Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-4_19-cv-00362/USCOURTS-azd-4_19-cv-00362-0/pdf.json

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

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IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Kim D Abramson,

Plaintiff,

v. 

Commissioner of Social Security 

Administration,

Defendant.

No. CV-19-00362-TUC-RM (DTF)

REPORT AND RECOMMENDATON

Plaintiff Kim D. (Abramson) brought this action pursuant to 42 U.S.C. §§ 405(g) 

and 1383(c)(3), seeking judicial review of a final decision by the Commissioner of Social 

Security (Commissioner). Abramson filed an opening brief, the Commissioner filed a

response brief, and Abramson filed a reply. (Docs. 16, 17, 18.) This matter was referred to 

United Magistrate Judge D. Thomas Ferraro for Report and Recommendation. (Doc. 11.) 

Based on the pleadings and the administrative record (AR) submitted to the Court, the 

Magistrate Judge recommends the district court, after its independent review, reverse the 

decision of the ALJ.

BACKGROUND

Procedural History

Abramson protectively filed an application for Disability Insurance Benefits (DIB) 

and Supplemental Security Income (SSI) pursuant to Titles II and XVI of the Social 

Security Act (Act) on November 2, 2017, alleging disability beginning on December 31, 

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2012. (AR 301-15.) Abramson’s date last insured was December 31, 2012. (AR 169.) 

Abramson’s application for DIB was denied initially and on reconsideration. (AR 193-96, 

198-201). 

A hearing was held before an Administrative Law Judge (ALJ) on August 9, 2018. 

(AR 113-47.) At the hearing Abramson amended her alleged onset date to July 1, 2012. 

(AR 118, 169.) In a decision dated August 21, 2018, the ALJ determined that Abramson 

was not disabled. (AR 169-80.) 

The Appeals Council granted Abramson’s request for review of the ALJ’s decision 

and remanded the case to the ALJ to: (1) evaluate the record period to determine any 

periods during which Abramson worked at the substantial gainful activity level; (2) obtain 

evidence from a medical expert related to the nature and severity of functional limitations 

related to Abramson’s impairments; (3) give further consideration to whether Abramson 

has past relevant work and, if so, whether she can perform it; and (4) obtain supplemental 

evidence from a vocational expert (VE) if warranted by the record. (AR 189-91.)

The ALJ held an additional hearing on January 31, 2019, where Abramson, medical 

expert (ME) Maria Rivero, M.D, and a VE testified. (AR 67-112.) The ALJ issued a

partially favorable decision on February 12, 2019. (AR 41-58.) The Appeals Council 

declined review of the ALJ’s February 2019 decision thus making that decision the 

Commissioner’s final decision. (AR 12-14.)

At step one, the ALJ determined Abramson may have engaged in substantial gainful 

activity since her alleged onset date. (AR 45.) The ALJ concluded:

Notwithstanding, while there is evidence that the claimant may have engaged 

in work activity since the amended alleged onset date, it is not necessary to 

determine whether that work activity constitutes disqualifying substantial 

gainful activity because there exists a valid basis on other grounds for 

denying her claim until her protective filing date...[.] 

(AR 45-46.)

At step two, the ALJ determined that since the alleged disability onset date of 

disability, July 1, 2012, Abramson has had as severe impairments: post laminectomy

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syndrome, right shoulder dysfunction, chronic fatigue syndrome, migraine headaches, 

obesity and sinusitis. (AR 46.) The ALJ determined that beginning on the established onset 

date of disability, November 2, 2017, Abramson has had as severe impairments: chronic 

fatigue syndrome, migraine headaches, obesity, sinusitis, hypertension, seizure disorder, 

Dercum’s syndrome, lymphedema and arachnoiditis. Id. 

At step three, the ALJ determined that since July 1, 2012, Abramson did not have 

an impairment or combination of impairments that met or equaled a listed impairment. (AR 

47.) Before step four the ALJ made her residual functional capacity (RFC) determination

that, prior to November 2, 2017, Abramson retained the RFC to perform:

[S]edentary work as defined in 20 CFR 404.1567(a) and 416.967(a) with the 

following limitations: Claimant can lift/carry/push/pull 10 pounds 

occasionally and 10 pounds frequently. Claimant can sit for 6 hours; stand 

for 2 hours; or walk for 2 hours per 8[-]hour workday. Claimant can never 

climb ladders/ropes/scaffolds, kneel, crouch or crawl and can occasionally 

climb stairs, bend, stoop or overhead reach with her right dominant upper 

extremity. Claimant can have occasional exposure to temperature 

dust/fumes/smoke.

Id. The ALJ determined that beginning on November 2, 2017, Abramson had the RFC to 

perform:

[S]edentary work as defined in 20 CFR 404.1567(a) and 416.967(a) with the 

following limitations: Claimant can lift or carry less than 10 pounds 

occasional[ly] or frequently. Claimant can sit for 4 hours per day, stand for 

1 hour per day and walk for 1 hour per day. Finally, [C]laimant has 

occasional ability to maintain attendance and concentration due to frequent 

medical appointments/treatments, pain and fatigue.

(AR 53.)

