Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-4_03-cv-04362/USCOURTS-cand-4_03-cv-04362-0/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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United States District Court

For the Northern District of California

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1 Malik is identified by the last name "Oliver" throughout

much of the record but provides no explanation for the change of

name.

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

DENISE R. MALIK,

Plaintiff,

v.

JO ANNE B. BARNHART, 

Commissioner of Social Security,

Defendant.

 /

No. C 03-04362 CW

ORDER DENYING

PLAINTIFF'S

MOTION FOR

SUMMARY JUDGMENT

AND GRANTING

DEFENDANT'S CROSS

MOTION FOR

SUMMARY JUDGMENT 

Plaintiff Denise R. Malik moves for summary judgment or

remand. Defendant Jo Anne B. Barnhart, Commissioner of the

Social Security Administration, opposes the motion and crossmoves for summary judgment. Having considered all of the papers

filed by the parties, the Court DENIES Plaintiff's motion and

GRANTS Defendant's cross-motion for summary judgment. 

BACKGROUND

I. Procedural History

On June 9, 2000, Malik1 applied for Supplemental Security

Income benefits under Title XVI of the Social Security Act (the

Act), 42 U.S.C. § 1381 et seq., alleging that her disability

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began on December 29, 1988, due to psoriasis that caused pain

and numbness in her fingers. (Administrative Record (AR) 93). 

Her application was denied initially and on reconsideration. 

(AR 79-82, 85-88). On May 21, 2002, a hearing was held before

an administrative law judge at which Malik, who was represented

by a non-attorney, appeared as a witness. (AR 42-76). On

August 23, 2002, the ALJ issued his ruling that, although Malik

was precluded from work requiring fine manipulation of objects

or sensation in the fingertips, she was not disabled within the

meaning of the Act because she retained the residual functional

capacity to perform unskilled medium, heavy and very heavy work. 

(AR 25-37). On October 22, 2002, Malik filed a request for

review with the Social Security Appeals Council. (AR 21). On

July 25, 2003, the Appeals Council affirmed the ALJ's decision. 

(AR 4-6). On September 26, 2003, Malik filed the instant

action, claiming that the ALJ erred in finding that she could do

medium, heavy and very heavy work. 

II. Factual History

Malik was thirty-seven years old at the time she filed her

application for Social Security benefits. She attended school

through the eleventh grade. (AR 47). Malik worked for

unspecified time periods in 1979 for Church's Fried Chicken; in

1985, 1986 and 1988 for a packaging company; and in 1989 for

McDonalds and another unspecified employer. (AR 98-99). Malik

has not been employed since 1989. She lives in an apartment

with her husband, her twenty-one year old daughter, her three

year old daughter and her sister. (AR 46). 

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2 Papilloma is a circumscribed, benign tumor projecting from

the surrounding surface. Stedman's Medical Dictionary, 27th

ed., 1307 (2000). 

3 Cipro is a synthetic broad spectrum antimicrobial agent

for oral administration. Physician's Desk Reference, 57th ed.,

875 (2003).

4 Osteomyelitis is an inflammation of the bone marrow and

adjacent bone. Stedman's Medical Dictionary, 27th ed., 1284

(2000).

3

A. Medical Evidence

On May 10, 1996, Malik went to Kaiser Permanente and

complained of pain in her left index finger. (AR 283). A

physical examination revealed a detached fingernail. Her

fingernail was removed and papilloma2 of the distal nailbed was

noted. On May 14, 1996, an x-ray of her left fingers revealed

no significant abnormalities. On May 20, 1996, Dr. Tenner noted

Malik had pus underneath her fingernails. (AR 277). A

treatment note dated May 23, 1996 indicated her finger improved

with medications such as Cipro,3 though she was still having

moderate pain at the proximal end of her finger. (AR 274-75). 

Repeat x-rays of her left fingers revealed no significant

abnormalities or changes, ruling out osteomyelitis.4 (AR 276). 

Malik was diagnosed with a localized form of pustular psoriasis

in her left index finger which did not involve an infection. 

(AR 274). On June 26, 1996, Dr. Tenner noted that pustular

psoriasis was beginning to flare in her right hand. (AR 271). 

Various medications were prescribed in varying dosages,

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5 Prednisone is a dehydrogenated analogue of cortisone with

the same actions and uses. Cortisone is a steroid-like compound

that influences the nutrition and growth of connective tissues. 

Stedman's Medical Dictionary, 27th ed., 417, 754 (2000). 

