Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-4_09-cv-00540/USCOURTS-azd-4_09-cv-00540-0/pdf.json

Nature of Suit Code: 863
Nature of Suit: Social Security - DIWC/DIWW (405(g))
Cause of Action: 42:405 Review of HHS Decision (SSID)

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WO

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Anthony Simmons, 

Plaintiff, 

vs. 

Michael J. Astrue, Commissioner of Social 

Security, 

Defendant. 

No. CV-09-00540-TUC-CRP

ORDER

 Anthony Simmons is 53 years old. He has worked as a switchboard operator, 

hotel engineer, and telemarketer. He suffers, among other things, from degenerative joint 

and disc disease of the spine, chronic pain, and depression. 

Mr. Simmons has applied for social security benefits multiple times. His first 

application was denied by an administrative law judge (“ALJ”), who found that he had 

the residual functional capacity (“RFC”) to perform sedentary work. Doc. 13, Tr. 46-55. 

The second application was denied on the ground that there had been no change in his 

condition. Tr. 153-56. Those decisions have not been appealed. 

With respect to the third application (Tr. 196-98, 724-25), Mr. Simmons claims to 

be disabled as of October 1, 2004 (Tr. 163). An ALJ issued an unfavorable decision on 

October 24, 2006. Tr. 73-79. The Appeals Council remanded the case for further 

consideration of Plaintiff’s depression, his subjective complaints, lay witness statements, 

the opinion of a nurse practitioner, and vocational evidence. Tr. 81-83. A hearing before 

the ALJ was held on November 5, 2008. Tr. 774-815. The ALJ issued a second decision 

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on March 24, 2009, finding Mr. Simmons not to be disabled within the meaning of the 

Social Security Act. Tr. 17-30. This decision became Defendant’s final decision when 

the Appeals Council denied review. Tr. 6-9. 

Mr. Simmons then brought this action for judicial review pursuant to 42 U.S.C. 

§ 405(g). Doc. 1. The issues are fully briefed. Docs. 18, 19, 20. Oral argument has not 

been requested. For reasons that follow, the Court will affirm Defendant’s decision 

denying benefits. 

I. Standard of Review.

The Court has the “power to enter, upon the pleadings and transcript of record, a 

judgment affirming, modifying, or reversing the decision of the Commissioner of Social 

Security, with or without remanding the cause for a rehearing.” 42 U.S.C. § 405(g). The 

decision denying benefits “should be upheld unless it is based on legal error or is not 

supported by substantial evidence.” Ryan v. Comm’r of Soc. Sec., 528 F.3d 1194, 1198 

(9th Cir. 2008). “This is a highly deferential standard of review: ‘Substantial evidence’ 

means more than a mere scintilla, but less than a preponderance. It means such relevant 

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

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

marks and citation omitted). 

II. Discussion. 

Whether a claimant is disabled is determined using a five-step evaluation process. 

To establish disability, the claimant must show he has not worked since the alleged 

disability onset date, he has a severe impairment, and his impairment meets or equals a 

listed impairment or his RFC precludes him from performing past work. Where the 

claimant meets his burden, the Commissioner must show that the claimant is able to 

perform other work. 20 C.F.R. §§ 404.1520, 416.920; see Valentine, 574 F.3d at 689. 

 Plaintiff has not worked since the alleged onset date. Tr. 19, ¶ 2. He has multiple 

severe impairments: status post back surgery, cervical degenerative joint disease, cervical 

and lumbar degenerative disc disease, adhesive capsulitis of the right shoulder, status post 

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left meniscectomy, chronic pain syndrome, depressive disorder, and alcohol-induced 

amnestic disorder. Tr. 19-23, ¶ 3. Those impairments do not meet or equal a listed 

impairment. Tr. 23, ¶ 4. Plaintiff is not disabled, the ALJ found, because he has the RFC 

to perform certain sedentary work, including his past job as a telemarketer. Tr. 24-29, 

¶¶ 5-6. 

Plaintiff claims that the ALJ erred by adopting the opinion of examining 

psychologist Dr. James Armstrong as the basis for the mental RFC determination. More 

specifically, Plaintiff contends that the ALJ improperly rejected the opinions of nurse 

practitioner Valerie Kading and examining psychologist Dr. Jill Caffrey and that Dr. 