At step four, the ALJ determined that prior to November 2, 2017, Abramson was 

not disabled, and she retained the ability to perform her past relevant work. (AR 55.) The 

ALJ also rendered two alternative decisions at Step 5. (AR 55-56.) In her first alternative 

Step 5 decision, the ALJ relied on an unspecified Rule of the Medical-Vocational 

Guidelines (the Grids) as a framework with VE testimony to determine that, from July 1, 

2012, through November 1, 2017, Abramson was not disabled. (AR 55.) The ALJ 

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determined that Abramson could transfer skills to a semi-skilled occupation and a skilled 

occupation during that time period such as Employment Clerk, SVP 5, Dictionary of 

Occupational Titles (DOT) No. 205.362-014 and Receptionist/SVP 4, DOT No. 237.367-

038. Id. The ALJ made the alternative finding that Abramson could perform the 

requirements of representative occupations such as General Office Clerk, Sedentary/SVP 

2, DOT No. 209.587-010, Information Clerk, Sedentary/SVP 2, DOT No. 237.367-046, 

and Credit Authorizer, Sedentary/SVP 2, DOT No. 205.367-014. (AR 55-56.)

ISSUES ON REVIEW

Abramson’s issues on review pertain to the unfavorable portion of the ALJ’s 

February 12, 2019, decision; namely, the time period of July 1, 2012, through November 

1, 2017. (Doc. 16 at 3, 10.) Abramson argues: (1) the ALJ gave legally insufficient reasons 

for rejecting examining physician Dr. Alvina’s opinion that Abramson was not capable of 

performing full-time work prior to her date last insured of December 31, 2012; (2) the ALJ 

gave legally insufficient reasons for rejecting non-examining medical expert Dr. Rivero, 

M.D.’s opinion about off-task time; and (3) the ALJ gave insufficient reasons for rejecting 

treating endocrinologist Dr. Herbst’s opinion that Abramson could not sustain full-time 

work prior to her date last insured of December 31, 2012. Abramson preemptively raises 

an issue regarding the ALJ’s step one determination. Lastly, Abramson argues the ALJ 

applied an “incorrect stricter definition of ‘disability.’” (Doc. 16 at 1-2.) 

The Commissioner argues against all of Abramson’s claims of error. (Doc. 18.)

FACTUAL HISTORY

Abramson was born in 1966. (AR 302.) She was 45 years old on her amended 

alleged onset date (July 1, 2012), 46 years old on her date last insured (December 31, 2012), 

and 51 years old on the last day of the period during which the ALJ determined that she 

was not disabled (November 1, 2017). (AR 44, 57-58.) 

Abramson testified that she has a bachelor’s degree in journalism and a master’s 

degree in intercultural communication. (AR 117.) Abramson testified that she stopped 

working due to a combination of fatigue, respiratory issues, changes in her lymphatic and 

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endocrine system, spinal issues and weight gain from high dose steroids that exacerbated 

her spinal pain. (AR 118.) Abramson testified that she lives in a house with a roommate 

and her roommate wakes her up every morning at 4:45 a.m. to use a lymphatic pumping 

system. (AR 121.) Abramson testified that she had been using the pumping system for 

several months due to her endocrinologist’s recommendation. Id. 

Abramson testified that she performs only a few chores and it takes her an hour and 

a half to prepare a meal. (AR 122.) She testified that she can only walk for a few minutes, 

standing is extremely difficult for an extended period and she can sit for about 20 minutes. 

(AR 129.) She testified that her Dercum’s disease prevents her from losing weight and that 

she suffers migraines at least two or three times per week. (AR 132.)

The vocational expert (VE) testified Abramson’s past work is classified as Civilian 

Manpower Management Officer, a sedentary occupation with an SVP of 8. (AR 106-07.)

MEDICAL EVIDENCE

During 9/11 Abramson was exposed to dust clouds and subsequently complained of 

cold and flu symptoms. (AR 952.) In October 2009, the World Trade Center Healthcare 

Center evaluated Abramson for exposure. Id. Abramson reported that she ran a non-profit 

organization based in Hawaii and that she lived out of hotels due to work. Abramson also 

reported that she traveled constantly and spent a significant amount of time in Washington, 

D.C. (AR 953.) Neel Choski, M.D., diagnosed Abramson with likely World Trade Center 

related reactive airway disease that was mild and intermittent in nature and rhinitis likely 

World Trade Center related. Id. Dr. Choski diagnosed Abramson with general fatigue that 

he suspected was from stress given her frequent travel and long hours. Dr. Choski 

counseled Abramson on work life balance. Id. 

In March 2011, Howard Boltansky, M.D., an allergy and asthma specialist 

examined Abramson. (AR 1010.) Dr. Boltansky noted that Abramson’s chest x-ray was 

normal, but a sinus CT scan showed some positive findings such as fluid. Id. Dr. Boltansky 

opined that chronic sinusitis might be the cause of Abramson’s symptoms and prescribed 

medication and an inhaler. (AR 1011.) Later that month, Dr. Boltansky reported that 

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Abramson had significant improvement in her pulmonary function tests, her FEV1 had 

normalized and she was at 100% of predicted values. (AR 1008.)