6 Methotrexate is used to treat arthritis and rheumatoid

arthritis. Stedman's Medical Dictionary, 27th ed., 1107 (2000).

4

including Prednisone5 and Methotrexate.6 (AR 264, 247, 253). On

February 19, 1997, Malik reported she was no better and no

worse. (AR 249). On March 20, 1997, Dr. Tenner commented that

her psoriasis was better with the Methotrexate, although Malik

believed it made the psoriasis worse and more painful and she

did not want to continue taking it. (AR 245). On April 21,

1997, Dr. Rik Smith noted that her psoriasis was "okay," with no

joint swelling. (AR 239). On August 20, 1997, an examination

by Dr. Chitra Reddy revealed right thumb swelling and pain at

the first proximal interphalangeal joint. Dr. Reddy noted that

Malik had self-discontinued all of her medications, such as

Prednisone and Methotrexate, because she thought they were

making her psoriasis worse. (AR 229). 

On September 26, 1997, Malik complained of bilateral hand

pain of two weeks duration and occasional numbness after using

her hands. (AR 223). Malik was referred to rheumatology for a

nerve conduction study. Treatment notes of December 18, 1997

indicate fungus was growing under Malik's fingernails. (AR

215). A nerve conduction study performed in February, 1998 was

normal. (AR 211, 214). In June, 1998, Malik was placed on

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7 Thioguanine is an agent used for leukemias and nephrosis. 

Stedman's Medical Dictionary, 27th ed., 1827 (2000). Nephrosis

is degeneration of the kidneys. Id. at 1192. 

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Thioguanine.7 (AR 205). On September 14, 1998, a treatment note

written by Dr. Tenner indicates Malik had taken Thioguanine for

only a few days in July and then had discontinued it. (AR 201-

02). Dr. Tenner indicated that Malik did not do well on oral

prescriptions due to compliance problems and side effects,

though no specific side effects were noted. (AR 201-02).

Also on September 14, 1998, it was determined that Malik was

pregnant and she was referred to genetics counseling because of

the potential risk of birth defects from the use of Thioguanine. 

Her Thioguanine prescription was discontinued and no other oral

medications were prescribed for her psoriasis during her

pregnancy. (AR 185, 191). Malik continued to complain of

bilateral hand pain throughout her pregnancy. (AR 181). 

Treatment records indicate a prior history of substance abuse

and Malik tested positive for cocaine during her pregnancy

according to urinalysis reports dated December 2, 1998 and March

25, 1999. (AR 171, 178, 324). Malik gave birth on March 31,

1999. (AR 176-77). 

On September 9, 1999, Dr. Selby saw Malik in urgent care and

noted that she was off her medications and was not doing well. 

Dr. Selby noted that lesions on her fingernails were quite

striking. (AR 172). On September 27, 1999, Malik was seen by

Kaiser Union City dermatology and diagnosed with psoriasis of

the second and third fingers of her right hand. (AR 173). Dr.

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8 Tylenol #3 is pain relief medication containing a moderate

dose of codeine, a narcotic pain reliever. Physician's Desk

Reference, 57th ed., 2507 (2003).

9 Arthropathy is any disease affecting the joint. Stedman's

Medical Dictionary, 27th ed., 150 (2000). 

10 Onychomycosis is a very common fungus infection of the

nails, causing thickening, roughness, and splitting. Stedman's

Medical Dictionary, 27th ed., 1262 (2000).

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Hardy recommended intramuscular steroids. Malik declined,

indicating she feared it might cause depression. (AR 173). Dr.

Hardy advised that oral medications would not be prescribed for

psoriasis without effective birth control. (AR 173). On

December 11, 1999, Malik went to the urgent care clinic

complaining of fingernail fungal infection and requested pain

medication. She was prescribed Tylenol #3.8 (AR 170). X-rays

of Malik's hands on December 23, 1999, revealed no evidence of

psoriatic arthropathy,9 yet changes in the tufts of the distal

phalanges of the right second and third fingers and left thumb

were noted. (AR 166). On June 2, 2000, Malik started

Methotrexate injections. (AR 154). A July 11, 2000 dermatology

note indicates that Malik's psoriasis was better. (AR 152). 

On September 16, 2000, the Social Security Administration

referred Malik for a consultative examination conducted by Dr.

