Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_04-cv-01436/USCOURTS-cand-3_04-cv-01436-0/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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United States District Court

For the Northern District of California

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

GOLDIE DUMAS,

Plaintiff,

 v

JO ANNE B BARNHARDT, Commissioner

of Social Security,

Defendant.

 /

No C 04-1436 VRW

 ORDER

Plaintiff Goldie Dumas brings this action under 42 USC

section 405(g), challenging the final decision of the Social

Security Administration (“SSA”) to deny her applications for

supplemental security income benefits and disability insurance

benefits. Pl Mot (Doc # 18) at 1. The parties have filed crossmotions for summary judgment. For the reasons that follow, the

court DENIES plaintiff’s motion for summary judgment and GRANTS

defendant Jo Anne B Barnhart’s motion for summary judgment.

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I

A

Plaintiff is in her mid-sixties. Plaintiff has not

completed high school. She has stated that her highest level of

education completed was, variously, the 11th grade (Administrative

Record, Doc #14 (“AR”) at 108, 287), the 3rd grade (AR 120), the

6th grade (AR 199) and the 12th grade (AR 149). In addition,

plaintiff stated that in school she received special education for

“slow learning” (AR 288) and “for pregnant [illegible word].” AR

149. Further, plaintiff stated that her mother institutionalized

her in 1950 at the age of twelve and that she received mental

health counseling for six months thereafter. AR 120, 200, 261. 

Plaintiff’s past jobs have included housekeeper, homecare provider and nurse’s aide, mostly caring for elderly people. 

AR 103, 289. Plaintiff stated that she was fired from her last job

because she was forgetful and “was drinking a lot and [] didn’t

show up to work often.” AR 200. Plaintiff also stated that she

was dismissed from jobs because the elderly people she cared for

passed away and because of personality conflicts. AR 289. 

Plaintiff also has a long history of drug and alcohol abuse. AR

156, 259. 

On November 7, 2001 and January 22, 2002, plaintiff filed

two separate applications for social security benefits under Title

II of the Social Security Act (the “Act”) claiming disability due

to diabetes and sickle cell disease. AR 75, 79. Plaintiff had

previously filed applications for social security benefits which

were denied upon reconsideration on November 8, 1996. AR 172. 

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Plaintiff’s new applications stated that she became

unable to work in 1995 and also stated the following: “feet get

swolen [sic] due to diabetes, cannot stand for more than 2 hrs a

day, tire easily, hard time concentrating and focusing.” AR 102. 

Plaintiffs applications also stated that she used alcohol and drugs

such as cocaine, crack and marijuana from 1987 to 1992 (AR 109),

and that she was “born w/ diabetes & sickocell [sic]: condition

didn’t affect her until 2000. So, with age her condition is

worsening.” AR 109.

On January 22, 2002, plaintiff filed two more

applications for social security benefits. AR 3, 79. These

applications stated that plaintiff became unable to work because of

her impairments on January 1, 2001. AR 79. Also on January 22,

2002, plaintiff amended her then-pending applications to state that

she became unable to work on April 1, 2001. AR 84.

On February 12, 2002, plaintiff stated in a daily

activities questionnaire, completed with assistance from her

“acquaintance” Beverly Chenieu, that “she has problems

comprehending routine info,” she “[can] only work domestic type

jobs with supervision” and she “has not been able to continue

employment as a care-giver due to anger management concerns.” AR

124. Plaintiff also stated that she shops for groceries on her

own, prepares her own meals but “ha[s] to be supervised so that

fire is controlled,” performs “all chores with some supervision,”

is a “talented and artistic woman” and “completes simple tasks.” 

AR 121, 124. 

Plaintiff’s acquaintance Ms Chenieu completed an undated

third-party daily activities questionnaire that contradicted some
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of the statements in plaintiff’s daily activities questionnaire,

notably that plaintiff “is great with chores” and required no

assistance in performing her chores. AR 117. 

On February 7, 2002, the SSA requested records regarding

plaintiff’s alleged impairments from facilities plaintiff

designated: the Contra Costa Regional Medical Center and the

Alameda Central Health Center. AR 204, 225. The Alameda Central

Health Center replied that it had no relevant information. AR 226. 

The SSA received few relevant medical records from Contra Costa

Health Services (AR 204-220): a December 18, 1998, clinic note

stating that plaintiff had “sickle cell trait, no disease” (AR

214), and a March 29, 1999, note stating that plaintiff was “O.K.

for in home care.” AR 212. 

In February 2002, plaintiff underwent SSA-ordered

physical and psychological consultative evaluations. AR 199, 221. 

Plaintiff claimed disability due to “memory problems” during both

consultative evaluations. Id. On February 19, 2002, Dr Amit

Rajguru, of QTC Medical Group, conducted the consultative physical

evaluations and found that plaintiff had no functional limitations. 

AR 224. Dr Rajguru noted that plaintiff had a history of mild

chronic headaches and “state[d] [that plaintiff] has a history of

diabetes mellitus; however, she is not treated for this, nor does

she seek medical care on a routine basis.” AR 222. Dr Rajguru’s

“impression” was that “the [plaintiff] is a 60-year-old female with

a history of memory problems and possible diabetes mellitus with no

objective findings on my examination at this time.” AR 224. 

On February 28, 2002, Dr Sokley Khoi, of Health Analysis,

Inc, conducted the consultative psychological evaluation and found
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that “[b]ased on today’s evaluation there appear[s] to be no

indication of a severe psychiatric disorder.” AR 202. During the

evaluation, Dr Khoi noted that plaintiff “currently drinks a pint

of gin every day * * * [and] currently uses three to four joints of

marijuana per day. The [plaintiff] reported that she drank a pint

of gin the night prior to [Dr Khoi’s consultative psychological]

evaluations and reported that she smoked five joints of marijuana

the night prior to the evaluation.” AR 200. 

Dr Khoi also noted that plaintiff “stated that she is

independently able to do all activities of daily living” and that

“her usual activities include going for a walk, running errands,

socializing with friends, going out to eat at shelters, watching

television, listening to music, or napping during the day.” AR

199. Dr Khoi further noted that plaintiff “was well dressed * * *. 

She was well groomed. She wore makeup, including lipstick and eye

shadow. Her eyebrows were well plucked. She wore red fingernail

polish.” AR 200. 

In addition, while plaintiff “was unable to correctly

complete serial sevens” (i e, serial subtraction of seven) and “was

unable to spell ‘WORLD’” (both two alternative tests of attention

in the Mini-Mental State Examination (MMSE), a cognitive screening

tool), Dr Khoi noted that plaintiff “had no obvious speech or

language comprehension difficulties,” her “mood was neutral” and

“[she] denied suicidal or homicidal ideation. She denied auditory

or visual hallucinations. During the current evaluation, [her]

thought processes appeared logical and coherent.” Id.

The psychological evaluation included a Bender-Gestalt

Test, which is used to evaluate visual-motor maturity, neurological
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impairments and emotional disturbances, and is sometimes used in

conjunction with other personality tests to determine the presence

of emotional and psychiatric disturbances such as schizophrenia. 

