Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_15-cv-00339/USCOURTS-azd-2_15-cv-00339-0/pdf.json

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

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WO 

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Kristel S. Defrees, 

Plaintiff, 

v. 

Carolyn W. Colvin, 

Defendant.

No. CV-15-00339-PHX-DGC

ORDER 

 Plaintiff Kristel S. Defrees seeks review under 42 U.S.C. § 405(g) of the final 

decision of the Commissioner of Social Security which denied her disability insurance 

benefits and supplemental security income under sections 216(i), 223(d), and 

1614(a)(3)(A) of the Social Security Act. Because the decision of the Administrative 

Law Judge (“ALJ”) is supported by substantial evidence and is not based on legal error, 

the Commissioner’s decision will be affirmed. 

I. Background. 

 Plaintiff, a 31-year-old female, has a high school diploma and previously worked 

as a fitness supervisor, a claims administrator, a medical biller, a retail sales associate, 

and a university resident aide. On June 29, 2011, Plaintiff applied for disability insurance 

benefits and supplemental security income, alleging disability beginning April 28, 2011. 

On March 19, 2013, she appeared with her attorney and testified at a hearing before the 

ALJ. A vocational expert also testified. On July 12, 2013, the ALJ issued a decision that 

Plaintiff was not disabled within the meaning of the Social Security Act. The Appeals 

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Council denied Plaintiff’s request for review of the hearing decision, making the ALJ’s 

decision the Commissioner’s final decision. 

II. Legal Standard. 

 The district court reviews only those issues raised by the party challenging the 

ALJ’s 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, less than a 

preponderance, and relevant evidence that a reasonable person might accept as adequate 

to support a conclusion considering the record as a whole. Id. In determining 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. 

As a general rule, “[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).

III. The ALJ’s Five-Step Evaluation Process. 

To determine whether a claimant is disabled for purposes of the Social Security 

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 at step five the burden shifts to the 

Commissioner. Tackett v. Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999). 

 At the first step, the ALJ determines whether the claimant is engaging in 

substantial gainful activity. § 404.1520(a)(4)(i). If so, the claimant is not disabled and 

the inquiry ends. Id. At step two, the ALJ determines whether the claimant has a 

“severe” medically determinable physical or mental impairment. § 404.1520(a)(4)(ii). If 

not, the claimant is not disabled and the inquiry ends. Id. 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. Pt. 404. 

§ 404.1520(a)(4)(iii). If so, the claimant is automatically found to be disabled. Id. If 

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not, the ALJ proceeds to step four. At step four, the ALJ assesses the claimant’s residual 

functional capacity (“RFC”) and determines whether the claimant is still capable of 

performing past relevant work. § 404.1520(a)(4)(iv). If so, the claimant is not disabled 

and the inquiry ends. Id. If not, the ALJ proceeds to the fifth and final step, where he 

determines whether the claimant can perform any other work based on the claimant’s 

RFC, age, education, and work experience. § 404.1520(a)(4)(v). If so, the claimant is 

not disabled. Id. If not, the claimant is disabled. Id. 

 At step one, the ALJ found that Plaintiff meets the insured status requirements of 

the Social Security Act through December 31, 2016, and that she has not engaged in 

substantial gainful activity since April 28, 2011. At step two, the ALJ found that Plaintiff 

has the following severe impairments: major depressive disorder with anxiety and 

depression, somatoform disorder,1

 body dysmorphic disorder, Lyme disease, and 

hypercoagulable state.2

 At step three, the ALJ determined that Plaintiff does not have an 

impairment or combination of impairments that meets or medically equals an impairment 

listed in Appendix 1 to Subpart P of 20 C.F.R. Pt. 404. At step four, the ALJ found that 

Plaintiff has the RFC to perform “sedentary work as defined in 20 [C.F.R. §§] 

404.1567(a) and 416.967(a) except the claimant can understand, remember, and carry out 

simple and detailed work tasks. The claimant is limited to superficial, occasional 

interaction with the public.” The ALJ further found that Plaintiff is unable to perform 

any of her past relevant work. At step five, the ALJ concluded that, considering 

Plaintiff’s age, education, work experience, and RFC, there are jobs that exist in 

significant numbers in the national economy that Plaintiff could perform. 

