Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-1_07-cv-00346/USCOURTS-caed-1_07-cv-00346-0/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 (DIWC)

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28 On May 1, 2007, the Honorable Lawrence J. O’Neill reassigned the case to the undersigned Magistrate 1

Judge for all purposes.

1

UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF CALIFORNIA

ANN CAROLYN LONG, )

)

Plaintiff, )

v. )

)

MICHAEL J. ASTRUE, )

Commissioner of Social )

Security, )

)

Defendant. )

)

 )

1:07-cv-00346-SMS

DECISION AND ORDER DENYING

PLAINTIFF’S SOCIAL SECURITY

COMPLAINT (DOC. 8)

ORDER DIRECTING THE ENTRY OF

JUDGMENT FOR DEFENDANT MICHAEL J.

ASTRUE, COMMISSIONER OF SOCIAL

SECURITY, AND AGAINST PLAINTIFF

ANN CAROLYN LONG

Plaintiff is represented by counsel and is proceeding with

an action seeking judicial review of a final decision of the

Commissioner of Social Security (Commissioner) denying

Plaintiff’s application for disability insurance benefits (DIB)

under Title II of the Social Security Act (Act). Pursuant to 28

U.S.C. § 636(c)(1), the parties have consented to the

jurisdiction of the Magistrate Judge to conduct all proceedings

in this matter, including ordering the entry of final judgment.1

The matter is currently before the Court on the parties’ briefs,

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which have been submitted without oral argument to the Honorable

Sandra M. Snyder, United States Magistrate Judge.

I. Procedural History

On February 2, 2004, Plaintiff applied for Disability

Insurance Benefits (DIB), alleging disability since June 10,

2003, due to her sciatic nerve, feeling weak at times, and a

heart condition. (A.R. 64-66, 75.) After Plaintiff’s claim was

denied initially and on reconsideration, Plaintiff requested a

hearing; she appeared with counsel and testified at a hearing

before the Honorable William C. Thompson, Jr., Administrative Law

Judge (ALJ) of the Social Security Administration (SSA), on

January 10, 2006. (A.R. 14, 21-22, 272-95.) On August 10, 2006,

the ALJ denied Plaintiff’s application for benefits. (Id. at 14-

18.) After the Appeals Council denied Plaintiff’s request for

review on January 3, 2007, Plaintiff filed the complaint in this

action on March 2, 2007, and an amended complaint on March 16,

2007. (Id. at 5-7.) Briefing commenced on October 30, 2007, and

was completed on November 8, 2007, with the filing of Defendant’s

opposition.

II. Standard and Scope of Review 

Congress has provided a limited scope of judicial review of

the Commissioner's decision to deny benefits under the Act. In

reviewing findings of fact with respect to such determinations,

the Court must determine whether the decision of the Commissioner

is supported by substantial evidence. 42 U.S.C. § 405(g).

Substantial evidence means "more than a mere scintilla,"

Richardson v. Perales, 402 U.S. 389, 402 (1971), but less than a

preponderance, Sorenson v. Weinberger, 514 F.2d 1112, 1119, n. 10

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(9th Cir. 1975). It is "such relevant evidence as a reasonable

mind might accept as adequate to support a conclusion."

Richardson, 402 U.S. at 401. The Court must consider the record

as a whole, weighing both the evidence that supports and the

evidence that detracts from the Commissioner's conclusion; it may

not simply isolate a portion of evidence that supports the

decision. Robbins v. Soc. Sec. Admin., 466 F.3d 880, 882 (9 Cir. th

2006); Jones v. Heckler, 760 F.2d 993, 995 (9th Cir. 1985). It

is immaterial that the evidence would support a finding contrary

to that reached by the Commissioner; the determination of the

Commissioner as to a factual matter will stand if supported by

substantial evidence because it is the Commissioner’s job, and

not the Court’s, to resolve conflicts in the evidence. Sorenson

v. Weinberger, 514 F.2d 1112, 1119 (9 Cir. 1975). th

In weighing the evidence and making findings, the

Commissioner must apply the proper legal standards. Burkhart v.

Bowen, 856 F.2d 1335, 1338 (9th Cir. 1988). This Court must

review the whole record and uphold the Commissioner's

determination that the claimant is not disabled if the

Commissioner applied the proper legal standards, and if the

Commissioner's findings are supported by substantial evidence.

See, Sanchez v. Secretary of Health and Human Services, 812 F.2d

509, 510 (9th Cir. 1987); Jones v. Heckler, 760 F.2d at 995. If

the Court concludes that the ALJ did not use the proper legal

standard, the matter will be remanded to permit application of

the appropriate standard. Cooper v. Bowen, 885 F.2d 557, 561 (9th

Cir. 1987).

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28 All references are to the 2006 version of the Code of Federal Regulations unless otherwise noted. 2

4

III. Disability

In order to qualify for benefits, a claimant must establish

that she is unable to engage in substantial gainful activity due

to a medically determinable physical or mental impairment which

has lasted or can be expected to last for a continuous period of

not less than twelve months. 42 U.S.C. §§ 416(i), 1382c(a)(3)(A).

A claimant must demonstrate a physical or mental impairment of

such severity that the claimant is not only unable to do the

claimant’s previous work, but cannot, considering age, education,

and work experience, engage in any other kind of substantial

gainful work which exists in the national economy. 42 U.S.C.

