not qualified to independently judge the sufficiency of the objective findings in the

record, gave legally insufficient, “vague boilerplate” reasons for rejecting the treating

physicians’ assessments, and unfairly rejected the treating physicians’ assessments because they

were based on Plaintiff’s reported symptoms. (Tr. 20 at 16-18.)

When there is a conflict between the opinions of a treating physician and an

examining physician, the ALJ may disregard the opinion of the treating physician only if he sets

forth “specific and legitimate reasons supported by substantial evidence in the record for doing

so.” Lester, 81 F.3d at 830; see also Cotton v. Bowen, 799 F.2d 1403, 1408 (9th Cir.1986). The

ALJ can meet this burden “by setting out a detailed and thorough summary of the facts and

conflicting clinical evidence, stating his interpretation thereof, and making findings.” Reddick,

157 F.3d at 725. As discussed below, the ALJ failed to meet this burden.7

1. Independently Judged Medical Evidence

Plaintiff first argues that because the ALJ lacks medical expertise, he erred by judging

“the sufficiency of the objective findings in the record.” (Doc. 20 at 16.) As Plaintiff notes, an

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ALJ may not substitute his own opinion for the findings and opinion of a physician. See

Gonzalez Perez v. Sec’y of Health and Human Servs., 812 F.2d 747, 749 (1st Cir. 1987); see

also McBrayer v. Sec’y of Health and Human Servs., 712 F.2d 795, 799 (2d Cir. 1983) (ALJ

cannot arbitrarily substitute own judgment for competent medical opinion). While the ALJ may

not base his decision on “his own expertise,” he may “choose between properly submitted

medical opinions.” Gober v. Matthews, 574 F.2d 772, 777 (3d Cir. 1978). Here, the ALJ

considered the medical opinions and, although the Court finds that he did not provide legally

sufficient reasons for rejecting the treating physicians’ opinions in favor of the examining

physician’s opinion, as discussed in Sections B.2, B.3 and B.4 below, the ALJ did not err by

substituting his own opinions.

2. Boilerplate Rationale

Plaintiff next argues that the ALJ’s “vague boilerplate” rationale is legally insufficient

for rejecting the treating physicians’ assessments. (Doc. 20 at 16-17.) The Court agrees. See

Embrey v. Bowen, 849 F.2d 418, 421 (9th Cir. 1988) (“[t]o say that medical opinions are not

supported by sufficient objective findings or are contrary to the preponderant conclusions

mandated by the [required] objective findings does not achieve the level of specificity”). The

ALJ gave “no weight” to the assessments of treating physicians Tsingine and Sumner because

they were “inconsistent with the objective findings or the record as a whole.” (Tr. 21.) The

ALJ’s opinion, however, includes a very limited discussion of the medical record. 

The opinion notes Plaintiff’s history of seronegative spondyloarthritis, her diagnoses

of osteoarthritis in her right knee, hypertension, and obesity, and her complaints of low back and

left shoulder pain. (Id.) The ALJ opined that the record contains “very little evidence of

treatment,” that Plaintiff “received conservative treatment,” and that examining physician

Dr. Rand noted that Plaintiff had a “normal gait.” (Id.) The ALJ, however, does not sufficiently

identify the “objective findings” or other record evidence with which the treating physicians’

opinions were inconsistent. 

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The ALJ must do more than offer his conclusions. “He must set forth his own

interpretations and explain why they, rather than the doctors’ are correct.” Embrey, 849 F.2d

at 422. The ALJ did not give sufficient specific and legitimate reasons, let alone “clear and

convincing” reasons, for rejecting the assessment of Plaintiff’s treating rheumatologist

Dr. Sumner, that Plaintiff’s “arthritis in her back and joints . . . causes considerable pain and

disability,” “limits her ability to work[,] and often makes it difficult for her to get out of bed in

the morning.” (Tr. 689.) Similarly, the ALJ did not sufficiently explain why he gave no weight

to Dr. Tsingine’s detailed assessment of Plaintiff’s capacity for standing, lifting, carrying, and

sitting. The ALJ erred in this regard. 