 

1

 Somatic symptom disorder “involves having a significant focus on physical symptoms—such as pain or fatigue—to the point that it causes major emotional distress and problems functioning.” Somatic symptom disorder, Mayo Clinic, http://www. mayoclinic.org/diseases-conditions/somatic-symptom-disorder/basics/definition/con- 20124065 (last visited September 25, 2015). 

2

 A hypercoagulable state occurs when “blood tends to clot too much.” It is also 

known as thrombophilia. Hypercoagulable states (blood clotting disorders), Cleveland 

Clinic, https://my.clevelandclinic.org/services/heart/disorders/hypercoagstate (last visited September 25, 2015). 

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IV. Analysis. 

Plaintiff argues the ALJ’s decision is defective for two reasons: (1) the ALJ 

improperly weighed the opinions of Plaintiff’s medical sources, and (2) the ALJ erred in 

evaluating Plaintiff’s credibility. The Court will address each argument below. 

A. The ALJ Did Not Err In Weighing Plaintiff’s Opinion Evidence. 

 Plaintiff argues that the ALJ improperly weighed the opinions of the following 

medical sources: Jonathan Murphy, M.D., and Dana Rosdahl, Ph.D., RN, FNP-BC. The 

Court will address the ALJ’s treatment of each opinion below. 

1. Jonathan Murphy, M.D. 

 Dr. Jonathan Murphy treated Plaintiff for Lyme disease. Plaintiff argues that the 

ALJ improperly weighed Dr. Murphy’s medical opinion. 

 The Ninth Circuit distinguishes between the opinions of treating physicians, 

examining physicians, and non-examining physicians. See Lester v. Chater, 81 F.3d 821, 

830 (9th Cir. 1995). Generally, an ALJ should give greatest weight to a treating 

physician’s opinion, and more weight to the opinion of an examining physician than to 

one of a non-examining physician. See Andrews v. Shalala, 53 F.3d 1035, 1040-41 (9th 

Cir. 1995). If it is not contradicted by another doctor’s opinion, the opinion of a treating 

or examining physician can be rejected only for “clear and convincing” reasons. Lester, 

81 F.3d at 830 (citing Embrey v. Bowen, 849 F.2d 418, 422 (9th Cir. 1988)). The ALJ 

need not accept the conclusions even of treating physicians where they are “brief, 

conclusory, and inadequately supported by clinical findings.” Thomas, 278 F.3d at 957. 

 Under the relevant Social Security Administration regulations, there are several 

factors to be considered when evaluating medical opinion evidence. To begin, both the 

length of the treatment relationship and the frequency of examination are relevant. 20 

C.F.R. § 404.1527(c)(2)(i). The regulations provide that the more times a claimant has 

been treated by the source, the more weight will be afforded the opinion. Id. In addition, 

the nature and extent of the treatment relationship is relevant. § 404.1527(c)(2)(ii). A 

medical opinion’s weight is also affected by the relevant evidence on which it rests, 

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including medical signs and laboratory findings. § 404.1527(c)(3). Finally, the more 

consistent a medical opinion is with the entire record, the more weight the opinion is to 

be afforded. § 404.1527(c)(4). 

 Although Dr. Murphy met with Plaintiff several times during a three month period 

in 2012, he only examined her once, on April 12, 2012. A.R. 333-38. Dr. Murphy’s 

physical examination revealed Plaintiff was “[n]ormotensive, in no acute distress,” but 

exhibited weak gait, needed assistance “to ambulate distances,” and possessed diminished 

strength in her hands. A.R. 335. On June 4, 2012, Dr. Murphy submitted a medical 

assessment of Plaintiff’s ability to do work related activities. A.R. 326-28. He opined 

that pain and fatigue constituted a moderately severe limitation on Plaintiff’s ability to 

function, including limits of no more than one hour of sitting and one hour of standing or 

walking, in ten-to-fifteen minute increments, per eight hour work day. A.R. 326-28. 

