Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-1_14-cv-00884/USCOURTS-caed-1_14-cv-00884-5/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

EASTERN DISTRICT OF CALIFORNIA

JARMAN YACOUB, 

Plaintiff,

v.

CAROLYN W. COLVIN,

Acting Commissioner of Social Security,

Defendant.

____________________________________

Case No. 1:14-cv-00884-SKO

ORDER ON PLAINTIFF’S COMPLAINT

(Doc. 25)

I. INTRODUCTION

Plaintiff, Jarman Yacoub (“Plaintiff”), seeks judicial review of a final decision of the 

Commissioner of Social Security (the “Commissioner”) denying her application for Supplemental 

Security Income (“SSI”) benefits pursuant to Title XVI of the Social Security Act. 42 U.S.C. 

§ 1381-83. The matter is currently before the Court on the parties’ briefs, which were submitted, 

without oral argument, to the Honorable Sheila K. Oberto, United States Magistrate Judge.1

 

1

 The parties consented to the jurisdiction of a U.S. Magistrate Judge. (Docs. 7; 9.)

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II. FACTUAL BACKGROUND

Plaintiff was born on May 31, 1961, and protectively filed for disability benefits on 

February 4, 2011. (Administrative Record (“AR”) 10; 18; 157.) Plaintiff claims she is disabled 

due to degenerative disc disease, bilateral carpal tunnel syndrome, degenerative joint disease of 

the knees, low back pain, and depression. (See AR 12; 162.)

A. Relevant Medical Evidence 

1. Treating Physicians, Physical Therapy, and Social Worker Records

On May 27, 2008, Plaintiff’s physician Dr. Amanda Crews, M.D., wrote a letter to the 

agency, noting that she had treated Plaintiff since October 24, 2006, for “chronic low back pain, 

carpal tunnel syndrome, hypercholesterolemia, depression, diplopia, and insomnia.” (AR 272.) 

Dr. Crews opined Plaintiff is “unable to perform any meaningful employment” due to the 

limitations of her impairments; cannot stand or walk “for more than a few minutes at a time” and 

must take frequent rest breaks; cannot sit for more than an hour at a time; cannot lift anything over 

ten pounds; and cannot climb, stoop, or bend. (AR 272.) Dr. Crews noted, however, that 

Plaintiff’s “biggest issue is her depression,” which contributes to “concentration issues and poor 

follow through with tasks.” (AR 272.) Plaintiff has had only a “partial response” to her 

antidepressant medication, and suffers from anxiety, startle response, and frequent suspicion as a 

side effect of her medication. (AR 272.) Plaintiff attended physical therapy in June and July of 

2008 (AR 460-61), but quit on August 4, 2008 (AR 464).

A February 25, 2010, x-ray of Plaintiff’s left foot revealed moderate posterior and plantar 

calcaneal spurring, but noted no fractures. (AR 344; 444.) An x-ray of Plaintiff’s left knee 

revealed “no significant soft tissue, bony, or articular pathology,” and an x-ray of Plaintiff’s right 

knee revealed mild patellar spurring but no joint effusion or fractures. (AR 345; 445.) On July 

27, 2010, Plaintiff was seen by Dr. Christopher Hawley, M.D., for evaluation of her left foot 

plantar fasciitis and left knee osteoarthritis. (AR 347; 447.) She had been seen for ten physical 

therapy visits, been on anti-inflammatory medications, and had a cortisone injection for the left 

knee, all without success in relieving her symptoms. (AR 347; 447.) On examination, Plaintiff 

had full range of motion and mild crepitus in her left knee and moderate tenderness to palpation 

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over both joint lines and around the patellar facets. (AR 347; 447.) Plaintiff also had tenderness 

to palpation over the inferior aspect of the left calcaneus, near the plantar fascia origin, and pain 

with stretching the plantar fascia. (AR 347; 447.) Plaintiff has bilateral mildly flat feet. (AR 347; 

447.) Dr. Hawley recommended semi-rigid orthotics for Plaintiff’s plantar fasciitis and continued 

stretching exercises and a trial of a Synvisc-One injection to her left knee. (AR 347; 447.) 

On February 4, 2011, Plaintiff told Pete Thompson, L.C.S.W., she had been depressed 

since the end of 2005 when a family member “became ill after a stroke” and she “has not been 

able to go back to work since.” (AR 335.) Plaintiff reported having “no energy or motivation to 

do anything,” feeling “worthless,” and having trouble sleeping at night. (AR 335.) On March 3, 

2011, Plaintiff reported having difficulty sleeping and feeling guilty over her mother’s stroke. 

(AR 334.) On April 8, 2011, Mr. Thompson noted Plaintiff was no longer seeing her daughter 

regularly and was upset by the distance. (AR 333.) Plaintiff was stressed because her husband 

and daughter had been in multiple bad accidents in a short span of time. (AR 333.) On May 13, 

2011, Mr. Thompson noted Plaintiff was depressed and continued to “lament” about being in pain. 

(AR 332.) Her son lived with her and her husband and was “overwhelmed with [the] 

responsibility” of caring for his parents. (AR 332.) 

Physical therapy notes on July 1, 2011, noted that despite visits since May of 2011, 

Plaintiff had shown “essentially no change in function” and “no significant improvement in [ ] 

pain,” continued to demonstrate a very slow, labored gait, and had “limited potential for 

significant progress.” (AR 449; 462-63; see also AR 456-58 (treating notes indicating no progress 

at each visit).) Because of her lack of progress, therapist Matt Tresenriter, P.T., recommended 

physical therapy be discontinued. (AR 449; 462-65.) 

On September 12, 2011, a lumbar spine x-ray revealed mild degenerative changes, noting 

five lumbar-type vertebral bodies with lumarization of S1, some levoconvex curvature of the 

lumbar spine with mild anterior marginal osteophyte formation, particularly of L2 through L4, and 

no subluxation. (AR 366.) On May 31, 2012, a right knee x-ray revealed mild patellar spurring, 

but noted no fracture, joint effusion, or joint narrowing, no loose bodies, and no spurring at the 

joint margins. (AR 442.) An x-ray of the right ankle revealed no significant osseous, articular, or 

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soft tissue abnormalities. (AR 443.) 

On November 7, 2012, Dr. Crews filled out an agency questionnaire. (AR 454.) Dr. 

Crews opined Plaintiff’s impairments of osteoarthritis, low-spine pain, carpal tunnel syndrome, 

and depression would prevent her from performing full-time work at any exertional level and, 

taken together, her impairments meet or equal Listing 1.04 (disorders of the spine). (AR 454.) 

Dr. Crews opined Plaintiff could sit a maximum of one hour and stand or walk a maximum of 

fifteen minutes at a time, and Plaintiff must lie down or elevate her legs at least two to three hours 

during an eight hour day. (AR 454.) 

2. Internal Medicine Evaluation

On May 27, 2011, Dr. Roger Wagner, M.D., performed a comprehensive internal medicine 

evaluation at the agency’s request. (AR 279-84.) Plaintiff spoke with the aid of an interpreter. 

(AR 279.) Plaintiff reported low back pain without radiation, bilateral knee pain, and bilateral 

carpal tunnel syndrome as her chief complaints. (AR 279.) Plaintiff used a walker and reported

having difficulty walking, but “refuse[d] to give [ ] any accurate walking distance.” (AR 279.) 

Plaintiff reported being able to sit for approximately 30 minutes before needing to move around to 

relieve her back pain, and reported bending and lifting as the worst triggers for her back pain. 

(AR 279.) Plaintiff described her left knee pain as worse than her right knee pain, and she has 

some patellar cartilage damage in both knees. (AR 279.) Plaintiff had never had surgery or 

arthrocentesis in her knees, and refused an injection. (AR. 279.) Plaintiff’s carpal tunnel 

syndrome is worse on her left side; she complained of forearm pain with occasional fingered 

numbness which usually faded after several minutes. (AR 280.) She reported that carpal tunnel 

release surgery had been recommended to relieve her symptoms, but she had declined to have it 

done. (AR 280.) Plaintiff reported she lived with her husband and son, and while she does not do 

any housecleaning, she cooks for her family, drives, shops occasionally, and performs her own 

activities of daily living without assistance. (AR 280.)