3. Inconsistency with Objective Findings

As previously noted, the ALJ rejected the assessments of treating physicians Sumner

and Tsingine in favor of the assessment of examining agency physician Dr. Rand. (Tr. 21, 201-

04.) The ALJ noted that Dr. Rand’s one-time physical examination of Plaintiff was

“unremarkable,” that he “diagnosed ankylosing spondylitis by history and obesity,” and

concluded that Plaintiff could “perform light exertion with postural and environmental

limitations.” (Tr. 21, 201-04.) The ALJ gave “significant weight” to Dr. Rand’s conclusions

“because he examined the claimant and his conclusions are consistent with the objective

findings and the evidence of record.” (Tr. 21.) The ALJ did not identify the objective findings

or other record evidence supporting Dr. Rand’s opinion. 

The ALJ also failed to explain the differences between Dr. Rand’s one-time

examination and the examinations that Plaintiff’s treating rheumatologist and primary care

doctor conducted. “[I]t is incumbent on the ALJ to provide detailed, reasoned, and legitimate

rationales for disregarding the physicians’ findings.” Embrey, 849 F.2d at 422 (citing Cotton,

799 F.2d at 1408). The ALJ erred by not providing such rationale in this case. See McAllister

v. Sullivan, 888 F.2d 599, 602 (9th Cir.1989) (rejection of treating physician’s opinion on the

ground that it was contrary to the clinical findings in the record and the claimant’s activities and

interests did not satisfy ALJ’s burden because such reasons were “broad and vague, failing to

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specify why the ALJ felt the treating physician’s opinion was flawed”); Franco v. Astrue, 2012

WL 3192110, *5-6 (W.D. Wash. July 13, 2012) (finding ALJ’s rejection of treating physician’s

opinion on the ground that it was not “consistent with the objective medical evidence” was

legally insufficient where ALJ listed a few objective findings and a lay statement that plaintiff

did not use her cane all of the time). 

4. Assessments based on Subjective Complaints 

Plaintiff also contends that it was “unfounded and unfair” for the ALJ to reject the

treating physicians’ opinions because they were based on Plaintiff’s subjective complaints.

Plaintiff argues that a patient’s reports of complaints and medical history are essential diagnostic

tools. (Doc. 20 at 17.) The ALJ rejected Dr. Tsingine’s and Dr. Sumner’s assessments because

they “appear[ed to be] based almost wholly upon the claimant’s subjective complaints,” which

the ALJ found were not credible. (Tr. 21-22.) 

A physician’s reliance on the subjective complaints of a properly -discredited claimant

can, in some circumstances, be a legitimate basis for disregarding that physician’s opinion. An

ALJ, however, does not provide legally sufficient “reasons for rejecting an examining

physician’s opinion by questioning the credibility of a patient’s complaints where the doctor

does not discredit those complaints and supports his ultimate opinion with his own

observations.” Ryan v. Comm’r of Soc. Sec., 528 F.3d 1194, 1199–1200 (9th Cir. 2008); see

also Morgan v. Apfel, 169 F.3d 595, 602 (9th Cir. 1999) (“A physician’s opinion of disability

‘premised to a large extent upon the claimant’s own accounts of his symptoms and limitations’

may be disregarded where those complaints have been ‘properly discounted.’”) (quoting Fair

v. Bowen, 885 F.2d 597, 605 (9th Cir. 1989)). Here, Dr. Sumner and Dr. Tsingine did not

discredit Plaintiff’s subjective complaints; thus, the ALJ erred in rejecting the treating

physicians’ assessments on the basis that they appeared to be based on Plaintiff’s subjective

reports. 

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 As Plaintiff notes, the ALJ also mentioned the assessment forms completed by

consulting physicians in October 2007, which found Petitioner capable of performing “light

exertion with postural and environmental limitations.” (Tr. 21.) However, because the ALJ did

not state that his opinion was based on those assessments, the Court will not further discuss

them. (See Tr. 21 (citing hearing exhibit 3F, Dr. Glodek’s October 2007 assessment, located

at Tr. 207-15)).

