Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_17-cv-01822/USCOURTS-casd-3_17-cv-01822-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:0405id Review of HHS Decision (SSID)

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UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF CALIFORNIA

MARINA PENA,

 Plaintiff,

v.

NANCY A. BERRYHILL, Acting 

Commissioner of Social Security

 Defendant.

Case No.: 3:17-cv-01822-AJB-KSC

REPORT AND 

RECOMMENDATION RE CROSSMOTIONS FOR SUMMARY 

JUDGMENT

[Doc. Nos. 14, 17]

Pursuant to Title 42, United States Code, Section 405(g), of the Social Security Act

("SSA"), plaintiff filed a Complaint to obtain judicial review of a final decision by the

Commissioner of Social Security ("Commissioner") denying her disability insurance

benefits.1 Pursuant to Title 28, United States Code, Section 636(b)(1)(B), and Civil Local 

Rules 72.1(c)(1)(c) and 72.2(a), this matter was assigned to the undersigned Magistrate 

Judge for a Report and Recommendation. 

 

1 Title 42, United States Code, Section 405(g), provides as follows: “Any individual, after any final 

decision of the Commissioner of Social Security made after a hearing to which he was a party ... may 

obtain a review of such decision by a civil action ... brought in the district court of the United States ... 

The court shall have power to enter, upon the pleadings and transcript of the record, a judgment 

affirming, modifying or reversing the decision of the Commissioner of Social Security, with or without 

remanding the cause for a rehearing. The findings of the Commissioner ... as to any fact, if supported by 

substantial evidence, shall be conclusive.” 

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Presently before the Court are: (1) defendant’s Motion for Summary Judgment and 

Opposition to plaintiff’s Motion for Summary Judgment [Doc. No. 14]; (2) plaintiff’s 

Motion for Summary Judgment [Doc. No. 17]; (3) plaintiff’s reply to defendant’s 

Opposition to plaintiff’s Motion for Summary Judgment [Doc. No. 19]; and (4) the 

Administrative Record [Doc. No. 10]. After careful consideration of the moving and 

opposing papers, as well as the Administrative Record and the applicable law, this Court 

RECOMMENDS that defendant’s Motion be GRANTED and plaintiff’s Motion be

DENIED.

I. BACKGROUND AND PROCEDURAL HISTORY

On July 22, 2015, plaintiff filed an application for supplemental security income

(“SSI”) under Title XVI of the Social Security Act (“SSA”), alleging disability beginning 

July 1, 2012. [Certified Administrative Record, at pp. 179-88 (“AR”)]. On February 23, 

2016, the Commissioner denied plaintiff’s application. [AR 111-14]. On May 13, 2016, 

upon reconsider, the Commissioner again denied plaintiff’s application. [AR 120-24]. 

On July 5, 2016, plaintiff requested a de novo hearing before an Administrative Law 

Judge (“ALJ”). [AR 125-27]. On February 1, 2017, plaintiff received notice of the hearing. 

[AR 143]. A hearing before an ALJ was held on April 24, 2017. [AR 39]. At the hearing, 

plaintiff amended the alleged onset date of disability from June 1, 2012 to July 22, 2015. 

[AR 19]. 

On May 2, 2017, the ALJ issued a written opinion concluding that plaintiff did not 

qualify for SSI under the SSA. [AR 19-29]. In reaching this decision, the ALJ found that 

the plaintiff has severe impairments of “history of breast cancer; metabolic syndrome with 

CAD; overweight/obesity; atypical chest pain; uterine tumor; neuropathy; and 

degenerative joint disease.” [AR 21]. However, the ALJ concluded that she did not have 

an impairment, or combination of impairments, that meet SSA disability criteria, and that 

she possesses the residual functional capacity to perform light work with six additional 

limitations. [AR 22-23]. 

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Plaintiff sought review from the Appeals Council, which was denied on July 18, 

2017 [AR 1-5], after which she filed the instant action on September 8, 2017. [Doc. No. 

