Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-4_13-cv-01098/USCOURTS-azd-4_13-cv-01098-0/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)

---

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Holly M. Beck, 

Plaintiff, 

v. 

Carolyn W. Colvin, Acting Commissioner 

of Social Security, 

Defendant.

No. CV-13-01098-TUC-DCB (EJM)

REPORT AND 

RECOMMENDATION 

Plaintiff Holly M. Beck (“Beck”) brought this action pursuant to 42 U.S.C. §§ 

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

Social Security (“Commissioner”). Beck raises three issues on appeal: 1) whether the 

Administrative Law Judge (“ALJ”) erred in evaluating Beck’s credibility, 2) whether the 

ALJ’s residual functional capacity (“RFC”) assessment was erroneous, and 3) as a result 

of these errors, whether the ALJ erred in her Step Four decision in concluding Beck could 

perform her past relevant work. 

Before the Court are Beck’s Opening Brief, Defendant’s Response and a Reply. 

(Docs. 13, 16, 17). Based on the pleadings and the administrative record submitted to the 

Court, the Magistrate Judge recommends that the District Court, after its independent 

review, deny relief.

I. Procedural History 

Beck filed an application for Supplemental Security Income (“SSI”) and Disability 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 1 of 27
- 2 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

Insurance Benefits (“DIB”) on October 2010. (Administrative Record (“AR”) 147). Beck 

alleged disability beginning December 4, 2008 (AR 147) based on breast cancer, kidney 

problems, and total hysterectomy (AR 175). Beck’s application was denied upon initial 

review (AR 103) and on reconsideration (AR 108). A hearing was held on May 31, 2012 

(AR 56), after which ALJ Laura Speck Havens found, at Step Four, that Beck was not 

disabled because she was able to perform her past relevant work as a dispatcher (AR 30). 

The Appeals Council denied Beck’s request to review the ALJ’s decision. (AR 4). 

II. Factual History 

Beck was born on May 4, 1954, making her 54 at the alleged onset date of her 

disability. (AR 147). Beck has a high school education. (AR 59). She has worked a 

number of different jobs including casino dealer, cashier, waitress, office work, and 

limousine dispatcher. (AR 202-11). Beck’s last job was with the Bellagio Hotel, from 

2003 through 2010, where she worked as a cashier, waitress, and office clerk. (AR 202, 

203, 207, 208). From 2001 to 2003, she worked as a cashier and stock person at Flamingo 

Chevron. (AR 202, 204, 207, 209). Beck indicated that she lifted up to fifty pounds at the 

Bellagio, and up to twenty pounds at Chevron. (AR 203-04, 208-09). In 1999 and 2000, 

Beck worked for another casino, AWI Keno, where she lifted up to fifty pounds. (AR 

202, 205, 207, 210). Finally, Beck worked as dispatcher for On Demand Sedan in 1997 

and 1998, and reported that she also lifted up to fifty pounds at this job. (AR 202, 206 

207, 211). 

a. Treating Physicians 

 At a mammography on December 18, 2008, a mass was found in Beck’s left breast 

that was consistent with invasive carcinoma. (AR 408). Beck underwent a lumpectomy 

on February 19, 2009 with Dr. Theodore Potruch. (AR 247). There were no 

complications with the surgery and Beck was discharged the same day in satisfactory 

condition. Id. Follow-up appointments with Dr. Potruch occurred on February 24, March 

18, April 15, May 13, June 10, July 15, and November 11, 2009, and January 20, July 21, 

and December 08, 2010. (AR 393-400). Dr. Potruch observed some thickening below the 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 2 of 27
- 3 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

scar (AR 393-94), but otherwise noted Beck was doing well (AR 393), nicely (AR 396), 

quite well (AR 397), fine (AR 399), and had recovered from all her surgeries (AR 395). 

 On February 24, 2009, Beck was seen for a radiation therapy consultation at the 

Compassionate Cancer Center. (AR 345). She reported no fatigue, no joint or muscle 

pain, and no pain. (AR 345-56). Beck was seen for radiation follow-up appointments on 

March 10 (AR 348), April 14 (AR 350), July 14 (AR 352), and October 20, 2009 (AR 

354). At each of these appointments, Beck had no complaints and reported no fatigue, no 

joint or muscle pain, no pain, and no decrease in quality of life. 

 Beck was seen by Dr. Jogesh Harjai on April 28, 2009 for a complaint of vaginal 

bleeding. (AR 257). She reported no dizziness, shortness of breath, back pain or nausea, 

and Dr. Harjai noted full range of motion of all four extremities. (AR 257). Dr. Harjai 

opined that the bleeding was most likely due to Beck’s uterine fibroids and recommended 

she follow up with her GYN. (AR 258). 

 Beck was seen by Dr. Cord Strebel for gynecological appointments in 2009 and 

2010. (AR 423-35). On an unknown date, Dr. Strebel documented pelvic pain and noted 

Beck did not control her caloric intake or follow a balanced diet. (AR 428). At another 

appointment, Dr. Strebel documented heavy bleeding and menorrhagia. (AR 434). 

 Beck was evaluated by Dr. Nicola Spirtos for a possible hysterectomy on May 11 

and June 4, 2009. (AR 262, 295, 436). Dr. Spirtos reviewed Beck’s subjective symptoms 

and noted no fatigue, no dizziness, no gait abnormality, no shortness of breath, no chest 

pain, no wheezing, no joint pain or leg cramps, no sleep disturbances, and no pelvic pain. 

(AR 262, 295, 437). Dr. Spirtos recommended a TAH BSO (total abdominal 

hysterectomy and bilateral salpingo-oophorectomy). (AR 263, 296). The procedure was 

performed on June 23, 2009 and Beck was discharged four days later, and was noted to 

be “recovering well.” (AR 260). 

 Following her hysterectomy, Beck was seen for a wound infection on July 2, 2009. 

(AR 294). Beck was seen for additional wound care appointments on July 3, 6, 8, 10, and 

22, 2009 (AR 287-92). At a follow-up appointment on August 7, 2009, Dr. Brewer noted 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 3 of 27
- 4 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

the wound had healed. (AR 286). At another follow-up appointment on September 9, 

2009, Dr. Brewer noted Beck’s wound had completely healed and that she was healing 

well. (AR 284). At the July 3, July 22 and September 9 appointments, Beck reported no 

fatigue, no dizziness, no gait abnormality, no shortness of breath, no chest pain, no 

wheezing, no nausea, and no joint pain, swelling, or stiffness. (AR 284, 287, 292). 

 Beck was seen for a urology consult by Dr. Victor Grigoriev on July 23, 2009. 

(AR 313, 381). She reported no breathing problems, shortness of breath, arthritis, or other 

pain. (AR 340). On August 12, 2009 Dr. Grigoriev noted a CT scan showed a renal mass 

on her right kidney and recommended surgery. (AR 312). Beck underwent a right radical 

nephrectomy (kidney removal) on September 1, 2009. (AR 298). She tolerated the 

procedure well and had no nausea, vomiting, fever, chills, shortness of breath or chest 

pain. (AR 298-99, 459-61). At follow-up appointments on January 20, 2010 (AR 310) 

and July 21, 2010 (AR 309), Beck reported no new complaints. 

 Beck was seen for a post-lumpectomy mammography on January 20, 2010 (AR 

365). Post-lumpectomy scarring was observed and no evidence of malignancy was found. 