Armstrong’s opinion is not otherwise supported by substantial evidence. Doc. 18 at 

10-21. Plaintiff further contends that the ALJ erred in concluding that he can do his past 

work as generally performed. Id. at 21-22. 

Defendant argues that the ALJ did not err and his decision is supported by 

substantial evidence. Doc. 19. The Court agrees. 

A. Medical Opinions.

 Dr. Armstrong, a licensed psychologist, reviewed medical records and examined 

Plaintiff on July 16, 2008. Tr. 617. Plaintiff scored 27 out of 30 on the Folstein mental 

status test, a score within normal limits. Tr. 622. He was diagnosed with moderate 

depression, pain disorder, mild alcohol-induced amnestic disorder, and alcohol and 

cocaine abuse, reported to be in remission. Tr. 623. 

In a medical source statement concerning the ability to do work-related activities, 

Dr. Armstrong opined that Plaintiff has moderate limitations in the ability to make 

judgments on complex decisions and understand, remember, and carry out complex 

instructions. Tr. 624. He further opined that Plaintiff has only mild limitations with 

respect to simple decisions and instructions and the ability to interact appropriately with 

others. Tr. 624-25. 

 After having considered multiple opinions concerning Plaintiff’s psychological 

condition – three by examining psychologists, two by consulting psychiatrists, and one by 

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a nurse practitioner – the ALJ decided to adopt the opinion of Dr. Armstrong. Tr. 28. 

Plaintiff makes several arguments as to why the adoption of that opinion is erroneous. 

None has merit. 

 Plaintiff first argues that the ALJ improperly discounted the opinion of nurse 

practitioner Valerie Kading, who, along with other staff members, treated Plaintiff at 

CODAC Behavioral Health Services. Doc. 18 at 12-15. In a mental RFC assessment 

dated January 13, 2006, Ms. Kading noted that Plaintiff had experienced significant 

psychological stressors in the past year, including the death of family members, and 

suffers from chronic depressed mood. Tr. 594. She opined that Plaintiff is markedly 

limited in his ability to maintain attention and concentration, to work within a schedule 

and maintain regular and punctual attendance, and to complete a normal workweek and 

perform at a consistent pace without interruptions from psychological symptoms. Tr. 

592-93. 

Under the relevant regulations, nurse practitioners are listed among the examples 

of “other” medical sources. 20 C.F.R. §§ 404.1513(d)(1), 416.913(d)(1). Nurse 

practitioners, unlike licensed psychologists such as Dr. Armstrong, generally do not 

qualify as “acceptable medical sources.” 20 C.F.R. §§ 404.1513(a), 416.913(d)(a). The 

distinction between “other sources” and “acceptable medical sources” is significant 

because only opinions from acceptable medical sources may be considered “treating 

source” opinions deserving of “special weight.” 20 C.F.R. §§ 404.1502, 416.902; see 

Register v. Astrue, No. CV-10-2749-PHX-LOA, 2011 WL 6369766, at *9-10 (D. Ariz. 

Dec. 20, 2011) (distinguishing between “other sources” and those entitled to “treatingsource” status); Embrey v. Bowen, 849 F.2d 418, 421 (9th Cir. 1988) (noting that 

opinions of treating physicians are entitled to “special weight”). 

The medical records from CODAC (Tr. 530-71, 686-708) do not show, and 

Plaintiff does not otherwise assert, that nurse practitioner Kading worked closely with, 

and under the supervision of, a licensed psychologist or physician. See Taylor v. Comm’r 

of Soc. Sec. Admin, 659 F.3d 1228, 1234 (9th Cir. 2011); Gomez v. Chater, 74 F.3d 967, 

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971 (9th Cir. 1996). Ms. Kading, therefore, is not an acceptable medical source. See 

Register, 2011 WL 6369766, at *9-11. Her opinion properly may be discounted for 

“germane” reasons. Id. at *11 (citing Lewis v. Apfel, 236 F.3d 503, 511 (9th Cir. 2001)); 

see also Turner v. Comm’r of Soc. Sec., 613 F.3d 1217, 1224 (9th Cir. 2010); Dodrill v. 