1]. 

II. STANDARDS OF REVIEW

The final decision of the Commissioner must be affirmed if it is supported by 

substantial evidence and if the Commissioner has applied the correct legal standards. 

Batson v. Comm’r of Social Security Admin., 359 F.3d 1190, 1193 (9th Cir. 2004); 42 

U.S.C § 405(g). Under the substantial evidence standard, the Commissioner’s findings are 

upheld if supported by inferences reasonably drawn from the record. [Id.]. If there is 

evidence in the record to support more than one rational interpretation, the District Court 

must defer to the Commissioner’s decision. [Id.]. Substantial evidence means “such 

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

Osenbrock v. Apfel, 240 F.3d 1157, 1162 (9th Cir. 2001). The Court must weigh both the 

evidence that supports and detracts from the administrative ruling. Tackett v. Apfel, 180 

F.3d 1094, 1097 (9th Cir. 1999). 

Pursuant to Federal Rule of Civil Procedure 56(a), “[t]he court shall grant summary 

judgment if the movant shows that there is no genuine dispute as to any material fact and 

the movant is entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a). “Summary 

judgment motions, as defined by [Rule 56], contemplate the use of evidentiary material in 

the form of affidavits, depositions, answers to interrogatories, and admissions. In Social 

Security appeals, however, the Court may ‘look no further than the pleadings and the 

transcript of the record before the agency,’ and may not admit additional evidence.” Morton 

v. Califano, 481 F.Supp. 908, 914 n. 2 (E.D. Tenn. 1978); 42 U.S.C. § 405(g). “[A]lthough 

summary judgment motions are customarily used [in social security cases], and even 

requested by the Court, such motions merely serve as vehicles for briefing the parties’ 

positions, and are not a prerequisite to the Court’s reaching a decision on the merits.” Kenny 

v. Heckler, 577 F.Supp. 214, 216 (D.C. Ohio 1983). 

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III. MEDICAL EVIDENCE

A. Chronological Summary of Medical Records

Plaintiff is a fifty-three year old Hispanic-American female with a family history of 

breast cancer, and is a chronic smoker. [AR 274]. 

In 2012, plaintiff was diagnosed with high blood pressure and later was hospitalized 

for a heart attack, for which she received an angioplasty and a stent. [AR 448]. She also 

had her gallbladder removed in August of 2012. [AR 449]. 

In August of 2014, a mammogram revealed breast cancer in plaintiff’s right breast, 

for which she underwent radiation therapy from December 2014 through January 2015. 

[AR 273, 276]. The record does not indicate whether plaintiff underwent surgery to remove

the cancer. She tolerated the radiation therapy with mild, acute side effects [AR 277], and 

a mammogram of both breasts in May, 2015 indicated a benign result. [AR 279]. During 

a September, 2014, checkup, plaintiff’s EKG was within normal limits and indicated “good 

exercise capacity.” [AR 272]. During an October, 2014 checkup, plaintiff indicated feeling 

more anxious than usual and smoking more. [AR 289]. 

Plaintiff indicated during an April, 2015 checkup that she was generally tolerating 

the prescribed medication Tamoxifen.

2

[AR 281]. However, she did express that she was 

experiencing hot flashes as a side effect. [Id.]. 

In May, 2015, plaintiff had a second heart attack [AR 1014], was diagnosed with 

“acute coronary syndrome,” and had two stent placements. [AR 297]. The discharge report 

also indicated “breast cancer, coronary artery disease, and deep vein thrombosis in the 

past.” [Id.]. Plaintiff was noted to be noncompliant in taking Plavix because she was “very 

preoccupied and depressed related to her breast cancer diagnosis.” [Id.]. Her doctor 

indicated that she suffered from a “significant amount of anxiety and depression.” [AR 

 

2 Tamoxifen is commonly used to treat breast cancer and used to decrease the chance of breast cancer 

recurrence in women who have received treatment for the disease. Tamoxifen in Pill Form (Brand 

Name: Nolvadex), Breastcancer.org (March 30, 2018), 

http://www.breastcancer.org/treatment/hormonal/serms/tamoxifen. 

