Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-1_22-cv-01497/USCOURTS-caed-1_22-cv-01497-1/pdf.json

Nature of Suit Code: 865
Nature of Suit: Social Security - RSI (405(g))
Cause of Action: 42:416 Denial of Social Security Benefits

---

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

1

UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF CALIFORNIA

Catherine Ann Lutz,

Plaintiff,

v.

Commissioner of Social Security,

Defendant.

No. 1:22-cv-1497-TLN-GSA

FINDINGS AND RECOMMENDATIONS 

TO GRANT PLAINTIFF’S MOTION FOR 

SUMMARY JUDGMENT, TO REMAND 

FOR FURTHER PROCEEDINGS, AND TO 

DIRECT ENTRY OF JUDGMENT IN 

FAVOR OF PLAINTIFF AND AGAINST 

DEFENDANT COMMISSIONER OF 

SOCIAL SECURITY

(Doc. 7, 10)

I. Introduction

Plaintiff Catherine Ann Lutz seeks judicial review of a final decision of the Commissioner 

of Social Security terminating her social security disability insurance benefits pursuant to Title II

of the Social Security Act.1 

II. Factual and Procedural Background

In a favorable determination dated April 17, 2015 (the “Comparison Point Decision” or 

“CPD”), Plaintiff was found disabled and awarded benefits as of May 1, 2014, based on her stage 

4 non-Hodgkin’s follicular lymphoma meeting listing 13.05 of 20 CFR Part 404, Subpart P, 

Appendix 1 (20 CFR 404.1520(d)). AR 17; 94–99; 367–73. On July 1, 2018, the “disability 

cessation date”, following a continuing disability review (“CDR”) the agency found that Plaintiff 

was no longer disabled due to medical improvement, a decision which was upheld on 

reconsideration. AR 116; 133–42. Plaintiff requested a hearing before an ALJ, and three such 

hearings were held on the following dates, April 21, 2020, May 18, 2021, and August 24, 2021. 

AR 36–65; 66–80; 81–92. On September 9, 2021, the ALJ issued an unfavorable decision 

upholding the termination of Plaintiff’s benefits as of July 1, 2018. AR 12–35. On September 12, 

2022, the Appeals Council denied review making the Commissioner’s decision final. AR 1–6. 

1 The parties did not consent to the jurisdiction of a United States Magistrate Judge. Doc. 5, 13.

Case 1:22-cv-01497-TLN-GSA Document 16 Filed 09/09/24 Page 1 of 18
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

2

Plaintiff subsequently filed a complaint in this Court.

III. The Disability Standard Generally

Pursuant to 42 U.S.C. §405(g), this court has the authority to review a decision by the 

Commissioner denying a claimant disability benefits. “This court may set aside the 

Commissioner’s denial of disability insurance benefits when the ALJ’s findings are based on legal 

error or are not supported by substantial evidence in the record as a whole.” Tackett v. Apfel, 180 

F.3d 1094, 1097 (9th Cir. 1999) (citations omitted). Substantial evidence is evidence within the 

record that could lead a reasonable mind to accept a conclusion regarding disability status. See 

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

preponderance. See Saelee v. Chater, 94 F.3d 520, 522 (9th Cir. 1996) (internal citation omitted). 

When performing this analysis, the court must “consider the entire record as a whole and 

may not affirm simply by isolating a specific quantum of supporting evidence.” Robbins v. Social 

Security Admin., 466 F.3d 880, 882 (9th Cir. 2006) (citations and quotations omitted). If the 

evidence could reasonably support two conclusions, the court “may not substitute its judgment for 

that of the Commissioner” and must affirm the decision. Jamerson v. Chater, 112 F.3d 1064, 1066 

(9th Cir. 1997) (citation omitted). “[T]he court will not reverse an ALJ’s decision for harmless 

error, which exists when it is clear from the record that the ALJ’s error was inconsequential to the 

ultimate nondisability determination.” Tommasetti v. Astrue, 533 F.3d 1035, 1038 (9th Cir. 2008). 

To qualify for benefits under the Social Security Act, a plaintiff must establish that 

he or she is unable to engage in substantial gainful activity due to a medically 

determinable physical or mental impairment that has lasted or can be expected to 

last for a continuous period of not less than twelve months. 42 U.S.C. § 

1382c(a)(3)(A). An individual shall be considered to have a disability only if . . . 

his physical or mental impairment or impairments are of such severity that he is not 

only unable to do his previous work, but cannot, considering his age, education, and 

work experience, engage in any other kind of substantial gainful work which exists 

in the national economy, regardless of whether such work exists in the immediate 

area in which he lives, or whether a specific job vacancy exists for him, or whether 

he would be hired if he applied for work.

42 U.S.C. §1382c(a)(3)(B).

IV. Continuing Disability Review

After finding a claimant disabled, the agency must conduct a continuing disability review 

Case 1:22-cv-01497-TLN-GSA Document 16 Filed 09/09/24 Page 2 of 18
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

3

“from time to time.” 20 C.F.R. § 416.989; 42 U.S.C. § 1382c(a)(3)(H)). Continuing disability is 

not presumed, rather the claimant must establish it. 42 U.S.C. § 1382c(a)(4); see also Lambert v. 

