Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-3_05-cv-00972/USCOURTS-azd-3_05-cv-00972-0/pdf.json

Nature of Suit Code: 865
Nature of Suit: Social Security - RSI (405(g))
Cause of Action: 42:205 Denial Social Security Benefits

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WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

DAVID D. STOKES, )

)

Plaintiff, ) 

) No. CIV 05-972 PCT RCB

vs. ) 

) O R D E R

JO ANNE B. BARNHART, )

Commissioner of Social )

Security )

)

Defendant. ) )

On March 31, 2005, Plaintiff David D. Stokes filed the

above-entitled action pursuant to 42 U.S.C. §§ 405(g) and

1383(c)(3) for judicial review of a final decision of the

Commissioner of Social Security (the "Commissioner") denying his

applications for supplemental security income under Title XVI of

the Social Security Act (the "Act") and disability insurance

benefits under Title II of the Act. Compl. (doc. # 1). Currently

pending before the Court are Plaintiff's motion for summary

judgment (doc. # 8) and Defendant's cross-motion for summary

judgment (doc. # 18). The Court finds the matter suitable for 

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decision without oral argument. See LRCiv 7.2(f), 56.1(b). Having

carefully considered the arguments raised, the Court now rules.

I. BACKGROUND

On April 11, 2002, Plaintiff filed applications for

supplemental security income under Title XVI of the Act and

disability insurance benefits under Title II of the Act, alleging

an onset date of July 10, 2000. See Admin. R. (doc. ## 8A, 8B)

(collectively "Admin. R.") at 71-73, 439-41. The primary

impairments complained of included lower back pain, depression, and

breathing problems. Id. at 487-507. Plaintiff's applications were

denied initially and on reconsideration. Id. at 30-33, 35-38, 437-

38. Plaintiff timely sought review by an administrative law judge

("ALJ"), id. at 39-40, who held a hearing on October 19, 2004, id.

at 15. Plaintiff, represented by counsel, appeared and testified

at that hearing as did a vocational expert. Id. at 482-519.

Other evidence in the record included, inter alia, (1) a

Mental Impairment Questionnaire dated April 30, 2004 by mental

health therapist Kimberly Kelsey, (2) a Physical Residual

Functional Capacity Questionnaire dated March 26, 2004 signed by

Stephanie Duensing, M.D. and nurse practitioner Thomas Bast (the

"RFC Questionnaire"), (3) a polysomnogram report dated November 8,

2002 by Jeffrey Arnold, M.D., (4) a consultative examination report

dated October 31, 2002 by Robert Barker, II, M.D., (5) a

Psychiatric Review Technique Form dated July 31, 2002 by Jane

George, Ph.D., and (6) a Psychological Evaluation dated July 26,

2002 by Carl Mansfield, Ph.D. Id. at 305-41, 359-64, 416-31.

On November 22, 2004, the ALJ issued a decision finding that

Plaintiff was not disabled within the meaning of the Act. Id. at

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15-24. After discounting Plaintiff's testimony, the RFC

Questionnaire, and the Mental Impairment Questionnaire, the ALJ

determined that Plaintiff retains the residual functional capacity

to engage in other gainful work that exists in significant numbers

in the national economy. Id.

On February 11, 2005, the Appeals Council of the Social

Security Administration (the "SSA") denied Plaintiff's request for

a review of the ALJ's decision. Id. at 7-9. At that point, the

decision of the ALJ became the final decision of the Commissioner. 

See 20 C.F.R. § 404.981; Tackett v. Apfel, 180 F.3d 1094, 1097 (9th

Cir. 1999). In accordance with 42 U.S.C. § 405(g), Plaintiff

sought review in this Court.

II. STANDARD OF REVIEW

A. Fed. R. Civ. P. 56

Summary judgment is appropriate "when there is no genuine

issue of material fact" such that "the moving party is entitled to

judgment as a matter of law." Fed. R. Civ. P. 56. In determining

whether to grant summary judgment, a district court must view the

underlying facts and the inferences to be drawn from those facts in

the light most favorable to the nonmoving party. See Matsushita

Elec. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986).

If a party will bear the burden of proof at trial as to an

element essential to its claim, and fails to adduce evidence

establishing a genuine issue of material fact with respect to the

existence of that element, then summary judgment is appropriate. 

See Celotex Corp. v. Catrett, 477 U.S. 317, 322-23 (1986). Not

every factual dispute is capable of defeating a properly supported

motion for summary judgment. Rather, the party opposing the motion

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must show that there is a genuine issue of material fact. See

Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48 (1986). A

factual dispute is genuine if the evidence is such that a rational

trier of fact could resolve the dispute in favor of the nonmoving

party. Id. at 248. A fact is material if determination of the

issue might affect the outcome of the case under the governing

substantive law. Id. Thus, a party opposing a motion for summary

judgment cannot rest upon bare allegations or denials in the

pleadings, but must set forth specific facts demonstrating a

genuine issue for trial. See id. at 250. If the nonmoving party's

evidence is merely colorable or not significantly probative, a

court may grant summary judgment. See id. at 249; see also Cal.

Architectural Build. Prods., Inc. v. Franciscan Ceramics, 818 F.2d

1466, 1468 (9th Cir. 1987).

Finally, the fact that both parties have moved for summary

judgment does not alter these standards. "It is well settled that

a court's duty to ascertain whether facts remain in contention is

not obviated by cross motions for summary judgment." Eby v. Reb

Realty, Inc., 495 F.2d 646, 649 (9th Cir. 1974).