On examination, Plaintiff displayed positive Tinel’s in both wrists and negative Phalen’s, 

mild paravertebral muscle tenderness, and continuous grinding in the left knee but no real 

tenderness. (AR 280; 282.) Plaintiff’s motor strength is 5/5 bilateral upper and lower extremities. 

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(AR 282.) Dr. Wagner further observed that Plaintiff 

. . . was easily able to get out of her chair in the waiting room, however, then bent 

over approximately 30 degrees at the low back and pushed a wheeled walker and 

mov[ed] at a slow to moderate rate. She did this without assistance. She sat 

comfortably through the entire history taking. She was able to get on and off the 

examination table . . . . slightly slowly with some moaning and groaning. She was 

easily able to bend over at the waist, take off shoes and put them on without any 

obvious significant problems. [She] did show very poor compliance when 

attempting to get her to perform the arm strength exercises. 

(AR 280.) Plaintiff was able to walk on her toes and on her heels, though she complained of pain 

while doing so. (AR 281.) Though Plaintiff came in using her walker, Dr. Wagner opined that 

“[t]his does not appear to be necessary at the current time.” (AR 281.) 

Dr. Wagner opined Plaintiff is able to stand and walk up to six hours a day due to her knee 

problems and low back pain and has no limitations on her ability to sit, does not need an assistive 

device, can lift 20 pounds occasionally and ten pounds frequently, should not climb or balance on 

ladders or scaffolds, can climb stairs occasionally, perform manipulative activities frequently, and 

has no environmental limitations. (AR 283-84.) 

3. Mental Status Evaluation

On June 24, 2011, Dr. Carol Fetterman, Ph.D., performed a comprehensive mental status 

evaluation at the agency’s request. (AR 285-87.) Plaintiff spoke with the assistance of an 

interpreter. (AR 285.) Plaintiff presented “in a friendly manner, made fair eye contact, and [her] 

facial expression was normal.” (AR 285.) Plaintiff used a walker and her gross motor function 

was “not normal.” (AR 285.) Plaintiff reported “moderately disabling” depression and anxiety, 

and stated that her “current mental health symptoms” impact her daily living. (AR 285.) Plaintiff 

was born in Iran and came to California in 2000. (AR 285.) Plaintiff reported she had completed 

the tenth grade and had a learning disability in math, but denied being placed in special education. 

(AR 285.) Plaintiff reported leaving work due to physical and emotional difficulties, and noted 

she “was very depressed over the death of her mother.” (AR 285-86.) Plaintiff reported being

independent for basic activities of daily living and not needing help with preparing meals, but 

reported being unable to make change at the store and being unable to drive. (AR 286.) 

//

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On examination, Dr. Fetterman noted Plaintiff had a very difficult time understanding and 

remembering instructions, and observed her to be passively uncooperative. (AR 286.) Plaintiff 

was partially oriented to place and time; she did not know the date or the day or the season and did 

not know the county or clinic name. (AR 286.) Plaintiff’s concentration and attention was

impaired, her memory was adequate, her judgment and insight were limited, and her abstraction 

and proverbs were intact. (AR 286.) Dr. Fetterman diagnosed Plaintiff as having a mood 

disorder, and opined that Plaintiff’s ability to understand, remember, and carry out job 

instructions, her ability to maintain attention, concentration, persistence and pace, her ability to 

relate and interact with supervisors, co-workers, and the public, and her ability to adapt to day-today work activities were all mildly impaired. (AR 286-87.) 

Dr. Fetterman opined that, “from a psychological standpoint alone,” Plaintiff is unable to 

manage funds, is able to perform one- or two-step simple repetitive tasks but cannot adequately 

perform complex tasks, has a fair ability to accept instructions from supervisors and interact with 

coworkers and the public, is unable to perform work activities on a consistent basis without 

special or additional instruction, has a fair ability to maintain regular attendance in the workplace 

and complete a normal workday or workweek without interruptions, and has a fair ability to 

handle normal work related stress. (AR 287.) Dr. Fetterman concluded Plaintiff would benefit 

from continuing mental health counseling and medication, and opined that her prognosis “is fair.” 

4. Consultative Examiners

On July 26, 2011, consultative examiner Dr. Winston Brown, M.D., completed a 

psychiatric review technique form, noting Plaintiff suffered from a mood disorder associated with 

her general medical condition. (AR 304-17.) Dr. Brown opined Plaintiff had moderate difficulties 

in maintaining social functioning and concentration, persistence, or pace, mild restriction in her 

activities of daily living, and no episodes of decompensation. (AR 314.) 

Dr. Brown also completed a mental functional capacity assessment and opined Plaintiff is 

moderately limited in her ability to carry out detailed instructions, maintain attention and 

concentration for extended period, sustain an ordinary routine without special supervision, 

complete a normal workday and workweek without interruptions, accept instructions and respond 

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appropriately to criticism from supervisors, respond appropriately to changes in the work setting, 

and set realistic goals or make plans independently. (AR 302.) Dr. Brown noted no significant 

limitations in any other category. (AR 302.) On March 27, 2012, consultative psychiatrist Dr. 

Cheryl Woodson-Johnson, Psy.D., affirmed Dr. Brown’s mental residual functional capacity 

assessment. (AR 398.) 

On September 15, 2011, consultative examiner Dr. Karmen Hopkins, M.D., completed a 

physical residual functional capacity assessment. (AR 371-78.) Dr. Hopkins opined Plaintiff 

could lift 50 pounds occasionally and 25 pounds frequently, could stand, walk, and sit six hours in 

an eight hour day, had no manipulative limitations, could never balance but could frequently climb 

ramps, stairs, ladders, ropes, or scaffolds, could frequently stoop, kneel, crouch, and crawl, and 

had no environmental limitations. (AR 371-75.) Dr. Hopkins opined that though Plaintiff 

reported pain “all over my body” and limitations imposed by her pain and depression, “[t]here is 

no objective evidence to support [the] extent of [the] limitations of [activities of daily living] 

reported . . . and, therefore, [those activities of daily living] are not considered fully credible.” 

(AR 378.) 

On March 28, 2012, consultative examiner Dr. Alice M. Davidson, M.D., completed a 

physical residual functional capacity assessment. (AR 401-08.) Dr. Davidson opined Plaintiff 

could lift 10 pounds frequently and 20 pounds occasionally, stand, walk, and sit six hours in an 

eight-hour day, had no manipulative limitations, could never balance but could occasionally climb 

ramps, stairs, ladders, ropes, or scaffolds, could frequently stoop, kneel, crouch, and crawl, and 

had no environmental limitations. (AR 401-05.) Dr. Davidson opined Plaintiff was limited to 

light work with postural restrictions due to her degenerative disc disease, degenerative joint 

disease, and carpal tunnel syndrome. (AR 408.) 

B. Written Testimony

1. Plaintiff’s Adult Disability Form, Function Report, and Pain Questionnaire

On February 24, 2011, Plaintiff’s daughter Ramona Yacoub Davoudi completed an adult 

disability report form on Plaintiff’s behalf, reporting that Plaintiff cannot speak, read, or 

understand English, but can “write more than [her] name in English.” (AR 161.) Plaintiff 

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complains of pain in her bilateral arms, low back pain, diplopia, insomnia, and depression, and 

describes her “mind” as “sometimes . . . not working.” (AR 176; 179; 242; 245.) Walking, lifting, 

bending, standing, sitting, reaching, and using her hands all cause pain, and Plaintiff cannot stand

or sit more than an hour at a time. (AR 176; 242.) 

