Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_13-cv-02407/USCOURTS-azd-2_13-cv-02407-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:405 Review of HHS Decision (SSID)

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WO 

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Barbara Flint, 

Plaintiff, 

v. 

Carolyn W. Colvin, Acting Commissioner 

of Social Security, 

Defendant. 

No. CV-13-02407-PHX-NVW 

ORDER 

Plaintiff Barbara Flint seeks review under 42 U.S.C. § 405(g) of the final decision 

of the Commissioner of Social Security (“the Commissioner”), which denied her 

disability insurance benefits and supplemental security income under sections 216(i), 

223(d), and 1614(a)(3)(A) of the Social Security Act. Because the decision of the 

Administrative Law Judge (“ALJ”) is supported by substantial evidence and is not based 

on legal error, the Commissioner’s decision will be affirmed. 

I. BACKGROUND 

Plaintiff was born in May 1969 and was 40 years old on her alleged onset date. 

She has completed one year of college. From 2000 to July 2009, she worked for an 

insurance company in several positions, which included administrative assistant and a 

long term disability claims analyst. Plaintiff’s neck condition began with a work-related 

injury in 2002. Beginning in 2005, she had three neck surgeries and a spinal cord 

stimulator implanted in her hip, but she continues to have pain in her neck and right 

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shoulder. She began receiving short-term disability benefits in June 2009 and long-term 

disability benefits in January 2010. At the time of the administrative hearing, Plaintiff 

continued receiving long-term disability benefits and remained an employee of the 

insurance company. 

On August 10, 2010, Plaintiff applied for disability insurance benefits and 

supplemental security income, alleging disability beginning July 7, 2009. On June 13, 

2012, she appeared with her attorney and testified at a hearing before the ALJ. A 

vocational expert also testified. On July 5, 2012, the ALJ issued a decision that Plaintiff 

was not disabled within the meaning of the Social Security Act. The Appeals Council 

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

the Commissioner’s final decision. On November 22, 2013, Plaintiff sought review by 

this Court. 

II. STANDARD OF REVIEW 

The district court reviews only those issues raised by the party challenging the 

ALJ’s decision. See Lewis v. Apfel, 236 F.3d 503, 517 n.13 (9th Cir. 2001). The court 

may set aside the Commissioner’s disability determination only if the determination is 

not supported by substantial evidence or is based on legal error. Orn v. Astrue, 495 F.3d 

625, 630 (9th Cir. 2007). Substantial evidence is more than a scintilla, less than a 

preponderance, and relevant evidence that a reasonable person might accept as adequate 

to support a conclusion considering the record as a whole. Id. In determining whether 

substantial evidence supports a decision, the court must consider the record as a whole 

and may not affirm simply by isolating a “specific quantum of supporting evidence.” Id. 

As a general rule, “[w]here the evidence is susceptible to more than one rational 

interpretation, one of which supports the ALJ’s decision, the ALJ’s conclusion must be 

upheld.” Thomas v. Barnhart, 278 F.3d 947, 954 (9th Cir. 2002) (citations omitted); 

accord Molina v. Astrue, 674 F.3d 1104, 1111 (9th Cir. 2012) (“Even when the evidence 

is susceptible to more than one rational interpretation, we must uphold the ALJ’s findings 

if they are supported by inferences reasonably drawn from the record.”). 

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Harmless error principles apply in the Social Security Act context. Molina v. 

Astrue, 674 F.3d 1104, 1115 (9th Cir. 2012). An error is harmless if there remains 

substantial evidence supporting the ALJ’s decision and the error does not affect the 

ultimate nondisability determination. Id. The claimant usually bears the burden of 

showing that an error is harmful. Id. at 1111. 

III. FIVE-STEP SEQUENTIAL EVALUATION PROCESS 

To determine whether a claimant is disabled for purposes of the Social Security 

Act, the ALJ follows a five-step process. 20 C.F.R. § 404.1520(a). The claimant bears 

the burden of proof on the first four steps, but the burden shifts to the Commissioner at 

step five. Tackett v. Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999). 

At the first step, the ALJ determines whether the claimant is engaging in 

substantial gainful activity. 20 C.F.R. § 404.1520(a)(4)(i). If so, the claimant is not 

disabled and the inquiry ends. Id. At step two, the ALJ determines whether the claimant 

has a “severe” medically determinable physical or mental impairment. 

§ 404.1520(a)(4)(ii). If not, the claimant is not disabled and the inquiry ends. Id. At step 

three, the ALJ considers whether the claimant’s impairment or combination of 

impairments meets or medically equals an impairment listed in Appendix 1 to Subpart P 

of 20 C.F.R. Pt. 404. § 404.1520(a)(4)(iii). If so, the claimant is automatically found to 

be disabled. Id. If not, the ALJ proceeds to step four. At step four, the ALJ assesses the 

claimant’s residual functional capacity and determines whether the claimant is still 

capable of performing past relevant work. § 404.1520(a)(4)(iv). If so, the claimant is not 

disabled and the inquiry ends. Id. If not, the ALJ proceeds to the fifth and final step, 

where he determines whether the claimant can perform any other work based on the 

claimant’s residual functional capacity, age, education, and work experience. 