Id. Another mammography appointment on July 21, 2010 showed a mass-like scar that 

was “felt to represent benign scar/fat necrosis.” (AR 366). 

 Beck was seen at Compassionate Cancer Center on April 7, 2010. (AR 356). She 

had no complaints related to the breast but reported “a bulge in her abdomen after she 

eats.” (AR 356). The doctor noted she would be “following up with a surgeon to evaluate 

a possible recurrent hernia.” (AR 356). At a follow-up on December 7, 2010, Beck had 

no complaints related to the breast and reported she had an abdominal hernia found that 

she planned to have repaired in the future. (AR 358). At the April 7 and December 7 

appointments, Beck had no complaints of pain and reported no fatigue, no joint or muscle 

pain, and no decrease in quality of life. (AR 356, 358). 

 Beck was seen for a cardiology consultation in June 2010. Beck reported she 

becomes severely short of breath when walking her dog. (AR 369). Dr. Timothy Marshall 

noted Beck had no chest pain and was negative for other cardiac systems, and that her 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 4 of 27
- 5 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

EKG was normal. (AR 369-70). Dr. Marshall scheduled an echocardiogram and an 

adenosine thallium scan. (AR 370). Following these tests, Dr. Marshall noted the 

echocardiogram showed normal left ventricular function with mild mitral regurgitation. 

(AR 368). He stated Beck’s “exertional dyspnea does not appear to be related to 

obstructive coronary heart disease or structural heart disease.” Id. Dr. Marshall 

recommended annual follow-up in the absence of new symptoms. Id. 

 Plaintiff was examined by Dr. Tracey Jeck in December 2010 for a full body skin 

check. (AR 470). Dr. Jeck recommended that Beck’s skin tags were not skin cancer or 

precursors for skin cancer, and that removal of them would be for cosmetic reasons only. 

(AR 471). 

 Beck was seen by nurse practitioner Vickie Clous on June 14, August 13, and 

November 16, 2010 regarding constipation, hyperlipidemia (high cholesterol) and 

hypertension. At each of these appointments, Beck reported no new problems or 

concerns, and denied chest pain at rest, chest pain with exertion, shortness of breath, 

shortness of breath with exertion, dizziness, nausea, or fatigue. (AR 473, 476, 481, 492, 

494). Beck also denied exercise intolerance and dyspnea (shortness of breath), and denied 

joint and muscle pain. (AR 473, 481, 492). At each appointment, Clous noted her exam 

showed “no stigmata of inflammatory or degenerative arthritis” and that Beck’s gait was 

normal. (AR 477, 484, 495). Clous advised Beck to limit fat and sodium intake, lose 

weight, follow a low-fat and low-cholesterol diet, and exercise 30 minutes four days per 

week. (AR 479, 486, 497). 

 Beck was seen for a hearing evaluation on January 6, 2011. (AR 503). Beck 

reported “a gradual deterioration of the hearing in both ears over many years,” and also 

said she had occasional dizziness that she treats with Meclizine. Id. Dr. Tilsner found 

Beck had “significantly asymmetric sensorineural hearing loss” and opined it was 

probably not caused by Meniere’s disease because Beck’s symptoms were not typical of 

Meniere’s. Id. Dr. Tislner recommended a CT scan, which revealed some abnormalities 

in the left ear. (AR 504). 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 5 of 27
- 6 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

 Beck was seen by Dr. Mindy Jan on February 2, February 22, March 31, August 

17, September 8, and December 29, 2011 for chronic renal failure. (AR 591-96, 645). Dr. 

Jan noted no dizziness, nausea, vomiting, or diarrhea. Id. Dr. Jan assessed ARF/CKD 

(acute renal failure/chronic kidney disease). Id. 

 Beck was seen by nurse practitioner Vickie Clous on February 16, May 13 and 

November 18, 2011 for hyperlipidemia and hypertension. On February 16 and November 

18, Beck denied chest pain at rest, chest pain with exertion, shortness of breath, shortness 

of breath with exertion, dizziness, nausea, or fatigue. (AR 640, 657). Beck also denied 

exercise intolerance and dyspnea. (AR 640). On May 13, Beck complained of shortness 

of breath with exertion and dyspnea, but denied chest pain at rest, chest pain with 

exertion, shortness of breath, dizziness, nausea, or fatigue. (AR 674). At each 

appointment, Clous noted her exam showed “no stigmata of inflammatory or 

degenerative arthritis.” (AR 643, 661, 678). 

 Beck was seen by Dr. David Engelsberg for a pulmonary consultation on June 15, 

2011 with a chief complaint of exertional dyspnea. (AR 508). Beck reported the problem 

had been going on for one year, and that “walking one block or doing house work will 

make her short of breath.” Id. On examination, Dr. Engelsberg reported that with 

exertion, Beck’s oxygen saturation level was 95%. (AR 509.) His impression was 

“[d]yspnea of unknown etiology, probably most related to her weight, obesity, [and] 

possible asthma.” Id. Dr. Engelsberg recommended an x-ray, which revealed “no acute 

cardiopulmonary process” (AR 510) and a Symbicort inhaler (AR 509). At a follow up 

appointment on July 13, 2011, Dr. Engelsberg reported Beck was doing well and 

breathing well and using the Symbicort. (AR 507). His impression was “[a]sthma, 

stable.” Id. 

 Beck was seen for an orthopedic consultation on June 16, 2011. (AR 547). She 

reported significant hip and groin pain for four to six months, and also reported 

significant problems rolling over in bed and walking. Id. Dr. Murray Robertson observed 

Beck walked with a mild antalgic gait and had no difficulty on getting onto the exam 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 6 of 27
- 7 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

table, but had pain on log rolling of the hips, worse on the right, and that flexion and 

rotation were particularly painful on the right hip. Id. Dr. Robertson reviewed x-rays and 

assessed severe osteoarthritis of both hips and recommended Beck consider total hip 

arthroplasty. Id. 

 Beck was seen for a hernia operation consultation on June 17, 2011 with Dr. 

Shawn Stevenson. (AR 560). Beck also expressed interest in bariatric surgery, but told 

Dr. Stevenson she was unwilling to alter her diet, which he noted would severely limit 

the effectiveness of bariatric surgery. (AR 561). Dr. Stevenson also discussed with Beck 

that her ongoing morbid obesity put her at significantly higher risk for recurrence of the 

hernia. Id. Beck underwent laparoscopic repair of incarcerated incisional ventral hernia 

on July 21, 2011. (AR 539). There were no complications and Beck tolerated the 

procedure well. (AR 540). In a follow up note to Beck’s nurse practitioner, Vickie Clous, 

on August 8, 2011, Dr. Stevenson noted Beck had done relatively well since the 

operation and had healed appropriately. (AR 558). 

 Beck was seen by nurse practitioner Vickie Clous on August 9, 2011 for nausea 

and vomiting (AR 578) and was referred to the ER (AR 583). Beck was admitted to TMC 

Hospital the same day with chief complaints of dizziness and difficulty breathing. (AR 

528). She reported vomiting for two and half weeks following her hernia operation. Id. 

On examination, heart rate, breath effort, and breath sounds were normal. (AR 531). 

