Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_13-cv-00733/USCOURTS-azd-2_13-cv-00733-0/pdf.json

Nature of Suit Code: 863
Nature of Suit: Social Security - DIWC/DIWW (405(g))
Cause of Action: 42:405 Review of HHS Decision (SSID)

---

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

WO 

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Stacee Kensler Baxla, 

Plaintiff, 

v. 

Carolyn W. Colvin, 

Defendant.

No. CV-13-00733-PHX-BSB

ORDER 

 Plaintiff Stacee Kensler Baxla seeks judicial review of the final decision of the 

Commissioner of Social Security (the Commissioner) denying her application for 

disability insurance benefits under the Social Security Act (the Act). The parties have 

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

§ 636(b) and have filed briefs in accordance with Local Rule of Civil Procedure 16.1.1

 

For the following reasons, the Court affirms the Commissioner’s decision. 

I. Procedural History 

 On May 19, 2009, Plaintiff applied for disability insurance benefits under Title II 

of the Act alleging a disability beginning on October 27, 2007. (Tr.13.)2

 After the Social 

Security Administration (SSA) denied Plaintiff’s initial application and her request for 

 

1

 Plaintiff also submitted a notice of supplemental authority citing a recent Ninth Circuit decision, Garrison v. Colvin, 2014 WL 3397218 (9th Cir. Jul. 14, 2014), which 

discusses the law applicable to review of the Commissioner’s disability determination. (Doc. 32.) 

2

 Citations to “Tr.” are to the certified administrative transcript of record. (Doc. 15.) 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 1 of 29
- 2 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

reconsideration, Plaintiff requested a hearing before an administrative law judge (ALJ). 

After conducting a hearing, the ALJ issued a decision finding Plaintiff not disabled under 

the Act. (Tr. 13-22.) This decision became the final decision of the Commissioner when 

the Social Security Administration Appeals Council denied Plaintiff’s request for review. 

(Tr. 1); see 20 C.F.R. § 404.981 (explaining the effect of a disposition by the Appeals 

Council.) Plaintiff now seeks judicial review of this decision pursuant to 42 

U.S.C. § 405(g). 

II. Medical Record 

The record before the Court establishes the following history of examination, 

diagnosis, and treatment. The record also include opinions from medical sources who 

either examined Plaintiff or reviewed the record, but who did not provide treatment. 

 A. Treatment Related to Mental Health

 In October 2006, Plaintiff sought treatment at Value Options and was diagnosed 

with bipolar disorder, depressive disorder, obsessive compulsive disorder, post-traumatic 

stress disorder, and schizoaffective traits. (Tr. 929.) She continued treatment at Value 

Options throughout 2006. (Tr. 904-42.) 

 In March 2007, Plaintiff attempted suicide and was hospitalized for several days. 

(Tr. 262.) The emergency room report noted Plaintiff’s diagnoses as bipolar disorder, 

depression, obsessive-compulsive disorder, and thoughts of self-destructive behavior. 

(Tr. 262-64.) In June 2007, Plaintiff continued receiving care at Value Options for 

anxiety, paranoia, increased sleep, auditory hallucinations, and thoughts of self-harm. 

(Tr. 877-78.) 

 Plaintiff then sought treatment at Magellan Health Services (Magellan). On 

November 29, 2007, Plaintiff was treated at Magellan for bipolar disorder. (Tr. 859.) 

She was instructed to contact the crisis line if she experienced an increase in auditory 

hallucinations (hearing voices), anxiety, a desire to mutilate herself, or suicidal ideation. 

(Tr. 859-860.) Magellan’s records include a July 30, 2008 annual assessment of 

Plaintiff’s care, which noted that Plaintiff received treatment for irritability and mood 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 2 of 29
- 3 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

cycling. (Tr. 298.) Plaintiff also reported some depression due to headaches, pain issues, 

and trouble sleeping. (Tr. 298-99.) She reported that she was on “medical leave” from 

her job and stated that she would probably be unable to return to work “due to the 

physical demands.” (Tr. 298.) On examination, Plaintiff’s mood was euthymic and sad, 

her affect was appropriate, her thought process was goal directed and coherent, she had 

good insight and judgment, and she denied having thoughts of self-harm. (Tr. 299.) 

Plaintiff continued treatment at Magellan throughout 2008. (Tr. 727-42.) 

 On January 8, 2009, Plaintiff sought treatment at Southwest Network Direct Care 

Clinic (Southwest) for obsessive compulsive disorder (OCD) tendencies. (Tr. 724.) A 

mental status examination indicated that she was appropriately dressed, had a cooperative 

attitude, a euthymic mood, an appropriate affect, goal directed thought, no delusions or 

hallucinations, and no self-injury. (Tr. 724-25.) In addition, she was alert, had good 

concentration, grossly intact memory, but poor insight and judgment. (Tr. 725.) She was 

diagnosed with OCD, major depressive disorder, and panic. (Tr. 724-25.) 

 On January 12, 2009, Plaintiff received treatment at Magellan for bipolar disorder. 

(Tr. 303.) She reported experiencing “a lot of anxiety.” (Id.) On examination, Plaintiff’s 

mood was appropriate, she had a logical thought process, and was cooperative. (Tr. 303-

04.) She denied visualizations and hallucinations. (Tr. 304.) She reported that when she 

felt well she liked going places and spending time with her children or visiting her 

mother. (Tr. 303.) When Plaintiff was not doing well, she was tearful, slept a lot, and 

experienced an increase in hearing voices and anxiety. (Tr. 304.) 

 On March 11, 2009, Plaintiff was treated at Southwest for “depressive symptoms 

of anxiety, isolation, fear of leaving home, [and] anhedonia.” (Tr. 719.) A mental status 

examination indicated that her mood was depressed with a tearful affect. (Id.) 

Additionally, her appearance was appropriate, she was cooperative, her speech and motor 

activity were within normal limits, and she had a goal-directed thought process. 

(Tr. 719.) Plaintiff was also alert, had good concentration, grossly intact memory, good 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 3 of 29
- 4 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

insight and judgment, and no hallucinations or delusions. (Tr. 720.) She was diagnosed 

with bipolar disorder and unspecified personality disorder. (Tr. 719-20.) 

 On May 6, 2009, Plaintiff continued treatment at Southwest for “affective 

reactivity anxiety, depression, [and] chronic low self-esteem.” (Tr. 717.) A mental status 

examination reflected that her mood was depressed and her affect was neutral. (Id.) She 

exhibited some paranoia, believing everyone was talking about her. (Id.) She was 

prescribed Abilify to augment the Effexor that she was already taking. (Id.) She was 

diagnosed with bipolar disorder and unspecified personality disorder. (Tr. 717-18.) 

 Plaintiff was next treated at Southwest on June 3, 2009. Plaintiff reported that her 

depression seemed “a little better with the Abilify.” (Tr. 715.) Plaintiff continued to 

report having anxiety with panic attacks when she “had to leave home.” (Id.) Plaintiff 

also worried about others and had poor sleep. (Id.) A mental status examination 

reflected that Plaintiff’s appearance was appropriate, her mood was depressed with a 

neutral affect. (Tr. 715.) She was alert, her memory was grossly intact, and she had good 

insight and judgment. (Tr. 716.) Plaintiff continued to struggle with panic and 

motivation. She was diagnosed with bipolar disorder, panic disorder, and unspecified 

personality disorder. (Tr. 715-16.) 

 On July 29, 2009, Plaintiff reported to treatment providers at Southwest that the 

increase in Abilify had helped “a little” with her depression, her anxiety “was better” 

with Klonopin, and her sleep was improved with Ambien. (Tr. 713.) She still reported 

some social anxiety. (Id.) She exhibited a neutral mood with appropriate affect. (Id.) 

