Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_17-cv-01453/USCOURTS-casd-3_17-cv-01453-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:0405id Review of HHS Decision (SSID)

---

1

3:17-cv-1453-CAB-PCL

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

UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF CALIFORNIA

GLORY J. AMBRIZ,

Plaintiff,

v.

NANCY A. BERRYHILL, Acting 

Commissioner of Social Security,

Defendant.

Case No.: 3:17-cv-1453-CAB-PCL

REPORT AND RECOMMENDATION 

OF U.S. MAGISTRATE JUDGE RE: 

PLAINTIFF'S MOTION FOR 

SUMMARY JUDGMENT AND 

DEFENDANT'S CROSS MOTION FOR 

SUMMARY JUDGMENT

I. INTRODUCTION

Before the Court now is Plaintiff GLORY J. AMBRIZ (“Plaintiff”), seeking 

judicial review of a decision by the Social Security Administration regarding Plaintiff’s 

application for supplemental security income benefits (“SSI”) pursuant to 42 U.S.C. § 

405(g). (Doc. 1.) Plaintiff has filed a motion for summary judgment. (Doc. 14.) 

Defendant NANCY A. BERRYHILL (“Commissioner”) filed an opposition to Plaintiff’s 

motion concurrently with her own cross-motion for summary judgment. (Doc. 18.) 

The Honorable Cynthia A. Bashant has referred the matter to the undersigned 

Judge for Report and Recommendation pursuant to 28 U.S.C. § 636(b)(1)(B) and Local 

Civil Rule 72.1(c)(1)(d). Having carefully considered the motions, pleadings, and 

administrative record lodged in this case, the Court recommends Commissioner’s motion 

Case 3:17-cv-01453-CAB-PCL Document 21 Filed 05/11/18 PageID.<pageID> Page 1 of 20
2

3:17-cv-1453-CAB-PCL

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

for summary judgment be GRANTED and Plaintiff’s motion for summary judgment be 

DENIED.

II. FACTUAL BACKGROUND

On December 10, 2012, Plaintiff applied for SSI. (Administrative Record (AR) at 

192.) At that time, Plaintiff was 18 years old. (Id.) In this original application, Plaintiff 

claims she is qualified to receive SSI because she is disabled as a result of the following 

ailments: fibromyalgia, chronic fatigue syndrome, dysmenorrhea, xenotropic murine 

leukemia virus (XMRV), mitochondrial myopathy, a weakened immune system, and 

chronic infections. (Id. at 212.)

Plaintiff recalls her medical issues beginning when she was scratched by a cat in 

third grade, from which she contracted mononucleosis. (Id. at 41, 440.) After recovering 

from this illness, Plaintiff was hospitalized intermittently throughout the following year 

as a result of “elevated liver levels.” (Id.) In sixth grade, Plaintiff contracted 

mononucleosis once again. (Id. at 42.) In that same year, Plaintiff was diagnosed with 

XMRV. (Id. at 291, 367, 440.) This retrovirus, similar to HIV, caused Plaintiff to have a 

severely weakened immune system. To accommodate her newly weakened immune 

system, Plaintiff left public school and began a homeschooling program. (Id. at 440.) 

In the years that followed, Plaintiff has been tested for a myriad of autoimmune 

diseases and other conditions in order to diagnose and treat her various complaints. (See, 

e.g., id.) These tests led medical professionals to believe Plaintiff suffers from both 

chronic fatigue syndrome as well as fibromyalgia. (Id. at 259, 312.) Plaintiff was also 

diagnosed with severe dysmenorrhea at the age of 12. (Id. at 312.) At some point, 

Plaintiff was diagnosed also with mitochondrial myopathy. (Id. at 322.) On May 25, 

2013, after having received all of these diagnoses and been prescribed various 

medications to alleviate the worst symptoms, Plaintiff presented at a psychiatric 

consultative examination complaining of depression. (Id. at 315.) Plaintiff stated the 

combination of her medical conditions and the restraints the conditions impose upon her

//

Case 3:17-cv-01453-CAB-PCL Document 21 Filed 05/11/18 PageID.<pageID> Page 2 of 20
3

3:17-cv-1453-CAB-PCL

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

life were the cause of her depression. (Id. at 316.) Prior to this examination, Plaintiff had 

been prescribed both Ambien and Zoloft to address her depression symptoms. (Id.) 

As a result of Plaintiff’s medical conditions, Plaintiff is essentially homebound. On 

most days, Plaintiff states she is in too much pain or too uncomfortable to do more than 

simple tasks around the house. These tasks include laundry, straightening up her 

bedroom, and working in the kitchen. On better days, Plaintiff can complete these tasks 

alone; but more often than not, Plaintiff requires assistance to do so. (See, e.g., id. at 44.) 

Although Plaintiff can leave her home, she chooses not to do so very frequently. Plaintiff 

generally does not leave her home for two reasons. First, Plaintiff lives in constant 

apprehension of a “flare up,” meaning when Plaintiff will be overcome with pain or 

discomfort such that she must immediately return home to rest. Plaintiff stated she does 

not have much warning of these flare ups before they occur. Secondly, Plaintiff has a 

significantly weakened immune system, which makes her especially susceptible to 

contracting any viruses which may be present in any environment Plaintiff enters. (Id. at 

232.) When Plaintiff does leave her home, she is able to drive, but Plaintiff prefers to 

have another person with her in case she has a flare up while she is away from the home. 

(Id. at 42-43.) Plaintiff primarily goes grocery shopping and to the movie theatre with her 

boyfriend on her excursions away from home. 