Anthony Gabriel. Dr. Gabriel detected severe onychomycosis10 at

the fingertips and nailbeds of the second and third fingers of

the right hand. He indicated that there was no evidence of

acute inflammation. Dr. Gabriel conducted a test of Malik's

upper extremities, including her wrists and hands. He indicated

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11 Dorsiflexion is the upward movement of the foot or toes

or of the hand or fingers. Stedman's Medical Dictionary, 27th

ed., 537 (2000). 

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Malik's dorsiflexion11 to be 60/60o bilaterally and palmar

flexion to be 70/70o bilaterally, and her finger approximation

to be intact. Dr. Gabriel tested Malik's grip strength and

found it to be 20/12 lbs., right over left. Dr. Gabriel's

clinical findings were that Malik had some swelling around the

digits causing some pain when manipulating fine objects, but

that she had generally good strength of the right hand, and

retained complete use of the fingers of the right hand. Dr.

Gabriel stated that Malik would be unable to perform activities

requiring fine manipulation of objects or sensation in the

fingertips of the right hand, but otherwise she had no

limitations. (AR 284-87). 

On November 21, 2000, three non-examining doctors employed

by the State Disability Determination Services (DDS) reviewed

the medical evidence in the record and found that Malik did not

have a medically determinable impairment. (AR 294-301). 

In March, 2001, Malik went to Kaiser complaining of muscle

pain. She was referred to rheumatology for evaluation. Malik

reported that she had stopped taking birth control pills but

that she was not sexually active. She continued to receive

Methotrexate. (AR 357). On May 11, 2001, Dr. Becker reduced

the dosage of Methotrexate. Dr. Becker's note dated May 23,

2001 indicated Malik's psoriasis had been much improved with

Methotrexate, but also that she was inconsistent in getting the

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injections and follow up laboratory studies. (AR 355). 

However, Dr. Becker noted that Malik reported that she might be

pregnant. On May 25, 2001, Dr. Becker discontinued the

Methotrexate until June 8, 2001, after Malik had taken a

pregnancy test. (AR 356, 354). Dr. Becker's note indicated

that Malik was to be given monthly pregnancy tests and he was to

be notified if Malik did not hold to the monthly schedule. (AR

354). 

On June 11, 2001, Malik was evaluated by Dr. Stephanie Chu

for complaints of hand pain. Physical examination revealed mild

diffuse swelling and increased warmth. There was no indication

of any joint problems. Dr. Chu stated that Malik's hand pain

could not be explained, yet it was clearly not classic for

psoriatic arthropathy. (AR 351-52). An x-ray of Malik's right

hand dated June 11, 2001 revealed no abnormality except a

discrete radiolucent area in the terminal phalanx of the index

finger which was probably developmental. (AR 366). A follow-up

examination by Dr. Chu on July 9, 2001, again revealed mild

diffuse swelling. (AR 349-50). On August 22, 2001, a Kaiser

doctor noted that Malik's left index fingernail was swollen with

the nail lifted fifty-percent off. (AR 347). On September 8,

2001, Dr. Chu noted that Malik had marked psoriatic scaling and

onychomycosis on multiple fingertips. (AR 343). In a Medical

Assessment of Ability to Do Work Related Activities (Physical)

dated November 9, 2001, Dr. Chu opined that Malik would be

capable of lifting and/or carrying less than ten pounds over the

course of less than one-third of an eight-hour day, and she

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would be unable to perform the fine motor functions required to

handle, feel, push, or pull. Dr. Chu also opined that Malik had

no limitations in standing, walking, sitting, reaching, seeing,

hearing, or speaking, no postural limitations, and no

environmental restrictions. (AR 319-20). On January 22, 2002,

Dr. Chu noted that Malik had not been on any medications for two

weeks because she lost them when her luggage was stolen. (AR

333). 

In a letter dated March 29, 2002 to Malik's representative,

Dr. Chu states, "This is a patient with unusual hand pains . . .

I do believe that her pain and discomfort, due to the psoriatic

process in her nails and her fingertips, are significant enough

that they preclude her from doing most types of work. 

Certainly, any type of work that would involve constant use of

the hands is not possible for this patient." (AR 316-18). 

To assess Malik's allegation of a mental impairment due to

depression, she was referred for a psychological evaluation by

psychologist Jennifer B. Kirkland, Ph.D., on October 11, 2000. 

Dr. Kirkland noted that Malik did not put much effort into the

evaluation, and generally did not make it past the introductory

items on the psychological tests she was given. Dr. Kirkland

observed that Malik would spontaneously give a correct answer

and then go back and change it to an incorrect answer. Dr.