Saul, 980 F.3d 1266, 1275-76 (9th Cir. 2020). To find a claimant no longer disabled substantial 

evidence must show cessation of the previously disabling impairment, or medical improvement 

which renders the claimant able to perform substantial gainful activity. Id.

The inquiry is governed by a seven-step analysis. At step one, the ALJ must determine 

whether the claimant has an impairment or combination of impairments which meets or medically 

equals the criteria of an impairment listed in 20 CFR Part 404, Subpart P, Appendix 1 (20 CRF 

416.920(d), 416.925 and 416.926). If the claimant does, her disability continues (20 CFR 

416.994(b)(5)(i)).

At step two, the ALJ must determine whether medical improvement has occurred (20 CFR 

416.994(b)(5)(ii)). Medical improvement is any decrease in medical severity of the impairment(s) 

as established by improvement in symptoms, signs and/or laboratory findings (20 CFR 

416.994(b)(1)(i)). If medical improvement has occurred, the analysis proceeds to the third step. If 

not, the analysis proceeds to the fourth step. 

At step three, the ALJ must determine whether medical improvement is related to the ability 

to work (20 CFR 416.994(b)(5)(iii)). Medical improvement is related to the ability to work if it 

results in an increase in the claimant’s capacity to perform basic work activities (20 CFR 

416.994(b)(1)(iii)). If it does, the analysis proceeds to the fifth step.

At step four, the ALJ must determine if an exception to medical improvement applies (20 

CFR 416.994(b)(5)(iv)). There are two groups of exceptions found at 20 CFR 416.994(b)(3) and

(b)(4). If the first group exceptions apply, the analysis proceeds to the next step. If the second 

group exceptions apply, the claimant’s disability ends. If none apply, the claimant’s disability 

continues.

At step five, the ALJ must determine whether all of the claimant’s current impairments in

combination are severe (20 CFR 416.994(b)(5)(v)). If all current impairments in combination do

not significantly limit the claimant’s ability to do basic work activities, the claimant is no longer

disabled. If they do, the analysis proceeds to the sixth step.

Case 1:22-cv-01497-TLN-GSA Document 16 Filed 09/09/24 Page 3 of 18
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

4

At step six, the ALJ must assess the claimant’s residual functional capacity based on the

current impairments and determine if s/he can perform past relevant work (20 CFR

416.994(b)(5)(vi)). If the claimant has the capacity to perform past relevant work then his/her 

disability has ended. If not, the analysis proceeds to the last step.

At step seven, the ALJ must determine whether other work exists that the claimant can 

perform given his/her residual functional capacity and considering his/her age, education, and past

work experience (20 CFR 416.994(b)(5)(vii)). If the claimant can perform other work, s/he is no

longer disabled. If the claimant cannot perform other work, his/her disability continues.

V. The ALJ’s Decision

The ALJ noted that the prior disability determination was based on the finding that Plaintiff 

met Listing 13.05 due to lymphoma. AR 17. The ALJ found that since July 1, 2018, Plaintiff had the 

following medically determinable impairments: scoliosis; obesity; depressive disorder; somatic 

disorder; and a mixed personality disorder. AR 17.

The ALJ further found that, since July 1, 2018, Plaintiff did not have an impairment or 

combination thereof that met or medically equaled any of the impairments listed at 20 CFR Part 404, 

Subpart P, Appendix 1 (20 CFR 404.1525 and 404.1526). AR 17. The ALJ stated that medical 

improvement was not an issue because an exception applied, explaining as follows:

This case involves a Group 1 error, which is an exception to the medical 

improvement requirement. Here, substantial evidence shows that the prior 

determination/decision was in error. After review of the record, multiple medical 

consultants determined the prior finding that the claimant met listing 13.05 was in 

error, and the claimant's conditions were non-severe (3A/8-9; 17F/6). Likewise, at 

the hearing, Steven Golub, MD, testified that the claimant did not meet listing 

13.05A at any point because there was no persistence or recurrence of a lymphoma 

subsequent to treatment as required under 13.05(A)(1), and the claimant’s 

chemotherapy followed by radiation was the standard treatment regimen, indicating 

this was part of a one, multi-modal, anticancer treatment which does not meet the 

requirements of 13.05(A)(2) (hearing testimony).

AR 17–18.

Next, the ALJ concluded that since July 1, 2018, Plaintiff’s medically determinable 

impairments referenced above did not cause more than a minimal impact on her ability to perform 

basic work activities and therefore were not severe. AR 18–25. Because of the absence of any severe 

Case 1:22-cv-01497-TLN-GSA Document 16 Filed 09/09/24 Page 4 of 18
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

5

impairment the analysis did not proceed to the formulation of an RFC or consideration of Plaintiff’s 

ability to perform past relevant work or other work in the national economy. The ALJ thus found that 

Plaintiff was no longer disabled as of July 1, 2018, and did not become disabled again thereafter. AR 

25.

