Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-4_12-cv-00407/USCOURTS-azd-4_12-cv-00407-0/pdf.json

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

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IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Deanna McDermott, 

Plaintiff, 

vs.

Carolyn W. Colvin, Commissioner of 

Social Security,

Defendant. 

 

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No. CIV 12-407-TUC-LAB

ORDER

The plaintiff filed this action for review of the final decision of the Commissioner for

Social Security pursuant to 42 U.S.C. § 405(g). 

The Magistrate Judge presides over this case pursuant to 28 U.S.C. § 636(c) having

received the written consent of both parties. See FED.R.CIV.P. 73; (Doc. 11).

The final decision of the Commissioner is not “supported by substantial evidence and

free from legal error.” Fair v. Bowen, 885 F.2d 597, 601 (9th Cir. 1989). Specifically, the ALJ

improperly discounted the treating physician’s opinion and improperly discounted the

claimant’s subjective testimony of disabling pain and fatigue. The case will be remanded for

payment of benefits.

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PROCEDURAL HISTORY

On April 12, 2006, McDermott constructively filed an application for disability insurance

benefits. (Tr. 318, 370) She alleged disability beginning on January 9, 2006, due to

fibromyalgia, arthritis, and depression. (Tr. 318, 342) Her claim was denied initially and upon

reconsideration. (Tr. 170-173, 180-182) 

McDermott requested review and appeared with counsel at a hearing before

Administrative Law Judge (ALJ) Lauren R. Mathon on March 30, 2009 and again on July 1,

2009. (Tr. 27-72, 155) In her decision, dated November 5, 2009, the ALJ found McDermott

was not disabled. (Tr. 155-161) McDermott appealed, and the Appeals Council remanded the

case to the ALJ. (Tr. 167-169) 

McDermott again appeared with counsel at a hearing before ALJ Mathon on November

10, 2010. (Tr. 119-148) In her decision, dated December 10, 2010, the ALJ again found

McDermott was not disabled because she could return to her job as an accountant. (Tr. 10-19)

McDermott appealed and submitted an additional medical statement, but the Appeals Council

denied review making the decision of the ALJ the final decision of the Commissioner. (Tr. 1-3,

737-38); See Bass v. Social Sec. Admin., 872 F.2d 832, 833 (9th Cir. 1989). 

McDermott subsequently filed this action appealing the Commissioner’s final decision.

(Doc. 1). She argues the ALJ failed to properly evaluate the opinions of her treating physicians,

the lay evidence, and her own credibility. (Doc. 30) She further argues the ALJ’s use of the

vocational expert testimony was error. Id. 

Claimant’s Work History and Medical History

From 1986 to 2006, McDermott worked as an accountant at Eastern Arizona College.

(Tr. 324-25, 343) Her supervisor, Timothy E. Curtis, submitted an affidavit explaining that

McDermott was a good worker until she became sick and “began developing problems in

concentration, trouble remembering things, and appeared not to feel well.” (Tr. 740,

supplement) Her duties were lessened, but even those accommodations proved inadequate to

permit her to continue. Id. She stopped working after nineteen and one-half years on the job

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on January 9, 2006. (Tr. 34, 342) If she had been able to work for another six months to a year,

she would have been eligible for retirement benefits. (Tr. 52) In her application for disability

benefits, McDermott claims she is no longer able to work due to fibromyalgia, arthritis, and

depression. (Tr. 318, 342) 

Physical Impairments

In October of 2005, McDermott was examined by Berchman A. Vaz, M.D., for an

evaluation of her fibromyalgia. (Tr. 434-435) Vaz found “no obvious synovitis” in her joints,

but he found “Heberden’s and Bouchard’s nodes of the small joints of the hands.” Id. She had

“restriction of movement in the cervical spine and the lumbar spine” and “a few fibromyalgia

tender points present.” Id. Vaz noted that McDermott had “a long history of fibromyalgia with

generalized aches and pains,” but he expressed concern that some of her pain could be

secondary to worsening depression or osteoarthritis of the neck and spine. Id.

The record contains radiology studies of McDermott’s cervical spine, lumbar spine, and

hips performed in October of 2005. (Tr. 447-48) The radiologist offered the following

impression: “1) Prominent degenerative changes at C5-C6; 2) Mild degenerative changes of

the lumbar spine, most pronounced at L2-L3; 3) Mild degenerative changes in the hips and

symphysis pubis.” Id.

The medical record contains treatment notes from McDermott’s treating physician, Lynn

E. Smith, M.D., dating from April of 2006 to April of 2009. (Tr. 605-613) In April of 2009,

Smith assessed McDermott as follows: “1. Severe fibromyalgia. 2. Anxiety and depression,

severe. 3. Allergies.” (Tr. 605)

In April of 2006, Smith completed a Physical Capacities Worksheet. (Tr. 449-51, 603)

He opined that due to fibromyalgia and associated depression, McDermott could walk only 500

feet daily due to “severe pain in joints.” Id. She could stand daily for two hours and sit daily

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1

 An inability to sit for more than two hours and stand for more than two hours in an 8-

hour work day precludes sedentary or light work. See S.S.R. 96–9P, 1996 WL 374185; S.S.R.