Kirkland indicated that Malik's low performance on the tests was

suggestive of malingering and her low effort and motivation

rendered testing essentially invalid and not indicative of her

current functioning. Dr. Kirkland also noted inconsistencies in

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Malik's reporting of her medical condition, raising questions as

to her credibility. For instance, Dr. Kirkland noted that she

observed Malik scratch and pick at the scabs on the fingers and

nails of her right hand throughout the testing, despite the fact

that she reported her hand was often too sensitive to use for

anything. Dr. Kirkland diagnosed Malik with malingering and

substance abuse of alcohol, recreational street drugs and pain

killers. Dr. Kirkland acknowledged the difficulty in assessing

Malik's day-to-day functional capacity on the basis of a single

consultation. However, she opined that Malik could be expected

to understand, carry out and remember simple instructions. (AR

289-92). 

B. Hearing Before the ALJ

At the May 21, 2002 hearing before the ALJ, Malik testified

that she was currently unable to work due to pain in her hands. 

She testified that she was unable to do any household chores,

cooking, shopping, go to church, go to the movies, play sports

or do any activities with her daughter. (AR 49-51). Malik

testified that during a typical day she usually sat in the front

yard and watched children play. (AR 51). She testified that

she was sometimes unable to get herself dressed and undressed

and could not put on or tie her shoes. She also testified that

she had to bandage her hands before putting on clothes because

her nails clung to them. (AR 55-56). She was wearing a splint

at the hearing which she stated she wore to keep pus from

draining out of her fingernails and to protect her nails and

fingers. (AR 56-57). She stated that she did not cook because

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her hands got numb and she had been dropping plates and cups a

couple of days before the hearing. (AR 57). She stated that in

order to eat she had to cradle a spoon between her thumb and

index finger. (AR 58). She testified that her hand problem

first made it hard to work in 1996 after the doctor removed her

fingernail. (AR 59). She also stated that her hands were so

tender that anytime she touched or picked up an object she was

in pain. (AR 59-60). She stated she had pain even without

touching things, though it was not as bad. (AR 60). She also

testified that she could pick up objects but could not hold them

for too long. (AR 68-69). She stated there was nothing she

could do at home to make her pain better. (AR 69). She stated

she had been taking Methotrexate pills but they did not help. 

She testified that she stopped getting Methotrexate injections

because it was not doing anything for her. (AR 69). 

C. The ALJ's Decision 

The ALJ employed the five-step sequential process to

evaluate Malik's claim of disability. 20 C.F.R. §§ 404.1520(b)-

(f). At step one, the ALJ concluded that Malik's work activity

in 1989 did not constitute substantial gainful activity and she

had not worked since. (AR 26). 

At step two, the ALJ found that Malik's psoriasis was a

severe impairment because it resulted in difficulty with

sensation in the fingertips of her right hand and limitation in

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12 At step two, the ALJ analyzed whether Malik's claim of

depression was severe and concluded that it was not. Malik does

not contest this conclusion. Therefore, the Court will not

address the ALJ's analysis of Malik's depression. 

12

her ability to perform fine manipulation with her right hand.12 

At step three, the ALJ found that Malik's impairment was not

severe enough to meet or medically equal one of the impairments

listed in Appendix 1, Subpart P, Regulation No. 4 (Social

Security Ruling (S.S.R.) 96-6p). (AR 32). The ALJ found that,

although Malik has a long history of pustular psoriasis, it has

been confined primarily to several fingers of her right hand and

there is no indication that her condition does not respond to

prescribed treatment. (AR 32).

At step four, the ALJ found that Malik had no past relevant

work so he proceeded to step five. At step five, to decide

whether Malik could do her past relevant work or other work

existing in significant numbers in the national economy, the ALJ

considered the medical evidence to assess Malik's residual

functional capacity (RFC). The ALJ determined that Malik was

precluded from work requiring fine manipulation of objects or

sensation in the fingertips, but that she was not limited in her

capacity for gross manipulation or reaching with either upper

extremity or standing, walking, sitting, lifting, carrying,

pushing or pulling. Relying on the Medical Vocational

Guidelines (Grids), the ALJ found that, although Malik's

limitation significantly narrowed the potential occupational

base of unskilled sedentary and light work, she was not disabled

because the potential occupational base of unskilled medium,

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heavy and very heavy work remained intact. (AR 35).

To support his conclusion, the ALJ noted that Malik had made

a number of inconsistent statements which brought her

credibility into question. The ALJ found that Malik's

allegation of constant pain was not supported by the evidence. 