AR 201. The evaluation also included a Weschler Adult Intelligence

Scale (“WAIS-III”) test, which included IQ tests that yielded

scores in the “extremely low” range (61-68). Id. Plaintiff’s

levels of ability for the various administered tests ranged from

“boderline” to “extremely low,” “impaired” and “inconclusive.” Id. 

Dr Khoi noted, however, that “clinical observation and the

[plaintiff’s] pattern of performance on the tests administered

suggested inadequate motivation and effort. Therefore, today’s

test results are considered invalid.” AR 202. 

Dr Khoi noted that plaintiff “appears to be functioning

within the low average to average range of intellectual ability.” 

Id. Further, while Dr Khoi was “unable to determine due to

decreased effort and motivation” a number of work-related

abilities, Dr Khoi found that plaintiff had no level of impairment

when it came to the “ability to follow simple instructions,” “the

ability to withstand the stress of a routine work day,” and “the

ability to interact appropriately with co-workers, supervisors, and

public on a regular basis.” Id. 

Dr Khoi diagnosed plaintiff with “alcohol and cannabis

abuse, r/o alcohol and cannabis dependence malingering (cognitive

symptoms).” AR 201. The American Psychiatric Association defines

“malingering” as “the intentional production of false or grossly

exaggerated physical or psychological symptoms, motivated by

external incentives such as * * * avoiding work, obtaining

financial compensation * * *.” Diagnostic and Statistical Manual
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of Mental Disorders, 4th ed, text revision (Washington, DC:

American Psychiatric Association, 2000) (“DSM-IV”), 739.

SSA non-examining physician evaluations agreed with the

consulting physicians’ conclusions. On March 18, 2002, Dr Lola Lee

Van Compernolle found that the evidence in plaintiff’s file did not

establish a medically determinable impairment. AR 203. On July

16, 2002, Dr Joan Bradus affirmed this assessment. Id. 

On March 20, 2002, Dr Thomas Gragg found that the

evidence in plaintiff’s file established that plaintiff was “not

significantly limited” in the categories of “understanding and

memory,” “sustained concentration and persistence,” “social

interaction,” and “adaptation.” AR 179-180. Dr Gragg also

determined that plaintiff’s functional capacity assessment was “hx

of substance abuse - no current restrictions.” AR 180. Dr Gragg

based plaintiff’s medical disposition on substance addiction

disorders (AR 183) and rated plaintiff’s degree of limitation as

“mild” in the functional limitation categories of “restriction of

activities of daily living,” “difficulties in maintaining social

functioning,” and “difficulties in maintaining concentration,

persistence, or pace.” AR 193. 

On March 21, 2002, an internal SSA analysis of the

evidence found that there were “no objective findings to indicate

impairment of functioning,” that plaintiff was “not credible on a

physical basis because he [sic] physical allegations clearly do not

limit her functioning,” that “[plaintiff’s] past medical records

reveal that she has sickle cell trait, not disease. There is no

evidence that she has diabetes, or anything else,” and that

“according to [the record plaintiff] has no severe psychiatric
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disorder and her performance was considered invalid due to

inadequate motivation and effort. There [sic] [plaintiff’s]

condition is probably non-severe.” AR 172-173.

 On March 25, 2002, the SSA’s disability determination

returned a primary diagnosis of “None Established (Med. Evd. -

Insuf. to Est. Diagnosis)” and a secondary diagnosis of “Substance

Dependence Disorders (Drug).” AR 51. On March 25, 2002, the SSA

denied plaintiff’s applications for social security benefits. AR

53. Plaintiff submitted a reconsideration disability report dated

April 8, 2002, in which plaintiff stated she was experiencing “more

memory loss” and alleged extreme fatigue, memory loss and inability

to comprehend simple tasks. AR 126. Plaintiff’s request for

reconsideration was denied. AR 63. Plaintiff submitted a timely

request for a hearing before an administrative law judge (“ALJ”). 

AR 67. From this time on, plaintiff appears to have abandoned her

claims of disability due to diabetes and sickle cell disease.

On March 24, 2003, plaintiff visited the San Francisco

General Hospital Medical Center Emergency Department for pain in

her right shoulder (“c/o 2 wk [right] shoulder p w/o trauma. Feels

like torn tendon * * *”). AR 252. Plaintiff also complained of

depression (though plaintiff denied suicidal tendencies and

“feelings of worthlessness”) and hallucinations (though the

resident physician found plaintiff had “no paranoia”). Id. 

Plaintiff was diagnosed with “[right] shoulder biceps tendinitis.” 

AR 253.

On May 7, 2003, during the first of several general

visits with Dr Cynthia Salinas, a level II resident at the San

Francisco General Hospital Medical Center, plaintiff complained of
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persistent right shoulder pain. AR 250. Dr Salinas noted that

plaintiff took Motrin and “Tyco #3 for pain” (i e, Tylenol #3,

acetaminophen with codeine, a narcotic analgesic prescribed for

mild to moderately severe pain). Id. On May 29, 2003, Dr Salinas

examined plaintiff during an “urgent care apt for rash. [Patient

complained of right] shoulder pain [and a] rash on [her] buttocks.” 

AR 251. Dr Salinas found no evidence of a rash and noted that

plaintiff took Motrin for her shoulder pain. Id. 

On June 26, 2003, Dr Salinas again examined plaintiff,

who still complained of persistent right shoulder pain. AR 248. 

Dr Salinas prescribed plaintiff with naprosyn (i e, naproxen, a

nonsteroidal anti-inflammatory drug with analgesic and antipyretic

properties used to relieve mild to moderate pain). Id. Further,

Dr Salinas noted that “[patient complains of] voices even now” and

referred plaintiff to the Westside Community Mental Health Center

of San Francisco. Id. 

On June 28, 2003, Dr Girish Subramanyan, of the Westside

Community Mental Health Center of San Francisco, examined

plaintiff, who complained of “hearing voices including her Mother,

sister and first husband. She also [complained of] symptoms of

depression and poor memory,” and stated “that she has had [sic]

voices for the past 2 years.” AR 233. During the examination,

plaintiff stated that she “used to be a heavy drinker” (AR 231) and

that her “[l]ast drink [was] 3-4 ‘little bottles’ of champagne last

night. [She] [a]dmits to drinking 1x/week about 3-4 ‘little

bottles’ of champagne,” “uses [marijuana] 1x/week,” and “used to

have a crack habit in the past, none now.” AR 233. 

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Dr Subramanyan noted that plaintiff was “fashionably

dressed,” had “well-done hair” and was “pleasant/cooperative,” but

was “spacy, slow to respond - as if she were high/stoned. Mood -

‘Depressed.’” AR 234. In addition, Dr Subramanyan noted that

plaintiff “did not know how to spell world” and was “working with

an ‘attorney’ to get some ‘disability.’” AR 233. 

Dr Subramanyan diagnosed plaintiff with “Psychotic

Disorder NOS [i e, Not Otherwise Specified], Depressive Disorder

NOS, Rule out MDD [i e, Major Depressive Disorder] with Psychotic

Features, r/o [i e, rule out] primary psychotic disorder, r/o

Polysubstance Dependence (EtoH/MJ), r/o Cognitive Disorder NOS,

early dementing condition.” AR 234. Under Axis IV, Dr Subramanyan

noted “poor overall psychosocial supports, financial, estrangement

from family.” Id. 