She had normal speech and motor activity, goal directed thought, no delusions or 

hallucinations, no thoughts of self-injury, she was alert, had good concentration, grossly 

intact memory, and good insight and judgment. (Tr. 713-14.) Plaintiff’s depression was 

“somewhat better,” but she continued to struggle with motivation and panic. (Id.) 

 From September 15 through 17, 2009, Plaintiff was hospitalized at Banner 

Thunderbird Medical Center for suicidal ideation with a recent attempt. (Tr. 349.) After 

her release from the hospital, Plaintiff was transferred to Aurora Behavioral Health 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 4 of 29
- 5 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

(Aurora) for inpatient psychiatric care from September 17 through 21, 2009 for severe, 

recurrent major depression. (Tr. 359.) On discharge, it was noted that Plaintiff had 

responded well to treatment. (Id.) She denied depressive symptoms. (Id.) On 

examination, Plaintiff was cooperative, alert, her thought was logical and coherent, her 

speech and motor activity were normal, her affect was full, her cognitive functioning was 

average, and her insight and judgment were fair. (Tr. 359-60.) She denied 

hallucinations, delusions, and suicidal ideation. (Id.) 

 After her discharge from Aurora, Plaintiff continued treatment at Magellan and 

Southwest. (Tr. 711.) The Magellan records include an October 15, 2009 annual 

assessment (for the period July 30, 2008 to October 15, 2009), which noted that Plaintiff 

had received treatment for bipolar disorder and obsessive-compulsive disorder with 

schizoaffective traits. (Tr. 388.) Her symptoms included irritability and self-abusing 

behavior such as cutting herself, mood cycling, and isolation. (Id.) During a home visit 

the week before the annual assessment, Plaintiff exhibited a dull, blunted affect, poor eye 

contact, and her voice was low and rambling. (Id.) She reported that recent neck surgery 

contributed to her depression. (Id.) Plaintiff reported that she had low energy and was 

spending a lot of time in bed. (Id.) She displayed good information processing and 

problem solving. She was diagnosed with bipolar disorder. (Tr. 380-90.) 

 On January 15, 2010, Plaintiff was treated at Southwest. (Tr. 698.) She described 

her mood as “blah” and her energy as poor. (Id.) She reported some paranoia and social 

phobia, and stated that she stayed home most of the time. (Tr. 697.) A mental status 

examination indicated that Plaintiff was appropriately groomed with good hygiene. She 

had an appropriate affect, normal speech and motor activity, and goal directed thought. 

(Tr. 699.) She denied delusions, hallucinations, or self-injury. (Id.) She was alert and 

had fair concentration, insight, and memory. (Id.) She was diagnosed with bipolar 

disorder, social phobia, and post-traumatic stress disorder (PTSD). (Tr. 698-99.) 

 On February 16, 2010 Plaintiff was treated at Magellan. (Tr. 691.) Plaintiff’s 

affect was appropriate and her mood was anxious. (Id.) She reported that she stayed 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 5 of 29
- 6 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

home most of the time. (Tr. 692.) Her symptoms were described as moderate and 

minimally improved. (Id.) She was diagnosed with bipolar disorder, PTSD, social 

phobia, and OCD. (Tr. 697.) 

 On August 6, 2010, after Plaintiff’s girlfriend committed suicide, Petitioner was 

treated at Magellan for bipolar disorder. (Tr. 682.) Plaintiff was tearful, shocked and 

upset, and reported that she might pursue inpatient psychological admission to Aurora. 

(Tr. 681.) Plaintiff’s affect was appropriate and tearful, with an anxious and depressed 

mood. (Tr. 682.) Her symptoms were noted to be moderate and globally minimally 

worse. (Id.) She was diagnosed with bipolar disorder, PTSD, social phobia, and 

obsessive-compulsive disorder. (Id.) 

 From August 21 through 26, 2010, Plaintiff received inpatient care at Aurora for 

suicidal ideation, bipolar disorder, OCD, and PTSD. (Tr. 556-679) Plaintiff “improved 

rapidly and greatly during her stay.” (Tr. 556.) She was “free of any depression and 

suicidal ideation at the end of her stay.” (Id.) On discharge, Plaintiff was diagnosed with 

bipolar disorder, PTSD, obsessive-compulsive disorder, and cluster B traits. (Tr. 556-

675.) 

B. Treatment Related to Physical Health 

 In addition to mental health issues, Plaintiff had chronic migraine headaches, neck 

pain, optic neuritis, and syncope. (Tr. 911-15.) In 2006, her treating neurologist, 

Dr. Shyamala Kumar, M.D., noted that Topamax resulted in a “35% improvement in 

headaches.” (Tr. 766.) In 2007, Dr. Kumar discontinued Topamax because he thought 

that it could be contributing to suicidal thoughts. (Tr. 763.) 

 In January 2008, Plaintiff had an episode of syncope while she was at work. 

(Tr. 515.) At Arrowhead Hospital, she was diagnosed with neurocardiogenic syncope 

and directed to follow-up with her neurologist. (Id.) On February 1, 2008, Plaintiff 

followed up with Dr. Kumar for tremors, syncope, migraine headaches, and neck pain. 

(Tr. 539.) Dr. Kumar noted that Plaintiff had had “few near syncope episodes” since she 

had such an episode at work the previous week. (Id.) 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 6 of 29
- 7 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

 On February 18, 2008, Plaintiff saw Dr. Rick Okagawa, M.D. at Cardiovascular 

Consultants for syncope. (Tr. 547.) Plaintiff reported continued episodes of syncope 

without warning. (Id.) She reported that the “total duration of the episodes [was] usually 

1 minute.” (Id.) Dr. Okagawa advised Plaintiff to follow-up with his colleague 

Dr. Deepak Khosla in two weeks. (Tr. 548.) On June 26, 2008, Plaintiff saw Dr. Khosla. 

(Tr. 543.) He noted that Plaintiff still had “symptoms of lightheadedness and a few 

episodes of syncope.” (Tr. 543.) He advised Plaintiff to ask her psychiatrist to prescribe 

Paxil in place of Effexor because there was “not much experience with Effexor in 

neurocardiac syncope.” (Id.) 

 On August 27, 2009, Plaintiff had an anterior cervical discectomy with fusion and 

plating. (Tr. 477-79, 480-82.) In October 2009, Plaintiff reported ongoing headaches. 

(Tr. 388-94.) Plaintiff also reported that her neck pain and radicular symptoms subsided 

post fusion. (Tr. 470-71.) Approximately ten months later, Plaintiff’s migraine 

headaches returned. (Tr. 530-31, 997.) 

 In September 2010, Plaintiff was treated for a recurrence of neck pain. On 

examination, she was tender to palpation and had a markedly decreased range of motion. 

(Tr. 823, 954, 991-92, 820-22.) In May 2011, Plaintiff continued experiencing 

headaches, but they were less intense and less frequent than in the past. (Tr. 816-17.) 

Medical records also show that Plaintiff had optic neuritis, and macular damage to the 

right eye and blindness in the left. (Tr. 459.) Her right eye exhibited a retinal hole, with 

severe loss of visual field. (Tr. 979.) 

C. Medical Opinion Evidence 

 1. Akrum Al-Zubaidi, M.D. 

 In February 2010, Plaintiff was examined by State Agency Physician Dr. Akrum 

Al-Zubaidi. (Tr. 441.) Plaintiff’s “chief complaint” was “vasovagal syncope.” (Id.) 

Plaintiff reported that she had past cervical neck problems, but after cervical fusion her 

neck pain was resolved. (Id.) 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 7 of 29
- 8 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

 She reported that she had “vasovagal syncope two years ago while working at 

UPS,” and that at the time of Dr. Al-Zubaidi’s examination, she was passing out twice a 

week. (Id.) She stated that “her mental condition is the main reason she that she [was] 

unable to work, not her physical condition.” (Id.) Plaintiff reported that she could cook, 

clean, do yard work, and take care of her personal needs. (Tr. 442.) On examination, 

Dr. Al-Zubaidi noted that Plaintiff was “very polite, well-dressed.” (Id.) She had a 

normal gait, was able to squat, heel talk, toe walk, tandem walk, and hop on either foot. 