At one point in 2011, Plaintiff did obtain employment at an art store, where 

Plaintiff performed data entry in the back room of the store. (Id. at 39.) Plaintiff also 

would bring products from the storeroom to the front of the store for others. (Id.) 

However, after three eight-hour workdays, Plaintiff was not able to continue the 

employment. (Id.) Plaintiff stated she was “okay for about a day, and then after that [she] 

was so tired [she] couldn’t wake up on time.” (Id.) After these three days of working, 

Plaintiff took three and a half weeks to recover back to what she considers “normal.” (Id.)

Currently, Plaintiff is not employed. Plaintiff resides with her boyfriend at his 

parents’ residence in San Diego. Plaintiff obtained her GED, but she is unable to 

complete college courses – even those online prove too physically demanding. (Id. at 38-

Case 3:17-cv-01453-CAB-PCL Document 21 Filed 05/11/18 PageID.<pageID> Page 3 of 20
4

3:17-cv-1453-CAB-PCL

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

39.) In order to ensure Plaintiff is able to go about her daily routine, Plaintiff is on a 

robust regimen of medications. These medications, as of May 8, 2015, included: four 

medications for both food and environmental allergies, sleeping medications, birth 

control to alleviate the dysmenorrhea, fibromyalgia medication, two medications for pain, 

nausea medication, medication to address familial Mediterranean virus, and depression 

medication. (Id. at 255.) 

III. ADMINISTRATIVE PROCEEDINGS

Plaintiff filed this application for SSI on December 10, 2012. (Id. at 192.) The 

application was initially rejected by the Social Security Administration on June 28, 2013. 

(Id. at 91-92.) The reason cited for this rejection was that Plaintiff’s “condition result[s] 

in some limitations in [Plaintiff’s] ability to perform work related activities but does not 

prevent [Plaintiff] from working.” (Id. at 92.) Plaintiff requested her case be reconsidered 

by sending a letter on August 14, 2013. (Id. at 96.) In this letter, Plaintiff argued the 

denial of her application was incorrect because Plaintiff is “disabled and [in] poor health 

due to all of [her] medical conditions [which] affect[] every aspect of [Plaintiff’s] daily 

life.” (Id.)

On November 20, 2013, the Social Security Administration reviewed Plaintiff’s 

case, and found the first decision was correctly made. (Id. at 97.) Again, the 

Administration found Plaintiff’s “condition is not severe enough to keep [Plaintiff] from 

working.” (Id.) Upon this denial, Plaintiff requested a de novo hearing for review by an 

Administrative Law Judge (ALJ) on January 17, 2014. (Id. at 102.) On May 12, 2015, 

Plaintiff received notice that her hearing was scheduled on July 20, 2015. (Id. at 139.) 

During this hearing, technical difficulties complicated the proceedings and the ALJ also 

determined the hearing was being held in an improper venue. (Id. at 61-63.) The hearing 

was terminated upon a motion being made to transfer Plaintiff’s case to the proper venue. 

(Id.)

On January 6, 2016, Plaintiff received another hearing before a different ALJ who 

heard Plaintiff’s testimony. (Id. at 35-53.) After this hearing, the ALJ rendered an 

Case 3:17-cv-01453-CAB-PCL Document 21 Filed 05/11/18 PageID.<pageID> Page 4 of 20
5

3:17-cv-1453-CAB-PCL

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

unfavorable decision, denying Plaintiff’s application. (Id. at 14-26.) Specifically, the ALJ 

issued the following findings of fact and conclusions of law:

1. The claimant has not engaged in substantial gainful activity since 

November 28, 2012, the application date. 

2. The claimant has the following severe impairments: fibromyalgia; 

history of chronic fatigue syndrome; and history of dysmenorrhea.

3. The claimant does not have an impairment or combination of 

impairments that meets or medically equals the severity of one of the listed 

impairments in 20 CFR Part 404, Subpart P, Appendix 1.

4. After careful consideration of the entire record, I find that the claimant 

has the residual functional capacity to perform the full range of light work as 

defined in 20 CFR 416.967(b).

5. The claimant has no past relevant work.

6. The claimant was born on February 10, 1994 and was 18 years old, 

which is defined as a younger individual age 19-49, on the date the 

application was filed.

7. The claimant has at least a high school education and is able to 

communicate in English.

8. Transferability of job skills is not an issue because the claimant does 

not have past relevant work.

9. Considering the claimant’s age, education, work experience, and 

residual functional capacity, there are jobs that exist in significant numbers 

in the national economy that the claimant can perform.

10.The claimant has not been under a disability, as defined in the social 

Security Act, since November 28, 2012, the date the application was filed.

(Id. at 19-26.)

Upon receipt of this unfavorable decision, Plaintiff appealed to the Appeals 

Council on March 25, 2016. (Id. at 189.) On May 16, 2017, the Appeals Council 

considered Plaintiff’s appeal, as well as new evidence submitted, but ultimately found 

there was no basis for changing the ALJ’s denial of Plaintiff’s application for SSI. (Id. at 

1-6.) Plaintiff then filed the instant case in this Court on July 18, 2017. (Doc. 1.) 

Commissioner filed an answer and lodged the administrative record on October 30, 2017. 

(Docs. 11, 12.) Following this, each party submitted its own motion for summary 

judgment: Plaintiff filed hers on December 7, 2017, and Commissioner filed hers on 

January 2, 2018. (Docs. 14, 18.) These cross motions are now before the Court.

Case 3:17-cv-01453-CAB-PCL Document 21 Filed 05/11/18 PageID.<pageID> Page 5 of 20
6

3:17-cv-1453-CAB-PCL

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

IV. STANDARD OF REVIEW

The decision that a claimant is not disabled will be upheld if the findings of fact 

are supported by substantial evidence in the record and the proper legal standards were 

applied. Schneider v. Comm'r of the Soc. Sec. Admin., 223 F.3d 968, 973 (9th Cir. 2000); 

Morgan v. Comm'r of the Soc. Sec. Admin., 169 F.3d 595, 599 (9th Cir. 1999); Tackett v. 