B. 42 U.S.C. §§ 405(g), 1383(c)(3)

The Commissioner's denial of benefits is subject to judicial

review pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3). The

decision of the Commissioner must be affirmed if it is supported by

substantial evidence and the Commissioner applied the correct legal

standards. Bayliss v. Barnhart, 427 F.3d 1211, 1214 n.1 (9th Cir.

2005); Benton v. Barnhart, 331 F.3d 1030, 1035 (9th Cir. 2003);

Tackett, 180 F.3d at 1097; Reddick v. Chater, 157 F.3d 715, 720

(9th Cir. 1998). Factual determinations by the Commissioner,

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acting through an ALJ, must be affirmed if supported by substantial

evidence. See Celaya v. Halter, 332 F.3d 1177, 1180 (9th Cir.

2003); Saelee v. Chater, 94 F.3d 520, 521 (9th Cir. 1996).

Substantial evidence is "such relevant evidence as a

reasonable mind might accept as adequate to support a conclusion." 

Richardson v. Perales, 402 U.S. 389, 401 (1971). It is more than a

"mere scintilla," but less than a preponderance. Richardson, 402

U.S. at 401 (1971) (internal quotations omitted); Connett v.

Barnhart, 340 F.3d 871, 873 (9th Cir. 2003); Tackett, 180 F.3d at

1098; Reddick, 157 F.3d at 720; Sorenson v. Weinberger, 514 F.2d

1112, 1119 n.10 (9th Cir. 1975).

 In reviewing the Commissioner's decision, the district court

must "consider the evidence as a whole, weighing both the evidence

that supports and the evidence that detracts from the

Commissioner's conclusion." Smolen v. Chater, 80 F.3d 1273, 1279

(9th Cir. 1996). If the evidence can reasonably support either

affirming or reversing the Commissioner’s conclusion, the district

court may not substitute its judgment for that of the Commissioner

and must affirm. See McCartey v. Massanari, 298 F.3d 1072, 1075

(9th Cir. 2002); Tackett, 180 F.3d at 1098; Reddick, 157 F.3d at

720; Andrews v. Shalala, 53 F.3d 1035, 1039-40 (9th Cir. 1995).

III. DISCUSSION

A person is considered disabled under the Act when he or she

becomes unable "to engage in any substantial gainful activity by

reason of any 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. §§ 423(d)(1)(A),

1382c(a)(3)(A). In an administrative proceeding to determine

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eligibility for supplemental security income or disability

insurance benefits, the Commissioner conducts a five-step

sequential evaluation process to determine whether a claimant is

disabled within the meaning of the Act. See 20 C.F.R. §

404.1520(b)-(f). If at any of those five steps the Commissioner

can find the claimant disabled or not, the inquiry ends. 20 C.F.R.

§ 404.1520(a).

In this case, Plaintiff was found "not disabled" at the fifth

stage of the sequential evaluation process when the ALJ determined

that Plaintiff retains the residual functional capacity to engage

in other gainful work that exists in significant numbers in the

national economy. Admin. R. at 21-24; 20 C.F.R. § 404.1520(f). 

Plaintiff argues that the ALJ erred by (1) not giving sufficient

weight to his testimony regarding his pain, (2) not giving

sufficient weight to the RFC Questionnaire signed by Dr. Duensing

and nurse practitioner Bast, (3) not giving sufficient weight to

the Mental Impairment Questionnaire by mental health therapist

Kimberly Kelsey, (4) relying on the Medical-Vocational Guidelines

to analyze his occupational base, (5) not developing the record by

ordering a consultative examination, and (6) ultimately determining

that Plaintiff retains the residual functional capacity to engage

in medium work. The Court considers each argument in turn.

A. Plaintiff's Testimony Regarding His Pain

Plaintiff argues that the ALJ should have considered his

subjective complaints of pain in the disability determination

process and improperly discredited his testimony without setting

forth a sufficient basis for doing so. Pl.'s Mem. in Supp. (doc. #

11) at 8-11. In interpreting the Act, the Ninth Circuit has held

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that a claimant's pain testimony should be considered in the

disability determination process "so long as the pain is associated

with a clinically demonstrated impairment." Howard v. Heckler, 782

F.2d 1484, 1488 n.4 (9th Cir. 1986). It is undisputed in this case

that the pain of which Plaintiff complains is associated with a

clinically demonstrated impairment. Instead, the Commissioner

contends that the ALJ properly discredited Plaintiff's testimony

based on the reasons set forth in the decision. Def.'s Mem. in

Supp. (doc. # 20) at 10.

The ALJ cannot discount a claimant's subjective complaints of

excess pain without making specific findings regarding the

claimant's credibility. Morgan v. Comm'r of the Soc. Sec. Admin.,

169 F.3d 595, 599 (9th Cir. 1999); Johnson v. Shalala, 60 F.3d

1428, 1433 (9th Cir. 1996). These findings must be based on clear

and convincing reasons that are supported by substantial evidence

in the record as a whole. Johnson, 60 F.3d at 1433. "Clear and

convincing" reasons to reject a claimant's credibility may include

internal inconsistencies in the claimant's testimony, Light v. Soc.

Sec. Admin., 119 F.3d 789, 792 (9th Cir. 1997), "the claimant's

reputation for lying, prior inconsistent statements concerning the

symptoms, and other testimony by the claimant that appears less

than candid; unexplained or inadequately explained failure to seek

treatment or to follow a prescribed course of treatment; and the

claimant's daily activities," Smolen, 80 F.3d at 1284. In

evaluating the claimant's credibility, the ALJ must also consider

the "location, duration, frequency, and intensity of the

[claimant's] pain or other symptoms," any precipitating and

aggravating factors, and the "type, dosage, effectiveness, and side

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1

 Because Social Security Ruling 96-7p is a reasonable

interpretation of 20 C.F.R. §§ 404.1529 and 416.929 to which this

Court owes deference, see Chevron U.S.A., Inc. v. Natural Res. Def.

