Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-4_13-cv-01098/USCOURTS-azd-4_13-cv-01098-1/pdf.json

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

---

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

WO

UNITED STATES DISTRICT COURT

DISTRICT OF ARIZONA

Holly M. Beck,

Plaintiff,

v.

Carolyn W. Colvin, Acting Commissioner of the

Social Security Administration, 

Defendant, _______________________________________

)

)

)

)

)

)

)

)

)

)

)

CV 13-1098 TUC DCB

O R D E R

On August 18, 2014, Magistrate Judge Markovich issued a Report and Recommendation

(R&R), pursuant to the Rules of Practice for the United States District Court, District of Arizona

(LRCiv), Rule 72.1(a). (Doc. 19: R&R.) He recommends affirming the denial of disability

benefits by an administrative law judge (ALJ). The Court does not adopt the R&R. The Court

remands the case to the Social Security Commissioner for further hearing and development of

the record. 

STANDARD OF REVIEW

The duties of the district court, when reviewing a R&R by a Magistrate Judge, are set

forth in Rule 72 of the Federal Rules of Civil Procedure and 28 U.S.C. § 636(b)(1). The district

court may “accept, reject, or modify, in whole or in part, the findings or recommendations made

by the magistrate judge.” Fed.R.Civ.P. 72(b), 28 U.S.C. § 636(b)(1). 

Pursuant to 28 U.S.C. § 636(b), this Court makes a de novo determination as to those

portions of the R&R to which there are objections. 28 U.S.C. § 636(b)(1) ("A judge of the court

shall make a de novo determination of those portions of the report or specified proposed

findings and recommendations to which objection is made.") To the extent that no objection

has been made, arguments to the contrary have been waived. McCall v. Andrus, 628 F.2d 1185,

Case 4:13-cv-01098-DCB Document 22 Filed 09/30/14 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 -

1187 (9th Cir. 1980) (failure to object to Magistrate's report waives right to do so on appeal); see

also, Advisory Committee Notes to Fed. R. Civ. P. 72 (citing Campbell v. United States Dist.

Court, 501 F.2d 196, 206 (9th Cir. 1974) (when no timely objection is filed, the court need only

satisfy itself that there is no clear error on the face of the record in order to accept the

recommendation). But even where there are no objections, the Court nevertheless reviews at

a minimum, de novo, the Magistrate Judge’s conclusions of law. Robbins v. Carey, 481 F.3d

1143, 1147 (9th Cir. 2007) (citing Turner v. Duncan, 158 F.3d 449, 455 (9th Cir. 1998)

(conclusions of law by a magistrate judge reviewed de novo); Martinez v. Ylst, 951 F.2d 1153,

1156 (9th Cir. 1991) (failure to object standing alone will not ordinarily waive question of law,

but is a factor in considering the propriety of finding waiver)). 

REPORT AND RECOMMENDATION

The Magistrate Judge recommends the Court affirm the ALJ’s determination that the

Plaintiff was not credible, and she had the residual functional capacity (RFC) to perform

sedentary work as she had performed it in her past work as a dispatcher and as performed,

generally, in the national economy. Because the ALJ found she could perform her past work

which was sedentary, the ALJ found she was not disabled. The Magistrate Judge found no legal

error in the ALJ’s credibility determination and that substantial evidence exists in the record to

support the ALJ’s disability decision.

By objection, the Plaintiff challenges the R&R because: 1) the Magistrate Judge

recommendation affirms the ALJ’s RFC that omitted Plaintiff’s need for a cane; 2) the

Magistrate Judge presupposed the ALJ adequately developed the record; 3) the Magistrate

Judge made an error of law in assessing the duration requirement for determining disability,

especially in respect to Plaintiff’s assertions of disability related to severe osteoarthritis in her

hips.

This Court reviews an ALJ’s disability determination based only on the reasons provided

by the ALJ and may not affirm the ALJ on a ground upon which he did not rely. Garrison v.

Colvin, ___ F.3d ___, 2014 WL 3397218 *11 (9th Cir. July 14, 2014) (citing Connett v.

Barnhart, 340 F.3d 871, 874 (9th cir. 2003). Accordingly, this Court turns directly to the ALJ’s

Case 4:13-cv-01098-DCB Document 22 Filed 09/30/14 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

 1The ALJ’s decision became the Commissioner’s final decision on August 6, 2013, when the

Appeals Council denied Beck’s request for review.

- 3 -

decision issued June 21, 2012. The Court recaps the record in summary fashion to reflect an

overview of Plaintiff’s medical conditions spanning what is approximately 5 years: 2008

through 2012. 

