Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_19-cv-00396/USCOURTS-azd-2_19-cv-00396-0/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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WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Ashraf Youssef,

Plaintiff,

v. 

Commissioner of Social Security 

Administration,

Defendant.

No. CV-19-00396-PHX-JZB

ORDER 

At issue is the denial of Plaintiff Ashraf Youssef’s Application for Disability 

Insurance Benefits by the Social Security Administration under the Social Security Act

(The Act). Plaintiff filed a Complaint (doc. 1) with this Court seeking judicial review of 

that denial, and the Court now addresses Plaintiff’s Opening Brief (doc. 9), Defendant 

Social Security Administration Commissioner’s Response Brief (doc. 10), and Plaintiff’s 

Reply Brief (doc. 11). The Court has reviewed the briefs and Administrative Record (doc. 

8) and now reverses the Administrative Law Judge’s (ALJ) decision (AR 26-44) as upheld 

by the Appeals Council (AR 1-6).

I. Background.

On May 29, 2015, Plaintiff filed an application for Disability Insurance Benefits for 

a period of disability beginning on May 5, 2014. (AR 29.) His claim was denied initially 

on August 1, 2015, and upon reconsideration on January 22, 2016. (AR 29.) On March 5, 

2018, Plaintiff appeared before the ALJ for a hearing regarding his claim. (AR 29.) On 

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June 11, 2018, the ALJ denied Plaintiff’s claim, and on December 20, 2018, the Appeals 

Council denied Plaintiff’s Request for Review of the ALJ’s decision. (AR 1, 29.)

The Court has reviewed the medical evidence in its entirety and finds it unnecessary 

to provide a complete summary here. The pertinent medical evidence will be discussed in 

addressing the issues raised by the parties. Upon considering the medical records and 

opinions, the ALJ evaluated Plaintiff’s disability based on the following severe 

impairments: degenerative disc disease of the cervical and thoracic spine (DDD), 

polyneuropathy diabetes, artherosclerotic heart disease of native coronary artery, statuspost left heart catheterization, malignant carcinoid tumor of the duodenum, sleep apnea, 

obesity, cardiomyopathy, diabetes mellitus, chronic prostatitis, and premature ventricular 

contractions. (AR 31.) 

Ultimately, the ALJ evaluated the medical evidence and testimony and concluded 

that Plaintiff is not disabled. (AR 38.) The ALJ determined that Plaintiff “does not have an 

impairment or combination of impairments that meets or medically equals the severity of 

one of the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1.” (AR 32.)

Additionally, the ALJ determined that Plaintiff has the residual functional capacity (RFC) 

to “perform light work . . . except he could never climb ladders, ropes or scaffolds but could 

occasionally climb ramps and stairs. He could frequently balance, stoop, kneel, crouch and 

crawl. He must not have exposure to hazards or extreme cold or heat.” (AR 33.) 

Accordingly, the ALJ found Plaintiff can perform his past relevant work as a software 

engineer. (AR 37.) 

II. Legal Standard.

In determining whether to reverse an ALJ’s decision, the district court reviews only 

those issues raised by the party challenging the decision. See Lewis v. Apfel, 236 F.3d 503, 

517 n.13 (9th Cir. 2001). The Court may set aside the Commissioner’s disability 

determination only if the determination is not supported by substantial evidence or is based 

on legal error. Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007). Substantial evidence is 

more than a scintilla, but less than a preponderance; it is relevant evidence that a reasonable 

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person might accept as adequate to support a conclusion considering the record as a whole. 

Id. To determine whether substantial evidence supports a decision, the Court must consider 

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

supporting evidence.” Id. Generally, “[w]here the evidence is susceptible to more than one 

rational interpretation, one of which supports the ALJ’s decision, the ALJ’s conclusion 

must be upheld.” Thomas v. Barnhart, 278 F.3d 947, 954 (9th Cir. 2002) (citations 

omitted).

