Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_12-cv-00267/USCOURTS-azd-2_12-cv-00267-0/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 

Jennifer Lynn Littlejohn, 

Plaintiff, 

vs. 

Michael J. Astrue, Commissioner of Social 

Security Administration, 

Defendant.

No. CV-12-00267-PHX-NVW

ORDER 

Plaintiff Jennifer Lynn Littlejohn seeks review under 42 U.S.C. § 405(g) of the 

final decision of the Commissioner of Social Security (“the Commissioner”), 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 

A. Factual Background 

Littlejohn was born in July 1972. She has a high school education plus two years 

of college and is able to communicate in English. She worked as an insurance agent for 

thirteen years, but has not worked since June 26, 2009. As a result of degenerative disc 

disease of the lumbar spine, she required surgery in September 2009 for removal of a 

herniated disc and widening of the holes where the nerve roots leave the spinal canal. 

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Littlejohn testified that she continues to have constant back pain, except for brief, 

temporary relief after epidural steroid injections. She also testified that she is able to 

drive and go grocery shopping, but cannot sit or stand in one position for very long. 

B. Procedural History 

On July 20, 2009, Littlejohn applied for disability insurance benefits and 

supplemental security income, alleging disability beginning June 26, 2009. On March 2, 

2011, she appeared with her attorney and testified at a hearing before the ALJ. A 

vocational expert also testified. 

On June 13, 2011, the ALJ issued a decision that Littlejohn was not disabled 

within the meaning of the Social Security Act. The Appeals Council denied Littlejohn’s 

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

Commissioner’s final decision. On February 8, 2012, Littlejohn sought review by this 

Court. 

II. STANDARD OF REVIEW 

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). The 

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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). 

III. FIVE-STEP SEQUENTIAL 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. 20 C.F.R. § 404.1520(a)(4)(i). If so, the claimant is not 

disabled and the inquiry ends. Id. At the 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 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 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 residual functional capacity, 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. 

IV. ANALYSIS 

The ALJ found that Littlejohn meets the insured status requirements of the Social 

Security Act through December 31, 2014, and that she has not engaged in substantial 

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gainful activity since June 26, 2009. At step two, the ALJ found that Littlejohn has the 

following severe impairments: degenerative disc disease of the lumbar spine, status post 

lumbar decompression, and discectomy with radiculopathy. At step three, the ALJ found 

that Littlejohn’s impairments did not meet a listing. At step four, the ALJ found that 

Littlejohn: 

has the residual functional capacity to perform sedentary 

work as defined in 20 CFR 404.1567(a) and 416.967(a) with 

the following limitations: she may occasionally lift and/or 

carry up to 10 pounds and can stand and/or walk up to 6 hours 

in an 8-hour workday. She can sit for up to 6 hours of an 8-

hour workday, but should never climb ladders, ropes, or 

scaffolds. She can occasionally balance, stoop, crouch, kneel, 

and crawl, but should avoid concentrated exposure to 

vibration, hazardous machinery, and unprotected heights. 

Because her previous work as an insurance agent was not sedentary, the ALJ found that 

Littlejohn was unable to perform any past relevant work. At step five, the ALJ 

determined that, considering her age, education, work experience, and residual functional 

capacity, there are jobs that exist in significant numbers in the national economy that 

Littlejohn can perform. 

A. The ALJ Did Not Err in Weighing Medical Source Evidence. 

1. Legal Standard 

In weighing medical source opinions in Social Security cases, the Ninth Circuit 

distinguishes among three types of physicians: (1) treating physicians, who actually treat 

the claimant; (2) examining physicians, who examine but do not treat the claimant; and 

(3) non-examining physicians, who neither treat nor examine the claimant. Lester v. 

Chater, 81 F.3d 821, 830 (9th Cir. 1995). Generally, more weight should be given to the 

opinion of a treating physician than to the opinions of non-treating physicians. Id. A 

treating physician’s opinion is afforded great weight because such physicians are 

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“employed to cure and [have] a greater opportunity to observe and know the patient as an 

individual.” Sprague v. Bowen, 812 F.2d 1226, 1230 (9th Cir. 1987). Where a treating 

physician’s opinion is not contradicted by another physician, it may be rejected only for 

“clear and convincing” reasons, and where it is contradicted, it may not be rejected 

without “specific and legitimate reasons” supported by substantial evidence in the record. 