1382c(a)(3)(B); Quang Van Han v. Bowen, 882 F.2d 1453, 1456 (9th

Cir. 1989). The burden of establishing a disability is initially

on the claimant, who must prove that the claimant is unable to

return to his or her former type of work; the burden then shifts

to the Commissioner to identify other jobs that the claimant is

capable of performing considering the claimant's residual

functional capacity, as well as her age, education and last

fifteen years of work experience. Terry v. Sullivan, 903 F.2d

1273, 1275 (9 Cir. 1990). th

The regulations provide that the ALJ must make specific

sequential determinations in the process of evaluating a

disability: 1) whether the applicant engaged in substantial

gainful activity since the alleged date of the onset of the

impairment, 20 C.F.R. § 404.1520 (2006); 2) whether solely on the 2

basis of the medical evidence the claimed impairment is severe,

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that is, of a magnitude sufficient to limit significantly the

individual’s physical or mental ability to do basic work

activities, 20 C.F.R. § 404.1520(c); 3) whether solely on the

basis of medical evidence the impairment equals or exceeds in

severity certain impairments described in Appendix I of the

regulations, 20 C.F.R. § 404.1520(d); 4) whether the applicant

has sufficient residual functional capacity, defined as what an

individual can still do despite limitations, to perform the

applicant’s past work, 20 C.F.R. §§ 404.1520(e), 404.1545(a); and

5) whether on the basis of the applicant’s age, education, work

experience, and residual functional capacity, the applicant can

perform any other gainful and substantial work within the

economy, 20 C.F.R. § 404.1520(f).

Here, the ALJ found that Plaintiff had severe impairments of

arthritis of the lumbar spine and right knee, but she did not

have an impairment or combination thereof that met or medically

equaled a listed impairment; Plaintiff retained the residual

functional capacity (RFC) to sit and stand and/or walk for six

hours in an eight-hour workday, with the requirement to change

positions during usual break periods; lift and carry thirty

pounds occasionally and twenty pounds frequently; and stoop,

crouch, and climb ramps or stairs occasionally but never climb

ladders. Plaintiff could perform her past relevant work as an

accounting clerk, and thus Plaintiff was not disabled. (A.R. 16-

18.) 

IV. Residual Functional Capacity

Plaintiff argues that the RFC assigned to Plaintiff was not

supported by substantial evidence; the ALJ erred in giving little

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weight to the opinion of Plaintiff’s treating physician, Dr.

Smith, and in concluding that Plaintiff could perform her past

relevant work of an accounting clerk based on the opinions of

consulting, examining physician Dr. Gable and state agency

medical consultant Dr. John T. Bonner.

A. Medical Records

Plaintiff’s medical records include entries for her cardiac

condition as well as her spine and right knee. Plaintiff does not

raise any issues concerning the ALJ’s findings about her cardiac

condition. Because Plaintiff’s contentions concern only opinions

of medical sources bearing on Plaintiff’s back and knee, the

Court will not refer to the medical record relating solely to

Plaintiff’s cardiac condition.

With respect to Plaintiff’s back and knee problems, an x-ray

of the lumbar spine taken May 20, 2003, revealed discogenic

disease of the fifth and “questionably” the fourth lumbar disc

spaces with facet arthropathy in the lower lumbar region with

minimal anterolisthesis of L4 upon L5; there was no evidence of

spondylolysis or other abnormalities. (A.R. 199.)

An MRI of the lumbar spine taken June 20, 2003, revealed L4-

5 moderately advanced bilateral facet arthropathy with mild

diffuse disc bulge but with no localizing protrusion or foraminal

or canal stenosis; and L5-S1 advanced intervertebral

osteochondrosis, diffuse disc bulge/marginal osteophyte with

facet arthropathy, moderate left and mild right foraminal

stenosis, and no central canal stenosis at any level. (A.R. 133-

34.)

Between November and July 20, 2004, Plaintiff was treated by

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Susie Suh, M.D., with medication and physical therapy for back

and knee pain. Plaintiff generally improved; there was no

vertebral tenderness or positive signs with straight leg raising

in November 2003 (A.R. 175); Plaintiff also had full knee

extension and flexion and full toe/heel walking in November 2003

(A.R. 174). In January 2004, there was no vertebral tenderness,

but the sciatic notch was tender on the right; notes for “neuro”

indicate “full motor”; Plaintiff was to continue with exercise

and medication. (A.R. 173.) In February 2004, Plaintiff

complained that her medications and physical therapy had not

helped; there was no vertebral tenderness or sign on straight leg

raising; forward flex was to knees only. The doctor noted that an

MRI had been done, and there was to be a referral for evaluation.

(A.R. 172.)

On May 8, 2004, consulting examiner Dr. C. E. Gable, who was

board certified in internal medicine, examined Plaintiff and

prepared an internal medicine report. (A.R. 157-59.) Dr. Gable

found that Plaintiff’s muscles were all well developed with no

atrophy. There was no clubbing, cyanosis, or edema in Plaintiff’s

extremities; both knees could be flexed maximally with no

crepitation, and there was no deformity, swelling, or redness;

straight leg raising was negative with sixty-five degrees lying;

Plaintiff walked very slowly across the room but without a limp,

and she reported that she could not walk on her toes because of

back pain. Dr. Gable found that Plaintiff’s neck was supple, and

grip strength and range of motion about her neck and upper

extremities was normal. Plaintiff could anteflex to ninety

degrees but complained of back pain. There was diffuse tenderness

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over the right lumbosacral area but no significant spasm;

extension at the lumber area was possible about zero to twenty

degrees, and lateral flexion about the same. Deep tendon reflexes

were brisk and symmetrical. Dr. Gable’s impression was low back

pain with the eleven-month-old MRI showing intervertebral

osteochondrosis suggesting significant arthritic problems but

certainly not nerve impingement. Although Plaintiff complained of

knee pain, there was no crepitation, deformity, heat, swelling,

or redness about the knees, and both knees could be flexed

maximally without crepitation. Dr. Gable opined that Plaintiff

could sit up to six hours a day with usual breaks; he stated, “I

think certainly that she should be able to move about and stand

up and sit down as necessary.” (A.R. 159.) Plaintiff could stand

and/or walk probably up to six hours a day, but “she did so at

her own pace, stop when she wishes to.” (Id.) She could lift,

push, or pull twenty pounds frequently and thirty pounds

occasionally, with occasional squatting and bending, and only one

flight of stairs at a time.

