Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_11-cv-00353/USCOURTS-casd-3_11-cv-00353-1/pdf.json

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

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11cv0353 1

UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF CALIFORNIA

KATHLEEN A. KNOWLES,

Plaintiff,

v.

MICHAEL J. AS TRUE,

Commissioner of Social

Security,

Defendants.

 

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Civil No. 11-0353-MMA(WVG)

REPORT AND RECOMMENDATION

DENYING PLAINTIFF’S MOTION FOR

SUMMARY JUDGMENT AND GRANTING

DEFENDANT’S MOTION FOR SUMMARY

JUDGMENT

(DOC. NOS. 16, 19)

I

 INTRODUCTION

Plaintiff Kathleen A. Knowles (“Plaintiff”), filed a

Complaint for Review of the Final Decision of the Commissioner of

Social Security (“Complaint”). Defendant Michael J. Astrue,

Commissioner of Social Security, (“Defendant”), filed an Answer to

the Complaint and lodged the administrative record (“Tr.”),

pertaining to this case. Plaintiff has filed a Motion for Summary

Judgment. Defendant has filed an Opposition to Plaintiff’s Motion

for Summary Judgment and a Cross-Motion for Summary Judgment. 

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11cv0353 2

Upon examination of the entire record, the Court RECOMMENDS

Plaintiff’s Motion for Summary Judgment be DENIED, and Defendant’s

Cross Motion for Summary Judgment be GRANTED.

II

PROCEDURAL HISTORY

On September 28, 2006 Plaintiff filed a claim for disability

benefits, and supplemental security income under Titles II and XVI

of the Social Security Act. (TR. 141 - 146; 147 - 150.) On April

9, 2007, the Defendant denied the initial claim for benefits, and on

May 18, 2007, denied reconsideration. (TR. 59-60; 91.) 

Plaintiff requested a hearing before an Administrative Law

Judge (“ALJ”) which was held on December 15, 2008. (Tr. 17 - 58.)

Plaintiff, who was represented by counsel, appeared at the hearing

before ALJ Eva B. Godfrey. (Id.) Following the hearing, at the

request of her representative, Plaintiff underwent an orthopedic

consultation with medical examiner Dr. Thomas Sabourin. Dr.

Sabourin’s findings were incorporated into the decision of the ALJ.

The ALJ found that Plaintiff did not suffer from a disability as of

the date of her initial application through the decision date of May

28, 2009. (TR. 63 - 76.)

On September 25, 2009, Plaintiff appealed the ALJ’s decision

to the Social Security Appeals Council. On January 5, 2011, the

Appeals Council denied review of the ALJ’s decision and the ALJ’s

decision became the final opinion of the Commissioner. (TR. 1 - 5.)

On February 18, 2011 Plaintiff filed a Complaint in this Court for

Review of the Commissioner’s Final Decision.

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1/ References to Plaintiff’s claims were taken from her testimony at the

December 15, 2008 administrative hearing (Tr. 18 - 58), unless referenced to some

other part of the administrative record.

11cv0353 3

III

STATEMENT OF FACTS

Plaintiff was born on September 5, 1957. She began working

in 1975, accruing over thirty years of a sporadic work history. Over

the course of those thirty years, she earned an aggregate income of

approximately $65,000. (Tr. 27.) From 2002 - 2004, she worked as a

waitress, nurse assistant, and day laborer (responsible for

primarily cleaning-up construction demolition sites and laying

bricks). (Tr. 25-26.) She claims to have stopped working in 2004 due

to pain in both her feet and back, suffering from dizzy spells and

chest pain.1/ (Id.) 

Plaintiff claims to have become disabled as early as December

31, 2003, at the age of 46, however she filed her initial application for disability benefits three years later, on September 14,

2006. (Tr. 22 - 23.) At the onset of her disability, Plaintiff

alleges to have experienced multiple heart attacks beginning in

2001. (Tr. 26.) She also claims to have had two strokes, the last

occurring in 2006. (Id.) She contends that her residual functional

capacity (“RFC”) is less than sedentary, because she is required to

use a walker to assist with her mobility. (Tr. 24-26; 57.)

The ALJ, applying the five step sequential analysis in 20

C.F.R. Section 416.920, found Plaintiff was not disabled in

accordance with the Social Security Act Section 1614(a)(3)(A).

Though the ALJ determined Plaintiff suffered from degenerative disc

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2/ A transient ischemic attack is a stroke that comes and goes quickly.

It happens when the blood supply to part of the brain stops briefly. Symptoms are

like other stroke symptoms but do not last as long. They happen suddenly, and

include numbness or weakness, confusion or trouble speaking or understanding

speech, loss of balance or coordination. Most symptoms disappear within an hour,

although they may last for up to 24 hours. MedlinePlus: A Service of the U.S.

National Library of Medicine,

http://www.nlm.nih.gov/medlineplus/transientischemicattack.html (Last updated Nov.

11, 2011)

3/ Coronary artery disease is a condition in which fatty plaque deposits

build up in the heart’s arteries. These plaque deposits cause arteries to become

narrow and blocked, which restricts blood and oxygen flow to the heart muscle.

A.D.A.M. Medical Encyclopedia, (May 15, 2009)

http://adam.about.net/reports/Coronary-artery-disease.htm

4/ Chronic obstructive pulmonary disease is a lung disease typically

presented in the form of chronic bronchitis, involving long-term cough with mucus;

or emphysema, involving destruction of the lungs over time. Some symptoms of COPD

include fatigue, respiratory infections, shortness of breath that worsens with

mild activity, and wheezing. A.D.A.M. Medical Encyclopedia (May 11, 2011),

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001153/

11cv0353 4

disease, status post-ischemic attack2/, mild coronary artery disease3/

(“CAD”), and chronic obstructive pulmonary disease4/ (“COPD”), these

conditions were not so debilitating as to restrict Plaintiff beyond

light work, with the limitations of occasional bending and crouching, the ability to alternate her position every 30 minutes and to

take asthma precautions. (Tr. 68, 71 - 76.) The ALJ, relying on

the opinion of a vocational rehabilitation specialist, determined

Plaintiff could perform work as a counter attendant, cashier,

telephone clerk, and assembler. (Tr. 75.) The ALJ rejected the

notion that Plaintiff’s RFC was less than sedentary due to her use

of a walker. (Tr. 25; 73 -74.) 

Plaintiff contends that the ALJ erred in finding that she was

not disabled under sections 216(i)and 223(d)of the Social Security

Act, because the medical opinion of her treating physician, Denise

Parnell, M.D., who prescribed Plaintiff’s walker, was ignored when

the ALJ determined her RFC. (Complaint, Doc. No. 16, 6-7.) 

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5/ Nurse Burgin completed County of San Diego Department of Social

Services Form, 16-3 DSS (5/84).

6/ Prior to this assessment, the records do not report Plaintiff had an

arthritis diagnosis, nor are there tests or findings contained in the record that

support the existence of arthritis. 

7/ Hyperlipidemia is “an excess of lipids in the blood.” The American

Heritage Medical Dictionary (2007), 

http://medical-dictionary.thefreedictionary.com/hyperlipidemia

11cv0353 5

A. MEDICAL HISTORY 

1. TREATMENT WITH DOWNTOWN FAMILY HEALTH CENTER

Beginning in 2005, Plaintiff received her primary care from

Downtown Family Health Center (“DFHC”). (Tr. 30.) While Plaintiff

treated at the facility, a number of providers cared for her. (Tr.

418; 350-361; 416-426; 446-473.) 

In February 2005, Plaintiff initially sought treatment for

pain in her sciatica and lumbar spine which radiated to her left hip

traveling down to her knee. There is no indication that she

suffered trauma at the onset of these symptoms. (Tr. 444.) 