§ 404.1520(a)(4)(v). If so, the claimant is not disabled. Id. If not, the claimant is 

disabled. Id. 

At step one, the ALJ found that Plaintiff meets the insured status requirements of 

the Social Security Act through March 31, 2015, and that she has not engaged in 

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substantial gainful activity since July 7, 2009, the alleged onset date. At step two, the 

ALJ found that Plaintiff has the following severe impairments: obesity, cervical 

degenerative disc disease status post fusion in 2008, right shoulder osteoarthritis, 

hypertension, bilateral carpal tunnel syndrome, and history of regional complex pain 

syndrome. At step three, the ALJ determined that Plaintiff does not have an impairment 

or combination of impairments that meets or medically equals an impairment listed in 20 

C.F.R. Part 404, Subpart P, Appendix 1. 

At step four, the ALJ found that Plaintiff: 

has the residual functional capacity to perform sedentary work as defined in 

20 CFR 404.1567(a) and 416.967(a) except she can occasionally lift/carry 

10 pounds; stand/walk 6 hours in an 8 hour workday; sit 6 hours in an 8 

hour workday; she can occasionally push/pull with her right upper 

extremity; no climbing of ladders, ropes or scaffolds; occasional ramps and 

stairs; she can occasionally balance, stoop, crouch and crawl; she can 

frequently kneel; occasional reaching overhead with her right upper 

extremity; avoid concentrated exposure to extreme heat and cold and 

excessive vibration; avoid all exposure to dangerous machinery with 

moving mechanical parts and unprotected height; and she can frequently 

handle and finger with her dominant right hand. 

The ALJ further found that Plaintiff is capable of performing past relevant work as a 

policy administrator, claims examiner, insurance clerk, and administrative assistant. 

IV. ANALYSIS 

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

1. Legal Standard 

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

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

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

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

Chater, 81 F.3d 821, 830 (9th Cir. 1995). The Commissioner must give weight to the 

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

interpretation of test results. Id. at 832-33. Where a treating physician’s opinion is not 

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contradicted by another physician, it may be rejected only for “clear and convincing” 

reasons, and where it is contradicted, it may not be rejected without “specific and 

legitimate reasons” supported by substantial evidence in the record. Id. at 830; Orn v. 

Astrue, 495 F.3d 625, 632 (9th Cir. 2007) (where there is a conflict between the opinion 

of a treating physician and an examining physician, the ALJ may not reject the opinion of 

the treating physician without setting forth specific, legitimate reasons supported by 

substantial evidence in the record). 

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

than that of a non-examining physician. Lester, 81 F.3d at 830. As with a treating 

physician, there must be clear and convincing reasons for rejecting the uncontradicted 

opinion of an examining physician, and specific and legitimate reasons, supported by 

substantial evidence in the record, for rejecting an examining physician’s contradicted 

opinion. Id. at 830-31. 

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

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

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

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

clinical findings or other evidence in the record.” Thomas v. Barnhart, 278 F.3d 947, 957 

(9th Cir. 2002). 

Factors that an ALJ may consider when evaluating any medical opinion include 

“the amount of relevant evidence that supports the opinion and the quality of the 

explanation provided; the consistency of the medical opinion with the record as a whole; 

[and] the specialty of the physician providing the opinion.” Orn, 495 F.3d at 631. The 

ALJ may discount a physician’s opinion that is based only the claimant’s subjective 

complaints without objective evidence. Batson v. Comm’r of Soc. Sec. Admin., 359 F.3d 

1190, 1195 (9th Cir. 2004). The opinion of any physician, including that of a treating 

physician, need not be accepted “if that opinion is brief, conclusory, and inadequately 

supported by clinical findings.” Bray v. Comm’r of Soc. Sec. Admin., 554 F.3d 1219, 

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1228 (9th Cir. 2009). An ALJ may reject standardized, check-the-box forms that do not 

contain any explanation of the bases for conclusions. Molina v. Astrue, 674 F.3d 1104, 

1111 (9th Cir. 2012). 

Generally, more weight should be given to the opinion of a treating physician than 

to the opinions of physicians who do not treat the claimant, and the weight afforded a 

non-examining physician’s opinion depends on the extent to which he provides 

supporting explanations for his opinions. Garrison v. Colvin, 759 F.3d 995, 1012 (9th 

Cir. 2014). The Commissioner is responsible for determining whether a claimant meets 

the statutory definition of disability and does not give significance to a statement by a 

medical source that the claimant is “disabled” or “unable to work.” 20 C.F.R. 

§ 416.927(d). 

2. Treating Pain Specialists 

Plaintiff contends the ALJ erred by giving minimal weight to the opinions of 

treating pain specialists Michael Minehart, M.D. and Asim Khan, M.D. It appears that 

Dr. Minehart treated Plaintiff in California from March 11, 2011, through August 4, 

2011, and Dr. Khan treated Plaintiff in Arizona from November 21, 2011, through the 

date of hearing in June 2012. 