Further, Dr. Murphy opined that Plaintiff required “supine rest after either [fifteen] 

minutes on her feet or [one] hour in seated position.” A.R. 326. Ultimately, Dr. Murphy 

concluded that Plaintiff could not perform even sedentary work. A.R. 25. 

 The ALJ afforded Dr. Murphy’s medical opinion no weight because his 

assessment was based on only one examination and was therefore likely subjective, rather 

than based on Dr. Murphy’s limited objective findings. Id. Furthermore, the ALJ found 

Dr. Murphy’s conclusions to be inconsistent with both Dr. Murphy’s own clinical 

findings and Plaintiff’s other medical records. Id. Finally, the ALJ noted that, although 

Dr. Murphy was a board-certified medical physician, Dr. Murphy’s credibility was 

undermined by a note in nurse practitioner Dana Rosdahl’s records that she “[f]ound a 

doctor to sign off on [Plaintiff’s] disability paperwork. They will be requesting her test 

results and he will sign off on everything. His name is Dr. Murphy at Arizona Center for 

Advanced Medicine.” A.R. 25, 395. 

 Plaintiff asserts that the ALJ erroneously concluded that Dr. Murphy’s opinion 

was a subjective, single assessment, but Plaintiff submitted evidence showing that Dr. 

Murphy examined her only once. Plaintiff did not establish a treating relationship with 

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Dr. Murphy sufficient to demonstrate a “longitudinal picture of [her] impairment.” 

§ 404.1527(c)(2)(i). In addition, the ALJ correctly observed that Dr. Murphy’s modest 

clinical findings in his April 12, 2012, examination do not support the drastic limitations 

he recommended in his June 4, 2012, medical assessment. A.R. 25. During his 

examination, Dr. Murphy noted that although Plaintiff was “[n]ormotensive, in no acute 

distress,” she did require assistance to “ambulate distances” and “otherwise has a weak 

ataxia.” A.R. 335. Dr. Murphy also observed that Plaintiff had a “weak gait” and 

“diminished strength” in her hands. Id. In his medical assessment, Dr. Murphy opined 

that pain and fatigue constituted a moderately severe limitation on Plaintiff’s ability to 

function, including limits of no more than one hour of sitting and one hour of standing or 

walking, in ten-to-fifteen minute increments, per eight hour work day. A.R. 326-28. Dr. 

Murphy ultimately concluded that Plaintiff could not perform even sedentary work. A.R. 

25. Dr. Murphy’s objective medical findings do not support such extreme limitations. 

§ 404.1527(c)(3). In particular, Dr. Murphy’s findings do not reveal any objective 

evidence on which to conclude that Plaintiff cannot sit for more than one hour per eighthour work day, which was necessary to conclude that Plaintiff could not even perform 

sedentary work. The ALJ did not err in concluding that Dr. Murphy’s findings are 

inconsistent with his own clinical findings and with the preponderance of Plaintiff’s 

medical records. Thomas, 278 F.3d at 957; § 404.1527(c)(4).

 Plaintiff also asserts that the ALJ erred in concluding that Dr. Murphy lacked 

credibility. The ALJ found that Dr. Murphy’s credibility was undermined by nurse 

practitioner Dana Rosdahl’s note that they had “found a doctor” to “sign off on” 

Plaintiff’s disability paperwork. Although such a note may not in itself be sufficient to 

discount the opinion of a treating physician, it is relevant and can be considered with 

other factors. See Saelee v. Chater, 94 F.3d 520, 522-23 (9th Cir. 1996) (upholding 

ALJ’s finding that treating physician’s report was untrustworthy because it was procured 

solely for purposes of the administrative hearing, varied from the physician’s own 

treatment notes, and was worded ambiguously to assist the claimant’s attempts to obtain 

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benefits). 