On September 21, 2006, Plaintiff was evaluated at DFHC by

Stacey Burgin, Family Nurse Practitioner (“FNP”), Plaintiff

requested the nurse complete paperwork on her behalf so she could

obtain food stamps. Although at the time of the examination,

Plaintiff used a wheelchair at the appointment, Nurse Burgin did not

explain why the wheelchair was needed. (Tr. 356.) On the San Diego

County5/ form, Nurse Burgin indicated Plaintiff was disabled due to

COPD, CAD, rheumatoid arthritis6/, hypertension (“HTN”), and

hyperlipidemia7/, with a fair-to-poor prognosis due to Plaintiff’s

impaired mobility. (Tr. 446-447.) She also opined that Plaintiff

was unemployable until March 1, 2007. (Id.)

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8/ Pre-syncope is an “episode of near-fainting which may include

lightheadedness, dizziness, severe weakness, blurred vision, which may precede a

syncopal episode.” 

McGraw-Hill Concise Dictionary of Modern Medicine(2007), available at

http://medical-dictionary.thefreedictionary.com/presyncope

9/ Carotid Stenosis is the narrowing of the carotid artery (a key artery

located in the front of the neck through which blood from the heart goes to the

brain). MedicineNet.com,

http://www.medterms.com/script/main/art.asp?articlekey=39717 (Last updated Oct.

9, 2004)

10/ While there is a prescription, the administrative record does not

contain a corresponding report explaining the necessity for the wheelchair. 

11cv0353 6

 In October 2006, Plaintiff suffered a pre-syncope8/ episode

resulting in blurred vision, dizziness and slurred speech, which

lasted approximately three hours. (Tr. 353.) She was referred to

Scripps Mercy Hospital where, on November 1, 2006, an echocardiogram

test was performed. (Id.) This test revealed Plaintiff had a right

carotid moderate-to-severe stenosis9/. (Tr. 343-348.) She was

referred to a vascular surgeon for consultation, who determined she

was not a surgical candidate. (Tr. 46, 352, 462.) Following this

episode, on October 13, 2006, Dr. Facick Tafara, gave Plaintiff a

prescription for a motorized wheelchair10/. The Center for Medicare

& Medicaid Services (“CMS”) denied payment for the electric

wheelchair. (Tr. 39.) 

On February 6, 2007, Plaintiff saw Denise L. Parnell, M.D.,

to whom she complained of back, hip, knee and hand pain. (Tr. 419.)

At a follow-up appointment on March 3, 2007, Dr. Parnell noted that

Plaintiff “wants” a walker and bus pass (Tr. 417). At that examination, Dr. Parnell observed plaintiff had decreased range of motion

in her right hip and tenderness in her lumbar spine. X-rays of the

hip, knee and lumbar spine were requested (Id.) Dr. Parnell also

recorded that Plaintiff felt she could not work because “she can not

walk more than one block.” (Id.) In May 2007, Plaintiff had not yet

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11/ There appears to be an inconsistency regarding whether Plaintiff

obtained a regular walker or a “walker with chair”. In a medical report dated

June 19, 2007, it was noted that CMS denied a “walker with chair”. (Tr. 462.)

Later, Dr. Parnell prescribed a regular walker (Tr. 458), however at the

administrative hearing, Plaintiff stated that CMS paid for a “walker with a seat”

to assist with her mobility. (Tr. 42.)

12/ No other objective testing had been performed to determine the source

of Plaintiff’s pain.

13/ The record states, “order walker (regular) to use ‘prn’”. Prn is a

medical abbreviation for the Latin term pro re nata, meaning “as the circumstances

require or as needed”. Medline Plus Medical Dictionary (2011),

http://www.merriam-webster.com/medlineplus/prn

11cv0353 7

obtained her x-rays or physical therapy as prescribed by Dr.

Parnell. (Tr. 462.) Most of Plaintiff’s pain was in her right knee,

hip and lumbar spine. (Id.) Furthermore, Plaintiff complained that

she can not use a cane because “[it] doesn’t hold her up.” (Id.) Dr.

Parnell prescribed Plaintiff a “walker with chair”11/. (TR. 462.)

 By June 19, 2007, Plaintiff still had not obtained x-rays of

her spine and knee, however she continued to complain that she was

unable to walk or stand and that cooking was difficult due to pain12/.

(Tr. 460.) Dr. Parnell noted the “walker with chair” prescription

had been denied by CMS. (Id.) The doctor’s assessment was that

Plaintiff was overweight, suffering from chronic pain, hypertension

and right carotid stenosis.(Id.)

On September 4, 2007, despite not having x-rays, Plaintiff

once more complained of right knee pain. (Tr. 458.) When Dr. Parnell

asked Plaintiff about the status of obtaining physical therapy,

Plaintiff replied, “What’s the point - I can’t do physical therapy”.

(Id.) Dr. Parnell prescribed medication refills and gave Plaintiff

a prescription for a regular walker, however, the doctor noted the

use of the walker was to be on an “as needed”13/ basis.(Id.) 

One year later, on September 30, 2008, Plaintiff sought

treatment from Dr. Parnell for lumbar spine and mid-back pain. Once

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14/ The actual x-ray impressions are not contained in the file. This

diagnosis was recorded in a DFHC medical report (Tr. 450). However, the report

does not state at which level the degeneration had occurred or its severity.(Id.)

15/ The tronchanters are points at which hip and thigh muscles attach.

The greater tronchanter is a powerful protrusion located at the proximal (near)

and lateral (outside) part of the shaft of the femur. The greater tronchanter

gives attachment to a number of muscles including the gluteus medius and minimus,

piriformis, obturator internus and externus, and gemelli muscles. MedicineNet.com,

http://www.medterms.com/script/main/art.asp?articlekey=39717 (Last updated April

27, 2011)

16/ Dr. Sabourin performed Lasegue Testing (which tests straight leg

raising), Trendelenburg Testing (which tests the valves of the leg veins) and

Romberg Testing (which tests whether a patient becomes unsteady while standing

11cv0353 8

more, Dr. Parnell ordered x-rays for the lumbar and thoracic spine.

(Tr. 451.) On October 28, 2008, a medical report indicated that

Plaintiff obtained the x-rays, which revealed negative findings for

the thoracic spine and degenerative disc disease in the lumbar

spine14/. (Tr. 450.) 

2. ORTHOPEDIC CONSULTATION WITH THOMAS J. SABOURIN, M.D.

On March 10, 2009, Dr. Sabourin, a medical examiner for the

Department of Social Services, performed an orthopedic consultation

assessing Plaintiff’s low back, greater tronchanters15/ and bilateral

knee complaints. (Tr. 514-519.) Dr. Sabourin obtained a medical

history from Plaintiff. (Tr. 514.) Plaintiff claimed that x-rays

from previous examinations showed she had arthritis and degenerative

disc disease. (Id.) The actual x-rays were not provided for Dr.

Sabourin’s review. (Id.)

Upon examination of Plaintiff’s lumbar spine, Dr. Sabourin

noted her forward flexion was limited to 0 - 35 degrees, while

normal readings would be 0 - 90 degrees. In extension and right and

left lateral flexions, she measured just under the normal range and

she fell within normal ranges in her right and left rotations. Dr.

Sabourin found unremarkable findings for various orthopedic tests16/.