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304]. In May, 2015, plaintiff also had a positive stress test prompting a cardiac 

catheterization that proceeded without complications. [AR 297]. 

A June 2015 “Behavioral Health Adult Intake Assessment” indicated plaintiff was 

depressed after the death of a close relative, but was feeling better and optimistic about her 

recovery from cancer and her heart condition. [AR 398]. She did not report any signs or 

symptoms requiring any clinical attention, and otherwise had a healthy evaluation. [AR 

388-399].

Plaintiff stopped taking her prescribed Tamoxifen due to abnormal uterine bleeding 

according to a December, 2015 medical appointment report. [AR 428]. She also relayed

having severe hot flashes and night sweats around the same time. [AR 430]. Although 

scheduled for a uterine biopsy, the medical report indicated she could not tolerate the 

procedure due to an anxiety attack. [AR 432].

In November, 2015, plaintiff underwent a pelvic ultrasound. [AR 435]. The 

ultrasound identified “small cystic structures in the endometrium.” [AR 435-36]. A 

medical consultation in January of 2016 noted that there were no masses present. [AR 452]. 

Further, a pathology report in February of 2016 indicated “mainly mucus and minute strips 

of benign endometrial surface epithelium, [and] no evidence of hyperplasia or malignancy 

in the submitted sample.” [AR 762]. 

In February of 2016, plaintiff was evaluated for complaints of chest plain. [AR 778]. 

She was diagnosed with chest pressure, hypertension, shortness of breath, and dizziness,

and referred for a stress test. [AR 778-79]. The March 2016 stress test indicated a “resting 

left ventricular ejection fraction” of 74%, which is within the normal range. [AR 522]. In 

April of 2016, plaintiff had a normal echocardiogram, indicating systolic function with 

ejection fraction of 57%, which was within the normal range. [AR 1013-14]. 

Plaintiff had a breast cancer follow-up in April, 2016. [AR 480]. She had a negative 

endometrial biopsy, despite an episode of vaginal bleeding. [Id.]. She was placed back on 

Tamoxifen, and although she had stopped taking her antidepressant medications, she

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denied any depressive or suicidal thoughts. [Id.]. Further, she planned to undergo a 

hysterectomy to treat her diagnosed uterine fibroids. [Id.]. 

In July of 2016, plaintiff reported having hot flashes. [AR 1247]. That same month, 

plaintiff was instructed to stop taking Tamoxifen and take Anstrasol in its place. [AR 

1249]. 

During a December 2016 physical exam, plaintiff reported mild shortness of breath. 

[AR 1385]. She was cooperative, but anxious. [Id.]. The discharge records indicated panic 

attacks, pain without a known cause, nonspecific chest pain, and generalized anxiety. [AR 

1388]. 

At a January, 2017 physical exam, plaintiff reported vision issues and was referred 

to an optometrist. [AR 1137]. All other results were normal and her existing medical 

conditions were stable. [AR 1138]. 

In February, 2017, plaintiff had a checkup before a cataract removal surgery. [AR 

1033]. She complained of hot flashes at that time. [AR 1157]. The Administrative Record 

reveals plaintiff was scheduled to undergo the planned hysterectomy in March, 2017. [Id.]. 

However, there is no information in the record indicating whether plaintiff underwent the 

surgery. Plaintiff underwent cataract surgery on May 4, 2017. [AR 1465].

Plaintiff was referred for right hand/bilateral “trigger fingers”

3

in May of 2017. [AR 

1480]. 

B. Findings of Medical Experts

The ALJ determined that the medical evidence showed plaintiff was able to perform 

a range of light work (despite her physical conditions), with limitations. [AR 871; 1064]. 