 The ALJ found that Dr. Murphy’s credibility was undermined by inconsistency 

with Nurse Rosdahl’s records. § 404.1527(c)(4). This was not error. For example, Dr. 

Murphy observed that Plaintiff exhibited “weak gait” when he examined her on April 12, 

2012. A.R. 335. Nurse Rosdahl, however, noted that Plaintiff exhibited a normal gait on 

over thirty occasions over an 18-month period. See, e.g., A.R. 262, 459. Notably, Nurse 

Rosdahl observed a normal gait on the occasions immediately before and after Dr. 

Murphy examined Plaintiff, on March 29, 2012, and April 17, 2012. A.R. 393, 396. 

Such inconsistencies in the record support the ALJ’s decision to discount the weight of 

Dr. Murphy’s medical opinion, especially in light of the role that Plaintiff’s poor 

ambulation played in Dr. Murphy’s opinion. § 404.1527(c)(4). 

 The Court finds that the ALJ provided clear and convincing reasons for 

discounting Dr. Murphy’s medical opinion and that those reasons are supported by 

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

2. Dana Rosdahl, Ph.D., RN, FNP-BC. 

 Dana Rosdahl, a certified nurse practitioner and former professor of nursing at 

Arizona State University, treated Plaintiff for Lyme disease and fatigue. Plaintiff argues 

that the ALJ improperly weighed Nurse Rosdahl’s opinion evidence. 

 Nurse practitioners are not “acceptable medical sources” for documenting a 

medical impairment. 20 C.F.R. § 404.1513(a). They are, however, considered “other 

sources” the Commissioner may rely on to show the severity of a claimant’s impairments 

and how those impairments may affect her ability to work. § 404.1513(d)(1). The ALJ 

may discount testimony from other sources if he provides “reasons germane to each 

witness for doing so.” Ghanim v. Colvin, 763 F.3d 1154, 1161 (9th Cir. 2014) (citations 

omitted). A germane reason includes a conflict between treatment notes and a treating 

provider’s opinion. Id. A germane reason also includes the fact that an opinion is 

inconsistent with objective medical evidence in the record. Bayliss v. Barnhart, 427 F.3d 

1211, 1218 (9th Cir. 2005). 

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 Nurse Rosdahl treated Plaintiff from June 2011 to January 2013. A.R. 26. Nurse 

Rosdahl’s physical examinations of Plaintiff over that time period revealed that generally 

Plaintiff was well-developed, well-nourished, and in no acute distress. Id. Plaintiff also 

generally exhibited normal breath sounds, normal gait, and normal mental and emotional 

status. Id. Nurse Rosdahl provided a medical assessment of Plaintiff’s ability to do work 

related activities on two separate occasions. A.R. 356-58, 472-74. On June 14, 2011, 

Nurse Rosdahl opined that pain and fatigue constituted a severe limitation on Plaintiff’s 

ability to function, and recommended limits of no more than one hour of sitting and less 

than one hour of standing or walking per eight hour work day. A.R. 356-58. On 

January 22, 2013, Nurse Rosdahl provided a second assessment, reaching substantially 

similar conclusions. A.R. 472-74. Ultimately, Nurse Rosdahl concluded that Plaintiff 

could not perform even sedentary work. A.R. 26. 

 The ALJ noted that Nurse Rosdahl’s opinion did not qualify as an acceptable 

medical source because she is a nurse practitioner. A.R. 26. The ALJ afforded Nurse 

Rosdahl’s opinion very little weight due to inconsistencies between her treatment notes 

and her opinion, and inconsistencies within the notes themselves. A.R. 26-27. The ALJ 

noted that the objective physical manifestations set forth in Nurse Rosdahl’s notes were 

inconsistent with the radical limitations recommended in both of her assessments. 

A.R. 26. In addition, the ALJ highlighted inconsistencies within Nurse Rosdahl’s 

treatment notes, including conflicting evidence as to whether Plaintiff had experienced 

any unintended weight gain or loss and whether Plaintiff had been working since the 

alleged onset date. A.R. 26-27. 