83-10, 1983 WL 31251.

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for two hours.1

 Id. She was restricted in her ability to climb and balance, but she could lift 20

pounds occasionally and 10 pounds frequently. Id. She could not tolerate temperature

extremes, fumes, gasses, or poor ventilation. Id.

The record contains examination and treatment notes from a rheumatologist, Michael

Maricic, M.D., taken between July of 2006 and July of 2010. (Tr. 561-66, 639-45, 701-06)

Maricic noted a positive Epstein-Barr virus titer for IgG early antigen and nuclear antigen. (Tr.

640) He assessed McDermott as follows: “1. Fibromyalgia – 729.0 (Primary). 2. Depression

with anxiety – 300.4.” (Tr. 640) He noted “[t]he patient does meet [American College of

Rheumatology] criteria for fibromyalgia based upon her widespread pain, greater than 11 tender

points [in] both the upper and lower extremities and history of sleep disturbance.” (Tr. 640)

He noted “there are no currently approved FDA treatments for fibromyalgia” although

Cymbalta shows some promise. (Tr. 640) The “most consistently proven beneficial treatment

for fibromyalgia” is aerobic exercise. (Tr. 640) 

McDermott was examined by Richard Palmer, M.D., for the state disability

determination service in August of 2006. (Tr. 472-75) His impression reads as follows: “1.

Fibromyalgia with multiple tender points and comorbid symptoms of fatigue, insomnia and

headaches. 2. Signs of arthritis of the right shoulder. 3. Depression.” (Tr. 475)

Palmer completed a Medical Source Statement of Ability to do Work-related Activities

(Physical). (Tr. 469-71). He opined that McDermott could lift 20 pounds occasionally and 10

pounds frequently. Id. She could stand and/or walk for 6-8 hours in an 8-hour day. Id. She

could sit for 6-8 hours in an 8-hour day. (Tr. 470) She should only occasionally crouch; crawl;

or climb ladders, rope, or scaffolds. Id. 

In September of 2006, Anita Stafford, M.D., reviewed the record and completed a

Physical Residual Functional Capacity Assessment for the state disability determination service.

(Tr. 505-12) She concluded McDermott could lift and/or carry 20 pounds occasionally and 10

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2

 Light work involves lifting no more than 20 pounds at a time with frequent lifting or

carrying of objects weighing up to 10 pounds. 20 CFR §§ 404.1567; 416.967.

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pounds frequently.2

 (Tr. 506) She could stand and/or walk with normal breaks for 6 hours in

an 8-hour day. (Tr. 506) She could sit with normal breaks for 6 hours in an 8-hour day. Id.

She should only occasionally balance; crouch; crawl; or climb ladders, rope, or scaffolds. (Tr.

507) She should avoid even moderate exposure to vibration and hazards such as machinery and

heights. (Tr. 509) Stafford explained she adopted Palmer’s functional limitations finding

Smith’s too restrictive. (Tr. 511) On the other hand, she stated that McDermott’s functional

limitations were consistent with the medical evidence and that McDermott “appears mostly

credible.” (Tr. 510)

The record contains treatment and examine notes from Goodman Chiropractic between

July of 2006 and October of 2010. (Tr. 531-33, 580-601, 634-37, 707-36). McDermott

reported taking chiropractic treatment on a weekly basis for pain relief. 

In April of 2008, John Fahlberg, M.D., reviewed the record and completed a Physical

Residual Functional Capacity Assessment for the state disability determination service. (Tr.

545-52) He concluded McDermott could lift and/or carry 20 pounds occasionally and 10

pounds frequently. (Tr. 546) She could stand and/or walk with normal breaks for 6 hours in an

8-hour day. (Tr. 506) She could sit with normal breaks for 6 hours in an 8-hour day. Id. She

should only occasionally kneel; crouch; crawl; or climb ramps or stairs. (Tr. 547) She should

never climb ladders, rope, or scaffolds. (Tr. 547) She should avoid concentrated exposure to

fumes, odors, dust, gasses, and poor ventilation and hazards such as machinery and heights. (Tr.

549) He stated there was a treating or examining source statement on file, but it did not contain

restrictions differing significantly from his own. (Tr. 551)

In August of 2009, McDermott was given the Any Occupation Evaluation by ProActive

Physical Therapy. (Tr. 648-89) McDermott’s work tolerance included sitting up to 2

hours/day; standing 1 hour/day, walking 20 minutes/day, and lifting/carrying 10 pounds

occasionally. (Tr. 650) She could not tolerate kneeling, squatting, crouching, bending, reaching

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overhead, balancing, or climbing. (Tr. 650) In summary, the report states McDermott

“demonstrated a less than sedentary work capacity as defined by the Dictionary of Occupational

Titles . . . .” (Tr. 649)

Mental Impairments

In August of 2006, McDermott was examined by Andrew C. Jones, Ph.D., for the state

disability determination service. (Tr. 481) Jones offered the following diagnosis: “I:

Adjustment disorder with depressed mood; II: None; III: Fibromyalgia.” (Tr. 483) He offered

the following summary: “This claimant experiences mild to moderate depressed mood in

relationship to chronic pain from fibromyalgia. As her pain has worsened, her emotional

distress as well as ability to concentrate and pay attention have also worsened. She does report

that her level of emotional distress has significantly improved since leaving work.” (Tr. 483)

Jones completed a Medical Source Statement of Ability to do Work Related Activities

(Mental). (Tr. 484-90) In all work related activities, he found McDermott displayed “no

evidence of limitation” or was “not significantly limited.” Id. 