On June 22, 2004, state agency medical consultant Dr. John

T. Bonner reviewed Plaintiff’s file and documented his opinion.

(A.R. 160-67, 236-39.) He opined that due to Plaintiff’s

degenerative disc disease and arthritis of the lumbar spine, as

well as her hypertension and minimal coronary artery disease,

Plaintiff could lift and/or carry thirty pounds occasionally and

twenty pounds frequently, and she could stand and/or walk with

normal breaks for a total of about six hours in an eight-hour

workday. Plaintiff could sit with normal breaks for a total of

about six hours in an eight-hour work day, but she “must be able

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to move about, stand/walk, and sit as she finds necessary and at

her own pace, but only usual breaks, not additional,” due to back

pain. (A.R. 161.) She could only occasionally stoop, crouch, and

climb stairs and ramps, but never climb a ladder or rope. The

doctor concluded that the severity or duration of the symptoms

was disproportionate to the expected severity or duration on the

basis of Plaintiff’s medically determinable impairments;

subjective symptomatology and limitations on activities of daily

living were not fully supported by the medical evidence of

record, and the fatigue complaints were not supported. (A.R.

165.) The doctor instructed the reader to see the attached

addendum (A.R. 167.) The addendum appears to be at A.R. 236-39,

where the consultation request for June 21, 2004, notes that

Plaintiff would need to be able to change positions and move

about as necessary to relieve back pain, and thus it appeared

that Plaintiff might be considered less than sedentary (i.e., to

have a RFC for less than a sedentary work). (A.R. 239.) Dr.

Bonner wrote that Plaintiff did have low back pain with plain xray and MRI evidence of L5 spondylosis, but it was not that

severe, and there was no radiculopathy. (A.R. 239.) He noted that

just as with Plaintiff’s low back pain, with respect to

Plaintiff’s claimed coronary problems, Plaintiff could do more

than she claimed, and she could “well do light RFC, at least.”

(Id.) 

In June 2004, Plaintiff still felt unable to return to work;

Dr. Suh’s exam revealed no vertebral tenderness and good range of

motion in the knees, with tenderness to palpation at the joint

spaces. Cortisone for the knees and aquatics were prescribed.

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(A.R. 171.)

In July 2004, Dr. Suh found good range of motion of the

right hip with some guarding, no vertebral tenderness in the

back, and no signs at strait leg raising; x-rays were ordered.

(A.R. 170.) X-rays taken on July 21, 2004, of the lumbar spine

revealed severe degenerative loss of disc space at L5-S1 and mild

disc space narrowing at L4-5; other disc spaces were normal; the

impression was lower lumbar facet joint osteoarthritis, stable

grade I anterolisthesis of L4 on L5, and osteopenia. (A.R. 169.)

As to the right hip, there was a negative right hip joint, mild

pelvic enthesopathy, and osteopenia. (Id.)

On September 13, 2004, another state agency medical

consultant affirmed Dr. Bonner’s assessment after a review of it

and of all the evidence in the file. (A.R. 167.)

In April 2005, Plaintiff visited a new treating physician,

Dr. Steven A. Smith, M.D. (A.R. 253.) In May 2005, Dr. Smith

found that Plaintiff’s knees exhibited changes consistent with

bilateral knee arthritis, with full range of motion and bilateral

crepitus with range of motion, but no locking or catching; he

prescribed topical Capsaicin cream and Vicodin 5/500, to be used

sparingly. (A.R. 251.) 

On August 4, 2005, Plaintiff was examined by Dr. Smith for

complaints that included pain in the right knee and hip and

radiating from her right back down the thigh. (A.R. 248-49.) The

musculoskeletal and neurologic exams were noncontributory. There

was no tenderness over the spinous processes, no paraspinous

muscle spasm, full range of motion with flexion, extension, and

rotation, and no costovertebral angle tenderness. Straight leg

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raising was negative; strength in the lower extremity bilaterally

was 5/5. McMurray’s test was positive on the right; there was an

obvious bony deformity of the knees bilaterally, a 1+ effusion on

the left, and a 2+ effusion on the right without increased

warmth. Lachman and posterior drawer testing were negative

bilaterally; there was no instability with valgus or varus

stress. The assessment was right knee osteoarthritis, for which

Vicodin and Advil were prescribed; and right-sided sciatica, for

which Neurontin and Advil were prescribed. (Id.) 

On January 4, 2006, Dr. Smith completed a medical report and

assessment of Plaintiff based on his treatment of her from April

2005 through December 19, 2005, for hip, back, and knee pain.

(A.R. 264-68.) Clinical findings stated by Dr. Smith included a

minimally tender right hip over the posterior; knees crepitant,

4/5 strength, with weakly positive right-sided lift-off test; and

the back was mildly tender over the sciatic notch. (A.R. 264.)