Dr Subramanyan’s report described plaintiff’s psychiatric

etiology as “unclear,” noted the need for further work-up to assess

substance abuse and prescribed Risperidone (an antipsychotic drug

used to treat schizophrenia, psychosis and bipolar disorder) and

Zoloft (an antidepressant used to treat depression and anxiety) for

plaintiff’s psychosis and depression, respectively. Id. 

On July 9, 2003, plaintiff stated in a SSA disability

report that she had “problems comprehending / poor concentration”

which limited her ability to work starting April 1, 2001, and that

she stopped working on July 25, 2001, because “I injuries [sic] my

arm.” AR 143. 

Also on July 9, 2003, Dr Salinas again examined plaintiff

and reviewed Dr Subramanyan’s report, noting that plaintiff was

still complaining of right shoulder pain, hearing voices and
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depression. AR 244. Dr Salinas diagnosed plaintiff with

hypertension and proteinuria, and referred in her clinic notes to

Dr Subramanyan’s diagnosis of psychosis and depression. Id. On

July 21, 2003, Dr Salinas again examined plaintiff and noted that

plaintiff had no pain and an “improved mood.” AR 240. Dr Salinas

also put plaintiff on blood pressure medication for persistent high

blood pressure and high lipidemia. Id.

In a “disability & adult programs division - Evaluation

Form For Mental Disorders” submitted in July 2003, Dr Salinas noted

that plaintiff has alleged a “history of ‘hearing voices.’ She has

since reported voices since childhood.” AR 236. Dr Salinas also

noted that plaintiff denied drug and alcohol use (AR 236) and that

plaintiff had a “pleasant attitude,” had “no current feelings of

worthlessness, fearfulness” (AR 237) and was a “[w]ell dressed

African American woman, upright posture, normal gait. Mannerisms

childlike at times and often affected by loud voices in clinic.” 

AR 236. 

In addition, Dr Salinas noted that plaintiff had “no

outward psychosis (i e disorganized behavior),” that plaintiff

“[could] perform activities of daily living. She does rely on

support of friends for food/shelter,” that plaintiff’s

“interactions [with] staff + physician appropriate” and that

plaintiff had “normal concentration. Able to perform simple [sic]

tasks and oral instructions.” AR 237. Further, Dr Salinas noted

that plaintiff was diagnosed with “Depression” and “Psychosis NOS”

(referring to Dr Subramanyan’s diagnosis) and that plaintiff’s

prognosis was “good.” AR 238. 

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On July 28, 2003, the ALJ held a hearing in which

plaintiff was represented by counsel and testified that she was

disabled due to depression, hearing voices, and pain in her right

arm. AR 297-99, 304. Plaintiff stated that she had suffered

depression for the past four or five years (AR 297-98) and that

“losing [her] mother and [her] father” made her depressed. AR 300. 

Plaintiff’s mother passed away in 2002 and her father passed away

in 1988. AR 301. Plaintiff also asserted that she has been

hearing voices for the past two or three years. AR 299. 

Plaintiff testified that she could not continue her

previous work because “[she is] just really tired” (AR 302) and she

“forget[s] things and dates” (AR 304), and that she had pain in her

arm for the past four months, but that her arm is getting better

with pain medication. AR 305. In addition, plaintiff stated that

she has high blood pressure (AR 305) and that she can only walk

“maybe a block or two” before she needs to rest, which she does

“maybe two, three hours, four hours” every day because her

medication “makes [her] woozy.” AR 307. Plaintiff further stated

that she smoked crack every day around 1999 or 2000 and stopped

using crack, marijuana and alcohol “about six months ago” (AR 291-

92), but still drinks “a pint, half a pint” of cognac every other

day. AR 310. 

Dr Gerald Belchiek, a vocational expert, testified that

plaintiff’s past work as a nurse’s aide was at the unskilled,

rather than skilled level, and that such work was classified at the

medium exertional level, because of the need to move patients. AR

311-12. The vocational expert did not give testimony as to

plaintiff’s current occupational outlook.
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At the hearing, the ALJ stated that the key inquiry was

whether or not drug addiction or alcoholism (“DAA”) was a

contributing factor material to the determination of plaintiff’s

disability. AR 312-13. The ALJ held the record open for thirty

days to allow plaintiff and her counsel to submit additional

medical reports. AR 316. Two additional reports were later

submitted: one by treating internist Dr Salinas, the other by a

psychiatrist, Dr Fischer.

On August 14, 2003, Dr Salinas completed a questionnaire

from the SSA in which she stated that she has seen plaintiff every

month since May 2003 “to medically manage hypertension, proteinuria

and coordinate mental health services with outside clinic.” AR

254. Dr Salinas noted that plaintiff “complains of right shoulder

pain * * * hearing voices and is at times anxious. Poor

concentration,” and diagnosed plaintiff with “[h]ypertension,

proteinuria (with ongoing workup for renal disease), psychosis NOS

and hyperlipidemia.” Id. 

In addition, Dr Salinas also noted that plaintiff’s

prognosis was “good,” that plaintiff’s impairment has lasted or can

be expected to last at least twelve months, that plaintiff can

continuously stand for at least six of eight hours, that plaintiff

can continuously sit upright for at least six of eight hours that

plaintiff can walk “probably 5” city blocks without stopping, can

frequently lift 5-10 pounds over an eight hour period and can

frequently carry 5-10 pounds. AR 255. Dr Salinas further noted

that “[plaintiff] appears to have decreased ability to handle loud

environments and crowds. In these settings her anxiety level

increases and concentration ability decreases.” AR 256.
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On August 22, 2003, plaintiff saw Dr Stephen Fisher, of

the San Francisco Community Mental Health Services, for a

“psychiatric/medication evaluation.” AR 259-65. Dr Fisher noted

that plaintiff “has a very lengthy history of emotional problems

going back to childhood but she [has presented] new symptoms in the

past year involving hearing voices and this is both associated in

her mind with previous illicit drug use (‘flashbacks’) and her

depressed mood.” AR 259. Plaintiff stated that she “[came] from a

very disturbed background where her mother was extremely abusive,

including beating her, chaining her into the house, and whipping

her with an ironing cord.” AR 261. 

Dr Fisher also noted that “[plaintiff] is a very welldressed, well-groomed, woman who appears to be her stated age, with

dyed hair color and shows no sign of any physical impairment. She

is alert, oriented, and with good speech. It should be noted that

no formal mental status testing was done but despite her complaint

of memory difficulty, did not evidence any during this evaluation

today. Her communications did not have any psychotic quality -

although * * * she is reporting hearing voices. She says the

voices were partically [sic] relieved by the Risperdal * * * Her

mood seemed mildly depressed and she looked tired but with no

agitation or indication of any acute anxiety.” AR 264. In

addition, Dr Fischer noted that plaintiff “stopped using drugs

entirely as of one year ago but still drinks [a half of a fifth

bottle of cognac] about once a week.” AR 259. 