The limitations included: “[plaintiff] could life and/or carry, push and/or pull, 20 pounds 

occasionally and 10 pounds frequently; sit for 6 hours in an 8-hour workday; stand and/or 

walk for six hours in an 8-hour workday; occasionally climb ramps, stairs, ladders, ropes, 

 

3 A condition where finger is stuck in a bent position. Trigger Finger, American Society for Surgery of 

the Hand (2015), http://www.assh.org/handcare/hand-arm-conditions/trigger-finger. 

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and/or scaffolds; and frequently perform all other postural activity, including balancing, 

stooping, kneeling, crouching, and crawling.” [AR 26]. This was confirmed by State 

agency reviewers upon their evaluation of the record. [AR 86-91; 103-08]. The ALJ further

determined that “the treatment records supported that [the plaintiff] was also limited to 

frequent use of the right upper extremity for manipulation [sic] and feeling; standing and/or 

walking for 20 minutes, at a time, and for 5.5 hours; and lift and/or carry, push and/or pull, 

10 pounds occasionally and 10 frequently with the right upper extremity.” [AR 26]. 

Reading the ALJ’s opinion in context, it is apparent that the ALJ identified substantial 

physical limits on plaintiff’s ability to use her right arm and hand. 4

A consultative examiner found, upon an independent review, that plaintiff was 

capable of a full range of light work capacity. [AR 452]. However, the ALJ concluded, 

contrary to the consultative examiner’s findings, that the overall medical evidence 

“support[ed] that the [plaintiff] [had] limitations with postural activity, along with 

additional limitations in lifting and/or carrying with the right upper extremity.” [AR 26]. 

Another consultative examiner, a licensed psychologist, evaluated the claim and 

determined that plaintiff had either no, or mild, mental limitations. [AR 456-60]. The ALJ 

concluded that these findings were “fully consistent with the evidence of the record, and 

[were] afforded great weight.” [AR 27]. 

Furthermore, a medical expert at the oral hearing testified that plaintiff’s medical 

conditions did not meet or equal any medical listing, and that she was not disabled because

she was capable of a range of medium work. [AR 42-54]. Despite the medical expert’s 

testimony, the ALJ concluded that the objective record supported a more restrictive

residual functional capacity. [AR 27]. 

/ / /

 

4 The ALJ’s wording in the direct quote appears to incorrectly imply that plaintiff was required to use 

her right side due to limitations with her left side, and that, by implication, her right side was the 

stronger. Yet plaintiff actually experienced substantial difficulty with her right side, which is reflected 

accurately in the ALJ’s opinion when read fully and in context.

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C. Plaintiff’s Oral Testimony

Plaintiff testified at her oral hearing that she could not work because of “really bad

hot flashes” and “dizzy spells.” [AR 58]. She would easily become short of breath, 

requiring short and frequent breaks. [Id.]. When walking, she experienced fatigue and 

shortness of breath. [Id.]. Indeed, she stated that she could not walk more than two blocks 

without sitting down to catch her breath. [Id.]. Further, her chest pain was triggered by 

walking. [AR 63]. [Id.]. Standing up too quickly was also a problem, and she struggled to 

use a computer due to vision issues. [Id.; AR 68].

Plaintiff testified she could perform simple household tasks and chores (e.g., 

cooking a meal, errands for groceries, minor housecleaning), [AR 59]. She also explained 

that she was weaker on her right side, and thus could not carry common items in her right 

hand (e.g., her purse or groceries). [Id.]. Aside from the general weakness, plaintiff 

complained of particular difficulty and pain in her right hand ring finger. [AR 66]. Pain

and numbness was a daily struggle, rendering her unable to carry items of roughly twenty 

pounds without both hands. [AR 60, 69]. She stated she was likely unable to carry that 

much weight for two cumulative hours a day in a typical forty hour work week. [AR 63]. 