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with feet approximated, after closing their eyes). (Tr. 515.) Stedman’s Medical

Dictionary (2006), available at http://www.medilexicon.com/medicaldictionary

17/ Callosities is a marked or abnormal hardness and thickness (as of the

skin). Merriman - Webster’s Medical Dictionary (Nov. 21, 2007) available at

http://dictionary.reference.com/browse/callosities

18/ Hemoglobin is the oxygen-carrying pigment and predominate protein in

the red blood cells. MedicineNet.com (April 27, 2011, 5:27:15 PM),

http://www.medterms.com/script/main/art.asp?articlekey=15738

19/ Hematocrit is the proportion, by volume, of blood that consists of red

blood cells. MedicineNet.com (Nov. 3, 2008)

http://www.medicinenet.com/hematocrit/article.htm 

11cv0353 9

Plaintiff’s range of motion in her upper extremities were

normal and painless. (Tr. 516.) The same was found for her hips,

ankles and feet. (Tr. 517.) Dr. Sabourin found no gross instability

in Plaintiff’s knees. With regard to Plaintiff’s station and gait,

he opined that “she walked quite well without her walker with no

specific limp.” (Tr. 516.)

In fact, Dr. Sabourin could find no orthopedic reason why

Plaintiff required use of a walker. (Id.) He did observe that she

refused to walk without the walker during the examination, however,

upon further encouragement, Plaintiff walked quite well when he

substituted his hands for the walker. (Tr. 516-519.) Furthermore, Dr.

Sabourin opined that Plaintiff did “a lot of walking given the

callosities17/ and ground-in dirt on her feet.” (Tr. 518.) 

Despite the absence of x-ray results or MRI testing, Dr.

Sabourin found it likely that Plaintiff would have a non-disabling

degenerative disc disease common for her age. (Id.) However, he

found it unlikely she suffered from rheumatoid arthritis based upon

her high hemoglobin18/ and hematocrit19/ levels, and he noted she did

not take medication for such an ailment. (Id.) Finally, even though

Plaintiff claims to have suffered multiple strokes, Dr. Soubourin

found that her gait had not been altered as a result. (Id.)

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20/ A positive Tinsel sign is commonly associated with carpal tunnel

syndrome. It involves tingling in a specific anatomic distribution after slight

percussion over the median nerve. Frank L. Urbano, M.D., Tinsel’s Sign and

Phalen’s Maneuver: Physical Signs of Carpal Tunnel Syndrome; Hospital Physician

(July 2000), available at http://www.turner-white.com/pdf

21/ The Phalen’s Maneuver is a wrist flexion test. Patients with carpel

tunnel syndrome will develop numbness and tingling within one to two minutes in

the territory of the median nerve after holding wrists in forced flexion for

approximately 60 seconds. Id.

22/ “Angina is a type of chest pain caused by reduced blood flow to the

heart muscle. Angina is a symptom of coronary artery disease, [and is] typically

described as squeezing, pressure, heaviness, tightness or pain in [the] chest.”

MayoClinic.com, (June 24, 2011), http://www.mayoclinic.com/health/angina/DS00994

11cv0353 10

In Dr. Sabourin’s opinion, Plaintiff’s RFC was restricted to

lifting, carrying, pushing or pulling objects that weigh 20 pounds

occasionally and 10 pounds frequently; and standing, walking or

sitting up to six hours of an eight-hour workday.(Id.) He found that

she had no need for using a walker as a result of her orthopedic

complaints.(Id.)

3. INTERNIST CONSULTATION WITH AJIT RAISINGHANI, M.D.

On December 19, 2006, Dr. Raisinghani examined Plaintiff for

her stroke, carpal tunnel syndrome, heart attack, and mobility

complaints. (Tr. 362-63.) After taking Plaintiff’s medical history

and conducting a physical examination, he diminished or negated many

of her complaints. 

With respect to Plaintiff’s carpal tunnel syndrome complaints,

she had negative findings for the Tinel’s20/ and Phalen’s21/ tests. As

a result, Dr. Raisinghani found that Plaintiff does not have that

condition.(Tr. 366.) He also determined at the time of the examination, Plaintiff had atypical symptoms of angina22/

 with respect to her

heart complaints, and ischemic attack with no residual symptoms with

respect to her complaints of suffering from strokes. (Id.) 

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23/ The record bears no reference to Dr. Steiner’s first name.

24/ Exhibit 17 F of the administrative record is three reports from Logan

Heights Family Health Center. It appears the second report, dated February 3,

2005, is the one referenced in the testimony. This report contains the statement,

“three months ago, back pain radiating through the hips, started in left leg

moderately.” The report contains no objective evidence that substantiates those

complaints. (Tr. 44-45; 444.)

11cv0353 11

Dr. Raisinghani observed that Plaintiff moved slowly and was

slow to respond to questions. Therefore, he opined that those

symptoms may require further evaluation. (Id.) He found it unclear

whether she suffered a specific organic brain disease. (Id.) 

Dr. Raisinghani found that Plaintiff’s RFC was limited to

occasionally lifting and carrying items no more than 20 pounds, and

frequently lifting and carrying items no more than 10 pounds.

Plaintiff could stand, walk, and sit up to six hours in an eight-hour

day, and she was allowed to bend or crouch occasionally. (Tr. 366.)

B. TESTIMONY AT THE ADMINISTRATIVE HEARING

1. TESTIMONY OF MEDICAL EXPERT, DR. STEINER23/

Dr. Steiner, serving in the capacity as a medical expert,

provided sworn testimony at the December 15, 2008 administrative

hearing. Following a review of the medical file, Dr. Steiner found

that Plaintiff did not undergo any medical work-up to support a need

for a walker or wheelchair in connection with her back complaints.

(Tr. 44.) In fact, Plaintiff offered no objective testing such as CAT

scans, MRIs, or x-rays, to support her claim. (Id.) 

Though Plaintiff offered a medical report24/ prepared at DFHC

as evidence of her condition, Dr. Steiner dismissed the report for

its lack of objective evidence. (Tr. 44-45.) Dr. Steiner opined it

was “incredible, or incredulous” that a person would be confined to

a wheelchair or walker without a medical work-up or referral to an

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25/ The record bears no reference to Ms. Sinclair’s first name. 

11cv0353 12

orthopedist or neurologist. (Tr. 44.) Due to the lack of objective

medical testing, Dr. Steiner was unable to render an opinion

regarding Plaintiff’s spinal complaints at the administrative

hearing. (Tr. 49.) 

2. TESTIMONY OF VOCATIONAL REHABILITATION

SPECIALIST

Ms. Sinclair25/, a Vocational Rehabilitation Specialist,

provided testimony at the administrative hearing. She classified

Plaintiff’s previous employment as waitress, cook and nurse assistant

as semi-skilled work, and construction laborer as unskilled. (Tr. 55-

56.) 

The ALJ posed a hypothetical question to Ms. Sinclair

regarding the type of positions that were available for light work

with occasional bending and crouching with the added restriction of

alternating positions every 30 minutes. Ms. Sinclair found work as

a counter attendant, and cashier would meet that criteria. (Tr. 56.)

In a hypothetical question posed to Ms. Sinclair which

referred to a person who was restricted to sedentary work with the

ability to change positions every 30 minutes, and to avoid dust,

fumes, gases, excessive dust, toxic substances and hazards, Ms.

Sinclair found that a telephone clerk position or assembler would

meet that criteria. (Tr. 56-57.)

However Ms. Sinclair stated if an employee were required to

use a wheelchair or walker, they probably would be unable to sustain

employment in any of the positions discussed. (Tr. 57.) 