Dr Fisher diagnosed plaintiff with “1) Dysthymic Disorder

(300.4) (a type of depression), 2) Psychotic Disorder, NOS,

(298.9), possibly secondary to depression or hallucinosis,
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secondary to 3) Polysubstance Dependence (304.80) in partial

remission,” and “Hypertension.” AR 264-65. Dr Fisher recommended

that “[plaintiff] re-start the previous medications, Risperdal 0.5

mgm and Zoloft 25 mgm,” increased the dosage of plaintiff’s

medication and suggested “to the [plaintiff] that she consider

getting into a recovery program or attend 12-step self-held

meetings.” AR 265. 

On October 24, 2003, the ALJ issued a decision denying

plaintiff’s applications for social security benefits based on

“careful consideration of the entire record, including the

testimony presented at the hearing, the arguments made by the

[plaintiff’s] representative” and the evidence presented at the

hearing. AR 14-19.

The ALJ noted that plaintiff’s alleged impairments, save

her recent allegations of shoulder pain (AR 16), met the twelvemonth duration requirement set forth in regulations §§ 404.1509 and

416.909, and found that: (1) plaintiff had not engaged in

substantial gainful activity since her alleged disability onset

date of April 1, 2001; (2) plaintiff had “severe limitations due to

depression, psychosis NOS; cocaine and crack cocaine addiction in

remission by history; and ongoing alcohol addiction”; (3)

plaintiff’s impairments did not meet any of the impairments in the

Listing of Impairments; (4) plaintiff’s allegations regarding the

extent of her impairments were not supported by the medical

evidence and do not support a finding of disability; (5) factoring

in the effects of plaintiff’s drug and alcohol use, plaintiff lacks

the residual functional capacity to perform sustained work activity

at any exertion level and is therefore unable to perform her past
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relevant work and is unable to perform other work which exists in

substantial numbers in the national economy; and (6) but for

plaintiff’s use of drugs and alcohol, plaintiff would be able to

perform work which exists in substantial numbers in the national

economy because plaintiff’s alcohol addiction is a contributing

factor material to the determination of disability pursuant to

Public Law 104-121 and plaintiff would not be disabled if she

stopped drinking. AR 18.

In reaching these conclusions, the ALJ noted that “[t]he

medical evidence in this case is minimal,” and discussed the

medical opinions of Drs Rajguru, Khoi, Salinas and Fisher. AR 16-

17. The ALJ made no mention of Dr Subramanyan’s medical opinion. 

Id. The ALJ also made note of plaintiff’s history of drug and

alcohol abuse and of her testimony at the hearing that “she

currently drinks from one half to one pint of cognac every other

day. Her presentation at the hearing was consistent with this

testimony.” AR 17. On the basis of his findings regarding DAA,

the ALJ found plaintiff ineligible for benefits, citing a 1996

congressional enactment barring awards of benefits if a claimant’s

DAA is a contributing factor material to the determination of his

or her disability, discussed in Part III A, infra.

On December 23, 2003, plaintiff appealed to the SSA’s

Appeals Council. AR 9. On February 9, 2004, the Appeals Council

denied plaintiff’s request for review, and the ALJ’s decision

became final. AR 5. On April 13, 2004 plaintiff commenced the

instant action for judicial review of the ALJ’s final decision. 

Compl (Doc #1).

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II

The court’s jurisdiction is limited to determining

whether the SSA’s denial of benefits is supported by substantial

evidence in the administrative record. 42 USC § 405(g). A

district court may overturn a decision to deny benefits only if the

decision is not supported by substantial evidence or if the

decision is based on legal error. See Andrews v Shalala, 53 F3d

1035, 1039 (9th Cir 1995); Magallanes v Bowen, 881 F2d 747, 750

(9th Cir 1989). The Ninth Circuit defines “substantial evidence”

as “more than a mere scintilla but less than a preponderance; it is

such relevant evidence as a reasonable mind might accept as

adequate to support a conclusion.” Andrews, 53 F3d at 1039. 

Determinations of credibility, resolution of conflicts in medical

testimony and all other ambiguities are to be resolved by the ALJ. 

See id; Magallanes, 881 F2d at 750. The decision of the ALJ will

be upheld if the evidence is “susceptible to more than one rational

interpretation.” Andrews, 53 F3d at 1040.

III

A

The Social Security Act provides that certain individuals

who are disabled shall receive disability benefits. 42 USC §

423(a)(1)(D). Disability is the “inability to do any substantial

gainful activity by reason of any medically determinable physical

or mental impairment which can be expected to result in death or

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

of not less than 12 months.” 42 USC § 423(d)(2)(A). An individual

is considered “disabled” if his impairments are such “that he is
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not only unable to do his previous work but cannot * * * engage in

any other kind of substantial gainful work which exists in the

national economy * * *.” Id.

SSA regulations require that an ALJ follow a five-step

sequential evaluation process to determine whether a claimant is

disabled. 20 CFR §§ 404.1520, 416.920. The five-step evaluation

process is as follows: (1) determine whether the claimant is

currently employed in substantial gainful activity (i e, work that

involves significant physical or mental activities, and is

performed for pay or profit); (2) if the claimant is not currently

employed in such activity, then determine whether the claimant has

a severe impairment or combination of impairments that

significantly limits his or her physical or mental ability to do

basic work; (3) if the claimant does have such an impairment or

combination of impairments, then determine whether the claimant has

an impairment(s) which meets or equals the impairments in the

Listing of Impairments, 20 CFR pt 404, subpt p, app 1; (4) if the

claimant does have such an impairment(s), then the claimant will be

considered disabled, but if the claimant does not have such an

impairment(s), then determine whether the claimant has the residual

functional capacity to perform his or her past work; and (5) if the

claimant is unable to perform his or her past work, then determine

whether the claimant has the residual functional capacity to

perform any other work which exists in substantial numbers in the

national economy. 20 CFR § 404.1520. The determination that a

claimant can perform other work may be established: (1) by the

testimony of a vocational expert, or (2) by reference to the

Medical-Vocational Guidelines at 20 CFR pt 404, subpt p, app 2. 
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Id. If a claimant is unable to perform any other work, then the

claimant will be considered disabled. Id.

A claimant may be found “not disabled” at any step in the

five-step evaluation process; a claimant may be found “disabled”

only at step three or five. 20 CFR § 404.1520(a)(4). The claimant

bears the burden of proof at steps one through four. Bustamante v

Massanari, 262 F3d 949, 953-54 (9th Cir 2001) (citing Tackett v

Apfel, 180 F3d 1094, 1098 (9th Cir 1999)). At step five, the

burden of proof shifts to the SSA. Id; see also Brown v Apfel, 192

F3d 493 (5th Cir 1999) (“This shifting of the burden of proof [] is

neither statutory nor regulatory, but instead, originates from

judicial practices.”) (citing Walker v Bowen, 834 F2d 635, 640 (7th

Cir 1987)). In addition, the ALJ has an affirmative duty to assist

the claimant in developing the record at each step of the

evaluation process. Bustamante, 262 F3d at 954.