To determine whether a claimant is disabled for purposes of the Act, the ALJ 

follows a five-step process. 20 C.F.R. § 404.1520(a). The claimant bears the burden of 

proof on the first four steps, but the burden shifts to the Commissioner at step five. Tackett 

v. Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999). At the first step, the ALJ determines whether 

the claimant is presently engaging in substantial gainful activity. 20 C.F.R. 

§ 404.1520(a)(4)(i). At step two, the ALJ determines whether the claimant has a “severe”

medically determinable physical or mental impairment. 20 C.F.R. § 404.1520(a)(4)(ii). At 

step three, the ALJ considers whether the claimant’s impairment or combination of 

impairments meets or medically equals an impairment listed in Appendix 1 to Subpart P 

of 20 C.F.R. Part 404. 20 C.F.R. § 404.1520(a)(4)(iii). If so, the claimant is automatically 

found to be disabled. Id. At step four, the ALJ assesses the claimant’s RFC and determines 

whether the claimant is still capable of performing past relevant work. 20 C.F.R. 

§ 404.1520(a)(4)(iv). If so, the claimant is not disabled, and the inquiry ends. Id. At the 

fifth and final step, the ALJ determines whether the claimant can perform any other work

in the national economy based on the claimant’s RFC, age, education, and work experience. 

20 C.F.R. § 404.1520(a)(4)(v). If not, the claimant is disabled. Id.

III. Analysis.

Plaintiff raises two arguments for the Court’s consideration. (Doc. 9 at 1.) First, 

Plaintiff argues that the ALJ erroneously rejected his testimony regarding the severity of 

his symptoms. (Id. at 12.) Second, Plaintiff argues that the ALJ misevaluated the opinion 

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of Dr. Rami Doss, Plaintiff’s treating cardiologist.1 The Court agrees with both arguments. 

A. The ALJ erred because she rejected Plaintiff’s testimony for an

insufficient reason—a lack of supporting objective medical evidence. 

At his hearing before the ALJ, Plaintiff testified to various functional limitations 

stemming from his medical impairments. Specifically, he testified that he could not 

perform sedentary work because of issues with focus, dizziness, balance, memory, 

excessive sweating, and sleep. (AR 143-44.) He also testified regarding the surgeries on 

his heart and abdomen, but claimed that his symptoms have persisted and progressed. (AR

142-44.) Finally, he testified regarding walking and standing limitations due to 

musculoskeletal impairments and diabetic neuropathy. (AR 145-47.) According to the 

vocational expert, these limitations, if they caused Plaintiff to be off task for more than ten 

percent of a workday, would preclude employment. (AR 151.) 

The ALJ rejected Plaintiff’s testimony regarding his symptoms because Plaintiff’s 

“statements concerning the intensity, persistence and limiting effects of these symptoms 

are not entirely consistent with the medical evidence and other evidence in the record.” 

(AR 33-34.) The ALJ summarized the medical findings related to Plaintiff’s impairments. 

(AR 34-35.) She noted that some of these findings undermine Plaintiff’s statements 

regarding his symptoms. (AR 33-35.) However, many of the findings the ALJ summarized

appear to bolster Plaintiff’s testimony. (AR 34-35.) Finally, the ALJ stated that she

considered Plaintiff’s statements to medical providers (AR 35.) Notably, she cited a single 

record in March 2016 that indicated that Plaintiff denied certain symptoms at that 

appointment. (AR 35.) 

An ALJ performs a two-step analysis to evaluate a claimant’s testimony regarding 

pain and symptoms. Garrison v. Colvin, 759 F.3d 995, 1014 (9th Cir. 2014). First, the ALJ 

1 Plaintiff also argues that the ALJ failed to adopt the standing and walking 

limitations opined to by Dr. Jerry Dodson, a non-examining physician who evaluated 

Plaintiff’s functional capacity. (Doc. 9 at 11.) The Court disagrees. The ALJ gave Dr. 

Dodson’s opinion great weight and the ALJ accounted for the limitations in Plaintiff’s 

RFC. Additionally, the ALJ was not required to accept every limitation Dr. Dodson opined 

to. See Carmickle v. Comm’r of Soc. Sec., 533 F.3d 1155, 1164 (9th Cir. 2008) (noting that 

ALJs are not required to accept medical opinions wholesale). 