VI. Issues Presented

Plaintiff asserts two claims of error: 1- the ALJ erred in the evaluation of Plaintiff’s treating 

physicians’ opinions, including applying the wrong standard and relying on erroneous reasoning 

and insubstantial evidence to reject the opinions2; 2- the ALJ erred in the evaluation of Plaintiff’s 

subjective testimony and symptom complaints, including a lack of specificity and erroneous 

reliance on activities of daily living3.

A. Opinions of Dr. Sarang and Dr. Renner 

1. Legal Standard

For applications filed before March 27, 2017, the regulations provide that more weight is 

generally given to the opinion of treating physicians, which are given controlling weight when well 

supported by clinical evidence and not inconsistent with other substantial evidence. 20 C.F.R. § 

404.1527(c)(2); see also Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995), as amended (Apr. 9, 

1996) (noting that the opinions of treating physicians, examining physicians, and non-examining 

physicians are entitled to varying weight in residual functional capacity determinations). 

An ALJ may reject an uncontradicted opinion of a treating or examining physician only for 

“clear and convincing” reasons. Lester, 81 F.3d at 831. In contrast, a contradicted opinion of a 

treating or examining physician may be rejected for “specific and legitimate” reasons. Id. at 830. 

In either case, the opinions of a treating or examining physician are “not necessarily conclusive as 

to either the physical condition or the ultimate issue of disability.” Morgan v. Comm’r of Soc. Sec. 

Admin., 169 F.3d 595, 600 (9th Cir. 1999). Regardless of source, all medical opinions that are not 

2 Plaintiff discussed these as two distinct arguments (numbered 1 and 4) but herein will be considered together. 

3 Plaintiff also discussed these as two distinct arguments (numbered 2 and 3) but herein will be considered together.

Case 1:22-cv-01497-TLN-GSA Document 16 Filed 09/09/24 Page 5 of 18
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

6

given controlling weight are evaluated using the following factors: examining relationship, 

treatment relationship, supportability, consistency, and specialization. 20 C.F.R. § 404.1527(c). 

For applications filed on or after March 27, 2017, the new regulations eliminate a hierarchy 

of medical opinions, and provide that “[w]e will not defer or give any specific evidentiary weight, 

including controlling weight, to any medical opinion(s) or prior administrative medical finding(s), 

including those from your medical sources.” 20 C.F.R. § 404.1520c(a). Rather, when evaluating 

any medical opinion, the regulations provide that the ALJ will consider the factors of supportability, 

consistency, treatment relationship, specialization, and other factors. 20 C.F.R. § 404.1520c(c). 

Supportability and consistency are the two most important factors and the agency will articulate 

how the factors of supportability and consistency are considered. Id.

On April 22, 2022, the Ninth Circuit addressed whether the specific and legitimate 

reasoning standard is consistent with the revised regulations, stating as follows: 

The revised social security regulations are clearly irreconcilable with our caselaw 

according special deference to the opinions of treating and examining physicians on 

account of their relationship with the claimant. See 20 C.F.R. § 404.1520c(a) (“We 

will not defer or give any specific evidentiary weight, including controlling weight, 

to any medical opinion(s) ..., including those from your medical sources.”). Our 

requirement that ALJs provide “specific and legitimate reasons” for rejecting a 

treating or examining doctor's opinion, which stems from the special weight given 

to such opinions, see Murray, 722 F.2d at 501–02, is likewise incompatible with the 

revised regulations. Insisting that ALJs provide a more robust explanation when 

discrediting evidence from certain sources necessarily favors the evidence from 

those sources—contrary to the revised regulations.

Woods v. Kijakazi, 32 F.4th 785, 792 (9th Cir. 2022). 

2. Analysis

a. Quoting the Wrong Legal Standard

Before addressing the medical opinion evidence, the ALJ explained:

As for the medical opinion(s) and prior administrative medical finding(s), we will 

not defer or give any specific evidentiary weight, including controlling weight, to 

any prior administrative medical finding(s) or medical opinion(s), including those 

from your medical sources. We fully considered the medical opinion(s) and prior 

Case 1:22-cv-01497-TLN-GSA Document 16 Filed 09/09/24 Page 6 of 18
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

7

administrative medical finding(s) in your case. AR 19

Thus, the ALJ quoted the revised regulations applicable to claims filed on or after March 

27, 2017 (20 C.F.R. § 404.1527c(a)) rather than the regulations that applied to claims filed earlier 

(20 C.F.R. § 404.1527(a)). The prior version was known as the “treating physician rule.” 

Neither party cites authority specifically addressing which version applies where, as here, 

the original claim was filed prior to March 27, 2017, but the claimant challenges a continuing 

disability review (CDR) which found she was no longer disabled as of July 1, 2018. Plaintiff 

contends that because the regulations reference only the “filing” date, that should be considered the 

operative date absent any authority suggesting otherwise. MSJ at 11, Doc. 7. Because Defendant 

does not dispute this, the Court need not take a formal position on the issue. The parties agree that 

the ALJ quoted the wrong regulation. 

