Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-3_14-cv-08159/USCOURTS-azd-3_14-cv-08159-0/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 

Sandra E. Reichard, 

Plaintiff, 

v. 

Carolyn W. Colvin, 

Defendant.

No. CV-14-08159-PCT-DGC

ORDER 

Plaintiff Sandra E. Reichard 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 was born on July 7, 1964. She left school during the tenth grade and later 

acquired a GED. She has been a convenience-store cashier, a night stocker at a retail 

store, a kennel keeper for a veterinarian, a food handler at a grocery store, and a baker. 

Plaintiff is also a regular smoker. Plaintiff started smoking when she was 12 and now 

smokes a pack or two a day. Sometime after 2008, Plaintiff stopped working. Among 

other ailments, she suffers from shortness of breath and has been diagnosed with chronic 

obstructive pulmonary disease. On September 26, 2010, she applied for disability 

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insurance benefits and supplemental security income, alleging disability beginning 

February 5, 2010. On December 7, 2012, the ALJ held a hearing and Plaintiff appeared 

by video teleconference. Plaintiff’s attorney was present at the hearing and a vocational 

expert testified. On January 10, 2013, the ALJ issued a decision that Plaintiff was not 

disabled within the meaning of the Social Security Act. The Appeals 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) (citing 42 U.S.C. § 405(g)). Substantial evidence is more than a 

scintilla, but less than a preponderance. Id. It is relevant evidence that a reasonable 

person might accept as adequate to support a conclusion. 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). The 

ALJ is responsible for resolving conflicts in medical testimony, determining credibility, 

and resolving ambiguities. Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir. 1995). In 

reviewing the ALJ’s reasoning, the court is “not deprived of [its] faculties for drawing 

specific and legitimate inferences from the ALJ’s opinion.” Magallanes v. Bowen, 881 

F.2d 747, 755 (9th Cir. 1989). 

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 

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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. 20 C.F.R. § 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 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, 2014, and that she has not engaged in 

substantial gainful activity since February 5, 2010. At step two, the ALJ found that 

Plaintiff has the following severe impairments: chronic obstructive pulmonary disease 

(“COPD”), mild degenerative disc disease of the lumbar spine, and compression fracture 

of the thoracic spine. 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 “light work as defined in 20 C.F.R 404.1567(b) and 

416.967(b) except she can frequently climb, stoop, kneel, crouch, crawl, and reach; and 

she has restrictions working around extremes in temperature, with or around chemicals, 

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and around dust/fumes or gases.” A.R. 84-85. The ALJ further found that Plaintiff is 

able to perform her past work as a baker, food handler, and cashier. A.R. 91. For that 

reason, the ALJ found that Plaintiff is not disabled. Id.

IV. Analysis. 

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

in discounting Plaintiff’s pulmonary tests and finding that Plaintiff’s lung condition did 

not meet a listing under which she would be deemed disabled, (2) the ALJ erred in 

rejecting the opinion of Dr. McEleney, a treating physician, in favor of Dr. Brecheisen, 

an examining physician, and (3) the ALJ erred in rejecting the opinions of two nurse 

practitioners. The Court will address each argument below. 

A. Chronic Obstructive Pulmonary Disease. 

Plaintiff argues that the ALJ erred in finding that Plaintiff’s lung condition did not 

meet or medically equal listing 3.02. Under this listing, a person of Plaintiff’s height who 

has a FEV1 – a measure of the volume of air a person can exhale in one second – that is 

less than or equal to 1.15 liters is considered disabled. 20 C.F.R. Pt. 404, Subpt. P, App. 

1. This disability is chronic obstructive pulmonary disease. Id. The ALJ found: 

The claimant’s impairments, considered singly and in combination, do not 

meet or medically equal the criteria of any medical listing, including listing 

3.02. . . . While the record contains pulmonary function tests, these tests 

were all incomplete. Some of the tests suggested poor or inadequate effort 

by the claimant. Thus, these tests are invalid and cannot be used to 

determine whether the COPD meets the criteria of medical listing 3.02. 