Laboratory findings included an x-ray of the knee that showed a

narrowed joint space consistent with arthritis. The diagnosis was

right sciatica, chronic low back pain, knee arthritis, and

fibromyalgia; treatment was narcotics and NSAIDS. Response to

treatment was fair, as was the prognosis, in which Dr. Smith

stated that Plaintiff needed MRI imaging and orthopedic

evaluation. (A.R. 264.) Plaintiff could lift and carry no more

than ten pounds, which she could lift continuously and

occasionally; Dr. Smith stated that the right shoulder limited

lifting more, and hip and back pain limited carrying. (A.R. 265.)

Plaintiff could sit, stand, and walk eight hours total in an

eight-hour work day, but positional changes were required every

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ten to fifteen minutes due to sciatic pain. (A.R. 266.) Because

of back and intermittent sciatic pain, Plaintiff could never

climb; she could occasionally stoop, crouch, and kneel; reaching,

pushing, and pulling would worsen her sciatica and knee symptoms,

so she could only occasionally reach and push or pull. (A.R.

267.) There were no other restrictions. 

B. Dr. Smith’s Opinion

Plaintiff argues that the ALJ erred in failing to adopt the

opinions of Plaintiff’s treating physicians.

The standards for evaluating treating source’s opinions are

as follows: 

By rule, the Social Security Administration favors

the opinion of a treating physician over

non-treating physicians. See 20 C.F.R. § 404.1527.

If a treating physician's opinion is

“well-supported by medically acceptable clinical

and laboratory diagnostic techniques and is not

inconsistent with the other substantial evidence

in [the] case record, [it will be given]

controlling weight.” Id. § 404.1527(d)(2). If a

treating physician's opinion is not given

“controlling weight” because it is not

“well-supported” or because it is inconsistent

with other substantial evidence in the record, the

Administration considers specified factors in

determining the weight it will be given. Those

factors include the “[l]ength of the treatment

relationship and the frequency of examination” by

the treating physician; and the “nature and extent

of the treatment relationship” between the patient

and the treating physician. Id. § 

404.1527(d)(2)(i)-(ii). Generally, the opinions of

examining physicians are afforded more weight than

those of non-examining physicians, and the

opinions of examining non-treating physicians are

afforded less weight than those of treating

physicians. Id. § 404.1527(d)(1)-(2). Additional

factors relevant to evaluating any medical

opinion, not limited to the opinion of the

treating physician, 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;

the specialty of the physician providing the

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opinion; and “[o]ther factors” such as the degree

of understanding a physician has of the

Administration's “disability programs and their

evidentiary requirements” and the degree of his or

her familiarity with other information in the case

record. Id. § 404.1527(d)(3)-(6).

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

As to the legal sufficiency of the ALJ’s reasoning, the

governing principles have been recently restated:

The opinions of treating doctors should be given more

weight than the opinions of doctors who do not treat

the claimant. Lester [v. Chater, 81 F.3d 821, 830 (9th

Cir.1995) (as amended).] Where the treating doctor's

opinion is not contradicted by another doctor, it may

be rejected only for “clear and convincing” reasons

supported by substantial evidence in the record. Id.

(internal quotation marks omitted). Even if the

treating doctor's opinion is contradicted by another

doctor, the ALJ may not reject this opinion without

providing “specific and legitimate reasons” supported

by substantial evidence in the record. Id. at 830,

quoting Murray v. Heckler, 722 F.2d 499, 502 (9th

Cir.1983). This can be done by setting out a detailed

and thorough summary of the facts and conflicting

clinical evidence, stating his interpretation thereof,

and making findings. Magallanes [v. Bowen, 881 F.2d

747, 751 (9th Cir.1989).] 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 v. Bowen, 849 F.2d 418,

421-22 (9th Cir.1988).

Reddick v. Chater, 157 F.3d 715, 725 (9th Cir.1998);

accord Thomas, 278 F.3d at 957; Lester, 81 F.3d at

830-31.

Orn v. Astrue, 495 F.3d 625, 632 (9 Cir. 2007). th

Here, the ALJ found that Plaintiff could lift and carry

thirty pounds occasionally and twenty pounds frequently; sit and

stand and/or walk for six hours in an eight-hour work day with a

requirement to change positions during usual break periods; and

only occasionally stoop, crouch, and climb ramps or stairs but

never climb ladders. (A.R. 16.) The ALJ noted Dr. Smith’s opinion

of January 2006, which required “positional changes every 10 to

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15 minutes,” (A.R. 17), and he stated:

I give little weight to Dr. Smith’s assessment as there 

is a lack of objective support for the restrictions

given, including support from the doctor’s own 

treatment notes. Dr. Smith wrote that the claimant’s

lifting restriction was the result of a left shoulder

impairment (Exhibit 9F/2). However, an examination of

Dr. Smith’s treatment notes shows no treatment nor 

complaint involving the claimant’s left shoulder

(Exhibit 8F). Also, there is no objective basis for 

a requirement of frequent positional changes. Additionally,

the doctor’s treatment notes contain no imaging of 

the claimant’s knee and back, suggesting that these

conditions were not so severe as to require such action. 

Although testing was performed on the claimant’s heart,

the results were mostly normal, including normal ejection

fraction (Exhibit 8F/19, 21). Dr. Smith wrote that the

claimant had an occasional irregular heartbeat “which

was not severe” and occasional shortness of breath,

which the claimant described as non-severe (Exhibit 8F/14).

I find no necessity to recontact Dr. Smith for clarification

as the claimant’s representative stated at the hearing

that all relevant medical evidence had been submitted.