At step two of the evaluation process, if the claimant

suffers from a combination of impairments, the combined effect of

all impairments will be considered “without regard to whether any

such impairment, if considered separately, would be of sufficient

severity.” 42 USC § 423(d)(2)(B), 20 CFR § 404.1523. Further, if

the claimant has “a medically severe combination of impairments,

the combined effect of the impairments will be considered

throughout the evaluation process.” Id.

A physical or mental impairment is “an impairment that

results from anatomical, physiological, or psychological

abnormalities * * *.” 42 USC § 423(d)(3). SSA regulations set

forth a list of impairments that include sickle cell disease

(7.05), diabetes mellitus (9.08), affective disorders (12.03),
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psychotic disorders (12.04) and substance addiction disorders

(12.09). See 20 CFR pt 404, subpt p, app 1; 20 CFR § 404.1525

(“The Listing of Impairments describes, for each of the major body

systems [such as the hemic and lymphatic system (7.00), the

endocrine system (9.00) and mental disorders (12.00)], impairments

which are considered severe enough to prevent a person from doing

any gainful activity.”). It is not enough simply to have the named

impairment(s); a claimant must have signs and symptoms that meet or

equal the detailed criteria set forth in the Listing of

Impairments. Id. 

B

Plaintiff contends that the final decision of the ALJ is

in error because the ALJ: (1) failed properly to apply the law

regarding the materiality of drug addiction and alcoholism to her

case; (2) failed to give proper weight to the medical opinions of

plaintiff’s treating physicians and to give adequate consideration

to the non-exertional limitations imposed by plaintiff’s mental

impairments; (3) failed adequately to consider the evidence from

plaintiff’s treating physicians; (4) failed properly to evaluate

plaintiff’s credibility; and (5) failed to use a medical or

psychiatric expert in accordance with SSR 96-6p as to plaintiff’s

residual functional capacity. Doc # 18 at 2.

1

Plaintiff contends that the ALJ erred in applying the law

regarding the materiality of DAA to her case. Doc # 18 at 11-17. 

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In 1995, the SSA added sections 404.1535 through 404.1541

to Volume 20, Part 404 of the Code of Federal Regulations (“CFR”). 

Section 404.1535 provides that “if we find that you are disabled

and have medical evidence of your drug addiction or alcoholism, we

must determine whether your drug addiction or alcoholism is a

contributing factor material to the determination of disability.” 

20 CFR § 404.1535(a). Sections 404.1536 through 404.1541 provide,

inter alia, that “[i]f we determine that you are disabled and drug

addiction or alcoholism is a contributing factor material to the

determination of disability (as described in § 404.1535), you must

avail yourself of appropriate treatment for your drug addiction or

alcoholism * * *.” 20 CFR § 404.1536(a). Accordingly, an initial

finding of disability under the five-step evaluation process, in

addition to a finding that DAA is a contributing factor material to

the determination of the claimant’s disability pursuant to §

404.1535, meant that the claimant must avail himself or herself of

treatment pursuant to §§ 404.1536 through 404.1541 to receive

disability benefits.

In 1996, Congress passed the Contract with America

Advancement Act (“CAAA”), Public Law 104-121, 110 Stat 847 (March

29, 1996). The CAAA, inter alia, amended the Social Security Act

and modified the definition of the term “disability” such that “an

individual shall not be considered to be disabled for purposes of

[benefits under Title II or XVI of the Act] if alcoholism or drug

addiction would (but for this subparagraph) be a contributing

factor material to the Commissioner’s determination that the

individual is disabled.” 42 USC § 423(d)(2)(C). 

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The SSA did not issue new regulations to reflect the

changes to the definition of disability wrought by 42 USC §

423(d)(2)(C). Instead, the SSA and a number of courts have

construed 42 USC § 423(d)(2)(C) to work in conjunction with 20 CFR

§ 404.1535. As a result, if a claimant is found “disabled” under

the five-step evaluation process in 20 CFR § 404.1520 and there is

medical evidence that DAA is a contributing factor material to the

determination of the claimant’s disability, the claimant is

considered “not disabled” and is disqualified from receiving

disability benefits. See, e g, SSA, Office of Disability, EM-96200

(08/30/96) (originally EM-96-94) (“Questions and Answers Concerning

DAA from the 07/02/96 Teleconference - Medical Adjudicators -

ACTION”); Ball v Massanari, 254 F3d 817 (2001); Bustamante v

Massanari, 262 F3d 949 (2001). Accordingly, an initial finding of

“disabled” under the five-step evaluation process is not sufficient

to qualify an individual for disability benefits if there is

evidence of DAA in the record.

Section 423(d)(2)(C) did not amend the CFR, the five-step

evaluation process or the “materiality analysis” in 20 CFR §

404.1535; its effect is only to bar a finding of disability if a

claimant’s DAA is found to be “material” pursuant to § 404.1535. 

In addition, for all intents and purposes, 42 USC § 423(d)(2)(C)

made the materiality analysis the final determination regarding

whether a claimant is considered disabled, following the nowprovisional determination of disability under the five-step

evaluation process in 20 CFR § 404.1520.

The Ninth Circuit held that “it is premature to evaluate

the impact of [a claimant’s] alcoholism without a finding that he
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is disabled under the five-step inquiry.” Bustamante, 262 F3d at

955 n 1 (2001). The court explained that:

[A]n ALJ must conduct the five-step inquiry without

separating out the impact of alcoholism or drug

addiction. If the ALJ finds that the claimant is not

disabled under the five-step inquiry, then the claimant

is not entitled to benefits and there is no need to

proceed with the analysis under 20 CFR §§ 404.1535 or

416.935. If the ALJ finds that the claimant is disabled

and there is “medical evidence of [his or her] drug

addiction or alcoholism,” then the ALJ should proceed

under 404.1535 or 416.935 to determine if the claimant

“would still [be found] disabled if [he or she] stopped

using alcohol or drugs.” 

Id at 955 (quoting 20 CFR § 404.1535) (citing Drapeau v Massanari,

255 F3d 1211, 1213 (10th Cir 2001): “[the ALJ erred by] fail[ing]

to determine whether [the claimant] was disabled prior to finding

that alcoholism was a contributing material factor thereto * * *

The implementing regulations make clear that a finding of

disability is a condition precedent to an application of §

423(d)(2)(C).”).

In addition, the language of 42 USC § 423(d)(2)(B), which

mirrors that of 20 CFR §§ 404.1523 and 416.923 (which govern step

two of the five-step evaluation process), states that “in

determining whether a claimant’s physical or mental impairment or

impairments are of a sufficient medical severity * * * the combined

effect of all of the claimant’s impairments [shall be considered]

without regard to whether any such impairment, if considered

separately, would be of such severity. * * * [T]he combined impact

of the impairments shall be considered throughout the disability

determination process.” And, supra, “substance addiction disorder”

remains a listed impairment in 20 CFR pt 404, subpt p, app 1. 

Accordingly, under 42 USC § 423(d)(2)(B) and 20 CFR §§ 404.1523 and
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416.923, DAA is an impairment that may not be considered separately

from other impairments until after an initial finding of disability

at either step three or step five in the five-step evaluation

process. See Brueggemann v Barnhart, 348 F3d 689, 694 (8th Cir

2003) (“The ALJ must reach [a disability] determination initially *

* * using the standard five-step approach described in 20 CFR §

404.1520 without segregating out any effects that might be due to

substance use disorders.”). 