Laboratory studies indicated severe acute renal failure (AR 534) and it was noted that 

“[b]reathing difficulty and her case most likely is from acidosis secondary to the 

dehydration and acute renal failure” (AR 535). Dr. Mohammed Sikder diagnosed acute 

renal failure due to ATN (acute tubular necrosis—a kidney disorder) and recommended 

IV fluids. (AR 527). Dr. Sikder also diagnosed Type II diabetes and noted Beck did not 

usually check her blood sugars. Id. Beck was discharged in stable condition on August 

14, 2011. (AR 523). 

 Beck was seen by nurse practitioner Vickie Clous for a follow up on August 17, 

2011. (AR 571). Beck denied chest pain at rest, chest pain with exertion, shortness of 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 7 of 27
- 8 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

breath, shortness of breath with exertion, dizziness, and nausea. Id. Beck complained of 

joint pain and swelling (AR 574), but Clous noted no stigmata of inflammatory or 

degenerative arthritis (AR 575). Clous advised Beck to limit fat and sodium intake, lose 

weight, follow a low-fat and low-cholesterol diet, and exercise 30 minutes four days per 

week. (AR 576-77). 

 Beck was seen again at TMC on August 21, 2011 with chief complaints of 

constipation, difficulty urinating and urinary frequency. (AR 516). She was negative for 

neck pain, shortness of breath, chest pain, and gait problem, and positive for abdominal 

pain and constipation. Id. On examination, the doctor noted no neck problems, normal 

heart rate and rhythm, normal breath, and normal range of musculoskeletal movement. 

(AR 519). It was recommended Beck follow-up with her surgeon and noted that Beck’s 

complaints were very common following hernia operations. (AR 521). 

 Beck was admitted to TMC on December 8, 2011 with a complaint of severe pain 

in both hips. (AR 697). Dr. Robertson observed that Beck “walk[ed] into the office with a 

wide-based gait using a cane complaining about pain in both hips.” Id. 

 Beck was seen by Vickie Clous on February 15, 2012 to follow up on her 

hypertension and hyperlipidemia. (AR 651). Beck denied chest pain at rest, chest pain 

with exertion, shortness of breath, shortness of breath with exertion, dizziness and 

nausea. (AR 651, 654). Clous advised Beck to limit fat and sodium intake, lose weight, 

follow a low-fat and low-cholesterol diet, and exercise 30 minutes four days per week. 

(AR 576-77). 

b. Additional Medical Information 

 On April 26, 2012 Tucson Physical Therapy, PC completed a Functional Capacity 

Evaluation. (AR 706). Beck’s current complaints were shortness of breath and bilateral 

leg pain. (AR 707). Some of the pain profile results were abnormal and indicated possible 

symptom magnification. Id. The results on all cardiovascular activities tested showed 

“questionable” effort by Beck, with the exception of the reach 2 min test, where Beck’s 

effort was marked as “good.” (AR 709, 710). Testing for oxygen saturation showed 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 8 of 27
- 9 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

oxygen uptake of 99-100 percent for all activities tested. (AR 709). Beck was noted to 

have decreased lordosis (curvature of the spine), minimal rounded shoulders, minimal 

Dowager’s hump, and limited stride length. (AR 710). The form also documents Beck’s 

use of a single-point cane. Id. Beck had severe limitations for external and internal hip 

rotation of both legs. (AR 711). Minimal ulnar drift was noted in Beck’s right hand. (AR 

713). Static strength tests revealed some inconsistent results (AR 714), and Beck’s effort 

on dynamic lifting tests was “questionable” (AR 715). Validity profile results indicated a 

submaximal and inconsistent effort (AR 717), and the therapist commented that Beck’s 

effort level was questionable. (AR 718). The therapist also noted that Beck consistently 

reported she was limited by her reported shortness of breath. Id. 

 On April 30, 2012, MHC Freedom Park Health Center completed a Medical 

Source Statement. (AR 701). The form states Beck’s diagnoses are hip pain and arthritic 

hips, that her prognosis is fair, and that her symptoms are daily pain and stiffness. Id. The 

forms states Beck’s impairments have lasted or can be expected to last at least 12 months, 

and that she is not a malingerer. Id. Per Beck’s responses, she can walk less than one 

block without pain, can sit for 30-45 minutes before needing a break, and can stand for 5-

10 minutes before needing a break. (AR 702). Beck also indicated she could stand/walk 

less than 2 hours of an 8-hour work day and sit for 2-4 hours. Id. Beck further reported 

she needed a cane for standing/walking. (AR 703). 

c. State-Agency Consulting Physicians 

 State-agency physician Dr. Mansour reviewed Beck’s records and completed a 

Disability Determination Explanation form (initial) on March 23, 2011. (AR 81-87). Dr. 

Mansour found no evidence of an MDI (medically determinable impairment) severe 

enough to prevent SGA (substantial gainful activity). (AR 85). Disability examiner Alma 

Quesada further noted that there was “[n]o indication on medical records of hearing aid 

or need for cane.” (AR 84). 

 State-agency physician Dr. Hirsch reviewed Beck’s records and completed a 

Disability Determination Explanation form (reconsideration) on September 15, 2011. 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 9 of 27
- 10 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

(AR 89-101). The form notes that Beck reported she began experiencing new problems in 

January 2010, specifically shortness of breath and use of a cane. (AR 90, 94). Dr. Hirsch 

opined that Beck was only partially credible because the severity of her allegations was 

not entirely consistent with the available medical evidence. (AR 97). He further stated 

that the use of an AD (assistive device) did not appear to be supported. (AR 99). 

 Dr. Hirsch completed a Residual Functional Capacity Assessment, noting the 

following exertional limitations: occasionally lift or carry 10 pounds, frequently lift or 

carry less than 10 pounds, stand/walk for a total of 2 hours, sit for a total of 6 hours, 

occasionally climb ramps or stairs, never climb ropes or ladders, occasionally balance, 

kneel, and crouch, frequently stoop, and never crawl. (AR 98). Dr. Hirsch further 

recommended Beck avoid extreme heat and cold, fumes, and hazards. (AR 99). Dr. 

Hirsch opined Beck had the RFC to perform her past relevant work as dispatcher as 

generally performed in the national economy. (AR 100-101). 

d. Plaintiff’s Testimony 

 In response to an Exertional Daily Activities Questionnaire in December 2010, 

Beck reported that her average daily activities include getting dressed, walking her dog 

short distances, watching TV and visiting friends. (AR 186). She also reported shortness 

of breath when walking, constant pain in her left breast, and pain in both legs most of the 

time. (AR 186). Beck stated she used a cane for all walking and had been doing so for 

one year. (AR 188). 

 Beck completed another questionnaire in August 2011 and reported chronic pain 

in her hips, legs, groin, and left breast, and arthritis pain in her hands, back, and legs. (AR 

198). Beck also reported dizziness, nausea, difficulty breathing, and chronic fatigue. (AR 

198). She again stated she used a cane for walking. (AR 201). 

 In an undated Disability Report – Appeal, Beck reported that she sometimes needs 

help showering, that she has trouble picking things up off the floor, and that she walks 

with a cane. (AR 229-30). 

 Beck testified at her hearing before the ALJ on May 31, 2012 that she became 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 10 of 27
- 11 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

unable to work in December 2008 when she was diagnosed with breast cancer. (AR 59-

60). She was terminated from her last job in 2008 and filed for unemployment benefits, 

and received unemployment for a year and a half. (AR 60-61). While she was receiving 

unemployment she applied for other jobs such as waitress, secretary, and hostess. (AR 

60). Beck reported that she wakes at 7:00 a.m. and is able to dress and bathe herself. (AR 

61-62). She sometimes helps with chores, including mopping, sweeping, and washing the 

dishes. (AR 62). Her husband does the cooking and she sends out her laundry. (AR 62). 