A.R. 84 (citations omitted). 

 The ALJ cited numerous tests. Although these tests showed an abnormally low 

FEV1, the testers noted that Plaintiff made an inadequate effort or was unable to 

complete the test. A.R. 361, 495, 568, 574, 616. For example, after recording a FEV1 of 

0.42, one tester noted: 

The above study is not a true representation of the claimants [sic] condition. 

After repeated instruction on how to perform the PFT test adequately, and 

after numerous attempts, the patient still displayed poor effort during the 

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exam. Claimant was unusually interested in her FEV1 number after each 

attempt. . . . I would characterize this claimant as noncompliant with this 

test, even after repeated instruction on how to perform the test properly. 

A.R. 568. The ALJ did not err in rejecting these tests when the testers themselves found 

that the results were questionable. 

Plaintiff criticizes the ALJ for failing to cite or discuss a test that listed Plaintiff’s 

FEV1 as being between 1.07 and 1.14. A.R. 399. But this same test stated: “Caution: 

Only One Acceptable Maneuver – Interpret With Care.” Id. Thus, the test was 

questionable, with the tester specifically urging caution. 

Plaintiff also faults the ALJ for rejecting a test that listed a low FEV1 and that 

stated its results were “acceptable.” A.R. 484. But again, the technician noted that 

Plaintiff gave “inadequate effort.” A.R. 361.1

Plaintiff correctly cites portions of the record that discuss her shortness of breath 

and coughing. A.R. 366, 402, 619. But documented shortness of breath and coughing do 

not prove that Plaintiff has a FEV1 below 1.15, nor do they undermine the ALJ’s reason 

for rejecting the tests. Furthermore, the ALJ reasonably discounted Plaintiff’s allegations 

of shortness of breath based on her continued smoking of up to two packs a day. A.R. 86. 

The ALJ’s conclusion that Plaintiff’s condition did not satisfy listing 3.02 was reasonable 

and based on substantial evidence in the record. See, e.g., Ukolov v. Barnhart, 420 F.3d 

1002, 1006 (9th Cir. 2005) (upholding ALJ’s decision to reject a test that was 

“susceptible to subject manipulation”). 

B. Weighing of Medical Source Evidence. 

Plaintiff argues that the ALJ improperly rejected the medical opinion of Dr. 

Emmett McEleney, M.D. Plaintiff also argues that the ALJ gave too much weight to the 

opinion of Dr. Mark Brecheisen, D.O. 

 

1

 Although the technician’s notes and the results are separated in the record, the notes bear the same date as of the test and record the same spirometer that was used for 

the test. A.R. 361, 484. 

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1. Legal Standard. 

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); see also 20 C.F.R. § 404.1527(c)(2)-(6). 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)). But when the opinion is contradicted by another doctor, 

the ALJ may reject that opinion “for specific and legitimate reasons that are supported by 

substantial evidence in the record.” Id. at 830-31 (citing Andrews, 53 F.3d at 1043). An 

ALJ can meet the “specific and legitimate reasons” standard “by setting out a detailed 

and thorough summary of the facts and conflicting clinical evidence, stating his 

interpretation thereof, and making findings.” Cotton v. Bowen, 799 F.2d 1403, 1408 (9th 

Cir. 1986). “The ALJ must do more than offer his conclusions. He must set forth his 

own interpretations and explain why they, rather than the doctors’, are correct.” Embrey, 

849 F.2d at 421-22. 

2. Dr. Emmett McEleney, M.D. 

Dr. McEleney’s medical opinion was contradicted by the opinion of Dr. Mark 

Brecheisen. For example, Dr. Brecheisen found that Plaintiff would be able to sit, stand, 

or walk for six to eight hours in a workday (A.R. 358), while Dr. McEleney found that 

she could perform these activities for less than two hours in a workday (A.R. 630). 