Another reason to reject Dr. Smith’s opinion is that he 

apparently did not feel the claimant’s condition was 

severe enough to refer the claimant to a specialist

for her back and knee. Furthermore, Dr. Smith’s treatment

notes do no[t] contain any functional limitations. This

omission suggests he did not think that claimant’s

conditions to be so severe as to warn the claimant

not to engage in certain physical activities.

(A.R. 18.)

Here, the ALJ expressed his evaluation that Dr. Smith’s

assessment was inconsistent with the objective medical evidence. 

As the foregoing summary of the medical evidence of record

demonstrates, substantial evidence supported the ALJ’s

evaluation. 

Objective findings concerning Plaintiff’s back were limited

to discogenic disease (lower lumbar facet joint osteoarthritis),

with facet arthropathy absent stenosis at L4-L5, moderate left

and mild right foraminal stenosis at L5-S1, and no central canal

stenosis at any level; the latest films in July 2004 reflected

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only severe loss of disc space at L5-S1 and mild loss at L4-5,

along with stable grade I anterolisthesis of L4 on L5. (A.R. 133-

34, 199.) Dr. Suh’s notes from 2004 reflect essentially mild

signs with no vertebral tenderness or signs on straight leg

raising; there was only tenderness of the sciatic notch on the

right, with full motor function. (A.R. 170-75.) Dr. Bonner opined

that Plaintiff’s subjective claims were not supported by the

medical evidence of record; Plaintiff’s condition at L5 was not

that severe, and there was no radiculopathy. (A.R. 239.) In May

2004, Dr. Gable opined that the MRI findings suggested

significant arthritic problems but not nerve impingement. (A.R.

159.) Dr. Smith’s notes either reflect mild or no findings in

2005, including no tenderness over the spinous processes, no

paraspinous muscle spasms, full range of motion with flexion,

extension, and rotation; negative straight leg raising; and only

one finding of mild paraspinous muscle spasm in the thoracic

spine and more prominent spasm over the trapezius. (A.R. 248-49,

253.)

Objective findings concerning Plaintiff’s knee were likewise

mild. Plaintiff had full knee flexion and extension in November

2003. (A.R. 174.) In May 2004, Dr. Gable encountered knees that

permitted maximal flexion with no crepitation, deformity,

swelling, redness, or limp; the MRI findings suggested

significant arthritic problems but not nerve impingement. (A.R.

159.) In June 2004, Dr. Suh found good range of motion in the

knees, with tenderness to palpation at the joint spaces. (A.R.

171.) Dr. Smith found full range of motion with bilateral

crepitus but without locking or catching, and unspecified changes

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consistent with bilateral knee arthritis in April 2005. (A.R.

251.) In August 2005, Dr. Smith found lower extremity strength of

5/5 bilaterally; although he found McMurray’s test positive on

the right, with a bony deformity and effusions without increased

warmth, he also found Lachman and posterior drawer testing

negative bilaterally with no instability with valgus or varus

stress. (A.R. 248-49.)

In summary, the record contains substantial evidence

supporting the ALJ’s characterization of the objective medical

evidence of record as not supporting Dr. Smith’s restrictions.

The SSA will generally give more weight to an opinion to the

extent that it is more consistent with the record as a whole. 20

C.F.R. § 404.1527(d)(4). 

It is established that it is appropriate for an ALJ to

consider the absence of supporting findings, and the

inconsistency of conclusions with the physician’s own findings,

in rejecting a physician’s opinion. Johnson v. Shalala, 60 F.3d

1428, 1432-33 (9 Cir. 1995); Matney v. Sullivan, 981 F.2d 1016, th

1019 (9th Cir. 1992); Magallanes v. Bowen, 881 F.2d 747, 751 (9th

Cir. 1989). A conclusional opinion that is unsubstantiated by

relevant medical documentation may be rejected. See Johnson v.

Shalala, 60 F.3d 1428, 1432-33 (9 Cir. 1995). th

Here, the ALJ also relied on the lack of findings within Dr.

Smith’s own notes that would support Dr. Smith’s restrictions.

(A.R. 17.) Again, Dr. Smith’s findings were essentially mild. His

own findings stated as the basis for his restrictions were

minimal or mild tenderness over the right hip and sciatic notch,

and crepitus, slightly diminished strength, a weakly positive

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lift-off test, and reference to an x-ray indicating narrowed

joint space consistent with arthritis of the knees. The ALJ’s

reliance was reasonable, particularly in light of the absence of

the doctor’s process of reasoning from the mild findings to an

assessment of inability to perform even sedentary work. The SSA

will consider the supportability of an opinion; the more a source

presents relevant evidence to support an opinion, particularly

medical signs and laboratory findings, or the better the source

explains the opinion, the more weight the opinion will be given.

20 C.F.R. § 404.1527(d)(3). The ALJ considered the extent to

which the treating physician’s opinion was consistent with the

medical evidence, and he stated specific and legitimate reasons,

supported by substantial evidence in the record, for placing less

weight on Dr. Smith’s opinion.

The ALJ specifically noted the lack of record support for

Dr. Smith’s imposing a limitation on lifting based on Plaintiff’s

left shoulder impairment, noting that Dr. Smith’s treatment notes

did not reflect complaint or treatment for the left shoulder.

(A.R. 17-18.) Substantial evidence does not support this finding.

Dr. Smith limited Plaintiff’s lifting and stated that there was

no left shoulder impairment, but that the right shoulder limited

lifting. (A.R. 265.) A treatment note from April 5, 2005,

reflects a reference to the right or bilateral shoulder (the

character is unclear), with an arrow pointing to the word “trap,”

followed by the words “muscle strain.” (A.R. 254.) Further, a

prominent thoracic spasm was noted over the trapezius up into the

neck musculature. (A.R. 253.) Because this reason is not

supported by substantial evidence, the Court will not address

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Plaintiff’s additional contention that observations concerning

the shoulder are not significant because it is Plaintiff’s knee

and/or spinal impairments that are or were being considered.