On an average day, Plaintiff wakes up late due to trouble sleeping at night, watches 

television for an hour, prepares frozen food for her lunch, and then takes a nap because she 

“feel[s] tired, sad or empty, alone, tearful.” (AR 178; 244.) Plaintiff is unable to wash or dry her 

hair without difficulty and pain. (AR 179; 245.) Her daughter organizes Plaintiff’s medicine for 

the week, and calls Plaintiff to remind her to care for her personal needs. (AR 180; 246.) Plaintiff 

is able to do her own laundry, but does not do any other household chores. (AR 180; 246.) Once 

a week, Plaintiff’s daughter “takes her out” of the house to go shopping. (AR 181; 247.) Plaintiff 

is able to drive and is able to go out alone. (AR 181; 247.) Plaintiff reports difficulty 

concentrating more than an hour at a time, “nerves” as a side effect of her medication, and poor 

ability to follow instructions because she “do[es]n’t want to listen to anybody.” (AR 183; 249.) 

2. Plaintiff’s Work History Report

Plaintiff worked for two years as a caregiver for an in-home supporting service. (AR 163; 

168-75.) Her duties included taking care of elderly clients, cooking, shopping, cleaning, taking 

them to doctor’s appointments, and washing their laundry. (AR 164; 169.) She would walk and 

stand for six hours, climb and crouch for an hour and a half, stoop and kneel for three and a half 

hours, crawl for six hours, handle large objects for five hours, and reach for six hours out of a 

typical day. (AR 164; 169.) The heaviest weight she lifted exceeded a hundred pounds, and she 

frequently lifted fifty pounds or more, as she frequently pushed shopping carts, lifted her clients 

from their beds to chairs, and helped her clients take showers. (AR 164.) 

3. Third Party Adult Function Report

Plaintiff’s daughter Ramona Davoudi completed a third party adult function report on 

March 8, 2012. (AR 232-40.) Ramona speaks with her mother on the phone every day and helps 

her parents with cleaning, laundry, grocery shopping, and cooking. (AR 233; 238.) She describes 

Plaintiff’s symptoms as including difficulty sleeping, feeling tired/sleepy, anxiety, pain all over 

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her body and especially her arms, legs, and lower back, dizziness, insomnia, depression, and lack 

of energy. (AR 233; 236; 238.) Ramona gives Plaintiff showers, dries and combs her hair, and 

noted Plaintiff uses a walker to get to the toilet and to walk. (AR 234; 240.) Ramona organizes 

Plaintiff’s medication and calls to remind her to take her pills, and purchases frozen meals for 

Plaintiff to prepare easily with the microwave. (AR 233; 235.) She noted Plaintiff used to go to 

church and visit with family but is no longer able to do so. (AR 238.) 

C. Hearing Testimony

1. Plaintiff’s Testimony

Plaintiff testified at a hearing before an ALJ on November 8, 2012, with the aid of an 

interpreter. (AR 30-48.) Plaintiff testified that she could speak Persian and Syrian fluently but 

could not speak English (AR 31; 35), and that she could read and write in Persian, could neither

read nor write in Syrian, and could only read and write “very little” in English (AR 33-34). 

Plaintiff testified she does not “read or write [English] well enough to have a grocery list of all 

[her] shopping needs and go grocery shopping.” (AR 34.) Plaintiff also stated she is unable to 

understand enough English to testify without the use of an interpreter. (AR 35.) Plaintiff 

completed nine years of school in Iran.2 (AR 33.) Plaintiff worked for two years as in-home 

caretaker for elderly individuals. (AR 34.) 

Plaintiff stated she suffers from depression and pain in her hands, her back, and her left 

foot. (AR 34-36.) She wears prescribed bilateral hand braces, though she only wore one on her 

left hand at the hearing because the pain is worse on her left side. (AR 34-36; see also AR 37 

(noting she is right-handed).) She is able to lift a gallon of milk with both hands but has trouble 

lifting anything heavier. (AR 36.) She can only use her hands about ten minutes at a time without 

needing to rest. (AR 37.) She testified that her treating physician Dr. Crews prescribed a walker 

for her to use (AR 36) and complained that her pain worsens when she stands on her left foot for 

long periods of time (AR 38). Plaintiff can only stand about a half an hour at a time. (AR 38.) 

//

 

2

 The Court notes that Plaintiff’s statement regarding her completion of nine years of school in Iran is inconsistent 

with her statement to Dr. Fetterman that she had completed the tenth grade. (AR 285.) The ALJ, however, did not 

address this inconsistency in the decision.

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Plaintiff reported she takes pain medication and does in-home exercises to relieve her pain. 

(AR 38.) She is 5’2” and 200 pounds, and her weight exacerbates her back and knee pain. 

(AR 38-39.) She has arthritis in her knees. (AR 39.) Her impairments have restricted her ability 

to do the housework she performed in the past. (AR 39-43.) She used to cook meals for her 

family and now is limited to microwaving frozen meals to feed only herself. (AR 40.) She 

previously attended church and visited with family and friends, and no longer does so due to her

“pain and illness.” (AR 40.) 

2. Vocational Expert’s Testimony 

The vocational expert (“VE”) testified at the hearing that Plaintiff had prior relevant work 

experience as a caregiver, Dictionary of Occupational Titles (“DOT”) 354.377-014, medium work 

with an SVP3level of 3 performed as very heavy work. (AR 44.) The ALJ asked the VE to note 

if the VE’s testimony was inconsistent with the DOT, and the VE said she would do so. (AR 44.) 

The ALJ asked the VE whether a person of Plaintiff’s age, education, and work 

experience, who is limited to light work, simple, routine, and repetitive tasks, and low stress work 

defined as no more than occasional decision making or changes in the work setting; may only 

occasionally interact with the public and co-workers; can occasionally climb ramps or stairs, 

balance, stoop, kneel, crouch, and crawl; can never climb ladders, ropes or scaffolds; and is unable 

to perform Plaintiff’s past relevant work, would be able to perform any other work at the light 

level. (AR 45.) The VE testified that such an individual could work as an assembler, DOT 

706.684-042, and as a film developer, DOT 976.685-014, both light work with an SVP of 2. 

(AR 45.) 

The ALJ posed a second hypothetical, adding to the first the additional restriction that the 

individual would require “an ambulatory device at all times when standing and walking[.]” 

(AR 46.) The VE testified that such a person could not perform any work at the light level. 

 

3

 Specific Vocational Preparation (“SVP”), as defined in DOT, App. C, is the amount of lapsed time required by a 

typical worker to learn the techniques, acquire the information, and develop the facility needed for average 

performance in a specific job-worker situation. DOT, App. C, 1991 WL 688702. Jobs in the DOT are assigned SVP 

levels ranging from 1 (the lowest level - “short demonstration only”) to 9 (the highest level - over 10 years of 

preparation). Id.

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(AR 46.) The ALJ posed a third hypothetical, adding to the first the additional restriction that the 

individual “bilaterally could only occasionally handle and finger[.]” (AR 46.) The VE testified 

that such a person could not perform any work at the light level. (AR 46.) 

D. Administrative Proceedings4

On December 7, 2012, the ALJ issued his decision finding Plaintiff not disabled. (AR 10-

20.) The ALJ found Plaintiff had severe impairments including degenerative disc disease, 

bilateral carpal tunnel syndrome, degenerative joint disease of the knees, and depression. (AR 12.) 

The ALJ noted that Plaintiff’s Body Mass Index score of 36.6 met the identified medical criteria 

for the diagnosis of obesity. (AR 12.) The ALJ determined that Plaintiff’s impairments, singly 

and in combination, did not meet or equal a listed impairment. (AR 12-13.) The ALJ found 

Plaintiff retained the RFC5to perform light work as defined in 20 C.F.R. § 416.967(b), with the 

limitations that she can lift or carry 20 pounds occasionally and 10 pounds frequently; sit, stand, 

and walk for six hours during an eight-hour work day; occasionally climb ramps or stairs, balance, 

stoop, kneel, crouch, and crawl; never climb ladders, ropes, or scaffolds; and is limited to work 

involving simple, routine, and repetitive tasks, low stress work defined as no more than occasional 

decision making or changes in the work setting, and can only occasionally interact with the public 

and coworkers. (AR 13-14.) The ALJ also determined that Plaintiff “has a limited education and 

is able to communicate in English.” (AR 18.) 