Plaintiff contends the ALJ’s misquotation of the relevant legal standard alone warrants 

remand given the Ninth Circuit’s clear instruction that reliance on the wrong legal standard is 

harmful error. Reply at 2 (citing Stone v. Heckler, 761 F.2d 530, 531 (9th Cir.1985)). Defendant 

suggests however, that the misquotation amounted to a mere “transcription error” and that the ALJ 

nevertheless applied the correct legal standard by assigning varying amounts of “weight” to each 

medical opinion. Resp. at 6, Doc. 10.

On this point of contention, Defendant’s argument is not particularly compelling as the 

difference between the two regulations is not just a matter of semantics. Rather, the old regulations 

began with the proposition that the treating physician’s opinion “generally”

4

is given the most 

weight, and this is so when “well-supported by medically acceptable clinical and laboratory 

diagnostic techniques” and “not inconsistent with the other substantial evidence.” 20 C.F.R. § 

4

It is worth noting that Plaintiff also misstates the legal standard in asserting that the applicable regulations require the 

treating source opinion be given controlling weight. See MSJ at 11.

Case 1:22-cv-01497-TLN-GSA Document 16 Filed 09/09/24 Page 7 of 18
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

8

404.1527(c)(2).

Here, the ALJ did not demonstrate awareness that the analysis begins with the presumption that the 

treating source opinions are given the most weight, even quoting the revised regulation stating 

otherwise. 

Further, as the Ninth Circuit explained in Woods (quoted above), for cases governed by the 

prior regulations, Ninth Circuit caselaw imposed upon ALJ’s a heightened standard of articulation 

when rejecting a treating source opinion than would otherwise apply. Treating source opinions 

could only be rejected for “clear and convincing reasons” if the opinion was uncontradicted, or for

“specific and legitimate reasons” where, as here, the treating source opinions were contradicted by 

another opinion like that of the consultative examiner. As quoted above, the Ninth Circuit clarified 

in Woods that the judicially created heightened standard of articulation is also defunct under the 

new regulatory scheme. 

However, the Court need not take a position as to whether the incorrect recitation of the 

legal standard alone warrants remand. Even assuming the error was a mere “transcription error” as 

Defendant suggests, and assuming further that the ALJ had the correct regulations in mind when 

assigning varying degrees of “weight” to each medical opinion, the ALJ’s articulated reasoning 

still fails under the “specific and legitimate reasoning standard.”5

b. The ALJ’s Reasoning for Rejecting the Treating 

Source Opinions

First with respect to Dr. Sarang, Plaintiff’s primary care physician, the ALJ explained:

The record also contains various opinions which predate the cessation date. For 

example, in 2016, Monica Sarang, MD, noted the claimant required extra protection 

from UV radiation and was photosensitive during radiation therapy (40F/15). 

However, the record does not establish any ongoing radiation therapy after the July 

1, 2018 cessation date. As such, the record does not support that this limitation is 

5 Of note again, Plaintiff does not discuss the heightened standard of articulation, or make an attempt to apply it--

instead resting her argument on the contention that the ALJ is required to give controlling weight to the treating source

opinion. 

Case 1:22-cv-01497-TLN-GSA Document 16 Filed 09/09/24 Page 8 of 18
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

9

ongoing, and the undersigned gives it no weight for the period at issue. Similarly, 

the undersigned has considered the application for a permanent parking placard also 

signed off by Dr. Sarang in March 2016, due to pelvic lymphoma with right hip pain 

(40F/17). The undersigned notes that this document does not specify any specific 

functional limitations. Moreover, this predates the cessation date by more than 2 

years. Further, it is also inconsistent with other evidence including the July 2019 

consultative examination where the claimant was noted to have an unremarkable 

gait and generally good range of motion of all major joints (18F/4-5). As such, the 

2016 parking permit application is not persuasive for the period at issue and the 

undersigned gives it no weight. 

The timing of opinion evidence in relation to “the cessation date” is not significantly 

relevant here as it is undisputed that Plaintiff had no active lymphoma as of that date, and Plaintiff’s 

treating physicians did not suggest otherwise.6 As will be discussed, what the opinion evidence did

suggest is that Plaintiff had ongoing pelvic pain and limitation as a result of her admittedly 

successful lymphoma treatment and the presence of a residual inoperable mass. This opinion 

evidence is relevant to the extent it speaks to her pain and limitation after the “cessation date,” even 

if the opinion was authored prior to or after that date. The letter concerning UV sensitivity and the 

disabled parking placard application have little importance given Dr. Sarang had elsewhere 

specified functional limitations, including limitations on walking, with much more clarity and 

support.

The ALJ then explained as follows:

In October 2018, Dr. Sarang also provided a jury duty excuse letter stating that due 

to pelvic pain and nerve discomfort, the claimant was unable to sit for prolonged 

periods, was home-bound, and needed pain medication every 4 hours (9F/4; 42F/1). 

This opinion was made during the period at issue. However, it is not supported by 

Dr. Sarang’s records showing good stable clinical findings (2F/13). Additionally, 

the vague limitation on sitting is not fully consistent with the claimant's ability to 

take long flights at least twice a year as she relocates from spending winter in 

California to summer in Switzerland (3F/10, 13, 20). Further, the statement that the 

claimant was home-bound in October 2018, the sitting limitation, and the implied 

effect of pain medications, are all inconsistent with the claimant’s ability to make 

the “long drive” to psychiatry appointments with Margaret Stuber, MD in 2018 (see 

36F). As a result, the undersigned gives very little weight to this opinion.