However, in view of the ALJ’s statement of multiple specific,

legitimate reasons that were supported by substantial evidence,

the weakness of this particular reasoning is not dispositive.

The ALJ also drew inferences from the nature of Dr. Smith’s

treatment of Plaintiff, concluding that his failure to refer

Plaintiff to a specialist for her back and knee, and his lack of

any imaging results regarding Plaintiff’s knee and back,

warranted an inference that Dr. Smith did not consider

Plaintiff’s impairment to be so severe as to warrant his

functional assessment, and/or that Plaintiff’s impairment was not

as severe as Dr. Smith assessed. (A.R. 18.) 

An ALJ is entitled to draw inferences logically flowing from

the evidence. Sample v. Schweiker, 694 F.2d 639, 642 (9 Cir. th

1982). The ALJ had noted in connection with his rejection of

Plaintiff’s subjective complaints of disabling pain that there

were significant gaps in Plaintiff’s history of treatment. (A.R.

17.) The ALJ further relied on the absence of any diagnostic

work-up of Plaintiff’s allegedly disabling back and knee

impairments. The record reveals that Plaintiff was referred to

numerous specialists during the ten months covered by Dr. Smith’s

treatment notes, including a cardiologist in April 2005 (A.R.

260-62); an ear, nose, and throat specialist for dryness in her

throat and heartburn in May 2005 (A.R. 259-60); a radiologist for

an esophagram in June 2005 (A.R. 255); and specialists for an

echocardiogram and treadmill tests in August 2005 (A.R. 256-58). 

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In contrast, despite Plaintiff’s complaints of constant pain

associated with her back and knees, the doctor did not refer

Plaintiff to an orthopedist or to specialists for diagnostic

studies; it was not until he actually reported Plaintiff to be

unable to engage even in sedentary work in January 2006, some ten

months after his first visit from Plaintiff, that he first even

adverted to the need for diagnostic tests or specialists’

assessments by stating that Plaintiff needed MRI imaging and an

orthopedic evaluation. (A.R. 264.)

In light of the marked contrast between Dr. Smith’s handling

of Plaintiff’s conditions involving her throat, digestion, and

various aspects of Plaintiff’s cardiovascular condition, and the

doctor’s handling of Plaintiff’s back and knee impairments, it

was reasonable for the ALJ to draw the inference that the latter

impairments were not sufficiently serious, or considered

sufficiently serious, to merit follow-up from specialists or to

warrant precise diagnostic information, and thus were not

disabling. 

In addition, the familiarity of a physician with the

claimant’s medical condition is pertinent to the evaluation of an

opinion. Factors considered in evaluating the treatment

relationship include the extent of knowledge the medical source

has about the impairment, the treatment provided, and the kinds

and extent of examinations and testing ordered or performed by

the source or by specialists and independent laboratories. It is

only when a treating source has reasonable knowledge of the

impairments that the SSA will give the source’s opinion more

weight than if it were from a nontreating source. 20 C.F.R. §

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404.1527(d)(2)(ii). 

Here, the only evidence concerning any diagnostic imaging

that had occurred by the time Dr. Smith rendered the opinion in

question is a reference in Dr. Smith’s summary of Plaintiff’s

visit of May 3, 2005. There it is stated in the context of knee

complaints that Plaintiff reported that she was diagnosed in the

past with an x-ray six months before as having osteoarthritis for

which Ben Gay and commercial Icy Hot patches had provided relief.

(A.R. 251.) No party cites to evidence that Dr. Smith had, or

attempted to obtain copies of, previous reports or images, and

the Court is aware of no such evidence. The fact that Plaintiff

reported a past diagnosis of the general condition of

osteoarthritis in her knees did not give Dr. Smith the same

specificity, degree, and depth of knowledge about Plaintiff’s

condition as would have been imparted by appropriate diagnostic

testing and examination and evaluation by an orthopedic

specialist. The ALJ’s reasoning in this regard was specific and

legitimate and was supported by substantial evidence in the

record.

Further, the ALJ appropriately considered the treatment

given to Plaintiff by Dr. Smith, who basically provided

medication but did not impose any detailed functional limitations

on Plaintiff. Plaintiff testified that her doctor restricted her

from climbing or walking up a steep incline; she took Vicodin

once or twice daily and had to rest at least twice daily, but

even with the side-effects of her medication, she nevertheless

was able to dust, wipe the counters, cook with her husband’s

help, do some laundry-related tasks, shop for ten to fifteen

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minutes, walk five or ten minutes in front of her house, and sit

for thirty or forty minutes if allowed to shift. (A.R. 283-91.)

In view of Plaintiff’s testimony regarding her daily activities,

it was significant that her treating physician had not warned her

about the many activities that he stated would exacerbate the 

symptoms of her condition. For example, Dr. Smith stated that

with respect to postural activities, more than occasional

reaching, pushing, or pulling would worsen Plaintiff’s sciatica

and her knee symptoms. (A.R. 267.) Further, back pain and

intermittent sciatic pain were listed as the medical findings

that supported his limitation of only occasional stooping,

crouching, and kneeling. (A.R. 267.) The absence of these

restrictions, when considered in the context of the entire

record, warranted an inference that Plaintiff’s condition was not

severe enough to warrant restrictions. 