Apfel, 180 F.3d 1094, 1097 (9th Cir. 1999).

The findings of the ALJ as to any fact, if supported by substantial evidence, are 

conclusive. See Miller v. Heckler, 770 F.2d 845, 847 (9th Cir. 1985). Substantial 

evidence is more than a mere scintilla, but less than a preponderance. Saelee v. Chater, 

94 F.3d 520, 521 (9th Cir. 1996). "'It means such evidence as a reasonable mind might 

accept as adequate to support a conclusion.'" Richardson v. Perales, 402 U.S. 389, 401

(1971) (quoting Consol. Edison Co. v. N.L.R.B., 305 U.S. 197, 229 (1938)).

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

testimony, and resolving ambiguities. Edlund v. Massanari, 253 F.3d 1152, 1156 (9th 

Cir. 2001). "Where the evidence is susceptible to more than one rational interpretation, 

one of which supports the ALJ's decision, the ALJ's conclusion must be upheld." Thomas 

v. Barnhart, 278 F.3d 947, 954 (9th Cir. 2002).

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 v. Chater,

80 F.3d 1273, 1282 (9th Cir. 1996). Instead, the claimant must only show that an 

objectively verifiable impairment "could reasonably be expected" to produce his pain." 

Lingenfelter, 504 F.3d at 1036 (quoting Smolen, 80 F.3d at 1282); see also Carmickle v. 

Case 3:17-cv-01453-CAB-PCL Document 21 Filed 05/11/18 PageID.<pageID> Page 6 of 20
7

3:17-cv-1453-CAB-PCL

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

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").

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

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

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

the symptoms, including pain, limit the claimant's ability to work. See 20 C.F.R. § 

404.1529(c)(1). In making this evaluation, the ALJ may consider the objective medical 

evidence, the claimant's daily activities, the location, duration, frequency, and intensity of 

the claimant's pain or other symptoms, precipitating and aggravating factors, medication 

taken, and treatments for relief of pain or other symptoms. See 20 C.F.R. § 404.1529(c); 

Bunnell, 947 F.2d at 346.

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

the severity of her symptoms only if the ALJ "makes a finding of malingering based on 

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

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

reasons" for finding the claimant not credible. Carmickle, 533 F.3d at 1160 (quoting 

Lingenfelter, 504 F.3d at 1036).

IV. DISCUSSION

The ALJ found Plaintiff has the following severe impairments: fibromyalgia,

history of chronic fatigue syndrome, and history of dysmenorrhea. (Id.) The ALJ further 

concluded Plaintiff had additional impairments which are non-severe. These conditions 

include: recurrent sinus infections, asthma, obesity, depression disorder, and anxiety 

disorder. (Id. at 19-20.) The ALJ deemed these conditions non-severe because they “do 

not more than minimally affect” Plaintiff’s ability to perform basic work activities. (Id., 

emphasis in original.) The ALJ did not categorize Plaintiff’s XMRV as either severe or 

//

Case 3:17-cv-01453-CAB-PCL Document 21 Filed 05/11/18 PageID.<pageID> Page 7 of 20
8

3:17-cv-1453-CAB-PCL

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

non-severe. The ALJ also determined Plaintiff’s impairments did not meet or medically 

equal the severity of one of the listed impairments in the regulations. (Id. at 21.)

Finally, the ALJ made a finding that Plaintiff “has the residual functional capacity 

to perform the full range of light work” as set out in the regulations. (Id.) In making this 

finding, the ALJ “considered all symptoms and the extent to which [they] can reasonably 

be accepted as consistent with the objective medical evidence and other evidence, . . . .” 

(Id.) Specifically, the ALJ noted Plaintiff presented “very little objective evidence” to 

support her testimony of being in almost constant pain. (Id. at 23.) Instead of showing 

any signs of the extreme pain Plaintiff complained of, Plaintiff’s numerous 

comprehensive physical examinations produced results which the ALJ considered 

“otherwise unremarkable” in that they showed no symptoms other than tenderness in 

areas complained of. (Id.) Based on this, the ALJ found Plaintiff was not disabled and 

therefore denied her application. (Id. at 25.)

Plaintiff argues summary judgment is appropriate because the ALJ’s denial of 

Plaintiff’s application, finding Plaintiff was not in fact disabled, lacked “the support of 

substantial evidence” and ultimately rested “upon error of law.” (Doc. 14-1 at 10.) 

Specifically, Plaintiff argues the ALJ erred in not believing Plaintiff’s testimony 

concerning her pain and fatigue. (Id. at 10-11.) Instead, the ALJ found there was no 

objective evidence supporting Plaintiff’s claims of pain and fatigue, which, according to 

Plaintiff, meant the ALJ incorrectly ignored the medical diagnostic testing. (Id.) Initially, 

Plaintiff sought judicial review of the ALJ’s decision based on the following grounds: (1) 

there being no substantial medical or vocational evidence to support the ALJ’s conclusion 

Plaintiff is not disabled; (2) no substantial evidence supports the finding that Plaintiff can 

perform any substantial gainful activity; (3) the evidence only shows Plaintiff has been, 

and continues to be, disabled under the Social Security Act; and (4) new evidence 

warrants a remand for further proceedings. (Doc. 1 at 2-3.)