IV

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11cv0353 13

SUMMARY OF APPLICABLE LAW

 Title II of the Social Security Act, (“ACT”) as amended,

provides for the payment of insurance benefits to persons who have

contributed to the program and who suffer from a physical or mental

disability. 42 U.S.C. § 423 (a)(1)(D). Title XVI of the Act provides

for the payment of disability benefits to indigent persons under the

Supplemental Security Income (SSI) program. § 1382 (a). Both titles

of the Act define “disability” as the “inability to engage in any

substantial gainful activity by reason of any medically determinable

physical or mental impairment which can be expected to last for a 

continuous period of not less than 12 months...” Id. The Act further

provides that an individual:

shall be determined to be under a disability only if

his physical or mental impairment or impairments are

of such severity that he is not only unable to do his

previous work but cannot, considering his age, education, and work experience, engage in any other kind of

substantial gainful work which exists in the national

economy, regardless of whether such work exists in the

immediate area in which he lives, or whether a specific job vacancy exists for him, or whether he would

be hired if he applied for work. Id.

The Secretary of the Social Security Administration has

established a five-step sequential evaluation process for determining

whether a person is disabled. 20 C.F.R. §§ 404.1520, 416.920. Step

one determines whether the claimant is engaged in “substantial

gainful activity.” If he is, disability benefits are denied. 20 C.F.

R. §§ 404.1520(b), 416.920(b). If he is not, the decision maker

proceeds to step two, which determines whether the claimant has a

medically severe impairment or combination of impairments. That

determination is governed by the “severity regulation” at issue in

this case. The severity regulation provides in relevant part:

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11cv0353 14

If you do not have any impairment or combination of

impairments which significantly limits your physical

or mental ability to do basic work activities, we will

find that you do not have a severe impairment and are,

therefore, not disabled. We will not consider your

age, education, and work experience. §§ 404.1520(c),

416.920(c). 

The ability to do basic work activities is defined as “the

abilities and aptitudes necessary to do most jobs.” 20 C.F.R. §§

404.1521(b), 416.921(b). Such abilities and aptitudes include

“[p]hysical functions such as walking, standing, sitting, lifting,

pushing, pulling, reaching, carrying, or handling;” “[c]apacities for

seeing, hearing, and speaking;” “[u]nderstanding, carrying out, and

remembering simple instructions;” [u]se of judgment;” “[r]esponding

appropriately to supervision, co-workers, and usual work situations;”

and “[d]ealing with changes in a routine work setting.” Id. 

If the claimant does not have a severe impairment or combination of impairments, the disability claim is denied. 

If the impairment is severe, the evaluation proceeds to the

third step, which determines whether the impairment is equivalent to

one of a number of listed impairments that the Secretary acknowledges

are so severe as to preclude substantial gainful activity. 20 C.F.R.

§§ 404.1520(d), 416.920(d). If the impairment meets or equals one of

the listed impairments, the claimant is conclusively presumed to be

disabled. If the impairment is not one that is conclusively presumed

to be disabling, the evaluation proceeds to the fourth step, which

determines whether the impairment prevents the claimant from

performing work he has performed in the past. If the claimant is

able to perform his previous work, he is not disabled. 20 C.F.R. §§

404.1520(e), 416.920(e). If the claimant cannot perform his previous

work, the fifth and final step of the process determines whether he

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is able to perform other work in the national economy in view of his

age, education, and work experience. The claimant is entitled to

disability benefits only if he is not able to perform other work. 20

C.F.R. §§ 404.1520(f), 416.920(f). 

As a general rule, more weight should be given to the opinion

of a treating source than to the opinion of doctors who do not treat

the claimant. Benton v. Barnhart, 331 F.3d 1030, 1036 (9th Cir.

2003)[citing Lester v. Chater, 81 F.3d 821, 831 (9th Cir. 1995)]. If

the treating doctor’s opinion is contradicted by another doctor, the

ALJ may not reject this opinion without providing “specific and

legitimate reasons” supported by substantial evidence in the record

for doing so. Id. The ALJ must give consideration to the physicians’

examining and treatment relationships; what support, including

objective testing, relied upon; consistency of the opinions;

physicians’ specializations; and any other factors used to arriving

at the opinions. 20 C.F.R. § 404.1527(d). If an ALJ fails to

consider each 20 C.F.R. § 404.1527(d) factor before giving no weight

to the opinions of a [plaintiff]’s treating specialist, then a

federal court may remand the case; the ALJ should conduct the

analysis on remand. Id.

V

ALJ’S FINDINGS

The ALJ made the following pertinent findings: 

1. [Plaintiff] meets the insured status requirements of

the Social Security Act through June 30, 2005. 

2. [Plaintiff] has not engaged in substantial gainful

activity since December 31, 2003, the alleged onset date

(20 CFR 404.1571 et seq., and 416.971 et seq.).

3. [Plaintiff] has the following severe impairments:

degenerative disc disease, status post transient ischemic

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attack, mild coronary artery disease, and chronic

obstructive pulmonary disease (20 CFR 404.1520(c)) and

416.920(c)).

[Plaintiff] underwent diagnostic cardiac catheterization

in December 2001 after she experienced new onset episodes

of chest pain (Exhibit 1F/50-93). The cardiac

catherterization revealed 30% lesion in the LAD, normal

right coronary and circumflex arteries, and normal left

ventricular function. [Plaintiff] was diagnosed with mild

coronary artery disease and was advised about the need to

quit smoking..., exercise, and follow a low fat diet.

On July 7, 2004, [Plaintiff] was seen at Scripps Mercy

Hospital because of chest pain (Exhibit 24F/21-36). She

was held in the chest pain center overnight for observation. EKG revealed normal sinus rhythm and no ST elevations suggestive of ischemia, her troponins were negative, and her other labs were within normal limits. She

was diagnosed with atypical chest pain and discharged the

following day with instructions to continue on her

current medications and follow up with her outside

physician. 

***

On December 19, 2006, [Plaintiff] saw Ajit Raisinghani,

M.D., for a consultative internal medicine evaluation

(Exhibit 4F.) [Plaintiff] reported having a history of

two strokes resulting in difficulty with memory, carpal

tunnel syndrome, a history of a heart attack, and

difficult walking more than one-half block. On exam,

[Plaintiff] did not appear to have any residuals. Her

mental status, at least by a basic examination, appeared

somewhat diminished in further evaluation. [Plaintiff]

did not meet the criteria for carpal tunnel syndrome, and

she had a negative Tinel’s and Phalen’s. Her chest pain

was atypical for angina and Dr. Raisinghani noted the

December 2001 catheterization was negative. With regard

to [Plaintiff]’s difficulty walking, she did move slowly

in the office, but it was unclear whether there was any

specific organic brain disease - [Plaintiff]’s exam did

not reveal a physical reason for the slow movements. Dr.

Raisinghani opined [Plaintiff] could perform light work,

i.e., lift/carry 20 pounds occasionally and lift/carry

less than 10 pounds frequently and stand and/or walk and

sit for up to six hours each in an eight-hour day. 

On January 31, 2007, [Plaintiff] saw Frantz Derenoncourt,

M.D., for evaluation of carotid artery disease (Exhibit

7F). [Plaintiff] reported having no recurrent symptoms

related to her transient ischemic attack and no history

of weakness in the upper or lower extremities. She was

continuing to smoke one pack a day. She appeared in a

wheelchair “apparently because of arthritis or COPD”

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(Exhibit 7F/3). She was scheduled carotid MRA to be

followed with an endarterectomy if indicated. 

On February 1, 2007, [Plaintiff] saw Dan Whitehead,

Ph.D., for a consultative psychological examination

(Exhibit 8F). Dr. Whitehead took a history, performed a

mental status exam and conducted neuropsychological

testing. [Plaintiff] took public transportation to the

evaluation and there was no mention of [Plaintiff]

arriving in a wheelchair or with a walker. [Plaintiff]’s

mental state exam was within normal limits, and she

seemed to perform to good ability on all testing. Her

WAIS-3 Full Scale IQ score was in the low average range,

her Verbal IQ score was low average range, her performance IQ was in the low average range, her Bender Gestalt

II results were in the average range, and her WMS-3

Working Memory Index score indicated that her ability to

use concentration, attentional abilities and memory

processes was in the low average range. Dr. Whitehead

found no objective signs of serious cognitive impairment

and opined [Plaintiff]’s prognosis was good and that she

was fully capable of performing full range of simple and

repetitive tasks. Dr. Whitehead noted that if cognitive

impairments were present around the time of her reported

onset of problems, they seemed to have improved, at least

when considering objective measures. 