6 Nor does there appear to be any dispute that Plaintiff’s lymphoma never met Listing 13.05 despite the fact that she 

was awarded benefits on that basis. 

Case 1:22-cv-01497-TLN-GSA Document 16 Filed 09/09/24 Page 9 of 18
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

10

Though not significant to the analysis, the inability to meet the obvious sitting demands of

jury service implies at least some non-trivial work-related functional limitation even if not 

necessarily a disabling level of limitation. The ALJ references “good stable” findings, discussed 

more below, which the ALJ referenced on a number of occasions and which Plaintiff reasonably 

disputes as insufficiently specific. 

As to Plaintiff’s twice-yearly flights from California to Switzerland and back, this is not 

inconsistent with significant sitting limitations as the records, even those cited by the ALJ, suggest 

it was not leisure travel but was at least in part for medical care as her oncologist Dr. Renner was 

located in Switzerland where she was a citizen and received free treatment. See AR 813 (Dr. Sarang 

writes “I regularly communicate with Dr. Renner in Switzerland, where the patient is able to 

undergo medical care for free as a citizen.); AR 830 (“The major impetus for the move is health 

care expenses. She cannot get the health care in the US that she can get in Switzerland.”); AR 954 

(“However, due to her insurance, it was significantly cheaper for her to return home to Switzerland 

for her to get her treatment. Because of this, she established with a Dr. Christoph Renner in Zurich 

and received 2 cycles of dose adjusted R-EPOCH.”).

Even if adequate care was available and/or affordable in California, which the records 

suggest was not the case, Plaintiff should not be faulted for her treatment choices when faced with 

a potentially terminal illness. It is not inconsistent that she would be willing and able to endure a 

long flight occasionally in furtherance of her treatment, while at the same time not able to sit 

without limitation in the context of full time work as Dr. Sarang opined. Similarly, with respect 

to the “long drive” to see her psychiatrist Dr. Stuber (roughly 2 hours from Plaintiff’s home in 

Tehachapi to UCLA medical center), it was not leisure travel, and it presumably could have been

broken up by any number of breaks. 

Finally, the ALJ explained as follows:

Case 1:22-cv-01497-TLN-GSA Document 16 Filed 09/09/24 Page 10 of 18
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

11

Dr. Sarang also provided additional opinions generated after the June 2019 date last 

insured. In June 2020, about a year after the date last insured, Dr. Sarang wrote the 

claimant had balance issues and experienced frequent falls due to pelvic scar tissue 

and gluteus tears (25F/1; 43F/10), and neuropathy “prevents her to be able to work 

with her hands as well.” As a result, Dr. Sarang opined the claimant was “medically 

disabled.” The undersigned notes this final opinion is on an issue reserved to the 

Commissioner of the Social Security Administration. Dr. Sarang also completed a 

medical opinion form in June 2020 (26F; 43F/16-23), indicating a less than 

sedentary residual functional capacity due to significant limitations including an 

inability to sit, stand, or walk for more than 2 hours total, an inability to lift more 

than 10 pounds, along with regular breaks to lie down, and more than 3 estimated 

absences per month. In March 2021, Dr. Sarang provided an updated letter providing 

similar limitations to those contained in her 2020 letter and questionnaire (34F/1). 

This reiterated similar assessments made in her earlier opinions, without providing 

any additional support. 

These opinions are given little weight as they refer to conditions after the date last 

insured including gluteal muscle tears identified in February 2020 (25F/3; 30F/2). 

Additionally, emails between the claimant and Dr. Sarang reference a more than a 

yearlong gap in treatment from December 2018 into 2020 (see 43F/33). Moreover, 

Dr. Sarang’s opinions are not supported by her records that showed good stable 

findings (e.g. 25F/5; 42F/25). Further, they are not consistent with the claimant's 

activities including regularly traveling abroad, providing care for her son, and 

driving 2 hours to go to Los Angeles by herself (3F/10, 13, 20; 14F/5; 18F/2).

As to the June 2020 letter from Dr. Sarang, the ALJ was correct that “medically disabled” 

is a conclusion on an ultimate issue of disability which is reserved for the Commissioner. However, 

that was not the only assertion in the letter. The letter did provide an explanation on the mechanism 

of injury and the functional relevance of the injuries which provides contextual detail in support of 

the other opinions. Dr. Sarang explained that radiation therapy caused the pelvic scar tissue and 

gluteal muscle tears, the latter of which was confirmed by an MRI.

7 Dr. Sarang further explained 

that Plaintiff had limited use of her hands due to chemotherapy induced neuropathy.