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C. Weight Assigned to Examining Physician’s Opinion 

Plaintiff next argues that the ALJ erred in assigning “significant weight” to the report

of consultative examining physician Dr. Rand and considering that report as substantial

evidence to reject the treating physicians’ opinions and to support his disability determination.8

Plaintiff contends that Dr. Rand’s report does not constitute substantial evidence because the

report does not “even mention review of any background medical information,” which is in

violation of the applicable regulations, and because it is not based on independent findings.

(Doc. 20 at 18 (citing 20 C.F.R. § 416.919n(c)(3)-(4))). 

When a consultative examining physician bases his opinion on independent clinical

findings, such findings are substantial evidence. Orn, 495 F.3d at 632. “Independent clinical

findings can be either (1) diagnoses that differ from those offered by another physician and that

are supported by substantial evidence . . . , or (2) findings based on objective medical tests that

the treating physician has not herself considered[.]” Id. (citation omitted); see also Tonapetyan

v. Halter, 242 F.3d 1144, 1149 (9th Cir. 2001) (consultative examining physician’s opinion on

its own constituted substantial evidence because it rested on the physician’s independent

examination of the plaintiff). 

However, when the diagnoses of the treating physician and the examining physician

are the same but their conclusions about the claimant’s functional limitations differ, the

examining physician’s opinion based on his examination is not considered an “independent

finding,” and the physician’s “opinion does not alone constitute substantial evidence to support

the rejection of [the claimant’s] treating physicians’ opinions.” Orn, 495 F.3 at 633 (because

examining physician’s diagnoses were the same as those of the treating physicians, and only his

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conclusions differed, examining physician’s “conclusion concerning [the plaintiff’s] ability to

stand or walk based on that examination was not an ‘independent finding,” and his opinion does

not alone constitute substantial evidence to support the rejection of [the plaintiff’s] treating

physicians’ opinions.”).

The record reflects that during his one-time examination of Plaintiff, Dr. Rand

obtained a medical history from Plaintiff. She discussed her x-rays and the magnetic resonance

imaging that her treating physicians considered when diagnosing her with ankylosing

spondylitis. (Tr. 201.) Plaintiff described her symptoms and daily activities, and identified her

current medications. (Id.) Dr. Rand performed a physical examination and stated that, based

on Plaintiff’s reported history and his examination, he diagnosed “ankylosing spondylitis” and

“obesity.” (Tr. 203-04.) 

Dr. Rand’s diagnosis does not substantially differ from Dr. Sumner’s or

Dr. Tsingine’s. Additionally, the Commissioner’s response does not identify any specific

independent clinical findings supporting Dr. Rand’s opinion or describe how Dr. Rand’s

examination differed from those performed by Plaintiff’s treating physicians. Plaintiff and the

Commissioner agree that Dr. Rand relied on the same clinical findings, as reported by Plaintiff,

and gave the same diagnoses as the treating physicians, but differed in his conclusions regarding

Plaintiff’s functional limitations. (Doc. 20 at 18, Doc. 24 at 15.) In such a case, the examining

physician’s conclusion based on his examination of Plaintiff was not an “‘independent finding,’

and his opinion does not alone constitute substantial evidence to support the rejection of [the

plaintiff’s] treating physicians’ opinions.” Orn, 495 F.3d at 633 (emphasis added).

Accordingly, the ALJ erred in concluding that Dr. Rand’s report alone constituted substantial

evidence in support of the ALJ’s disability determination. 

Plaintiff argues that because Dr. Rand’s report does not constitute “substantial

evidence,” there is no substantial evidence in the record that could support the ALJ’s disability

determination and the Court should remand for a determination of benefits. Although

Dr. Rand’s report standing alone does not constitute substantial evidence, it may be considered

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such evidence in conjunction with other record evidence. As previously discussed, the ALJ did

not adequately discuss and evaluate the medical record, including Dr. Tsingine’s and

Dr. Sumner’s assessments, and the Court declines to speculate whether substantial evidence

would support the ALJ’s disability determination reached after sufficient consideration and

discussion of the medical record. 