Shalala, 12 F.3d 915, 919 (9th Cir. 1993). 

The ALJ gave little weight to the opinion of Ms. Kading on the ground that she 

failed to distinguish between effects of depression and those of substance abuse and 

fleeting life stressors. Tr. 29. The ALJ also noted that the same month Ms. Kading 

found marked limitations, CODAC progress notes show that Plaintiff was “high in spirits 

– believ[ing] that things are finally coming together.” Tr. 708. The Court agrees with 

Defendant (Doc. 19 at 10-11) that those are germane reasons for discounting Ms. 

Kading’s opinion. See Bayliss v. Barnhart, 427 F.3d 1211, 1216 (9th Cir. 2005) 

(discrepancy between a doctor’s opinion and his clinical notes constitutes a “clear and 

convincing reason” for not relying on the opinion); Connett v. Barnhart, 340 F.3d 871, 

875 (9th Cir. 2003) (ALJ properly rejected physician’s opinion where it was contradicted 

by treatment notes); Weetman v. Sullivan, 877 F.2d 20, 23 (9th Cir. 1989) (substantial 

evidence supported decision to discount doctor’s opinion where it was inconsistent with 

medical notes); Betts v. Astrue, No. CV-10-02189-PHX-NVW, 2011 WL 3681561, at *5 

(D. Ariz. Aug. 23, 2011) (ALJ did not err in declining to give a nurse practitioner’s 

“other source” opinion greater weight than those of acceptable medical sources where 

there were inconsistencies between the nurse’s RFC assessment and progress notes). 

Noting that he was depressed and dysphoric in December 2006 (Tr. 562) and 

angry after the denial of his claim for benefits (Tr. 700, 703), Plaintiff asserts that Ms. 

Kading’s opinion accurately reflects his mood over a long period of time. Doc. 18 at 14. 

But even if this were a reasonable interpretation of the medical record, the question is not 

whether Ms. Kading’s opinion is supported by substantial evidence. Rather, the relevant 

question is whether the ALJ’s decision to adopt the opinion of Dr. Armstrong over that of 

Ms. Kading is supported by substantial evidence – that is, “such relevant evidence as a 

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reasonable mind might accept as adequate to support [the ALJ’s] conclusion.” Valentine, 

574 F.3d at 690. The Court answers in the affirmative. 

Plaintiff contends that pursuant to Social Security Ruling 96-5p, 1996 WL 374183 

(July 2, 1996), the ALJ was required to recontact Ms. Kading for clarification as to 

whether she distinguished between effects of depression and those of substance abuse and 

fleeting life stressors. Doc. 18 at 13. But the duty to recontact does not apply to the 

“other source” opinion provided by Ms. Kading. Ruling 96-5p, by its express terms, is 

limited to recontacting “treating sources.” SSR 96-5p, 1996 WL 374183, at *6; see 

Billings v. Astrue, No. CV 08-518-N-CWD, 2010 WL 1248258, at *6 (D. Idaho Mar. 23, 

2010). 

The ALJ, according to Plaintiff, violated Social Security Ruling 06-03p, 2006 WL 

2329939 (Aug. 9, 2006). Although Ruling 06-03p discusses the importance of “other 

source” evidence in establishing disability, nowhere does it purport to overrule the 

regulations’ classification of nurse practitioners as “other sources.” The Ruling makes 

clear that the distinction between “acceptable medical sources” and “other” healthcare 

providers is an important one given that “only ‘acceptable medical sources’ can give us 

medical opinions” and “only ‘acceptable medical sources’ can be considered treating 

sources[.]” SSR 06-03p, 2006 WL 2329939, at *2; see Nestle v. Astrue, No. 10-6203-JE, 

2011 WL 7082542, at *13 (D. Or. Dec. 30, 2011). 

Contrary to Plaintiff’s assertion (Doc. 18 at 13), Ruling 06-03p does not require 

the ALJ to evaluate the opinion of Ms. Kading – an “other source” healthcare provider – 

according to the factors set out in 20 C.F.R. §§ 404.1527(d) and 416.927(d). The Ruling 

makes clear that those factors “apply only to the evaluation of medical opinions from 

‘acceptable medical sources[.]’” SSR 06-03p, 2006 WL 2329939, at *4. Moreover, as 

explained more fully above, the ALJ provided “good reasons” for discounting Ms. 