Lester, 81 F.3d at 830. Moreover, the Commissioner must give weight to the treating 

physician’s subjective judgments in addition to his clinical findings and interpretation of 

test results. Id. at 832-33. 

Further, an examining physician’s opinion generally must be given greater weight 

than that of a non-examining physician. Id. at 830. As with a treating physician, there 

must be clear and convincing reasons for rejecting the uncontradicted opinion of an 

examining physician, and specific and legitimate reasons, supported by substantial 

evidence in the record, for rejecting an examining physician’s contradicted opinion. Id.

at 830-31. 

The opinion of a non-examining physician is not itself substantial evidence that 

justifies the rejection of the opinion of either a treating physician or an examining 

physician. Id. at 831. “The opinions of non-treating or non-examining physicians may 

also serve as substantial evidence when the opinions are consistent with independent 

clinical findings or other evidence in the record.” Thomas, 278 F.3d at 957. Factors that 

an ALJ may consider when evaluating any medical opinion include “the amount of 

relevant evidence that supports the opinion and the quality of the explanation provided; 

the consistency of the medical opinion with the record as a whole; [and] the specialty of 

the physician providing the opinion.” Orn, 495 F.3d at 631. 

Moreover, Social Security Rules expressly require a treating source’s opinion on 

an issue of a claimant’s impairment be given controlling weight if it is well-supported by 

medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent 

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with the other substantial evidence in the record. 20 C.F.R. § 404.1527(d)(2). If a 

treating source’s opinion is not given controlling weight, the weight that it will be given 

is determined by length of the treatment relationship, frequency of examination, nature 

and extent of the treatment relationship, relevant evidence supporting the opinion, 

consistency with the record as a whole, the source’s specialization, and other factors. Id. 

Where there is a conflict between the opinion of a treating physician and an examining 

physician, the ALJ may not reject the opinion of the treating physician without setting 

forth specific, legitimate reasons supported by substantial evidence in the record. Id. at 

632. 

2. Neurosurgeon Brian Fitzpatrick, M.D. 

In August 2009, Littlejohn was referred for urgent back surgery. On September 

10, 2009, Littlejohn consulted with Dr. Fitzpatrick. His notes state that she was “a 

candidate for surgery considering her persistent left lower extremity complaints which 

are consistent with a radiculopathy and considering her imaging studies which do reveal a 

left L5-S1 disk bulge/herniation.” He explained to her that “her symptoms seem 

somewhat out of proportion to the size of the herniated disk” as shown by her August 14, 

2009 MRI scan, and he ordered a repeat MRI scan based on the worsening of her 

symptoms. Dr. Fitzpatrick also noted that he explained to Littlejohn that he was 

“somewhat concerned about her narcotic use” because she had been at “a very high dose 

of narcotics on a daily basis” and had been on daily narcotics for at least 9 months. The 

repeat MRI scan was taken September 16, 2009, and showed no change. On September 

29, 2009, Dr. Fitzpatrick performed her back surgery. 

On January 4, 2010, Dr. Fitzpatrick assessed Littlejohn’s ability to do work-related 

physical activities. He opined that she could occasionally lift and/or carry 20 pounds, 

frequently lift and/or carry less than 10 pounds, stand and/or walk less than 2 hours in an 

8-hour workday, and sit less than 2 hours in an 8-hour workday. He further opined that 

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she must alternate sitting and standing after less than one hour of sitting or standing, she 

could occasionally climb and stoop, frequently balance, and never kneel or crouch. He 

assessed her level of pain as moderate, i.e., pain affects but does not preclude her ability 

to function. He also opined that Littlejohn’s pain was often sufficiently severe enough to 

interfere with attention and concentration and that she often experiences deficiencies of 

concentration, persistence, or pace, resulting in failure to complete tasks in a timely 

manner. 