Also, in March 2011, Richard Schubert, M.D., performed a rheumatologic 

consultation. (AR 845.) Abramson’s main complaint was persistent fatigue. Id. Upon 

examination, Abramson is recorded as having right shoulder pain, but no tender spots that 

would be typically identified with fibromyalgia. (AR 846.) Testing was generally 

unremarkable; a repeat DNA antibody test and a rheumatoid factor test were negative. (AR 

846-47.) Dr. Schubert concluded that Abramson was likely suffering from chronic fatigue 

syndrome and prescribed medication. (AR 847.) In September 2011 at a follow up 

appointment, Abramson reported that her fatigue is “getting better ...definitely.” (AR 836.)

In December 2014, Abramson presented to Seth Waldman, M.D., with complaints 

of fatigue and back, neck and leg pain. (AR 764-65.) Dr. Waldman reported that 

Abramson’s lumbar spine showed a well-healed non-tender scar, good range of motion and 

full flexing ability. (AR 765.) Dr. Waldman noted that Abramson’s sciatic notches were 

tender bilaterally and that she had some difficulty with heel and toe walking but no frank 

weakness or foot drop. Id. Dr. Waldman also noted that Abramson had increased sensation 

in the left leg but no allodynia. Id. Dr. Waldman also reported that Abramson ambulated 

easily with no assistive devices. Id. 

In January 2015, Dr. Waldman noted that Abramson’s lumbar spine MRI showed 

operative changes post-fusion from many years ago and some positive findings such as 

mild facet arthrosis. (AR 760.) An MRI/MRA of Abramson’s head was normal. Id. Dr. 

Walkman noted that medication had been effective in treating Abramson’s pain in the past 

and restarted it. Id. 

In March 2015, Abramson received a series of bilateral L5-S12 transforaminal 

epidural steroid injections and radio frequency denervation. (AR 751-56.) Abramson 

indicated the treatment improved her symptoms of leg and lower back pain. (AR 752, 753, 

755.) In December 2015, Abramson was evaluated in Maryland for complaints of 

dysphonia of the speaking voice. (AR 900.) Following a series of tests, Kristine Teets, 

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M.A., determined that “much of [Abramson’s] cough is behavioral, with chronic sinus 

irritation and potentially reflux.” (AR 902-03.) Voice therapy and behavioral modification 

were recommended. Id. After voice therapy, Abramson reported substantial improvement. 

(AR 889.) 

In January 2016, Abramson reported that her back pain was fairly controlled due to 

radiofrequency ablation and pain management treatment. (AR 1022.) Abramson reported 

that her migraines returned and reported that she stopped taking her medication because 

she ran out. Id. Ezra Cohen, M.D., restarted the medication. Id. 

In May 2017, endocrinologist Karen Herbst, M.D., began treating Abramson. (AR 

1088.) Dr. Herbst reviewed Abramson’s medical records that began in 2010. (AR 1093.) 

In July 2018, Dr. Herbst prepared a report discussing Abramson’s medical conditions. (AR 

1093-94.) Dr. Herbst stated:

I continue to treat [Abramson] ... for her ongoing chronic medical conditions 

including Dercum’s Disease, duodenitis, lipedema, lymphedema, and 

steatosis of liver. These disorders are complicated by diagnoses of accidental 

exposure to arsenic compounds, arthritis, carpal tunnel syndrome, chronic 

fatigue syndrome, cobalamin deficiency, decreased immunoglobulin, 

gastroesophageal reflux disease, hypokalemia, leukocytosis, migraine 

headaches, low back pain and radiculopathy, and chronic pain.

(AR 1093.) Dr. Herbst opined:

It is my opinion that Ms. Abramson is unable to do full-time work secondary 

to the combination of her conditions such as persistent fatigue and pain. The 

issue with Ms. Abramson is not competence or drive, but that she lacks the 

physical exertional ability, stamina, and cognitive ability to sustain a regular 

8-hour workday, even in a sit-down context. Unfortunately, Ms. Abramson 

has been unable to sustain full-time work without causing significant added 

physical and mental stress that leads to a decline in her overall functioning. 

Her memory and ability to concentrate is significantly impacted by her 

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conditions so that she would likely be off task in even a simple work setting 

for at least 25% of a workday. [...]

(AR 1094.)

In December 2017, Abramson underwent a spinal cord stimulator trial. (AR 630.) 

The trial ultimately proved unsuccessful. (AR 626, 1232.) 

Peggy Avina, M.D., is a certified physician for the World Trade Center Health 

Program, a program providing medical monitoring and treatment for survivors who were 

in the New York City 9/11 disaster area. (AR 1250.) Dr. Avina examined Abramson on 

November 1, 2018. Id. Dr. Avina reviewed Abramson’s medical records pertaining to 

“respiratory (and related pulmonary/chronic fatigue) issues.” Id. Dr. Avina opined:

In summary, the World Trade Center Health Program has identified that the 

types of respiratory, pulmonary, sleep, chronic fatigue and psychological 

issues that [Abramson] faces are certifiable disabilities for which the U.S. 