 

[Plaintiff] has been seen at Downtown Family Health

Center since September 2006 for follow up care with

regard to hypertension, coronary artery disease status

post stroke in 2004, chronic obstructive pulmonary

disease, generalized pain, medication refills and

referrals (Exhibits 3F, 12F, and 22F). On September 4,

2007, there is a note to order a regular walker for use

on an as needed basis, but no medical reason for the

walker was provided (Exhibit 22F/9). 

[Plaintiff] also has a history of drug abuse (methamphetamine and crack cocaine). In July 2004, she reported

being drug free for 15 years (Exhibit 24F/21). Then on

January 12, 2005, she reported being clean for 25 days

(Exhibit 17F/3). In January 2007, she told Dr.

Deroncourt she had been clean for two years (Exhibit

7F/4). She also told Dr. Whitehead in February 2007 that

she had been clean for two years (Exhibit 8F/2). 

At the close of the hearing, the undersigned asked

[Plaintiff]’ representative if there were any outstanding

treatment records. Mr. Butt stated there were none

outstanding, and he requested that the claimant be

scheduled for a consultative orthopedic examination. The

undersigned agreed with this request in order to better

assess the claimant’s alleged orthopedic impairments. 

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Following the hearing, [Plaintiff] saw Thomas Sabourin,

M.D., on March 10, 2009 for an orthopedic consultative

examination (Exhibit 25F). [Plaintiff]’s primary complaint was that of low back pain since high school. Dr.

Sabourin found no objective evidence of carpal tunnel

syndrome or rheumatoid arthritis. Despite her complaints

of having a stroke, she had no long track signs and her

gait was relatively normal, although she used a walker

and refused to try and walk without assistance. Dr.

Sabourin noted that [Plaintiff] obviously does a lot of

walking given the callosities and ground-in dirt on her

feet. Dr. Sabourin opined that [Plaintiff] could perform

light work. He also found no reason why [Plaintiff]

needs a walker to walk since her strength, sensation and

general neurological condition was not helpful in

determining why she would need a walker. 

4. [Plaintiff] does not have an impairment or combination

of impairments that meets or medically equals one of the

listed impairments in 20 CFR Part 404, Subpart P,

Appendix 1 (20 CFR 404.1525, 404.1526, 416.925 an

416.926). 

No physician has opined that [Plaintiff]’s condition

meets or equals any listing, and the state agency program

physicians opined that it does not. At the hearing Dr.

Steiner testified that [Plaintiff]’s impairments, singly

or in combination, do not meet or equal any listed

impairment. 

5. After careful consideration of the entire record, the

undersigned finds that [Plaintiff] has the residual

functional capacity to perform light work as defined in

20 CFR 404.1567(b) and 416.967(b) except for: occasional

bending and crouching; ability to alternate positions as

often as every 30 minutes; and asthma precautions, i.e.,

avoid exposure to dust, fumes, gases, toxics and hazards.

In making this finding, the undersigned has considered

all symptoms and the extent to which these symptoms can

reasonably be accepted as consistent with the objective

medical evidence and other evidence, based on the

requirements of 20 CFR 404.1529 and 416.929 and SSRs 96-

4p and 96-7p. The undersigned has also considered opinion

evidence in accordance with the requirements of 20 CFR

404.1527 and 416.927 and SSRs 96-2p, 95-5p, 96-6p and 06-

3p. 

In considering [Plaintiff]’s symptoms, the undersigned

must follow a two-step process in which it must first be

determined whether there is an underlying medically

determinable physical or mental impairment(s)–i.e., an

impairment(s) that can be shown by medically acceptable

clinical and laboratory diagnostic techniques–that could

reasonably be expected to produce [Plaintiff]’s pain or

other symptoms. 

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Second, once an underlying physical or mental impairment(s) that could be expected to produce [Plaintiff]’s

pain or other symptoms has been shown, the undersigned

must evaluate the intensity, persistence, and limiting

effects of [Plaintiff]’s symptoms to determine the extent

to which they limit [Plaintiff]’s ability to do basic

work activities. For this purpose, whenever statements

about the intensity, persistence, or functionally

limiting effects of pain or other symptoms are not

substantiated by objective medical evidence, the undersigned must make a finding on the credibility of the

statements based on a consideration of the entire case

record. 

[Plaintiff] reports she cannot work due to a stroke,

heart attack, breathing problems, arthritis and carpal

tunnel syndrome (Exhibit 1E). As a result, her activities of daily living are very limited and she has

difficulty lifting, squatting, bending, standing,

walking, sitting, and kneeling because these activities

hurt her back and knees (Exhibit 5E). She also has

trouble breathing and spends most of the day lying down

to relieve her pain and headaches (Exhibits 9E). 

At the hearing, [Plaintiff] indicated one of the primary

reasons she cannot work is because of back pain, degenerative disc disease and arthritis. She testified she could

not even perform the job of handing out tickets at a

movie theater because of pain in her lower back, arthritis and hip pain. She testified further that performing

simple tasks take her a long time. For example, when she

tried to bake cookies it takes her two hours, and she

starts and stops a lot due to the need to sit down. 

After careful consideration of the evidence, the undersigned finds that [Plaintiff]’s medically determinable

impairments could reasonably be expected to cause the

alleged symptoms; however, the claimant’s statements

concerning the intensity, persistence and limiting

effects of these symptoms are not credible to the extent

they are inconsistent with the above residual functional

capacity assessment. 

With regard [to Plaintiff]’s alleged back pain and other

arthritic complaints, Dr. Steiner testified at the

hearing that there are no work ups for this pain, and

there are no x-rays, MRIs or other diagnostic tests to

show or confirm a back and/or arthritic problem. [Plaintiff]’s representative referred to Exhibit 17F in support

of the proposition that [Plaintiff] has undergone a

diagnostic work up, but Dr. Steiner pointed out this was

not a diagnostic work up; rather it is simply a statement

or account of the claimant’s complaints. In fact, if one

looks at Exhibit 17F, there is a treatment note dated

February 3, 2005, wherein the claimant reports a three

month history of back pain with no history of trauma or

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injury (Exhibit 17F/2). She was given an extremely

cursory physical exam and was then diagnosed as having

only back strain. Dr. Steiner also noted [Plaintiff] has

not even been referred to, or treated by, an orthopedist

or neurologist. Dr. Steiner testified further that the

[Plaintiff] may well have limitations from her back pain,

but there are certainly no records to document that the

[Plaintiff] is disabled and cannot perform any work due

to a back and/or arthritic problem. 

At the hearing, [Plaintiff] testified she has used a

walker or electric wheelchair since 2006. She testified

further that she got a prescription for a wheelchair but

CMS would not pay for it. So then she got a prescription

for a walker from Dr. Parnell and CMS did pay for this

about a year prior to the hearing. Likewise, [Plaintiff]’s friend states in a 3rd party function report that

[Plaintiff] uses a wheelchair (Exhibit 4E). In a prescription pad note dated October 13, 2006, Facika Tafara,

M.D., at Downtown Family Health Center wrote that

[Plaintiff] needed a motorized wheelchair due to “multiple health conditions” (Exhibit 2F). At the hearing, Dr.