8

Finally, the ALJ reaches the actual RFC questionnaire that Dr. Sarang completed which 

7 This phenomenon is referred to as “radiation fibrosis syndrome,” or “RFS.” 

8

“Approximately 30-40% of cancer patients experience some form of neuropathy during or after chemotherapy 

treatment.” https://www.mdanderson.org/patients-family/diagnosis-treatment/emotional-physical-effects/peripheralneuropathy.html#:~:text=Chemotherapy%3A%20Chemotherapy%20can%20also%20cause,cause%20damage%20to

%20nearby%20nerves.

Case 1:22-cv-01497-TLN-GSA Document 16 Filed 09/09/24 Page 11 of 18
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

12

identified a less than sedentary exertional capacity, as well as a 2021 letter reiterating similar 

limitations secondary to chemotherapy induced neuropathy, along with radiation induced pelvic 

scar tissue and muscle tears. AR 780–87. However, the ALJ gave this little weight as “they refer 

to conditions after the date last insured including gluteal muscle tears identified in February 2020 

(25F/3; 30F/2).” In any event, this only addresses the timing of the muscle tear, not the chemoinduced neuropathy. 

Further, the fact that the gluteal muscle tear was not confirmed by MRI until February 2020 

does not mean that the condition arose after the date last insured in July 2019. To the contrary, Dr. 

Sarang attributed the injury to radiation therapy. The radiation and chemotherapy concluded in

2015, thus the ALJ’s suggestion that Plaintiff’s chemo-induced neuropathy and radiation induced 

muscle tears post-dated the June 2020 DLI is not compelling. 

The ALJ also found the opinion inconsistent with Dr. Sarang’s “good stable findings,” 

which is somewhat ambiguous. AR 21 (citing (e.g. 25F/5; 42F/25)). Specifically, the first of the 

cited examinations purportedly demonstrating “good stable findings” in fact notesseveral abnormal

findings, including: 1- “right gluteus TTP with dec. ability to flexion,” (musculoskeletal); 2- “fine 

motor decrease bl, with difficulty buttoning,” (neurological); 3- “gait normal but coordination with 

tandem poor” (neurological); and 4- “dec. vibratory sensation of tip of fingers and toes” 

(neurological). AR 778. These would seem to be precisely the types of findings that would 

corroborate the radiation induced gluteal muscle tears and chemo-induced peripheral neuropathy. 

Returning for a moment to the July 2019 consultative examination, as quoted above in 

relation to the disabled parking placard application, the ALJ found Dr. Sarang’s statements therein 

“inconsistent with other evidence including the July 2019 consultative examination where the 

claimant was noted to have an unremarkable gait and generally good range of motion of all major 

joints (18F/4-5).” AR 20. Yet the consultative examiner noted similar findings that Dr. Sarang 

Case 1:22-cv-01497-TLN-GSA Document 16 Filed 09/09/24 Page 12 of 18
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

13

noted in the examination described above, including decrease muscle strength in the right hip of 

4/5 in flexion and extension, as well as decreased pinprick sensation in the hands and feet. AR 713. 

These findings, though few in number and perhaps not extremely abnormal, are nevertheless

reasonably specific in terms of corroborating radiation induced damage to the muscles of the right 

hip and chemo-induced peripheral neuropathy, lending further support to Dr. Sarang’s opinion as 

to the source of Plaintiff’s ongoing limitations despite lymphoma remission. 

Finally, the ALJ reiterates that Dr. Sarang’s opinions are inconsistent with Plaintiff’s ability 

to fly internationally, drive two hours to psychotherapy, and “providing care for her son.” The first 

two of these have already been addressed above, and “providing care for her son” is non-specific.

In sum, the ALJ’s basis for rejecting Dr. Sarang’s opinions was not specific and legitimate.

Next, the ALJ addressed the opinion of the oncologist, noting as follows:

In January 2019, Christoph Renner, MD, the claimant’s oncologist in Switzerland, 

completed an opinion questionnaire stating the claimant was limited to less than 

sedentary work, including sitting and standing/walking limited to less than 2 hours 

total, sedentary-to-light lifting, and more than 4 estimated absences per month 

(11F/7-10). In February 2019, Dr. Renner also wrote the claimant was “mostly 

hampered by pain and fatigue” (12F/3). However, there are no contemporaneous 

treatment records for either of these opinions. The most recent treatment note prior 

to these opinions was in July 2018. At that time, Dr. Renner noted the claimant’s 

neurological examination was inconspicuous, and there was no indication of active 

lymphoma (8F/4). Similar good stable findings were noted at Dr. Renner’s next 

treatment note in July 2019 (43F/38). As such the limitations are not supported by 

Dr. Renner’s records. Likewise, these extreme limitations are also inconsistent with 

good stable clinical findings in Dr. Sarang’s records (25F/5; 42F/25), and the 

claimant’s actual functioning including the previously noted traveling abroad, 

providing care for her son, and driving 2 hours to Los Angeles by herself (3F/10, 

13, 20; 14F/5; 18F/2). As such, the undersigned gives Dr. Renner’s opinions little 

weight.