On December 1, 2010, Dr. Minehart completed a form for long term disability 

insurance on which for “current physical, mental and cognitive limitations and work 

activity restrictions,” he stated “no heavy lifting 20 lbs” without further explanation or 

any additional limitations. The form indicates that he began treating Plaintiff on 

November 24, 2010, but the record shows that neurologist Dr. Lancelot Alexander 

referred Plaintiff to Dr. Minehart on November 24, 2010, for a possible series of cervical 

blocks to better control her right arm pain. Dr. Alexander wrote that if the blocks did not 

relieve her pain, Plaintiff may need a cervical spine cord stimulator for better pain control 

and to allow Plaintiff to lessen her long-term narcotic dependency. Dr. Alexander’s notes 

regarding his physical examination include observing that Plaintiff’s neck showed “some 

reduction in range of motion in flexion and extension, and mild to moderate reduction in 

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horizontal rotation bilaterally.” Dr. Alexander’s motor exam showed “normal muscle 

power, bulk, and tone in all extremities.” Because the record indicates that Dr. Minehart 

first saw Plaintiff on March 11, 2011, any opinion by Dr. Minehart dated December 1, 

2010, is not supported by the record. Moreover, if it was based on his review of Dr. 

Alexander’s referral, it would be entitled to no weight as it is a brief, conclusory opinion 

of a non-examining physician without any supporting explanation. 

On December 15, 2010, Dr. Minehart certified Plaintiff’s application for a 

California temporary disabled person placard (valid for six months) and described 

Plaintiff’s impaired mobility as due to “limited use of [right] hand and to nerve injury in 

neck.” On January 20, 2011, Dr. Minehart completed a treating physician medical source 

statement in which he opined that Plaintiff could carry a maximum of less than ten 

pounds, could stand/walk less than two hours in an eight-hour workday, and could not sit 

without alternating sitting and standing. He also stated that Plaintiff had weakness of her 

right upper extremity from pain and was “unable to hold a pen.” The ALJ found that 

Plaintiff’s medical records did not establish a significant change in her condition to 

explain why on December 1, 2010, she could lift twenty pounds, but on January 20, 2011, 

she could lift no more than ten pounds. The ALJ also found the medical records did not 

support Dr. Minehart’s opinion that she was limited to standing/walking less than two 

hours. In fact, the record does not support finding that Dr. Minehart had any personal 

knowledge of Plaintiff’s limitations on January 20, 2011. 

In June 2011, Dr. Minehart completed another form for long term disability 

insurance, in which he stated that Plaintiff’s current limitations were no lifting more than 

five pounds and “cannot turn head at right side.” The ALJ found that these opinions 

lacked objective support, were inconsistent with Dr. Minehart’s earlier opinions, and 

appeared to be based on Plaintiff’s subjective complaints. Moreover, the ALJ found that 

being unable to turn her head would be inconsistent with Plaintiff retaining a driver 

license because turning her head is necessary for the safe operation of a motor vehicle. 

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On July 28, 2011, Dr. Minehart performed a five-level cervical facet denervation 

on Plaintiff. On August 4, 2011, Dr. Minehart reported that Plaintiff was able to turn her 

neck toward the left side and the right side, and she had “slight tenderness over the 

shoulder area where the injections and needles were placed.” He noted that her pain 

syndrome of the right upper extremity was responding well to spinal cord stimulation. 

He also wrote that the plan was for her to follow up on a monthly basis, continue her 

prescriptions, and gradually wean off morphine sulfate. The record does not show that 

Plaintiff received any treatment between August 4, 2011, and November 21, 2011. 

On November 21, 2011, Dr. Khan of the Arizona Pain and Spine Institute began 

treating Plaintiff for chronic neck pain. He noted that he explained to Plaintiff that he 

does not like to use narcotics long term in patients with chronic pain syndromes because 

of tolerance, dependence, and increased sensitivity to pain. Dr. Khan said his goal was to 

improve pain and function while minimizing Plaintiff’s reliance on narcotics. He further 

noted that Plaintiff seemed to have a tolerance to the narcotic medications she had been 

taking and may need a “drug holiday.” He prescribed Topamax for her migraines and 

oxymorphone to replace the morphine sulfate and hydrocodone she had been taking. He 

reported that Plaintiff described constant pain, radiating from the neck to the right arm 

and hand, but she denied any intermittent associated numbness, tingling, and weakness in 

the right arm and hand. On December 5, 2011, nurse practitioner Linda Milam saw 

Plaintiff and noted she reported the Topamax made her very lethargic but provided more 

pain relief, and Plaintiff had been able to reduce the morphine sulfate from three times to 

two times per day. 

On December 7, 2011, Dr. Khan performed an electrodiagnostic study from which 

he found evidence of denervation changes from a moderate carpal tunnel syndrome on 

the right and mild on the left. He referred Plaintiff to a hand surgeon for carpal tunnel 

syndrome. 