The ALJ stated that, although treating physicians had indicated

that some pain could reasonably be expected due to her

psoriasis, several doctors had expressed concerns that Malik had

been abusing pain medications. The ALJ noted that there was no

indication that her condition did not respond to prescribed

treatment and there was evidence that Malik was not compliant in

following prescribed treatment. The ALJ also pointed out that

Malik had failed to keep no fewer than twenty-five appointments,

which suggested her symptoms may not have been as limiting as

she claimed. In addition, the ALJ noted that Malik's work

history revealed that she worked only sporadically prior to the

alleged disability onset date, which raised questions as to

whether her continuing unemployment was actually due to medical

impairments. 

The ALJ stated that he afforded Dr. Chu's opinion little

weight because it was not supported by the record, particularly

with respect to Malik's ability to lift or carry. However, the

ALJ indicated that he had not entirely rejected Dr. Chu's

opinion and had incorporated some of her limitations into the

RFC he adopted. The ALJ noted the possibility that a doctor may

express an opinion in an effort to assist a patient with whom

she sympathizes or that a doctor may provide such a note in

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order to avoid tension with the patient. The ALJ concluded that

because Dr. Chu's opinion departed substantially from the rest

of the evidence, such a motive may have been likely. The ALJ

"afforded significant weight" to Dr. Gabriel's opinion, "as it

is well-supported by the objective evidence as well as the other

substantial evidence of record, and supported a finding of not

disabled." (AR 33-34).

LEGAL STANDARD

A court cannot set aside a denial of benefits unless the

Commissioner's findings are based upon legal error or are not

supported by substantial evidence in the record as a whole. 42

U.S.C. § 405(g); Magallanes v. Bowen, 881 F.2d 747, 750 (9th

Cir. 1989); Martinez v. Heckler, 807 F.2d 771, 772 (9th Cir.

1986); Taylor v. Heckler, 765 F.2d 872, 875 (9th Cir. 1985). 

Substantial evidence 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); Orteza v.

Shalala, 50 F.3d 748, 749 (9th Cir. 1995). It is more than a

scintilla but less than a preponderance. Sorenson v.

Weinberger, 514 F.2d 1112, 1119 n.10 (9th Cir. 1975). 

To determine whether substantial evidence exists to support

the ALJ's decision, a court reviews the record as a whole, not

just the evidence supporting the decision of the ALJ. Walker v.

Matthews, 546 F.2d 814, 818 (9th Cir. 1976). A court may not

affirm the Commissioner's decision simply by isolating a

specific quantum of supporting evidence. Hammock v. Bowen, 879

F.2d 498, 501 (9th Cir. 1989). In short, a court must weigh the

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evidence that supports the Commissioner's conclusions and that

which does not. Martinez, 807 F.2d at 772. 

If there is substantial evidence to support the decision of

the ALJ, it is well-settled that the decision must be upheld

even when there is evidence on the other side, Hall v.

Secretary, 602 F.2d 1372, 1374 (9th Cir. 1979), or when the

evidence is susceptible to more than one rational

interpretation. Gallant v. Heckler, 753 F.2d 1450, 1453 (9th

Cir. 1984). If supported by substantial evidence, the findings

of the Commissioner as to any fact will be conclusive. 42

U.S.C. § 405(g); Vidal v. Harris, 637 F.2d 710, 712 (9th Cir.

1981). 

Under the Social Security Act, “disability” is defined as

the: 

inability 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 twelve months. 

42 U.S.C. § 423 (d)(1)(A). The impairment must be so severe

that the claimant “is not only unable to do his previous work

but cannot . . . engage in any other kind of substantial gainful

work.” 42 U.S.C. § 423(d)(2)(A). In addition, the impairment

must result “from anatomical, physiological, or psychological

abnormalities which are demonstrable by medically acceptable

clinical and laboratory techniques.” 42 U.S.C. § 423(d)(3). 

To determine whether a claimant is disabled within the

meaning of the Social Security Act, the Social Security

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Regulations set out a five-step sequential process. 20 C.F.R. §

404.1520 (b)-(f); Baxter v. Sullivan, 923 F.2d 1391, 1395 (9th

Cir. 1991); Reddick v. Chater, 157 F.3d 715, 721 (9th Cir.