(Id.) She had a normal range of motion and full strength in her upper and lower 

extremities. (Id.) 

 Dr. Al-Zubaidi completed a physical functional assessment. (Tr. 444-46.) He 

opined that Plaintiff could sit and stand or walk six to eight hours in an eight-hour 

workday. (Tr. 444.) He found that Plaintiff could lift fifty pounds occasionally and 

twenty-five pounds frequently and that she was unrestricted in all other postural and 

manipulative activities. (Tr. 444-45.) He further found that Plaintiff should avoid 

working around heights and moving machinery. (Tr. 445.) He explained that Plaintiff 

“suffer[ed] from vasovagal syncope with two full syncopal episodes per week. This 

would make it dangerous for her to work around heights and around moving machinery.” 

(Tr. 446.) 

 2. Jacqueline Farwell, M.D 

 On March 2010, State Agency Physician Dr. Farwell reviewed the record and 

completed a physical residual functional capacity (RFC) assessment. (Tr. 447-54.) She 

assessed functional limitations similar to those found by Dr. Al-Zubaidi, but was 

skeptical of Plaintiff’s reports that she fainted twice a week. (Tr. 454.) 

 3. Nicole Robicheau Psy.D. 

 On February 5, 2010, Dr. Robicheau reviewed the medical records and completed 

a mental RFC assessment. (Tr. 422.) She found Plaintiff not significantly limited in her 

ability to remember work-like procedures, understand, remember, and carry out simple 

instructions, perform activities within a schedule, maintain regular attendance, be 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 8 of 29
- 9 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

punctual, sustain an ordinary routine without special supervision, make simple workrelated decisions, to interact appropriately with the general public, to ask simple 

questions, to maintain socially appropriate behavior, to respond appropriately to changes 

in the work setting, to be aware of and respond to normal hazards, and to travel in 

unfamiliar places or use public transit. (Tr. 422-23.) 

 She also found that Plaintiff had moderate limitations in her abilities to 

understand, remember, and carry out detailed instructions, maintain concentration and 

attention for extended periods, work in proximity of others without being distracted by 

(or distracting to) them, complete a normal workday and workweek without interruptions 

from psychologically based symptoms, perform at a consistent pace, accept instruction 

and criticism from supervisors, and to set realistic goals or make plans independently of 

others. (Tr. 422-23.) At the end of the RFC assessment, in a section labeled “functional 

capacity assessment,” Dr. Robicheau opined that Plaintiff was “able to meet the demands 

of, at least, simple work.” (Tr. 424.) 

III. Administrative Hearing Testimony 

Plaintiff was in her late thirties at the time of the administrative hearing. (Tr. 36.) 

She had a Bachelor’s Degree and past work as a teacher and a package handler. (Tr. 38-

40.) Plaintiff testified that she cried daily and experienced feelings of worthlessness, 

helplessness, and hopelessness. (Tr. 43, 45.) She stated that she had lost all of her 

friends because she isolated herself and was agoraphobic. (Tr. 45, 47.) She had anxiety 

that worsened when she left the house and required her to take Klonopin, which left her 

feeling drained and fatigued. (Tr. 48-49.) Plaintiff testified that before and after cervical 

fusion, she suffered from headaches. (Tr. 49-51.) She had three to five headaches per 

week, resulting in photophobia and a need to lie down in a dark room for approximately 

one hour. (Tr. 49-50.) Plaintiff also testified that once a week she experienced syncope 

that caused her to “completely black out and hit the floor.” (Tr. 52.) She testified that 

such episodes “usually last[ed] as little as one to three minutes.” (Tr. 53-54.) She also 

testified that three to five times a week she had syncope that did not make her pass out, 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 9 of 29
- 10 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

but that made her “dizzy, lightheaded, and confused,” and lasted about “a half-hour.” 

(Tr. 53.) 

 The ALJ concluded that Plaintiff had the RFC to perform “a significant range of 

medium work.” (Tr. 17.) Specifically, the ALJ found that Plaintiff could “lift and/or 

carry 50 pounds occasionally and 25 pounds frequently,” “stand and/or walk for six hours 

out of an eight-hour workday with regular breaks,” and “sit for six hours out of an eighthour workday with regular breaks.” (Tr. 17.) The ALJ further found that Plaintiff was 

“precluded from climbing ladders, ropes or scaffolds,” that she could occasionally stoop, 

and could frequently perform “all other postural activities.” (Id.) Finally, he found that 

“she should avoid work requiring use of dangerous machinery or work at unprotected 

heights, [and that she was] limited to occasional interaction with the public and coworkers.” (Id.) 

 The vocational expert testified that an individual with the limitations that the ALJ 

included in his assessment of Plaintiff’s RFC could perform work as a hand packager 

“either as claimant performed it or as it was customarily performed.” (Tr. 63.) In 

response to questions from Plaintiff’s attorney, the vocational expert testified that 

Plaintiff’s reported symptoms and limitations would preclude her from performing her 

past work and from sustaining other full time competitive employment. (Tr. 67-70.) 

IV. The ALJ’s Decision 

Under the Social Security Act, a plaintiff is considered disabled if she is unable to 

“engage in any substantial gainful activity by reason of any medically determinable 

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

lasted or can be expected to last for a continuous period of not less than 12 months.” 42 

U.S.C. § 423(d)(1)(A); see also 42 U.S.C. § 1382c(a)(3)(A) (nearly identical standard for 

supplemental security income disability insurance benefits). The ALJ uses a five-step 

sequential evaluation process to determine whether an individual is disabled. See 20 

C.F.R. §§ 404.1520, 416.920. 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 10 of 29
- 11 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

A. Five-Step Evaluation Process 

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

demonstrate (1) that she is not presently engaged in a substantial gainful activity, and 

(2) that her impairments are severe. 20 C.F.R. § 404.1520(a) (c). If a claimant meets 

steps one and two, she may be found disabled in two ways at steps three and four. At 

step three, she may prove that her impairment or combination of impairments meets or 

equals an impairment in the Listing of Impairments found in Appendix 1 to Subpart P of 

20 C.F.R. pt. 404. 20 C.F.R. § 404.1520(a)(4)(iii). If so, the claimant is presumptively 

disabled. If not, the ALJ determines the claimant’s RFC. At step four, the ALJ 

determines whether a claimant’s RFC precludes her from performing her past work. 20 

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

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

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

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

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

 B. The ALJ’s Application of the Five-Step Evaluation Process 

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

Plaintiff had not engaged in substantial gainful activity during the relevant period. 

(Tr. 15.) At step two, the ALJ found that Plaintiff had the following severe impairments: 

“post-traumatic stress disorder, migraines, post neck fusion in August 2009; syncope 

(loss of strength or fainting); obsessive compulsive disorder; panic attacks; fatigue; 

insomnia; agoraphobia; depression; loss of vision in the right eye; and bipolar disorder.” 

(Tr. 16.) At step three, the ALJ found that Plaintiff did not have an impairment, or 

combination of impairments, that met or equaled the severity of the listed impairments in 

20 C.F.R. part 404, subpart P, appendix 1. (Id.) At step four, the ALJ found that, 

considering Plaintiff’s RFC, age, education, work experience, she could perform her past 

relevant work as a hand packager. (Tr. 22.) Accordingly, without reaching step five, the 

ALJ concluded that Plaintiff was not disabled within the meaning of the Act. (Id.) 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 11 of 29
- 12 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

V. Standard of Review 

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

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

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

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

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

and it is free from legal error. Smolen v. Chater, 80 F.3d 1273, 1279 (9th Cir. 1996); 

Ryan v. Comm’r of Soc. Sec. Admin., 528 F.3d 1194, 1198 (9th Cir. 2008). Even if the 

ALJ erred, however, “[a] decision of the ALJ will not be reversed for errors that are 

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

 Substantial evidence means more than a mere scintilla, but less than a 

preponderance; it is “such relevant evidence as a reasonable mind might accept as 

adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 401 (1971) 

(citations omitted); see also Webb v Barnhart, 433 F.3d 683, 686 (9th Cir. 2005). In 

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

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

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

quotation and citation omitted). 