THE ALJ’S DECISION

Plaintiff’s date of last employment was December 4, 2008, the alleged onset date of

disability due to breast cancer, kidney problems and a total hysterectomy. Plaintiff filed her

claim of disability for both Supplemental Security Income (SSI) and Disability Insurance

Benefits (DIB) on October 15, 2010. She had collected unemployment benefits from her

termination, December 4, 2008, to approximately October 2010. On March 23, 2011, she was

initially denied disability due to breast cancer, kidney and total hysterotomy because she was

found to not have a severe disability precluding her from working. She filed for reconsideration

on June 30, 2011, and on September 15, 2011, she was denied disability due to these same

impairments, plus bilateral hip arthritis, because she could perform sedentary work. The

hearing before the ALJ was held on May 31, 2012, with the decision issued June 21, 2012.1

 For

purposes of DIB, she met the insured status requirements for receiving benefits through June

30, 2013.

Under the Social Security Act, “disability” is the inability to engage “in 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 U.S.C. § 1382c(a)(3)(A). A claimant “shall be

determined to be under 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).

Case 4:13-cv-01098-DCB Document 22 Filed 09/30/14 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 -

The Court has the power to enter 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). However, an ALJ's disability determination should be upheld

unless it contains legal error or is not supported by substantial evidence. Stout v. Comm'r, Soc.

Sec. Admin., 454 F.3d 1050, 1052 (9th Cir.2006); 42 U.S.C. §§ 405(g), 1383(c)(3). “‘Substantial

evidence’ means more than a mere scintilla, but less than a preponderance; it is such relevant

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

v. Astrue, 504 F.3d 1028, 1035 (9th Cir.2007). The Court must consider the entire record as a

whole, weighing both the evidence that supports and the evidence that detracts from the

Commissioner's conclusion, and may not affirm simply by cherry picking a quantum of

supporting evidence. Id.

Of importance, here, is the ALJ’s responsibility to determine credibility, resolve conflicts

in medical testimony, and resolve ambiguities. Andrews v. Shalala, 53 F.3d 1035, 1039

(9thCir.1995). Where the evidence can reasonably support either affirming or reversing a

decision, the Court may not substitute its judgment for that of the ALJ. Id. However,

adjudicating social security claims diverges from the adversary model by making the ALJ

responsible for developing sufficient medical evidence about an impairment to make a

determination of disability. 20 C.F.R. § 416.917(a). “‘It is reversible error for an ALJ not to

order a consultative examination when such an evaluation is necessary for him to make an

informed decision.” Holladay v. Bowen, 848 F.2d 1206, 1209 (9th Cir. 1988) (quoting Reeves

v. Heckler, 734 F.2d 519, 522 n. 1 (11th Cir. 1984) (further citations omitted). With these

standards in mind the Court turns to the reasons provided by the ALJ in the disability

determination.

At step one of the five-step disability determination, the ALJ concluded the Plaintiff had

not engaged in substantial gainful activity since the alleged onset of her disability in 2008. At

step two, the ALJ concluded that Plaintiff established that her obesity, diabetes; hypertension;

Meniere’s disease; osteoarthritis, and asthma were all severe impairments because these

impairments result in more than a minimal impact on her ability to perform basic work

Case 4:13-cv-01098-DCB Document 22 Filed 09/30/14 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 -

activities. The ALJ recognized that because Plaintiff had a severe medically determinable

impairment, “all medically determinable impairments must be considered in the remaining steps

of the sequential analysis.” See 42 U.S.C. § 423(d)(2)(B). These included: history of breast

cancer, left-sided sensorineural hearing loss, post-hernia surgery and chronic Stage III kidney

disease. (P’s Opening Brief (Doc. 13) at 6.) At step three, the ALJ concluded that none of

Plaintiff’s impairments met or equaled a listed impairment which would require an automatic

finding of disability. At step four, the ALJ concluded that given all Plaintiff’s impairments, her

RFC did not prevent her from performing sedentary work, that her past work as a dispatcher was

sedentary work and, therefore, Plaintiff was not disabled.

Plaintiff’s burden of proof to establish a prima facia case of disability, means that at step

four in the disability determination process she must show impairments which prevent her from

doing former work. Gamer v. Secretary of Health & Human Services, 815 F.2d 1275, 1278 (9th

Cir. 1987) (citing Gallant v. Heckler, 753 F.2d 1450, 1452 (9th Cir. 1987). Because the ALJ

found Plaintiff could perform her past work, Plaintiff was found not disabled at step four. It

is at step five, that the burden shifts to the Commissioner to establish that the Plaintiff is not

disabled, Fife v. Heckler, 767 F.2d 1427 (9th Cir. 1985), by showing, based on the claimant's

residual functional capacity, age, education, and past work experience, that Plaintiff can do

other work. Smolen v. Chater, 80 F.3d 1273, 1291 (9th Cir. 1996) (citing Bowen v. Yuckert, 482

U.S. 137, 142 (1987); 20 C.F.R. § 404.1520(f)). Here, the burden never shifted to the

Commissioner and remains on the Plaintiff to establish her disability at step four.