Counsel, Inc., 467 U.S. 837, 842-43 (1984), the Commissioner's

interpretive commentary is controlling.

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effects of any medication the [claimant] takes or has taken to

alleviate pain or other symptoms." SSR 96-7p.1 The ALJ cannot,

however, discredit a claimant's pain testimony based solely on a

lack of corroborating medical evidence. Bunnel v. Sullivan, 947

F.2d 341, 345 (9th Cir. 1991) (en banc); Cotton v. Bowen, 799 F.2d

1403, 1407 (9th Cir. 1986) ("'Excess pain' is, by definition, pain

that is unsupported by objective medical findings."); 20 C.F.R. §§

404.1529, 416.929; SSR 88-13; SSR 96-7p.

A reviewing court may not speculate as to the basis for the

ALJ's credibility determination. See Bunnel, 947 F.2d at 346 (en

banc) (citation omitted). "The ALJ must state specifically which

symptom testimony is not credible and what facts in the record lead

to that conclusion." Smolen, 80 F.3d at 1284 (citation omitted);

see also Dodrill v. Shalala, 12 F.3d 915, 918 (9th Cir. 1993)

("It's not sufficient for the ALJ to make only general findings; he

must state which pain testimony is not credible and what evidence

suggests the complaints are not credible.").

Having carefully reviewed the decision and the record in this

case, including Plaintiff's hearing testimony, the Court is not

clearly convinced by the ALJ's reasons for rejecting Plaintiff's

pain testimony. The following are the only possible explanations,

express and implied, for the ALJ's credibility determination: (1)

lack of corroborating medical evidence, (2) "evidence of possible

symptom magnification by [Plaintiff] during testing," (3)

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2

 Under the law of the Ninth Circuit, the ALJ must expressly

state which testimony is not credible and identify the facts

supporting that conclusion. See Bunnel, 947 F.2d at 346 (en banc)

(citation omitted); Smolen, 80 F.3d at 1284 (citation omitted);

Dodrill, 12 F.3d at 918. In this case, only the first and second

reasons meet this standard. The ALJ rejected the entirety of

Plaintiff's pain testimony because he "[did] not find [Plaintiff]

credible in light of evidence of possible symptom magnification by

the claimant during testing and the substantial weight of the

[medical] opinion evidence . . . ." Admin. R. at 20-21. Although

the remaining reasons-- numbered "3" through "7"-- may be inferred

from the related discussion, they are not expressly identified as

bases for the ALJ's credibility determination. See id. at 19-21.

The Court is not obligated to derive unstated reasons by speculation.

Nevertheless, the Court will explain why those reasons too would be

insufficient to support the ALJ's rejection of Plaintiff's testimony.

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Plaintiff's daily activities, (4) Plaintiff's favorable response to

treatment for his sleep apnea, (5) Plaintiff's statements to Dr.

Barker regarding his alcohol consumption, (6) Plaintiff's lack of

explanation to Dr. Barker regarding his reasons for quitting his

previous employment, (7) inconsistency between Plaintiff's

testimony of biweekly visits to friends and his "allegation of

isolation."2 Admin. R. at 19-21.

As to the first of these reasons, the ALJ acknowledges that he

cannot discredit Plaintiff's pain testimony based solely on a lack

of corroborating medical evidence. Id. at 20; Bunnel, 947 F.2d at

345 (en banc); Cotton, 799 F.2d at 1407; 20 C.F.R. §§ 404.1529,

416.929; SSR 88-13; SSR 96-7p. Thus, the legitimacy of the ALJ's

credibility determination lies in the balance of the evidence

supporting the other reasons.

Second, the ALJ states that he "[did] not find the claimant

credible in light of evidence of possible symptom magnification by

the claimant during testing." Admin. R. at 20-21 (emphasis added). 

However, the decision below does not point toward any evidence that

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3

 Because the ALJ focuses on Dr. Barker's findings regarding

Plaintiff's pulmonary function, it may be that the ALJ felt that

Plaintiff had exaggerated his complaints of shortness of breath.

Absent specific findings to that effect, the Court may not speculate

as to the ALJ's intent. See Bunnel, 947 F.2d at 345 (en banc).

Moreover, the Court would be reluctant to agree that one instance of

perceived symptom magnification on an ancillary ailment would warrant

striking all of Plaintiff's testimony regarding his back pain.

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Plaintiff ever magnified his symptoms during testing. The ALJ

alludes to "evidence strongly suggesting that the claimant has

exaggerated [his] symptoms and limitations," Admin. R. at 20, but

does not explain what complaints, if any, appear to have been

exaggerated.3 This may explain the ALJ's tentative choice of words

in referring to "possible symptom magnification." Id. at 21

(emphasis added). Based on the lack of supporting evidence and the

ALJ's expressed reservations, the Court cannot accept this

qualified statement as a clear and convincing reason for rejecting

Plaintiff's testimony.