Steiner testified it was simply unbelievable and incredulous that [Plaintiff] was prescribed the use of a

wheelchair without any diagnostic tests being performed

or being seen by an orthopedist or neurologist for

further evaluation, let alone having had a diagnostic

work up for the alleged back pain to assess the cause and

severity of the back pain. In fact, Dr. Steiner opined it

would be malpractice for someone of [Plaintiff]’s age to

be confined to a wheelchair without a proper diagnostic

work up and evaluation to substantiate the use of the

wheelchair. 

The undersigned agrees with Dr. Steiner’s opinion and so

finds, especially in light of the complete lack of

diagnostic work up of [Plaintiff]’s back pain. In fact,

a thorough orthopedic evaluation was performed at the

request of [Plaintiff]’s representative following the

hearing. Dr. Sabourin, who performed this exam, could

find no basis for the need for a walker, let along (sic)

a wheelchair, from an orthopedic viewpoint. In fact, this

orthopedic evaluation showed no neurological deficits and

only minimal findings on physical exam. [Plaintiff] told

Dr. Sabourin she has had x-rays showing degenerative disc

disease. As pointed out by Dr. Sabourin, given [Plaintiff]’s age, she would be expected to have a certain

amount of degenerative disc disease, but age-related

degenerative disc disease alone is not disabling. 

[Plaintiff} alleges she cannot walk more than 1/2 block

without collapsing in pain. However, Dr. Sabourin also

opined it was obvious [Plaintiff] does a lot of walking

given the callosities and ground-in dirt on her feet

(Exhibit 25F/7). 

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** **

[Plaintiff] does have chronic obstructive pulmonary

disease. Unfortunately, this is due to her many years of

heavy smoking. She has been smoking one or two packs a

day for over 35 years and has not quit despite medical

recommendations to do so. Nonetheless, she has not

undergone work up for this, there are no pulmonary tests

to document the severity of it, and she appears to have

required minimal treatment for this impairment other than

medication. 

As for the opinion evidence, the undersigned gives

moderate weight to the opinion of Dr. Steiner, who

testified based on the records available at the hearing,

[Plaintiff] could perform light work with the usual

asthma precautions on account of her chronic obstructive

pulmonary disease. The undersigned gives great weight to

the opinions of the State Agency physicians, Dr.

Raisinghani, and Dr. Sabourin, who all concluded [Plaintiff] could perform light work. However, in light of the

claimant’s subjective complaints, the undersigned finds

that she must be allowed to alternate positions up to

every 30 minutes. 

Finally, the undersigned has considered the following

submissions: 1) a prescription pad noted(sic)dated

February 18, 2005 wherein Tanya Kapka, M.D., at Logan

Heights Family Health Center, states [Plaintiff] is

“disabled because of cardiovascular disease” (Exhibit

21F); 2) a prescription pad note dated September 21,

2006, wherein Stacey Burgin, F.N.P., at Downtown Family

Health Center, states [Plaintiff] has “disability based

on COPD, CAD, and arthritis” (Exhibit 19F); and 3) a form

completed by Stacy Burgin, FNP, on September 21, 2006

wherein it is reported [Plaintiff] is unemployable until

March 1, 2007, for the purposes of receiving county

services (Exhibit 18F). 

According to the evidence of record, Dr. Tran saw

[Plaintiff] only once in February 2005 (Exhibit 17F). In

any event, reports from physicians, including cardiologists, clearly document [Plaintiff] does not have a

disabling cadiovascular disease (Exhibits 1F, 2F, 4F,

23F, and 24F). With regard to exhibits 19F and 21F, these

are entitled to less weight since they were completed by

a nurse practioner and not a physician. With regard to

the form for county services, it states only that

[Plaintiff] is unable to work for a period of 5 or 6

months and not on a long term basis. In addition, her

opinions are not supported by objective medical evidence.

In fact, Nurse Burgin’s opinions are clearly contradicted

by the opinions of physicians who performed thorough

physical evaluations both from cardiac and orthopedic

perspectives. Accordingly, the undersigned cannot give

significant weight to these statements since they are

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brief, conclusory, and inadequately supported by clinical

findings (20 CFR 404.1527(d)(2)and 416.927(d)(2)). 

In sum, the above residual functional capacity assessment

is supported by the State Agency physician assessments

and the opinions of Dr. Raisinghani, Dr. Sabourin, and

Dr. Steiner, who all concluded [Plaintiff] could perform

a broad range of light work. 

6. [Plaintiff] is unable to perform any past relevant

work (20 CFR 404.1565 and 416.965). 

[Plaintiff] had past relevant work as a waitress,

construction laborer, cook, and nurse assistant. At the

hearing, the vocational expert testified these jobs are

classified as follows: waitress, semi-skilled work at the

light exertional level (DOT#311.477-030); construction

laborer, unskilled at the very heavy exertional level

(DOT#869.687-026); cook, semi-skilled at the light

exertional level (DOT#313.374-014); and nurse assistant,

semi-skilled at the medium exertional level (DOT#355.674-

014). Hypothetically assuming [Plaintiff]’s residual

functional capacity as found above, the vocational expert

opined that [Plaintiff] would not be able to perform any

of her past work. The undersigned accepts the testimony

of the vocational expert and so finds. Accordingly,

[Plaintiff] was unable to perform past relevant work. 

********

10. Considering [Plaintiff]’s age, education, work

experience, and residual functional capacity, there are

jobs that exist in significant numbers in the national

economy that the [Plaintiff] can perform (20 CFR

404.1569, 404.1569a, 416.969, and 416.969a). 

In determining whether a successful adjustment to other

work can be made, the undersigned must consider [Plaintiff]’s residual functional capacity, age, education, and

work experience in conjunction with the Medical-Vocational Guidelines, 20 CFR Part 404, Subpart P, Appendix

2. If [Plaintiff] can perform all or substantially all

of the exertional demands at a given level of exertion,

the medical-vocational rules direct a conclusion of

either “disabled” or “not disabled” depending upon

[Plaintiff]’s specific vocational profile (SSR 83-11).

When [Plaintiff] cannot perform substantially all of the

exertional demands of work at a given level of exertion

and/or has nonexertional limitations (SSRs 83-12 and 83-

14). If [Plaintiff] has solely nonexertional limitations, section 204.00 in the Medical-Vocational Guidelines provides a framework for decisionmaking (sic) (SSR

85-15). 

If [Plaintiff] had the residual functional capacity to

perform the full range of light work, a finding of “not

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11cv0353 23

disabled” would be directed by Medical-Vocational Rule

202.21 and Rule 202.14. However, [Plaintiff]’s ability

to perform all or substantially all of the requirements

of this level of work has been impeded by additional

limitations. To determine the extent of which these

limitations erode the unskilled light occupational base,

the Administrative Law Judge asked the vocational expert

whether jobs exist in the national economy for an

individual with the [Plaintiff]’s age, education, work

experience, and residual functional capacity. The

vocational expert testified that given all of these

factors the individual would be able to perform the

requirements of representative occupations such as:

counter attendant (DOT#311.477-014)with 1,800 jobs

regionally and 85,000 jobs nationally; cashier

(DOT#211.462.010)with 8,600 jobs regionally and 981,000

jobs nationally; telephone clerk (DOT#237.367-046) with

1,100 jobs regionally and 96,000 jobs nationally; and

assembler (DOT#700.687-026) with 800 jobs regionally and

100,000 jobs nationally. 

Pursuant to SSR 00-4p, the vocational expert’s testimony

is consistent with the information contained in the

Dictionary of Occupational Titles. 

Based on the testimony of the vocational expert, the

undersigned concludes that, considering the [Plaintiff]’s

age, education, work experience, and residual functional

capacity, the [Plaintiff] is capable of making a successful adjustment to other work that exists in significant

numbers in the national economy. A finding of “not

disabled” is therefore appropriate under the framework of

the above-cited rules. 