[g]overnment takes responsibility for the rest of a patient’s life. It is clear to 

me that [Abramson] has suffered from these debilitating conditions since 

2002, with a significant exacerbation reported in 2009. Her additional history 

and ongoing complications from her 1990 MVA and subsequent failed 

lumbar spinal surgery, and 1998 MVA and subsequent cervical damage, 

significantly impact her ability to function on a day-to-day basis. Patients in 

the World Trade Center Health Program with respiratory and pulmonary 

issues like [Abramson] have good days and bad days – this is not uncommon. 

However, overall quality of life and ability to function and work regularly is 

severely impacted. It is my opinion that [Abramson] has been unable to 

perform a regular, full-time work as a result of the combination of the 

conditions explained in this report since 2009. This opinion is based on a 

thorough review of medical records dating back prior to 2009 as well as a 

physical examination and interview of the patient.

(AR 1254.)

Maria Rivero, M.D., was the testifying medical expert. (AR 48.) Dr. Rivero testified 

that the records reflect Abramson was working and that she traveled a lot. (AR 96.) Dr. 

Rivero testified that Abramson’s back problem was not severe and later testified that 

Abramson would only be able to walk for two hours in an eight-hour day due to back 

problems. (AR 101, 103-04.) Dr. Rivero opined that Abramson would be able to lift, carry, 

push and pull ten pounds occasionally and less than ten pounds frequently; sit six hours in

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an eight-hour day, perform occasional bending, stooping and reaching overhead with the 

left arm, she could not crawl or squat, not climb ladders, ropes or scaffolds and could not 

be exposed to concentrations of dust or fumes. (AR 104.) Dr. Rivero also opined that 

Abramson would be off task over 10% of the time. (AR 105.) Dr. Rivero also testified that 

one problem was that the record showed Abramson was working and moving from place 

to place and “you would think someone with chronic fatigue wouldn’t be able to do that[.]” 

(AR 105.) 

STANDARD OF REVIEW

The Commissioner employs a five-step sequential process to evaluate DIB claims. 

20 C.F.R. § 404.1520; see also Heckler v. Campbell, 461 U.S. 458, 460-462 (1983). To 

establish disability the claimant bears the burden of showing she (1) is not working; (2) has 

a severe physical or mental impairment; (3) the impairment meets or equals the 

requirements of a listed impairment; and (4) claimant’s RFC precludes her from 

performing her past work. 20 C.F.R. § 404.1520(a)(4). At step five, the burden shifts to the 

Commissioner to show that the claimant has the RFC to perform other work that exists in 

substantial numbers in the national economy. Hoopai v. Astrue, 499 F.3d 1071, 1074 (9th 

Cir. 2007). If the Commissioner conclusively finds the claimant “disabled” or “not 

disabled” at any point in the five-step process, she does not proceed to the next step. 20 

C.F.R. § 404.1520(a)(4).

“The ALJ is responsible for determining credibility, resolving conflicts in medical 

testimony, and for resolving ambiguities.” Andrews v. Shalala, 53 F.3d 1035, 1039 (9th 

Cir. 1995) (citing Magallanes v. Bowen, 881 F.2d 747, 750 (9th Cir. 1989)). The findings 

of the Commissioner are meant to be conclusive if supported by substantial evidence. 42 

U.S.C. § 405(g). Substantial evidence is “more than a mere scintilla but less than a 

preponderance.” Tackett v. Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999) (quoting Matney v. 

Sullivan, 981 F.2d 1016, 1018 (9th Cir. 1992)). The court may overturn the decision to 

deny benefits only “when the ALJ’s findings are based on legal error or are not supported 

by substantial evidence in the record as a whole.” Aukland v. Massanari, 257 F.3d 1033, 

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1035 (9th Cir. 2001). This is so because the ALJ “and not the reviewing court must resolve 

conflicts in the evidence, and if the evidence can support either outcome, the court may not 

substitute its judgment for that of the ALJ.” Matney, 981 F.2d at 1019 (quoting Richardson 

v. Perales, 402 U.S. 389, 400 (1971)); Batson v. Comm’r of Soc. Sec. Admin., 359 F.3d 

1190, 1198 (9th Cir. 2004). The Commissioner’s decision, however, “cannot be affirmed 

simply by isolating a specific quantum of supporting evidence.” Sousa v. Callahan, 143 

F.3d 1240, 1243 (9th Cir. 1998) (citing Hammock v. Bowen, 879 F.2d 498, 501 (9th Cir. 

1989)). Reviewing courts must consider the evidence that supports as well as detracts from 

the Commissioner’s conclusion. Day v. Weinberger, 522 F.2d 1154, 1156 (9th Cir. 1975).

DISCUSSION

Issues One Through Three: Weight Assigned to the Medical Opinions

Dr. Avina

Abramson argues the ALJ’s rejection of Dr. Avina’s opinion on the grounds that the 

opinion was limited to conditions that Dr. Avina determined were related to 9/11 is 

“untrue.” (Doc. 16 at 12.) Abramson argues Dr. Avina considered not only 9/11 

impairments but also additional impairments, like musculoskeletal impairments. Id. 