On January 16, 2012, family nurse practitioner Eva Lim noted that Plaintiff said 

she could not afford the copayment for the oxymorphone prescription and had refilled the 

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hydrocodone. On February 3, 2012, FNP Lim prescribed a fentanyl patch to control pain. 

On February 8, 2012, FNP Lim noted that Plaintiff said she could not afford the 

copayment for the fentanyl patch, so FNP Lim replaced the fentanyl prescription with one 

for methadone and also discontinued the Topamax prescription. 

On March 12, 2012, Dr. Kahn noted Plaintiff was off morphine sulfate, taking 

methadone, and not reporting any side effects. On March 26, 2012, Dr. Kahn noted 

Plaintiff’s neurological exam was grossly normal but limited by pain on the right side. 

Dr. Kahn administered a series of cervical epidural steroid injections on April 5, 12, and 

26, 2012. 

On June 4, 2012, Dr. Khan completed a physical residual functional capacity 

questionnaire in which he reported that Plaintiff’s “right arm and hand has tingling, 

numbness, right arm weakness, low back and leg pain (right),” and “Patient described the 

pain as throbbing, stabbing which is worsened with any movement and increased 

activity.” When asked to identify the clinical findings and objective signs, Dr. Khan 

wrote: “The patient appears to be suffering from discogenic axial neck pain, x-ray of the 

C-spine does have [degenerative disc disease] and a fusion.” When asked how often 

Plaintiff’s experience of pain and other symptoms is severe enough to interfere with 

attention and concentration needed to perform even simple work tasks, Dr. Khan selected 

the response “constantly.” He further opined that Plaintiff is incapable of even “low 

stress” jobs because of chronic pain and fatigue. Regarding functional limitations, Dr. 

Khan opined that Plaintiff can walk less than one block without rest or severe pain, can 

sit only thirty minutes at one time, can stand one to two hours at one time, and can sit and 

stand/walk a total of less than two hours in an eight-hour working day. He also opined 

that every fifteen to twenty minutes during an eight-hour working day Plaintiff would 

need to walk for ten minutes. He further opined that every 45 minutes she would need to 

take a fifteen-minute unscheduled break. Dr. Khan opined that Plaintiff was likely to be 

absent from work as a result of impairments or treatment more than four days per month. 

He also said that the earliest date for which his description of Plaintiff’s symptoms and 

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limitations applied was November 2011. On June 7, 2012, Dr. Khan noted that he spent 

20 minutes going over Plaintiff’s paperwork with her. 

The ALJ stated she gave minimal weight to Dr. Khan’s opinions because they 

were based on Plaintiff’s subjective complaints, they were contradicted by credible 

evidence, and Dr. Khan failed to provide a medically supported reason for many of the 

limitations opined. In fact, when the questionnaire expressly asked for clinical findings, 

Dr. Khan said only that Plaintiff appears to be suffering from neck pain and that an x-ray 

showed degenerative disc disease, neither of which as described support any limitation. 

3. Treating and State Agency Physicians 

Plaintiff contends the ALJ erred by failing to consider opinions of treating 

neurosurgeon Dr. Michael Sandquist and by relying on the opinions of the State agency 

physicians because they misinterpreted Dr. Sandquist’s March 15, 2010 letter as opining 

that Plaintiff could perform sedentary work. Although materials related to Plaintiff’s 

long-term disability insurance claim refer to “Dr. Sandquist’s 01/18/10 assessment,” the 

record here does not include an assessment dated January 18, 2010, or any other medical 

source statement or functional analysis from Dr. Sandquist. 

The record shows that Plaintiff received treatment from Dr. Walter Buhl and Dr. 

Elizabeth Callaghan of Northwest Primary Care Group from September 2007 through 

July 2010, who referred Plaintiff to Dr. Sandquist of Microneurosurgical Consultants, 

PC. The record includes Dr. Sandquist’s treatment notes from July 2008 through August 

2010. In July 2008 Dr. Sandquist noted that Plaintiff had a history of pain and headaches 

and the July 2008 cervical spine MRI was generally similar to one from December 2004. 

In October 2008 Dr. Sandquist noted a CT scan of the cervical spine showed a mild bony 

encroachment on the left at C5-6 due to degenerative disease of the left uncovertebral 

joint and no other abnormality. He identified the reason for the exam as “neck pain, 

headaches and muscle spasms.” In December 2008 Dr. Sandquist reported to Dr. 

Callaghan that six weeks after C5-6 arthroplasty and C6-7 anterior cervical discectomy 

and fusion Plaintiff was doing quite well overall. He explained that Plaintiff’s “neck pain 

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had essentially almost completely resolved compared with her preoperative pain” until 

she fell on ice. Since then she had had some soreness, but still thought she felt better than 

preoperatively. Dr. Sandquist wrote Plaintiff a release to return to work half-time for two 

weeks. 