1998). The burden of proof is on the claimant in steps one

through four. Sanchez v. Secretary of Health and Human Servs.,

812 F.2d 509, 511 (9th Cir. 1987). In step one, the claimant

must show that she or he is not currently engaged in substantial

gainful activity. 20 C.F.R. § 404.1520(b). In step two, the

claimant must show that he or she has a "medically severe

impairment or combination of impairments" that significantly

limit his or her ability to work. 20 C.F.R. § 404.1520(c);

Bowen v. Yuckert, 482 U.S. 137, 140 (1987); Smolen v. Chater, 80

F.3d 1273, 1290 (9th Cir. 1996). If the claimant does not, he

or she is not disabled. Otherwise, the process continues to

step three for a determination of whether the impairment meets

or equals a "listed" impairment which the regulations

acknowledge to be so severe as to preclude substantial gainful

activity. Bowen, 482 U.S. at 141; 20 C.F.R. § 404.1520(d); 20

C.F.R. § 404, Subpt. P, App.1. If this requirement is met, the

claimant is conclusively presumed disabled; if not, the

evaluation proceeds to step four. At step four, it must be

determined whether the claimant can still perform "past relevant

work." Bowen, 482 U.S. at 141; 20 C.F.R. § 404.1520(e). If the

claimant can perform such work, he or she is not disabled. If

the claimant meets the burden of establishing an inability to

perform prior work, the burden of proof shifts to the

Commissioner for step five. At step five, the Commissioner must

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show that the claimant can perform other substantial gainful

work that exists in the national economy. Bowen, 482 U.S. at

141; 20 C.F.R. § 1520(f).

DISCUSSION

Malik moves for summary judgment or remand on the grounds

that: (1) the ALJ improperly rejected the opinion of her

treating physician, Dr. Stephanie Chu, with insufficient

substantive analysis; (2) the ALJ failed to follow the SSA's own

rules and regulations in assessing Malik's RFC; (3) the ALJ

failed to obtain vocational expert testimony, but instead relied

on the Medical Vocational Guidelines despite the presence of

significant non-exertional impairments; and (4) the ALJ's key

findings are not supported by substantial evidence.

I. Opinion of the Treating Physician

Citing Reddick v. Chater, 157 F.3d 715, 725 (9th Cir. 1998),

Malik argues that the ALJ improperly rejected the opinion of Dr.

Chu, her treating physician, because the ALJ failed to set forth

specific and legitimate reasons for doing so, and instead

adopted the opinion of Dr. Gabriel, whom Malik saw only once. 

Malik also argues that Dr. Chu's conclusion that Malik has

significant limitations in lifting and constant use of her hands

has a strong evidentiary basis in the record. 

As a general rule, the opinion of a treating doctor should

be given more weight than the opinion of doctors who do not

treat the claimant. Winans v. Bowen, 853 F.2d 643, 647 (9th

Cir. 1987). Where a treating physician’s opinion is contradicted

by another doctor, the Commissioner may reject the treating

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physician’s opinion, but must provide “specific, legitimate

reasons” supported by substantial evidence in the record for

doing so. Rodriguez v. Bowen, 876 F.2d 759, 762 (9th Cir.

1989); Murray v. Heckler, 722, F.2d 499, 502 (9th Cir. 1983). 

The opinion of a non-examining physician alone will not

constitute substantial evidence that justifies the rejection of

the opinion of either a treating or examining physician. Pitzer

v. Sullivan, 908 F.2d 502, 506 n.4 (9th Cir. 1990); Gallant v.

Heckler, 753 F.2d 1450, 1456 (9th Cir. 1984). However, the

opinion of a non-examining physician in conjunction with medical

evidence and contradictory reports from examining physicians

constitutes substantial evidence for rejecting a treating

physician’s opinion. Magallanes, 881 F.2d at 751-52; Andrews v.

Shalala, 53 F.3d 1035, 1042-43 (9th Cir. 1995). 

Although the ALJ stated that he gave Dr. Chu's opinion

little weight, he only rejected the part of her opinion

regarding Plaintiff's ability to lift and carry. The ALJ did

provide specific, legitimate reasons for rejecting this part of

Dr. Chu's opinion: it departed substantially from the rest of

the evidence. There is no evidence that Dr. Chu tested Malik's

hand strength or her functional abilities. Dr. Gabriel tested

Malik's grip strength and her upper extremities. He found that

she had some swelling around the digits causing some pain when

manipulating fine objects, but that she had generally good

strength of the right hand, and retained complete use of the

fingers of the right hand. He stated that Malik would be unable

to perform activities requiring fine manipulation of objects or

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sensation in the fingertips of the right hand, but otherwise she

had no limitations. The ALJ also noted that the non-examining

DDS physicians' opinions supported Dr. Gabriel's. Further, even

Dr. Chu indicated that Malik's hand pains were unusual and very

difficult to explain.