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evaluates whether the claimant has presented objective medical evidence of an impairment 

“which could reasonably be expected to produce the pain or symptoms alleged.” 

Lingenfelter v. Astrue, 504 F.3d 1028, 1035–36 (9th Cir. 2007) (quoting Bunnell v. 

Sullivan, 947 F.2d 341, 344 (9th Cir. 1991) (en banc) (internal quotation marks omitted)). 

If the claimant presents such evidence then “the ALJ can reject the claimant’s testimony 

about the severity of her symptoms only by offering specific, clear and convincing reasons 

for doing so.” Garrison, 759 F.3d at 1014-15 (citing Smolen v. Chater, 80 F.3d 1273, 1281 

(9th Cir. 1996)). This is the most demanding standard in Social Security cases. Id. at 1015.

“In evaluating the credibility of pain testimony after 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 v. Barnhart, 400 F.3d 676, 680 (9th Cir. 2005).

Here, the ALJ erred because the only reason she gave for rejecting Plaintiff’s 

testimony was that it was purportedly unsupported by the medical evidence. (AR 33-35.) 

An ALJ is permitted to reduce the weight given to a claimant’s testimony because it 

unsupported by objective medical evidence, but it cannot be the sole reason the testimony

is rejected. Burch, 400 F.3d at 681. Both Plaintiff and Defendant confuse the law on this 

issue. (Doc. 9 at 13-14, Doc. 10 at 10.) None of the cases cited by either party support the 

proposition that an ALJ may reject a claimant’s testimony solely because it is unsupported 

by the objective medical evidence. Regardless of whether the lack of support is 

characterized as an inconsistency or a contradiction, a mere lack of support, without more, 

is insufficient to reject a claimant’s testimony. Burch, 400 F.3d at 680. 

Conversely, actual inconsistencies in a claimant’s testimony or statements, without 

more, are a sufficient reason to reject a claimant’s testimony. Moisa v. Barnhart, 367 F.3d 

882, 885 (9th Cir. 2004). These inconsistencies are not merely reports of the absence of 

symptoms in isolated medical records. Instead, they are actual statements by the claimant 

or others that undermine the credibility of the claimant’s testimony. 

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In this case there were no inconsistencies in Plaintiff’s testimony or statements. The 

medical record the ALJ cited where Plaintiff denied “bladder symptoms, bowel symptoms, 

numbness, tingling, confusion, memory loss, speech disorder, weakness, muscle twitching, 

cramping, headaches, vertigo, dizziness, imbalance or falling, blurred vision or difficulty 

with gait walking” (AR 35), is not an inconsistency in Plaintiff’s testimony or statements. 

The absence of symptoms described in the record are more appropriately considered an 

absence of certain medical evidence, rather than inconsistent statements that reflect on 

Plaintiff’s credibility.2

Because the only reason the ALJ provided for rejecting Plaintiff’s symptom 

testimony was a purported lack of objective medical support, she erred

B. The ALJ also erred by rejecting the opinion of Dr. Ramy Doss, 

Plaintiff’s treating cardiologist. 

Dr. Doss opined to various impairments and limitations that interfered with 

Plaintiff’s ability to perform his work as a software engineer. (AR 544-45.) Dr. Doss 

described 11 different impairments and symptoms including: dizziness, fatigue, daytime 

sleepiness, leg and back pain, and memory and concentration issues. (AR 545.) Finally, 

Dr. Doss noted that these limitations would limit his ability to function in his previous 

position as a software engineer. (AR 545.) 

The ALJ gave this opinion little weight for three reasons. (AR 35.) First, the ALJ 

found that Dr. Doss did not provide a function-by-function analysis of Plaintiff’s work 

abilities. (AR 35.) Second, the ALJ noted that Dr. Doss did not diagnose or treat Plaintiff

for DDD, so Dr. Doss’s opinion regarding orthopedic issues was without basis. (AR 35–

36.) Third, the ALJ concluded that there were no sleep apnea studies to substantiate Dr. 