3. Consultative Examiner Jeffrey Levison, M.D. 

After the administrative hearing, the ALJ ordered a consultative examination and 

review of medical records by Jeffrey Levison, M.D., which Dr. Levison performed on 

April 21, 2011. He observed that Littlejohn had full range of motion about the cervical, 

thoracic, and lumbar spine and was able to bend forward and touch her toes. He also 

opined that Littlejohn could lift and carry up to 20 pounds continually and up to 50 

pounds occasionally; sit, stand, and walk for 8 hours at one time without interruption; 

continuously climb stairs and ramps and balance; frequently kneel, crouch, and crawl; 

occasionally stoop; never climb ladders or scaffolds; and never work at unprotected 

heights or near moving mechanical parts. Dr. Levison noted that he imposed some 

limitations because she was taking sedating medications. 

The ALJ gave substantial weight to Dr. Levison’s opinion, which contradicted Dr. 

Fitzpatrick’s opinion, and minimal weight to Dr. Fitzpatrick’s opinion. The ALJ was 

required to provide specific and legitimate reasons, supported by substantial evidence in 

the record, for rejecting a treating physician’s contradicted opinion. The ALJ stated that 

he was unable to assign more than minimal weight to Dr. Fitzpatrick’s opinion for several 

reasons: (1) it was inconsistent with his own treatment records and other medical 

evidence of record; (2) it reflected Littlejohn’s “condition at a time closely following her 

surgery, rather than a longitudinal view of her ongoing medical impairments and 

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limitations”; and (3) “there is little or no evidence of treatment from this provider 

following surgery.” These reasons are specific and legitimate and supported by 

substantial evidence in the record. 

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

In evaluating the credibility of a claimant’s testimony regarding subjective pain or 

other symptoms, 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). 

First, the ALJ found that Littlejohn’s medically determinable impairments could 

reasonably be expected to cause the alleged symptoms. Second, the ALJ found 

Littlejohn’s statements regarding the intensity, persistence, and limiting effects of the 

symptoms not credible to the extent they are inconsistent with the ALJ’s residual 

functional capacity assessment. 

Littlejohn testified that she had driven to the grocery store two days before the 

administrative hearing and had recently been in a minor hit-and-run car accident when 

she was driving. She also said that her husband usually goes grocery shopping with her, 

but if he is not available, she asks someone at the store to assist her with getting things. 

She said that after her back surgery, her condition improved for a while, but now she is in 

constant pain. She testified that she has no problems getting dressed, but is not able to 

dress her daughter. She said bathing in a bathtub is difficult, but she just has to “move 

around a lot” and “be quick about it.” Littlejohn said she usually takes a bath with her 

daughter. She said she is not able to cook, just get cereal. She said she is not able to do 

household chores except dusting at a level that does not require her to bend over. She 

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said that she reads a lot and reads to her daughter. They go to the park across the street 

and sit on a blanket on the grass. She said she needs to alternate between sitting and 

standing about every 15 minutes. She takes one nap of at least 45-60 minutes during the 

day and spends the rest of the day alternating between sitting and standing. 

In his hearing decision, the ALJ stated that Littlejohn’s complaints of pain after 

her September 29, 2009 lumbar surgery are not corroborated by the post-hearing 

consultative examination, which reported 5/5 muscle strength, normal sensation in the 

upper and lower extremities, negative straight leg raising, no tenderness on palpation, full 

range of spinal motion, and normal tandem gait, hopping, and squatting. The ALJ also 

noted that Littlejohn is able to drive and care for her 4-year-old daughter, grocery shop, 

and do some household chores. The ALJ noted that “the medical evidence appears to 

reveal a potential issue of drug dependence which could serve as motivation for her 

continued complaints to providers” and identified specific references in the record. 

Moreover, the ALJ noted that his overall impression of Littlejohn’s testimony was that 

she was being less than fully credible and possibly underreporting her activities of daily 

living. 

Thus, the ALJ provided specific, clear, and convincing reasons for finding 

Littlejohn’s statements regarding the intensity, persistence, and limiting effects of her 

symptoms not credible to the extent they are inconsistent with the residual functional 

capacity assessment. 

IT IS THEREFORE ORDERED that the final decision of the Commissioner of 

Social Security is affirmed. The Clerk shall enter judgment accordingly and shall 

terminate this case. 

Dated this 11th day of December, 2012. 

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