Kading’s opinion. 20 C.F.R. §§ 404.1527(d)(2), 416.927(d)(2); see Docs. 18 at 13, 20 

at 3. 

Plaintiff further argues that in adopting the opinion of Dr. Armstrong, the ALJ 

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improperly discounted the opinion of examining psychologist Dr. Jill Caffrey. Doc. 18 

at 18-19. Dr. Caffrey examined Plaintiff on February 7, 2006, diagnosing him with major 

depressive order and rule-out cognitive disorder, not otherwise specified. Tr. 604-07. In 

a medical source statement concerning the ability to do work-related activities, Dr. 

Caffrey opined that Plaintiff has moderate limitations in the ability to understand, 

remember, and carry out detailed instructions, to make simple work-related decisions, to 

maintain attention and concentration for extended periods, to work within a schedule and 

maintain regular and punctual attendance, to complete a normal workweek and perform 

at a consistent pace without interruptions from psychological symptoms, and to respond 

appropriately to changes in the work setting. Tr. 598-603. 

The ALJ discounted Dr. Caffrey’s opinion because it is based, at least in part, on 

misinformation. Tr. 29. Plaintiff reported to Dr. Caffrey that he “last worked in 

approximately 1993 or 1994[.]” Tr. 605. Plaintiff in fact worked for another decade. 

Tr. 190, 782-83. He reported having last used illicit drugs in 1970 “when he was using 

marijuana” (Tr. 605), but tested positive for cocaine in 2005 (Tr. 548, 800). The ALJ 

noted, correctly, that Plaintiff’s lack of candor could have affected Dr. Caffrey’s 

evaluation of him. Tr. 29. The Court finds that the ALJ provided “specific and 

legitimate reasons” for discounting Dr. Caffrey’s opinion, and those reasons are 

supported by substantial evidence. Lester v. Chater, 81 F.3d 827, 830 (9th Cir. 1995); 

see Sandgathe v. Chater, 108 F.3d 978, 980 (9th Cir. 1997) (ALJ did not err in 

discounting examining physician’s opinion where it was based in part on the claimant’s 

exaggerated claims). 

Plaintiff contends that pursuant to 20 C.F.R. § 404.1512(e), the ALJ should have 

recontacted Dr. Caffrey to resolve any ambiguities in her opinion. Doc. 18 at 19. But 

that “regulation applies only to a ‘treating’ source,” not examining sources such as Dr. 

Caffrey. Thomas v. Barnhart, 278 F.3d 947, 958 (9th Cir. 2002); see Billings, 2010 WL 

1248258, at *6. Moreover, the duty to recontact is triggered “only when the evidence 

from the treating medical source is inadequate to make a determination as to the 

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claimant’s disability.” Thomas, 278 F.3d at 958. The ALJ found the evidence, including 

the opinion of Dr. Caffrey, adequate to make a determination regarding Plaintiff’s 

disability. Tr. 17-30. He therefore had no duty to recontact Dr. Caffrey. See Thomas, 

278 F.3d at 958; Bayliss, 427 F.3d at 1217; Billings, 2010 WL 1248258, at *6. 

Plaintiff further argues that Dr. Armstrong’s opinion is not supported by 

substantial evidence. Doc. 18 at 15-18. Citing a letter authored by Dr. Caffrey 

(Tr. 745-46), Plaintiff claims that Dr. Armstrong’s own psychological testing undermines 

his opinion concerning cognitive abilities. Doc. 18 at 15-17. Referencing Dr. 

Armstrong’s narrative report (Tr. 617-23), Dr. Caffrey speculated that the 27 out of 30 

score on the Folstein mental status test “may not be correct,” that Plaintiff “likely lost” 

between one and three points on word recall trials, and that it “may well be the case” that 

Plaintiff has greater limitations than those assessed by Dr. Armstrong. Tr. 745-46. Dr. 

Caffrey also had “concerns” about Plaintiff’s well-being and decision-making abilities, 

noting that he had reported having homicidal and suicidal thoughts. Tr. 46; see Tr. 21-

22, 621. 