She also testified that she could not be on her feet for more than twenty minutes at a time, 

unless she was leaning on something [Id.]. Yet at other times in her testimony she indicated

she stood for approximately two-thirds of the day on most days. [AR 61]. When pressed 

by the ALJ, plaintiff testified that she believed she would be unable to stand for six hours

a day in an eight-hour workday, but that five and a half hours would be more realistic. [AR 

62]. 

Finally plaintiff testified that she frequently went to the hospital due to anxiety 

attacks. [AR 64]. 

/ / /

/ / /

/ / /

/ / /

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IV. THE ALJ’S FIVE-STEP DISABILITY ANALYSIS

To qualify for disability benefits under the SSA, an applicant must show that he or 

she is unable to engage in any substantial gainful activity because of a medically 

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

least twelve months. 42 U.S.C. § 423(d). The Social Security regulations establish a fivestep sequential evaluation for determining whether an applicant is disabled under this 

standard. 20 C.F.R. § 404.1520(a); Batson v. Comm’r of the Social Security Admin., 359 

F.3d at 1193-94. 

At step one, the ALJ must determine whether the applicant is engaged in substantial 

gainful activity. 20 C.F.R. § 404.1520(a)(4)(i). Here, the ALJ concluded plaintiff had not 

engaged in substantial gainful activity since July 22, 2015, the amended alleged onset date 

of plaintiff’s impairments. [AR 21].

At step two, the ALJ must determine whether the applicant is suffering from a 

“severe” impairment within the meaning of Social Security regulations. 20 C.F.R. 

§ 404.1520(a)(4)(ii). “An impairment or combination of impairments is not severe if it does 

not significantly limit [the applicant’s] physical or mental ability to do basic work 

activities.” 20 C.F.R. § 404.1521(a). For example, a slight abnormality or combination of 

slight abnormalities that only have a minimal effect on the applicant’s ability to perform 

basic work activities will not be considered a “severe” impairment. Webb v. Barnhart, 433 

F.3d 683, 686 (9th Cir. 2005). Examples of basic work activities include walking, standing, 

sitting, lifting, pushing, pulling, reaching, carrying, handling, seeing, hearing, speaking, 

understanding, carrying out and remembering simple instructions, use of judgment, 

responding appropriately to supervision, co-workers and usual workers and usual work 

situations, and dealing with changes in routine work setting. 20 C.F.R. § 404.1521(b)(1)-

(6). “If the ALJ finds that the claimant lacks a medically severe impairment, the ALJ must 

find the claimant not to be disabled.” Barnhart, 433 F.3d at 686. 

Here, at step two, the ALJ concluded that plaintiff has the following severe 

impairments: “history of breast cancer; metabolic syndrome with [coronary artery disease]; 

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overweight/obesity; atypical chest pain; uterine tumor; neuropathy; and degenerative joint 

disease.” [AR 21]. 

If a claimant is deemed to have severe impairments, the ALJ then determines at step 

three whether any impairment equals, or rises to the level of, one of the “Listing of 

Impairments” in the Social Security regulations. 20 C.F.R. § 404.1520(a)(4)(iii). If so, he 

or she must be found disabled. [Id.]. Here, the ALJ found at step three that plaintiff’s 

impairment or combination of impairments did not meet or equal a listed impairment. [AR 

22]. This included those found under medical 1.02 (major dysfunction of a joint(s) due to 

any cause); 4.00 (cardiovascular system); 11.00 (neurological disorders); and 14.00 

(immune system disorders). [AR 22]. The ALJ based this determination on recorded 

findings of treating or examining physicians and the evidence of medical findings. [AR 

22]. 

If an impairment does not meet or equal a “Listing of Impairments”, the ALJ must 

make a step four determination of the claimant’s residual functional capacity based on all 

impairments, including impairments that are not severe. 20 C.F.R. §§ 404.1520(e), 

404.1545(a)(2). “Residual functional capacity” (“RFC”) is “the most [an applicant] can 

still do despite [his or her] limitations. 20 C.F.R. § 404.1545(a)(1). The ALJ must 

determine whether the applicant retains the residual functional capacity to perform his or 

her past relevant work. 20 C.F.R. § 404.1520(a)(4)(iv). 