 The ALJ is responsible for resolving conflicts in testimony, determining 

credibility, and resolving ambiguities. See Andrews v. Shalala, 53 F.3d 1035, 1039 (9th 

Cir. 1995). “When the evidence before the ALJ is subject to more than one rational 

interpretation, [the court] must defer to the ALJ’s conclusion.” Batson v. Comm’r of Soc.

Sec. Admin., 359 F.3d 1190, 1198 (9th Cir. 2004) (citing Andrews, 53 F.3d at 1041). 

VI. Plaintiff’s Claims

Plaintiff asserts that the ALJ erred by discounting her symptom testimony 

(Doc. 23 at 13-22), failing to properly weigh medical source opinions (Id. at 22-25), and 

erroneously finding that she had past relevant work as a hand packager. (Id. at 25-26.) 

Plaintiff argues that this matter should be remanded for computation of benefits. (Id. at 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 12 of 29
- 13 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

26.) The Commissioner opposes Plaintiff’s assertions and argues that the 

Commissioner’s decision should be affirmed because it is free from legal error and 

supported by substantial evidence in the record. (Doc. 28.) 

A. Plaintiff’s Symptom Testimony 

 1. The Two-Step Credibility Analysis 

Plaintiff asserts that the ALJ erred in finding her symptom testimony less than 

credible. (Doc. 23 at 14.) An ALJ engages in a two-step analysis to determine whether a 

claimant’s testimony regarding subjective pain or symptoms is credible. Garrison, 2014 

WL 3397218, at *16 n.18 (citing Lingenfelter v. Astrue, 504 F.3d 1028, 1035-36 (9th Cir. 

2007)). 

 “First, the ALJ must determine whether the claimant has presented objective 

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

produce the pain or other symptoms alleged.’” Lingenfelter, 504 F.3d at 1036 (quoting 

Bunnell v. Sullivan, 947 F.2d 341, 344 (9th Cir. 1991) (en banc)). The claimant is not 

required to show objective medical evidence of the pain itself or of a causal relationship 

between the impairment and the symptom. Smolen, 80 F.3d at 1282. Instead, the 

claimant must only show that an objectively verifiable impairment “could reasonably be 

expected@ to produce his pain.” Lingenfelter, 504 F.3d at 1036 (quoting Smolen, 80 F.3d 

at 1282); see also Carmickle v. Comm’r of Soc. Sec., 533 F.3d at 1160B61 (9th Cir. 2008) 

(“requiring that the medical impairment ‘could reasonably be expected to produce’ pain 

or another symptom . . . requires only that the causal relationship be a reasonable 

inference, not a medically proven phenomenon”). 

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

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

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

the symptoms, including pain, limit the claimant’s ability to work. See 20 

C.F.R. § 404.1529(c)(1). In making this evaluation, the ALJ may consider the objective 

medical evidence, the claimant’s daily activities, the location, duration, frequency, and 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 13 of 29
- 14 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

intensity of the claimant’s pain or other symptoms, precipitating and aggravating factors, 

medication taken, and treatments for relief of pain or other symptoms. See 20 

C.F.R. § 404.1529(c); Bunnell, 947 F.2d at 346. 

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

regarding the severity of her symptoms only if the ALJ “makes a finding of malingering 

based on affirmative evidence,” Lingenfelter, 504 F.3d at 1036 (quoting Robbins v. Soc. 

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

convincing reasons” for finding the claimant not credible. Carmickle, 533 F.3d at 1160 

(quoting Lingenfelter, 504 F.3d at 1036). “‘The clear and convincing standard is the 

most demanding required in Social Security Cases.’” Garrison, 2014 WL 3397218, at 

*15-18 (quoting Moore v. Soc. Sec. Admin., 278 F.3d 920, 924 (9th Cir. 2002)). 

 2. The ALJ’s Assessment of Plaintiff’s Credibility 

 The ALJ found that Plaintiff had the RFC to perform a significant range of 

medium work with some postural and environmental limitations. (Tr. 17.) In making 

this determination, the ALJ found that Plaintiff’s allegations of disabling symptoms 

(including “anxiety, syncope, depression, and neck pain”) were “less than fully credible” 

with regard to the “intensity, persistence, and limiting effects” of those symptoms. 

(Tr. 18.) Because there was no finding of malingering, the ALJ was required to give 

clear and convincing reasons for finding Plaintiff not credible. Carmickle, 533 F.3d at 

1160. Plaintiff asserts that the ALJ failed to give clear and convincing reasons for 

rejecting her symptom testimony. (Doc. 23 at 14.) 

 a. Lack of Objective Verification of Daily Activities 

 Plaintiff testified that she spent most of the day at home in her pajamas, she did 

simple household chores, and that her adult daughter did most of the shopping and 

cleaning. (Tr. 44-46.) In finding Plaintiff’s symptom testimony “less than fully 

credible,” the ALJ stated that “although the claimant has described daily activities that 

are fairly limited, . . . the allegedly limited daily activities cannot be objectively verified 

with any reasonable degree of certainty.” (Tr. 18.) 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 14 of 29
- 15 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

 “This . . . justification for the ALJ’s credibility finding has been used in almost 

identical form by other ALJs and rejected.” Garcia v. Astrue, 2013 WL 1797029, at *15 

(S.D. Cal. Mar. 13, 2013) (citing McKim v. Astrue, 2012 WL 5250096, *4–*5 

(W.D. Wash. Sept. 4, 2012))3

. As the Garcia and McKim courts found, the fact that “‘a 

fact cannot be verified objectively provides little evidence to support the conclusion that 

the individual is not being truthful about such fact in any particular instance.’” Garcia, 

2013 WL 1797029, at *15 (quoting McKim, 2012 WL 525096, at 4). Therefore, the 

Court concludes that this is not a legally sufficient basis for the ALJ’s credibility 

determination. 

 b. Other Explanations for Plaintiff’s Limited Daily Activities 

 The ALJ next stated that: 

[E]ven if the claimant’s daily activities are truly as limited as 

alleged, it is difficult to attribute that degree of limitation to the claimant’s medical condition, as opposed to other reasons, in view of the relatively weak medical evidence and other 

factors discussed in this decision. It appears that the limited range of daily activities is a lifestyle choice and not due to 

any established impairment. 

(Tr. 18.) (emphasis added.) 

 The record reflects that, in July 2010, Plaintiff reported that her “social/leisure 

time was important to her.” (Tr. 835.) She “enjoyed shopping, movies, and outings with 

her children.” (Id.) Plaintiff’s mental health care providers encouraged her “continue to 

engage in activities that she love[d] and to increase her activity level.” (Id.) Plaintiff 

agreed to short-term goals that included walking her dogs daily and hiking weekly with 

her family. (Tr. 836.) The treatment provider noted that Plaintiff could drive, attend 

 

3

 In McKim, the ALJ rejected Plaintiff’s symptom testimony and stated that “[w]hile the claimant has alleged daily activities that are fairly limited, . . . allegedly limited daily activities cannot be objectively verified with any reasonable degree of certainty. 2012 WL 5250096, at *4-*5. In Garcia, the ALJ provided the same reasons for rejecting the claimant’s symptom testimony. 2013 WL 1797029, at *15. 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 15 of 29
- 16 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

appointments, and “complete her activities of daily living.” (Tr. 834.) This record 

evidence supports that ALJ’s finding that Plaintiff’s restriction of her daily activities may 

have been a lifestyle choice. 

 c. Inconsistency with Medical Evidence 

 The ALJ also discounted Plaintiff’s symptom testimony because it was 

inconsistent with the medical record.4

 (Tr. 18-20.) Plaintiff contends that medical record 

supports her subjective complaints. (Doc. 31 at 5.) “[A]fter a claimant produces 

objective medical evidence of an underlying impairment, an ALJ may not reject a 

claimant’s subjective complaints based solely on a lack of medical evidence to fully 

corroborate the alleged severity of pain.” Burch, 400 F.3d at 680. “Although lack of 

medical evidence cannot form the sole basis for discounting pain testimony, it is a factor 

that the ALJ can consider in his credibility analysis.” Id. at 681. 