Given this RFC, the ALJ found Plaintiff was unable to perform past relevant work but was 

capable of performing the requirements of representative occupations assembler, DOT 706.684-

042, and film developer, DOT 976.685-014. (AR 18-19.) The ALJ concluded that Plaintiff was 

 

4

 Plaintiff was previously denied SSI benefits in a decision dated November 21, 2008. (See AR 52-61; 67-77.) As 

the result of that decision is not disputed, the contents of that decision will not be summarized or reviewed in this

order. 

5

 Residual functional capacity (“RFC”) is an assessment of an individual’s ability to do sustained work-related 

physical and mental activities in a work setting on a regular and continuing basis of 8 hours a day, for 5 days a week, 

or an equivalent work schedule. Social Security Ruling (“SSR”) 96-8p. The RFC assessment considers only 

functional limitations and restrictions that result from an individual’s medically determinable impairment or 

combination of impairments. Id. “In determining a claimant’s RFC, an ALJ must consider all relevant evidence in 

the record including, inter alia, medical records, lay evidence, and ‘the effects of symptoms, including pain, that are 

reasonably attributed to a medically determinable impairment.’” Robbins v. Soc. Sec. Admin., 466 F.3d 880, 883 (9th 

Cir. 2006). 

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not disabled, as defined in the Social Security Act, from February 4, 2011, the date the application 

was filed, through the date of the decision. (AR 20.) Plaintiff sought review of the ALJ’s decision 

with the Appeals Council on February 7, 2014 (AR 5-6), but review was denied on April 10, 2014, 

making the ALJ’s decision final (AR 1-4). 

E. Plaintiff’s Complaint

On June 10, 2014, Plaintiff filed a complaint before this Court seeking review of the ALJ’s 

decision. (Doc. 1.) Plaintiff contends the ALJ erred by failing to adequately consider Plaintiff’s 

illiteracy in his RFC assessment, improperly weighing the medical evidence, and improperly 

assessing Plaintiff’s credibility. (Docs. 18; 24.) 

III. SCOPE OF REVIEW

The ALJ’s decision denying benefits “will be disturbed only if that decision is not 

supported by substantial evidence or it is based upon legal error.” Tidwell v. Apfel, 161 F.3d 599, 

601 (9th Cir. 1999). In reviewing the Commissioner’s decision, the Court may not substitute its 

judgment for that of the Commissioner. Macri v. Chater, 93 F.3d 540, 543 (9th Cir. 1996). 

Instead, the Court must determine whether the Commissioner applied the proper legal standards 

and whether substantial evidence exists in the record to support the Commissioner’s findings. See 

Lewis v. Astrue, 498 F.3d 909, 911 (9th Cir. 2007).

“Substantial evidence is more than a mere scintilla but less than a preponderance.” Ryan v. 

Comm'r of Soc. Sec., 528 F.3d 1194, 1198 (9th Cir. 2008). “Substantial evidence” means “such 

relevant 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. of N.Y. v. NLRB, 

305 U.S. 197, 229 (1938)). The Court “must consider the entire record as a whole, weighing both 

the evidence that supports and the evidence that detracts from the Commissioner’s conclusion, and 

may not affirm simply by isolating a specific quantum of supporting evidence.” Lingenfelter v. 

Astrue, 504 F.3d 1028, 1035 (9th Cir. 2007) (citation and internal quotation marks omitted).

IV. APPLICABLE LAW

An individual is considered disabled for purposes of disability benefits if he is unable to 

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

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mental impairment that can be expected to result in death or that 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), 

1382c(a)(3) (A); see also Barnhart v. Thomas, 540 U.S. 20, 23 (2003). The impairment or 

impairments must result from anatomical, physiological, or psychological abnormalities that are 

demonstrable by medically accepted clinical and laboratory diagnostic techniques and must be of 

such severity that the claimant is not only unable to do his previous work, but cannot, considering 

his age, education, and work experience, engage in any other kind of substantial, gainful work that 

exists in the national economy. 42 U.S.C. §§ 423(d)(2)-(3), 1382c(a)(3)(B), (D).

The regulations provide that the ALJ must undertake a specific five-step sequential 

analysis in the process of evaluating a disability. In Step 1, the ALJ must determine whether the 

claimant is currently engaged in substantial gainful activity. 20 C.F.R. §§ 404.1520(b), 

416.920(b). If not, the ALJ must determine at Step 2 whether the claimant has a severe 

impairment or a combination of impairments significantly limiting her from performing basic 

work activities. Id. §§ 404.1520(c), 416.920(c). If so, the ALJ moves to Step 3 and determines 

whether the claimant has a severe impairment or combination of impairments that meet or equal 

the requirements of the Listing of Impairments (“Listing”), 20 § 404, Subpart P, App. 1, and is 

therefore presumptively disabled. Id. §§ 404.1520(d), 416.920(d). If not, at Step 4 the ALJ must 

determine whether the claimant has sufficient RFC despite the impairment or various limitations 

to perform her past work. Id. §§ 404.1520(f), 416.920(f). If not, at Step 5, the burden shifts to the 

Commissioner to show that the claimant can perform other work that exists in significant numbers 

in the national economy. Id. §§ 404.1520(g), 416.920(g). If a claimant is found to be disabled or 

not disabled at any step in the sequence, there is no need to consider subsequent steps. Tackett v. 

Apfel, 180 F.3d 1094, 1098-99 (9th Cir. 1999); 20 C.F.R. §§ 404.1520, 416.920.

V. DISCUSSION

Plaintiff contends the ALJ erred by failing to adequately consider or incorporate Plaintiff’s 

illiteracy in his RFC assessment, improperly weighing the medical evidence, and improperly 

assessing Plaintiff’s credibility. (Docs. 18; 24.)

//

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A. The ALJ’s Evaluation of Testimony

Plaintiff asserts the ALJ failed to articulate clear and convincing reasons for discounting 

her statements regarding the severity and extent of her ongoing symptoms. (Doc. 18, pp. 10-13.) 

The Commissioner contends the ALJ properly evaluated Plaintiff’s subjective complaints. (Doc. 

22, pp. 10-13.) 

1. Legal Standard

In evaluating the credibility of a claimant’s testimony regarding subjective pain, an ALJ 

must engage in a two-step analysis. Vasquez v. Astrue, 572 F.3d 586, 591 (9th Cir. 2009); Bunnell 

v. Sullivan, 947 F.2d 341, 344 (9th Cir. 1991) (en banc). First, the ALJ must determine whether 

the claimant has presented objective medical evidence of an underlying impairment that could 

reasonably be expected to produce the pain or other symptoms alleged. Vasquez, 572 F.3d at 591. 

The claimant is not required to show that her impairment “could reasonably be expected to cause 

the severity of the symptom [she] has alleged; she need only show that it could reasonably have 

caused some degree of the symptom.” Id. (quoting Lingenfelter, 504 F.3d at 1036). If the 

claimant meets the first test and there is no evidence of malingering, the ALJ can only reject the 

claimant’s testimony about the severity of the symptoms if she gives “specific, clear and 

convincing reasons” for the rejection. Id. 

The ALJ also may consider (1) the claimant’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 claimant’s daily activities. 

Tommasetti v. Astrue, 533 F.3d 1035, 1041 (9th Cir. 2008); see also Bray v. Comm’r of Soc. Sec. 

Admin., 554 F.3d 1219, 1226-27 (9th Cir. 2009); Smolen v. Chater, 80 F.3d 1273, 1284 (9th Cir. 