Beck stated that she does not do the grocery shopping because she can’t walk to the store. 

(AR 62). She reported no hobbies but watches TV for five to eight hours per day. (AR 

62-63). 

 Beck testified that she has problems sleeping and sleeps about five hours each 

night. (AR 63). She takes two or three naps per day. (AR 69). She takes several 

medications but has no side effects from them. (AR 64-65). Beck reported she can walk 

and stand for 15 minutes at a time, but that sitting hurts because of her arthritis and hip 

replacements. (AR 66). She can sit for 15 to 20 minutes and then has to lay down or 

recline. (AR 66). Beck reported her knees, fingers, and elbows hurt from arthritis, that 

she also has arthritis in her neck, and that her “hips bother me because they’re not 

completely healed.” (AR 66). As to frequency of pain, Beck reported that she has a 

stabbing pain in her hips that comes and goes, the pain in her neck and fingers is always 

there, and the arthritis is a tingly sensation that goes away and comes back. (AR 67). On a 

scale of one to ten, she rated her pain as a five or six with medication. (AR 67). 

 On examination by her attorney, Beck testified that she cannot walk without a 

cane, and that she has been using it since 2008.1

 (AR 70). She uses the cane for balance, 

because she gets tired from walking, and to help her stand erect. (AR 70). 

 

1

 The Court notes that while Beck testified she began using a cane in 2008, on the 

Disability Determination Explanation form (reconsideration) and Disability Report- Appeal form, Beck reported that she began using a cane in January 2010. (AR 90, 190). On the Exertional Daily Activities form dated December 15, 2010, Beck reported she had been using a cane for all walking for one year. (AR 188). The Court further notes that the 

record contains no allegations of hip pain until June 2011. (AR 547). 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 11 of 27
- 12 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

e. Vocational Evidence 

 At the hearing before the ALJ, Judith Najarian testified as a vocational expert. She 

stated that Beck’s past work as a dispatcher was classified as sedentary work. (AR 75). 

Beck’s work as a casino writer, office staff clerk, and self-service gas station attendant 

was semi-skilled, light work. (AR 76). Beck’s work as a cashier was classified as light 

and unskilled, and her waitressing work was semi-skilled light to medium work. (AR 76). 

Based on the hypothetical presented by the ALJ, Najarian testified that the only job a 

person with Beck’s restrictions could perform was dispatcher. (AR 77). Najarian opined 

that a person with Beck’s restrictions could not work competitively if she were to miss 

three or more days of work per month. (AR 77-78). 

f. ALJ’s Findings 

 The ALJ found that Beck had the following severe impairments: obesity, diabetes, 

hypertension, Meniere’s disease, osteoarthritis, and asthma. (AR 25). The ALJ found that 

Beck’s testimony regarding the severity and functional consequences of her symptoms 

was not fully credible in light of the medical records, findings on examination, and 

treating source reports. (AR 28-29). 

 The ALJ gave reduced weight to the Medical Source Statement (AR 701) 

completed by MHC Freedom Park Health Center because the signature on the form was 

illegible and Beck testified that the form was not completed by her regular physician. 

(AR 29). In addition, the ALJ noted that “the functional limitations are qualified 

throughout the form responses with ‘per patient response.’ This indicates that the 

provider completed the form based on the claimant’s subjective self-report rather than 

objective evidence.” Id. 

 The ALJ gave substantial weight “to the findings of the State agency medical 

consultants,” which “found the claimant capable of a wide range of sedentary level 

work.”(AR 29). The ALJ further found that “[i]n reviewing the evidence available at the 

hearing level, this assessment is consistent with the overall evidence.” Id. 

 The ALJ concluded that Beck could perform sedentary work that required 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 12 of 27
- 13 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

occasionally lifting and carrying 10 pounds and frequently lifting and carrying less than 

10 pounds. (AR 27). At Step Four2

 of the SSI/DIB evaluation process, the ALJ found 

Beck was able to perform her past relevant work as a dispatcher both as actually 

performed and as generally performed. (AR 29-30). The ALJ therefore concluded Beck 

was not disabled. (AR 30). 

g. Additional Evidence Submitted to Appeal’s Council 

After the ALJ’s June 21, 2012 decision, Beck submitted additional evidence to the 

Appeals Council. (AR 719). This evidence consists of medical records from the 

University of Arizona Medical Center. On June 7, 2012, Beck was seen for a chief 

complaint of shortness of breath. (AR 745). She reported the problem had been occurring 

for two years, and that she “can hardly walk for 100-200 yards.” Id. The doctor referred 

Beck for a spirometry (test measuring lung function) and sleep study, and opined “[a]t 

this time we would not recommend any treatment.” (AR 746). On June 21, 2012, Beck 

underwent pulmonary testing. (AR 723-36). Post-test comments noted that Beck exerted 

maximal effort and that “since performance on spirometry was so good, bronchdilators 

were not given.” (AR 730). Other comments noted “no obstruction, no restriction, mild 

decrease in diffusion, respiratory alkalosis, and normal oxygenation.” Id. No additional 

evidence was submitted on Beck’s ability to walk, her hip pain, or her use of a cane. 

The Appeals Council found that the additional evidence did not provide a basis for 

changing the ALJ’s decision. (AR 4). 

III. Standard of Review 

The Commissioner employs a five-step sequential process to evaluate SSI and 

DIB claims. 20 C.F.R. §§ 404.920, 416.1520; see also Heckler v. Campbell, 461 U.S. 

458, 460-462 (1983). To establish disability the claimant bears the burden of showing she 

(1) is not working; (2) has a severe physical or mental impairment; (3) the impairment 

meets or equals the requirements of a listed impairment; and (4) claimant’s residual 

 

2

 At Step Four, the Commissioner determines whether the claimant has sufficient 

residual functional capacity to perform past work. 20 C.F.R. §§ 404.1520(e), 416.920(e). 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 13 of 27
- 14 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

functional capacity (“RFC”) precludes her from performing her past work. 20 C.F.R. §§ 

404.920(a)(4), 416.1520(a)(4). At Step Five, the burden shifts to the Commissioner to 

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

numbers in the national economy. Hoopai v. Astrue, 499 F.3d 1071, 1074 (9th Cir. 2007). 

If the Commissioner conclusively finds the claimant “disabled” or “not disabled” at any 

point in the five-step process, she does not proceed to the next step. 20 C.F.R. §§ 

404.920(a)(4), 416.1520(a)(4). 

In this case, Beck was denied at Step Four of the evaluation process. Step four 

requires a determination of whether the claimant has sufficient RFC to perform past 

work. 20 C.F.R. §§ 404.1520(e), 416.920(e). RFC is defined as that which an individual 

can still do despite her limitations. 20 C.F.R. §§ 404.1545, 416.945. If the ALJ concludes 

the claimant has the RFC to perform past work, the claim is denied. 20 C.F.R. §§ 

404.1520(f), 416.920(f). An RFC finding is based on the record as a whole, including all 

physical and mental limitations, whether severe or not, and all symptoms. Social Security 

Ruling (SSR) 96-8p. 