Contrarily, Commissioner seeks summary judgment on the grounds that the ALJ 

properly evaluated Plaintiff’s complaints in light of her subjective testimony and the 

Case 3:17-cv-01453-CAB-PCL Document 21 Filed 05/11/18 PageID.<pageID> Page 8 of 20
9

3:17-cv-1453-CAB-PCL

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

XMRV diagnosis. (Doc. 17 at 13-14.) Commissioner argues that in considering all the 

factors of Plaintiff’s complaints, the ALJ properly weighed the evidence and properly 

determined Plaintiff’s residual functional capacity. (Id.) According to Commissioner, 

Plaintiff is mistaken because the ALJ’s conclusion was not reached based on faulty 

premises. (Id.) 

A. Classification of Plaintiff as not disabled

The ALJ found, after considering Plaintiff’s alleged disabling conditions, the 

related testimony, and all the medical evidence, that Plaintiff has a residual functional 

capacity to perform the full range of light work. (AR at 25.) Given this finding, the ALJ 

found Plaintiff is not in fact disabled, though she is afflicted by severe medical 

conditions. Plaintiff disputes this and claims “the evidence in the record supports only the 

finding that [P]laintiff is disabled.” (Doc. 1 at 3.) The Court will consider each condition 

deemed severe by the ALJ in turn.

1. Fibromyalgia 

Ninth Circuit cases have determined that fibromyalgia can be disabling. In Benecke 

v. Barnhart, 379 F.3d 587, 589-90 (9th Cir. 2004), the Ninth Circuit described 

fibromyalgia as follows:

Fibromyalgia, previously called fibrositis, [is] a rheumatic disease that 

causes inflammation of the fibrous connective tissue components of 

muscles, tendons, ligaments, and other tissue. See, e.g., Lang v. Long-Term 

Disability Plan of Sponsor Applied Remote Tech, Inc., 125 F.3d 794, 796 

(9th Cir. 1997); Brosnahan v. Barnhart, 336 F.3d 671, 672 n. 1 (8th Cir. 

2003). Common symptoms, . . . , include chronic pain throughout the body, 

multiple tender points, fatigue, stiffness, and a pattern of sleep disturbance 

that can exacerbate the cycle of pain and fatigue associated with this disease. 

See Brosnahan, 336 F.3d at 672 n. 1; Cline v. Sullivan, 939 F.2d 560, 563 

(8th Cir. 1991). Fibromyalgia's cause is unknown, there is no cure, and it is 

poorly understood within much of the medical community. The disease is 

diagnosed entirely on the basis of patients' reports of pain and other 

symptoms. The American College of Rheumatology issued a set of agreedupon diagnostic criteria in 1990, but to date there are no laboratory tests to 

confirm the diagnosis. See Jordan v. Northrop Grumman Corp., 370 F.3d 

869, 872 (9th Cir. 2004); Brosnahan, 336 F.3d at 672 n. 1.

Case 3:17-cv-01453-CAB-PCL Document 21 Filed 05/11/18 PageID.<pageID> Page 9 of 20
10

3:17-cv-1453-CAB-PCL

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

Id.; see also Harman v. Apfel, 211 F.3d 1172 (9th Cir. 2000) (reversing ALJ decision 

denying benefits for fibromyalgia); Bunnell, 947 F.2d 341 (upholding benefits for 

fibrositis, now known as fibromyalgia). Jordan v. Northrop Grumman Corp., 370 F.3d 

869, 877 (9th Cir. 2003), a case in which benefits were denied for fibromyalgia, 

recognized that the accepted diagnostic test is that Plaintiff must have pain in 11 of 18 

tender points. See also Rollins v. Massanari, 261 F.3d 853, 855 (9th Cir. 2001) (11 of 18 

tender points). 

a. Plaintiff’s medical history

Dr. Amal Mehta treated Plaintiff from June 18, 2013 to September 29, 2014. (AR 

542-554.) At Plaintiff’s initial consultation with Dr. Mehta, Plaintiff reported she had 

been previously diagnosed with fibromyalgia. (Id. at 554.) During the time Dr. Mehta 

treated Plaintiff, Plaintiff’s medical records continued to reflect this diagnosis of 

fibromyalgia; however, nowhere in the records is it indicated that Dr. Mehta undertook to 

perform the tender point test on Plaintiff to confirm the diagnosis. (See id. at 542-554.)

Also during this time, Plaintiff was being treated by Physician Assistants Shana 

Forsman and Chondra Shanks at Neighborhood Healthcare in Temecula, California. On 

January 20, 2014, P.A. Forsman first noted Plaintiff’s fibromyalgia in the assessment 

section of the medical record, indicating the condition was a current rather than a “past 

diagnosis.” (Id. at 505.) Also during this appointment, P.A. Forsman prescribed Norco 

tablets to Plaintiff to alleviate the pain associated with the fibromyalgia. (Id.) Finally, 

P.A. Forsman requested a second opinion from a rheumatologist regarding this diagnosis. 

In the same medical office, P.A. Shanks also examined Plaintiff on September 30, 2014. 

(Id. at 477.) During this appointment, eight months after the appointment with P.A.

Forsman, P.A. Shanks included in her notes a reminder to obtain the recommendations 

from the rheumatologist. (Id.) These medical records do not indicate either P.A. Forsman 

or P.A. Shanks performed the diagnostic tender points test on Plaintiff at any point; 

instead, the diagnosis simply appears in the records, likely as a result of Plaintiff 

reporting the diagnosis, beginning on January 20, 2014. 