In Ball v Massanari, the Ninth Circuit further explained

that before conducting a materiality analysis pursuant to 20 CFR §

404.1535, an ALJ should look to the record to see whether there is

a clear indication that the claimant’s non-substance-abuse-related

impairments are not “severe” within the meaning of step two of the

five-step evaluation process. 254 F3d 817, 823 (9th Cir 2001). If

there is such a clear indication, then the ALJ need not conduct the

materiality analysis and “separate out” the non-substance-abuserelated impairments from the substance-abuse-related impairments. 

Id. Accordingly, if there is no such clear indication, then the

ALJ must conduct the materiality analysis. 

Plaintiff contends, incorrectly, that the SSA bears the

burden of proving that a claimant’s DAA is a contributing factor

material to the determination of her disability pursuant to 20 CFR

§ 404.1535. Doc # 18 at 11.

Plaintiff cites Sousa v Callahan, 143 F3d 1240, 1245 (9th

Cir 1998), in which the Ninth Circuit held that “[c]laimants

subject to [42 USC § 423(d)(2)(C)] must be given an opportunity to

present evidence as to whether their disability would have remained

if they stopped using drugs and alcohol.” Sousa, however, does not
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support plaintiff’s contention, but rather the opposite

proposition: that the claimant bears the burden of presenting

evidence to establish his or her impairments would remain if he or

she stopped using drugs or alcohol (i e, that DAA is not a

contributing factor material to the determination of the claimant’s

disability). See Doughty v Apfel, 245 F3d 1274, 1279-80 n 3

(2001). 

Further, although Sousa resulted in a remand to the

district court, it is readily distinguishable from the present

case. In Sousa, “when the [ALJ] hearing was held, [42 USC §

423(d)(2)(C)] was not yet in existence. At that time, [DAA] could

support a finding of disability, and plaintiff presented her case

accordingly.” 143 F3d at 1245 (9th Cir 1998). Accordingly, the

Ninth Circuit remanded because the “plaintiff never had an

opportunity to present evidence relevant to the amendment’s primary

inquiry: whether plaintiff’s [impairments] would remain during

periods when she stopped using drugs and alcohol.” Sousa, 143 F3d

at 1245. Because the plaintiff presented her case before the

intervening law change, reasonably believing that DAA would support

a finding of disability, the court held that the plaintiff was

entitled to further process. 

By contrast, no intervening law change assists plaintiff

in the instant matter; 42 USC § 423(d)(2)(C) was part of the legal

landscape for seven years before plaintiff presented her case to

the ALJ. Moreover, at plaintiff’s hearing, the ALJ stated, and

plaintiff’s counsel acknowledged, that the key inquiry before the

court was whether or not DAA was a contributing factor material to

the determination of plaintiff’s disability. AR 312-13.
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In addition, in Ball, the Ninth Circuit clarified that

“[i]n materiality determinations pursuant to 42 USC § 423(d)(2)(C),

the claimant bears the burden of proving that his alcoholism or

drug addiction is not a contributing factor material to his

disability determination.” 254 F3d 817, 821 (9th Cir 2001) (citing

Brown v Apfel, 192 F3d 492 (5th Cir 1999); Mittlestedt v Apfel, 204

F3d 847 (8th Cir 2000)). Cf Bustamante, 262 F3d 949, 955 n 1

(2001) (“[T]he claimant bears the burden of proving that his

alcoholism or drug addiction is not a contributing factor material

to his disability determination.”). 

Further, in Reeves v Barnhart, 2002 WL 31553376 at *13

(ND Cal 2002) (James, MJ), another judge of this court stated that

“plaintiff has the burden of * * * presenting evidence as to

whether his disability would remain if he stopped using alcohol.”

(citing Ball, 254 F3d at 821; Sousa 143 F3d at 1245). See also

Brueggemann v Barnhart, 348 F3d 689, 694 (8th Cir 2003) (“The

burden of proving that alcoholism was not a contributing factor

material to the disability determination falls on [the

claimant].”); Doughty v Apfel, 245 F3d 1274, 1280 (11th Cir 2001)

(“[I]n materiality determinations pursuant to 42 USC §

423(d)(2)(C), the claimant bears the burden of proving that his

alcoholism or drug addiction is not a contributing factor material

to his disability determination.”); Brown v Apfel, 192 F3d 492, 498

(5th Cir 1999) (“[The claimant] bears the burden of proving that

drug or alcohol addiction is not a contributing factor material to

her disability.”); Eltayyeb v Barnhart, 2003 WL 22888801 at *4 (SD

NY 2003) (“When the record reflects drug or alcohol abuse, the 

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claimant bears the burden of proving that substance abuse is not a

contributing factor material to the disability determination.”).

Plaintiff also contends, incorrectly, that language in 20

CFR § 404.1535 such as “we will determine,” “we must determine,”

“process we will follow” and “we will evaluate” supports her

contention that once a claimant has demonstrated substantial

evidence of disability, the burden shifts to the SSA (“we”) to

establish that DAA is a contributing factor material to the

determination of the claimant’s disability. Doc # 18 at 13. Each

step of the five-step evaluation process in 20 CFR § 404.1520,

however, contains nearly identical language to that in § 404.1535,

such as “process we will use to decide,” “we make a determination

or decision,” “we assess,” “we evaluate,” “we consider” and “we

will find,” and yet the burden in steps one through four lies with

the claimant, not with the SSA. See Bustamante, 262 F3d at 953

(“The claimant has the burden of proof for steps one through four *

* *.”). 

As the Fifth Circuit stated in Brown, “[The claimant] is

the party best suited to demonstrate whether she would still be

disabled in the absence of drug or alcohol addiction. We are at a

loss to discern how the [SSA] is supposed to make such a showing,

the key evidence for which will be available most readily to [the

claimant].” 192 F3d at 498. See also Bowen v Yuckert, 482 US 137,

146 n 5 (1987) (“It is not unreasonable to require the claimant,

who is in a better position to provide information about his own

medical condition, to do so.”). 

Plaintiff also relies on a 1996 Social Security teletype

(“teletype”) for the proposition that “once the evidence
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establishes that the claimant is under a disability, if SSA is

unable to separate the effects of substance abuse from other mental

restrictions and limitations, the claimant is to be found

disabled.” Doc #18 at 14. That teletype states in pertinent part: 

“When it is not possible to separate the mental restrictions and

limitations imposed by DAA and the various other mental disorders

shown by the evidence, a finding of ‘not material’ would be

appropriate.” EM-96200 (08/30/96). The teletype essentially

suggests that a claimant, having established disability under the

five-step disability evaluation process, may be found disabled if

the claimant is able to establish that his or her DAA-based

impairments are inseparable from his or her underlying mental

impairments. 

Plaintiff offers no support for her contention that the

teletype shifts the burden of proof onto the SSA to establish that

plaintiff’s DAA-based impairments are inseparable from her mental

impairments. At a minimum, it is reasonable for a claimant who

hopes to benefit from the favorable presumption set forth in the

teletype to retain the burden of establishing that his or her DAAbased impairments are inseparable from his or her mental

impairments. Plaintiff has not met this burden, and the record

does not support her contention.