The ALJ concluded that the Plaintiff had medically determinable impairments that could

reasonably be expected to cause the alleged symptoms, but not to the extent of intensity,

persistence and limiting effects claimed by the Plaintiff. She testified at her hearing on May 31,

2012, that she is able to handle her personal care; she does some household chores; she does not

cook or go shopping; she does not exercise; she can ride in a car for 25 to 60 minutes; she can

walk or stand for 15 minutes; sitting hurts due to arthritis and hip replacements; she can lift five

to ten pounds; she has constant arthritis in her fingers, and she has difficulty breathing and being

tired. (AR at 54-72.) Plaintiff submitted a Medical Source Statement completed on April 30,

Case 4:13-cv-01098-DCB Document 22 Filed 09/30/14 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

 2Shortness of breadth: also referred to in medical notes as SOB and dyspnea, which is the

feeling associated with shortness of breadth.

- 6 -

2012, which reflected that her impairment related to “hip pain/arthritic hips” had lasted or was

expected to last at least 12 months and that due to having good days and bad days, Plaintiff

would likely be absent from work about four days a month or more than four days. (AR at 701-

704.) Both the hearing testimony and the Medical Source Statement reflected the Plaintiff

needed a cane. (AR at 70; AR at 703.) 

The ALJ rejected Plaintiff’s assertions of functional limitations as follows: 1) breast

cancer: there was no objective medical record of ongoing breast pain reported to her medical

providers; 2) hysterectomy and hernia repair were successfully performed with no objective

medical evidence of ongoing complaints to her medical provider; 3) cardiac evaluation for

shortness of breath indicated dyspnea2

 was possibly related to obesity, but claimant chose not

to pursue any medical course to loose weight; 4) hip pain resolved by surgeries and no evidence

of a cane being medically required by any physician; 5) no objective medical evidence of

constant arthritic pain and limited daily activities; 6) shortness of breath and level of effort was

questionable for physical therapist’s evaluation; 7) the Plaintiff had asserted she could work

when filing for unemployment benefits from 2008 through October 2010; 8) the weight given

to the Medical Source Statement by Plaintiff’s doctor was reduced because it was not made by

her regular doctor and was qualified as being based on patient’s self-reporting; 9) substantial

weight was given to State-agency medical consultant’s opinion. 

Based on the State-agency medical consultant’s opinion issued September 15, 2011, the

ALJ found the Plaintiff was not credible in regard to her functional capacity, and he assessed

her RFC for an 8-hour work day to be: sit 6 hours; stand 2 hours; walk 2 hours; occasionally lift

and carry 10 pounds; frequently lift and carry less than 10 pounds; occasionally climb stairs;

never climb ladders; occasionally balance; frequently stoop; occasionally kneel and crouch;

never crawl; she should avoid moderate exposure to heights and moving machinery; avoid

concentrated exposer to dust, fumes and smoke and temperature extremes. (AR at 97-98.) And,

there was no medical need for a cane. The ALJ’s RFC resulted in a finding that the Plaintiff

Case 4:13-cv-01098-DCB Document 22 Filed 09/30/14 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 -

could perform a wide array of sedentary jobs, which included the type of job she had previously

performed when she was a dispatcher for a limousine company from 1997 to1998.

1. The ALJ failed to offer specific, clear and convincing reasons for rejecting claimant’s

testimony about the severity of her symptoms.

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

affirm such a determination unless it is supported by specific findings and reasoning.’” (R&R

(Doc. 19) at 16) (quoting Robbins v. Comm’r Soc. Sec. Admin., 466 F.3d 880, 885 (9th Cir.

2006)). “‘To determine whether a claimant’s testimony regarding subjective pain or symptoms

is credible, an ALJ must engage in a two-step analysis.’” Id. (quoting Ligenfelter v. Astrue, 504

F.3d 1028, 1035-36 (9th Cir. 2007). “‘First, the ALJ must determine whether the claimant has

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

expected to produce the pain or other symptoms alleged.’” Id. (quoting Ligenfelter, 504 F. 3d

at 1036 (quoting Bunnell v. Sullivan, 947 F. 2d 341, 344 (9th Cir. 1991)). She is not required

to show her impairment could reasonably be expected to cause the severity of the symptom she

has alleged; she need only show that the impairment could reasonably have caused some degree

of symptom. Smolen, 80 F.3d at 1282. “‘Second, if the claimant meets this first test and there

is no evidence of malingering, ‘the ALJ can reject the claimant’s testimony about the severity

of the symptoms only by offering specific, clear and convincing reasons for doing so.’” Id.

(quoting Lingenfelter, 504 F.3d at 1036 (quoting Smolen, 80 F.3d at 1282 (9th Cir. 1996)).

“The clear and convincing standard is the most demanding required in Social Security cases.”

Moore v. Comm’r of Soc. Sec. Admin., 278 F.3d 920, 924 (9th Cir. 2002).

Here, the ALJ determined the Plaintiff’s objective medical record satisfied the first step

in assessing credibility. Only the second step is at issue: whether there is clear and convincing

evidence that she overstated the severity of her symptoms and their functional effect. An ALJ

may not disregard Plaintiff’s asserted severity of symptoms solely because it is not substantiated

affirmatively by objective medical evidence. (R&R (Doc. 19) at 16-17) (citing Bunnell v.