Case 3:17-cv-01453-CAB-PCL Document 21 Filed 05/11/18 PageID.<pageID> Page 10 of

 20
11

3:17-cv-1453-CAB-PCL

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

About one year later, Plaintiff finally underwent a diagnostic test during a 

consultation with Dr. David J. Smith. Plaintiff, during an examination on February 23, 

2015, had pain in 12 out of the 18 “trigger points.” (Id. at 445.) Despite this pain, during 

a later consultation with Nurse Practitioner Timothy Lazarek on March 9, 2015, less than 

one month after the positive test, N.P. Lazarek noted Plaintiff “has no difficulty 

performing daily activities.” (Id. at 571.) Instead, Plaintiff’s pain on a one to ten scale is a 

five; she has morning stiffness in her neck and back which lasts for about 30 minutes

after waking up; and her fatigue is moderate. (Id.) 

b. ALJ’s opinion

In his opinion, the ALJ noted the numerous medical professionals’ observations 

that Plaintiff’s overall ability to function and complete day to day tasks was not impaired 

by her fibromyalgia. (Id. at 24.) In fact, Plaintiff “indicated that she could open jars; write 

legibly; turn door knobs; reach overhead; reach her back pocket; put on socks; climb 

stairs; and walk long distances.” (Id.) The ability to complete these tasks clearly 

distinguishes Plaintiff’s case from those where fibromyalgia makes daily activities 

practically impossible. See, e.g., Benecke, 370 F.3d 587, 590-593 (describing the 

plaintiff’s medical history which included consulting with numerous doctors, missing 

work due to symptoms, seeking treatment through medications, physical therapy, 

massage treatments, and a support group, and so on, and not being able to perform menial 

tasks regularly). 

In this case, Plaintiff initially was deemed able to function by N.P. Lazarek. (Id. at 

571.) This was also the conclusion of Dr. Smith on May 22, 2015, (Id. at 654, “[Plaintiff] 

feels that the current treatment plan [Norco tablets] is effective for her and that although 

she [is] not pain free[,] she is able to function independently”), June 19, 2015, (Id. at 650 

(same)), July 22, 2015, (Id. at 646 (same)), August 24, 2015, (Id. at 642 (same)), 

September 23, 2015, (Id. at 637 (same)), and October 23, 2015, (Id. at 632 (same)). Thus, 

while Plaintiff was in fact diagnosed with fibromyalgia, there is significant evidence in 

the record that her diagnosis does not prevent her from performing regular daily 

Case 3:17-cv-01453-CAB-PCL Document 21 Filed 05/11/18 PageID.<pageID> Page 11 of

 20
12

3:17-cv-1453-CAB-PCL

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

activities. It follows then, that while fibromyalgia may be considered a severe 

impairment, the condition does not automatically render a person disabled. See Benecke, 

370 F.3d 587, 589-90. Such is the situation in Plaintiff’s case.

2. Chronic Fatigue Syndrome

Cases in the Ninth Circuit have found chronic fatigue syndrome ("CFS") to be 

disabling. Reddick v. Chater, 157 F.3d 715, 724, 729 (9th Cir. 1998) (CFS); Wilson v. 

Comm'r, 303 Fed. Appx. 565, 567 (9th Cir. 2008) (fibromyalgia and CFS); Smolen, 80 

F.3d at 1284 (chronic fatigue and pain). Chronic fatigue or CFS is defined as "selfreported persistent or relapsing fatigue lasting six or more consecutive months." Reddick, 

157 F.3d at 726.

In Salomaa v. Honda Long Term Disability Plan, 642 F.3d 666 (9th Cir. 2011), the 

Ninth Circuit addressed a similar situation and explained CFS and its diagnostic 

procedure as follows:

[T]he final denial emphasized Salomaa's normal objective findings, 

and that there was "no underlying condition, such as cancer or HIV disease" 

to explain his fatigue or weight loss. These reasons were illogical, because 

such objective measures as blood tests are used to rule out alternative 

diseases, not to establish the existence of chronic fatigue syndrome. There is 

no blood test or other objective laboratory test for chronic fatigue syndrome. 

As we said in Friedrich v. Intel Corp.[, 181 F.3d 1105 (9th Cir. 1999)], the 

condition "does not have a generally accepted 'dipstick' test" and "[t]he 

standard diagnosis technique for [chronic fatigue syndrome] includes testing, 

comparing symptoms to a detailed Centers for Disease Control list of 

symptoms, excluding other possible disorders, and reviewing thoroughly the 

patient's medical history."

As we said in dicta in a fibromyalgia case, "if the administrator had 

said, 'we will not accept fibromyalgia as a diagnosis unless you present 

objective evidence of it such as positive findings on x-rays,' she would have 

been demanding what cannot exist. . . ." We now establish as holding what 

was then dicta, that conditioning an award on the existence of evidence that 

cannot exist is arbitrary and capricious.

Id. at 677 (emphasis added) (citations omitted).

//

Case 3:17-cv-01453-CAB-PCL Document 21 Filed 05/11/18 PageID.<pageID> Page 12 of

 20
13

3:17-cv-1453-CAB-PCL

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

Here, the ALJ found that although Plaintiff had seen numerous different doctors 

for the “same complaints of fatigue and pain all over,” the multiplicity of tests run on 

Plaintiff, including x-rays, MRIs, and CT scans “have consistently been within normal 

limits.” (AR at 23.) The ALJ focused on the lack of objective medical evidence showing 

Plaintiff was in fact severely affected by CFS. (Id.) However, the ALJ was mistaken in 

searching for such objective evidence because no such evidence exists in any case. 

Salomaa, 637 F.3d at 968-69 (recognizing the Center for Disease Control’s definition of 

chronic fatigue system, which notes in part that there are no “diagnostic tests for this 

condition [that] have been validated in scientific studies.”). Thus, the Court is not 

concerned whether the ALJ was correct in finding Plaintiff’s CFS was severe, because 

the ALJ was not proper in focusing his analysis of Plaintiff’s disability status on the lack 

of objective medical evidence. A lack of objective evidence, as presented here, is not an 

absolute indicator of a person’s ability or disability. (Id.).