Speculation by one doctor that another doctor’s opinion may be without merit does 

not render that opinion unsupported by substantial evidence. Dr. Armstrong’s opinion 

concerning Plaintiff’s mental RFC was based on more than the results of the Folstein test. 

His psychological examination encompassed many factors, including an evaluation of 

Plaintiff’s appearance, his hearing, vision, and speech, his insight, judgment, and 

memory, his alertness and orientation, and his emotional state. Tr. 617-22. Dr. 

Armstrong further considered Plaintiff’s history of mental health treatment, interpersonal 

relations, daily activities, and family psychological history. Tr. 619-23. Aside from the 

Folstein test results, Dr. Armstrong found “no significant difficulty in [Plaintiff] 

attending to [the] interview and tracking questions.” Plaintiff “responded to questions 

with no significant latency.” Tr. 621. The Court finds that Dr. Armstrong’s opinion is 

supported by substantial evidence. Cf. Tonapetyan v. Halter, 242 F.3d 1144, 1149 (9th 

Cir. 2001) (doctor’s opinion alone constituted substantial evidence where it rested on his 

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own independent examination of the claimant); Cashin v. Astrue, No. EDCV 09-161 JC, 

2010 WL 749884, at *7 (C.D. Cal. Feb. 24, 2010) (“The opinions of [the two doctors] 

were supported by each examining psychologists’ independent clinical findings, and thus 

constituted substantial evidence[.]”). 

Finally, Plaintiff argues that the ALJ erred in adopting the opinion of Dr. 

Armstrong because it is not supported by “other substantial evidence.” Doc. 18 at 19. 

The relevant inquiry is not whether substantial evidence conflicts with a medical opinion, 

but instead whether the ALJ’s decision to adopt the opinion is supported by substantial 

evidence – that is, evidence which is “more than a mere scintilla, but less than a 

preponderance.” Valentine, 574 F.3d at 690. Dr. Armstrong’s opinion is supported by 

more than a scintilla of evidence, including his own clinical findings. 

With respect to the purported “other substantial evidence,” Plaintiff claims that lay 

evidence does not support the opinion of Dr. Armstrong. Doc. 18 at 19-21. Plaintiff’s 

friend, Mary Cline, completed a function report in November 2004. Tr. 276-84. 

Testimony from friends of the claimant constitutes competent evidence and therefore 

cannot be disregarded without comment. Stout v. Comm’r Soc. Sec. Admin., 454 F.3d 

1050, 1053 (9th Cir. 2006). If the ALJ wishes to discount the testimony of lay witnesses, 

“‘he must give reasons that are germane to each witness.’” Id. (citation omitted). 

The ALJ has met his burden with respect to Ms. Cline. She stated that she had 

known Plaintiff for six years and that during that entire time “he’s been disabled.” 

Tr. 276-77. Noting, correctly, that Plaintiff had worked and earned substantial income 

between 2000 and 2003 (Tr. 190), the ALJ found that Ms. Cline “does not understand 

what is required to qualify for disability under the Social Security Act and Regulations.” 

Tr. 26. This is a legitimate reason germane to Ms. Cline. The ALJ did not err in 

deciding to adopt Dr. Armstrong’s medical opinion despite the testimony of Ms. Cline. 

This is true even if, as Plaintiff asserts (Doc. 20 at 2), Dr. Armstrong did not explicitly 

mention lay testimony in his report. 

Ms. Cline’s statement that Plaintiff had been “disabled” prior to the alleged onset 

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date, Plaintiff asserts, could also be taken to mean that he was having problems working. 

Doc. 20 at 6. “Although Plaintiff may interpret the evidence differently, it is the province 

of the ALJ to analyze the testimony.” Edwards v. Astrue, No. 1:09cv1002 DLB, 2010 

WL 2942081, at *12 (E.D. Cal. July 23, 2010). His interpretation of Ms. Cline’s 

statement is reasonable and, therefore, will not be disturbed. Plaintiff asserts that the ALJ 

could have subpoenaed Ms. Cline (Doc. 20 at 6), but presents no legal authority or 

argument that the ALJ erred in failing to do so. 