Doss’s opinion regarding Plaintiff’s daytime sleepiness. (AR 36.) Consequently, the ALJ 

concluded that the medical evidence does not support Dr. Doss’s opinion. (AR 36.) 

While “[t]he ALJ must consider all medical opinion evidence,” there is a hierarchy

2 Even if it had been proper for the ALJ to treat the record as evidence of inconsistent 

statements by Plaintiff, the single record would not constitute substantial evidence.

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among the sources of medical opinions. Tommasetti v. Astrue, 533 F.3d 1035, 1041 (9th Cir. 

2008). Those who have treated a claimant are treating physicians, those who examined but 

did not treat the claimant are examining physicians, and those who neither examined nor 

treated the claimant are nonexamining physicians. Lester v. Chater, 81 F.3d 821, 830 (9th 

Cir. 1995). “The medical opinion of a claimant’s treating physician is given ‘controlling 

weight’ so long as ‘it is well-supported by medically acceptable clinical and laboratory 

diagnostic techniques and is not inconsistent with other substantial evidence in [the record].” 

Trevizo v. Berryhill, 871 F.3d 664, 675 (9th Cir. 1995) (citing 20 C.F.R. § 404.1527(c)(2)). 

If a treating physician’s opinion is not given controlling weight, then the ALJ must consider 

the relevant factors listed in 20 C.F.R. § 404.1527(d)(2)-(6) and determine the appropriate 

weight to give the opinion. Orn, 495 F.3d at 632.

If a treating doctor’s opinion is contradicted by another doctor’s opinion, the ALJ 

may not reject the treating doctor’s opinion without setting forth “specific and legitimate 

reasons” for doing so that are based on substantial evidence in the record. Bayliss v. 

Barnhart, 427 F.3d 1211, 1216 (9th Cir. 2005). A treating doctor’s opinion will often be 

entitled to significant deference, even when contradicted. Orn, 495 F.3d at 632–33.

The ALJ’s first reason for rejecting Dr. Doss’s opinion—that Dr. Doss did not 

provide a function-by-function analysis—is specific and legitimate, but it is not supported 

by substantial evidence. See Morgan v. Comm’r of Soc. Sec. Admin., 169 F.3d 595, 601 

(9th Cir. 1999). Dr. Doss’s opinion specifies the functional limitations—lack of 

concentration, drowsiness, daytime sleepiness, fatigue, chronic pain, and excessive 

sweatiness—that prevent Plaintiff from fully performing his past work. Dr. Doss connected 

Plaintiff’s diagnoses to symptoms and connected those symptoms to functional limitations. 

Therefore, the ALJ erred in rejecting his opinion on this basis. 

The ALJ also erred by rejecting Dr. Doss’s opinion because Dr. Doss did not 

personally diagnose or treat Plaintiff for DDD. Plaintiff’s spinal issues were extensively 

documented through clinical findings and noted by the ALJ in his review of Plaintiff’s 

medical records. (AR 34.) The ALJ specifically noted severe spinal degeneration that was 

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confirmed via MRI. (AR 34.) Even though Dr. Doss—Plaintiff’s cardiologist—did not 

specifically diagnose or treat Plaintiff for this impairment, Plaintiff’s DDD is clearly 

documented in the record. (AR 34.) In fact, the ALJ found that DDD was one of Plaintiff’s 

severe impairments, which means it is a documented impairment that causes “more than a 

minimal effect on an [Plaintiff]’s ability to work.”

3

(AR 31). See Webb v. Barnhart, 433 

F.3d 683, 687 (9th Cir. 2005).

Finally, the ALJ erred by rejecting Dr. Doss’s opinion because his opinion regarding 

daytime sleepiness was not verified by sleep apnea studies. (AR 35). This reason is 

inconsistent with the ALJ classifying sleep apnea as one of Plaintiff’s severe impairments. 