In August of 2006, Paul J. Tangeman, Ph.D., reviewed the medical record for the state

disability determination service and completed a Psychiatric Review Technique form. (Tr. 491)

He documented affective disorder (adjustment disorder), but he found the impairment not

severe. (Tr. 491, 494) Upon analyzing the “B” criteria of mental limitations, he found no

episodes of decompensation and only mild limitation in activities of daily living; maintaining

social functioning; and maintaining concentration, persistence, or pace. (Tr. 501); see 20 C.F.R.

Pt. 404, Subpt. P., App. 1, § 12.00. Tangeman opined that her condition is non-severe. (Tr.

503) 

In March of 2008, Randall J. Garland, Ph.D., reviewed the medical record for the state

disability determination service and affirmed Tangeman’s prior assessment. (Tr. 544) 

The record contains treatment notes from Gail L. Schwartz, M.D., from March of 2007

to December of 2009. (Tr. 523-26, 568-70, 692) Schwartz notes McDermott is currently taking

Cymbalta (for fibromyalgia), Methylin (central nervous system stimulant), trazodone

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(antidepressant), Lunesta, (for insomnia), gabapentin (for insomnia) and ibuprofen (analgesic).

(Tr. 569)

After the ALJ issued her opinion, McDermott submitted an additional medical statement

from Schwartz. (Tr. 738) In that statement, Schwartz explains that McDermott has “a long

history of depression as well as chronic pain and fatigue secondary to fibromyalgia.” (Tr. 738)

She further explains that McDermott “has problems with quality and quantity of sleep” that

results in “fogginess” that prevents her from completing complex tasks. Id. Furthermore, “[h]er

pain level, mood, and cognitive functioning are unpredictable.” Id. Accordingly, if she were

to attempt working full-time, her performance and attendance would be inconsistent. Id. 

Third Party Statements

In March of 2009, Carolyn J. Dabbs, “chairman of the Baby Photo Service for the Mt.

Graham Regional Medical Center,” submitted a statement on McDermott’s behalf. (Tr. 420)

Dabbs explained that McDermott worked “one day a week for about 2 to 3 hours taking pictures

of newborn babies.” Id. McDermott “appeared to be in a great deal of pain and would tire

quickly.” Id. Eventually, she “asked to be relieved of her duties.” Id. 

McDermott also worked at the Christmas House project “for about 2 hours each day for

2 days.” Id. She “was unable to sell, take cash, or wait on people but she did sit [in] the room”

and greet people. Id. Eventually, she “dropped out of the Auxiliary because she just could not

participate.” Id. 

In June of 2009, Timothy E. Curtis, one of McDermott’s supervisors, submitted a

statement describing McDermott’s job performance. (Tr. 740, supplement) Curtis explained

that he has know McDermott for 15 years. Id. She “was a good worker [and] had good

motivation.” Id. Unfortunately, she “began developing problems in concentration, trouble

remembering things, and appeared not to feel well.” Id. Eventually, “the quality of her work

severely suffered, and she missed more and more time from work because of her condition.”

Id. Her job duties were modified, but eventually she was unable to continue. Id.

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In June of 2009, Michael McDermott, the claimant’s husband, submitted a statement on

her behalf. (Tr. 302-03) He stated that she has struggled with fibromyalgia since they met.

Id. “She seemed to get worse every year until the only thing she could do was go to work then

come home and lay down for most of the evening.” Id. Eventually, she had to quit work due

to the pain and fatigue. Id. At first, she paid the household bills each month, but he eventually

took over this task because “it was too much stress on her and she would get confused and make

mistakes.” Id.

In November of 2010, Antoinette Griffin, McDermott’s daughter, submitted a statement

on her behalf. (Tr. 300-01) Griffin explained that her mother “was always sharp and extremely

motivated to work and could multitask in a way that would amaze me.” Id. In 2005, when she

was still working, McDermott would take a break in the middle of the day and come to

Griffin’s house to lie down for a time. Id. Eventually, the pain and fatigue forced her to stop

working altogether. Id. When she was well, McDermott could baby-sit Griffin’s children and

attend their performances. Id. But, as her condition got worse, she was unable to do these

things. Id. McDermott “missed [her] [grandson’s] eighth grade graduation which devastated

her, as she really wanted to be there[,] but she was in too much pain and fatigued.” Id.

Hearing Testimony

 On March 30, 2009, McDermott appeared with counsel at a hearing before ALJ Lauren

R. Mathon. (Tr. 29) At the time of the hearing, McDermott was 60 years old. (Tr. 33) 

McDermott testified she worked at Eastern Arizona College in financial services for

nineteen and one-half years. (Tr. 34) She eventually stopped working due to pain, fatigue, and

lack of mental acuity. (Tr. 35) If she had been able to stay on the job for another six months

to a year, she would have been eligible for retirement benefits. (Tr. 52)

Her pain is most acute in her hips, buttocks, and thighs, but she also has pain in her

shoulders and knees. (Tr. 35) She takes Lunesta, trazodone, Cymbalta, Neurontin, and

ibuprofen. (Tr. 37)

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3

 Residual functional capacity is defined as that which an individual can still do despite

his or her limitations. 20 C.F.R. §§ 404.1545, 416.945.