1996); 20 C.F.R. §§ 404.1529, 416.929. “If the ALJ’s finding is supported by substantial 

evidence, the court may not engage in second-guessing.” Tommasetti, 533 F.3d at 1039. 

2. The ALJ Pointed to Substantial Evidence in the Record to Discount Plaintiff’s 

Credibility

Plaintiff contends the ALJ improperly discredited her testimony as inconsistent with the 

ALJ’s RFC assessment and the objective medical evidence. (Doc. 18, p. 12.) The Commissioner 

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asserts the ALJ properly found the evidence in the record did not support Plaintiff’s testimony of 

subjectively disabling pain and symptoms. (Doc. 22, p. 11.) Plaintiff responds that the ALJ relied 

solely upon objective medical evidence to find her not credible, “in clear violation of precedent.” 

(Doc. 24 p. 5.) 

In weighing a claimant’s credibility, the ALJ may consider her reputation for truthfulness, 

inconsistencies either in her testimony or between her testimony and her conduct, her daily 

activities, her work record, and testimony from physicians and third parties concerning the nature, 

severity, and effect of the symptoms of which she complains. Smolen, 80 F.3d at 1284; Moncada 

v. Chater, 60 F.3d 521, 524 (9th Cir. 1995) (quoting Orteza v. Shalala, 50 F.3d 748, 749-50 (9th 

Cir.1995)). While the ALJ is required to consider a claimant’s statements about her symptoms, in 

evaluating the intensity and persistence of those symptoms, the ALJ considers “all of the available 

evidence.” 20 C.F.R. § 404.1529(c). This includes objective medical evidence, defined as 

“evidence obtained from the application of medically acceptable clinical and laboratory diagnostic 

techniques, such as evidence of reduced joint motion, muscle spasm, sensory deficit or motor 

disruption.” 20 C.F.R. § 404.1529(c)(2). It also includes “other evidence,” such as “information 

that you, your treating or nontreating source, or other persons provide about your pain or other 

symptoms (e.g., what may precipitate or aggravate your symptoms, what medications, treatments 

or other methods you use to alleviate them, and how the symptoms may affect your pattern of 

daily living)[.]” 20 C.F.R. § 404.1529(c)(3). 

While the inconsistency of objective findings with subjective pain complaints may not be 

the sole reason for rejecting subjective complaints of pain, Light v. Soc. Sec. Admin., 119 F.3d 

789, 792 (9th Cir. 1997); Lester v. Chater, 81 F.3d 821, 834 (9th Cir.1995); Social Security Rule 

(“SSR”) 95-5P61995 WL 670415, at *1, it is one factor which may be permissibly considered with 

others, Moisa v. Barnhart, 367 F.3d 882, 885 (9th Cir. 2004); Morgan v. Comm’r of Soc. Sec. 

 

6

 The Commissioner issues Social Security Rulings to clarify the Secretary’s regulations and policy. See Bunnell v. 

Sullivan, 947 F.2d 341, 346 n.3 (9th Cir. 1991). The Secretary’s interpretation of 20 C.F.R. §§ 404.1529 and 416.929 

is found in SSR 88-13. Id. “Although SSRs are not published in the federal register and ‘do not have the force of 

law,’ we nevertheless give deference to the Secretary’s interpretation of its regulations.” Id. (internal citations 

omitted).

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Admin., 169 F.3d 595, 600 (9th Cir. 1999). Here, however, the ALJ permissibly pointed to both 

the objective medical evidence and to other evidence in discounting Plaintiff’s credibility. 

(AR 14-18.) 

//

The ALJ first reviewed the objective medical evidence of the record that was inconsistent 

with Plaintiff’s testimony regarding the limitations imposed by her medically determinable 

impairments. (AR 16.) “The record does not demonstrate clearly that she has the significantly 

limited range of motion, muscle spasms, muscle atrophy, motor weakness, sensation loss, or reflex 

abnormalities, which are associated with intense and disabling pain.” (AR 16.) The ALJ pointed 

to Dr. Hawlett’s findings that Plaintiff retained full range of motion in her right knee with mild 

crepitus as inconsistent with Plaintiff’s claims of extremely limited functional capacity. (AR 16.) 

The ALJ also pointed to multiple imaging studies of Plaintiff’s knees, right ankle, and left foot as 

revealing only “mild” patellar spurring, moderate posterior and plantar calcaneal spurring, and no 

other abnormalities. (AR 18; see 344; 345; 442-44.) A lumbar spine x-ray similarly revealed only 

mild degenerative changes and no subluxation. (AR 366.) On examination, Dr. Wagner observed 

that Plaintiff had motor strength of 5/5 in her bilateral upper and lower extremities, mild 

paravertebral muscle tenderness, and continuous grinding in the left knee with no real tenderness. 

(AR 280; 282.) 

The ALJ then discussed “other evidence” within the record, including the opinion evidence 

of Plaintiff’s treating and examining medical sources. (AR 15-18.) The ALJ noted that examining 

physician Dr. Wagner opined Plaintiff does not require the use of assistive devices and “can walk 

fine without the walker.” (AR 16.) Despite that Plaintiff appeared at the examination with a 

walker, during the examination, she was able to “easily” get out of her chair in the waiting room, 

sat comfortably throughout the entire history table, get on and off the examination table slowly, 

“easily” bend over at the waist, walk on her toes and on her heels, and take off her shoes and put 

them on without significant problems. (AR 15; see also AR 279-81.) Dr. Wagner further opined 

that while Plaintiff “complained” during the examination, she “did not give good effort with the 

upper extremity motor strength examination.” (AR 15; see also AR 282.) 

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During the hearing, Plaintiff testified that Dr. Crews had prescribed both handbraces and a 

walker (AR 36); as the ALJ noted, however, there is no indication in the medical record Dr. Crews

or any other physician prescribed an assistive device to aid Plaintiff in walking (AR 18; see AR 

272; 318-48; 409-53; 454.) “In weighing a [Plaintiff]’s credibility, the ALJ may consider 

‘ordinary techniques of credibility evaluation, such as . . . other testimony by the claimant that 

appears less than candid[.]’” Turner v. Comm’r of Soc. Sec., 613 F.3d 1217, 1224 n.3 (9th Cir. 

2010) (quoting Smolen v. Chater, 80 F.3d 1273, 1284 (9th Cir. 1996)); see also Molina v. Astrue, 

674 F.3d 1104, 1112 (9th Cir. 2012). Plaintiff’s testimony that she had been prescribed a walker

by Dr. Crews is not supported by the record, and the ALJ permissibly pointed to this inconsistency 

at several points in his opinion in discounting Plaintiff’s credibility. Verduzco v. Apfel, 188 F.3d 

1087, 1090 (9th Cir. 1999) (ALJs may consider whether the Plaintiff’s testimony is believable or 

not). 

In sum, the ALJ’s reasons were properly supported by the record and sufficiently specific 

to allow the Court to conclude that he rejected Plaintiff’s testimony on permissible grounds, and 

did not arbitrarily discredit Plaintiff’s testimony. 

B. The ALJ’s Evaluation of the Medical Evidence

Plaintiff next contends the ALJ improperly rejected treating physician Dr. Crews’ medical 

opinion regarding Plaintiff’s functioning. (Doc. 18, pp. 13-17.) The Commissioner responds that 

substantial evidence supports the ALJ’s evaluation of Dr. Crews’ opinion. (Doc. 17, pp. 7-9.) 

1. Legal Standard

The medical opinions of three types of medical sources are recognized in Social Security 

cases: “(1) those who treat the claimant (treating physicians); (2) those who examine but do not 

treat the claimant (examining physicians); and (3) those who neither examine nor treat the 

claimant (nonexamining physicians).” Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995). 

Generally, a treating physician’s opinion should be accorded more weight than opinions of doctors 

who did not treat the claimant, and an examining physician’s opinion is entitled to greater weight 

than a non-examining physician’s opinion. Id. 