Sullivan, 947 F.2d 341, 346-47 (9th Cir. 1991); Robbins, 466 F.3d at 887 (citing SSR 96-7p,

Case 4:13-cv-01098-DCB Document 22 Filed 09/30/14 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 -

1996 WL 374186 at *1; Light v. Soc. Sec. Admin., 119 F.3d 789m 792 (9th Cir. 1997)) (emphasis

added). 

At step two, the ALJ may consider the objective medical evidence, the claimant's daily

activities, the location, duration, frequency, and intensity of the claimant's pain or other

symptoms, precipitating and aggravating factors, medication taken, and treatments for relief of

pain or other symptoms. See 20 C.F.R. § 404.1529(c); SSR 96–7p at 3; Bunnell, 947 F.2d at

346. Other “‘[f]actors that an ALJ may consider in weighing a claimant’s credibility include

reputation for truthfulness, inconsistencies in testimony or between testimony and conduct, daily

activities, and unexplained, or inadequately explained, failure to seek treatment or follow a

prescribed course of treatment.’” (R&R (Doc. 19) at 17) (quoting Orn v. Astrue, 495 F.3d 625,

636 (9th Cir. 2007).

So, rejecting a claimant's testimony because it was “not consistent with or supported by

the overall medical evidence of record” is the type of justification the Ninth Circuit has

recognized as prohibited by the social security regulations, Robbins, 466 F.3d at 884 (citing

SSR 96–7p); Light v. Soc. Sec. Admin., 119 F.3d 789, 792 (9th Cir.1997), but “[c]ontradiction

with the medical record is a sufficient basis for rejecting the claimant's subjective testimony,”

See Carmickle v. Comm'r of Soc. Sec. Admin., 533 F.3d 1155, 1161 (9th Cir.2008) (citing

Johnson v. Shalala, 60 F.3d 1428, 1434 (9th Cir.1995) (ALJ must adequately discuss the

medical record and identify contradictions between claimant’s testimony and medical evidence).

In short, it is not enough for the ALJ to provide a lengthy summary of the medical evidence; the

ALJ must identify any contradictions between Plaintiff’s testimony and this medical evidence.

The ALJ needs to state what symptom or limitation testimony he finds not credible and what

facts in the record lead to that conclusion. Smolen, 80 F.3d at 1284. To be clear and

convincing, there must be something more or in addition to a lack of objective medical

evidence.

The Plaintiff does not object to the ALJ’s conclusion that by the end of 2009, Plaintiff

had been successfully treated and recovered from breast cancer that required a mastectomy and

radiation; menorrhagia that required an hysterectomy, and a urological problem that required

Case 4:13-cv-01098-DCB Document 22 Filed 09/30/14 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 -

the removal of one kidney. Plaintiff had no residual effects from these conditions, with the

exception of her chronic stage III renal condition. Plaintiff alleged an onset date of December

4, 2008, the date of her last employment. The first surgery, the mastectomy, occurred February

2009 and the last surgery, the nephrectomy, was September 2009, with Plaintiff being fully

recovered from the surgery by January 20, 2010. (AR at 310.) It is undisputed that subsequent

to the removal of her one kidney, the Plaintiff suffers from chronic Stage III kidney disease. 

The ALJ found the Plaintiff was not credible because she asserted she was disabled

during this time period when she was collecting unemployment from December 2008 through

October 2010. Plaintiff’s application for disability was filed October 15, 2010, at which time

she asserted she was disabled due to “cancer, kidney, and hysterotomy.” By December, 2010,

she reported: she did not do much of anything, get dressed, wash, husband cooks, walks dog

short distance two times a day, sometimes visits friends, watches T.V. She reported whenever

she walked for more than a few feet she has shortness of breath, pain in both legs most of the

time; she could walk 50 yards in 4 minutes; lift and carry 5 lbs, 5 to 6 times a day; she does not

clean the house, cook, or do laundry, yard work, or other household chores. She reported using

a cane for all walking for one-year. (AR at 186-188.) 

Receiving unemployment benefits after the alleged onset date of disability can be

considered by an ALJ to cast doubt on Plaintiff’s credibility because it shows she has held

herself out as capable of working. Carmickle v. Commissioner, Soc. Security, 533 F.3d 1155,

1661-62 (9th Cir. 2008); Copeland v. Bowen, 861 F.2d 536, 542 (9th Cir.1988). But, the two are

not necessarily inconsistent. Cf. Cleveland v. Policy Management Systems Corp., 526 U.S. 795

(1999) (finding social security disability benefits often consistent with claim for relief under the

ADA even though there must be an ability to work to obtain relief under the ADA). “It is the

underlying circumstances that will be of greater relevance than the mere application for and

receipt of the benefits.” (Reply (Doc. 17), Ex. A: August 9, 2010 Soc. Sec. Memo to ALJs.)