On July 9, 2009, Plaintiff saw Dr. Buhl for a two-day history of “steady symptoms 

with her right neck and trapezius spasming and hurting.” Dr. Buhl noted that Plaintiff 

had seen Dr. Sandquist the previous week, and he “had ordered EMG for these very 

symptoms so he is definitely involved in this particular therapy.” Although Dr. Buhl 

found no neuro deficit and only one specific indicator of carpal tunnel syndrome, he 

wrote Plaintiff a note specifying that he was “taking her off work as of today.” He also 

recommended that she begin physical therapy, but subsequently Dr. Sandquist postponed 

that until after surgery. On July 23, 2009, Dr. Callaghan noted that she completed Family 

Medical Leave Act forms for Plaintiff to be off work for three to four weeks and wrote 

Plaintiff a prescription for a refill of hydrocodone. 

On November 11, 2009, Plaintiff underwent surgery again with Dr. Sandquist for 

a right C7-T1 foraminotomy. On December 10, 2009, Dr. Sandquist wrote that Plaintiff 

could return to work as of December 21, 2009, working half-days and increasing to full 

time as tolerated. He also said she was to limit repetitive lifting, pushing, and pulling to 

less than ten pounds. 

On February 9, 2010, Plaintiff saw Dr. Kevin J. Jamison of Oregon Neurology for 

right arm pain. He described her as an “uncomfortable-appearing woman with dramatic 

pain behaviors.” She reported severe pain in the anterior right trapezius area, but not 

significant cervical pain. Dr. Jamison observed normal bulk, tone, and strength in her 

bilateral upper and lower extremities. He provided the following assessment: 

Dramatic pain syndrome involving the entire right arm with painful area 

centered in the trapezius and in the hand. Her overall presentation is most 

compatible with a functional pain disorder or at least extensive 

embellishment. There is no clinical sign for complex regional pain 

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syndrome. Aside from the focality of her symptoms there are features to 

suggest a myofascial pain syndrome. 

In a letter dated March 15, 2010, Dr. Sandquist wrote that Plaintiff “underwent a 

physical capacities examination as to whether or not she thinks she is able to perform her 

job or any job in the sedentary category with her current amount of pain” followed by the 

statement, “The pain is obviously subjective, but I would agree with this assessment.” 

He did not say that he had seen the results of the physical capacities examination and 

agreed with the consultant’s assessment. Although the term “this assessment” is 

ambiguous, it is preceded by the phrase “whether or not she thinks she is able to perform 

her job” which implies that Dr. Sandquist was referring to Plaintiff’s assessment. It can 

be presumed, although he did not clearly say so, that Plaintiff thought she was not able to 

perform her job or any job in the sedentary category. Dr. Sandquist agreed with Plaintiff, 

based on her subjective complaints, which he discussed with her that day “at length.” 

But Dr. Sandquist’s letter is not an opinion regarding Plaintiff’s functional capacity, nor 

is it based on any observations or clinical findings. The ALJ was not required to identify 

every document in the record she considered, nor was she required to give specific and 

legitimate reasons for not giving great weight to Dr. Sandquist’s comment regarding 

Plaintiff’s subjective pain affecting her ability to work. Moreover, an ALJ is not required 

to acknowledge a medical source’s opinion that a claimant is unable to perform a job, 

which is a determination reserved to the Commissioner. 

State agency physicians reviewed Plaintiff’s records and gave opinions in 

November and December 2010 and in March 2011. The December 2010 opinion updated 

one given in November 2010 with additional medical records and agreed with the 

November 2010 opinion. The November 2010 assessment concluded that Plaintiff was 

capable of sedentary work with postural and manipulative restrictions. It did not 

expressly rely on Dr. Sandquist’s comment, but among “significant objective findings” it 

identified: “3/15/10 Providence Primary Clinic. MD Visit. Pain subjective, capable of 

SED work.” It is unclear whether “capable of sedentary work” is the reviewer’s 

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conclusion or the reviewer’s interpretation of Dr. Sandquist’s letter. The “significant 

objective findings” also included: “6/10 Clmt submit evidence. PT MSS. SED w/ 

manipulation of RUE,” but the record does not include a medical source statement dated 

June 2010. The March 2011 opinion rejected Dr. Minehart’s January 2011 opinion that 

Plaintiff was capable of less than sedentary work as “too restrictive compared to medical 

records in file.” The State agency physicians may have misinterpreted Dr. Sandquist’s 

comment, but there is no evidence to support finding they would have reached a different 

conclusion if they had interpreted his comment as meaning capable of less than sedentary 

work. 

The ALJ gave great weight to the opinions of the State agency physicians because 

they had reviewed Plaintiff’s records and were familiar with the relevant Social Security 

disability rules and regulations. Many of the other opinions included in this record were 

submitted for Plaintiff’s disability insurance claim and primarily stated conclusions 

regarding whether Plaintiff could perform full-time sedentary work, which is a 

determination reserved to the Commissioner. Plaintiff contends that the State agency 

physicians did not review her records after March 2011, such as those regarding carpal 

tunnel syndrome and hip pain after implantation of the spinal cord stimulator, but 

Plaintiff bore the burden of proving disability beginning on her alleged onset date, July 9, 

2009, and she did not amend her alleged onset date as a result of developments after 

March 2011. Moreover, Plaintiff has not shown that her functional capacity significantly 

deteriorated after March 2011. 