Third, the ALJ is correct to note that Plaintiff's subjective

pain testimony may be discredited if it is found that he is able to

perform daily activities involving skills transferable to a work

setting. Id. at 21 (citing Fair v. Bowen, 885 F.2d 597, 600-604

(9th Cir. 1989)). Plaintiff complains, however, that the ALJ has

misconstrued his daily activities. Pl.'s Mem. in Supp. (doc. # 11)

at 11. This point is well taken. The ALJ's decision implies that

Plaintiff testified to daily activities including light cooking and

helping with housework, see Admin. R. at 19, when in fact Plaintiff

specifically stated that those activities occur only on "good

days," not on a daily basis. Id. at 498, 502-503. Moreover, he

testified that his "good days" are often followed by "bad days" due

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4

 At the hearing, the ALJ only asked Plaintiff whether he had

a continuous positive airway pressure mask to alleviate his sleep

apnea, and Plaintiff responded that he did. Admin. R. at 507. There

was no subsequent questioning to determine whether Plaintiff was

still using the device or whether it had given him any relief for his

symptoms. More importantly, the ALJ did not ask Plaintiff whether

his sleep was fitful due to his sleep apnea or his back pain.

In the decision, the ALJ mentions Plaintiff's favorable response

to treatment for his sleep apnea, id. at 20, and later states that a

claimant's pain testimony may be rejected if the claimant

inexplicably fails to follow a prescribed course of treatment. See

id. at 21 (citing Fair, 885 F.2d at 600-604). Because there are no

facts showing that Plaintiff failed to follow the prescribed

treatment for his sleep apnea, this too would be an insufficient

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to the pain precipitated by the physical exertion of the previous

day's activities. Id. at 499. Reading Plaintiff's testimony in

context, it is clear that his periodic activities contribute to his

pain. SSR 96-7p (precipitating and aggravating factors). The

complete testimony of Plaintiff's self-reported activities tends to

corroborate, not discredit, his subjective complaints of pain.

Fourth, the ALJ suggests that Plaintiff's credibility is

somehow diminished by his favorable response to treatment for his

sleep apnea with the use of a continuous positive airway pressure

mask. See Admin. R. at 20-21, 325. It is unclear how this is

relevant to Plaintiff's credibility when he did not even complain

of sleep apnea at the hearing. It is evident from the transcript

that Plaintiff testified primarily about back pain and depression,

not sleep apnea. Id. at 487-507. In all of his hearing testimony,

Plaintiff uttered only a single word to describe his sleep--

"fitful." Id. at 504. However, it is unclear in light of his

other testimony whether his sleep was "fitful" due to his sleep

apnea or his back pain, see id. at 499, and the ALJ did not develop

the record to address this ambiguity when examining Plaintiff,4 id.

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at 504-07. The Court is not clearly convinced that the entirety of

Plaintiff's testimony may be discarded based on an inadequately

developed inconsistency on a tangential matter.

Fifth, the ALJ briefly mentions an incident in which Plaintiff

may have been less than candid with Dr. Barker regarding his

alcohol consumption. Plaintiff had apparently told the doctor that

he had quit drinking, but the doctor had noted in his report that

Plaintiff smelled of alcohol and had an unsteady gait. Id. at 20,

361. As before, the ALJ did not address this on his examination of

Plaintiff, id. at 504-07, and furthermore accepted the truth of a

written statement by Plaintiff's mother that Plaintiff had not been

drinking that day, id. at 20. Therefore, the Court does not expect

that this incident could be legitimately referenced on remand to

discredit Plaintiff's hearing testimony.

Sixth, the ALJ mentions in the decision that Plaintiff

"deferred to give a reason for quitting" his previous employment

when he saw Dr. Barker, insinuating perhaps that Plaintiff had the

ability to return to his previous work. Id. at 20. Because a

patient's reasons for leaving work are not directly pertinent to

the purposes of a medical examination, the Court finds it untenable

that Plaintiff would be unwittingly penalized for his failure to

thoroughly discuss every facet of his professional history with the

doctor. This was an issue that could have been more properly

developed during the ALJ's examination of Plaintiff at the hearing. 

See id. at 504-07. Furthermore, the ALJ's finding that Plaintiff

lacks the residual functional capacity to return to his previous

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employment repudiates the notion that, by deferring to tell Dr.

Barker his reasons for quitting, he retained the capacity to return

to his former work. Accordingly, this too would be rejected as an

insufficient basis to reject Plaintiff's testimony.

Finally, it is suggested that Plaintiff's account of his

visits to friends "once or twice every two weeks or so," id. at

500, is inconsistent with his testimony regarding his depression,

id. at 20. In describing his depression, Plaintiff stated that he

"want[s] to be by [himself]" and, on bad days, usually isolates

himself and tries to think of "what to do to make it better." Id.

at 499, 501. The ALJ claims that Plaintiff's testimony about

seeing friends "is inconsistent with the claimant's allegation of

isolation." Id. at 20. The Court does not agree. There is no

inconsistency, because Plaintiff stated that he isolated himself

only on "bad days," leaving open the possibility that he saw his

friends on "good days." Rather than explore and rule out this

possibility on his examination of Plaintiff, id. at 504-07, the ALJ

assumed that there was an actual inconsistency. Even so, the Court

does not see how Plaintiff's failure to assume a reclusive

existence, completely disengaged from society, casts any doubt on

the genuineness of his feelings of loneliness. Cf. Smolen, 80 F.3d

at 1284 n.7 ("The Social Security Act does not require that

claimants be utterly incapacitated to be eligible for benefits 

. . . ."). Quite simply, the Court does not find that there is any

inconsistency in the referenced testimony warranting dismissal of

Plaintiff's testimony regarding his depression, let alone his

entire pain testimony.