Abramson also argues the ALJ failed to evaluate Dr. Avina’s expertise in 9/11 related 

impairments. Id. at 13. Abramson argues the ALJ erred in rejecting Dr. Avina’s opinion on 

the grounds that it is retrospective and that it conflicted with Abramson’s allegation that 

she became disabled on July 1, 2012. Id.

The Commissioner argues that the limited scope of Dr. Avina’s opinion supports 

the ALJ’s reduced credibility determination because Dr. Avina “had only a limited picture 

of [Abramson’s] conditions.” (Doc. 17 at 16.) The Commissioner also points out that the 

ALJ determined Dr. Avina’s opinion was inconsistent with Abramson’s own allegations 

that she was not disabled until July 1, 2012. Id. at 16-17. The ALJ was, according to the 

Commissioner, reasonable in determining this inconsistency undermined Dr. Avina’s 

opinion that Abramson was disabled since 2009. Id. at 17.

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The ALJ gave reduced weight to the opinion of Dr. Avina reasoning:

Dr. Avina did not examine the claimant until October 2018 and her review 

of the evidence was limited to conditions she determined were related to 

9/11, i.e., ENT (chronic rhinosinusitis), psychiatry (PTSD), and pulmonary 

(asthma, obstructive sleep apnea) condition. Furthermore, she opined that the 

claimant could not sustain regular work or home activity since 2009, which 

is inconsistent with the claimant’s own alleged onset date and the medical 

evidence as detailed herein.

(AR 54.) 

When evaluating a medical opinion, the ALJ considers factors including the treating 

or examining relationship between the opinion’s source and the claimant; how well the 

opinion is supported; how consistent the opinion is with the record as a whole; and 

familiarity with the disability program. See 20 C.F.R. § 404.1527(c). An ALJ need not 

accept an opinion of any physician if it is brief, conclusory, and inadequately supported by 

clinical evidence. Thomas v. Barnhart, 278 F.3d 947, 957 (9th Cir. 2002). When weighing 

a medical opinion, the ALJ does not have to agree with everything contained in that opinion 

and can consider some portions less significant than others when evaluated against the 

other evidence of record. Magallanes, 881 F.2d at 753.

Dr. Avina’s report states that she “only reviewed records pertaining to respiratory 

(and related pulmonary/chronic fatigue) issues.” (AR 1250.) However, Dr. Avina’s report 

also states that her opinion is based on “the combination of conditions explained” in her 

report and makes clear that she interviewed Abramson and performed a physical 

examination. (AR 1254.) This Court agrees with Abramson that the ALJ’s decision to 

assign reduced weight to Dr. Avina’s opinion on the grounds that Dr. Avina’s opinion was 

limited to conditions that she determined were related to 9/11 was erroneous. This Court is 

also persuaded by Abramson’s point that if a physician opines that an individual is unable 

to perform sustained work based on some, but not all, of her impairments consideration of 

additional impairments “logically could provide only more support for the physician’s 

opinion.” (Doc. 16 at 12.) The Commissioner did not respond to this point.

This Court agrees with Abramson that the ALJ failed to evaluate Dr. Avina’s 

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opinion as an expert. Pursuant to 20 C.F.R. § 404.1527(c)(5), generally, more weight is to 

the opinion of a specialist that concern medical issues related to the specialist’s area of 

expertise. See 20 C.F.R. § 404.1527(c)(5). There is no indication in the ALJ’s decision that 

she considered Dr. Avina’s opinion as an expert. The Commissioner also did not respond 

to this point. 

This Court agrees also agrees with Abramson that it was error for the ALJ to assign 

reduced weight to Dr. Avina’s opinion because it was retrospective. See Smith v. Bowen, 

849 F.2d 1222, 1225-26 (9th Cir. 1988) (“It is obvious that medical reports are inevitably 

rendered retrospectively and should not be disregarded solely on that basis.”) This Court 

is not persuaded by the Commissioner’s response. (Doc. 17 at 16.) The Commissioner cites 

to two unpublished cases that are distinguishable. See E.R.H. v. Comm’r of Soc. Sec. 

Admin., 384 Fed. Appx. 573, 575 9th Cir. 2010) (opinion not based on treatment notes from 

relevant time period); Lair-Del Rio v. Astrue, 380 Fed. Appx. 684, 695 (9th Cir. 2010) 

(record devoid of relevant medical records from the period). 

This Court agrees with the Commissioner, however, that it was permissible for the 

ALJ to reduce the weight assigned to Dr. Avina’s opinion on the grounds that it conflicted 

with Abramson’s own allegation that she did not become unable to engage in substantial 

gainful activity until July 1, 2012. See generally, Magallanes, 881 F.2d at 751-55 (ALJ’s 

rejection of treating physician’s opinion upheld where claimant’s testimony contradicted 

physician’s opinion). 

This Court is not persuaded by Abramson’s response that the ALJ did not error 

because the ALJ did not find that she worked full-time from 2009 to July 1, 2012. It is true 

that the ALJ did not determine that Abramson worked full time from 2009 to July 1, 2012.

At step one, the ALJ did not render a conclusive decision on whether Abramson engaged 

in substantial gainful activity since the alleged onset date. (AR 45.) The ALJ stated that 

she could not render a decision at step one because Abramson was not forthcoming in 

providing answers to some of the information required such as how many employees she 

had and her specific duties throughout the relevant period. Id. It is the claimant’s burden 

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of proof at steps one through four. See 20 C.F.R. § 404.1520(a)(4). See also, Ukolov v. 