4. Other Sources 

On February 24, 2010, Lawrence Andes, PT, of Providence Rehabilitation 

Services performed a two-hour physical capacity evaluation. Mr. Andes noted that 

Plaintiff “displayed moderate and frequent pain behaviors in the forms of grunting, 

wincing, verbal reports of pain, changing positions, taking occasional rest breaks, 

keeping her right arm held close to her side, and moving stiffly.” He found that Plaintiff 

was not capable of work in the sedentary range of physical demand as defined by the U.S. 

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Department of Labor because she needed to alternate sitting and standing frequently and 

could perform only minimal overhead reaching, repetitive forward reaching with the right 

arm, bending, twisting, squatting, and kneeling. He was not able to test how long 

Plaintiff could sit, stand, or walk, but drew conclusions from her diagnosis, observed 

behavior, and subjective report. Mr. Andes opined that Plaintiff could sit for two hours, 

stationary stand for two hours, and move or walk about for four hours in an eight-hour 

day. 

A physical therapist is not an acceptable medical source, and a physical therapist’s 

statement is not a medical opinion. See 20 C.F.R. §§ 404.1513(a), 404.1527(a)(2). The 

ALJ gave Mr. Andes’ evaluation no weight because it was performed by an unacceptable 

medical source. Moreover, standards used for private long-term disability insurance are 

not equivalent to those applied under the Social Security Act. 

On July 28, 2010, Mark Shih, M.D., consulting rehabilitation specialist, reviewed 

Plaintiff’s medical records and opined that the conclusions of Mr. Andes’ physical 

capacity evaluation were valid. He further opined that Plaintiff was “reasonably 

incapable of sedentary level work on a full-time basis with any reasonable continuity as 

of 01/18/2010 and forward, pending improvement.” The ALJ gave Dr. Shih’s opinion no 

weight because it did not consider all of Plaintiff’s medical records, credibility, and 

activities of daily living and because Dr. Shih did not appear to have a treatment 

relationship with Plaintiff. 

Therefore, substantial evidence supports finding that the ALJ provided specific, 

legitimate, clear, and convincing reasons for giving minimal weight to the treating 

physicians’ contradicted opinions, great weight to the opinions of the State agency 

physicians, and no weight to the opinions of Mr. Andes and Dr. Shih. 

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

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

other symptoms, the ALJ is required to engage in a two-step analysis: (1) determine 

whether the claimant presented objective medical evidence of an impairment that could 

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reasonably be expected to produce some degree of the pain or other symptoms alleged; 

and, if so with no evidence of malingering, (2) reject the claimant’s testimony about the 

severity of the symptoms only by giving specific, clear, and convincing reasons for the 

rejection. Vasquez v. Astrue, 572 F.3d 586, 591 (9th Cir. 2009). In making a credibility 

determination, an ALJ “may not reject a claimant’s subjective complaints based solely on 

a lack of objective medical evidence to fully corroborate the claimant’s allegations.” 

Bray v. Comm’r of Soc. Sec. Admin., 554 F.3d 1219, 1227 (9th Cir. 2009) (internal 

quotation marks and citation omitted). But “an ALJ may weigh inconsistencies between 

the claimant’s testimony and his or her conduct, daily activities, and work record, among 

other factors.” Id. 

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

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

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

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

functional capacity assessment. The ALJ specifically found incredible: (1) Plaintiff’s 

claim of total inability to use her right arm because there was no evidence of severe 

atrophy; (2) Plaintiff’s claim of randomly falling asleep due to her medication because 

she did not report it to her doctors; (3) Plaintiff’s claim of frequent and severe headaches 

because it is not supported by Plaintiff’s medical records; and (4) Plaintiff’s claim of 

losing her balance and falling several times because there are no supporting objective 

findings. 

On October 25, 2010, Plaintiff completed an Exertion Questionnaire. She said she 

was living in her cousin’s house in Simi Valley, California, so that she could get help 

from other roommates and family. She said every day she showered, dressed, and tried to 

walk outside for a block or so. She reported that chronic neck and arm pain prevented 

her from lifting more than ten pounds, housecleaning, and doing yard work. She said she 

attempted to wash two loads of laundry each week, but it caused pain for at least two 

more days. At least once a week she drove to the grocery store where she spent 45–60 

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minutes shopping. She said she had difficulty opening heavy doors and other things. She 

said she wore a compression sleeve on her right arm or a splint all the time to reduce 

swelling and improve blood circulation. She reported that she drove a car, but scheduled 

her medical appointments in the morning before taking medications. On a separate form 

dated October 27, 2010, Plaintiff reported that she woke up with numb hands daily, 

began her day with pain of 3–4/10, and ended some days with pain of 9/10. She said she 

had not gone without pain for more than a few hours every day. She also reported having 

treatment four days a week and depending on family and friends for opening, carrying, 

and driving when it was not safe for her to drive, lift, or carry things. 