The ALJ stated that there was no objective basis for a

requirement of frequent positional changes. (A.R. 18.) In this

case, the ALJ expressly found that Plaintiff’s subjective

complaints of disabling limitations were not fully credible or

substantiated by medical evidence and consistent with the record

as a whole, and that Plaintiff could perform light work. (A.R. at

24-25.) Plaintiff does not mount a proper, legal challenge to the

sufficiency of the evidence supporting this finding or the

adequacy of the ALJ’s reasons given to explain the finding; there

is no heading or direct assertion in Plaintiff’s brief concerning

such issues. 

Plaintiff does state that the MRI of Plaintiff’s lumbar

spine, which showed moderately advanced bilateral facet

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arthropathy at L4-5 and intervertebral osteochondrosis with facet

arthropathy and moderate left and mild right foraminal stenosis,

is an objective basis from which the Plaintiff’s subjective

complaints can be gleaned, and determination of credibility be

found. However, it is not the role of this Court to redetermine

Plaintiff’s credibility de novo; although evidence supporting an

ALJ’s conclusions might also permit an interpretation more

favorable to the claimant, if the ALJ’s interpretation of

evidence was rational, this Court must uphold the ALJ’s decision

where the evidence is susceptible to more than one rational

interpretation. Burch v. Barnhart, 400 F.3d 676, 680-81 (9 Cir. th

2005). The review that this Court undertakes is not to discern

some evidence that might have tended to support a conclusion

contrary to the ALJ’s; rather, the Court is to review the

reasoning of the ALJ to determine whether the ALJ’s decision was

rendered pursuant to appropriate legal standards and was

supported by substantial evidence. Batson v. Commissioner of the

Social Security Administration, 359 F.3d 1190, 1196 (9 Cir. th

2004). 

Thus, the Court considers the ALJ’s unchallenged credibility

findings to be binding. The Court notes that the ALJ provided 

specific, cogent, clear, and convincing reasons for rejecting

specifically described subjective complaints of back and knee

pain, weakness, and inability to sit without pain. (A.R. at 17.) 

The fact that an opinion is based primarily on the patient’s

subjective complaints may be properly considered. Matney on

Behalf of Matney v. Sullivan, 981 F.2d 1016, 1020 (9 Cir. 1992). th

Where a treating source’s opinion is based largely on the

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Plaintiff’s own subjective description of his or her symptoms,

and the ALJ has discredited the Plaintiff’s claim as to those

subjective symptoms, the ALJ may reject the treating source’s

opinion. Fair v. Bowen, 885 F.2d 597, 605 (9 Cir. 1989). Thus, th

the ALJ’s reliance here on the lack of objective evidence, as

distinct from subjective claims, with respect to the extent and

severity of Plaintiff’s functional limitations, was reasonable.

As previously detailed, the record contains substantial

evidence supporting the ALJ’s determination that there was a lack

of objective evidence supporting the nature and extent of the

limitations placed on Plaintiff. Although there may have been

some evidence that Plaintiff had an impairment that could produce

some limitations, the ALJ considered appropriate factors, 

properly weighed the opinion of Dr. Smith, and concluded that

there was an absence of objective evidence supporting limitations

as extreme as those imposed by Dr. Smith, which the VE testified

would result in an absence of work that could be performed. (A.R.

292-94.) In the present case, it was appropriate and adequate for

the ALJ to determine that the level of impairment stated was

unreasonable in light of the symptoms and other evidence in the

record, and to set forth that analysis. See, Morgan v.

Commissioner of Social Security 169 F.3d 595, 601 (9 Cir. 1999). th

C. Dr. Gable’s Opinion

Plaintiff argues that the opinion of Dr. Gable was

consistent with Dr. Smith’s opinion with respect to Plaintiff’s

RFC, and that the ALJ’s ultimate conclusion lacked the support of

substantial evidence in the record.

Consulting examiner Dr. Gable did conclude that Plaintiff

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could sit up to six hours a day with usual breaks; he stated

immediately thereafter, “I think certainly that she should be

able to move about and stand up and sit down as necessary.” (A.R.

159.) The ALJ characterized Dr. Gable’s opinion as finding that

Plaintiff could sit for six hours with usual breaks and stand

and/or walk for six hours in an eight-hour day. (A.R. 17.) He

omitted the language concerning position changes as necessary. 

The ALJ then stated the opinion of state agency consultant

Dr. Bonner, to the effect that Plaintiff could sit for six hours

and stand and/or walk for six hours “with position changes during

usual breaks.” (A.R. 17.) The ALJ then stated that he gave

substantial weight to these opinions as they were consistent with

each other and consistent with the treatment record.

Plaintiff points to the fact that the opinions of Drs. Gable

and Bonner were inconsistent with respect to the need for a

sit/stand option outside of normal or usual breaks. If the ALJ’s

characterization of the opinions as stated on page 17 of the

administrative record is the only part of the decision

considered, then it could be inferred that the ALJ misunderstood

the opinion of Dr. Gable or used faulty reasoning. 

However, the Court will consider the entire decision, which

includes the ALJ’s more detailed review of the RFC assessment

made by Dr. Smith, in which the ALJ expressly adverted to Dr.

Smith’s conclusion that Plaintiff could sit and stand and/or walk

for eight hours in an eight-hour work day “with positional

changes every 10 to 15 minutes.” (A.R. 17.) The ALJ expressly

rejected the assessment for lack of objective support; he clearly

stated that there was no objective basis for a requirement of

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frequent positional changes. (A.R. 17-18.) As previously

detailed, substantial evidence supported this conclusion. The

Court agrees with Defendant, who notes that it is reasonable to

apply the ALJ’s reasoning regarding the limitation stated by Dr.