 Plaintiff asserts that the ALJ rejected Nurse Rosdahl’s opinion because she is a 

nurse practitioner and not an acceptable medical source. The ALJ correctly noted that the 

opinions of nurse practitioners are not “acceptable medical sources” as defined by the 

relevant Social Security Administration regulations (§ 404.1513(a)), but did not 

completely disregard Nurse Rosdahl’s opinion. Instead, the ALJ considered the opinion 

to the extent it was credible to show the severity of Plaintiff’s impairments and how those 

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impairments affect her ability to do work. Id.

 Plaintiff also asserts that the ALJ erred by relying on inconsistencies within the 

record to discount Nurse Rosdahl’s opinions. Despite the fact that over an 18-month 

period Nurse Rosdahl’s physical examinations generally indicated that Plaintiff was 

healthy, Nurse Rosdahl opined on two occasions that Plaintiff was subject to severe work 

limitations. The ALJ did not err in concluding that the opinion was inconsistent with 

Nurse Rosdahl’s own treatment notes. Ghanim, 763 F.3d at 1161. Nor did the ALJ err in 

finding the treatment internally inconsistent. For example, the notes contain 

inconsistencies with respect to whether Plaintiff had experienced any unintended weight 

gain or loss. A.R. 396, 399, 402. The notes are also inconsistent as to whether Plaintiff 

was working after the alleged onset date, an inconsistency the ALJ particularly noted and 

which is discussed below. 

The Court finds that the ALJ provided germane reasons for discounting Nurse 

Rosdahl’s opinion and that those reasons are supported by substantial evidence in the 

record. Id.

B. The ALJ Did Not Err in Evaluating Plaintiff’s Credibility. 

 Plaintiff argues that the ALJ erred in evaluating her credibility. In evaluating 

credibility, the ALJ is required to engage in a two-step analysis: (1) determine whether 

the claimant presented objective medical evidence of an impairment that could 

reasonably be expected to produce some degree of the pain or other symptoms alleged; 

and, if so with no evidence of malingering, (2) reject the claimant’s testimony about the 

severity of the symptoms only by giving specific, clear, and convincing reasons for the 

rejection. Vasquez v. Astrue, 572 F.3d 586, 591 (9th Cir. 2009). 

 Applying this two-step procedure, the ALJ first found that Plaintiff’s medically 

determinable impairments could reasonably be expected to cause the alleged symptoms. 

The ALJ then found that Plaintiff’s statements regarding the intensity, persistence, and 

limiting effects of the symptoms were not credible. The ALJ gave two primary reasons. 

First, the ALJ noted that Plaintiff made numerous statements indicating that she had 

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worked after the alleged disability onset date. A.R. 21-22. Second, the ALJ found that 

Plaintiff provided inconsistent information regarding her daily activities. A.R. 22. 

Plaintiff challenges both of these findings. 

 Evidence of work after the onset date is relevant to a claimant’s credibility. 

Greger v. Barnhart, 464 F.3d 968, 972 (9th Cir. 2006). At the hearing, Plaintiff 

maintained that she had not worked since April 28, 2011, the disability onset date. A.R. 

38-39, 52. This is consistent with the Social Security Administration’s earning records. 

A.R. 180-81. Plaintiff’s assertions at hearing, however, are contradicted by Nurse 

Rosdahl’s treatment notes. Nurse Rosdahl met with Plaintiff dozens of times over an 18-

month period after April 28, 2011. See, e.g., A.R. 267, 465. During that time period, the 

notes refer to Plaintiff’s employed status over forty times. See A.R. 267-465. The notes 

contain numerous statements by Plaintiff indicating that she was working after April 28, 

2011. For example, on September 1, 2011, Plaintiff stated that she “[f]eels a lot of stress 

with her landlord and boss.” A.R. 287. On October 25, 2011, Plaintiff reported that 

fatigue made it “very difficult to do . . . her job.” A.R. 305. On April 17, 2012, Plaintiff 

reported having an “incredible” three weeks, including “[g]oing to the pool, walking and 

working.” A.R. 395. On May 10, 2012, Plaintiff reported nasal congestion because 

“there is a tree at work that is bothering her[.]” A.R. 402. On August 29, 2012, Nurse 