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On July 1, 2009, McDermott appeared with counsel at a supplemental hearing before the

ALJ. (Tr. 75) At that hearing, medical expert Adam Christopher Alexander III, M.D., offered

his opinion of McDermott’s residual functional capacity 3

 based on his review of the medical

record. (Tr. 83) Alexander opined that she could lift or carry 20 pounds occasionally and 10

pounds frequently. (Tr. 89) She could sit, stand, and/or walk for six hours in an eight-hour day.

Id. She could not use ropes, ladders, or scaffolding. Id. Alexander based his opinion of

McDermott’s limitations exclusively on the objective medical evidence in the record without

considering her subjective reports of pain. (Tr. 89, 92, 93, 98) He explained that fibromyalgia

has no objective signs and therefore does not result in any “limitations” as he understands the

term. (Tr. 93)

The ALJ took testimony from vocational expert Kathleen McAlpine. (Tr. 109)

McAlpine testified that McDermott’s previous position would be classified as accountant or

accountant clerk and that both positions are sedentary skilled occupations. (Tr. 111) A person

with a residual functional capacity as described by Alexander could perform those jobs. Id.

McAlpine further opined that a person whose pain and fatigue caused a loss of mental acuity

could not perform those occupations. Id. And, if a person had to miss more than one day of

work per month due to illness, that person could not work. (Tr. 112)

On November 10, 2010, after remand from the Appeals Council, McDermott appeared

with counsel at a third hearing before the ALJ. (Tr. 119) 

McDermott’s cousin, Carla Crockett, offered testimony on McDermott’s behalf. (Tr.

139) Crockett testified that she has known McDermott since they were children. (Tr. 139)

McDermott once was very energetic and “incredibly brilliant.” (Tr. 140) Afterwards, however,

she became increasingly fatigued and mentally foggy. (Tr. 140-41) She once was an excellent

cook, but became incapable of reliably following a recipe “she’d made 50 times before.” (Tr.

141) She once was a gifted seamstress, but “it got so we could sew for a few minutes, and I

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would have to check every seam she sewed to make sure it was right or every item she did.”

(Tr. 141) Crockett explained, “[y]ou know, she made the stupidest, dumbest mistakes on things

she’d done forever; just couldn’t do it.” Id.

CLAIM EVALUATION

Social Security Administration (SSA) regulations require that disability claims be

evaluated pursuant to a five-step sequential process. 20 C.F.R. §§ 404.1520, 416.920; Baxter

v. Sullivan, 923 F.2d 1391, 1395 (9th Cir. 1991). The first step requires a determination of

whether the claimant is engaged in substantial gainful activity. 20 C.F.R. §§ 404.1520(a)(4),

416.920(a)(4). If so, then the claimant is not disabled, and benefits are denied. Id. 

If the claimant is not engaged in substantial gainful activity, the ALJ proceeds to step

two, which requires a determination of whether the claimant has a “medically severe impairment

or combination of impairments.” 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4). In making a

determination at step two, the ALJ uses medical evidence to consider whether the claimant’s

impairment more than minimally limits or restricts his or her “physical or mental ability to do

basic work activities.” Id. If the ALJ concludes the impairment is not severe, the claim is

denied. Id. 

Upon a finding of severity, the ALJ proceeds to step three, which requires a

determination of whether the impairment meets or equals one of several listed impairments that

the Commissioner acknowledges are so severe as to preclude substantial gainful activity. 20

C.F.R. §§ 404.1520(a)(4), 416.920(a)(4); 20 C.F.R. Pt. 404, Subpt. P, App.1. If the claimant’s

impairment meets or equals one of the listed impairments, then the claimant is presumed to be

disabled, and no further inquiry is necessary. Ramirez v Shalala, 8 F.3d 1449, 1452 (9th Cir.

1993). If the claimant’s impairment does not meet or equal a listed impairment, evaluation

proceeds to the next step. 

The fourth step requires the ALJ to consider whether the claimant has sufficient residual

functional capacity (RFC) to perform past work. 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4).

If yes, then the claim is denied. Id. If the claimant cannot perform any past work, then the ALJ

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must move to the fifth step, which requires consideration of the claimant’s RFC to perform

other substantial gainful work in the national economy in view of claimant’s age, education, and

work experience. 20 C.F.R. §§ 404.1520(a)(4); 416.920(a)(4).