Barnhart, 420 F.3d 1002, 1004 (9th Cir. 2005) (it is claimant’s burden to produce evidence 

to establish disability). Although neither party addressed the ALJ’s failure to render a 

conclusive step one determination, this Court determines that on remand the ALJ must

render a conclusive decision at step one. The ALJ’s errors were not harmless. If, on remand, 

Dr. Avina’s opinion that Abramson cannot sustain full time work is credited then 

Abramson would be disabled. See SSR 96-8p (a claimant who can perform only part-time 

work is eligible for benefits with certain exceptions).

This Court determines that the matter should be remanded to the ALJ for a proper 

evaluation of Dr. Avina’s testimony and a conclusive step one decision.

Dr. Rivero:

Abramson argues the ALJ misstated Dr. Rivero’s opinion regarding her being offtask. She contends that the ALJ’s use of the word “may” is wrong as Dr. Rivero testified 

that Abramson “would” be off-task over ten percent of the workday. (Doc. 16 at 16.) She 

argues that the ALJ’s mention that Dr. Rivero was redirected to address the pre-date-lastinsured-period and that Dr. Rivero never mentioned post-date-last-insured evidence is 

incorrect. She also argues that the ALJ’s rejection of Dr. Rivero’s opinion as not being 

“entirely clear” means that the ALJ failed to develop an adequate record. Id. at 17-18.

The Commissioner points out that while Dr. Rivero opined that Abramson would 

be off-task over 10% of the day Dr. Rivero also noted Abramson’s repeated admissions of 

continued work activity and expressed doubt that an individual with her complaints of 

chronic fatigue would be that active. (Doc. 17 at 17.) The Commissioner contends that as 

the factfinder the ALJ permissibly resolved this conflict in the evidence and determined 

that Abramson’s activities were inconsistent with her subjective complaints. Id. The 

Commissioner also argues the ALJ’s determination that Dr. Rivero’s opinion that 

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Abramson would be off-task 10% of the day was not supported by the record is legally 

supported. Id.

An ALJ must evaluate expressly and reasonably the opinion of a non-examining 

testifying medical expert. See 20 C.F.R. § 404.1513a(b)(2) (2019); Lester v. Chater, 81 

F.3d 821, 830-31 (9th Cir. 1996). 

Regarding off-task time Dr. Rivero testified:

A. ... And I would say that, you know, that’s – this is the tricky part because 

overall it does appear that she would have been out during some periods of 

time, two to three times a month - -

Q. Okay.

A. – at least. And that she would be off task to some extent for – during that 

time period as well.

.

Q. Okay. How much off task? I mean, over ten percent or –

A. Yeah, I would say so, judge. And again, the problem with this record is 

that it is all of the other stuff that you see her telling people that she’s 

working.

Q. Right.

A. And that’s visible throughout the record. And that she’s you know, 

moving from place to place and, you now, which one would think that 

someone with chronic fatigue wouldn’t be able to do that. [...]

(AR 104-05.) In assigning weight to Dr. Rivero’s testimony, the ALJ reasoned:

However, with respect to off-task limit, Dr. Rivero also pointed out that the 

claimant’s activities, for example her extensive travel, seems inconsistent 

with the degree of fatigue and subjective complaints from the claimant that 

are documented in the record. The undersigned finds that Dr. Rivero’s 

testimony is generally consistent with the evidence, however the portion of 

her testimony regarding the claimant being off tasks and/or missing work is 

given reduced weight. The undersigned notes that Dr. Rivero had to be 

redirected several times that her testimony should only reflect the claimant’s 

limitations during the period of July 1 to December 31, 2012. Thus[,] it is not 

entirely clear whether this additional limitation was as of December 31, 2012 

or more recently as Dr. Rivero specifically referenced claimant’s travel as 

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late as May 2016. (EX 27F). Further, Dr. Rivero caveated this portion of her 

testimony with the fact that claimant’s activities appeared inconsistent with 

her subjective complaints that she would be off-tasks or be unable to work. 

For these reasons, this portion of Dr. Rivero’s testimony is given reduced 

weight as the undersigned also finds that the claimant’s activities and medical 

evidence does not support this limitation during the period of July 1 to 

December 31, 2012 as detailed below.

(AR 49.) 

Dr. Rivero opined that Abramson “would” be off task over 10% of the workday. 

See, AR 105 (“I would say so, judge.”) The Commissioner did not address this point. (Doc. 

17 at 27, n. 10.) This Court agrees with Abramson that the ALJ misstated Dr. Rivero’s 

testimony regarding off-task time or missing work as not relating to the time period before 

December 31, 2012.