The ALJ did not consider the Plaintiff’s circumstances which involved one severe impairment

followed unexpectedly on the heels of the other. Upon termination of her employment,

December 4, 2008, Plaintiff could not have known what lay ahead in terms of her medical

Case 4:13-cv-01098-DCB Document 22 Filed 09/30/14 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 -

conditions: first breast cancer and chemotherapy to be followed by a full hysterectomy, and then

the need to remove one kidney. Plaintiff’s hindsight claim, made October 15, 2010, for a

disability period beginning December 4, 2008, must be evaluated in light of the medical record

reflecting one severe impairment after another. 

Plaintiff received her primary care at the Freedom Park Health Center from Dr. Laurie

Miller and Vickie Clous, Family Nurse Practitioner (FNP). She was also seen by a cardiologist,

Dr. Marshall, a urologist, Dr. Jan, a pulmonologist, Dr. Engelsberg, an orthopedist, Dr.

Robertson, and a surgeon, who performed a hernia operation.

July 12, 2010, Plaintiff saw the cardiologist related to shortness of breath while walking

the dog. He found no obstructive coronary artery disease or structural heart disease. According

to the ALJ, “cardiac evaluation in June 2010 for shortness of breath indicated that dyspnea was

possibly related to obesity. However, the claimant chose not to pursue any medical course to

lose weight.” (AR at 28.) The Court has reviewed FNP Clous’ record from June 14, 2010 and

the cardiologist records for June 7 and July 12 and cannot find the reference relied on by the

ALJ. Even if such a reference existed, in the case of obesity, it is not legitimate to find a lack

of credibility based on a failure to follow even a prescribed treatment for obesity. Orn, 495 F.3d

at 637. Even when the medical record suggests a patient was advised to lose weight or even

prescribed weight loss treatment, a finding of “failure to follow prescribed treatment” would be

inappropriate unless the record also suggests that there was any chance of such a prescription

succeeding in eliminating or ameliorating Plaintiff’s obesity, let alone “clear evidence” that the

treatment would be successful. Id. The ALJ did not consider whether the “medical

recommendation” to lose weight stood any chance of succeeding in treating Plaintiff’s obesity

or any other condition, including any cardiological problem or shortness of breath with exertion.

One year after her appointment with the cardiologist for shortness of breath, on June 15,

2011, Plaintiff was referred to a pulmonary specialist. She described her exertional dyspnea as

getting worse over the approximate past year. She was at a point where she could not walk one

block or do housework without getting short of breath. The doctor’s impression was: possible

Case 4:13-cv-01098-DCB Document 22 Filed 09/30/14 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 -

asthma. Approximately a month later, the doctor, David A. Engelsberg, M.D., Pulmonary

Consultant, described her as breathing well and using Symbicort, asthma stable.

June 16, 2011, Plaintiff saw Dr. Robertson at Tucson Orthopaedic for a consult for pain

in both hips, with significant problem rolling over in bed and walking for any length of time.

She reported she had had significant hip and groin pain for approximately 4 to 6 months:

January or March 2011. Radiography revealed “advanced osteoarthritis of both hips.” Upon

examination, wherein she had no difficulty getting up on the examining table, the doctor found

definite pain on log rolling of the Right hip and some pain on log rolling of the Left hip.

Flexion and rotation was particularly painful on the Right hip. The doctor’s assessment was

severe osteoarthritis of both hips. He advised total hip arthroplasty of both hips, which would

follow a prescheduled hernia surgery. 

In August 2011, Plaintiff had hernia surgery, and subsequently was hospitalized on

August 9, 2011, through August 14, 2011 for acute renal failure. By September 8, 2011, she

appears to have recovered from the episode of renal failure and would fully recover from the

hernia surgery so she could undergo Right hip surgery December, 2011, and Left hip surgery

in January or February, 2012.

Simply looking at the chronology of surgeries in 2011, Plaintiff was either undergoing

surgery or recovering from a surgical procedure from August 2011 until January or February

of 2012. The June 16, 2011, medical record from Dr. Robertson at Tucson Orthopaedic notes

that Plaintiff reported to him that she had had significant hip and groin pain for approximately

4 to 6 months, which might place the onset for what Dr Robertson described as “advanced

osteoarthritis of both hips” to be January 2011. If so, impairment due to Plaintiff’s osteoarthritic

hips, in combination with her 2011 hernia surgery, renal failure, and end-of-the year hip

surgeries, might have resulted in an inability to work for a period of at least 12 months. But,

the ALJ failed to determine an onset date for the osteoarthritis of her hips because he found it

resolved by surgery. It appears the ALJ relied on this same conclusion made by the StateCase 4:13-cv-01098-DCB Document 22 Filed 09/30/14 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

 3The ALJ failed to specify that this conclusion was based on the State-agency physician’s

opinion, but there exists no other foundation for it.

- 12 -

agency physician,3 who’s opinion was issued September 15, 2011, prior to Plaintiff undergoing

either of the hip replacement surgeries.