The ALJ’s Findings

At step one of the disability analysis, the ALJ found McDermott “has not engaged in

substantial gainful activity since January 9, 2006, the alleged onset date . . . .” (Tr. 12). At step

two, she found McDermott “has the following severe impairments: fibromyalgia, osteoarthritis

of the fingers, bunion joints, big toes [] and thumb joints, and status post breast cancer and

breast reconstruction . . . .” (Tr. 12) At step three, the ALJ found McDermott’s impairments

did not meet or equal the criteria for any impairment found in the Listing of Impairments,

Appendix 1, Subpart P, of 20 C.F.R., Part 404. (Tr. 15)

The ALJ then analyzed McDermott’s residual functional capacity (RFC). She found

McDermott “has the residual functional capacity to perform light work . . . except that she

should avoid ropes, ladders and scaffolds and sustained and heavy gripping, grasping, and

handling on both hands; and she should also avoid unprotected heights and exposure to

hazardous moving machinery.” (Tr. 15)

At step four, the ALJ found McDermott “is able to perform past relevant work as an

accounting and accounting clerk” and therefore is not disabled. (Tr. 18) 

STANDARD OF REVIEW

An individual is entitled to disability benefits if he or she demonstrates, through

medically acceptable clinical or laboratory standards, an inability to engage in substantial

gainful activity due to a physical or mental impairment that can be expected to last for a

continuous period of at least twelve months. 42 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(A). “[A]

claimant will be found disabled only if the impairment is so severe that, considering age,

education, and work experience, that person cannot engage in any other kind of substantial

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gainful work which exists in the national economy.” Penny v. Sullivan, 2 F.3d 953, 956 (9th Cir.

1993).

The findings of the Commissioner are meant to be conclusive. 42 U.S.C. §§ 405(g),

1383(c)(3). The decision to deny benefits “should be upheld unless it contains legal error or is

not supported by substantial evidence.” Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007). 

Substantial evidence is defined as “such relevant evidence as a reasonable mind might accept

as adequate to support a conclusion.” Id. It is “more than a mere scintilla but less than a

preponderance.” Id.

“Where evidence is susceptible to more than one rational interpretation, the ALJ’s

decision should be upheld.” Orn, 495 F.3d at 630. “However, a reviewing court must consider

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

supporting evidence.” Id.

In evaluating evidence to determine whether a claimant is disabled, the opinion of a

treating physician is entitled to great weight. Ramirez v. Shalala, 8 F.3d 1449, 1453-54 (9th Cir.

1993). The Commissioner may reject a treating physician’s uncontradicted opinion only if she

sets forth clear and convincing reasons for doing so. Lester v. Chater, 81 F.3d 821, 830 (9th Cir.

1995). If the treating physician’s opinion is contradicted by another doctor, the Commissioner

may reject that opinion only if she provides specific and legitimate reasons supported by

substantial evidence in the record. Lester, 81 F.3d at 830. No distinction is drawn “between

a medical opinion as to a physical condition and a medical opinion on the ultimate issue of

disability.” Rodriguez v. Bowen, 876 F.2d 759, 761 n.7 (9th Cir. 1989). 

“Where medical reports are inconclusive, questions of credibility and resolution of

conflicts in the testimony are functions solely of the [Commissioner].” Magallanes, 881 F.2d

747, 751 (9th Cir. 1989) (punctuation omitted). The Commissioner’s finding that a claimant is

less than credible, however, must have some support in the record. See Light v. Social Sec.

Admin., 119 F.3d 789 (9th Cir. 1997).

The ALJ need not accept the claimant’s subjective testimony of disability, but if she

decides to reject it, “she must provide specific, cogent reasons for the disbelief.” Lester, 81

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 Smith’s opinion is contradicted by the opinion of the examining consultant, Richard

Palmer, M.D. (Tr. 469-80) 

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F.3d at 834. “Unless there is affirmative evidence showing that the claimant is malingering, the

Commissioner’s reasons for rejecting the claimant’s testimony must be clear and convincing.”

Id. “General findings are insufficient; rather, the ALJ must identify what testimony is not

credible and what evidence undermines the claimant’s complaints.” Id.

DISCUSSION

The ALJ committed legal error when she improperly discounted the opinion of

McDermott’s treating physician, Lynn E. Smith, M.D. See Orn v. Astrue, 495 F.3d 625, 631

(9th Cir. 2007). She also improperly discounted McDermott’s subjective testimony of disabling

pain and fatigue. The court does not reach McDermott’s alternative claims of error.

 “Because treating physicians are employed to cure and thus have a greater opportunity

to know and observe the patient as an individual, their opinions are given greater weight than

the opinions of other physicians.” Smolen v. Chater, 80 F.3d 1273, 1285 (9th Cir. 1996). The

Commissioner may reject the treating physician’s contradicted opinion4

 only if she sets forth

“specific and legitimate reasons supported by substantial evidence in the record.” Lester v.

Chater, 81 F.3d 821, 830 (9th Cir. 1996) (punctuation modified); see, e.g., Aukland v.

Massanari, 257 F.3d 1033, 1037 (9th Cir. 2001) (applying the Smolen “specific and legitimate”

test to the opinion of a treating physician). “This can be done by setting out a detailed and

thorough summary of the facts and conflicting clinical evidence, stating [her] interpretation

thereof, and making findings.” Orn v. Astrue, 495 F.3d 625, 632 (9th Cir. 2007). “The ALJ

must do more than offer [her] conclusions.” Id. “[She] must set forth [her] own interpretations

and explain why they, rather than the doctor[’s], are correct.” Id. 