This Court also agrees with Abramson that the ALJ’s mention that Dr. Rivero’s 

testimony was not “entirely clear” regarding off-task time or missing work is an indication 

that the ALJ did not develop Dr. Rivero’s testimony sufficiently. As pointed out by 

Abramson, Dr. Rivero was the ALJ’s witness. Although the Commissioner argues that it 

is the ALJ’s obligation to resolve conflicts in the evidence, this Court thinks that position 

misses the point. As pointed out by Abramson, the ALJ directed Dr. Rivero to address the 

pre-date-last-insured period with respect to other testimony that Dr. Rivero gave. See AR 

103. The ALJ admittedly failed to do so concerning Dr. Rivero’s opinion regarding offtask time.

Lastly, this Court also agrees with Abramson that the ALJ erroneously relied on 

Abramson’s activities as support for rejecting Dr. Rivero’s opinion regarding off-task time. 

The ALJ failed to cite any activities that Abramson engaged in that did not allow her to be 

off-task but, rather, cited her travel as support for reducing Dr. Rivero’s opinion regarding 

off-task time. Although the Commissioner points out that it is Abramson burden to 

establish disability, this Court determines the ALJ erred in relying on activities (travel) in 

support of her decision to reduce the weight assigned to the off-task opinion of the 

testifying medical expert. The ALJ’s errors regarding Dr Rivero’s off-task opinion were 

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harmful because the VE testified that a person could not perform sustained work if she 

were off-task more than 10% of the workday. (AR 111.) 

This Court determines the ALJ’s decision to assign reduced weight to the opinion 

of Dr. Rivero regarding off task-time is not legally supported.

Dr. Herbst:

Abramson argues the ALJ failed to evaluate Dr. Herbst’s opinion as a treating 

physician, failed to afford Dr. Herbst’s opinion deference as a treating physician, failed to 

acknowledge that Dr. Herbst had “reasonable knowledge” of Abramson’s medical 

conditions and failed to consider the treating relationship when evaluating Dr. Herbst’s

opinion. (Doc. 16 at 22-23.) She also argues the ALJ failed to evaluate Dr. Herbst’s 

expertise as an endocrinologist. Id. at 23. 

The Commissioner argues the ALJ properly assigned reduced weight to Dr. Herbst’s 

opinion because the medical evidence prior to December 31, 2012, showed generally 

unremarkable objective findings and that Abramson improved with treatment. (Doc. 17 at 

14-15.) The Commissioner points out that the record in 2012 showed that Abramson 

traveled extensively for work, she had relatively mild respiratory findings and her other 

conditions improved with treatment. Id. at 15. The Commissioner also argues that there is 

no requirement that the ALJ make an express statement that she considered all the factors 

outlined in 20 C.F.R. § 404.152(c) when evaluating Dr. Herbst’s medical opinion. Id. The 

Commissioner urges the district court to conclude that the ALJ properly considered Dr. 

Herbst’s treating relationship with Abramson. Id. 

An ALJ must provide clear and convincing reasons for rejecting the uncontroverted 

opinion of a claimant’s treating physician. Lester, 81 F.3d at 830. Even when the treating 

source’s opinion is controverted, an ALJ must still give specific and legitimate reasons for 

rejecting that opinion. Id. A treating physician’s opinion is generally owed more weight 

than the opinion of a non-treating source. See 20 C.F.R. § 404.1527(c)(2) (2019) 

(“Generally, we give more weight to opinions from your treating sources.”). 

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Here, the ALJ reasoned:

Reduced weight is given to the statements from Dr. Karen Herbst. (EX 42F). 

Although undersigned agrees that the claimant would be unable to sustain 

work activities on a regular and continuing basis, for the reasons detailed 

above, the medical evidence does not support that this was the case going 

back to 2009-2010 as Dr. Herbst indicated. The evidence as described above 

does not support that as of December 31, 2012, claimant could not sustain a 

range of sedentary work activity.

(AR 54.)

While Abramson argues that the ALJ failed to consider the treating relationship, the 

ALJ did acknowledge that “[Abramson] was treated by Dr. Herbst and sees her about every 

three months.” (AR 48.) The ALJ also considered Dr. Herbst’s treatment notes. See, e.g.,

AR 54 (“The final treatment note from Dr. Herbst dated December 10, 2018 indicates the 

claimant has had profound fatigue for the past year.”). As such, this Court rejects 

Abramson’s argument that the ALJ did not consider that Dr. Herbst is an endocrinologist, 

the treating relationship, and that Dr. Herbst did not have reasonable knowledge of 

Abramson’s conditions.

The Commissioner also points out that the ALJ gave reduced weight to Dr. Herbst’s 

opinion reasoning that the Dr. Herbst’s opinion of disability going back to 2009/2010 was 

not supported by the medical evidence. See AR 54 (“Although the undersigned agrees that 

the claimant would be unable to sustain work activities on a regular and continuing basis, 

for the reasons detailed above, the medical evidence does not support that this was the case 

going back to 2009-2010 as Dr. Herbst has indicated.”) Dr. Herbst did not treat Abramson 

until 2017. (AR 144.) In 2017, the record indicated that Abramson required assistance with 

getting out of a car, two lymph pumps and a CVAC machine for endocrine conditions. (AR 

1248.) However, in 2012, the record showed that Abramson traveled extensively for work 

and her respiratory conditions were mild and, as with other conditions, they improved with 

treatment. See AR 836 (September 6, 2011, medical record noting fatigue is getting better 

“definitely”); AR 846-47 (March 25, 2011, medical record stating a diagnosis of systemic 

rheumatologic disorder cannot be made, Abramson had normal complement levels, as well 

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as negative rheumatoid factor, negative CCP antibody, negative Sm antibody, negative 

RNP antibody, negative SS-A and SS-B, negative Scl-70 antibody and a negative 

centromere antibody); AR 953 (lab results for March 25, 2011, medical record); AR 961

(October 2009 medical record recording heart size and pulmonary vasculature are within 

normal limits); and AR 1008 (March 31, 2011, medical records recording significant 

improvement in Abramson’s pulmonary function tests.). 