In sum, the ALJ's expressly stated reasons for rejecting

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Plaintiff's pain testimony are inadequately supported because the

decision below does not point toward any evidence that Plaintiff

magnified his symptoms. Furthermore, even though the Court is not

required to speculate as to the unarticulated reasons for the ALJ's

credibility determination, any additional reasons that could be

inferred from elsewhere in the decision would be rejected for the

reasons discussed above. Credibility determinations must be based

on clear and convincing reasons supported by more than a "mere

scintilla" of evidence. See Johnson, 60 F.3d at 1433; Richardson,

402 U.S. at 401 (internal quotations omitted). Because the reasons

provided for discrediting Plaintiff's testimony are not "clearly

convincing" and are not supported by substantial evidence, the

Court will remand to allow the ALJ to make further determinations. 

If it is determined that any particular portion of Plaintiff's

testimony is not credible, the ALJ should state which pain

testimony is not credible and what evidence suggests the complaints

are not credible. Dodrill, 12 F.3d at 918.

B. The Physical Residual Functional Capacity Questionnaire

Under the Social Security Regulations (the "Regulations"),

evidence of a claimant's impairment may be provided by either an

"acceptable medical source" or "other source." 20 C.F.R. §§

404.1513(a), 404.1513(d), 416.913(a), 416.913(d). Only an

acceptable medical source can provide medical opinion evidence. 20

C.F.R. § 416.927(a)(2). As a general rule, an uncontradicted

medical opinion from a claimant's treating source must be accorded

controlling weight. 20 C.F.R. § 416.927(d)(2). The uncontradicted

opinion and ultimate conclusions of a treating source may not be

rejected unless the ALJ provides clear and convincing reasons

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supported by substantial evidence in the record for doing so. 

Baxter v. Sullivan, 923 F.2d 1391, 1396 (9th Cir. 1991); Embrey v.

Bowen, 849 F.2d 418, 422 (9th Cir. 1988). If controverted by other

medical evidence, the ALJ may disregard the opinion only by setting

forth "specific and legitimate reasons" supported by substantial

evidence in the record for doing so. See 20 C.F.R. §

416.927(f)(2)(ii); Andrews, 53 F.3d at 1043.

As evidence of his impairments in the case at hand, Plaintiff

offered an RFC Questionnaire signed by Stephanie Duensing, M.D. and

nurse practitioner Thomas Bast. Standing alone, Bast, as a nurse

practitioner, is not an acceptable medical source, see 20 C.F.R. §§

404.1513(d)(1), 416.913(d)(1), and the ALJ would not have been

required to give his opinion controlling weight. Plaintiff

asserts, however, that the RFC Questionnaire was also signed by Dr.

Duensing, who is a licensed physician. Plaintiff thus argues that,

because the report was countersigned by an acceptable medical

source, see 20 C.F.R. §§ 404.1513(a)(1), 416.913(a)(1), the ALJ

should have either given the opinion controlling weight or

explained in the decision the reasons for not doing so. Pl.'s Mem.

in Supp. (doc. # 11) at 4-6; Reply (doc. # 21) at 1-3. 

The preliminary issue that must be decided is whether, and

under what circumstances, a report signed by both an acceptable

medical source and other source can nonetheless be treated as the

opinion of the former. Plaintiff apparently believes that the RFC

Questionnaire should be credited to the doctor by virtue of her

signature. Pl.'s Mem. in Supp. (doc. # 11) at 4. The Commissioner

counters by characterizing Plaintiff's argument as relying on the

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5

 In the Social Security context, an interdisciplinary team is

generally understood as referring to a group of two or more different

types of health care professionals, typically consisting of at least

one acceptable medical source and one other source, who oversee a

claimant's treatment.

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outdated concept of an "interdisciplinary team."5 Def.'s Mem. in

Supp. (doc. # 20) at 3 (citing former 20 C.F.R. § 416.913(a)(6)

(2000)). The Regulations formerly provided that "[a] report of an

interdisciplinary team that contains the signature of an acceptable

medical source is also considered acceptable medical evidence." 20

C.F.R. § 416.913(a)(6) (2000). According to the Commissioner, the

SSA's abrogation of former paragraph (a)(6) means that an

acceptable medical source can no longer provide an opinion through

an interdisciplinary team report, but must instead issue a separate

report. Def.'s Mem. in Supp. (doc. # 20) at 3. The Court does not

agree. Close examination of the interpretive comments surrounding

the deletion of paragraph (a)(6) reveals that the SSA has long

rejected the position now argued by the Commissioner.

The SSA explained its deletion of 20 C.F.R. § 416.913(a)(6)

(2000) as follows:

Similarly, we are deleting prior paragraph (a)(6) (that 

appears only in § 416.913), which provided that reports of an 

interdisciplinary team were acceptable medical sources as long

as they contained the evaluation and signature of an 

acceptable medical source. It does not matter whether the 

evaluation by an acceptable medical source identified in final

paragraphs (a)(1) through (a)(5) is included in an 

interdisciplinary team report or is contained in a separate

report. Because acceptable medical sources are individuals, 

it is redundant and somewhat misleading to provide that an 

interdisciplinary team report containing the evaluation and 

signature of an acceptable medical source is such a source.

65 Fed. Reg. 34950, 34952 (June 1, 2000) (codified at 20 C.F.R.

pts. 416) (emphasis added). In stating that "[i]t does not matter

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6

 For all that appears, the deletion of former paragraph (a)(6)

was not intended to substantively alter the manner in which an

acceptable medical source could provide an opinion so much as it was

intended to cure that paragraph's "somewhat misleading" tendency to

conflate opinion evidence with its human sources. See 65 Fed. Reg.