The ALJ found: “Bilateral hip pain has been addressed with surgery. Medical record of

these surgeries was not provided at the hearing level. Although the claimant uses a single point

cane, there is no evidence that this is medically required or was prescribed by a physician.”

(AR at 29.) There is no requirement that a cane be prescribed by a doctor to be considered a

necessary assistive device, and an ALJ does not need to make an express finding of medical

necessity in all cases in which a claimant uses a cane. Plaintiff’s use of a cane, without a

medical prescription or directive, does not make Plaintiff’s credibility suspect. See Cf. Parker

v. Astrue, 597 F.3d 920, 922 (7th Cir. 2010) (finding it absurd the ALJ thought claimant’s use

of a cane without prescription was suspicious when prescription was not required to use a cane).

So for purposes of assessing credibility in respect to her using a cane, the ALJ should have

considered that Plaintiff suffered from Meniere’s disease, which can result in vertigo and for

which she was treated with meclizine for balance; she was obese, and had undergone hip

surgery. 

However, if the Plaintiff wants the ALJ to reach the conclusion that her cane is

“medically required” to show she is an individual capable of less than a full range of sedentary

work, SSR 96–9P, requires: “medical documentation establishing the need for a hand-held

assistive device to aid in walking or standing, and describing the circumstances for which it is

needed.” At best, Plaintiff presents medical evidence that the orthopedist and physical therapist

noted, without comment, her use of a cane. Morgan v. Commissioner Soc. Security, 2014 WL

1764922 * 1-2 (Md. April 30, 2014) (explaining even medical evidence of prescription for cane

may be insufficient; plaintiff must show medical documentation for how the cane was actually

needed).

The ALJ relied on a functional capacity evaluation performed on April 26, 2012, by a

physical therapist which, the ALJ concluded, reflected shortness of breath as well as her level

Case 4:13-cv-01098-DCB Document 22 Filed 09/30/14 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

 4 See eg: 

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

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

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

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

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

476, 481, 492, 494). Beck also denied exercise intolerance and dyspnea

(shortness of breath), and denied joint and muscle pain. (AR 473, 481, 492). At

- 13 -

of effort were questionable and invalidity of some of the results was noted. (AR at 29.) The

physical therapist’s report reflects normal but “questionable” effort given for trunk flexion,

trunk extension, trunk side bends, reaching overhead, reaching for 2 minutes, knuckle kyphosis,

knuckle to shoulder and carrying 16 pounds. (AR at 709); (AR at 715). The Waddell test for

symptom magnification was negative. (AR at 716.) The test results and examiner, however,

concluded: submaximal and inconsistent effort. (AR at 717, 718). Efforts to impede accurate

testing as to a claimant’s limitations can support a finding of lack of credibility. Thomas v.

Barnhart, 278 F.3d 947, 959 (9th Cir. 2002). According to the functional capacity evaluation,

Plaintiff’s effort was curtailed by her claimed shortness of breath. (AR at 718 (patient

consistently limited by reported shortness of breadth). The test questioned the grip and pinch

test results and noted Plaintiff’s purse weighed 4 pounds. Id. The test noted severe restriction

in regard to hip flexibility, without question. Id. at 711. The ALJ’s credibility determination

based on this functional capacity evaluation is limited to Plaintiff’s claims regarding shortness

of breadth and dyspnea and arthritis pain in her hands. 

The ALJ found: “very limited objective evidence to support the claimant’s allegations

of . . . limited daily activities.” (AR at 29.) The Defendant argues that read in context, the ALJ

meant that in light of objective medical evidence of successful surgeries and treatment and

minimal complaints about debilitating pain by Plaintiff to her doctors, the ALJ found her

claimed limitations regarding daily activities not credible. (Response (Doc. 16) at 12.) The

Defendant suggests the ALJ relied on the medical records from Plaintiff’s FNP, Vickie Claus,

from Plaintiff’s routine visits, which reflect no complaints for shortness of breath, arthritis, and

osteoarthritis in her hips.4

 The Court is not free to rely on a record not relied on by the ALJ, and

Case 4:13-cv-01098-DCB Document 22 Filed 09/30/14 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

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

or degenerative arthritis” and that Beck’s gait was normal. (AR 477, 484, 495).

Clous advised Beck to limit fat and sodium intake, lose weight, follow a low-fat

and low-cholesterol diet, and exercise 30 minutes four days per week. (AR 479,

486, 497). (R&R (Doc. 19) at 5.)

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

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

November 18, Beck denied chest pain at rest, chest pain with exertion,

shortness of breath, shortness of breath with exertion, dizziness, nausea, or

fatigue. (AR 640, 657). Beck also denied exercise intolerance and dyspnea.

(AR 640). On May 13, Beck complained of shortness of breath with exertion

and dyspnea, but denied chest pain at rest, chest pain with exertion, shortness

of breath, dizziness, nausea, or fatigue. (AR 674). At each appointment, Clous

noted her exam showed “no stigmata of inflammatory or degenerative

arthritis.” (AR 643, 661, 678). Id. at 6.