 Here, the ALJ did not discredit Plaintiff’s subjective complaints solely on the basis 

of a lack of supporting objective medical evidence. Rather, he provided additional clear 

and convincing reasons for concluding that Plaintiff’s subjective complaints were not 

wholly credible. Additionally, the ALJ cited more than a scintilla of evidence to support 

his finding that Plaintiff’s testimony regarding her symptoms was inconsistent with the 

objective medical evidence as a whole. (Tr. 19-21); see Ryan, 528 F.3d at 1198 

(substantial evidence is more than a scintilla and less than a preponderance). 

 As the ALJ noted, the record reflects, that although Plaintiff had low Global 

Assessment of Functioning (GAF) scores during “periods of crisis” (Tr. 21), her GAF 

scores during much of the relevant period were consistent with mild or transient mental 

health symptoms. (Tr. 557-58 (GAF 80), Tr. 707 (GAF 70), 733 (GAF 70), and 737 

(GAF 70).); see Nelson v. Colvin, 2013 WL 4010860, at *7 (D. Ariz. Aug. 6, 2013); 

 

4

 In her reply, Plaintiff states that “it is not clear whether the ALJ based his 

credibility finding” on a determination that her symptom testimony was not consistent with the medical record. (Doc. 31 at 5.) In his decision, the ALJ stated that he 

discounted Plaintiff’s credibility because her subjective complains were “inconsistent with the objective medical evidence.” (Tr. 18.) He also noted that the medical evidence 

was “relatively benign.” (Id.) Thus, the ALJ relied on the medical record as a basis for 

discounting Plaintiff’s credibility. 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 16 of 29
- 17 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

Bizonia v. Astrue, 2011WL 1656075, at *2 n.3 (C.D. Cal. May 3, 2011). The ALJ 

properly considered Plaintiff’s GAF scores in determining whether she was disabled.5

 

See Burkin v. Astrue, 2012 WL 21916984, at *6 (D. Ariz. Jun. 14, 2012) (stating that “the 

fact that [the claimant] routinely had GAF scores that reflected no more than moderate 

symptoms or limitations was a legitimate reason for the ALJ to consider when 

determining whether [the claimant] was unable to work.”). 

 The ALJ also noted that Plaintiff’s mental status examinations were mainly 

unremarkable. (Tr. 20.) Substantial evidence in the record supports this finding. For 

example, a January 29, 2009 progress note reflects that Plaintiff reported obsessively 

washing her hands. (Tr. 724.) On examination she had a euthymic mood, normal speech, 

a cooperative attitude, a goal-directed thought process. (Id.) She did not have any 

delusions, hallucinations, or “self-injury” behavior. (Tr. 724-25). Additionally, she was 

alert, had good concentration, her memory was “grossly intact,” and she had good insight 

and judgment. (Tr. 745.) Other treatment notes in the record include similar mental 

status examinations. (Tr. 299 (cooperative, appropriate affect, goal oriented thought, 

good insight and judgment, denies thoughts of self-harm); Tr. 736-37 (no mood swings, 

appropriate affect, no delusions or hallucinations, no self-injury, alert, intact memory, 

good insight and judgment); Tr. 741-42 (cooperative, happy mood, appropriate affect, 

goal directed thought, no delusions or self-injury, alert, good concentration, grossly intact 

memory, good insight and judgment).) 

 

5

 A GAF score is a rough estimate of an individual’s psychological, social, and occupational functioning used to reflect the individual’s need for treatment.” Brewes v.

Comm’r of Soc. Sec. Admin., 682 F.3d 1157, 1160 n.2 (9th Cir. 2012) (quoting Vargas v. Lambert, 159 F.3d 1161, 1164 n.2 (9th Cir. 1998)). GAF Scores range from 1-100. DSM–IV at 32. 

A GAF “score of 61-70 reflects mild symptoms or some difficulty in social, occupational, or school functioning, but generally functioning pretty well.” Nelson, 2013 

WL 4010860, at *7 (citing DSM-IV). 

A GAF between 71 and 80 indicates that if symptoms are present, they are transient and expectable reactions to psychological stressors (e.g., difficulty concentrating after family argument); “no more than slight impairment in social, occupational, or school functioning.” Bizonia, 2011WL 1656075, at *2 n.3 (citing DSM-IV). 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 17 of 29
- 18 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

 Although Plaintiff was hospitalized two separate times with suicidal ideation and 

depression, once in September 2009 and again in August 2010, Plaintiff quickly 

improved during her hospital stays. (Tr. 359 (Plaintiff “responded well to her treatment 

[and] denied any depressive symptoms prior to her discharge”); Tr. 359-60 (Plaintiff 

“denied suicidal ideation”); Tr. 556 (Plaintiff “improved rapidly and greatly during her 

[stay] and became free of any depression and suicidal ideation at the end of her stay”).) 

 The ALJ properly considered this evidence when weighing Plaintiff’s credibility. 

See Crane v. Shalala, 76 F.3d 251, 254 (9th Cir. 1996) (“While subjective pain testimony 

cannot be rejected on the sole ground that it is not fully corroborated by objective 

medical evidence, the medical evidence is still a relevant factor in determining the 

severity of the claimant’s pain and its disabling effects.” (citation omitted)). 

 d. Medical Treatment Inconsistent with Claimed Disability 

 The ALJ also found Plaintiff not entirely credible because she did not receive “the 

type of medical treatment one would expect for a disabled individual” and had “relatively 

infrequent trips to the doctor.” (Tr. 18.) “[E]vidence of “conservative treatment” can be 

sufficient to discount a claimant’s testimony regarding severity of an impairment.” Parra 

v. Astrue, 481 F.3d 742 (9th Cir. 2007) (citing Johnson v. Shalala, 60 F.3d 1428, 1434 

(9th Cir. 1995)). However, the record indicates that Plaintiff received both outpatient and 

inpatient care for her mental health complaints and that she was hospitalized two times in 

relation to those issues. Cf. Scott v. Astrue, 2012 WL 2000842, at *17 (S.D. Cal. Apr. 13, 

2012) (the ALJ did not err by discounting the claimant’s credibility on the ground that he 

had not received the type of treatment one would expect for a disabled individual when 

the record reflected that the claimant received intermittent outpatient care for his mental 

complaints, was only hospitalized for alcohol-related episodes, and his symptoms were 

controlled by medication when he was compliant). Accordingly, the ALJ’s finding that 

Plaintiff did not receive the type or frequency of treatment that one would expect of a 

disabled individual is not supported by substantial evidence in the record. 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 18 of 29
- 19 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

 e. Lack of Compliance with Treatment 

 To further support his credibility determination, the ALJ stated that Plaintiff had a 

history of poor compliance with treatment, including “failure to appear for scheduled 

appointments or to take medication as directed.” (Tr. 18.) The ALJ noted that Plaintiff 

explained that she had poor compliance with appointments because she did not want to 

leave the house due to her anxiety or she could not get a ride. (Tr. 18, Tr. 58.) 