Because of this contradiction, the ALJ was required to give specific and legitimate 

reasons for rejecting Dr. McEleney’s opinion. Lester, 81 F.3d at 830-31. 

The ALJ discounted Dr. McEleney’s opinion “because it is unsupported by the 

record. Dr. McEleney’s notes do not support the extreme limitations he assessed. His 

notes documented minimal objective findings.” A.R. 90. A discrepancy between a 

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doctor’s notes and his final opinion can be a specific and legitimate reason for rejecting a 

doctor’s opinion. See Bayliss v. Barnhart, 427 F.3d 1211, 1216 (9th Cir. 2005) (finding 

that such a discrepancy is a “clear and convincing reason for not relying on the doctor’s 

opinion”). On July 25, 2011, Dr. McEleney examined Plaintiff and noted that she 

“continues to improve . . . . is progressing with the rehab . . . . [and] says the home 

therapy has yielded significant benefits.” A.R. 560. He also reported that the result of 

the physical examination was “benign findings” and stated that he would see Plaintiff 

again “on an as-needed basis.” Id. On March 19, 2012, Dr. McEleney wrote an opinion 

regarding Plaintiff’s ability to work. A.R. 630. He found that Plaintiff was severely 

limited in her ability to work and that her condition would cause her to be absent from 

work more than three times a month. Id. Dr. McEleney’s “benign findings” and reports 

of progress are inconsistent with this opinion that Plaintiff’s ability to work was severely 

limited. By pointing to this discrepancy, the ALJ gave a specific and legitimate reason 

for rejecting Dr. McEleney’s opinion. 

3. Dr. Mark Brecheisen, D.O. 

Plaintiff argues that the ALJ gave too much weight to the opinions of Dr. 

Brecheisen, the state agency examiner, and the state agency reviewing physician. But as 

already noted, the ALJ may favor the opinion of an examining physician such as Dr. 

Brecheisen over that of a treating physician if the ALJ gives specific and legitimate 

reasons. The ALJ credited Dr. Brecheisen’s opinion, as well as that of the state agency 

physician on the initial review, because it was “consistent with the evidence of [the] 

record, which while documenting a diagnosis of COPD, also showed non-compliance. 

The evidence of record showed that the claimant continued to smoke even though she 

was repeatedly advised to quit smoking. Moreover, the notes showed that she was not 

compliant with medical treatment.” A.R. 91. 

In support of this statement, the ALJ cited portions of the record that document 

Plaintiff’s smoking habits. A.R. 455. The ALJ also relied on Dr. Nakao’s report that 

Plaintiff’s ailments do not have a “significant impact on activities of daily living. The 

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claimant is able to complete self care activities including meals, hygiene, and house 

work. The claimant is able to ambulate without significant limitations throughout the 

day.” A.R. 566. This evidence supports Dr. Brecheisen’s finding that Plaintiff’s ability 

to work was not significantly limited. A.R. 358-59. The ALJ did not err in relying on 

Dr. Brecheisen’s opinion. 

C. The ALJ Did Not Err in Rejecting Nurse Practitioners’ Opinions. 

Plaintiff argues that the ALJ improperly rejected the opinions of nurse 

practitioners Jessee Vanleeuwen-Beloussow and Lisa Workman. As already noted, “[i]n 

order to reject the testimony of a medically acceptable treating source, the ALJ must 

provide specific, legitimate reasons based on substantial evidence in the record.” Molina 

v. Astrue, 674 F.3d 1104, 1111 (9th Cir. 2012). Only licensed physicians and certain 

other qualified specialists are considered “[a]cceptable medical sources.” 20 C.F.R. 

§ 404.1513(a). Nurse practitioners are defined as “other sources,” id. § 404.1513(d), and 

are not entitled to the same deference. Molina, 674 F.3d at 1111. An ALJ may discount 

testimony from nurse practitioners for reasons that are germane to each witness. Id. 