- 14 -

if this were the record relied on by the ALJ, the Court notes that the medical record does contain

evidence of these complaints. Plaintiff complained of shortness of breath to two specialists,

both a pulmonologist and cardiologist. She saw an orthopedist and was diagnosed and treated

for severe osteoarthritis in both hips. Post-hearing, the Plaintiff continues to complain of

shortness of breath with exertion. (AR at 719-753: Univ. of Ariz. Medical Cntr. records of

pulmonary testing due to shortness of breath after exertion, finding no respiratory problems and

normal oxygenation). These specialists’ opinion are owed greater weight as a matter of

regulation. Garrison, 2014 WL 3397218 *14 (citing 20 C.F.R. § 404.1517(c)(5)). There is

objective medical evidence in the record to support both Plaintiff’s complaints of shortness of

breath with exertion and osteoarthritis. 

“ALJs must be especially cautious in concluding that daily activities are inconsistent with

testimony about pain and other symptoms because impairments that would unquestionably

preclude work will often be consistent with doing more than merely resting in bed all day. See,

e.g., Smolen, 80 F.3d at 1287 n. 7.” Id. at *17. “‘Many home activities may not be easily

transferable to a work environment where it might be impossible to rest periodically or take

medication.’” Id. (quoting Fair v. Bowen, 885 F.2d 597, 603 (9th Cir.1989). “Recognizing that

‘disability claimants should not be penalized for attempting to lead normal lives in the face of

Case 4:13-cv-01098-DCB Document 22 Filed 09/30/14 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 -

their limitations,’ we have held that ‘[o]nly if [her] level of activity were inconsistent with [a

claimant's] claimed limitations would these activities have any bearing on [her] credibility.’”

Id. (quoting Reddick v. Chater, 157 F.3d at 722 (further citations omitted)). “‘The critical

differences between activities of daily living and activities in a full-time job are that a person

has more flexibility in scheduling the former than the latter, can get help from other persons ...,

and is not held to a minimum standard of performance, as she would be by an employer. The

failure to recognize these differences is a recurrent, and deplorable, feature of opinions by

administrative law judges in social security disability cases.’” Id. (quoting Bjornson v. Astrue,

671 F.3d 640, 647 (7th Cir.2012)). 

In conclusion, the ALJ erred in finding the Plaintiff not credible based solely on a lack

of objective medical evidence to support her testimony about osteoarthritic hip pain and

shortness of breadth. The ALJ erred in finding the Plaintiff not credible because her shortness

of breadth was caused by obesity and she failed to loose weight; because she filed for

unemployment benefits during part of the time she claims to be disabled, and that her use of a

cane was suspicious. The ALJ erred in finding the Plaintiff not credible in all her testimony

based on the functional capacity evaluation by the physical therapist which reflected a lack of

effort due to shortness of breadth and in relation to the pinch test. 

2. The ALJ discounted Plaintiff’s Medical Source Statement and gave substantial weight

to the State-agency’s physician’s opinion.

It was error for the ALJ to rely on a non-examining State-agency physician’s opinion

issued prior to surgery that Plaintiff’s osteoarthritis in her hips would be fully resolved with

surgery and/or to construe this as evidence that Plaintiff was not credible post-surgery regarding

her assertions of severe hip pain affecting her ability to sit for 30 to 45 minutes at one time, (AR

at 702: Medical Source Statement 4/30/2012), and that her hips were not fully healed (AR at

66: 5/31/2012 hearing testimony). 

It was especially error to weigh the non-examining, State-agency consulting physician’s

outdated opinion as substantial over that of Plaintiff’s Medical Source Statement. The ALJ

found “reduced weight” in the Medical Source Statement because the doctor’s “functional

Case 4:13-cv-01098-DCB Document 22 Filed 09/30/14 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 -

limitations were qualified throughout the form statement with ‘per patient response, ’” (AR at

29), and the doctor’s signature was unreadable. The Plaintiff admitted the statement was not

completed by her treating physician Dr. Miller or the FNP Vickie Clous, but was completed by

another doctor, who sometimes covered for Dr. Miller. As noted by the ALJ, Plaintiff had been

treated at Freedom Park Health Center since 2010 and seen every three months. (AR at 27.)

As noted by the ALJ the doctor completing the statement very carefully identified which

portions of the statement were based on “patient’s response.” The statement did not, however,

include this qualifier throughout. In part, the doctor did not qualify the statements as follows:

Diagnosis: hip pain, arthritic hips; Prognosis: fair; Symptoms: pain, stiffness; the nature,

frequency, precipitation facts and severity of pain was described as: bilateral hips, daily, worse

with walking, climbing, cold weather, unable to squat; clinical and objective signs were

described as decreased ACM, X-rays, and hip replacements. (AR at 701.) Without any

qualifier, the doctor noted patient is not a malingerer, and Patient’s impairments lasted or can

be expected to last at least twelve months. (AR at 701.) The doctor estimated “the patient is

likely to be absent from work as a result of the impairments or treatment” for “about four days

per month” and “more than four days per month. (AR at 704.) The vocational expert testified

that if an employee is likely to be absent from work for three or more days per month, she

would lose her job. (AR at 77-78.)