 Non-compliance with treatment may support an adverse credibility finding. See 

Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989) (stating that “an unexplained, or 

inadequately explained, failure to . . . follow a prescribed course of treatment . . . can cast 

doubt on the sincerity of the claimant’s pain testimony); Burch, 400 F.3d at 681 (lack of 

consistent treatment may be considered in assessing credibility as to severity of pain); 

Bunnell, 947 F.2d at 346 (non-compliance with prescribed course of treatment is a 

relevant factor in assessing credibility). 

 The record reflects that Plaintiff missed multiple appointments at Magellan in 

2008 and 2009. (Tr. 722 (“no show”); Tr. 729 (“NS” “last seen 5/08”); Tr. 731-32 

(“consumer was a NS” “last seen 5/7/2008” at that time she “reported zero mood swings” 

and some depression, “no use of crisis system” “labs have been ordered but she has not 

showed for appointment”); Tr.738 (“No Show”); Tr. 739 (“No Show” “last seen on 1/08 

at that time she was doing well”); Tr. 303 (not compliant with scheduled medication 

meetings or with medication); Tr. 710 (“No show”).) A January 12, 2009 treatment notes 

states that Plaintiff “ha[d] not been compliant with her scheduled medical meetings.” 

(Tr. 395.) It also states that Plaintiff “was educated on the issues regarding noncompliance with medication” and was instructed “not to wait until [she was] out of 

medication before ordering them.” (Id.) 

 Similarly, a July 28, 2010 Behavioral Update and Review Summary from 

Magellan reports that for the period between October 5, 2009 and July 28, 2010, Plaintiff 

was “sporadic in attending her psychiatric appointments for medication monitoring to 

address signs and symptoms of psychiatric illness.” (Tr. 843.) 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 19 of 29
- 20 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

 Although Plaintiff testified at the administrative hearing that she missed 

appointments because she did not want to (or was afraid to) leave the house or could not 

get rides, a July 30, 2010 treatment record reflects that Plaintiff reported “that her 

social/leisure time [was] important to her” and that she enjoyed “shopping, movies, and 

outings with her children” (Tr. 835), but she had declined “groups and counseling.” (Id.) 

Thus, Plaintiff’s explanation for missing her appointments is inconsistent with other 

evidence in the record. 

 Plaintiff also asserts that her noncompliance was related to the symptoms of her 

mental impairments (Doc. 23 at 17 (referring to Plaintiff’s anxiety and depression)), and 

therefore is not an appropriate basis for discrediting her subjective symptom testimony. 

The symptoms of a claimant’s mental impairments may explain a claimant’s 

noncompliance with treatment. See Nguyen v. Chater, 100 F.3d 1462 (9th Cir. 1996) 

(“[I]t is a questionable practice to chastise one with a mental impairment for the exercise 

of poor judgment in seeking rehabilitation.”) (internal quotation marks and citation 

omitted). The medical providers in this case, however, did not make a connection 

between Plaintiff’s noncompliance and her mental health impairment. See Molina v. 

Astrue, 674 F.3d 1104, 1114 (9th Cir. 2012) (“Although Molina provided reasons for 

resisting treatment, there was no medical evidence that Molina’s resistance was 

attributable to her mental impairment rather than her own personal preference, and it was 

reasonable for the ALJ to conclude that the ‘level or frequency of treatment [was] 

inconsistent with the level of complaints.’”) (citing SSR 96-7p). Additionally, Plaintiff 

sought help for her mental health issues, but failed to follow through with that care. See

Minter v. Comm’r Soc. Sec., 2012 WL 1866608, at *5 (D. Or. May 22, 2012) (when the 

claimant recognized that she needed help and sought out counseling, her failure to follow 

through with that treatment was a clear and convincing reason for the ALJ to discredit her 

symptom testimony). 

 Although the record includes some treatment notes indicating that Plaintiff 

complied with treatment, “[w]hen the evidence before the ALJ is subject to more than 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 20 of 29
- 21 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

one rational interpretation, [the reviewing court] we must defer to the ALJ’s conclusion.” 

Batson v. Comm’r of Soc. Sec. Admin., 359 F.3d 1190, 1198 (9th Cir. 2004). Thus, 

Plaintiff’s noncompliance with treatment was an appropriate basis for the ALJ to discount 

her credibility. 

 f. Exaggeration of Symptoms 

 The ALJ also found Plaintiff less than entirely credible because there was 

“reference to treating physicians’ questioning whether [Plaintiff’s] symptoms [were] as 

severe as she alleges.” (Tr. 19, 21 (citing Admin. Hrg. Ex. B16F at 1).) To support this 

statement, the ALJ cites Dr. Kumar’s May 3, 2010 treatment note related to a follow-up 

appointment with Plaintiff. (Tr. 21 (citing Admin. Hrg. Ex. B16F at 1; Tr. 530).) 

Dr. Kumar noted that he had not seen Plaintiff since May 2009 when he had sent her to a 

cardiologist, Dr. Khosla, because she had several episodes of syncope. (Tr. 530.) During 

the follow-up appointment, Plaintiff reported that she “was passing out daily.” (Id.) 

Dr. Kumar concluded that it was “not convincing that [Plaintiff was] passing out daily.” 

(Id.) He noted that Plaintiff had not followed up with her cardiologist during the last 

eighteen months and that she was driving, even though she reported passing out daily. 

(Id.) Dr. Kumar again advised Plaintiff to follow up with her cardiologist for further 

testing. (Tr. 530.) 

 Evidence of symptom exaggeration is a valid basis for discounting a claimant’s 

credibility. See Benton v. Barnhart, 331 F.3d 1030, 1040 (9th Cir. 2003); Tonapetyan v. 

Halter, 242 F.3d 1144, 1148 (9th Cir. 2001). Here, Dr. Kumar’s May 3, 2010 treatment 

note is substantial evidence to support the ALJ’s conclusion that Plaintiff exaggerated the 

frequency of her syncope. Additionally, reviewing physician Dr. Farwell was skeptical 

of Plaintiff’s reports that she fainted as often as she reported. (Tr. 454.) Accordingly, 

symptom exaggeration was a legally sufficient basis for ALJ to discredit Plaintiff’s 

testimony regarding her symptoms related to her syncope. 

/ / / 

/ / / 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 21 of 29
- 22 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

 g. Inconsistencies between Testimony and the Record 

 The ALJ also discounted Plaintiff’s symptom testimony because she gave 

conflicting information about why her last job ended. (Tr. 19.) The ALJ stated that 

Plaintiff testified that she stopped working at UPS because of her impairments, and that 

this testimony conflicted with a disability report stating that Plaintiff was laid off from 

that position. (Tr. 19 (citing Admin. Hrg. Ex. B1E at 2).) 

 These two statements, however, are not in conflict. Plaintiff testified that her work 

at UPS ended because she missed a lot of days, left work, or had to be hospitalized due to 

anxiety and syncope. (Tr. 39.) The ALJ asked Plaintiff if she “quit or did [UPS] 

terminate [you ?]” (Tr. 40.) In response to the ALJ’s question, Plaintiff testified that, 

after her cardiologist diagnosed her with syncope, she gave “notice that [she] wasn’t 

coming back.” (Tr. 40.) Although it is not clear whether Plaintiff quit or was terminated, 

the record indicates that her job ended due to her impairments. 

 Plaintiff’s testimony is consistent with the disability report cited by the ALJ. 

(Tr. 19 (citing Admin. Hrg. Ex. B1E); Tr. 155-56).) On that report, Plaintiff stated that 

“going to work caused her blood pressure to drop so low that [she] would black out and 

had to go on medical leave and was diagnosed with vassal vascular syncope. Due to the 

medical leave [UPS] laid [her] off.” (Tr. 156.) Because substantial evidence in the 

record does not support the ALJ’s conclusion that Plaintiff gave conflicting testimony 

about why her job ended, the alleged conflicting statements were not legally sufficient 

reasons for the ALJ to discount Plaintiff’s symptom testimony. 