//

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Where a treating or examining physician’s opinion is uncontradicted by another doctor, the 

Commissioner must provide “clear and convincing” reasons for rejecting the treating physician’s 

ultimate conclusions. Id. If the treating or examining doctor’s medical opinion is contradicted by 

another doctor, the Commissioner must provide “specific and legitimate” reasons for rejecting that 

medical opinion, and those reasons must be supported by substantial evidence in the record. Id. at 

830-31; accord Valentine v. Comm’r Soc. Sec. Admin., 574 F.3d 685, 692 (9th Cir. 2009). The 

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

conflicting clinical evidence, stating her interpretation thereof, and making findings. Tommasetti, 

533 F.3d at 1041. 

2. The ALJ Stated Legally Sufficient Reasons for Rejecting Dr. Crews’ Opinion 

Plaintiff contends the ALJ failed to give legally sufficient reasons for rejecting Dr. Crews’ 

opinion that Plaintiff “was prevented from meaningful employment due to chronic low back pain, 

carpal tunnel syndrome, hypercholesterolemia, depression, diplopia and insomnia” and her

assessment of Plaintiff’s functional limitations. (Doc. 18, pp. 13-17.) In the decision, the ALJ 

gave “little weight” to Dr. Crews’ opinion because:

. . . The course of treatment pursued by [Dr. Crews] has not been consistent with 

what one would expect if [Plaintiff] were truly disabled, as the doctor has 

reported. Image studies taken on May 31, 2012, of the [Plaintiff’s] right and left 

knee revealed “mild” patellar spurring. Images of her right ankle were normal. 

Images of the left foot revealed calcaneal spurring with no other abnormalities. 

The doctor apparently relied quite heavily on the subjective report of symptoms 

and limitations provided by [Plaintiff], and seemed to uncritically accept as true 

most, if not all, of what [Plaintiff] reported. Furthermore, Dr. Crews[ ] is very 

specific in listing limitations such as elevating [Plaintiff]’s feet for 2-3 hours[,] 

however, she did not mention anything about using a cane or walker to ambulate. 

Lastly, Dr. Crews’ opinion that [Plaintiff] is permanently disabled touches on an 

ultimate issue that is reserved to the [C]ommissioner and is therefore not afforded 

controlling weight[.]

(AR 18.) 

Plaintiff asserts the ALJ impermissibly rejected Dr. Crews’ opinion because the ALJ

believed Dr. Crews’ opinion relied on Plaintiff’s subjective complaints. (Doc. 18, p. 15.) Plaintiff 

contends that a “physician can, with firsthand impressions and clinical evidence, give credence to 

a [Plaintiff]’s subjective claims.” (Doc. 18, p. 15 (citing Ryan v. Commissioner of Social Sec., 528 

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F.3d 1194, 1199-1200).) Plaintiff’s reliance on Ryan is misplaced, however, because Dr. Crews’ 

2008 letter and 2012 questionnaire are not supported by “firsthand impressions and clinical 

evidence” in the record. (See AR 272; 454.) 

A review of Dr. Crews’ treating notes, letter, and single-page questionnaire reveal only 

diagnoses and opined limitations imposed by those diagnoses; there are no clinical observations

offered in support of Dr. Crews’ conclusory opinion in the 2008 letter and 2012 questionnaire that 

Plaintiff is disabled. (See AR 272; 318-48; 409-53; 454.) In her 2008 letter, Dr. Crews does not 

refer to any objective medical evidence (AR 272); in her 2012 assessment, Dr. Crews lists several 

imaging studies as objective evidence supporting her opinion (AR 454). However, a review of the 

results of these studies offers no support for Dr. Crews’ opinion of total disability. (See AR 344 

(2010 left foot x-ray revealed moderate calcaneal spurring); 345 (2010 left knee x-ray revealed no 

significant problems and right knee x-ray revealed mild patellar spurring); 366 (2011 lumbar spine 

x-ray revealed mild degenerative changes); 442 (right knee x-ray revealed mild patellar spurring); 

443 (2011 right ankle x-ray revealed no abnormalities). In the absence of objective medical 

evidence or clinical observations supporting Dr. Crews’ opinion, the ALJ reasonably determined 

that Dr. Crews’ opinion must have relied “quite heavily” on Plaintiff’s subjective complaints and 

description of her symptoms and limitations. (AR 18.) 

As discussed above, the ALJ properly discounted Plaintiff’s excess pain testimony. 

Therefore, the ALJ did not err in rejecting Dr. Crews’ opinion because it is based “to a large 

extent” on Plaintiff’s self-reports that had already been discounted as incredible. Tommasetti, 533 

F.3d at 1041 (citing Morgan v. Comm’r Soc. Sec. Admin., 169 F.3d 595, 602 (9th Cir. 1999)) (“An 

ALJ may reject a treating physician’s opinion if it is based ‘to a large extent’ on a [plaintiff]’s selfreports that have been properly discounted as incredible”); Tonapetyan v. Halter, 242 F.3d 1144, 

1149 (9th Cir. 2001) (where the record supports the ALJ in discounting the plaintiff’s credibility, 

the ALJ’s rejection of a treating physician’s opinion premised on the plaintiff’s subjective 

complaints was also proper); Fair v. Bowen, 885 F.32d 597, 605 (9th Cir. 1989).

Plaintiff also asserts the ALJ impermissibly rejected Dr. Crews’ opinion that Plaintiff 

needed to elevate her feet every two to three hours because Dr. Crews failed to mention Plaintiff’s 

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use of a cane or walker to ambulate. (Doc. 18, p. 16.) Plaintiff contends that these facts have 

nothing to do with each other, and the ALJ impermissibly assumed that only someone requiring 

the prescription of an assistive device would have any need to elevate her legs at these intervals. 

(Doc. 18, pp. 16-17.) The Commissioner does not address this issue in her brief. (Doc. 22.) 

In her treating notes, Dr. Crews observed that Plaintiff used shoe inserts and walked 

barefoot at home in February 2010 (AR 331) and appeared at a May 2011 appointment “walking 

slowly with a walker” (AR 324), but at no point did Dr. Crews opine that Plaintiff required the use 

of any assistive device to aid Plaintiff in walking (see AR 272; 318-48; 409-53; 454). On its own, 

the ALJ’s assumption that Plaintiff’s need to elevate her legs would necessitate a prescription for 

an assistive device is not a sufficient basis to reject that portion of Dr. Crews’ opinion. However, 

Dr. Crews opinion was not rejected on this basis alone. Rather, in the absence of any supporting 

and consistent objective findings or clinical observations, Dr. Crews’ opinion that Plaintiff must 

“lie down or elevate her legs” for “2-3 hours” in an 8-hour workday appears to have been based on 

Plaintiff’s own self-reported limitations. (See AR 454.) Accordingly, because the ALJ 

permissibly rejected Plaintiff’s testimony, any portion of Dr. Crews’ opinion based on Plaintiff’s 

self-reports was also permissibly rejected. Tommasetti, 533 F.3d 1035, 1041; Bray, 554 F.3d at 

1228. The ALJ did not err by rejecting Dr. Crews’ opinion that Plaintiff needed to elevate her legs 

for two to three hours in a workday. 

Plaintiff finally asserts the ALJ impermissibly rejected Dr. Crews’ medical opinion based 

on her failure to prescribe a course of treatment consistent with total disability. (Doc. 18, p. 15.) 

Plaintiff contends that the ALJ failed to identify what course of treatment beyond physical 

therapy, cortisone injections, anti-inflammatory medication, and narcotic pain medication “would 

be necessary to fulfill this arbitrary requirement.” (Doc. 18, p. 15.) The Commissioner contends 

the ALJ properly pointed to Plaintiff’s conservative treatment history with Dr. Crews, including 

physical therapy, a prescription for a wrist brace, and medication, as inconsistent with the level of 

treatment one would expect for a patient with disabling impairments. (Doc. 22, p. 14.) 