All medical source opinions, including statements from treating physicians and 

specialists, must be supported by evidence. See generally, 20 C.F.R. § 404.1527(c)(4) 

(“Generally, the more consistent an opinion is with the record as a whole, the more weight 

[the agency will give] to that opinion.”). Abramson does not respond to the point raised by 

the Commissioner that medical records in the 2009 to 2012-time frame showed that her

respiratory conditions were mild and improved with treatment. (Doc. 18 at 7-8.) Instead, 

Abramson merely repeats her assertion that the ALJ did not afford Dr. Herbst’s opinion 

the deference as a treating physician and an expert. (Doc. 18 at 7-8.) 

This Court determines that the weight assigned to the opinion of Dr. Herbst is 

supported by specific and legitimate reasons.

Issue Four: Step One Determination

Abramson states that her fourth issue as “[d]id the ALJ decide that [she] was not 

disabled at [s]tep [one]?” (Doc. 16 at 2.) Abramson argues, “...if the Commissioner argues 

that Ms. Abramson was not disabled at [s]tep [one], the Commissioner will seek affirmance 

based on an improper post hoc rationalization.” (Emphasis in Plaintiff’s brief.) (Doc. 16 

at 24.) The Commissioner has made no such argument. (Doc. 17 at 12-20.) Abramson 

acknowledges the same. (Doc. 18 at 8-9.)

This Court determines that Abramson’s issue regarding the ALJ’s step one 

determination is moot. Abramson’s argument explicitly alleges that it addresses an 

argument that was never made by the Commissioner. As stated above, this Court 

determines that the ALJ must decide at step one.

...

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Issue Five: Disability Standard

Lastly, Abramson argues the ALJ applied an incorrect standard of disability. (Doc. 

16 at 24-25.) She focuses on one sentence in the ALJ’s decision that states, “Furthermore, 

her symptoms are not so severe as to prohibit her from performing all basic work 

activities.” See AR 51. Abramson contends “basic work activities” are not mentioned in 

the Act’s definition of disability but, rather, are a regulatory concept used at step two to 

determine whether a claimant has a severe impairment. (Doc. 16 at 24-25.) She argues “if 

the [c]ourt does not hold that [she] [is] disabled, it should remand with an order for the ALJ 

to apply the correct legal standard.” Id. at 25.

The Commissioner points out that the statement at issue was made in the context of 

determining Abramson’s RFC for the time period prior to November 2, 2017. (Doc. 17 at 

18; AR 47, 51.) The Commissioner also points out that the ALJ rendered a partially 

favorable determination. Id.; AR 55-56.

The ALJ rendered a partially favorable decision. Abramson has no issue with the 

favorable portion of the ALJ’s decision. Given the partially favorable decision as well as 

the placement of the phrase at issue in the ALJ’s decision (in the RFC formulation section), 

this Court determines that, on balance, the ALJ did not err in making the statement 

regarding “all basic work activities.” 

REMEDY

A federal court may affirm, modify, reverse, or remand a social security case. 42 

U.S.C. § 405(g). “[T]he proper course, except in rare circumstances, is to remand to the 

agency for additional investigation or explanation.” Treichler v. Comm’r of Soc. Sec., 775 

F.3d 1090, 1099 (9th Cir. 2014). The credit-as-true rule only justifies an award of benefits 

in narrow circumstances. Id. at 1105.

This Court does not think this case involves the rare circumstances necessitating the 

credit-as-true rule. The ALJ did not make a step one determination. The ALJ indicated that 

Abramson “may have engaged in substantial gainful activity since the alleged onset date[.]” 

(AR 45.) If, on remand, the ALJ determines that Abramson engaged in substantial gainful 

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activity since the alleged onset date, then she is not disabled. If, on remand, the ALJ 

determines that Abramson did not engage in substantial gainful activity since her alleged 

onset date, then the ALJ is to properly evaluate the medical opinions of Drs. Avina and 

Rivero.

CONCLUSION AND RECOMMENDATION

This Court determines the ALJ’s decision is not supported by substantial evidence 

nor free from reversible error. It is recommended that the district court, after its independent 

review, reverse the decision of the ALJ and remand to the agency for further proceedings.

Pursuant to Federal Rule of Civil Procedure 72(b)(2), any party may serve and file 

written objections within fourteen days of being served with a copy of the Report and 

Recommendation. A party may respond to the other party’s objections within fourteen 

days. No reply brief shall be filed on objections unless leave is granted by the district court. 

If objections are not timely filed, they may be deemed waived.

Dated this 8th day of May, 2020.

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