1. Jessee Vanleeuwen-Beloussow, N.P. 

The ALJ rejected Ms. Vanleeuwen-Beloussow’s because “[a]n opinion that is not 

from an acceptable medical source is not entitled to be given the same weight as a 

qualifying medical source opinion. Additionally, the treatment notes do not support the 

limitations she assessed.” A.R. 90. As for the latter reason, the Court is unable to discern 

a discrepancy between Ms. Vanleeuwen-Beloussow’s treatment notes and her opinion of 

Plaintiff’s work capabilities. Compare A.R. 619-20 with A.R. 631. Both the notes and 

opinion concluded that Plaintiff suffers from chronic obstructive pulmonary disease, 

gastroesophageal reflux disease, and idiopathic hypersomnia. These conditions could 

support Ms. Vanleeuwen-Beloussow’s opinion that Plaintiff was severely limited in her 

ability to work. A.R. 631. 

The Court finds, however, that the ALJ could properly reject Ms. VanleeuwenBeloussow’s opinion in favor of Dr. Mark Breschein’s. The ALJ discussed his reliance 

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on Dr. Brecheisen’s opinion (A.R. 91) and, as noted, pointed to substantial evidence in 

support of so doing. An examining physician’s opinion is entitled to more deference than 

that of a nurse practitioner. See SSR 06-03P, 2006 WL 2329939 (S.S.A. Aug. 9, 2006). 

The ALJ therefore did not err in rejecting Ms. Vanleeuwen-Beloussow’s opinion and 

gave germane reasons for so doing.2

 2. Lisa Workman, N.P. 

The ALJ rejected Ms. Workman’s opinion because she “is not an acceptable 

medical source, and she did not indicate any pertinent medical findings to support her 

limitations. . . . Ms. Workman’s notes and the notes from these other specialists do not 

support the extreme limitations she assessed. The treatment records documented minimal 

clinical findings.” A.R. 91. The Court finds some inconsistency between Ms. 

Workman’s notes and the limitations she assessed. In her notes, Ms. Workman 

repeatedly found that Plaintiff has “no difficulty ambulating” (A.R. 458), that Plaintiff’s 

“gait and stance [are] normal” (A.R. 438, 446), and that her “mobility was not limited” 

(A.R. 442). Ms. Workman had also advised Plaintiff to engage in “reg[ular] exercise 

especially on nice weather days with fast walking at the park.” A.R. 443. These findings 

are inconsistent with Ms. Workman’s final conclusion that Plaintiff was unable to stand 

and walk for more than two hours in a workday. A.R. 632. This inconsistency is a 

germane reason for rejecting Ms. Workman’s opinion. Furthermore, as already 

 

2

 Relying on Gomez v. Chater, 74 F.3d 967 (9th Cir. 1996), Plaintiff argues that because Ms. Vanleeuwen-Beloussow worked with a doctor as an “interdisciplinary- team,” her opinion is entitled to the same weight as that of a doctor. But the relevant 

regulations, 20 C.F.R. §§ 404.1513(a) and 416.913(a), have been amended since the 

Gomez decision, and the Commissioner no longer includes “interdisciplinary team,” under the definition of “acceptable medical sources.” See Mack v. Astrue, 918 F. Supp. 2d 975, 983 (N.D. Cal. 2013). Some district courts continue to recognize the vitality of the Gomez rule when the nurse practitioner acts as an agent of a doctor. Id. Here, Ms. 

Vanleeuwen-Beloussow’s notes state that patient care was “provided under direct supervision of Dr. Matheny.” A.R. 620, 832. Ms. Vanleeuwen-Beloussow’s opinion regarding Plaintiff’s ability to work, however, does not indicate Dr. Matheny’s approval or involvement. A.R. 631. Plaintiff has not pointed to other evidence of an agency relationship. The Court finds that the ALJ could properly discount Ms. Vanleeuwen- Beloussow’s opinion for germane reasons. 

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discussed, the ALJ was entitled to give greater deference to the opinion of Dr. 

Brecheisen. 

 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 13th day of April, 2015. 

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