Smith to the same limitation stated by Dr. Gable. The Court may

draw specific and legitimate inferences from the ALJ’s reasons

for rejecting one doctor’s limitation and impute those reasons to

the ALJ’s rejection of another doctor’s similar limitation. See,

Magallanes v. Bowen, 881 F.2d 747, 755 (9 Cir. 1989). Here, it th

is clear that the ALJ considered the more restrictive RFC in

light of the entire record and found that it was without

objective support; absent the proviso about the sit/stand option,

the opinions of Drs. Gable and Bonner were essentially consistent

with respect to Plaintiff’s capacity to sit, stand, walk, as the

ALJ noted. 

Further, it is clear that the ALJ relied on the opinion of

state agency medical consultant Dr. Bonner, correctly

characterizing Dr. Bonner’s assessed RFC as permitting sitting

for six hours and standing and/or walking for six hours in an

eight-hour work day with position changes during usual breaks.

(A.R. 17.)

Plaintiff speculates that the handwriting on the RFC

assessment of the state agency physician, which states that only

usual, and not additional, breaks were required for positional

changes, was added as an afterthought. (Brief at p. 10; A.R.

161.) However, the addendum concerning the consultation request

makes it clear that Dr. Bonner had carefully considered the

totality of the evidence summarized in the consultation request

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and had concluded that Plaintiff’s need to make any positional

changes could be accommodated with normal or usual breaks. (A.R.

236-39.)

D. Dr. Bonner’s Opinion 

Plaintiff argues that the opinion of Dr. Bonner does not

constitute substantial evidence to support the ALJ’s conclusion

that Plaintiff could sit and stand and/or walk for six hours with

the need for position changes only during usual breaks. Plaintiff

contends that the opinion of Dr. Bonner cannot constitute

substantial evidence because it was based on the very same

clinical findings upon which the conflicting opinion of the

treating physician was based.

An ALJ may disregard a treating physician’s opinion that is

controverted by other opinions only by setting forth specific,

legitimate reasons for doing so that are based on substantial

evidence in the record. Rodriguez v. Bowen, 876 F.2d 759, 762 (9th

Cir. 1989). This burden is met by stating a detailed and thorough

summary of the facts and conflicting clinical evidence, stating

the interpretation of the evidence, and making findings. Cotton

v. Bowen, 799 F.2d 1403, 1408 (9 Cir 1986). The opinion of an th

examining physician is entitled to greater weight than the

opinion of a nonexamining physician. Lester v. Chater, 81 F.3d

821, 830 (9 Cir. 1995). The uncontradicted opinion of an th

examining physician may be rejected only if the Commissioner

provides clear and convincing reasons for rejecting it. Id.;

Edlund v. Massanari, 253 F.3d 1152, 1158-59 (9 Cir. 2001). An th

ALJ can reject the opinion of an examining physician and adopt

the contradictory opinion of a nonexamining physician only for

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specific and legitimate reasons that are supported by substantial

evidence in the record. Moore v. Commissioner of Social Security

Administration, 278 F.3d 920, 925 (9 Cir. 2002) (quoting Lester th

v. Chater, 81 F.3d at 830-31). 

The opinion of a nontreating, nonexamining physician can

amount to substantial evidence as long as it is supported by

other evidence in the record, such as where it is consistent with

independent clinical findings or other evidence in the record,

Thomas v. Barnhart, 278 F.3d 947, 957 (9 Cir. 2002). The opinion th

of a non-examining doctor that conflicts with a treating doctor’s

opinion may constitute substantial evidence warranting rejection

of the treating doctor’s opinion where the non-examining doctor’s

opinion is based on opinions of other examining and consulting

physicians, which are in turn based on independent clinical

findings. Andrews v. Shalala, 53 F.3d 1035, 1041 (9 Cir. 1995). th

Independent clinical findings can be either 1) diagnoses that

differ from those offered by another physician and that are

supported by substantial evidence, or 2) findings based on

objective medical tests that the other physician has not himself

or herself considered. Orn v. Astrue, 495 F.3d at 632. 

 Here, the record contains the consultation request of June

21, 2004, to which Dr. Bonner’s evaluation and report responded.

The request details the underlying data which Dr. Bonner

considered, which included the x-rays of the lumbar spine from

May 2003, the MRI from June 2003, and Dr. Gable’s internal

medicine examination and report from May 2004. (A.R. 236-39.) It

is clear that Dr. Bonner’s opinion was based on the opinions of

another examining physician as well as clinical findings that

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appear from the record to be independent from those relied on by

Dr. Smith. There is no evidence that Dr. Smith had any of these

underlying data to consider or that he considered any such data

in reaching his opinion. The Court thus concludes that Dr.

Bonner’s opinion constituted substantial evidence supporting the

ALJ’s conclusions concerning Plaintiff’s RFC.

V. Disposition

Based on the foregoing, the Court concludes that the ALJ’s

decision was supported by substantial evidence in the record as a

whole and was based on the application of correct legal

standards. 

Accordingly, the Court AFFIRMS the administrative decision

of the Defendant Commissioner of Social Security and DENIES

Plaintiff’s Social Security complaint.

The Clerk of the Court IS DIRECTED to enter judgment for

Defendant Michael J. Astrue, Commissioner of Social Security, 

and against Plaintiff Ann Carolyn Long.

IT IS SO ORDERED.

Dated: February 29, 2008 /s/ Sandra M. Snyder 

icido3 UNITED STATES MAGISTRATE JUDGE

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