Rosdahl noted that Plaintiff “is [two] months behind in her work. She has been out of 

work most of last week. She only went into work to do payroll.” A.R. 446. On 

October 2, 2012, Plaintiff stated that she “forces herself to go to work” even though she 

“can get short of breath sitting at work.” A.R. 458. Given these and other references 

cited by the ALJ (A.R. 22), the Court finds substantial evidence to support the ALJ’s 

finding that Plaintiff’s credibility was harmed by inconsistent statements about her work 

after the alleged onset date. Greger, 464 F.3d at 972.3

 

3

 The ALJ’s finding on this issue is not inconsistent with his determination at step two that Plaintiff had not engaged in substantial gainful activity since April 28, 2011. The ALJ specifically noted at step two that there were numerous references to work in 

the medical records, but thought it best to “give the claimant the benefit of the doubt” at 

step two and proceed with a “sequential evaluation.” A.R. 17. 

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 Evidence of participation in everyday activities indicating “capacities that are 

transferable to a work setting” or nullifying “claims of a totally debilitating impairment” 

is also relevant to a claimant’s credibility. Molina v. Astrue, 674 F.3d 1104, 1112-13 (9th 

Cir. 2012) (citations omitted). During the hearing, Plaintiff testified that she constantly 

experiences severe fatigue and pain, and suffers daily migraines. A.R. 40, 43. She 

testified that she needs help getting out of bed and with her daily activities, including 

cooking, bathing, and opening things, such as a medicine bottle. A.R. 40, 42. Plaintiff 

testified that it is painful to walk, sit, or stand, and that she cannot lift anything heavier 

than a small book. A.R. 45. Plaintiff testified that she often has trouble thinking, which 

she described as “foggy brain.” A.R. 41. Plaintiff also testified that she takes medication 

to help with her ailments, and that the medication causes several side effects, including 

dizziness, nausea, diarrhea, constipation, and, occasionally, stomach bleeding. A.R. 44. 

 The ALJ found inconsistencies in Nurse Rosdahl’s treatment notes. A.R. 22-23. 

For example, the notes refer to an “incredible” three week period during which Plaintiff 

was “[g]oing to the pool, walking and working.” A.R. 395. The notes mention that 

Plaintiff attended a “water aerobics class,” despite her testimony that her only hobby was 

reading. A.R. 458. The notes reflect that Plaintiff took a two-day trip to Disneyland. 

A.R. 49-50, 359. Contrary to Plaintiff’s assertion of daily migraines, the notes reflect 

visits where Plaintiff “denied any migraine headaches” and where she reported that her 

headaches “come and go, not a big problem.” A.R. 451, 388. The ALJ also noted that 

although Plaintiff claims severe gastro-intestinal problems, she has not sought diagnosis 

or treatment for these conditions; although she claims fibromyalgia and rheumatoid 

arthritis, she produced no record of such diagnoses; and although she claims disabling 

depression and anxiety, with memory and concentrations problems, she has not sought 

treatment by a board certified mental health professional. A.R. 23-24. 

 The Court finds that the ALJ provided specific, clear, and convincing reasons for 

discounting Plaintiff’s testimony, and that those reasons are supported by substantial 

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evidence. Vasquez, 572 F.3d at 591.4

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

is affirmed. The Clerk shall enter judgment accordingly and terminate this case. 

 Dated this 25th day of September, 2015. 

 

4

 Plaintiff also objects, in passing, to the ALJ’s determination that the record 

lacked sufficient information to conclude that Plaintiff could not perform even sedentary work. A.R. 26. Plaintiff cannot disclaim responsibility for an inadequate record on this point. Plaintiff failed to attend the consultative physical examination. A.R. 77. She also 

failed to submit additional medical records that the ALJ requested during the hearing. A.R. 18. 

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