 The findings of the Commissioner are meant to be conclusive. 42 U.S.C. §§ 

405(g), 1383(c)(3). The court may overturn the decision to deny benefits only “when the 

ALJ’s findings are based on legal error or are not supported by substantial evidence in the 

record as a whole.” Aukland v. Massanari, 257 F.3d 1033, 1035 (9th Cir. 2001). As set 

forth in 42 U.S.C. § 405(g), “[t]he findings of the Secretary as to any fact, if supported by 

substantial evidence, shall be conclusive.” Substantial evidence “means such relevant 

evidence as a reasonable mind might accept as adequate to support a conclusion,” 

Valentine v. Comm’r Soc. Sec. Admin., 574 F.3d 685, 690 (9th Cir.2009) (internal 

quotation marks and citations omitted), and is “more than a mere scintilla, but less than a 

preponderance.” Aukland, 257 F.3d at 1035. The Commissioner’s decision, however, 

“cannot be affirmed simply by isolating a specific quantum of supporting evidence.” 

Sousa v. Callahan, 143 F.3d 1240, 1243 (9th Cir. 1998) (internal citations omitted). 

“Rather, a court must consider the record as a whole, weighing both evidence that 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 14 of 27
- 15 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

supports and evidence that detracts from the Secretary’s conclusion.” Aukland, 257 F.3d 

at 1035 (internal quotation marks and citations omitted). 

 The ALJ is responsible for resolving conflicts in testimony, determining 

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

1995). “When the evidence before the ALJ is subject to more than one rational 

interpretation, [the court] must defer to the ALJ’s conclusion.” Batson v. Comm’r Soc. 

Sec. Admin., 359 F.3d 1190, 1198 (9th Cir. 2004). This is so because “[t]he [ALJ] and not 

the reviewing court must resolve conflicts in evidence, and if the evidence can support 

either outcome, the court may not substitute its judgment for that of the ALJ.” Matney v. 

Sullivan, 981 F.2d 1016, 1019 (9th Cir. 1992) (internal citations omitted). 

 Additionally, “[a] decision of the ALJ will not be reversed for errors that are 

harmless.” Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir. 2005). The claimant bears the 

burden to prove any error is harmful. McLeod v. Astrue, 640 F.3d 881, 888 (9th Cir. 

2011) (citing Shinseki v. Sanders, 556 U.S. 396, 129 S.Ct. 1696, 1706 (2009)). An error 

is harmless where it is “inconsequential to the ultimate nondisability determination.” 

Molina v. Astrue, 674 F.3d 1104, 1115 (9th Cir. 2012) (internal citations omitted); see 

also Stout v. Comm’r Soc. Sec. Admin., 454 F.3d 1050, 1055 (9th Cir. 2006). “[I]n each 

case [the court] look[s] at the record as a whole to determine whether the error alters the 

outcome of the case.” Molina, 674 F.3d at 1115. In other words, “an error is harmless so 

long as there remains substantial evidence supporting the ALJ’s decision and the error 

does not negate the validity of the ALJ's ultimate conclusion. Id. (internal quotation 

marks and citations omitted). 

 Finally, “[a] claimant is not entitled to benefits under the statute unless the 

claimant is, in fact, disabled, no matter how egregious the ALJ’s errors may be.” Strauss 

v. Comm’r Soc. Sec., 635 F.3d 1135, 1138 (9th Cir. 2011).). 

IV. Analysis 

Beck argues the ALJ erred in assessing her credibility, determining her RFC, and 

in conducting the Step Four analysis. (Doc. 13). Beck asks the Court to reverse the 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 15 of 27
- 16 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

Commissioner’s final decision and remand this matter for rehearing. (Doc. 13 at 18-19). 

The Commissioner contends that the ALJ’s decision is supported by substantial evidence 

and that the record as a whole does not support a finding of total disability. (Doc. 16). 

The Court concludes that the ALJ’s decision is supported by substantial legal evidence 

and is free from legal error. 

a. Credibility finding 

The ALJ found that Beck’s statements regarding the severity and functional 

consequences of her symptoms were not fully credible in light of the medical records, 

findings on examination, and consulting physician reports. (AR 28-29). Beck argues that 

the ALJ failed to support this credibility finding with clear and convincing reasons, that 

the ALJ erroneously required objective evidence of Beck’s daily activities, and that the 

ALJ erroneously evaluated Beck’s hip pain. (Doc. 13 at 15-17). 

While questions of credibility are functions solely for the ALJ, this Court “cannot 

affirm such a determination unless it is supported by specific findings and reasoning.” 

Robbins v. Comm’r Soc. Sec. Admin. 466 F.3d 880, 885 (9th Cir. 2006). “To determine 

whether a claimant’s testimony regarding subjective pain or symptoms is credible, an 

ALJ must engage in a two-step analysis.” Ligenfelter v. Astrue, 504 F.3d 1028, 1035-36 

(9th Cir. 2007). “First, the ALJ must determine whether the claimant has presented 

objective medical evidence of an underlying impairment ‘which could reasonably be 

expected to produce the pain or other symptoms alleged.’” Id. at 1036 (quoting Bunnell v. 

Sulivan, 947 F. 2d 341, 344 (9th Cir. 1991)). “Second, if the claimant meets this first test 

and there is no evidence of malingering, ‘the ALJ can reject the claimant’s testimony 

about the severity of the symptoms only by offering specific, clear and convincing 

reasons for doing so.’” Lingenfelter, 504 F.3d at 1036 (quoting Smolen v. Chater, 80 F.3d 

1273, 1282 (9th Cir. 1996)). 

While it is permissible for an ALJ to look to the objective medical evidence as one 

factor in determining credibility, the ALJ’s adverse credibility finding must be supported 

by other permissible evidence in the record. Bunnell v. Sullivan, 947 F.2d 341, 346-47 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 16 of 27
- 17 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

(9th Cir. 1991) (“adjudicator may not discredit a claimant’s testimony of pain and deny 

disability benefits solely because the degree of pain alleged by the claimant is not 

supported by objective medical evidence”). However, “an ALJ may reject a claimant's 

statements about the severity of his symptoms and how they affect him if those 

statements are inconsistent with or contradicted by the objective medical evidence.” 

Robbins, 466 F.3d at 887 (emphasis in original). “Factors that an ALJ may consider in 

weighing a claimant’s credibility include reputation for truthfulness, inconsistencies in 

testimony or between testimony and conduct, daily activities, and unexplained, or 

inadequately explained, failure to seek treatment or follow a prescribed course of 

treatment.” Orn v. Astrue, 495 F.3d 625, 636 (9th Cir. 2007) (internal quotation marks 

and citations omitted). 

The ALJ did not make a finding that Beck was malingering; therefore, to support 

her discounting of Beck’s assertions regarding the severity of her symptoms, the ALJ had 

to provide clear and convincing, specific reasons. 

The ALJ’s finding that Beck was not entirely credible regarding her limitations 

was based on the medical record that reveals the treatment Beck received has been 

generally successful in treating her conditions and controlling her symptoms. First, the 

ALJ noted Beck was treated for breast cancer in 2009, that pathology for metastasis was 

negative, and that although Beck “reported ongoing left breast pain, there is no objective 

evidence that such complaints were addressed by her treating physicians.” (AR 28). 