 Although the Court does not accept all of the ALJ’s reasons in support of his 

adverse credibility determination, the ALJ provided sufficient legally sufficient reasons 

that are supported by substantial evidence in support of his credibility determination and, 

therefore, the Court affirms that determination. See Batson, 359 F.3d at 1197 (stating that 

the court may affirm an ALJ’s overall credibility conclusion even when not all of the 

ALJ’s reasons are upheld); Tonapetyan, 242 F.3d at 1148 (stating that “[e]ven if we 

discount some of the ALJ’s observations of [the claimant’s] inconsistent statements and 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 22 of 29
- 23 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

behavior . . . we are still left with substantial evidence to support the ALJ’s credibility 

determination.”). 

B. Weighing Medical Source Opinion Evidence 

 Plaintiff also argues that the ALJ improperly weighed medical source opinion 

evidence. (Doc. 23 at 22.) In weighing medical source evidence, the Ninth Circuit 

distinguishes between three types of physicians: (1) treating physicians, who treat the 

claimant; (2) examining physicians, who examine but do not treat the claimant; and 

(3) non-examining physicians, who neither treat nor examine the claimant. See Garrison, 

2014 WL 3397218, at *13 (citing Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995)). 

Generally, more weight is given to a treating physician’s opinion. Garrison, 2014 WL 

3397218, at *13. The ALJ must provide clear and convincing reasons supported by 

substantial evidence for rejecting a treating or an examining physician’s uncontradicted 

opinion. Reddick v. Chater, 157 F.3d 715, 725 (9th Cir. 1998). An ALJ may reject the 

controverted opinion of a treating or an examining physician by providing specific and 

legitimate reasons that are supported by substantial evidence in the record. Bayliss v. 

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

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

treating or examining physicians. Lester, 81 F.3d at 831. Although an ALJ generally 

gives more weight to an examining physician’s opinion than to a non-examining 

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

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

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

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

the opinion and the quality of the explanation provided; the consistency of the medical 

opinion with the record as a whole; [and] the specialty of the physician providing the 

opinion . . . .” Orn v. Astrue, 495 F.3d 625, 631 (9th Cir. 2007). 

/ / / 

/ / / 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 23 of 29
- 24 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

 1. The ALJ Properly Considered Dr. Al-Zubaidi’s Opinion 

 Upon examination of Plaintiff, Dr. Al-Zubaidi noted that Plaintiff suffered from 

vasovagal syncope with two full syncopal episodes per week. (Tr. 446.) He concluded 

that these episodes would “make it dangerous for [Plaintiff] to work around heights and 

around moving machinery.” (Id.) Dr. Al-Zubaidi opined that, with those restrictions, 

Plaintiff could perform a range of medium work, lifting up to fifty pounds for up to onethird of the workday. (Tr. 446.) The ALJ gave Dr. Al-Zubaidi’s opinion “great weight” 

(Tr. 21), and included limitations on working around heights and moving machinery in 

the RFC. (Tr. 17 (Plaintiff “should avoid work requiring the use of dangerous machinery 

or work at unprotected heights”).) 

 Plaintiff argues that the ALJ formulated an RFC that did not fully account for 

Dr. Al-Zubaidi’s opinions regarding her syncope. (Doc. 23 at 23.) Plaintiff suggests that 

the ALJ erred because the RFC did not fully account for the effects of a full syncope 

episode — “being off task for thirty minutes.” (Id.) This argument is based on Plaintiff’s 

subjective complaints that the ALJ properly discounted (see Section V.A.2.F) and does 

not correspond to Dr. Al-Zubaidi’s opinion. (Tr. 446.) The record reflects that the ALJ 

assessed an RFC that fully accounted for Dr. Al-Zubaidi’s opinion regarding Plaintiff’s 

functional limitations. Therefore, the Court rejects Plaintiff’s argument that the ALJ 

erred in formulating Plaintiff’s RFC. 

 2. The ALJ’s Assessment of Dr. Robicheau’s Opinion 

 Plaintiff next argues that the ALJ erred by assigning “some” weight to nonexamining physician Dr. Robicheau’s opinion, but not explaining why he excluded from 

the RFC Dr. Robicheau’s findings that Plaintiff was moderately limited in her activities 

of daily living, and in maintaining concentration, persistence, or pace. (Doc. 23 at 24 

(citing Tr. 436).) The Commissioner responds that Plaintiff “relies on the wrong form” to 

support her argument. (Doc. 28 at 10.) 

 Plaintiff relies on part of a Psychiatric Review Technique Form (Tr. 436) that 

Dr. Robicheau completed to determine whether Plaintiff’s impairments met or equaled a 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 24 of 29
- 25 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

listed impairment at step three of the sequential evaluation process. (Tr. 426-439).) On 

that form, Dr. Robicheau opined that Plaintiff had moderate limitations in her activities of 

daily living and in “maintaining concentration, persistence, or pace.” (Tr. 436.) 

Dr. Robicheau then concluded that Plaintiff’s mental health impairment did not meet or 

equal a listed impairment. (Tr.438.) The Commissioner argues that these findings were 

only relevant to whether Plaintiff’s impairments met a listed impairment, and did not bear 

on her functional abilities for purposes of assessing her RFC. (Doc. 28 at 10.) The Court 

does not resolve this issue because, as Plaintiff notes in her reply (Doc. 31 at 9-11), 

Dr. Robicheau also found Plaintiff moderately limited in several areas of functioning on 

the Mental Residual Functional Capacity (MRFC) Assessment. (Tr. 422.) 

 Specifically, Dr. Robicheau found Plaintiff moderately limited in her abilities to 

understand, remember, and carry out detailed instructions, maintain concentration and 

attention for extended periods, work in proximity of others without being distracted by 

(or distracting to) them, complete a normal workday and workweek without interruptions 

from psychologically based symptoms, to perform at a consistent pace, accept instruction 

and criticism from supervisors, and to set realistic goals or make plans independently of 

others. (Tr. 422-23.) Dr. Robicheau also found Plaintiff not significantly limited in 

other areas of mental functioning. (Id.) Based on all of her findings, she concluded that 

Plaintiff could “meet the demands of, at least, simple work.” (Tr. 424.) 

 The ALJ stated that he gave “some weight” to Dr. Robicheau’s opinion on the 

MRFC assessment. (Tr. 22.) The ALJ rejected Dr. Robicheau’s final conclusion that 

Plaintiff was “limited to simple, repetitive tasks” because he found that the medical 

record did not support that determination. (Tr. 22 (citing Admin. Hrg. Exs. B8F, 10F).) 

Because Dr. Robicheau’s opinion that Plaintiff retained the functional capacity to 

perform “simple work” incorporated all of the limitations that she found, including 

moderate limitations on Plaintiff’s functional abilities (Tr. 424), the ALJ’s discussion of 

that final opinion necessarily included all of those limitations. Thus, the Court rejects 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 25 of 29
- 26 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

Plaintiff’s assertion that the ALJ “offer[ed] no basis for excluding from the RFC 

assessment” the moderate limitations that Dr. Robicheau identified. (Tr. 23 at 24.) 

 Although the ALJ generally rejected Dr. Robicheau’s final opinion, he accepted 

her specific findings regarding Plaintiff’s limitations in her ability to interact with the 

public and co-workers, explaining that “the evidence better support[ed] limitations in 

interaction with others.” (Tr. 22.) Accordingly, the ALJ formulated an RFC that “limited 

[Plaintiff] to occasional interaction with the public and co-workers.” (Tr. 17.) 

 Before rejecting Dr. Robicheau’s final opinion that Plaintiff was limited to simple 

work as not supported by the record, the ALJ discussed the medical record and noted that 

the “medical evidence was relatively benign.” (Tr. 18.) As discussed above, the medical 

record includes many unremarkable mental status examinations and GAF scores 

indicating mild or transient symptoms. (Section V.A.2.c.) The ALJ properly considered 

the medical record when assigning weight to Dr. Robicheau’s opinion. See Sousa v. 