34950, 34952 (June 1, 2000) (codified at 20 C.F.R. pts. 416)

("[A]cceptable medical sources are individuals . . . .").

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whether the evaluation by an acceptable medical source . . . is

included in an interdisciplinary team report or is contained in a

separate report," see id. (emphasis added), the SSA expected that

the Commissioner would accord the same special weight to an

acceptable medical source's opinion, whether expressed in a report

signed only by that source or countersigned by others. This

expectation is also consistent with the observation that "it is

redundant . . . to provide that an interdisciplinary team report

containing the evaluation and signature of an acceptable medical

source is such a source." Id. Any redundancy of former paragraph

(a)(6) similarly reenforces the requirement that the Commissioner

must continue to accord the same special weight to the report of a

qualified interdisciplinary team as she would to an independent

report by the team's acceptable medical source. Rather than render

the concept obsolete, the commentary shows that the concept of the

interdisciplinary team retains vestigial significance

notwithstanding the deletion of paragraph (a)(6).6 In other words,

by removing the phrase "interdisciplinary team" from the

Regulations, the SSA did not intend to preclude an acceptable

medical source from providing an opinion through a report

countersigned by others. The change specifically contemplated that

an acceptable medical source could provide an opinion through a

report joined by other sources. Because this is a reasonable

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7

 It is well established that the Commissioner's official

interpretation of social security statutes and regulations is

entitled to deference. See Campbell ex rel. Campbell v. Apfel, 177

F.3d 890, 893 (9th Cir. 1999) (regulation and statute); Esselstrom v.

Chater, 67 F.3d 869, 872 (9th Cir. 1995) (regulation); Peura v. Mala,

977 F.2d 484, 487 (9th Cir. 1992) (statute). A district court need

not accept an agency's interpretation of its own regulations if that

interpretation is inconsistent with the wording of the regulations or

statute under which the regulations were promulgated. Esselstrom, 67

F.3d at 872.

In this instance, however, there is no such inconsistency. Both

the Act and the Regulations are silent on the question directly at

issue: Whether a report signed by both an acceptable medical source

and other source can nonetheless be treated as a medical opinion?

The Regulations only identify acceptable medical sources, see 20

C.F.R. §§ 404.1513(a), 416.913(a), but do not require that such

sources provide their medical opinions in separately issued reports.

Therefore, deference to the interpretive commentary to shed light on

the matter is appropriate.

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interpretation of paragraphs 416.913(a)(1)-(5) to which this Court

owes deference, see Chevron U.S.A., Inc., 467 U.S. at 842-43, the

SSA's interpretive commentary is controlling.7

The ALJ in this case did not address the fact that Dr.

Duensing's signature appears on the RFC Questionnaire or explain

why the report was treated solely as Bast's opinion. See Admin. R.

at 18-19. Absent such discussion, it is unclear to the Court

whether the ALJ would have disregarded the report if the opinion

expressed therein were attributed to the doctor. Therefore, the

Court will remand to allow the ALJ to determine whether the RFC

Questionnaire should be credited to Bast or Dr. Duensing. In

making this determination, the ALJ may consider, in light of the

history of both sources' treatment relationships with Plaintiff,

whether Dr. Duensing had close supervision and control over

Plaintiff's treatment with Bast. Cf. Gomez v. Chater, 74 F.3d 967,

971 (9th Cir. 1996) (holding that a nurse practitioner's opinion

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8

 The Court is aware that Gomez has been widely cited in cases

applying former 20 C.F.R. § 416.913(a)(6) (2000) for the court's

statement in dicta that "a nurse practitioner working in conjunction

with a physician constitutes an acceptable medical source, while a

nurse practitioner working on his or her own does not." See, e.g.,

Nichols v. Comm'r of the Soc. Sec. Admin., 260 F. Supp. 2d 1057,

1065-66 (D. Kan. 2003) (citing Gomez, 74 F.3d at 971). Because the

Ninth Circuit's interpretation of the phrase "interdisciplinary team"

in that case was not essential to its holding, the core of Gomez

remains the law notwithstanding the intervening deletion of 20 C.F.R.

§ 416.913(a)(6) (2000) from the Regulations.

Finally, if it is determined that the report contains the

opinion of the doctor, the ALJ must determine the weight to be

afforded that opinion based on Plaintiff's treatment relationship

with the doctor. One factor relevant to this determination is

whether a claimant's relationship with a doctor is based solely on

the need to obtain a report in support of a claim for disability. If

so, the source will be considered to be an examining source. 20

C.F.R. §§ 404.1502, 416.902. In her reply, the Commissioner calls

special attention to a note in the medical records from the Phoenix

VA reporting Plaintiff's chief complaint as his need to obtain a

medical opinion, see Def.'s Mem. in Supp. (doc. # 20) at 4 (citing

Admin. R. at 171), presumably to challenge the classification of Dr.

Duensing as a treating source. Because this note was entered more

than two years prior to the RFC Questionnaire, see Admin. R. 171,

421, the Court would give it no weight in its analysis of Plaintiff's

treatment relationship with Dr. Duensing. Moreover, the Court does

not find that the fact that a claimant requests a report to be fatal.

It is doubtful that the Regulations were intended to be applied in

such a manner as to chill doctor-patient communications to the point

that a doctor must divine a patient's needs without so much as a word

from the patient.