If the applicant cannot perform past relevant work, the ALJ – at step five – must 

consider whether the applicant can perform any other work that exists in the national 

economy. 20 C.F.R. § 404.1520(a)(4)(v). While the applicant carries the burden of proving 

eligibility at steps one through four, the burden at step five rests on the Agency. Celaya v. 

Halter, 332 F.3d 1177, 1180 (9th Cir. 2003). The ALJ must consider all of plaintiff’s 

medically determinable impairments, including any pain that could “cause a limitation of 

function” and any impairments that are not “severe,” and then determine plaintiff’s residual 

functional capacity to perform work in the national economy. 20 C.F.R. §§ 404.1520; 

404.1545; 416.929. “In determining [the claimant’s] residual functional capacity, the ALJ 

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must consider whether the aggregate of [the claimant’s] mental and physical impairments 

may so incapacitate him that he is unable to perform available work.” Light v. Soc. Sec. 

Admin., 119 F.3d 789, 793 (9th Cir. 1997), as amended on reh’g (Sept. 17, 1997). As noted 

above, “residual functional capacity” is “the most [an applicant] can still do despite [his or 

her] limitations.” 20 C.F.R. § 404.1545(a)(1). 

Considering the totality of plaintiff’s impairments, the ALJ concluded that plaintiff 

has the residual functional capacity to “perform light work as defined in 20 CFR 

416.967(b),” with six exceptions. [AR 23]. Plaintiff’s statements concerning “the intensity, 

persistence, and limiting effects of [her] symptoms,” the ALJ concluded, were “not entirely 

consistent with the medical evidence and other evidence in the record.” [AR 24]. The ALJ 

noted plaintiff participated in activities that undermined her allegations of disabling

functional limitations. [AR 23-24]. Specifically, that “she was able to keep up with general 

cleaning at home; she could shop for necessities; she could sweep for about 15 to 20 

minutes; she could prepare simple meals like hamburger helper; and she was able to go to 

her sister’s house . . . .” [Id.].

The ALJ gave great weight to the medical evidence in making his determination. 

[AR 24]. He also gave weight to the findings of the two agency reviewers, the two 

consultative examiners, and the medical expert. [AR 26]. He concluded that the 

“significant light range of light residual functional capacity [was] supported by the 

testimony of claimant; the claimant’s disability reports; the third party function report; and 

the claimant’s treatment records” and that “the less than light limitation addresses the 

claimant’s impairments and subjective complaints.” [AR 27]. 

While plaintiff was unable to perform any past relevant work, “considering the 

claimant’s age, education, work experience, and residual functional capacity” the ALJ 

concluded that there existed jobs in significant numbers in the national economy that the 

plaintiff could perform. [AR 27-28]. Specifically, plaintiff could, according to the 

testimony of the vocational expert, “perform the requirements of representative light 

occupations such as sub-assembler,” with 26,000 positions in the national economy; 

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“information clerk,” with 60,000 positions in the national economy; and “hand packager,” 

with 96,000 positions in the national economy. [AR 28]. From this testimony, the ALJ 

concluded, that plaintiff was “capable of making a successful adjustment to other work that 

exists in significant numbers in the national economy” and that a finding of “not disabled” 

was warranted under Section 1614(a)(3)(A) of the Social Security Act. [AR 28]. 

Accordingly, plaintiff was denied benefits. [AR 28].

V. DISCUSSION

As noted above, the final decision of the Commissioner must be affirmed if it is 

supported by substantial evidence and if the Commissioner has applied the correct legal 

standards. Batson v. Comm’r of the Social Security Admin., 359 F.3d 1190, 1193 (9th Cir. 

2004). The Commissioner’s findings are upheld if supported by inferences reasonably 

drawn from the record. Id. If there is evidence in the record to support more than one 

rational interpretation, the District Court must defer to the Commissioner’s decision. Id.