Second, the ALJ noted Beck “is status post hysterectomy and ventral hernia repair. There 

is no evidence of any residual functional limitations as a result of these surgeries, which 

were successfully performed, with no ongoing complaints.” Id. Third, the ALJ noted 

Beck’s 2010 cardiac evaluation indicated her shortness of breath was possibly related to 

obesity, but that Beck “chose not to pursue any medical course to lose weight.” Id.; see 

Molina v. Astrue, 674 F.3d 1104, 1113 (9th Cir. 2012) (ALJ may properly rely on an 

unexplained or inadequately explained failure to follow a prescribed course of treatment). 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 17 of 27
- 18 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

Fourth, the ALJ noted that Beck’s hip pain had been addressed with surgery,3 and 

although Beck uses a cane, “there is no evidence that this is medically required or was 

prescribed by a physician.” (AR 29). Fifth, the ALJ noted “[t]here is very limited 

objective evidence to support the claimant’s allegations of constant arthritic pain and 

limited daily activities.” Id. Finally, the ALJ noted the physical therapist questioned 

Beck’s level of effort and reported shortness of breath, and some of the test results were 

invalid. Id.; see Thomas v. Barnhart, 278 F.3d 947, 959 (9th Cir. 2002) (where claimant 

failed to give maximum or consistent effort during two physical capacity evaluations, 

“[her] efforts to impede accurate testing of her limitations supports the ALJ’s 

determinations as to her lack of credibility.”). 

The ALJ also pointed to Beck’s testimony that she believed she was able to work 

during the period she was receiving unemployment and applying for jobs: 

The claimant testified that after she stopped working in December 2008, the month she alleges she became disabled, she received unemployment benefits for the next year and a half. This indicates the claimant was willing, available, and 

more importantly, able to accept any offer of employment 

during the period she received those benefits. The claimant 

testified that she believed she was able to work while she was 

applying for various jobs. 

(AR 29); see Copeland v. Bowen, 861 F.2d 536, 542 (9th Cir. 1988) (upholding adverse 

credibility finding where ALJ noted that, because claimant received unemployment 

insurance after he was laid off, he “apparently consider[ed] himself capable of working 

and [held] himself out as available for work”).4

 

 For all of these reasons, the ALJ found that there was “very limited objective 

evidence to support [Beck’s] allegations of constant arthritic pain and limited daily 

 

3

 Beck testified that her right hip was replaced in December 2011 and her left hip was replaced in January or February 2012. (AR 66). 

4

 The Court also notes Beck’s inconsistency on this issue. For example, on the Disability Report form, Beck reported that she stopped working in December 2008 because of her condition (AR 175), when in fact she was terminated. (AR 60). In 

addition, Beck’s testimony suggests that while she was actively applying for jobs while receiving unemployment, at some point she simply got tired of submitting applications and being rejected. (AR 72). 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 18 of 27
- 19 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

activities.” (AR 29). In making this credibility finding, the ALJ drew primarily on the 

lack of medical evidence supporting Beck’s alleged symptoms, but also noted Beck’s 

ability to complete activities of daily living (AR 28),5

 and the fact that Beck believed she 

was capable of working when she received unemployment (AR 29). These were specific, 

clear, and convincing reasons, and the ALJ did not err by finding Beck’s allegations of 

subjectively disabling symptoms were not credible.6

 Contrary to Beck’s contention, the ALJ did not require objective evidence of 

Beck’s daily activities. Rather, after reviewing the medical record, the ALJ considered 

Beck’s testimony on her symptoms and daily activities, but found Beck was not fully 

credible in light of the fact that Beck’s statements were inconsistent with the objective 

medical evidence. See Robbins, 466 F.3d at 887. 

 Beck further contends that the ALJ erroneously evaluated her hip pain. Although 

the ALJ noted Beck’s “[b]ilateral hip pain has been addressed with surgery” (AR 29), 

Beck testified that sitting hurts because of her arthritis and hip replacements, and that her 

“hips bother me because they’re not completely healed.” (AR 66). Beck alleges disability 

beginning in December 2008, yet there is no mention of hip problems in the medical 

record until June 2011.7

 (AR 547). While Beck may have had hip pain at the time of the 

 

5

 The ALJ noted that Beck handles her personal care and does some chores, but 

does not cook, go shopping or exercise. (AR 28). 

6

 The ALJ’s finding on this issue are consistent with the medical record, which 

shows that while Beck no doubt experienced a number of medical issues, her major surgeries were all performed successfully and she recovered well, with no ongoing issues or problems related to her breast cancer, hysterectomy, kidney removal, or hernia repair. In addition, Beck’s reported shortness of breath was found to be not related to heart 

disease (AR 368-70), her oxygen saturation level was 95% (AR 509), and her symptoms improved with use of an inhaler (AR 507). Finally, Beck’s allegations of constant arthritic pain are not supported by the record, which shows that at almost all of Beck’s 

medical appointments from 2009 through 2012, she reported no pain, and no joint or muscle pain, and nurse practitioner Vickie Clous consistently noted no stigmata of inflammatory or degenerative arthritis. Despite Beck testifying that she has arthritis in her knees, fingers, elbows, and neck (AR 66), the medical record is absolutely devoid of any mention of these ailments. 

7

 The Court notes that this allegation of hip pain seems to be an eleventh hour attempt to bolster Beck’s claim for DIB. Beck alleges disability dating back to 2008, and saw numerous medical providers during 2009 and 2010, yet she never reported any pain or other issues with her hips until June 2011. At the June 16, 2011 appointment, Beck 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 19 of 27
- 20 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

hearing due to her recent surgery, Beck submitted no medical documentation of her hip 

surgeries, follow-up appointments, or any other medical records documenting ongoing 

hip pain. It is the claimant’s burden to provide objective evidence to support her 

allegations of disability, and in this case, it was not unreasonable for the ALJ to find 

Beck’s allegation of hip pain not fully credible where the medical evidence submitted on 

this issue is almost nonexistent. See 20 C.F.R. § 404.1512(a); Mayes v. Massanari, 276 

F.3d 453, 459 (9th Cir. 2001). 

By citing to the medical evidence that shows Beck’s medical issues have largely 

been resolved or are controlled, Beck’s daily activities, and Beck’s statements regarding 

her belief that she was able to work, the ALJ provided the requisite specific findings for 

discounting Beck’s testimony concerning the severity of her symptoms. See Bray v. 

Comm’r of Soc. Sec. Admin., 554 F.3d 1219, 1227 (9th Cir. 2009). Though Beck’s 

testimony may be susceptible to more than one interpretation, the ALJ’s credibility 

finding is “a reasonable interpretation and is supported by substantial evidence; thus, it is 

not our role to second-guess it.” Rollins v. Massanari, 261 F.3d 853, 857 (9th Cir. 2001). 

b. RFC and Cane

Beck alleges the RFC assessment is flawed because the ALJ did not take into 

account Beck’s use of a cane. 

Residual functional capacity is “the most [a claimant] can still do despite [her] 

limitations,” and includes assessment of the claimant’s “impairment(s), and any related 

symptoms, such as pain, [which] may cause physical and mental limitations that affect 

what [she] can do in a work setting.” 20 C.F.R. § 404.1545(a)(1). In determining the 

RFC, if the ALJ finds a claimant cannot do her past work, the ALJ may still find that a 

claimant can adjust to other work if she can do any jobs that “exist in significant numbers 

 reported “significant hip and groin pain for approximately 4-6 months” (AR 547), yet there is no documentation of Beck reporting hip pain to any of her providers prior to this appointment. The Court further notes that while there is insufficient evidence to 

substantiate Beck’s allegations of disabling hip pain and that Beck’s alleged hip problems do not support a disability onset date of December 2008, Beck could re-file a new DIB 

application based on the onset date of her alleged hip issues. 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 20 of 27
- 21 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

in the national economy.” 20 C.F.R. § 404.1560(c)(1). 