Although the ALJ made the favorable assumption that

plaintiff’s mental impairments were not dependent on plaintiff’s

DAA and would exist even if plaintiff’s DAA ceased (AR at 17),

there is no indication in the record that plaintiff’s DAA-based

impairments are inseparable from her underlying mental impairments

(in fact, contrary to the ALJ’s assumption, there is no indication
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in the record that plaintiff actually has any underlying mental

impairments). While plaintiff’s treating physicians’ diagnoses

establish that plaintiff suffers from depression and psychosis, the

diagnoses also establish that the physicians need to “rule out”

substance abuse as a potential cause of plaintiff’s mental

impairments (depression disorder NOS and psychotic disorder NOS are

both diagnoses in which it is unclear when given whether substance

abuse is a causal factor, DSM-IV at 337, 408). AR 234, 238, 244,

254 and 264. Notably, one of plaintiff’s treating physicians, Dr

Fischer, specifically diagnosed plaintiff’s mental impairments as

caused by (i e, “secondary to”) plaintiff’s DAA (thus diagnosing

plaintiff’s mental impairments as DAA-based impairments rather than

underlying mental impairments). AR 264. Accordingly, plaintiff

failed to establish that her DAA-based impairments are inseparable

from her underlying mental impairments, and indeed the ALJ found

just the opposite.

In summary, plaintiff’s various contentions that the ALJ

misapplied the law to her case are unavailing. The ALJ conducted

the requisite five-step disability evaluation pursuant to 20 CFR §

404.1520, considering the combined effect of plaintiff’s

impairments (including her ongoing alcohol addiction) throughout

the evaluation process pursuant to § 404.1523 and finding at step

five that plaintiff was disabled because she was unable to perform

other work which exists in substantial numbers in the national

economy. Then, perhaps believing that the record did not clearly

indicate that plaintiff’s non-substance-abuse-related impairments

were not severe, the ALJ proceeded to perform the materiality

analysis pursuant to § 404.1535. 
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Pursuant to 20 CFR § 404.1535, an ALJ must decide: “(1)

whether there is medical evidence of the claimant’s drug addiction

or alcoholism; and, if so, (2) whether the claimant would still be

disabled if the claimant stopped using drugs or alcohol. If the

claimant would still be disabled even if she stopped drinking or

using drugs, the drug or alcohol abuse is not a contributing factor

to the disability. If the claimant would no longer be disabled if

she stopped drinking or using drugs, the drug or alcohol addiction

is a contributing factor material to the finding of disability, and

the claimant is not entitled to benefits.” Dahho v Massanari, 2001

WL 1006817 at *3 (ND Cal 2001) (Breyer, J). Both determinations

must be supported by substantial evidence. Id. See, e g, Eltayyeb

v Barnhart, 2003 WL 22888801 at *4-7 (SD NY 2003).

First, substantial evidence supported the ALJ’s

conclusion that plaintiff was still abusing alcohol, including

plaintiff’s own admissions to the ALJ on the record, statements to

her treating physicians that she still drinks and plaintiff’s

treating physicians’ diagnoses which include, or at the least fail

to rule out, substance abuse. AR 16-17. 

The record is replete with instances of plaintiff’s

admitted substance abuse, already noted in Part I of this order. 

In 2001, plaintiff admitted using alcohol and drugs such as

cocaine, crack and marijuana from 1987 to 1992. AR 109. In

February 2002, plaintiff admitted consuming a pint of gin and three

to four joints of marijuana every day. AR 200. In June 2003,

plaintiff was still drinking as many as four “little bottles” of

champagne in one evening. AR 233. At the hearing before the ALJ 

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and in her evaluation with Dr Fischer shortly afterward, plaintiff

admitted drinking significant quantities of cognac. AR 310. 

Plaintiff offered no evidence that she has been sober for

any period of time since her complaints of depression and “hearing

voices” began, nor any doctors’ opinions or any other medical

evidence that are independent of alcohol abuse. In light of

plaintiff’s past drug addiction and alcohol abuse, her current

alcohol abuse, the ALJ reasonably concluded that plaintiff was

still abusing alcohol. AR 17.

Second, substantial evidence supports the ALJ’s

conclusion that “if [plaintiff] were to stop drinking, she would

have an unlimited physical residual functional capacity. If not

drinking, she would still be capable of simple tasks, despite her

depression and ‘voices.’” Id. While plaintiff’s counsel stated at

the hearing before the ALJ that “it appears [] from the record that

* * * the mental conditions cause the substance abuse and not vice

versa” (AR 314-15), plaintiff introduced no evidence in support of

this contention apart, perhaps, from plaintiff’s statement she

smoked crack cocaine to “feel high” and “dismiss[] all the horrible

things that happened in [her] life” (AR 293), an admission that

does not help her case. 

Moreover, in contrast to plaintiff’s supposition that her

mental impairments preceded and caused her DAA, the first

indication that plaintiff suffered from depression and “hearing

voices” came on March 24, 2003, only four months preceding the

hearing before the ALJ (AR 253), and long after plaintiff began to

abuse drugs and alcohol, as evidenced in the lengthy and welldocumented history of plaintiff’s DAA. AR 156, 259. 
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Further, plaintiff’s treating physicians noted that

plaintiff was “fashionably dressed” (AR 234), had “well-done hair”

(AR 236) and was “well-groomed” (AR 264). Further, the treating

physicians found that plaintiff was “pleasant/cooperative” (AR 234)

and had a “pleasant attitude * * * [and] no current feelings of

worthlessness,” and that her “interactions [with the] staff [and

the] physician [were] appropriate” (AR 237), all of which tends to

refute plaintiff’s claim of disability. Moreover, the treating

physicians found that plaintiff had “normal concentration,” was

“able to perform tasks and oral instructions” (AR 237), did not

evidence any memory difficulty and had “good speech” and

“communications [which] did not have any psychotic quality” (AR

264). Notably, one of plaintiff’s treating physicians, Dr Salinas,

to whom plaintiff denied the use of drugs and alcohol, consistently

stated that plaintiff’s prognosis was “good.” AR 238, 255.

Nonetheless, the ALJ found that the combination of

plaintiff’s impairments, including substance abuse, was severe, and

that “as a result of her impairments, the claimant is unable to * *

* sustain employment.” AR 17. The ALJ, however, found that

plaintiff’s alcoholism was responsible for plaintiff’s disability. 

Id. The court finds no medical evidence in the record to refute

this finding. Plaintiff failed to carry her burden of proof and

establish that her alcoholism was not a contributing factor

material to the determination of her disability. Accordingly, the

ALJ’s determination that plaintiff’s alcoholism was a contributing

factor material to her disability was supported by substantial

evidence.

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2

Plaintiff offers several other challenges to the SSA’s

determination of her case that are equally unavailing. 

Specifically, she asserts that the ALJ (1) failed to give proper

weight to the opinions of plaintiff’s treating physicians and to

give adequate consideration to the non-exertional limitations

imposed by plaintiff’s mental impairments; (2) failed adequately to

consider the evidence from plaintiff’s treating physicians; (3)

failed properly to evaluate plaintiff’s credibility; and (4) failed

to use a medical or psychiatric expert in accordance with SSR 96-6p

as to plaintiff’s residual functional capacity. Doc # 18 at 2. 