If the treating source’s opinion “is well-supported by medically and acceptable clinical

and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence

in [the] case record,” it must be given “controlling weight.” 20 C.F.R. § 404.1527(c)(2); §

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 The ALJ incorrectly refers to Smith using the feminine pronoun. See (Tr. 37).

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416.927(c)(2). If the treating source’s opinion is not given controlling weight, the ALJ must

nevertheless analyze other factors such as the length, nature, and extent of the treating

relationship; the supportability and consistency of the opinion; and the degree of medical

specialization possessed by the treating source. 20 C.F.R. § 1527(d)(2 - 6); § 416.927(d)(2- 6);

see also Sameena, Inc. v. U. S. Air Force, 147 F.3d 1148, 1153 (9th Cir. 1998) (“[A] federal

agency is obliged to abide by the regulations it promulgates.”). “In many cases, a treating

source’s medical opinion will be entitled to the greatest weight and should be adopted even if

it does not meet the test for controlling weight.” SSR 96-2p, 1996 WL 374188 at *4. In sum,

the ALJ must “give good reasons” for the weight given to the treating source’s opinion. 20

C.F.R. § 404.1527(c)(2); § 416.927(c)(2). 

In this case, McDermott’s treating physician, Smith, concluded that she cannot work due

to disabling fibromyalgia. See (Tr. 17) (“[He] opined that the claimant was permanently

disabled because of severe fibromyalgia.”) Specifically, Smith opined that McDermott could

walk only 500 feet daily due to “severe pain in joints.” (Tr. 449-51, 603) She could stand for

2 hours daily and sit for 2 hours daily. Id. She was restricted in her ability to climb and

balance but could lift 20 pounds occasionally and 10 pounds frequently. Id. She could not

tolerate temperature extremes, fumes, gasses, or poor ventilation. Id. 

The ALJ gave his opinions no weight at all and found McDermott had the physical

ability to perform light work relying primarily on the opinion of the state agency physicians.

(Tr. 15, 17) The ALJ’s stated reasons for doing so are not “specific and legitimate.”

The ALJ critiqued Smith’s opinion as follows:

[T]he claimant’s primary care physician, Lynn Smith, M.D., indicated that the

claimant has severe fibromyalgia with a [sic] vague objective findings that the

claimant had multiple joint pains and difficulty with movement . . . [His]5

assessment[s] are exceedingly difficult to substantiate. There is no evidence of

[his] objective medical findings, such as physical examination, in the progress

notes to support the allegations that the claimant has severe disabling

fibromyalgia, and [he] appears to base [his] assessment purely upon the

claimant’s subjective complaints. * **

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[He] opined that the claimant was permanently disabled because of severe

fibromyalgia. [His] assessment is not well-supported by the overall objective

evidence. As noted above, [he] relies on the claimant’s subjective complaints and

[his] notes fail to indicate [his] objective findings to support [his] assessment.

(Tr. 17) In sum, the ALJ discounted Smith’s opinion because he failed to support it with

objective medical evidence and relied instead on the claimant’s subjective complaints. 

McDermott, however, suffers from fibromyalgia, “a rheumatic disease that causes

inflammation of the fibrous connective tissue components of muscles, tendons, ligaments, and

other tissues.” Benecke v. Barnhart, 379 F.3d 587, 589 (9th Cir. 2004). Fibromyalgia “is

diagnosed entirely on the basis of patients’ reports of pain and other symptoms.” Id. at 590.

“[T]o date there are no laboratory tests to confirm the diagnosis.” Id.

Smith’s failure to provide objective support for his medical opinion and his reliance on

McDermott’s subjective reporting of symptoms is understandable given the nature of her

disease. Fibromyalgia does not result in objective medical signs. The ALJ unreasonably

discounted Smith’s opinion based on his failure to supply something that does not exist. The

ALJ, therefore, did not supply “specific and legitimate” reasons for discounting his opinion of

disability. See Benecke v. Barnhart, 379 F.3d 587, 594 (9th Cir. 2004) (“The ALJ erred by

effectively requiring ‘objective’ evidence for a disease that eludes such measurement.”)

(punctuation modified).

The Commissioner argues in the alternative that Smith’s opinions could be properly

discounted if they were based primarily on the claimant’s subjective complaints and the

claimant was not a credible witness. The Commissioner is correct in theory. The court finds,

however, that McDermott is a credible witness. 

A claimant who alleges disability based on subjective symptoms such as pain or fatigue

must establish the existence of an underlying impairment that “could reasonably be expected

to (not that it did in fact) produce some degree of symptom.” Smolen v. Chater, 80 F.3d 1273,

1282 (9th Cir. 1996). “The claimant need not produce objective medical evidence of the pain

or fatigue itself or the severity thereof.” Id. “Nor must the claimant produce objective medical

evidence of the causal relationship between the medically determinable impairment and the

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symptom.” Id. “Finally, the claimant need not 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 symptom.” Id. (emphasis added). This approach to the

evaluation of a claimant’s testimony “reflects the highly subjective and idiosyncratic nature of

pain and other such symptoms.” Id.