3. Dysmenorrhea

Dysmenorrhea is the medical term for pain experienced during menstruation. 

Wright v. Colvin, 2016 U.S. Dist. LEXIS 87561 at *4 n.2 (D. Or. July 6, 2016). In a May 

16, 2013, report following an examination done for the purposes of this application, Dr. 

Bryan To found Plaintiff had a history of severe dysmenorrhea, which had been 

diagnosed when Plaintiff was 12 years old. (AR at 312.) In order to treat this, Dr. To 

noted Plaintiff has been prescribed multiple different birth controls as well as pain killers. 

(Id.) However, no course of action has been able to alleviate Plaintiff’s symptoms. 

The ALJ found this diagnosis of dysmenorrhea to be a severe impairment. (Id. at 

19.) However, the ALJ further found that while severe, Plaintiff’s dysmenorrhea does not 

prove a disabling impairment. (Id. at 25.) In reaching this conclusion, the ALJ notes that 

while Plaintiff has been working regularly with a gynecologist in order to alleviate this 

pain, Plaintiff’s gynecological exam on March 3, 2015 had been “unremarkable.” (Id. at 

24, citing id. at 586-588.) Especially significant is that during this new patient 

//

Case 3:17-cv-01453-CAB-PCL Document 21 Filed 05/11/18 PageID.<pageID> Page 13 of

 20
14

3:17-cv-1453-CAB-PCL

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

examination, nowhere in the record did Plaintiff’s new gynecologist record Plaintiff’s 

diagnosis of dysmenorrhea. 

4. Discussion

The ALJ appears to have misunderstood the nature of plaintiff's severe

impairments. CFS and fibromyalgia would not be expected to reduce muscle strength or 

produce abnormal neurological findings; indeed, the diseases are not diagnosed on the 

basis of objective criteria. See Benecke, 379 F.3d at 594 (holding that ALJ erred in 

effectively requiring 'objective' evidence for a disease that eludes such measurement); 

Cook v. Liberty Life Assur. Co. of Boston, 320 F.3d 11, 21 (1st Cir. 2003) (requiring 

objective documentation of chronic fatigue syndrome is unreasonable); Mitchell v. 

Eastman Kodak Co., 113 F.3d 433 (3rd Cir.1997) (same). As Plaintiff's chief complaints, 

CFS and fibromyalgia, as well as dysmenorrhea, understandably cannot be supported by 

objective medical findings, the ALJ's determination of Plaintiff’s credibility is crucial to 

determining whether Plaintiff is entitled to benefits.

An ALJ determines whether a disability applicant is credible, and the court defers 

to the ALJ's discretion if the ALJ used the proper process and provided proper reasons. 

See, e.g., Saelee, 94 F.3d at 522. If credibility is critical, the ALJ must make an explicit 

credibility finding. Albalos v. Sullivan, 907 F.2d 871, 873-74 (9th Cir. 1990); Rashad v. 

Sullivan, 903 F.2d 1229, 1231 (9th Cir. 1990) (requiring explicit credibility finding to be 

supported by "a specific, cogent reason for the disbelief"). In evaluating whether 

subjective complaints are credible, the ALJ may consider: (1) the applicant's reputation 

for truthfulness, prior inconsistent statements or other inconsistent testimony, (2) 

unexplained or inadequately explained failure to seek treatment or to follow a prescribed 

course of treatment, and (3) the applicant's daily activities. Smolen, 80 F.3d at 1284. A 

failure to seek treatment for an allegedly debilitating medical problem may be a valid 

consideration by the ALJ in determining whether the alleged associated pain is not a 

significant nonexertional impairment. See Flaten v. Secretary of HHS, 44 F.3d 1453, 

1464 (9th Cir. 1995).

Case 3:17-cv-01453-CAB-PCL Document 21 Filed 05/11/18 PageID.<pageID> Page 14 of

 20
15

3:17-cv-1453-CAB-PCL

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

Here, the ALJ provided reasons for his determination that plaintiff was not 

credible. (See AR at 23, “. . . the [Plaintiff]’s statements concerning the intensity,

persistence and limiting effects of these symptoms are not entirely credible.”) First, in 

recent consultations with various doctors, Plaintiff “reported no difficulty performing 

daily activities.” (Id.) In fact, Plaintiff noted she was able to “open jars, write legibly, turn 

door knobs, reach overhead, reach her back pocket, put on socks, climb stairs, and walk 

long distances.” (Id.) Similarly, in a recent gynecologist appointment, Plaintiff failed to 

mention her dysmenorrhea altogether. (See AR 584-588.) Second, the ALJ noted that 

while examinations had shown tenderness on specific trigger points, further examination 

of Plaintiff’s spine showed Plaintiff had a full range of motion, she had full muscle 

strength, and she had no tenderness or swelling of any joints. (Id.) Plaintiff also showed 

no signs of connective tissue disease or inflammatory arthropathy. (Id.) Lastly, the ALJ 

determined Plaintiff’s testimony was not consistent with the medical evidence. (Id.)