The record indicates that Plaintiff failed to follow the fairly conservative course of 

treatment recommended to address her physical impairments. For example, Dr. Crews referred

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Plaintiff to physical therapy in 2008, where Plaintiff quit after eleven session because she “did not 

want to continue” despite making gains in range of motion and strength (AR 464), and again in 

2011, where therapy was discontinued after twelve sessions because there was no significant 

progress overall (AR 462.) Dr. Crews recommended a cortisone injection in June 2010 to treat 

Plaintiff’s left foot spurring, but it is unclear whether Plaintiff actually received this injection. 

(AR 330; see also AR 280 (examining physician Dr. Wagner noted that Plaintiff had never had 

surgery or arthrocentesis and refused an injection, and that carpal tunnel release surgery had been 

recommended but Plaintiff had declined); 347 (Dr. Hawley noted Plaintiff had received a cortisone 

injection in her left knee but it had not successfully relieved her symptoms).) Dr. Crews also 

recommended, and Plaintiff declined, an orthopedic referral in July of 2012. (AR 417.) It is not 

clear from the record, however, what more Dr. Crews could have done, given that Plaintiff did not 

follow her recommendations. Had Plaintiff actively pursued Dr. Crews’ repeated 

recommendations for physical therapy, injections, and surgical intervention, her course of 

treatment would have comprised more than basic “conservative treatment.” See Parra v. Astrue, 

481 F.3d 742, 751 (9th Cir. 2007), cert. denied, 552 U.S. 1141 (2008) (quoting Johnson v. 

Shalala, 60 F.3d 1428, 1434 (9th Cir. 1995)) (treatment with over-the-counter medication is 

“conservative treatment” sufficient to discount credibility as to the severity of an impairment). 

The Court is not persuaded that the ALJ’s belief that this course of treatment was 

inconsistent with total disability is a permissible reason to reject Dr. Crews’ medical opinion, as 

Plaintiff’s failure to follow Dr. Crews’ recommended course of treatment does not necessarily 

affect Dr. Crews’ credibility. Any error in discounting Dr. Crews’ opinion on this basis was 

harmless, however, because the ALJ articulated several other legally sufficient reasons for 

discounting Dr. Crews’ medical opinion. Stout v. Comm’r of Soc. Security, 454 F.3d 1050, 1054-

55 (9th Cir. 2006) (harmless error is inconsequential to the nondisability determination).

In sum, the ALJ articulated legally sufficient reasons for discounting Dr. Crews’ opinion. 

C. The ALJ’s Evaluation of Plaintiff’s Ability to Speak English

Plaintiff asserts the ALJ erred by not including Plaintiff’s English fluency limitation in his 

assessed RFC, and by not providing a reasonable explanation for how a non-English speaker could 

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perform any of the jobs identified by the VE. (Doc. 18, pp. 6-10.) The Commissioner responds 

that “Plaintiff’s ability to communicate in English is an educational factor that need not be 

included in an RFC assessment,” Plaintiff’s ability to communicate in English can be inferred 

from her testimony, and the ALJ properly relied on the VE’s testimony that Plaintiff could 

perform the requirements of the identified occupations. (Doc. 22, pp. 8-9.) The Commissioner 

also asserts Plaintiff’s contentions of illiteracy are not relevant because the ALJ found Plaintiff 

could perform unskilled work, and the regulations consider literacy as having “little significance” 

to her ability to perform unskilled work. (Doc. 22, p. 9.)

1. Legal Standards

The Commissioner bears the burden of proving Plaintiff is literate as part of the ALJ’s 

vocational analysis where, as here, Plaintiff has raised the question of her literacy. Silveira v. 

Apfel, 204 F.3d 1257, 1261 n.14 (9th Cir. 2000); 20 C.F.R. § 416.912(g). An ALJ must assess 

both a claimant’s “literacy” and “ability to communicate in English” in determining whether a 

claimant can perform work pursuant to the regulations. 20 C.F.R. §§ 404.1564(b), 416.964(b); see 

also Broadway v. Colvin, No. 1:13-CV-00793-SKO, 2014 WL 4249153 (E.D. Cal. Aug. 26, 

2014); Calderon v. Astrue, No. 1:08-CV-01015-GSA, 2009 WL 3790008, at *9 (E.D. Cal. Nov.

10, 2009). “Illiteracy” is defined as the “inability to read or write.” 20 C.F.R. §§ 404.1564(b)(1), 

416.964(b)(1). A claimant who is able to read or write a simple message in English is not 

considered illiterate. Id. The ability to “communicate in English” requires the ability to “speak, 

read, and understand” the language. Id., at 404.1564(b)(5), 416.964(b)(5). The Ninth Circuit has 

clarified that a claimant is considered “illiterate or unable to communicate in English” if she 

demonstrates she is either illiterate or unable to communicate in English or both. Silveira, 202 

F.3d at 1262, n.13.

2. The ALJ Did Not Properly Evaluate Plaintiff’s Literacy

The ALJ made no finding as to Plaintiff's literacy at Step Five, stating only that she is 

“able to communicate in English” at Step Four. (AR 18.) The ALJ did not make any other 

findings relating to Plaintiff’s literacy, and the record does not demonstrate Plaintiff’s literacy. 

Although the ALJ concluded Plaintiff was literate, substantial evidence did not support that 

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finding. (AR 18.) Plaintiff testified she completed nine years of school in Iran, can read and write 

in Persian, cannot read or write in Syrian, and can read and write in English only “very little.” 

(AR 33-34.) There is nothing in the record explaining, and the ALJ did not make any finding

describing, what “very little” means. (See AR.) In her disability report, Plaintiff stated that she 

cannot speak, read, or understand English but answered affirmatively when asked if she can “write 

more [her] name in English.” (AR 161.) Plaintiff testified that she is unable to read or write 

enough English to “have a grocery list of all [her] shopping needs and go grocery shopping.” 

(AR 34.) Plaintiff’s Adult Function Report was completed by and signed by her daughter. 

(AR 185.) Both examining physicians noted that Plaintiff required an interpreter. (AR 279; 285.) 

While the ability to read or write even a simple message in English may lead to a finding 

of literacy, 20 C.F.R. §§ 404.1564(b)(1), 416.964(b)(1), the record is not clear as to whether 

Plaintiff is capable of doing so (compare AR 161 (Plaintiff can write at least her name in English) 

with 34 (Plaintiff is unable to write or read a grocery list). Even if the ALJ’s conclusion that 

Plaintiff is “able to communicate in English” were supported by substantial evidence in the record, 

there is no finding or evidence in the record as to whether Plaintiff is literate. 

3. The ALJ Erred by Failing to Properly Incorporate Plaintiff’s Illiteracy into 

the Hypotheticals Posed to the VE

Plaintiff argues the ALJ failed to properly incorporate Plaintiff’s illiteracy in his 

hypotheticals to the VE or the resulting RFC. (Doc. 18, pp. 7-9.) The ALJ did not include any 

reference to Plaintiff’s ability to read and write English in his hypotheticals to the VE during the 

hearing and did not address Plaintiff’s literacy in his decision. (AR 12-20.) Neither the ALJ nor 

the VE addressed the impact of Plaintiff’s literacy on her ability to find and perform the 

requirements of unskilled work. (AR 18-20; 44-47.) The Commissioner contends the ALJ 

properly relied on the testimony of the VE because the VE necessarily took Plaintiff’s ability to 

communicate in English into account, since “the VE had heard Plaintiff’s testimony that was given 

with the assistance of an interpreter, including that she completed nine years of schooling in Iran 

and read and wrote ‘very little’ in English.” (Doc. 22, p. 9.) 

//

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While a claimant is not per se disabled if he or she is illiterate, the ALJ must “definitively 

explain” the impact of a claimant’s illiteracy on her ability to find and perform either past relevant 

work or alternative work. Pinto v. Massanari, 249 F.3d 840, 848 (9th Cir. 2001). The ALJ did not 

address Plaintiff’s literacy, but found Plaintiff capable of performing the requirements of light, 

unskilled work as an assembler, DOT 706.684-042, and as a film developer, DOT 976.685-014. 