Once a claimant makes the required showing “and there is no affirmative evidence

suggesting she is malingering, the ALJ may reject the claimant’s testimony regarding the

severity of her symptoms only if [she] makes specific findings stating clear and convincing

reasons for doing so.” Id. at 1283-84. “[T]he ALJ may consider, for example (1) ordinary

techniques of credibility evaluation, such as the claimant’s reputation for lying, prior

inconsistent statements concerning the symptoms, and other testimony by the claimant that

appears less than candid; (2) unexplained or inadequately explained failure to seek treatment

or to follow a prescribed course of treatment; and (3) the claimant’s daily activities.” Id. at

1284. In this case, there is no evidence that McDermott is malingering. Accordingly, the ALJ

could discount her subjective testimony of disability only by presented clear and convincing

reasons for doing so. This she did not do.

The ALJ explained she did not find McDermott to be credible based on three things: (1)

a lack of objective evidence supporting her symptoms, (2) her infrequent visits to her

physicians, and (3) the record of her daily activities. The court will consider them in turn.

First, and perhaps foremost, the ALJ objected to the lack of objective medical evidence

supporting the alleged severity of McDermott’s subjective symptoms. The ALJ stated, “[t]he

claimant’s alleged limitations are not corroborated by the medical evidence.” (Tr. 16)

Specifically, she noted that physical examinations “failed to reveal evidence of joint swelling,

diurnal variation of pain, synovitis, or effusion, and her joints have retained their normal ranges

of motion.” Id. “The only exception was the lumbar spine which merely showed decreased

range of motion with a negative straight leg test bilaterally – findings that would not adequately

support her complaints of overall pain and fatigue.” (Tr. 16-17)

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 McDermott lives in Pima, Arizona, near Safford. (Tr. 33) Maricic’s office is located

in Tucson. (Tr. 128) 

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A claimant, however, need not produce objective medical evidence to verify her level

of pain or fatigue. Smolen v. Chater, 80 F.3d 1273, 1282 (9th Cir. 1996). She need only

establish that she has an underlying impairment that is expected to cause some degree of

symptom, and McDermott has done that. The ALJ accepts that McDermott has fibromyalgia.

Accordingly, her objection that McDermott’s level of pain and fatigue is not supported by

objective evidence is not well taken.

Second, the ALJ objects to the fact that McDermott sees her treating physician, Smith,

and her rheumatologist, Maricic, only infrequently. The ALJ notes that McDermott sees

Maricic only once every six months. (Tr. 16, 129) She states that McDermott sees Smith only

“intermittently.” (Tr. 17)

An unexplained failure to seek treatment is recognized as a legitimate reason for

discounting a claimant’s subjective testimony of disabling pain. See Smolen v. Chater, 80 F.3d

1273, 1284 (9th Cir. 1996). Here, however, the record provides an explanation for McDermott’s

failure to visit her physicians more often. 

Maricic’s office is located 150 miles6

 away from McDermott’s home and travel is very

uncomfortable for her. (Tr. 128) She reported, however, that if she has a medical concern, she

will contact Maricic using the telephone. (Tr. 129) Accordingly, McDermott’s failure to

frequently visit Maricic in person is not evidence that her symptoms are less severe than she

alleges.

The ALJ also objects to the fact that McDermott only sees Smith “intermittently.” (Tr.

17) It is not entirely clear how frequently or regularly the ALJ believes McDermott should be

seeing her treating physician. Accordingly, it is difficult to assess this comment. The record

does, however, offer an explanation as to why McDermott does not seek treatment from her

doctors more frequently and more regularly. Maricic states in no uncertain terms that “there are

no currently approved FDA treatments for fibromyalgia.” (Tr. 640) Accordingly, it is

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understandable that McDermott does not frequently and regularly visit those health care

providers that have little to offer her in the way of effective treatment. The only medication that

Maricic believes has some chance of success is Cymbalta, and McDermott is already taking

that. (Tr. 38)

McDermott does report that massage and chiropractic treatments are effective in reducing

her pain. (Tr. 38) And she takes those treatments on a weekly basis. (Tr. 17, 38) It therefore

appears that she does regularly and frequently seek treatment for her condition. 

Considering the intractable nature of McDermott’s underlying impairment, her failure

to regularly and frequently visit her doctors in person is not evidence that her subjective

testimony of disabling pain and fatigue should be discounted.

Finally, the ALJ explains that she discounted McDermott’s credibility because of her

record of daily activities. Specifically, she notes that McDermott sees her chiropractor weekly,

attends church monthly, travels 150 miles to Tucson, shops with the help of an electric cart,

works on her computer for one-half hour at a time, and quilts. (Tr. 17) It does not appear,

however, that this collection of activities is inconsistent with her subjective testimony of

disabling pain and fatigue.

As discussed above, McDermott sees her chiropractor weekly because it reduces her pain

and travels 150 miles to Tucson to visit her rheumatologist. These activities are undertaken

because of her condition, not in spite of it. The fact that she can attend church monthly, shop

with the aid of an electric cart, and concentrate on the computer for one-half hour at a stretch

hardly seems indicative of an ability to perform substantial gainful activity. The record

indicates that McDermott still can quilt, but her skills are not what they used to be. Her quilting

partner explained that McDermott once was a gifted seamstress, but “it got so we could sew for

a few minutes, and I would have to check every seam she sewed to make sure it was right or

every item she did.” (Tr. 141) Accordingly, McDermott’s continued participation in her

quilting hobby is not evidence that justifies discounting her credibility. The ALJ did not

provide clear and convincing reasons for rejecting McDermott’s subjective testimony of

disability. See Benecke v. Barnhart, 379 F.3d 587, 594 (9th Cir. 2004) (“This court has

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repeatedly asserted that the mere fact that a plaintiff has carried on certain daily activities does

not in any way detract from her credibility as to her overall disability.” “One does not need to

be utterly incapacitated in order to be disabled.”) (punctuation modified).