11. [Plaintiff] has not been under a disability, as

defined in the Social Security Act, from December 31,

2003 through the date last insured on June 30, 2005 and

the date of this decision (20 CFR 404.1520(g) and

416.920(g)). 

DECISION

Based on the application for a period of disability and

disability insurance benefits filed on September 14,

2006, [Plaintiff] is not disabled under sections 216(i)

and 223(d) of the Social Security Act. 

Based on the application for supplemental security income

filed on September 14, 2006, [Plaintiff] is not disabled

under section 1614(a)(3)(A) of the Social Security Act.

VI

STANDARD OF REVIEW

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A [D]istrict [C]ourt may only disturb the Commissioner's

final decision "if it is based on legal error or if the fact

findings are not supported by substantial evidence." Sprague v.

Bowen, 812 F.2d 1226, 1229 (9th Cir. 1987); see Villa v. Heckler,

797 F.2d 794, 796 (9th Cir. 1986). The [C]ourt cannot affirm the

Commissioner's final decision simply by isolating a certain amount

of supporting evidence. Rather, the [C]ourt must examine the

administrative record as a whole. Gonzalez v. Sullivan, 914 F.2d

1197, 1200 (9th Cir. 1990). Yet, the Commissioner's findings are not

subject to reversal because substantial evidence exists in the

record to support a different conclusion. See, e.g., Mullen v.

Brown, 800 F.2d 535, 545 (6th Cir. 1986). "Substantial evidence,

considering the entire record, is relevant evidence which a

reasonable person might accept as adequate to support a conclusion."

Matthews v. Shalala, 10 F.3d 678, 679 (9th Cir. 1993); see Thompson

v. Schweiker, 665 F.2d 936, 939 (9th Cir. 1982). The Commissioner's

decision must be set aside, even if supported by substantial

evidence, if improper legal standards were applied in reaching that

decision. See, e.g., Benitez v. Califano, 573 F.2d 653, 655 (9th

Cir. 1978).

VII

 DISCUSSION 

A. THE ALJ PROPERLY APPLIED THE CORRECT STANDARD TO THE

MEDICAL OPINIONS IN THE ADMINISTRATIVE RECORD WHEN SHE

DETERMINED THAT PLAINTIFF WAS NOT DISABLED

Plaintiff contends she was denied Social Security disability

benefits because the ALJ erred in ignoring the medical opinion of

her treating physician, Dr. Parnell, who prescribed Plaintiff a

walker. Plaintiff states the ALJ’s determination that she can

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11cv0353 25

perform light work except for: occasional bending and crouching;

ability to alternate position as often as every 30 minutes; and

asthma precautions, (Tr. 71) was in error because she is required to

utilize a walker which greatly diminishes her abilities to perform

basic work functions. Therefore, the Commissioner’s decision should

be reversed or in the alternative remanded to the administrative

level for appropriate reconsideration. (Complaint, Doc. No. 16,

p.8.) 

Defendant contends that there was no legal error when the ALJ

did not weigh Dr. Parnell’s reports because they are not medical

opinions in accordance with 20 C.F.R. § 404.1527 (a)(2), and there

is substantial evidence, taking the entire record into consideration, to support the ALJ’s RFC assessment. 

There are two issues before this Court: first, whether the

ALJ should have considered Dr. Parnell’s medical reports as medical

opinions in accordance with 20 C.F.R. 404.1527, and second, whether

there was substantial evidence supporting the ALJ’s decision to

disregard Plaintiff’s walker when considering her RFC. 

1. DR. PARNELL’S REPORTS ARE NOT MEDICAL OPINIONS

PURSUANT TO 20 C.F.R. § 404.1527; THE ALJ PROPERLY WEIGHED

THE MEDICAL OPINIONS CONTAINED IN THE ADMINISTRATIVE RECORD

“Medical opinions are statements from physicians or psychologists or other acceptable medical sources that reflect judgments

about the nature and severity of [any] impairment(s), including ...

symptoms, diagnosis and prognosis, what [one] can still do despite

the impairment(s), and [any] physical or mental restrictions.” 20

C.F.R. Section 404.1527 (a)(2). 

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26/ Plaintiff represented to Nurse Burgin, and Dr. Parnell that she had

arthritis. (Tr. 419; 446.) Neither conducted independent objective testing to

verify this diagnosis. Also, Plaintiff told Dr. Sabourin, she had arthritis

verified by previous x-rays. However there are no x-ray results in the

administrative record and no mention of any x-ray taken while Plaintiff was

seeking care at DFHC, or anytime prior, that diagnosed Plaintiff with arthritis.

(Tr. 514.) 

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Here, Dr. Parnell’s reports are not medical opinions pursuant

to 20 CFR § 404.1527(a)(2). In order for these reports to constitute

medical opinions for the purposes of the Social Security Act, the

doctor’s assessments must be supported by objective evidence,

provide an independent opinion of the Plaintiff’s functional

limitations, and measure the severity of Plaintiff’s impairments.

(Id.) While these reports record Plaintiff’s symptoms and selfassessments26/, they do not contain the doctor’s independent

diagnosis, prognosis, or determine the severity of Plaintiff’s

impairments. The impressions recorded in Dr. Parnell’s reports,

regarding Plaintiff’s limitations, such as Plaintiff “can not walk

more than one block”, or that she has “trouble cooking” (Tr. 459-

460), are simply Plaintiff’s subjective complaints regarding her own

limitations. In one report, Dr. Parnell recorded that Plaintiff

“believes she can not work because of her mobility issues.” (Tr.

417.) However, these complaints are not, supported by “acceptable

clinical and laboratory diagnostic techniques.” 20 C.F.R. §

404.1527(a). 

Even though Dr. Parnell’s reports are not medical opinions,

the ALJ appropriately applied the specific and legitimate standard

to the reporting of Dr. Parnell and to the actual treating physicians’ opinions contained in the record. 

“Although a treating physician’s opinion is generally

afforded the greatest weight in disability cases, it is not binding

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on an ALJ with respect to the existence of an impairment or the

ultimate determination of disability.” McLeod v. Astrue, 640 F.3d

881, 884 (9th Cir. 2011), quoting Mayes v. Massanari, 276 F.3d 453,

459-460 (9th Cir. 2001); see also Lester v. Chater, 81 F.3d at 830.

Furthermore, “[t]he ALJ may disregard the treating physician’s

opinion whether or not that opinion is contradicted.” Magallanes v.

Bowen, 881 F.2d 747, 751 (9th Cir. 1989). However, when the treating

doctor’s opinion is contradicted by another physician, including an

examining physician or a non-examining physician, the Commissioner

must provide ‘specific and legitimate reasons’ in the record for

rejecting a treating physician’s opinion, supported by substantial

evidence. Lester, 81 F.3d at 830. 