While the ALJ’s second and third reasons are questionable in light of Plaintiff’s 

conditions eluding objective testing, the ALJ’s first reason, Plaintiff’s conflicting 

statements, is significant and sufficient to find Plaintiff is not credible. Here, the ALJ 

took into account Plaintiff’s prior statements to medical professionals that Plaintiff had 

little trouble performing day to day tasks. As noted in Smolen, an applicant’s daily 

activities and inconsistent testimony are available for use in determining Plaintiff’s 

credibility. 80 F.3d at 1284. According to Plaintiff’s own statements, Plaintiff is able to 

go about regular tasks during the day. (See also AR 632-54, where during numerous 

appointments, Plaintiff stated she was not completely pain free, but felt the treatment plan

was working and she could function independently.) Additionally, given Plaintiff had 

told doctors she was able to do so, Plaintiff’s later testimony before the ALJ is 

inconsistent. During her testimony, Plaintiff described pain as follows:

It’s the pain that it’s – it’s just everywhere. It’s in my back. It’s in my hands. 

Sometimes I can’t hold pencils. It’s just everywhere, my knees, my feet, all 

of my joints, and then the fatigue I don’t have. I – I feel as though I don’t 

have as much energy as everybody else. I feel like I get worn out so much 

Case 3:17-cv-01453-CAB-PCL Document 21 Filed 05/11/18 PageID.<pageID> Page 15 of

 20
16

3:17-cv-1453-CAB-PCL

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

faster just doing anything normal that somebody else would be able to do. 

And like doing dishes I – I can’t stand there that long. It hurts my back. I 

have to stop and go sit down, or lay down, and finish it later. I can’t sit there 

and do the whole task at the same time.

(Id. at 43-33.)

As part of the overall disability analysis, the ALJ must consider whether there are 

any inconsistencies in the evidence, such as Plaintiff's inconsistent statements. See 20 

C.F.R. § 404.1529(c)(4) (stating that an ALJ must consider "whether there are any 

inconsistencies in the evidence."); Social Security Ruling 96-7p, 1996 SSR LEXIS 4, 

1996 WL 374186, at *5 (stating that a strong indicator of the credibility an individual's 

statements is their consistency, both internally and with other information in the record); 

Webb v. Barnhart, 433 F.3d 683, 688 (9th Cir. 2005) ("Credibility determinations do bear 

on evaluations of medical evidence when an ALJ is presented with conflicting medical 

opinions or an inconsistency between a claimant's subjective complaints and his 

diagnosed condition."). Thus, the ALJ properly considered Plaintiff's inconsistent 

statements and inconsistencies between her statements and the medical record when 

assessing her credibility. The ALJ provided clear and convincing reasons for finding

Plaintiff's testimony to be not credible. (AR at 23.) Thus, the ALJ’s ruling that Plaintiff 

was not disabled was appropriate because the ALJ properly considered Plaintiff’s 

testimony in light of the nature of her conditions and the ALJ provided clear and 

convincing reasons for finding Plaintiff to not be credible.

B. XMRV Diagnosis

Plaintiff also argues the ALJ improperly ignored her diagnoses of XMRV.1(Doc. 

14-1 at 8-10.) Specifically, Plaintiff contends because the “ALJ did not state clear and 

 

1 Plaintiff does not explicitly make this argument, but Plaintiff’s entire motion for summary judgment 

(Doc. 14-4), focuses primarily on Plaintiff’s XMRV. So much so, in fact, that Plaintiff’s motion hardly 

mentions Plaintiff’s other conditions. The Court therefore addresses XMRV on its own in this section to 

determine whether the ALJ erred in not addressing XMRV such that the ALJ would have found Plaintiff 

disabled had he considered the XMRV.

Case 3:17-cv-01453-CAB-PCL Document 21 Filed 05/11/18 PageID.<pageID> Page 16 of

 20
17

3:17-cv-1453-CAB-PCL

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

convincing reasons for rejecting the complaints of pain and limitation” as well as 

rejecting the “inference that [Plaintiff] lacked the capacity for sustained exertion at any 

level in light of the diagnostic XMRV finding,” the ALJ’s determining Plaintiff is not 

disabled was erroneous. (Doc. 14-1 at 10.) Given this ultimate determination, Plaintiff 

seems to believe that had the ALJ considered her XMRV diagnosis, the ALJ’s decision 

would have been different.

Commissioner denies this argument made by Plaintiff and instead claims the ALJ 

was justified in his decision because multiple examining medical professionals had not 

necessarily taken notice or emphasized this diagnosis. (See Doc. 17 at 14-15.) 

Additionally, there is nothing in the record to support the claim that XMRV limits 

Plaintiff from performing substantial gainful activity. In fact, in making this claim, 

Plaintiff cited a medical journal article which Commissioner argues stands for the 

opposite of Plaintiff’s claim. (Id.) Given the simple lack of evidence presented regarding 

Plaintiff’s XMRV diagnosis, Commissioner argues “there is nothing in the evidence 

suggesting that the ALJ should have considered XMRV any more than Plaintiff’s own 

physicians did.” (Id. at 15.)

Plaintiff was first tested for XMRV on August 24, 2010. (Id. at 291.) She received 

a positive result on September 19, 2010. (Id.) On May 16, 2013, Dr. To issued a report to 

the Comissioner regarding Plaintiff, wherein Dr. To discussed each of Plaintiff’s 

ailments. (Id. at 308-314.) Nowhere in this report is Plaintiff’s XMRV mentioned. 

In his ruling, the ALJ briefly mentions Plaintiff’s diagnosis with XMRV. (Id. at 

22.) This mention pertains only to Plaintiff’s testimony that Plaintiff had been diagnosed 

with XMRV “which was likely weakening [Plaintiff’s] immune system.” (Id.) However, 

the ALJ continued to state “not much is currently known about treatment for this.” (Id.) 

Other than these two brief sentences, the ALJ does not address Plaintiff’s XMRV any 

further. 