(AR 19.) Both positions require a Language Level of 1. Although it may be reasonable to assume, 

as the Commissioner argues in her brief, that Plaintiff has some English language skills based on 

her answering questions before the interpreter finished interpreting them during the hearing7, has a 

California driver’s license, and has lived in the United States for twelve years (Doc. 22, pp. 8-9),

the impact of Plaintiff’s illiteracy on her ability to work was not given express consideration by the 

ALJ or the VE. The Court may review only the reasons stated by the ALJ in his decision “and may 

not affirm the ALJ on a ground upon which he did not rely.” Orn, 495 F.3d at 630. Because the 

VE did not address the impact of Plaintiff’s limited ability or inability to read and write in English, 

it is only an assumption that Plaintiff’s illiteracy does not impact her ability to perform the 

requirements of these jobs and that assumption is not sufficient to conclude that any failure to 

expressly consider Plaintiff’s literacy was harmless. 

The “representative occupations” which the VE testified Plaintiff can perform all require a 

Language Level of 1. See DOT 706.684-042; 976.685-014. Language Level 1 requires that a 

person have the following skills: 

Reading: Recognize meaning of 2,500 (two- or three-syllable) words. Read at a rate 

of 95-120 words per minute. Compare similarities and differences between 

words and series of numbers. 

Writing: Print simple sentences containing subject, verb, and object, and series of 

numbers, names, and addresses. 

Speaking: Speak simple sentences, using normal word order, and present and past 

tenses.

See 920.587-018; 319.484-010; 311.677-010. 

 

7

 The Commissioner interprets Plaintiff’s occasionally answering question before the interpreter was finished as

evidence that Plaintiff knew or understood the questions being posed by the ALJ, in English. It is unclear, however, 

whether this is in fact the case. Based on a review of the transcript, the Court is unable to conclusively determine that 

Plaintiff was answering the questions as asked in English, or if she was speaking directly to the interpreter to ask for 

clarification, to offer her answer, or to make some other comment. 

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“The ability to communicate is an important skill to be considered when determining what 

jobs are available to a claimant. Illiteracy seriously impacts an individual’s ability to perform 

work-related functions such as understanding and following instructions, communicating in the 

workplace, and responding appropriately to supervision.” Pinto, 249 F.3d at 846; see also 

20 C.F.R. § 416.695(b)(5) (“[W]e consider a person’s ability to communicate in English when we 

evaluate what work, if any, he or she can do”). An ALJ’s failure to explain how a plaintiff’s 

illiteracy limitation related to his finding that the plaintiff could perform her past relevant work as 

generally performed is reversible error. Pinto, 249 F.3d at 847. 

Here, the ALJ neither expressly included Plaintiff’s illiteracy as a limitation in his 

hypotheticals to the VE – though he did ask the VE to consider Plaintiff’s “education” and 

“language” – nor did he address Plaintiff’s illiteracy in his decision. (AR 14; 18 (determining 

Plaintiff is “able to communicate in English” but making no finding as to Plaintiff’s literacy); 44-

47.) Despite that Plaintiff testified she is unable to read or write enough English to make or use a 

grocery list for shopping (AR 34), the ALJ did not ask and the VE failed to explain the impact of 

Plaintiff’s illiteracy on her ability to perform the requirements of these representative occupations

and failed to account for any deviation from the Language Level 1 requirement set forth in the 

DOT descriptions. The fact that Plaintiff previously performed her past relevant work as a 

caretaker or obtained a driver’s license without being literate in English is neither sufficient nor 

persuasive evidence to support a deviation from the DOT requirement as to other work. See 

Pinto, 249 F.3d at 847; Mui Si Voong v. Astrue, 641 F. Supp. 2d 996, 1009-10 (E.D. Cal. 2009)

(the fact plaintiff passed a citizenship test and obtained a driver’s license did not mean she could 

speak and read English, even at Language Level 1). Although a plaintiff “is not per se disabled if 

he or she is illiterate,” the ALJ’s failure to provide a reasonable explanation for his deviation from 

the DOT’s language requirements to find Plaintiff capable of performing the alternative work 

identified is erroneous. Pinto, 249 F.3d at 847. 

The ALJ failed to provide any explanation as to why he found Plaintiff able to perform the 

requirements of work requiring Language Level 1 English reading, writing, and speaking abilities 

(AR 19), despite substantial evidence that Plaintiff is unable to read, write, or speak English at 

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Language Level 1 (AR 34-35; 161; 279; 285). As discussed, it is not clear from the ALJ’s 

decision whether Plaintiff is illiterate in English, and it is not clear whether Plaintiff’s illiteracy 

would impair her ability to perform light, unskilled work in either of the representative occupations 

the ALJ lists. See Mui Si Voong, 641 F. Supp. 2d at 1009-10 (remanding the case for further 

consideration because the hypothetical relied upon by the ALJ did not account for plaintiff’s need 

for an interpreter to explain instruction on how to perform one- to three-step commands). Because 

the ALJ made very few findings and relied largely on the conclusions of the VE, it is difficult for 

this Court to review the decision. As the Ninth Circuit has repeatedly stated, “requiring the ALJ to 

make specific findings on the record at each phase of the step four analysis provides for 

meaningful judicial review. When . . . the ALJ makes findings only about the [Plaintiff]’s 

limitations, and the remainder of the step four assessment takes place in the [VE’s] head, we are 

left with nothing to review.” Pinto, 249 F.3d at 847 (internal quotation omitted).

The Commissioner contends that Plaintiff’s contentions of illiteracy are ultimately 

harmless because the ALJ found Plaintiff could perform unskilled work, and the regulations state 

literacy has the least impact on performing unskilled work. (Doc. 22, p. 9.) The Commissioner’s 

argument is based on the presumption that the ALJ’s application of the Medical-Vocational 

Guidelines (“Grids”), which state literacy has the least impact on unskilled work, was appropriate. 

(See Doc. 22, p. 9 (citing 20 C.F.R. pt. 404, Subpt. P, App. 2 § 202.00(g).) However, the ALJ did 

not rely on the Grids to determine whether Plaintiff was disabled. (AR 18.) The ALJ employed a 

VE to determine the potential work Plaintiff could perform and failed to include Plaintiff’s literacy 

in any hypothetical posed to the VE. (AR 44-47.) The ALJ’s failure to properly analyze 

Plaintiff's literacy cannot be deemed harmless because, were Plaintiff illiterate, proper 

hypotheticals to the VE would include illiteracy. Upon remand the ALJ must resolve the 

ambiguity of Plaintiff’s literacy and, if appropriate, include illiteracy in Plaintiff’s RFC and in the 

vocational analysis at Step Five.

Based on the foregoing, the VE’s testimony that Plaintiff can perform work as an assembler 

and a film developer conflicts with the DOT Language Level requirements of those jobs, and the 

ALJ’s finding that Plaintiff can perform the requirements of these representative occupations is not 

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supported by substantial evidence. 

D. Remand for One Issue

This case shall be remanded for the ALJ to consider whether Plaintiff is illiterate and, if so, 

whether her illiteracy seriously impacts Plaintiff’s ability to work. 

In all other respects, the ALJ’s findings are affirmed. 

VI. CONCLUSION

Based on the foregoing, the Court finds that remand is necessary to reconsider the impact 

of Plaintiff’s illiteracy on her RFC. Accordingly, the Court GRANTS Plaintiff’s appeal from the 

administrative decision of the Commissioner of Social Security. The Clerk of this Court is 

DIRECTED to enter judgment in favor of Plaintiff Jarman Yacoub and against Defendant Carolyn 

W. Colvin, Acting Commissioner of Social Security. 

IT IS SO ORDERED.

Dated: February 11, 2016 /s/ Sheila K. Oberto 

UNITED STATES MAGISTRATE JUDGE

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