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could be considered as part of a physician's opinion provided that

the nurse practitioner worked closely under the supervision, and as

an agent of, the physician).8

C. The Mental Impairment Questionnaire

Plaintiff claims that the ALJ's decision did not adequately

explain his reasons for affording little or no weight to the Mental

Impairment Questionnaire by mental health therapist Kimberly Kelsey

(the "Kelsey opinion"). Plaintiff acknowledges that Kelsey is not

a licensed or certified psychologist and, therefore, is not an

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9

 Because medical opinions are generally entitled to greater

weight than other source evidence, this alone may be a sufficient

basis to justify the ALJ's decision to disregard the Kelsey opinion.

See Sprague v. Bowen, 812 F.2d 1226, 1230 (9th Cir. 1987); Pitzer v.

Sullivan, 908 F.2d 502, 506 n.4 (9th Cir. 1990).

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acceptable medical source under 20 C.F.R. §§ 404.1513(a),

416.913(a). Pl.'s Mem. in Supp. (doc. # 11) at 7. Nevertheless,

Plaintiff contends that the ALJ should either have considered the

Kelsey opinion as other source evidence under 20 C.F.R. §§

404.1527(d), 416.927(d), or explained in the decision the reasons

for not doing so. Id. at 6-8.

The law of the Ninth Circuit is unclear as to whether the ALJ

must set forth specific reasons for disregarding other source

evidence. The court has previously stated that "there is no

requirement that the Secretary accept or specifically refute such

evidence." Bunnell v. Sullivan, 912 F.2d 1149, 1152 (9th Cir.

1990), overruled on other grounds, 947 F.2d 341 (9th Cir. 1991) (en

banc). More recently, however, the court has held that lay

testimony, which is a form of other source evidence under 20 C.F.R.

§§ 404.1513(d)(4), 416.913(d)(4), may only be rejected if the ALJ

"expressly determines to disregard such testimony and gives reasons

germane to each witness for doing so." Lewis, 236 F.3d at 511.

Even under the latter standard, the Court finds that the ALJ's

express determination to disregard the Kelsey opinion is adequately

supported by reasons germane to that witness. See Admin. R. at 18-

19. The ALJ noted that the Kelsey opinion is materially

inconsistent with other credible medical evidence, citing the

opinions of two acceptable medical sources, Jane George, Ph.D. and

Carl C. Mansfield, Ph.D.9 Id. at 19, 309-22, 365-72, 422-31; see

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also 20 C.F.R. §§ 404.1513(a)(2), 416.913(a)(2). In addition, the

ALJ commented on the consistently high Global Assessment of

Function ("GAF") scores given to Plaintiff by Kelsey, apparently

perceiving the high scores to be internally inconsistent with

Kelsey's assessment of Plaintiff's inability to function usefully

in a regular work setting. See Admin. R. at 18, 422-31.

Where, as here, the ALJ has set forth specific reasons

supported by substantial evidence in the record, the Court may not

substitute its own judgment in lieu of the ALJ's credibility

determination. See McCartey, 298 F.3d at 1075; Mayes v. Massanari,

276 F.3d 453, 459 (9th Cir. 2001); Holohan v. Massanari, 246 F.3d

1195, 1201 (9th Cir. 2001); Lewis, 236 F.3d at 509. Having

examined the record as a whole, the Court finds that the ALJ's

decision to afford little or no weight to the Kelsey opinion was

legally proper, explained by reasons germane to Kelsey as a

witness, and supported by substantial evidence in the record. 

Lewis, 236 F.3d at 511; Bayliss, 427 F.3d at 1214 n.1.

D. Medical Vocational Guidelines

In determining a claimant's eligibility for disability

benefits, the ALJ must decide whether substantial gainful work

exists in the national economy for the claimant despite his

impairments. See 42 U.S.C. § 423(d)(2)(A). In doing so, the ALJ

typically refers to Medical-Vocational Guidelines ("guidelines")

that cover claimants with substantially uniform levels of

impairment. Burkhart v. Bowen, 856 F.2d 1335, 1340 (9th Cir.

1988). When significant non-exertional limitations are present,

reliance on the guidelines may be inappropriate, Desrosiers v.

Sec'y of Health & Human Serv., 846 F.2d 573, 577 (9th Cir. 1988),

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and the ALJ may be required to take the testimony of a vocational

expert to identify specific jobs within the claimant's

capabilities, Jones v. Heckler, 760 F.2d 993, 998 (9th Cir. 1985). 

However, the Ninth Circuit has cautioned that "[i]t is not

necessary to permit a claimant to circumvent the guidelines simply

by alleging the existence of a non-exertional impairment . . .

validated by a doctor's opinion that such impairment exists. To do

so frustrates the purpose of the guidelines." Desrosiers, 846 F.2d

at 577. Before calling for a vocational expert to supplement the

guidelines, the ALJ must first determine whether an alleged nonexertional impairment is sufficiently severe by considering

evidence of "the claimant's past work experience, education, and

present psychological and physical impairments." Id.

Plaintiff contends that the ALJ's reliance on MedicalVocational Rule 203.29 as a framework for decision making was not

proper because the guideline did not reflect Plaintiff's nonexertional limitations. Pl.'s Mem. in Supp. (doc. # 11) at 14

(citing Admin. R. at 24). In response, the Commissioner points out

that the ALJ did not rely exclusively on the guidelines, but used

them in conjunction with the testimony of the vocational expert in

reaching his decision. Def.'s Mem. in Supp. (doc. # 20) at 14; see

also Admin. R. at 22 ("A finding of "not disabled" is therefore

reached within the framework of Medical-Vocational Rule 203.29 and

the vocational expert's testimony.") (emphasis added). The

Commissioner's point is well taken. The decision reflects that the

ALJ also considered the vocational expert's testimony as well as

Plaintiff's age, educational background, work experience, and

residual functional capacity. Admin. R. at 22. Because the

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10 If a vocational expert is called again on remand, the

hypothetical questions put to the expert should be reformulated based

on all limitations established by any evidence not discounted.