Plaintiff, in her motion for summary judgment, focuses primarily on the XMRV 

diagnosis and its role in rendering Plaintiff disabled. (See Doc. 14-1 at 17-12.) In the 

Case 3:17-cv-01453-CAB-PCL Document 21 Filed 05/11/18 PageID.<pageID> Page 17 of

 20
18

3:17-cv-1453-CAB-PCL

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

motion, Plaintiff states XMRV’s symptoms and effects, including unexplained fatigue, 

impaired memory or cognition, pain, and immune, neurological, and autonomic 

symptoms. (Id. at 9, citing Simona Panelli et al., XMRV and Public Health: The 

Retroviral Genome Is Not a Suitable Template for Diagnostic PCR, and its Association 

with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Appears Unreliable, 

FRONTIERS IN PUBLIC HEALTH, May 22, 2017, at 1.) What Plaintiff fails to state, however, 

is where in the record these symptoms have both presented themselves and been 

attributed to the XMRV. Instead, Plaintiff makes a blanket claim that the ALJ was 

mistaken in finding there was no objective evidence pertaining to the XMRV diagnosis 

because the record included the actual diagnosis of XMRV. (Id. at 9.) While Plaintiff is 

correct in that the record does include her actual diagnosis of XMRV, Plaintiff fails to 

point to a place in the record where a medical report states how exactly this diagnosis 

affects Plaintiff. Although Plaintiff herself claims the XMRV causes her to have a 

weakened immune system, there is no medical professional noting this effect, or any 

other effects of the XMRV has on Plaintiff. 

As the ALJ states, “not much is currently known about treatment for [XMRV].” 

(Id. at 22.) Both Plaintiff and Commissioner have cited only to medical publications 

instead of any portion of the record, clearly indicating a lack of information in both case 

law and the record. (See Doc. 14-1 at 9, Doc. 17 at 11 n.3, 12 n. 4. See also AR at 448 

where Dr. Abel Toledo states “Will have to do some research on XMRV [because] there 

is a lot of controversy surrounding this subject and its connection with chronic fatigue 

syndrome, prostate ca[ncer], [and] other forms of ca[ncer].”) At this point in the analysis, 

Plaintiff still bears the burden of showing XMRV is a severe impairment. Bray v. Comm'r 

of Soc. Sec. Admin., 554 F.3d 1219, 1222. Despite Plaintiff showing she was in fact 

diagnosed with the disease, Plaintiff has not presented evidence in the record showing 

whether any of Plaintiff’s symptoms were caused or exacerbated by Plaintiff’s XMRV or 

how Plaintiff was otherwise affected by the disease. In light of this shortcoming, the ALJ 

cannot have erred in finding the XMRV was not a severe impairment. 

Case 3:17-cv-01453-CAB-PCL Document 21 Filed 05/11/18 PageID.<pageID> Page 18 of

 20
19

3:17-cv-1453-CAB-PCL

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

C. New evidence

The Plaintiff argues new evidence submitted should warrant a remand of this 

matter for further proceedings. (Doc. 1 at 3.) This Court was not supplied with any

evidence outside of that included in the AR, lodged by Commissioner. However, within 

the AR, there is a medical record that was submitted after the ALJ had ruled on Plaintiff’s 

case. This record was from Asthma & Allergy Medical Group, and shows an initial 

consult on October 17, 2013, and an allergy test result from an appointment on December 

2, 2013. (AR 31-34.) While the ALJ did not take this evidence into account as it was not 

provided by Plaintiff until after the hearing, the Appeals Council did. The Appeals 

Council found “this evidence does not show a reasonable probability that it would change 

the outcome of the decision.” (AR at 2.) Therefore, the Appeals Council disregarded the 

evidence. 

During Plaintiff’s initial consultation with the Asthma & Allergy Medical Group, 

Plaintiff complained of multiple allergens. Particularly, Plaintiff complained she had 

adverse reactions to walnuts, pecans, and avocados – all of which she claimed caused 

anaphalyaxis. (AR at 33.) However, during her second appointment, her allergy skin 

testing was negative for all foods tested. (Id. at 31.) Similarly, Plaintiff initially 

complained of a previous skin test showing she was sensitive to animals with fur; 

however, Plaintiff currently resides in a home with one dog and two cats. (Id. at 33, 31.) 

In submitting these medical records, Plaintiff failed to also submit any explanation 

as to why these alleged allergies should be considered a severe condition which would 

render Plaintiff disabled. Instead, Plaintiff merely stated in her complaint that “new and 

material evidence . . . warrants a remand of this matter for further proceedings.” (Doc. 1 

at 3.) Without any further explanation, the Court cannot agree with Plaintiff. Thus, the 

new evidence is immaterial and does not require the Court to remand.

//

//

//

Case 3:17-cv-01453-CAB-PCL Document 21 Filed 05/11/18 PageID.<pageID> Page 19 of

 20
20

3:17-cv-1453-CAB-PCL

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

V. CONCLUSION

For the reasons set forth above, the Court recommends GRANTING

Commissioner’s motion for summary judgment and DENYING Plaintiff's motion for 

summary judgment.

This report and recommendation is submitted to the Honorable Cynthia A. Bashant

pursuant to 28 U.S.C. § 636(b)(1). Any party may file written objections with the Court 

and serve a copy on all parties on or before June 1, 2018. The document should be 

captioned "Objections to Report and Recommendation." Any reply to the objections shall 

be served and filed on or before June 8, 2018. The parties are advised that failure to file 

objections within the specific time may waive the right to appeal the district court's order. 

Martinez v. Ylst, 951 F.2d 1153 (9th Cir. 1991).

IT IS SO ORDERED.

Dated: May 11, 2018

Case 3:17-cv-01453-CAB-PCL Document 21 Filed 05/11/18 PageID.<pageID> Page 20 of

 20