D. Credibility of Plaintiff’s Reported Pain and Symptoms

1. The Two-Step Analysis

An ALJ engages in a two-step analysis to determine whether a claimant’s testimony

regarding subjective pain or symptoms is credible. Lingenfelter v. Astrue, 504 F.3d 1028,

1035–36 (9th Cir. 2007). “First, the ALJ must determine whether the claimant has presented

objective medical evidence of an underlying impairment ‘which could reasonably be expected

to produce the pain or other symptoms alleged.’” Id. at 1036 (quoting Bunnell v. Sullivan, 947

F.2d 341, 344 (9th Cir. 1991) (en banc)). The claimant is not required to show objective

medical evidence of the pain itself or of a causal relationship between the impairment and the

symptom. Smolen, 80 F.3d at 1282. Instead, the claimant must only show that an objectively

verifiable impairment “could reasonably be expected” to produce his pain. Lingenfelter, 504

F.3d at 1036 (quoting Smolen, 80 F.3d at 1282); see also SSR 96–7p at 2; Carmickle v. Comm’r

of Soc. Sec., 533 F.3d at 1160–61 (9th Cir. 2008) (“requiring that the medical impairment ‘could

reasonably be expected to produce’ pain or another symptom . . . requires only that the causal

relationship be a reasonable inference, not a medically proven phenomenon”).

If a claimant shows that he suffers from an underlying medical impairment that could

reasonably be expected to produce his pain or other symptoms, the ALJ must “evaluate the

intensity and persistence of [the] symptoms” to determine how the symptoms, including pain,

limit the claimant’s ability to work. See 20 C.F.R. § 404.1529(c)(1). In making this evaluation,

the ALJ may consider the objective medical evidence, the claimant’s daily activities, the

location, duration, frequency, and intensity of the claimant’s pain or other symptoms,

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precipitating and aggravating factors, medication taken, and treatments for relief of pain or other

symptoms. See 20 C.F.R. § 404.1529(c); SSR 96–7p at 3; Bunnell, 947 F.2d at 346.

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

the severity of his symptoms only if the ALJ “makes a finding of malingering based on

affirmative evidence,” Lingenfelter, 504 F.3d at 1036 (quoting Robbins v. Soc. Sec. Admin., 466

F.3d 880, 883 (9th Cir. 2006)), or if the ALJ offers “clear and convincing reasons” for finding

the claimant not credible. Carmickle, 533 F.3d at 1160 (quoting Lingenfelter, 504 F.3d at

1036).

2. Plaintiff’s Pain and Symptoms

Here, the parties do not dispute that Plaintiff produced evidence that her medically

determinable impairments could reasonably be expected to cause her alleged symptoms and the

ALJ did not find that Plaintiff was malingering. The ALJ, however, did not find that Plaintiff’s

testimony was credible. The ALJ stated that he “g[a]ve no weight to [Plaintiff’s] pain testimony

because it is not consistent with the objective findings or the record as a whole.” (Tr. 21.) He

further stated, “I cannot rely on the claimant’s testimony as establishing greater limitations than

those set forth above because her statements are not entirely credible.” (Id. at 22.) The parties

dispute whether the ALJ offered legally sufficient reasons in support of his determination that

Plaintiff’s testimony regarding her pain and limitations was not credible. 

Relying on the Ninth Circuit decision in Bunnell, the Commissioner initially argues

that an ALJ need not provide “clear and convincing” reasons for discrediting a claimant’s

testimony regarding subjective symptoms, and instead must merely make findings “properly

supported by the record [and] sufficiently specific to allow a reviewing court to conclude the

adjudicator rejected the claimant’s testimony on permissible grounds and did not arbitrarily

discredit a claimant’s testimony regarding pain.” Bunnell, 947 F.2d at 345–46 (citation omitted).

In Bunnell, the Court did not apply the “clear and convincing” standard, and the Commissioner

argues that because no subsequent en banc court has overturned Bunnell, its standard remains

the law of the Ninth Circuit. (Doc. 24 at 16-17.) Although the Ninth Circuit has not overturned

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Bunnell, subsequent cases have elaborated on its holding and have accepted the clear and

convincing standard. See Taylor v. Comm’r of Soc. Sec. Admin., 659 F.3d 1228, 1234 (9th Cir.

2011); Vasquez v. Astrue, 572 F.3d 586, 591 (9th Cir. 2009); Lingenfelter, 504 F.3d at 1036;

Reddick, 157 F.3d at 722; Swenson v. Sullivan, 876 F.2d 683, 687 (9th Cir. 1989). Accordingly,

the Court will determine whether the ALJ provided clear and convincing reasons for

discounting Plaintiff’s credibility.