The Commissioner retains the ultimate responsibility for assessing a claimant’s 

RFC. 20 C.F.R. §§ 404.1527(e)(2), 416.927(e)(2). The ALJ was required to assess Beck’s 

RFC based on all the record evidence, including medical sources, examinations, and 

information provided by Beck. 20 C.F.R. §§ 404.1545(a)(1)-(3), 416.945(a)(1)-(3). 

However, the ALJ need not include all possible limitations in her assessment of what a 

claimant can do, but rather is only required to ensure that the residual functional capacity 

“contain[s] all the limitations that the ALJ found credible and supported by the 

substantial evidence in the record.” Bayliss v. Barnhart, 427 F.3d 1211, 1217 (9th Cir. 

2005); Greger v. Barnhart, 464 F.3d 968, 973 (9th Cir. 2006) (“The ALJ, though, ‘is free 

to accept or reject restrictions in a hypothetical question that are not supported by 

substantial evidence.’” (quoting Osenbrock v. Apfel, 240 F.3d 1157, 1164-65 (9th Cir. 

2001)). 

Beck contends “[t]he ALJ unreasonably found that Beck did not need a cane, in 

part, because Beck used a non-prescribed cane.” (Doc. 13 at 11). The ALJ did not include 

a cane in the RFC assessment (AR 27) and noted that there was “no evidence that [Beck’s 

use of the cane] is medically required or was prescribed by a physician” (AR 29). This 

assessment is consistent with the medical records, which are devoid of any 

recommendation that Beck should use a cane. Beck saw nurse practitioner Vickie Clous 

for a number of appointments from 2009 through 2012, but there is no documented use of 

a cane on any of these dates, and Clous consistently reported no gait abnormality.8

 In 

fact, there are only 3 instances where Beck’s use of a cane is mentioned, and in each of 

these cases, the medical provider was noting an observation, not making a 

recommendation. First, at an appointment on December 8, 2011 Dr. Robertson observed 

 

8

 The Court notes Beck attended numerous medical appointments with multiple providers between 2008-2012, yet none of the providers recommended or prescribed a cane for Beck. Rather, other providers in addition to Clous also reported Beck had no joint swelling, pain, or stiffness, no muscle pain, and no leg cramps. (See e.g. AR 262, 284, 356, 358). Further, had Beck been using a cane since 2008 as she alleges (AR 70), the Court presumes that at least one of Beck’s medical providers would have noted her 

use of the cane prior to the December 2011 appointment with Dr. Robertson. 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 21 of 27
- 22 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

that Beck “walk[ed] into the office with a wide-based gait using a cane complaining 

about pain in both hips.” (AR 697). Second, the Functional Capacity Evaluation from 

April 26, 2012 documents Beck’s use of a single-point cane. (AR 710). Finally, the 

Medical Source Statement from April 30, 2012 notes that Beck reported she needed a 

cane for standing/walking. (AR 703). 

Beck focuses on the fact that while each of these providers documented her use of 

the cane, they did not specifically state that the cane was not medically necessary. (Doc. 

13 at 11-12). However, the inverse is also true—none of the providers specifically stated 

that the use of the cane was medically necessary. Beck further alleges that the ALJ failed 

to consider or properly credit these providers’ observations. (Doc. 13 at 12). The ALJ did 

not make a specific finding as to the weight that should be given to Dr. Robertson’s 

observation or to the Functional Capacity Evaluation. The ALJ did state that the Medical 

Source Statement would be given reduced weight because the signature on the form was 

illegible and Beck testified that the form was not completed by her regular physician. 

(AR 29). In addition, the ALJ noted that “the functional limitations are qualified 

throughout the form responses with ‘per patient response.’ This indicates that the 

provider completed the form based on the claimant’s subjective self-report rather than 

objective evidence.” Id. There is no evidence that the ALJ failed to evaluate or consider 

each of the three observations noting Beck’s use of a cane. 

While Beck correctly points out that a purchasing and using a cane does not 

require a prescription (Doc. 13 at 11), a claimant’s choice to use a cane does not 

automatically entitle the claimant to an RFC finding that incorporates the use of a cane. 

In fact, Beck’s opening brief cites SSR 96-9p, which states: “To find that a hand-held 

assistive device is medically required, there must be medical documentation establishing 

the need for a hand-held assistive device to aid in walking or standing, and describing the 

circumstances for which it is needed.” Here, there is no such documentation. 

The case of Thomas v. Barnhart, 278 F.3d 947 (2002) is on point. In Thomas, the 

Court found that where the ALJ “determined that Mrs. Thomas’ subjective complaints of 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 22 of 27
- 23 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

pain were not credible ... the ALJ need not have included Ms. Thomas’ use of a cane or 

wheelchair in his hypothetical.” Id. at 959. The court further noted that “[w]hile the 

record contains conclusory statements that Ms. Thomas needed a cane ... [w]ithout 

objective medical evidence that Ms. Thomas needed a cane or wheelchair, and in light of 

the ALJ’s findings with respect to Ms. Thomas’ lack of credibility, there was no reason to 

include Ms. Thomas’ subjective use of those devices in the hypothetical to the VE.” Id. at 

959-60. Finally, the court stated that because “the ALJ’s hypothetical incorporated the 

option of sitting while working ... Ms. Thomas’ alleged use of a cane or wheelchair 

would be irrelevant.” Id. at 960. 

In Beck’s case, as in Thomas, there is no objective medical evidence that Beck 

needs a cane. Further, the ALJ found Beck to be only partially credible because the 

objective medical evidence did not fully support Beck’s statements regarding the extent 

and severity of her pain and limitations, thus the ALJ was not required to include Beck’s 

subjective use of a cane in the RFC or hypothetical to the VE. Finally, the ALJ’s RFC 

assessment and hypothetical included options for Beck to sit, stand, and walk during the 

work day, with the majority of time (6 out of 8 hours) spent sitting. 

Beck also suggests that she uses a cane due to her Meniere’s disease, which can 

cause vertigo. (Doc. 13 at 13-14). Although Beck testified that gets dizzy from the 

Meniere’s disease and takes medication for her dizziness, she did not testify that she uses 

the cane for dizziness. (AR 65, 69). Further, Beck consistently reported no dizziness to 

her medical providers from 2009 through 2012, with the exception of two appointments. 

On August 9, 2011 Beck was admitted to TMC Hospital with chief complaints of 

dizziness and difficulty breathing, which was found to be related to acute renal failure. 

(AR 528, 534-35). At Beck’s hearing evaluation on January 6, 2011, she reported 

occasional dizziness that she treats with Meclizine. (AR 503).There is no indication from 

the medical records or from Beck’s own testimony that her use of the cane is related to 

dizziness associated with Meniere’s disease. 