Accordingly, the ALJ did not err in rejecting Dr. Chu's

opinion regarding Plaintiff's ability to lift and carry in favor

of Dr. Gabriel's.

II. Residual Functional Capacity

Malik argues that the ALJ erred by not specifically

addressing her capacity for using her hands on a sustained basis

over the course of a work day, including forceful gripping,

lifting, or carrying heavy objects.

A plaintiff's RFC is the most he or she "can still do

despite his [or her] limitations." 20 C.F.R. § 416.945(1). It

is his or her maximum ability to perform sustained work in an

ordinary work setting on a regular and continuing basis, eight

hours a day for five days a week. Id. The RFC assessment must

first identify the individual's functional limitations or

restrictions and assess his or her work-related abilities on a

function-by-function basis. S.S.R. 96-8P at *1. Only after

that may an individual's RFC be expressed in terms of the

exertional levels of work: sedentary, light, medium, heavy and

very heavy. Id. 

The ALJ found that Malik could not perform work requiring

fine manipulation of objects or sensation in the fingertips of

the right hand, but that she is not limited in gross

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manipulation of objects or in reaching with either upper

extremity, lifting, carrying, pushing or pulling. To support

this conclusion, the ALJ relied on Dr. Gabriel's opinion,

stating that "it is well supported by the objective evidence as

well as the other substantial evidence of record . . ." (AR

34). The ALJ also based his finding on Malik's lack of

credibility. 

Malik does not dispute the ALJ's conclusions regarding her

credibility. However, she does dispute the ALJ's reliance on

Dr. Gabriel's opinion. 

As stated above, however, the ALJ did not err in relying on

Dr. Gabriel's opinion because it is supported by substantial

evidence in the record. Dr. Chu did conclusorily state that

Malik was limited in lifting and carrying; as stated above, the

ALJ did not err in discounting that part of her opinion. Dr.

Chu did not mention Malik's ability to grip. Thus, the ALJ did

not err in finding that Malik retained the ability to perform

unskilled medium, heavy and very heavy work despite her

impairments, and properly assessed Malik's RFC. 

III. Medical Vocational Guidelines

Malik argues that the ALJ failed to consider her nonexertional limitations such as in the constant use of her hands

or the performance of tasks requiring prolonged or repeated

forceful gripping. Malik argues that, had these additional nonexertional limitations been included in her RFC, at step five of

his analysis, the ALJ could not have relied on the Medical

Vocational Guidelines (Grids), but would have had to consult a

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vocational expert to determine whether jobs existed in

significant numbers in the economy to accommodate her

disability. 

The ALJ found that Malik was precluded from work requiring

fine manipulation of objects or sensation in the fingertips and

that, although this limitation significantly narrowed the

potential occupational base of unskilled sedentary and light

work, the potential occupational base of unskilled medium,

heavy, and very heavy work remained intact. Relying on the

guidelines set forth in S.S.R. 85-15, the ALJ found that,

because Malik's nonexertional limitations did not significantly

compromise her ability to perform work at all exertional levels,

a finding of not disabled was appropriate. 

The Medical-Vocational Guidelines are administrative tools

that the Commissioner may use at step five of the disability

evaluation. Burkhart v. Bowen, 856 F.2d 1335, 1340 (9th Cir.

1988). Based on age, education, work experience, and

“exertional capacity,” the guidelines determine the

employability of claimants with “substantially uniform levels of

impairment.” Id.; see also 20 C.F.R. pt. 404, subpt. P, app. 2.

However, the ALJ may rely on the guidelines only when they

“accurately and completely describe the claimant’s abilities and

limitations.” Burkhart, 856 F.2d at 1340; see also Tackett v.

Apfel, 180 F.3d 1094, 1102 (9th Cir. 1999). If a claimant has

an impairment that limits his or her ability to work without

directly affecting his or her strength, the claimant is said to

have non-exertional (not strength-related) limitations that are

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not covered by the grids. 20 C.F.R., pt. 404, subpt. P., app. 2

§ 200.00(d),(e). When a claimant suffers from non-exertional

impairments that are “sufficiently severe” to significantly

limit the range of work permitted by his or her exertional

abilities, the guidelines are inapplicable. Tackett, 180 F.3d

at 1102. In such instances, the ALJ must consider the testimony

of a vocational expert and identify specific jobs that are

within the claimant’s capabilities. Burkhart, 856 F.2d at 1340. 