These contentions stem primarily from plaintiff’s meritless

argument, discussed in Part III B 1, supra, that the ALJ bears the

burden of establishing that DAA is not material to the finding of

plaintiff’s disability.

Plaintiff mischaracterizes the ALJ’s ruling as rejecting

the opinions of plaintiff’s treating physicians and as relying

unduly on the opinions of the SSA’s consultative and reviewing

physicians. Doc # 18 at 6-9. 

“Generally, a treating physician’s opinion carries more

weight than an examining physician’s, and an examining physician’s

opinion carries more weight than a reviewing physician’s.” Holohan

v Massanari, 246 F3d 1195, 1202 (9th Cir 2001). In addition,

“treating doctors’ opinions can be rejected if they are

contradicted by other medical opinions and the ALJ supports his

judgment with specific, legitimate reasons. If the treating

doctors’ opinions are uncontradicted, the ALJ may still reject

them, but must provide clear and convincing reasons.” Dahho v
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Massanari, 2001 WL 1006817 at *5 (ND Cal 2001) (Breyer, J) (citing

Reddick v Chater, 157 F3d 715, 725 (9th Cir 1998)). Contrary to

plaintiff’s allegations, however, the ALJ explicitly gave more

weight to the opinions of plaintiff’s treating physicians than to

those of the SSA’s consulting examiners. AR 16-17. The ALJ

“note[d] the sparse and recent evidence of medical treatment” and

then accepted plaintiff’s treating physicians’ diagnoses of

depression and psychosis secondary to (per Dr Fisher), or possibly

secondary to (per Drs Subramanyan’s and Salinas), substance abuse. 

Id. Accordingly, the ALJ did not reject or give improper weight to

plaintiff’s treating physicians’ opinions, and was therefore not,

as plaintiff asserts, required to justify discounting them.

In addition, the ALJ implicitly accepted Dr Subramanyan’s

diagnosis that plaintiff’s level of functioning was moderately to

severely impaired (AR 234) by finding that “plaintiff is precluded

from sustaining work at any exertional level.” AR 17. Further,

the ALJ only accepted SSA consulting examiner Dr Rajguru’s medical

opinion that plaintiff had no functional limitations (AR 224) to

support his decision that but for plaintiff’s DAA, plaintiff would

be physically capable of performing a substantial number of jobs in

the national economy because Dr Rajguru had conducted his physical

examination without knowledge of plaintiff’s DAA. AR 17. 

Moreover, while Dr Salinas also conducted her examination of

plaintiff without knowledge of plaintiff’s DAA, Dr Salinas did not

herself diagnose plaintiff with psychosis and depression, but

simply incorporated Dr Subramanyan’s diagnosis into her own (and,

as already noted, the diagnoses of psychosis NOS and depression NOS

leave open the possibility of DAA as the cause of the symptoms). 
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AR 238, 248. Additionally, Dr Salinas repeatedly stated that

plaintiff’s prognosis was “good,” and that plaintiff possessed

normal concentration and could perform simple tasks and follow oral

instructions. AR 238, 255. The ALJ accepted these findings

regarding the non-exertional limitations imposed by plaintiff’s

mental impairments (AR 17) and accordingly did not fail to give

them adequate consideration. 

Moreover, the ALJ was under no duty to develop the record

further. SSA regulations state that “when the evidence [the SSA]

receives from [the claimant’s] treating physician or psychologist

or other medical source is inadequate for us to determine whether

you are disabled,” the SSA will seek additional information from

plaintiff’s treating physicians or through SSA-ordered consultative

examinations. 20 CFR §§ 404.1512(e), 416.912(d). SSA regulations

also state that the claimant bears the burden of establishing that

he or she is disabled; the claimant “must bring to [the SSA’s]

attention everything that shows that [he or she is] * * * disabled. 

This means that [the claimant] must furnish medical and other

evidence that [the SSA] can use to reach conclusions about [the

claimant’s] medical impairment(s) * * *.” 20 CFR § 404.1512(a)

(emphasis added).

SSA regulations only require an ALJ to seek additional

evidence when the medical reports from plaintiff’s treating

physicians are conflicting, ambiguous, or do not contain the

information necessary to making a determination regarding a

claimant’s disability. See generally, 20 CFR § 404.1512; see also

Mayes v Massanari, 276 F3d 453, 459-50 (9th Cir 2001). 

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The medical reports from plaintiff’s treating physicians

were neither conflicting nor ambiguous. Moreover, the ALJ held the

record open to allow plaintiff to submit further medical reports

from her treating physicians. AR 16. And, in one medical report

so submitted, plaintiff’s treating physician Dr Fisher recommended

that plaintiff attend “a recovery program or [] 12-step self-help

meetings” for her DAA and noted that medication relieved

plaintiff’s impairments. AR 264-65. See Hutton v Apfel, 175 F3d

651, 655 (8th Cir 1999) (“Impairments that are controllable or

amenable to treatment do not support a finding of total

disability.”). Plaintiff’s treating physicians’ uncontradicted

medical reports contained substantial evidence in support of the

ALJ’s findings.

Plaintiff also lists among the “issues presented” in her

motion that the ALJ failed properly to evaluate her credibility

(Doc #18 at 2), but her papers make no attempt to support or

develop this meritless contention. While the ALJ stated that

“[t]he claimant’s subjective complaints are not substantiated by

the medical evidence to the extent alleged and do not support a

finding of disability” (AR 18), the ALJ accepted these complaints

in his evaluation of plaintiff’s alleged disability. AR 15-17. 

Indeed, while plaintiff’s counsel at one point stated that

plaintiff’s DAA was not material to the finding of her disability,

plaintiff herself never testified that she would be disabled

without her DAA, nor did she introduce evidence to that effect. 

The ALJ’s decision did not rest on a credibility determination, so

there can have been no material error in this regard.

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Finally, plaintiff contends that the ALJ failed to use a

medical or psychiatric expert in accordance with SSR 96-6p as to

plaintiff’s residual functional capacity. As pertinent here, SSR

96-6p states that an ALJ “must obtain an updated medical opinion

from a medical expert * * * [w]hen additional medical evidence is

received that in the opinion of the administrative law judge * * *

may change the State agency medical or psychological consultant’s

finding that the impairment(s) is not equivalent in severity to any

listed impairment in the Listings of Impairments.” Again, while

plaintiff refers to “conflicting opinions,” the record reflects no

meaningful conflict. Accordingly, the ALJ was not required to seek

out the opinion of another medical expert.

IV

For the reasons stated herein, the court affirms the

ALJ’s decision to deny benefits. Accordingly, the court DENIES

plaintiff’s motion for summary judgment (Doc #18) and GRANTS

defendant Jo Anne B Barnhart’s motion for summary judgment (Doc #

23). 

The clerk is directed to enter judgment in favor of

defendant and to close the file. 

IT IS SO ORDERED.

 

VAUGHN R WALKER

United States District Chief Judge