Specific and legitimate reasons are established when the ALJ

“[sets] out a detailed and thorough summary of the facts and

conflicting clinical evidence, stating his interpretation thereof,

and making findings.” Magallanes, 881 F.2d at 751. The ALJ must not

only offer his conclusions, but he also must “set forth his own

interpretations and explain why they, rather than the doctors’, are

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

Embrey v. Bowen, 849 F.2d 418, 421-422 (9th Cir. 1988); See Hutchens

v. Astrue, 2009 WL 1762570 at *2 (9th Cir. 2011)(the ALJ’s observation that the opinions of the treating doctors were inconsistent

with claimant’s daily activities was a ‘specific and legitimate’

reason for giving them little weight. See McCoy v. Astrue, 405

Fed.Appx. 222 at *1 (9th Cir. 2010) (“[t]he ALJ’s statements

regarding the medical evidence as it related to the conflicting

medical opinions provided a specific and legitimate explanation for

rejecting the treating physician’s conclusions.”). The ALJ may

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28 27/ The Social Security Act requires a person to be disabled for at least

12 months to qualify for benefits. 20 C.F.R. § § 423(d)(1)(A); 1382c(a)(3)(A)

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discount a treating physician’s opinion if it is presented in the

form of a check list and does not have supportive objective

evidence, and is contradicted by other statements and assessments of

claimant’s medical condition. Batson v. Comm. of Social Security,

359 F.3d 1190, 1195 (9th Cir. 2004)

The ALJ recognized that Dr. Parnell prescribed the walker

(Tr. 72), then quickly noted that the walker prescription was

questioned by medical examiner Dr. Steiner. (Id.) As discussed

above, Dr. Parnell’s reporting does not constitute a medical

opinion, that would require weighing against the other medical

examiners’ opinions. However, the ALJ’s comparison of the evidence

in the record against the medical examiners’ opinions is a specific

and legitimate explanation. Therefore the ALJ applied the appropriate standard when considering Dr. Parnell’s reports. 

To the extent that any of the DFHC reports may be considered

medical opinions, the ALJ properly considered and applied little

weight to the opinions of Dr. Tafara and Nurse Burgin. Both of these

providers offered their impressions that Plaintiff was disabled as

a result of her multiple diagnosis. However, neither of these

providers offered assessments supported by objective evidence. With

respect to Nurse Burgin’s September 21, 2006 report that found

Plaintiff to be unemployable through March 1, 2007, the ALJ noted

that finding disability over a span of a few months is not sufficient to find a person disabled in accordance with the Social

Security Act27/. The ALJ also considered that Nurse Burgin is a nurse

practioner, while those contradicting her opinions were physicians

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and specialists in their areas of expertise. These are all “specific

and legitimate” reasons to give little weight to Nurse Burgin’s

opinions in favor of the opinions of Dr. Raisinghani and Dr.

Sabourin, who both performed thorough examinations of Plaintiff and

supported their opinions with objective evidence. Furthermore,

rather than merely state Plaintiff has a disability, both medical

examiners identified Plaintiff’s RFC as a result of her impairments,

and both rejected the notion that Plaintiff required the use of a

walker because of her conditions. 

As a result, the ALJ properly gave specific and legitimate

reasons as to why she assigned little weight to the opinions of Dr.

Tafara and Nurse Burgin and greater weight to the opinions of Dr.

Raisinghani and Dr. Sabourin. Furthermore, the ALJ acknowledged

that Dr. Parnell prescribed a walker and then quickly dismissed the

necessity for that prescription in light of Dr. Steiner’s testimony.

Therefore, the Court is satisfied that the ALJ committed no legal

error, as the specific and legitimate standard was appropriately

applied. 

2. THERE IS SUFFICIENT EVIDENCE THAT THE WALKER IS NOT

 A NECESSARY TREATMENT MODALITY

The Court must consider whether the record contains sufficient evidence to support the ALJ’s findings. Substantial evidence

is “evidence as a reasonable mind might accept as adequate to

support a conclusion”. Richardson v. Perales, 402 U.S. 389, 401

(1971). 

With respect to Plaintiff’s use of the walker, the Court

rejects Plaintiff’s contention that she is required to use the

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28/

Plaintiff contends the Code of Federal Regulation mandates that she must

follow prescribed treatment of her physician. The regulation states: In order to

get benefits, [Plaintiff] must follow treatment prescribed by [her] physician if

this treatment restores [her] ability to work. 20 C.F.R. §§ 404.1530. Likewise,

20 C.F.R § 416.930 also states Plaintiff must follow the prescribed treatment, “if

this treatment can restore [her] ability to work...”

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walker as prescribed by Dr. Parnell. There is sufficient evidence to

support that the actual prescription for the walker was based upon

the subjective complaints of Plaintiff, not Dr. Parnell’s objective

assessment. For instance, Plaintiff began to request a walker

because of pain in February 2007. Despite numerous requests by Dr.

Parnell for Plaintiff to obtain x-rays and physical therapy,

Plaintiff failed to obtain x-rays or physical therapy. Finally, four

months later, Dr. Parnell acquiesced to Plaintiff’s requests for a

walker prescription, however, she did so on an “as needed” basis.

(Tr. 458.) Therefore, the actual use of the walker was at Plaintiff’s discretion, not mandated by her physician. This notion

negates Plaintiff’s contention that she must comply with the

treatment choice of her physician in compliance with the Social

Security Act28/

,in order to qualify for benefits.

On the contrary, even if Dr. Parnell mandated Plaintiff to

utilize the walker at all times (which she did not) (Tr. 38), noncompliance with this order would not bar Plaintiff from receiving

Social Security benefits because the walker would not restore

Plaintiff’s ability to work. Furthermore, Plaintiff has a history

of failing to comply with Dr. Parnell’s treatment recommendations.

On two prior occasions, Plaintiff ignored Dr. Parnell’s recommendations when she failed to obtain physical therapy to address her back

pain complaints and when she waited nearly two years, to obtain xrays of her thoracic and lumbar spine. (Tr.450-451.) 

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The ALJ also took into consideration, inter alia, Plaintiff’s

testimony with respect to her symptoms, which she found not to be

credible to the extent that they are inconsistent with Dr. Sabourin

and Dr. Rasinghani’s RFC assessments. (Tr. 72.) Given that Dr.

Parnell relied on Plaintiff’s account of her symptoms as the

determinative factor for prescribing the walker, the medical

evidence the ALJ relied upon to dismiss the Plaintiff’s credibility

is also substantial and reasonable in supporting the ALJ’s decision

to dismiss Plaintiff’s need for the walker. 

The ALJ properly took into consideration the entire record,

including the examination by Dr. Sabourin, which was conducted

following the hearing, at Plaintiff’s request. (Tr. 417; 458; 460.)

Dr. Sabourin conducted a physical examination, orthopedic and

neurological testing, and found the Plaintiff did not need the

walker to ambulate. (Tr. 516-519.) He noted she was able to balance

and walk quite well without it. (Tr. 516-519.) He further observed

that Plaintiff had ground-in dirt and callouses on the soles of her

feet, indicating she did a considerable amount of walking. (Id.)

Therefore, the Court is satisfied that the administrative

record contains substantial evidence to support the final decision

of the ALJ finding that the Plaintiff’s RFC is limited to light work

except for occasional bending and crouching; ability to alternate

position as often as every 30 minutes; and asthma precautions. (Tr.

71.) 

VIII 

CONCLUSIONS AND RECOMMENDATION

After a review of the record in this matter, the undersigned

Magistrate Judge RECOMMENDS that the Plaintiff’s Motion for Summary

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Judgment be DENIED and Defendant’s Cross Motion for Summary Judgment

be GRANTED.

This Report and Recommendation of the undersigned Magistrate

Judge is submitted to the United States District Judge assigned to

this case, pursuant to the provision of 28 U.S.C. § 636(b)(1).3.

IT IS ORDERED that no later than December 30, 2011, any party

to this action may file written objections with the Court and serve

a copy on all parties. The document should be captioned “Objections

to Report and Recommendation.”

IT IS FURTHER ORDERED that any reply to the objections shall

be filed with the court and served on all parties no later than

January 13, 2012. The parties are advised that failure to file

objections within the specified time may waive the right to raise 

those objections on appeal of the Court’s order. Martinez v. Ylst,

951 F.2d 1153 (9th Cir. 1991).

DATED: December 2, 2011

 Hon. William V. Gallo

 U.S. Magistrate Judge

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