In response, the Commissioner argues the Smolen “clear and convincing” test is not the

law, because it conflicts with the Ninth Circuit’s prior statement in Bunnell that “an ALJ’s

credibility findings ‘must be sufficiently specific to allow a reviewing court to conclude the

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

discredit a claimant’s testimony regarding pain.’” (Tr. 35, p. 18) (citing Bunnell v. Sullivan, 947

F.2d 341, 345-46 (9th Cir. 1991) (en banc). According to the Commissioner, the Smolen test

impermissibly raises the standard of proof set in Bunnell, and because a mere panel decision

cannot overrule a prior pronouncement of the court sitting en banc, it is not good law.

 The Commissioner did not cite to any cases directly supporting her theory, and the court

could find none. But regardless, while the Commissioner correctly states the rule of panel

precedent, the court does not believe the Smolen “clear and convincing” test is in conflict with

the cited passage in Bunnell. 

The Bunnell passage discusses the specificity with which the ALJ should craft her

opinions. It does not set a ceiling on the standard of proof that the ALJ must meet in order to

justify discounting the claimant’s subjective testimony of disabling pain. The two cases discuss

different things. They are not in conflict. See, e.g., Aukland v. Massanari, 257 F.3d 1033, 1037

(9th Cir. 2001) (applying the Smolen “specific and legitimate” test).

The ALJ improperly discounted McDermott’s subjective testimony of disability.

Further, she did not provide specific and legitimate reasons for discounting the opinion of her

treating physician. “Where the Commissioner fails to provide adequate reasons for rejecting

the opinion of a treating or examining physician, we credit that opinion as a matter of law.”

Lester v. Chater, 81 F.3d 821, 834 (9th Cir.1996). “Similarly, where the ALJ improperly rejects

the claimant’s testimony regarding her limitations, and the claimant would be disabled if her

testimony were credited, we will not remand solely to allow the ALJ to make specific findings

regarding that testimony.” Id. “Rather, that testimony is also credited as a matter of law.” Id.

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“Where we conclude that a claimant’s testimony or a doctor’s opinion should have been

credited and, if credited, would have led to a finding of eligibility, we may order the payment

of benefits.” Regennitter v. Commissioner, 166 F.3d 1294, 1300 (9th Cir.1999); see also

Ghokassian v. Shalala, 41 F.3d 1300, 1304 (9th Cir.1994) (remanding for payment of benefits

where the Secretary did not provide adequate reasons for disregarding the treating physician’s

opinion); Rodriguez v. Bowen, 876 F.2d 759, 763 (9th Cir.1989); Winans v. Bowen, 853 F.2d

643, 647 (9th Cir.1987). 

In this case, the ALJ improperly discounted the opinion of the claimant’s treating

physician. The ALJ also improperly rejected the claimant’s subjective testimony of disability.

All of this evidence should be credited as a matter of law. Crediting this evidence indicates

McDermott has been disabled since January 9, 2006. See Loza v. Apfel, 219 F.3d 378, 394 (5th

Cir. 2000) (“Factors relevant to the determination of the date of disability include the

individual’s declaration of the date of when the disability began, work history and available

medical history.”); Swanson v. Secretary, 763 F.2d 1061, 1066 n.2 (9th Cir. 1985) (The

claimant’s onset date should be adopted by the Commissioner if it is consistent with the

available evidence.); Willbanks v. Secretary, 847 F.2d 301, 304 (6th Cir. 1988) (same). Remand

of the case would serve no useful purpose. See Benecke v. Barnhart, 379 F.3d 587, 595 (9th

Cir. 2004) (“Allowing the Commissioner to decide the issue again would create an unfair

‘heads we win; tails, let’s play again’ system of disability benefits adjudication.”); Holohan v.

Massanari 246 F.3d 1195, 1210 (9th Cir. 2001); Smolen v. Chater, 80 F.3d 1273, 1292 (9th Cir.

1996) (“We may direct an award of benefits where the record has been fully developed and

where further administrative proceedings would serve no useful purpose.”); See also SSR 96-2p

(“If a treating source’s medical opinion is well-supported and not inconsistent with the other

substantial evidence in the case record, it must be given controlling weight; i.e. it must be

adopted.”). McDermott has been waiting for her benefits for more than seven years. See, e.g.,

Podedworny v. Harris, 745 F.2d 210, 223 (3rd Cir. 1984). A finding of disability should be

entered.

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IT IS ORDERED that the final decision of the Commissioner is reversed. The case is

remanded for payment of benefits. 

The Clerk of the Court is directed to prepare a judgment and close this case.

DATED this 30th day of October, 2013.

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