11 Although this issue was first raised in Plaintiff's reply

memorandum (doc. # 21), the Court perceives no prejudice to the

Commissioner in reaching this argument now. Because Plaintiff's

reply memorandum (doc. # 21) served simultaneously as a response to

the Commissioner's cross-motion for summary judgment (doc. # 18), the

Commissioner could have responded by filing her own reply memorandum

in support of her cross-motion. In view of the Commissioner's

failure to file a timely reply, see LRCiv 7.2(d), 56.1(b), or to

request an extension of time for doing so, the Court finds it

entirely appropriate to take this argument under advisement in

consideration of the pending motions.

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guidelines were not given determinative weight, the Court finds

nothing improper about the ALJ's reference to the guidelines in his

finding of "not disabled."10

E. Development of the Record

Plaintiff argues that he was deprived of the right to a full

and fair hearing by the ALJ's failure to develop the record.11

Reply (doc. # 21) at 5-6. Plaintiff claims that the ALJ should

have developed the record by ordering a new consultative

examination because Dr. Barker's report, upon which the ALJ

extensively relied, was generated more than one year prior to the

more favorable RFC Questionnaire that the ALJ disregarded. Reply

(doc. # 21) at 5-6.

The Ninth Circuit has often repeated its admonishment that

"the ALJ has a special duty to fully and fairly develop the record

and to assure that a claimant's interests are considered," even

when the claimant is represented by counsel. Webb v. Barnhart, 433

F.3d 683, 687 (9th Cir. 2003); Tonapetyan v. Halter, 242 F.3d 1144,

1150 (9th Cir. 2001); Smolen, 80 F.3d at 1288; Brown v. Heckler,

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713 F.2d 441, 443 (9th Cir. 1983) (citing Thompson v. Schweiker,

665 F.2d 936, 941 (9th Cir. 1982)). Under the Regulations, a

consultative examination is normally required when "[t]here is an

indication of a change in [the claimant's] condition that is likely

to affect [the claimant's] ability to work, but the current

severity of [the claimant's] impairment is not established." See

20 C.F.R. §§ 404.1519a(b)(5), 416.919a(b)(5).

In this case, the RFC Questionnaire as well as Plaintiff's

hearing testimony signal that his condition may have deteriorated

since his earlier examination by Dr. Barker. Not knowing how the

record will develop on remand, the Court cannot say with certainty

whether the ALJ will be required to order another consultative

examination. However, the Court would find that the duty to

develop the record may require doing so where, as here, much if not

all of the most recent evidence favoring the claimant has been

discredited in lieu of potentially stale evidence.

F. Residual Functional Capacity Determination

Residual functional capacity reflects a claimant's ability to

work in spite of the physical and mental limitations arising from

the claimant's impairments and related symptoms. See 20 C.F.R. §§

404.1545(a), 416.945(a). A claimant's residual functional capacity

is determined based on all of the claimant's limitations and in

light of all relevant evidence in the record. Id.

Plaintiff challenges the ALJ's ultimate finding that he

retains the residual functional capacity to engage in other gainful

work. Plaintiff argues that the ALJ's finding of "not disabled" at

the fifth step of the sequential evaluation process was flawed

because the ALJ improperly excluded evidence of his limitations

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without setting forth sufficient reasons for doing so. Pl.'s Mem.

in Supp. (doc. # 11) at 11-13. The Court agrees. 

As explained above, the ALJ's decision does not set forth an

adequate basis for disregarding Plaintiff's testimony and the RFC

Questionnaire. In answering hypothetical questions based on

limitations established by the excluded evidence, the vocational

expert testified that Plaintiff would be unable to engage in any

gainful work. See Admin. R. at 514-18. Plaintiff would likely

have been found disabled within the meaning of the Act had this

evidence not been excluded.

This case is therefore remanded for the ALJ to make further

determinations. First, if it is determined that any particular

portion of Plaintiff's testimony is not credible, the ALJ should

state which pain testimony is not credible and what facts in the

record lead to that conclusion. Dodrill, 12 F.3d at 918. 

Otherwise, the testimony must be accepted. Second, the ALJ should

consider whether, in light of Plaintiff's treatment relationship

with Bast and Dr. Duensing, the RFC Questionnaire should be

credited as the opinion of the doctor. Cf. Gomez, 74 F.3d at 971. 

Finally, Plaintiff's residual functional capacity should be

reevaluated in light of all relevant evidence in the record.

IV. CONCLUSION

In light of the foregoing analysis,

IT IS ORDERED that Plaintiff's motion for summary judgment

(doc. # 9) is GRANTED.

IT IS FURTHER ORDERED that Defendant's cross-motion for

summary judgment (doc. # 18) is DENIED.

IT IS FURTHER ORDERED remanding to the Commission for further

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administrative action pursuant to 42 U.S.C. § 1383(c)(3) and

sentence 4 of 42 U.S.C. § 405(g).

IT IS FURTHER ORDERED that upon remand the Appeals Council

shall remand this case to the Administrative Law Judge ("ALJ") to

reevaluate Plaintiff's claims for supplemental security income and

disability insurance benefits in accordance with this decision and

the applicable Ninth Circuit law.

IT IS FINALLY ORDERED directing the Clerk of the Court to

enter judgment in favor of Plaintiff and terminate this case.

DATED this 23rd day of March, 2006.

Copies to counsel of record

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