Callahan, 143 F.3d 1240, 1244 (9th Cir. 1998) (stating that an ALJ “may reject the 

opinion of a non-examining physician by reference to specific evidence in the medical 

record.”). 

 Moreover, even if the ALJ erred in rejecting Dr. Robicheau’s opinion that Plaintiff 

was limited to simple work, that error was harmless because he found Plaintiff capable of 

performing her past relevant work as a hand packager, which is classified as “unskilled.” 

(Tr. 22); Dictionary of Occupational Titles 920.587-018; Johnson v. Astrue, 2008 WL 

346106, *4 (D. Or. Feb. 4, 2008) (stating that the “hand packager job, entitled “Packager, 

Hand” (DOT Code: 920.587-018) is classified as unskilled with a medium exertional 

level). 

C. The ALJ’s Step Four Analysis 

 As previously stated, at step four of the sequential evaluation process, the ALJ 

relied on the vocational expert’s testimony that Plaintiff’s past relevant work as a hand 

packager, defined in Dictionary of Occupational Titles (DOT) as job number 920.587-

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 26 of 29
- 27 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

018, was unskilled work with a medium exertion level.6 (Tr. 63); see Doyal v. Barnhart, 

331 F.3d 758, 760–61 (10th Cir. 2003) (at step four of the sequential evaluation process, 

an ALJ can comply with the requirements set forth in SSR 82–62 if he quotes the 

vocational expert’s testimony with approval to support his findings at the step-four 

analysis); Mora v. Astrue, 2008 WL 5076450, *2 (C.D. Cal. Dec.1, 2008) (“Information 

from the [DOT] or the testimony of a [vocational expert] may be used to ascertain the 

demands of an occupation as ordinarily required by employers throughout the national 

economy.”) (citing SSR 82-61). The vocational expert testified that Plaintiff could 

perform her past relevant work as a hand packager “either as the claimant performed it or 

as customarily performed.”7

 (Tr. 63.) 

 Past relevant work is work “that a [claimant] has done within the past 15 years that 

was substantial gainful activity, and that lasted long enough for you to learn it.” 20 

C.F.R. § 416.960(b)(1). Section 20 C.F.R. § 416.972 defines substantial and gainful 

work activity.8

 Plaintiff asserts that she does not have past relevant work as a hand 

 

6

 The vocational expert used the term “SVP 2.” (Tr. 63.) Specific vocational preparation (SVP) is a term used in the DOT to classify “how long it generally takes to learn the job.” Terry v. Sullivan, 903 F.2d 1273, 1276 (9th Cir. 1990). The regulations contain definitions for the skill requirements for particular jobs, which are classified as “unskilled,” “semi-skilled,” and “skilled. 20 C.F.R. §§ 404.1568, 416.968. Unskilled 

work corresponds to an SVP of 1-2. SSR 00-4p, 2000 WL 1898704, at *3. 

7

 Because the vocational expert testified that Plaintiff could perform work as a hand packager “either as the claimant performed it or as customarily performed,” (Tr. 63) (emphasis), Plaintiff’s argument that she performed the job of hand packager in 2003 and 

2004 at a higher-than-customary exertional level (Doc. 31 at 2) is of no consequence. 

8

 Substantial gainful activity is work activity that is both substantial and gainful: 

(a) Substantial work activity. Substantial work activity is work activity that involves doing significant physical or mental activities. Your work may be substantial even if it is 

done on a part-time basis or if you do less, get paid less, or have less responsibility than when you worked before. 

(b) Gainful work activity. Gainful work activity is work activity that you do for pay or profit. Work activity is gainful if it is the kind of work usually done for pay or profit, whether or not a profit is realized. 

20 C.F.R. § 416.972. 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 27 of 29
- 28 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

packager because the ALJ found that her work as hand packager in January and February 

2008 was not substantial gainful activity. (Doc. 23 at 25; Tr. 15.) 

 However, as the Commissioner notes (Doc. 28 at 11-12), the record also includes 

evidence that Plaintiff worked as a hand packager from 2003 to 2004. (Tr. 144, 209.) 

The vocational expert testified that he reviewed the record and that he was familiar with 

Plaintiff’s vocational history. (Tr. 62.) Plaintiff has not identified any reason to question 

the veracity of the vocational expert’s testimony. Additionally, in his step-four analysis, 

the ALJ noted that the vocational expert reviewed Plaintiff’s vocational file and the ALJ 

specifically cited to the portion of the record that includes evidence of Plaintiff’s work as 

a hand packager from 2003 to 2004. (Tr. 22 (citing Admin. Hrg. Ex. B14E); Tr. 209).) 

Thus, it is reasonable to infer that the ALJ considered Plaintiff’s work as a hand packager 

from 2003 to 2004 when making the step-four determination. 

 In her reply, Plaintiff suggests that her work as a hand packager from 2003 to 2004 

was not “past relevant work” because it was part-time work (four hours per day, five days 

per week), and thus it was not “substantial gainful activity.” (Doc. 31 at 2.) However, 

she does not cite any authority to support a conclusion that part-time work cannot be 

“substantial gainful activity,” and the regulations state that substantial gainful activity 

may include full or part-time work. See Byington v. Chater, 76 F.3d 246, 248 (9th Cir. 

1996) (citing 20 C.F.R. § 416.972(a) & (b)). The SSA authorizes the Commissioner to 

determine whether work is substantial gainful activity based on the amount of earnings 

and other factors.9

 See Byington, 76 F.3d at 248 (discussing factors for determining 

whether services performed or earnings derived from services demonstrate the ability to 

engage in substantial gainful activity) (citing 42 U.S.C. 423 (d)(4)). 

 9

 The Commissioner states that in 2003, the SSA defined substantial earnings as at least $800.00 per month. In 2004, it was $810.00 per month. (Doc. 28 at 12 n.2 (citing https://secure.ssa.gov/apps10/poms.nsf/lnx/0410501015).) The Court has confirmed this 

information by visiting the link to review the DI 10501.015 Tables of SGA Earnings Guidelines and Dates Based on Year of Work Activity. (last visited Sept. 9, 2014). 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 28 of 29
- 29 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

 There is a rebuttable presumption that the employee either was or was not engaged 

in substantial gainful activity if the employee’s average monthly earnings are above or 

below a certain amount established by the Commissioner’s Earnings Guidelines. Smith v.

Astrue, 2012 WL 440826, at *1 (W.D. Wash. Jan. 11, 2012) (citing 20 

C.F.R. §§ 404.1574(b)(2)-(3), 416.974(b)(2)-(3)). Plaintiff does not dispute the evidence 

in the record or the Commissioner’s assertion that her work as a hand packager in 2003 

and 2004 met the requirements for substantial work based on her level of earnings. 

(Doc. 31 at 2; Tr, 144, 209.) Accordingly, there was a presumption that Plaintiff’s work 

as a hand packager in 2003 and 2004 was substantial gainful activity and she did not 

rebut that presumption. Therefore, the Court finds that the ALJ did not err in finding that 

Plaintiff had past relevant work as a hand packager. 

VII. Conclusion 

As set forth above, the ALJ provided legally sufficient reasons for discounting 

Plaintiff’s credibility, appropriately weighed the medical opinion evidence, and properly 

found that Plaintiff had past relevant work as a hand packager. The ALJ’s opinion is 

supported by substantial evidence in the record and any legal errors are harmless. 

Accordingly, 

IT IS ORDERED that the Commissioner’s disability determination in this case is 

AFFIRMED. The Clerk of Court is directed to enter judgment in favor of the 

Commissioner and against Plaintiff and to terminate this action. 

 Dated this 9th day of September, 2014. 

 

Case 2:13-cv-00733-BSB Document 33 Filed 09/09/14 Page 29 of 29