Other than noting the presence of an inoperable residual mass (AR 669), which lends some 

support for residual pelvic pain, Dr. Renner’s opinion concerning Plaintiff’s physical limitations 

was admittedly not supported by his findings. But as an oncologist concerned with monitoring 

clinical and laboratory signs of lymphoma, Dr. Renner arguably would not make the types of 

Case 1:22-cv-01497-TLN-GSA Document 16 Filed 09/09/24 Page 13 of 18
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

14

detailed physical examination findings that would support or detract from the existence of residual 

pelvic pain and neuropathy as opined by Dr. Sarang. The physical examination notes spanned three 

lines of text, and his notes suggest that he deferred to Dr. Sarang concerning residual pain and 

neuropathy. See AR 648 (“Pain management and neuropathy: Per Dr. Sarang, patient can no longer 

tolerate NSAIDs, To reduce the reliance on pain medication, exercise 1-4/week as prescribed by 

physical therapist, Peripheral neuropathy in fingertips and toes but this has been reduced by 

Cymbalta . . . ).

B. Subjective Complaints

1, Applicable Law

An ALJ performs a two-step analysis to determine whether a claimant’s testimony regarding 

subjective pain or symptoms is credible. See Garrison v. Colvin, 759 F.3d 995, 1014 (9th Cir. 

2014); Smolen, 80 F.3d at 1281; S.S.R 16-3p at 3. First, the claimant must produce objective 

medical evidence of an impairment that could reasonably be expected to produce some degree of 

the symptom or pain alleged. Garrison, 759 F.3d at 1014; Smolen, 80 F.3d at 1281–82. If the 

claimant satisfies the first step and there is no evidence of malingering, the ALJ must “evaluate the 

intensity and persistence of [the claimant’s] symptoms to determine the extent to which the 

symptoms limit an individual’s ability to perform work-related activities.” S.S.R. 16-3p at 2. 

An ALJ’s evaluation of a claimant’s testimony must be supported by specific, clear and 

convincing reasons. Burrell v. Colvin, 775 F.3d 1133, 1136 (9th Cir. 2014); see also S.S.R. 16-3p 

at *10. Subjective testimony “cannot be rejected on the sole ground that it is not fully corroborated 

by objective medical evidence,” but the medical evidence “is still a relevant factor in determining 

the severity of claimant’s pain and its disabling effects.” Rollins v. Massanari, 261 F.3d 853, 857 

(9th Cir. 2001); S.S.R. 16-3p (citing 20 C.F.R. § 404.1529(c)(2)). 

As the Ninth Circuit recently clarified in Ferguson, Although an ALJ may use “inconsistent

Case 1:22-cv-01497-TLN-GSA Document 16 Filed 09/09/24 Page 14 of 18
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

15

objective medical evidence in the record to discount subjective symptom testimony,” the ALJ 

“cannot effectively render a claimant's subjective symptom testimony superfluous by demanding 

positive objective medical evidence fully corroborating every allegation within the subjective 

testimony.” Ferguson v. O'Malley, 95 F.4th 1194, 1200 (9th Cir. 2024) (emphasis in original).

In addition to the objective evidence, the other factors considered are: 1) daily activities; 2) 

the location, duration, frequency, and intensity of pain or other symptoms; 3) precipitating and 

aggravating factors; 4) the type, dosage, effectiveness, and side effects of any medication; 5) 

treatment other than medication; 6) other measures the claimant uses to relieve pain or other 

symptom; 7)) Other factors concerning the claimant’s functional limitations and restrictions due to 

pain or other symptoms. 20 C.F.R. § 416.929(c)(3).

2. Analysis

There are few novel issues to address here that are not subsumed in the above analysis. 

Plaintiff explains that “Ms. Lutz’s testimony in the record supports several subjective symptoms 

and pain. [AR at 137.].” MSJ at 14. Plaintiff cites to a summary of the testimony drafted by a 

disability hearing officer in a decision dated July 30, 2019, rather than the testimony itself. It 

reflects that Plaintiff reported similar limitations as opined by Dr. Sarang, including the ability to 

stand/walk between 30 minutes and 3 hours, and inability to sit for prolonged periods due to pelvic 

pain caused by the residual mass pressing on her sciatic nerve--a similar but subtly distinct 

mechanism of injury compared with Dr. Sarang’s explanation concerning radiation induced scar 

tissue and muscle tears. In any case, it is relatively consistent with her claim concerning debilitating

residual pelvic pain.

Any additional reasoning articulated by the ALJ not already discussed and refuted above 

will be considered to the extent it would apply equally to the ALJ’s analysis of Dr. Sarang’s opinion. 

The reasoning highlighted by Defendant and/or the ALJ is limited to: 1- Plaintiff’s ability to go 

Case 1:22-cv-01497-TLN-GSA Document 16 Filed 09/09/24 Page 15 of 18
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

16

swimming (AR 580); 2- improvement in pain and neuropathy symptoms with Cymbalta (AR 648) 

and Ketamine injections (AR 569, 598, 1178, 1189); 3- Dr. Sarang’s April 2018 examination 

showing no edema, no muscle tenderness, normal hip range of motion and negative straight leg 

raising (AR 585); and 4- Plaintiff’s last examination with Dr. Sarang, in December 2018, before 

her insured status expired, was normal and she reported no muscle aches or numbness (AR 1133).