On March 4, 2011, Plaintiff reported that her condition had become worse in 

January 2011, she was losing use of her right arm with continuous throbbing and chronic 

pain, she wore a brace and a sling on her right arm all the time, and she used her left arm 

for everything. She said she needed assistance with grocery shopping, opening jars and 

cans, lifting anything more than ten pounds, driving, and cleaning house. She said she 

experienced “throbbing, aching, sharp, and shooting with burning sensation and 

numbness of my right upper extremity.” She also reported, “My pain is 8 using 1–10 

verbal pain scale analog, made worse when I’m exposed to any cold weather, lifting, 

moving my hand, slightly relieved when I lye [sic] down, applying heat or ice.” She also 

said she was experiencing frequent migraines from chronic neck and right arm pain. She 

identified a number of medications she was currently taking, including morphine and 

hydrocodone, and indicated that most of them caused her drowsiness. 

On June 13, 2012, at the administrative hearing, Plaintiff testified that she lives 

alone in an apartment in Glendale, Arizona, but her sister and friend drive her places, and 

her friend cleans Plaintiff’s apartment monthly. She wore a sling and brace on her right 

arm at the hearing, which she said she wears daily because doing so reduces pain in her 

neck and right arm. She said she does not do housework, but she prepares simple meals 

and cleans up afterward. Plaintiff’s friend or sister takes her shopping, but Plaintiff does 

not do too much because she gets tired. She said she had started going to church again. 

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Plaintiff also testified that she can use her right hand to do some things, but doing so 

makes it hurt more. She said she can use her left hand to carry a gallon of milk, but 

carrying anything pulls on her neck. She said she gets stiff sitting more than 15 minutes 

without standing and she can walk about a block before she needs to take a break. She 

said it is too hard to use a computer, but she uses her phone “some” with her left hand. 

She testified that she can dress without assistance and friends come to take her to the 

store. She said she does not drive because she could get arrested for driving under the 

influence of narcotics and she does not want to put people in danger. She also testified 

that her medication interferes with her ability to focus and concentrate. She said that if 

she wants to remember something, it helps to write it down before taking medicine. She 

said she gets migraine headaches from the tension in her neck at least every other week 

and each episode lasts a couple days. 

Plaintiff testified that she falls asleep randomly as a result of her medications, 

which include methadone, Topamax, gabapentin, and a sleep medication. She said she 

sleeps a lot and takes a few naps during the day. She said it is the medication that makes 

her tired. She reported falling asleep and falling or dropping things as a result. The ALJ 

questioned why Dr. Kahn noted she was stable on a regimen of medications without any 

side effects if she was constantly sleepy. Plaintiff responded that she has told Dr. Kahn 

that “he needed to start making better notes, because they were not accurately 

documenting our conversations.” Dr. Kahn’s treatment notes for June 7, 2012, one week 

before the administrative hearing, include: 

She has chronic low back pain and leg pain and she is concerned about her 

pain in her low back and legs but her primary pain is in her neck. Her 

neuro exam is grossly normal at this time. I will have her decrease her 

Elavil because it is too strong. 

. . . . 

I have explained to the patient that I do not like to use narcotics longer term 

in patients with chronic pain syndromes because of tolerance, dependence, 

and opioid induced hyperalgesia [i.e., increased sensitivity to pain]. The 

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patient understands and agrees. She has been stable on her regimen of 

meds and we will continue it for now in regards to her methadone. 

. . . . 

6/7/12. Common side effects of the patient’s pain medications were 

discussed and all of the patient’s questions were answered. The patient has 

been instructed to call with all questions and concern[s]. There are no signs 

of any deleterious side effects (somnolence, constipation, respiratory 

depression) and should any of these occur the patient understands to stop 

the pain meds immediately and contact our office or report to the ED. The 

patient’s function and quality of life appear to be improved with the use of 

the prescribed pain medications. 

. . . . 

She has been stable on her regimen of meds at this time and she is not 

having any side effects. . . . She states that she has been sleeping better but 

she states that [the Elavil] may be too strong because she fell asleep on the 

toilet at night and fell and she bruised her arm. She continues to use her 

pain meds and she denies any side effects. 