If the Court does not agree that Beck’s use of the cane is medically necessary, 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 23 of 27
- 24 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

Beck alternatively argues that the ALJ should have developed the record further to 

determine whether it was necessary or not. (Doc. 13 at 14). Beck cites C.F.R. § 

404.1519a(b) (2014),9

 which states “[w]e may purchase a consultative examination to try 

to resolve an inconsistency in the evidence, or when the evidence as a whole is 

insufficient to allow us to make a determination or decision on your claim.” However, an 

ALJ is only required to further develop a record if the evidence is consistent but the ALJ 

does not have sufficient evidence to determine whether a claimant is disabled, or if after 

weighing the evidence, the ALJ still cannot reach a conclusion as to disability. 20 C.F.R. 

§ 404.1520b (2014); McLeod v. Astrue, 640 F.3d 881, 885 (9th Cir. 2011) (“an ALJ’s 

duty to develop the record further is triggered only when there is ambiguous evidence or 

when the record is inadequate to allow for proper evaluation of the evidence”) (citation 

and internal quotation marks omitted). The ALJ did not make a finding that the evidence 

was inadequate or inconsistent to make a finding regarding Beck’s use of a cane. Instead, 

the ALJ reasoned that based on all of the objective medical evidence, there was “no 

evidence that [Beck’s use of the cane] is medically required.” (AR 29). 

Beck further alleges the ALJ “did not obtain a medical opinion from an acceptable 

medical source.” (Doc. 13 at 15). Here, state agency physician Dr. Hirsch examined the 

medical evidence and opined that Beck’s use of a cane was not supported by the record. 

(AR 99). Beck was seen for numerous medical appointments from 2009 through 2012, 

yet the record is devoid of any recommendation that Beck should use a cane, and there 

are only three instances during this time period where Beck’s providers observed her 

using a cane. 

In sum, the ALJ was only required to ensure that the RFC “contained all of the 

limitations that the ALJ found credible and supported by the substantial evidence in the 

record.” Bayliss, 427 F.3d at 1217; Greger, 464 F.3d at 973. The ALJ was not required to 

include limitations requiring use of a cane, because although Beck testified that she used 

 

9

 Beck cites the 2013 version of the statute in her opening brief. The Court cites the more recent 2014 version here. 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 24 of 27
- 25 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

a cane and had trouble walking long distances without one,10 there was no medical 

evidence to support these claims, nor did any of the medical providers specifically 

recommend an assistive device. Based on this finding, as well as her finding that Beck’s 

testimony regarding her limitations was only partially credible, the ALJ chose not to 

include a cane in her RFC assessment. The Court finds that the ALJ’s assessment of 

Beck’s RFC was based on all the limitations the ALJ found credible and supported by 

substantial evidence, and the Court finds no error here. See Aukland, 257 F.3d at 1035. 

c. Step Four: Past Relevant Work 

Beck contends the ALJ erred in concluding Beck could perform her past relevant 

work as a dispatcher because the ALJ found Beck could lift and carry up to 10 pounds, 

but Beck reported she lifted up to 50 pounds when she worked as a dispatcher. (Doc. 13 

at 8). 

In determining the physical requirements of a claimant’s past work, and whether 

she has the RFC to perform it, the ALJ considers the information provided by a claimant, 

as well as others who are familiar with her work, vocational experts and the DOT. 20 

C.F.R. §§ 404.1560(b)(2), 416.960(b)(2). 

Here, the ALJ determined Beck could perform her past relevant work as a 

dispatcher both as actually performed and as generally performed in the national 

economy. (AR 30). The ALJ based this decision on testimony from the VE, who testified 

that a person of Beck’s age, education, past relevant work, and RFC could do Beck’s past 

relevant work as a dispatcher (AR 76-77). Under the Dictionary of Occupational Titles 

(DOT), work as a dispatcher is classified as sedentary. Dep’t of Labor, DOT, No. 

249.167-014 (9th ed. 1991), 1991 WL 672312. “The RFC to meet the physical and 

 

10 The Court also notes the ALJ’s credibility assessment on this issue is further 

supported by the numerous inconsistencies in Beck’s reports as to when she first began using a cane. For example, at the hearing before the ALJ, Beck testified that she has been 

using a cane since 2008 (AR 70), yet on the Disability Determination Explanation Form (reconsideration) and Disability Report-Appeal form, Beck reported that she began using a cane in January 2010 (AR 90, 190). On the Exertional Daily Activities form dated December 15, 2010, Beck reported she had been using a cane for all walking for one year. (AR 188). 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 25 of 27
- 26 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

mental demands of jobs a claimant has performed in the past (either the specific job a 

claimant performed or the same kind of work as it is customarily performed throughout 

the economy) is generally a sufficient basis for a finding of ‘not disabled.’” SSR 82-62 at 

*3. 

The Commissioner argues that because the ALJ found Beck was not fully credible, 

the ALJ did not have to credit Beck’s allegation that she lifted up to 50 pounds in her past 

work as a dispatcher. (Doc. 16 at 18). The ALJ’s decision does not include a specific 

finding as to Beck’s credibility regarding her past relevant work. Regardless, even if 

Beck did lift up to 50 pounds when she previously worked as a dispatcher, the ALJ found 

Beck was capable of performing work as a dispatcher as generally performed in the 

national economy. Based on the VE’s testimony, work as a dispatcher as generally 

performed meets Beck’s RFC restrictions of occasionally lifting or carrying 10 pounds, 

and frequently lifting or carrying less than 10 pounds. (AR 76-77). This is also consistent 

with the Functional Capacity Evaluation, which recommended Beck could occasionally 

lift 13 pounds, frequently lift 6 pounds, and constantly lift 3 pounds. (AR 718). 

Accordingly, the Court finds that even if Beck lifted up to 50 pounds when she 

previously worked as a dispatcher, substantial evidence supports the ALJ’s conclusion 

that Beck could perform her past relevant work as a dispatcher as generally performed in 

the national economy. See Aukland, 257 F.3d at 1035. 

V. Remedy 

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

U.S.C. § 405(g). Absent legal error or a lack of substantial evidence supporting the ALJ’s 

findings, this Court is required to affirm the ALJ’s decision. After considering the record 

as a whole, this Court simply determines whether there is substantial evidence for a 

reasonable trier of fact to accept as adequate to support the ALJ’s decision. Valentine, 

574 F.3d at 690. Here, the record contains sufficient substantial evidence to meet this 

standard. The Court concludes the ALJ’s findings are supported by substantial evidence 

and there is no legal basis for reversing or remanding her decision. Therefore, Beck is not 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 26 of 27
- 27 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

entitled to relief. 

VI. Recommendation 

For the foregoing reasons, the Magistrate Judge recommends the District Court, 

after its independent review, enter an order denying Plaintiff’s request to reverse the 

Commissioner’s final decision. 

Pursuant to 28 U.S.C. §636(b), any party may serve and file written objections 

within fourteen days after being served with a copy of this Report and Recommendation. 

A party may respond to another party’s objections within fourteen days after being served 

with a copy thereof. Fed. R. Civ. P. 72(b). No reply to any response shall be filed. See id. 

If objections are not timely filed, then the parties’ rights to de novo review by the District 

Court may be deemed waived. See United States v. Reyna-Tapia, 328 F.3d 1114, 1121 

(9th Cir. 2003) (en banc). 

 Dated this 18th day of August, 2014. 

 

Case 4:13-cv-01098-DCB Document 19 Filed 08/18/14 Page 27 of 27