In S.S.R 85-15, the SSA indicated that the loss of fine

manual dexterity narrows the sedentary and light ranges of work

much more than it does the medium, heavy and very heavy ranges

of work. S.S.R. 85-15 at *7. S.S.R. 85-15 also provides that a

vocational expert would not ordinarily be required where a

person has a loss of ability to feel the size, shape,

temperature, or texture of an object by the fingertips, because

this is a function required in very few jobs. Id. As stated

above, the ALJ did not err in finding that Malik had no other

limitations. There is no evidence that Malik could not perform

tasks requiring prolonged or repeated forceful gripping, as

Malik argues. Because Malik's non-exertional impairment is not

severe enough to limit significantly her range of work, the

ALJ's use of the grids was proper and there was no need to call

a vocational expert. 

IV. Substantial Evidence

Plaintiff argues that the ALJ's finding that Plaintiff is

totally unrestricted and able to perform work at every

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exertional level is not supported by substantial evidence. In

support of this argument, Plaintiff cites the medical evidence

and Plaintiff's testimony that she has significant limitations

in the use of her hands due to pain caused by the psoriatic

conditions.

As discussed previously, the ALJ correctly relied upon Dr.

Gabriel's opinion in determining Plaintiff's RFC. Additionally,

the ALJ found Plaintiff's credibility to be questionable. 

Although Plaintiff does not dispute the ALJ's finding regarding

her lack of credibility, it is appropriate to discuss it here

because she relies on her testimony to support this claim.

The ALJ's determination regarding Plaintiff's lack of

credibility was supported by substantial evidence. Dr. Kirkland

reported that Plaintiff did not put much effort into her

psychological testing and that she would even spontaneously give

a correct answer but then go back and change it to an incorrect

answer. Dr. Kirkland opined that Plaintiff's performance was

indicative of malingering which rendered her testing essentially

invalid. Dr. Kirkland noted inconsistencies in Plaintiff's

reporting of her medical condition which also raised questions

regarding her credibility. Dr. Kirkland reported that Plaintiff

admitted to substance abuse of alcohol, recreational street

drugs and pain killers. Furthermore, many notations in

Plaintiff's medical records questioned whether Plaintiff was

exaggerating her pain in order to obtain pain killers. Because

the ALJ's finding regarding Plaintiff's credibility is supported

by substantial evidence, Plaintiff cannot rely on her testimony

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to substantiate her argument that she could not use her hands

due to pain.

In addition, Defendant argues that a controlled impairment,

or one that is reasonably controllable, cannot be used as a

basis for disability. Odle v. Heckler, 707 F.2d 439, 440 (9th

Cir. 1983) (finding proper ALJ's decision not to consider

claimant's controlled impairments); Sample v. Schweiker, 694

F.2d 639, 643 (9th Cir. 1982) (proper inquiry is whether

impairment is amenable to control). Malik does not respond to

this argument. 

The ALJ found that Malik was not compliant with the

medication regimen that had been successful in treating her

impairment based on the following evidence. On March 20, 1997,

Dr. Tenner indicated that Malik's psoriasis had improved with

Methotrexate; however, Malik indicated she believed it made the

psoriasis worse. On August 20, 1997, Dr. Reddy noted that Malik

had self-discontinued her Prednisone and Methotrexate because

she thought they were making her psoriasis worse. On September

14, 1998, Dr. Tenner indicated that Malik took Thioguanine for

only a few days in July and then discontinued it. He stated

that Malik did not do well on oral medications due to compliance

problems. Dr. Becker's treatment note dated July 11, 2000

indicated that Malik's psoriasis had improved following

Methotrexate injections. Dr. Becker's note dated May 23, 2001

indicated Malik's psoriasis had been much improved with

Methotrexate but she was inconsistent in getting the injections. 

This evidence substantiates the ALJ's finding that Malik was not

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compliant with her prescribed treatment. 

Therefore, Plaintiff's claim that the ALJ's evidentiary

findings is not supported by substantial evidence is DENIED.

CONCLUSION

For the foregoing reasons, Malik's motion for summary

judgment or remand is DENIED. Defendant's cross motion for

summary judgment 

is GRANTED. Judgment shall enter accordingly. Each party shall

bear her own costs. 

IT IS SO ORDERED.

Dated: 5/18/05 /s/ CLAUDIA WILKEN 

CLAUDIA WILKEN

United States District Judge

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