During the hearing, the ALJ also asked Plaintiff whether she was using marijuana 

because her records showed a urine drug test positive for THC. Plaintiff said she smoked 

marijuana on one occasion because Dr. Kahn’s nurse made her “go through withdrawals 

without having medicine for six days.” She said her medication was changed, the new 

medication was not readily available, and as a result she went without narcotics for six 

days. She said she experienced painful shakes, hives, sweats, and twitching from the 

withdrawal, and she smoked some of her neighbor’s pot. Records show that Plaintiff saw 

family nurse practitioner Eva Liza Lim in Dr. Kahn’s office in January 2012, who told 

Plaintiff to taper down her use of hydrocodone. On February 3, 2012, FNP Lim 

prescribed a fentanyl patch. On February 8, 2012, Plaintiff saw FNP Lim to change her 

medications because she could not afford the copayment for the fentanyl patch. FNP Lim 

replaced the prescription for fentanyl with a prescription for 15 days of oral methadone 

on February 8, 2012, called Plaintiff on February 10, 2012, and noted on February 10, 

2012, that Plaintiff was “doing well with her medication, c/o mild itching but otherwise 

doing well.” The notes also state Plaintiff was to follow up in two weeks, but the record 

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does not show another office visit with Dr. Kahn or FNP Lim in February 2012. On 

March 5, 2012, Plaintiff saw family nurse practitioner Heather Chung at a different pain 

management clinic. FNP Chung noted that Plaintiff stated she was currently with Dr. 

Kahn in Mesa, “does not feel this pain management is helping with her needs,” and “she 

has been running out of her medications with this office because she is being prescribed 

medications that are not in store at the pharmacy.” FNP Chung also documented that 

Plaintiff was a former smoker and “Drug use: marijuana.” On March 12, 2012, Plaintiff 

saw Dr. Kahn, and his treatment notes state: “She states that she has been off of her 

[morphine sulfate] and she has been on methadone and she states that she is not having 

any side effects from her meds at this time.” The March 12, 2012 notes indicate that a 

prescription for 30 days of methadone was written. The drug test performed on March 

26, 2012, revealed methadone and THC. 

Records from Northwest Primary Care Group indicate that Plaintiff was seen by 

Dr. Callaghan in September 2008 for migraine headaches, and she has been prescribed 

medication for migraines, but they do not include any explanation or further information. 

The record does not show that Plaintiff reported an increase in frequency or severity of 

migraine symptoms in mid-2009 or sought additional treatment for migraines. 

Thus, substantial evidence supports finding that the ALJ provided clear and 

convincing reasons for partially discrediting Plaintiff’s subjective symptom testimony. 

C. The ALJ Did Not Err in Weighing Third-Party Reports. 

The ALJ found the opinions of Plaintiff’s friends and family credible only to the 

extent they are consistent with the ALJ’s decision because “[t]he opinions asserted are 

not based on personal knowledge but instead are based on what the claimant has told 

them.” In other words, the ALJ did not reject the third-party opinions entirely, but only 

discounted them to the extent they conflicted with other evidence. 

The ALJ considered statements by Plaintiff’s friend Ms. Luth, Plaintiff’s sister 

Ms. Flint, and Plaintiff’s neighbors Mr. Garth and Ms. Mitchell. Ms. Luth stated she 

helps Plaintiff with housecleaning and drives her to medical appointments and grocery 

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shopping. Ms. Luth opined, “Barbie cannot do it by herself without causing her pain to 

get worse and then she gets migraines if she overdoes anything.” Ms. Flint stated that she 

and their mother moved here to help with her sister’s needs, her sister used to be active 

and full of energy, and “now she is in so much pain, her life is very limited.” Mr. Garth 

said he had seen others do simple chores for Plaintiff and, “To me she seems to be in pain 

just walking outside, which is seldom.” Ms. Mitchell was a little more specific, stating 

that she had “watched her wince in pain from moving to try and reach something on a 

counter,” and “she has had difficulty getting in and out of my car.” Ms. Mitchell also 

referred to having seen Plaintiff in pain and said, “Barb was in pain when trying to do the 

smallest task.” 

When an ALJ discounts the testimony of lay witnesses, he or she must give 

reasons that are germane to each witness. Valentine v. Comm’r of Soc. Sec., 574 F.3d 

685, 693-94 (9th Cir. 2009). Here, the ALJ stated that the four opinions were not based 

on personal knowledge, but rather on what Plaintiff told them. The ALJ gave as an 

example Ms. Luth’s statement that Plaintiff “cannot clean or grocery shop on her own 

without causing her pain to worsen.” Ms. Luth could not actually know whether 

Plaintiff’s pain worsened after cleaning or shopping because she could not feel Plaintiff’s 

pain, so Ms. Luth had to rely on Plaintiff’s explanation for why Plaintiff needed Ms. 

Luth’s assistance with cleaning and shopping. The ALJ correctly stated that the other 

opinions were similar. To the extent that the third-party opinions merely repeated 

Plaintiff’s pain testimony, they could not bolster Plaintiff’s credibility, and they added 

nothing useful for the ALJ’s decision. If the opinions had included more personal 

observations regarding Plaintiff’s functional capacity, they likely would have been more 

useful. The ALJ also found the statements to be only partially credible because they 

claimed limitations not fully supported by Plaintiff’s records and because the sources 

were not qualified to opine regarding Plaintiff’s impairments or ability to perform work 

activity. That is, the friends and family were not qualified to opine that Plaintiff cannot

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do certain activities, only that she does not do them. Thus, the ALJ gave reasons 

germane to each witness for partially discounting the third-party opinions. 

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

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

terminate this case. 

Dated this 1st day of December, 2014. 

Neil V. Wake

United States District Judge

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