Plaintiff references a field office report dated July 11, 2003 (Tr. 295-97), in which 

social security employee Dora Walker noted that Plaintiff was uncooperative and rude. 

Doc. 18 at 20. To the extent the ALJ erred by not commenting on those observations, the 

error is harmless. 

This Circuit has held that “where the ALJ’s error lies in a failure to properly 

discuss competent lay testimony favorable to the claimant, a reviewing court cannot 

consider the error harmless unless it can confidently conclude that no reasonable ALJ, 

when fully crediting the testimony, could have reached a different disability 

determination.” Stout, 454 F.3d at 1056. Even when crediting Ms. Walker’s 

observations, the Court is confident that no reasonable ALJ could have found Plaintiff to 

be disabled. Ms. Walker explicitly noted “no physical or mental impairment.” Tr. 297. 

She further observed that Plaintiff had no difficulty hearing, reading, understanding, 

concentrating, talking, or answering questions. Tr. 296. The fact that Plaintiff was rude 

and uncooperative with Ms. Walker does support a finding of disability. Nor does it 

undermine the clinical findings and opinion of Dr. Armstrong. See Doc. 20 at 2. 

Plaintiff challenges the opinion of examining psychologist Dr. James Rau 

(Tr. 399-402), asserting that his “optimistic assessment of [Plaintiff’s] mental health 

turned out to be false.” Doc. 18 at 21. But Dr. Rau’s opinion was given weight by the 

ALJ only “to the extent consistent with Dr. Armstrong’s more specific limitations.” 

Tr. 28. Dr. Rau’s opinion in no way undermines that of Dr. Armstrong. 

“The ALJ is responsible for resolving conflicts in the medical record.” Carmickle 

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v. Comm’r, Soc. Sec., 533 F.3d 1155, 1164 (9th Cir. 2008). “Where the evidence is 

susceptible of more than one rational interpretation, it is the ALJ’s conclusion which 

must be upheld.” Gallant v. Heckler, 753 F.2d 1450, 1453 (9th Cir. 1984). The Court 

concludes that the ALJ “acted in accordance with his responsibility to determine the 

credibility of medical evidence.” Thomas, 278 F.3d at 958. His decision to adopt the 

opinion of Dr. Armstrong is supported by substantial evidence. 

B. Past Work.

After having considered the medical evidence and record as a whole, and having 

heard vocational expert testimony (Tr. 802-15), the ALJ determined that Plaintiff has the 

RFC to perform his past work as a telemarketer. Tr. 24-29, ¶¶ 5-6. The ALJ erred, 

Plaintiff contends, because he made no finding that Plaintiff can type at a competitive 

speed and failed to address Plaintiff’s migraine headaches and poor vision. Doc. 18 

at 22. 

Plaintiff’s alleged inability to type and headaches are based solely on his hearing 

testimony. Tr. 814. That testimony was found by the ALJ to be not fully credible. 

Tr. 24-26. Plaintiff does not challenge this finding. 

Plaintiff asserts that the ALJ did not specifically address the ability to type (Doc. 

20 at 8), but “in interpreting the evidence and developing the record, the ALJ does not 

need to ‘discuss every piece of evidence.’” Howard v. Barnhart, 341 F.3d 1006, 1012 

(9th Cir. 2003) (citation omitted). “The ALJ’s decision reflects that he considered the 

record as a whole and weighed the functional assessments contained in [P]laintiff’s 

mental health records in both assessing [his] RFC and finding that [he] could perform his 

past work.” Wade v. Astrue, N. 2:10-cv-01153 KJN, 2011 WL 4500863, at *4 (E.D. Cal. 

Sept. 27, 2011). 

Moreover, the regulations make clear that all physical and mental impairments 

“must be established by medical evidence consisting of signs, symptoms, and laboratory 

findings, not only by [the claimant’s] statement of symptoms.” 20 C.F.R. §§ 404.1508, 

416.908; see Ukolov v. Barnhart, 420 F.3d 1002, 1005 (9th Cir. 2005). The alleged 

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preclude him

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affirmed. 

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), but Plain

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refore need

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0 C.F.R. §§

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Case 4:09-cv-00540-CRP Document 23 Filed 02/09/12 Page 12 of 12