Here, the ALJ rejected Plaintiff’s pain testimony because it was “not consistent with

the objective findings or the record as a whole.” (Tr. 21.) As Plaintiff argues, this justification

for rejecting Plaintiff’s testimony is insufficient because the Ninth Circuit recognizes that an

ALJ may not reject a claimant’s testimony regarding the severity of his subjective symptoms,

including pain, on the ground that no objective medical evidence supported that testimony. See

Robbins v. Soc. Sec. Admin., 466 F.3d 880, 884 (9th Cir. 2006) (ALJ’s rejection of claimant’s

testimony because it was “not consistent with or supported by the overall medical evidence of

record” is the type of justification the Ninth Circuit has recognized as prohibited by the social

security regulations) (citing SSR 96-7p); Light v. Soc. Sec. Admin., 119 F.3d 789, 792 (9th Cir.

1997) (same). Additionally, although “[c]ontradiction with the medical record is a sufficient

basis for rejecting the claimant’s subjective testimony,” the ALJ’s inadequate discussion of the

medical record and failure to identify any contradictions between Plaintiff’s testimony and the

relevant medical evidence impedes the Court’s ability to evaluate the ALJ’s credibility

determination. See Carmickle v. Comm’r of Soc. Sec. Admin., 533 F.3d 1155, 1161 (9th Cir.

2008) (citing Johnson v. Shalala, 60 F.3d 1428, 1434 (9th Cir. 1995)).

The ALJ also rejected Plaintiff’s pain testimony because there was “very little

evidence of treatment,” and because Plaintiff “does not receive ongoing care and when treated,

she received only conservative treatment.” (Tr. at 21-22.) “Although a conservative course of

treatment can undermine allegations of debilitating pain, such fact is not a proper basis for

rejecting the claimant’s credibility where the claimant has a good reason for not seeking more

aggressive treatment.” Orn, 495 F.3d at 638. Here, the ALJ did not provide a narrative of the

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medical record and did not identify the treatment he considered conservative. The lack of such

a discussion prevents the Court from meaningfully assessing the legitimacy of the ALJ’s

adverse credibility determination based on the nature of treatment Plaintiff received. See

Robbins, 466 F.3d at 884 (even when ALJ gives “facially legitimate” reasons in support of an

adverse credibility determination, “a complete lack of meaningful explanation gives th[e] court

nothing with which to assess its legitimacy”). 

The ALJ also rejected Plaintiff’s pain testimony because she did not seek “out

treatment modalities that alleviate . . . severe and unremitting pain” and did not use a TENS

unit, cane, walker, wheelchair, or heating pad. (Tr. 21-22.) The record, however, indicates that

Plaintiff took medication for pain, including Percocet, MS Contin, and sulfasalazine. (Tr. 44-45,

237, 267.) Additionally, Plaintiff received treatment from pain specialist Dr. Irick at PIMC.

(Tr. 222.) There is no evidence in the record that Plaintiff was prescribed a TENS unit, cane,

walker, wheelchair, or directed to use a heating pad and thus the ALJ’s speculation that Plaintiff

should have used those or other “treatment modalities”is not a clear and convincing reason for

discounting her credibility. See Santiago v. Astrue, 2010 WL 466052, *17 (D. Ariz. Feb. 10,

2010) (ALJ improperly discounted plaintiff’s credibility because she did not use biofeedback,

acupuncture, or a TENS unit because there was no evidence that those modalities had been

prescribed).

 In further support of his rejection of Plaintiff’s pain testimony, the ALJ found that

Plaintiff was uncooperative during Dr. Rand’s examination because she refused to walk on her

toes or heels, or squat. (Tr. 22.) Dr. Rand, however, did not report that Plaintiff was

uncooperative, but rather that she “refused” to perform certain actions “because of back and leg

pain.” (Tr. 202.) In rejecting Plaintiff’s pain testimony because she refused to do certain things

during Dr. Rand’s examination, the ALJ also disregarded Dr. Tsingine’s July 2009 treatment

notes stating that Plaintiff was “unable to walk on toes, heels . . . squat 20%.” (Tr. 226.) 