3. Remand

“There is no bright line test for determining when the [Commissioner] has failed to

develop the record. The determination in each case must be made on a case by case basis.”

Battles v. Shalala, 36 F.3d 43, 45 (8th Cir.1994). “An ALJ is permitted to issue a decision

without obtaining additional medical evidence so long as other evidence in the record provides

a sufficient basis for the ALJ's decision.” Anderson v. Shalala, 51 F.3d 777, 779 (8th Cir.1995).

To warrant reversal, the Plaintiff must demonstrate prejudice or unfairness in the proceedings

from the ALJ’s failure to develop the record. Cruz v. Schweiker, 645 F.2d 812, 814 (9th Cir.

1981). The ALJ’s “‘special duty to fully and fairly develop the record and to assure that the

claimant's interests are considered ... even when the claimant is represented by counsel.’”

Case 4:13-cv-01098-DCB Document 22 Filed 09/30/14 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 -

Celaya v. Halter, 332 F.3d 1177, 1183 (9th Cir. 2003) (quoting Brown v. Heckler, 713 F.2d 441,

443 (9th Cir.1983). 

First and foremost, the claimant has the burden to raise the issue, i.e., there must be

sufficient objective evidence in the record to suggest the “existence of a condition which could

have a material impact on the disability decision.” Hawkins v. Chater, 113 F.3d 1162, 1167

(10th Cir.1997.) The ALJ's duty to further develop the record is triggered “only when there is

ambiguous evidence or when the record is inadequate for proper evaluation of evidence.” Mayes

v. Massanari, 276 F.3d 453, 4509–60 (9th Cir.2001) (citing Tonapetyan v. Halter, 242 F.3d

1144, 1150 (9th Cir.2001)). To further develop the record, the Commissioner may order

consultative examinations, subpoena evidence and opinions from treating physicians, and seek

advice from vocational experts. 

Here, the ALJ’s duty to develop the record further was triggered in respect to Plaintiff’s

hip pain when she testified in May 2012 that she had the last, left, hip replacement surgery in

January or February of 2012, and her hips were not yet fully healed. The ALJ noted, “medical

record of these surgeries was not provided at the hearing level.” (AR at 29.) There were no

medical records for Plaintiff’s post-surgical treatment and recovery from these surgeries. The

fact of the surgeries was not at issue, therefore, there was insufficient evidence for the ALJ to

assess Plaintiff’s disability post-surgery. The State-agency’s non-examining opinion, issued

pre-surgery, was not substantial evidence to support a functional capacity assessment postsurgery. 

Because the ALJ discounted Plaintiff’s credibility related to her assertion of debilitating

hip pain based on the State-agency physician’s opinion that hip pain was resolved by surgery,

the ALJ did not determine an onset date or consider how long debilitating pain persisted postsurgery. See Regennitter v. Comm’r of Soc. SEC. Admin., 166 F.3d 1294, 1300 (9th Cir. 1999)

(finding, even when claimant’s testimony and doctor’s opinion are credited, unresolved issue

of claimant’s disability onset date prevented remand for award of benefits). As noted above,

there was no basis for the ALJ to discount Plaintiff’s credibility regarding her assertion that she

was precluded from sitting uninterrupted for 6 hours in an 8 hour work day. See (AR at 27 (ALJ

Case 4:13-cv-01098-DCB Document 22 Filed 09/30/14 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 -

noting that based on Plaintiff’s self-reporting, the Medical Source Statement reflected she was

incapable of even sedentary work). 

Finally, remand in this case is necessary in fairness to the Commissioner. In respect to

Plaintiff’s other impairments, the case cannot be resolved under the credit-as-true rule. Plaintiff

carries the burden to establish disability, but the record when reviewed as a whole is missing

any functional assessment from even one of her many treating physicians, who personally

treated her over the five-year span she claims to be the relevant period of disability. See

Garrison, 2014 WL 3397218 *20-23 (even when all conditions are met for an award of benefits

based on the credit-as-true rule, remand for further proceedings is appropriate where there is

serious doubt on the record as a whole that claimant is, in fact, disabled).

There are ample sources for both the ALJ and Plaintiff to compile a more accurate

picture of the severity and duration of Plaintiff’s impairments.

Accordingly

IT IS ORDERED that the R&R (Doc. 19) is not adopted by the Court.

IT IS FURTHER ORDERED that the Decision of the Commissioner is REVERSED

and this action is REMANDED to the ALJ to further develop and consider the record as

explained herein.

IT IS FURTHER ORDERED that the Clerk of the Court shall enter Judgment

accordingly.

DATED this 29th day of September, 2014.

Case 4:13-cv-01098-DCB Document 22 Filed 09/30/14 Page 18 of 18