As for swimming, it is a non-weight bearing activity which mimics neither sitting, standing, 

nor walking, and does not by its nature lend much weight or support to Defendant’s argument. 

Non-specific “improvement” in neuropathy symptoms with Cymbalta (AR 648) is not

inconsistent with Plaintiff’s alleged limitations. Importantly, this is not a case where the ALJ 

assessed an RFC accounting for some significant pain and limitation and where the claimant argues 

a more restrictive RFC was warranted. Rather, the ALJ never reached the RFC stage when finding 

the lymphoma did not meet a listing-- most notably that Plaintiff had no other severe impairments 

which more than minimally impacted her ability to perform work functions. AR 18, The alleged 

pain and limitation as described by Plaintiff and Dr. Sarang could easily meet the step-two severity

threshold despite the non-specific improvement with medication. See Smolen, 80 F.3d at 1290 

(noting the step-two severity threshold is not high, but is a “de minimis screening device to dispose 

of groundless claims.”).

With respect to improved pain levels following Ketamine injections (AR 569, 598, 1178, 

1189), one could equally apply the ALJ’s reasoning for discounting evidence suggestive of 

limitations which either: 1- predated the July 1, 2018 disability cessation date, a period of time for 

which Plaintiff was already paid benefits, or 2- post-dated the July 30, 2019 date last insured, a 

period of time for which Plaintiff would be ineligible for benefits. Likewise, the notes dated 

November 8, 2017 (AR 598), December 14, 2017 (AR 569), January 15, 2020 (AR 1178), and 

October 6, 2020 (AR 1189) all reflected improved pain levels following Ketamine injections prior 

Case 1:22-cv-01497-TLN-GSA Document 16 Filed 09/09/24 Page 16 of 18
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

17

to the disability cessation date or after the date last insured, and thus would be of limited relevance 

to Plaintiff’s level of pain and limitation during the period under review. The same would also

apply to Dr. Sarang’s April 2018 examination showing no edema, no muscle tenderness, normal 

hip range of motion and negative straight leg raise (AR 585).

Finally, Defendant emphasizes that Plaintiff’s last examination with Dr. Sarang in 

December 2018, before her insured status expired, was normal and that she reported no muscle 

aches or numbness (AR 1133). However, the visit appears to be primarily for a chief complaint of 

left elbow pain which resulted in a diagnosis of lateral epicondylitis followed by an injection at that 

site. The musculoskeletal findings would most naturally be understood to apply to the left elbow 

in question and not to refute the existence of pelvic pain. Further, the commentary about no muscle 

aches or numbness appears related to Plaintiff’s minor child’s upper respiratory infection (“URI”),

or perhaps a URI she caught from him, both of which would be equally irrelevant. AR 1133. 

In sum, the ALJ’s analysis of Plaintiff’s testimony did not add persuasiveness to the 

discussion.

VII. Findings

Substantial evidence and applicable law do not support the ALJ’s decision that Plaintiff was 

not disabled. Remand is appropriate for the ALJ to conduct a new hearing and issue a new decision: 

1- applying the correct legal standard from the pre-March 27, 2017 regulations and associated 

“treating physician rule” referenced at 20 C.F.R. § 404.1527(c)(2), 2- reconsideration of Dr. 

Sarang’s opinions and Plaintiff’s subjective statements concerning her residual/inoperable pelvic 

mass compressing her sciatic nerve, radiation induced pelvic scarring and muscle tears, 

chemotherapy induced peripheral neuropathy, and associated pain and limitation.

VIII. Recommendations

For the reasons stated above, the recommendation is as follows:

Case 1:22-cv-01497-TLN-GSA Document 16 Filed 09/09/24 Page 17 of 18
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

18

1. That Plaintiff’s motion for summary judgment (Doc. 7) be GRANTED.

2. That Defendant’s cross-motion (Doc. 10) be DENIED.

3. That the matter be remanded to the Commissioner of Social Security pursuant to 

sentence four of 42 U.S.C. § 405(g) for further proceedings consistent with the 

Findings and Recommendations.

4. That the Court Clerk of Court be directed to enter judgment in favor of Plaintiff

Catherine Ann Lutz and against Defendant Commissioner of Social Security. 

IX. Objections Due Within 14 Days

These Findings and Recommendations will be submitted to the United States District Judge 

assigned to the case, pursuant to the provisions of Title 28 U.S.C. § 636(b)(l). Within fourteen (14) 

days after being served with these Findings and Recommendations, any party may file written 

objections with the Court. The document should be captioned “Objections to Magistrate Judge’s 

Findings and Recommendations.” The parties are advised that failure to file objections within the 

specified time may result in the waiver of rights on appeal. Wilkerson v. Wheeler, 772 F.3d 834, 

838-39 (9th Cir. 2014) (citing Baxter v. Sullivan, 923 F.2d 1391, 1394 (9th Cir. 1991)).

IT IS SO ORDERED.

Dated: September 9, 2024 /s/ Gary S. Austin 

 UNITED STATES MAGISTRATE JUDGE

Case 1:22-cv-01497-TLN-GSA Document 16 Filed 09/09/24 Page 18 of 18