Finally, the ALJ discounted Plaintiff’s credibility based on her activities of daily

living, including caring for her three children ages eight, eighteen and twenty-two, performing

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 These errors were not harmless because the vocational expert testified that the

limitations assessed by Dr. Tsingine would preclude work and Plaintiff testified to limitations

that would preclude sustained work. (Tr. 48, 57.) 

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“household chores, grocery shopp[ing], r[unning] errands (doctors’ appointments, AFDC

appointments), and us[ing] public transportation.” (Doc. 22.) These limited activities standing

alone do not support the ALJ’s rejection of Plaintiff’s pain testimony. See Vertigan v. Halter,

260 F.3d 1044, 1050 (9th Cir. 2001) (stating that “the mere fact that a plaintiff has carried on

certain daily activities . . . does not in any way detract from her credibility as to her overall

disability”). Considering the Court’s previous finding that the ALJ failed to properly consider

and discuss the medical opinion evidence and the medical record, the ALJ should reconsider

Plaintiff’s credibility especially because his adverse credibility determination was largely based

on unspecified inconsistencies between Plaintiff’s testimony and “the objective findings or the

record as a whole.” (Tr. 21.)

VII. Remand

Having found that the ALJ erred by failing to give sufficiently specific reasons for

rejecting the assessments of Plaintiff’s treating physicians Sumner and Tsingine, considering

the report of examining physician Rand “substantial evidence” in support of the ALJ’s nondisability determination, and failing to provide clear and convincing reasons for rejecting

Plaintiff’s symptom testimony, the Court must determine whether to remand for a determination

of benefits or for further proceedings.9

 Smolen, 80 F.3d at 1292. “[R]emand for further

proceedings is unnecessary if the record is fully developed and it is clear from the record that

the ALJ would be required to award benefits.” Holohan v. Massanari, 246 F.3d 1195, 1210 (9th

Cir. 2001). Specifically, benefits should be awarded when (1) the ALJ has failed to provide

legally sufficient reasons for rejecting [the claimant’s] evidence, (2) there are no outstanding

issues that must be resolved before a determination of disability can be made, and (3) it is clear

from the record that the ALJ would be required to find the claimant disabled were such evidence

credited. Smolen, 80 F.3d at 1292. 

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However, “[r]emand for further proceedings is appropriate where there are outstanding

issues that must be resolved before a determination can be made, and it is not clear from the

record that the ALJ would be required to find claimant disabled if all the evidence were properly

evaluated.” Hill, 2012 WL at *8 (citing Vasquez v. Astrue, 572 F.3d 586, 593 (9th Cir. 2009)).

Additionally, when an ALJ fails to “give sufficiently specific reasons for rejecting the

conclusion of [a physician],” it is proper to remand the matter for “proper consideration of the

physicians’ evidence.” See Embrey, 849 F.2d at 422 (remanding for further proceedings when

ALJ rejected opinion of treating physician but did not relate objective factors on which he relied

to reject the opinion); see also Nguyen v. Chater, 100 F.3d 1462, 1464-65 (9th Cir. 1996)

(remanding for further proceedings where ALJ failed to “set forth specific, legitimate reasons”

for crediting opinion of nonexamining consultant over that of examining psychologist).

Accordingly, the Court exercises its discretion and remands this matter to the ALJ for

further proceedings and consideration of the record because “[t]here may be evidence in the

record to which the [ALJ] can point to provide the requisite” reasons for rejecting the opinions

of Dr. Tsingine and Dr. Sumner and for discounting Plaintiff’s credibility and the “Secretary

is in a better position than this court to perform this task.” See McAllister v. Sullivan, 888 F.2d

599, 603 (9th Cir. 1989) (remanding to allow the Secretary to review the record and provide

legally sufficient reasons for rejecting the treating physician’s report and, alternatively,

permitting the Secretary to award benefits). 

Accordingly,

IT IS ORDERED that the decision of the Commissioner is REVERSED and this

matter is REMANDED to the ALJ for further proceedings consistent with this Order. The

Clerk of Court is directed to terminate this action.

 DATED this 23rd day of January, 2013.

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