(AR 31.) In order to find that an impairment is severe, the ALJ must first determine that it 

is a medically determinable impairment. To establish a medically determinable 

impairment, a claimant must provide evidence from a medically acceptable source, such as 

laboratory results or a licensed physician. 20 C.F.R. § 404.1513(a); Ukolov v. Barnhart, 

420 F.3d 1002, 1005 (9th Cir. 2005). The ALJ’s rejection of Dr. Doss’s opinion because 

Plaintiff’s sleep apnea was not verified is inconsistent with the ALJ’s finding that

Plaintiff’s sleep apnea was a severe impairment, i.e., it causes more than a minimal effect 

on Plaintiff’s ability to work. (AR 31.)

Because the ALJ offered no specific and legitimate reasons supported by substantial 

evidence, she erred by rejecting Dr. Doss’s opinion. 

C. The proper remedy is to remand Plaintiff’s case for calculation of 

benefits.

The credit-as-true rule, if applied here, would result in a remand of Plaintiff’s case 

for a calculation and payment of benefits. Garrison, 759 F.3d at 1020. It applies if each 

part of a three-part test is satisfied. Id. First, the record must have been fully developed and 

3 Even if the ALJ’s rejection of Dr. Doss’s opinion had been backed by substantial

evidence as to DDD, the ALJ would still have erred. The ALJ’s rejection of Dr. Doss’s 

opinion regarding DDD because Dr. Doss did not treat Plaintiff for that impairment does 

not justify rejecting the entire opinion. Dr. Doss’s opinion also contains limitations from 

impairments he did treat Plaintiff for, and the ALJ did not offer a specific and legitimate 

reason for rejecting those limitations. 

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further administrative proceedings would serve no useful purpose. Id. Next, the ALJ must 

have failed to provide sufficient reasons for rejecting claimant’s testimony or medical 

opinions. Id. Finally, if the improperly discredited evidence were credited as true, then the 

ALJ would be required to find the claimant disabled. Id. The credit-as-true rule allows for 

some flexibility and balances efficiency and fairness in conjunction with the requirement 

that a claimant actually be disabled in order to receive benefits. Id. at 1021. Finally, even 

if all the rule’s requirements are met, the Court may still decline to apply the rule if there 

is “serious doubt” that the claimant is, in fact, disabled. Id.

All of the elements of the credit-as-true rule are met. First, the record is fully 

developed and remand for additional proceedings would serve no useful purpose. Next, the 

ALJ provided insufficient reasons for rejecting Plaintiff’s symptom testimony and Dr. 

Doss’s opinion. Finally, if Plaintiff’s symptom testimony and Dr. Doss’s opinion were 

credited as true, the ALJ would be required to find Plaintiff disabled. The vocational expert 

at Plaintiff’s hearing testified that Plaintiff would be unable to work if he was off task for 

more than ten percent per day. (AR 151.) Plaintiff’s testimony and Dr. Doss’s opinion 

establish that because of his various limitations, especially those stemming from his 

cardiac, diabetic, and spinal impairments, he would be off task for more for than ten percent 

per workday. (AR 143, 545.) 

Finally, there is not serious doubt as to whether Plaintiff is, in fact, disabled. His 

spinal issues are extensively documented throughout the clinical records, which the ALJ 

noted. (AR 34.) Furthermore, although the record does not confirm beyond all doubt that 

Plaintiff’s numerous impairments prevent him from working, the medical records do not 

raise serious doubt that he is unable to work. This result squares with the purpose of the 

credit-as-true rule, which aims to ensure a thorough examination of claimants’ cases in the 

first instance and prevent an inefficient and “unfair ‘heads we win; tails, let’s play again’ 

system of disability benefits adjudication.” Benecke v. Barnhart, 379 F.3d 587 595 (9th 

Cir. 2004). 

Accordingly, the Court will remand for calculation and entry of benefits.

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IT IS ORDERED that the final decision of the Commissioner of Social Security is 

vacated, and this case is remanded for calculation of benefits. The Clerk is directed to 

enter final judgment consistent with this Order and terminate this case.

Dated this 11th day of March, 2020.

Honorable John Z. Boyle

United States Magistrate Judge

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