Substantial evidence means “such relevant evidence as a reasonable mind might accept as 

adequate to support a conclusion.” Osenbrock v. Apfel, 240 F.3d 1157, 1162 (9th Cir. 

2001). A court must weigh both the evidence that supports and detracts from the 

administrative ruling. Tackett v. Apfel, 180 F.3d 1094, 1097 (9th Cir. 1999). 

Plaintiff contends the ALJ erred by not properly considering plaintiff’s subjective 

testimony about “the intensity, persistence, and limiting effects of her symptoms ‘not 

entirely consistent with the medical evidence and other evidence’” in making his final 

determination. [Doc. No. 17, at p. 5] (quoting AR 24). Specifically, plaintiff asserts: 

1. The ALJ failed to cite either specific testimony or cite specific reasons for 

discounting plaintiff’s testimony [Id., at p. 7];

2. The ALJ improperly relied on medical evidence in support of his findings [Id., at 

p. 9];

3. The ALJ improperly considered plaintiff’s activities of daily living in discounting 

her pain testimony [Id., at pp. 6-7]; and

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4. The ALJ improperly considered plaintiff’s failure to take a prescribed medication

[Doc. No. 19, at p. 3].

Thus, according to plaintiff, “the final decision of the ALJ lacks the support of substantial 

evidence and rests on legal error.” [Doc. No. 17, at p. 10]. Therefore, she asserts that the 

ALJ’s decision should be reversed and remanded for payment of benefits, or, in the 

alternative, remanded to reconsider her subjective pain and symptom testimony. [Id.].

The Commissioner argues that the ALJ properly considered plaintiff’s testimony, 

but that such testimony was not reliable because: (1) the objective medical evidence 

undermined her testimony; (2) plaintiff’s activities were inconsistent with disability; (3) 

there was evidence that plaintiff was not compliant with her treatment; and (4) plaintiff’s 

testimony conflicted with examining and reviewing physicians. [Doc. No. 15, at p. 3, 5-

6]. Thus, the Commissioner asserts, the ALJ “provided numerous, valid reasons for 

discounting [p]laintiff’s subjective complaints,” and the decision is therefore supported by 

substantial evidence and without legal error. [Id., at p. 7].

A. Whether the ALJ failed to cite specific reasons for discounting plaintiff’s 

testimony

Turning to plaintiff’s first argument, the Ninth Circuit sets out a two-step analysis 

for evaluating pain. Vasquez v. Astrue, 572 F.3d 586 (9th Cir. 2009). First, the claimant 

must provide objective medical evidence of an underlying impairment which could 

reasonably be expected to produce the pain. Id. at 591. The claimant need not show that 

her impairment could be expected to cause the severity of the pain she claims, only that it 

could cause some degree of pain. Id. Here, the ALJ found that the medical evidence 

supported a finding of an underlying impairment that could be reasonably expected to cause 

her alleged pain. [AR 24]. 

Once, as here, the first prong is met without evidence of malingering, the claimant’s 

testimony regarding the degree of her pain may be rejected only for clear and convincing 

reasons. Vasquez, 572 F.3d at 592. The ALJ must specify which testimony he finds not 

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credible, and failure to do so is legal error. Brown-Hunter v. Colvin, 806 F.3d 487, 489 (9th 

Cir. 2015).5

Here, the ALJ found no evidence of malingering in the record. Plaintiff’s testimony, 

therefore, could only be properly rejected if there were explicitly stated clear and 

convincing reasons for doing so. The relevant issues thus presented to the Court are (1) 

whether the ALJ clearly identified the testimony he found not to be credible; and, (2) 

whether the ALJ provided clear and convincing reasons for rejecting plaintiff’s subjective 

pain testimony. Each issue, and the accompanying arguments, is addressed in Section 1 

below.

In support of his decision, the ALJ rejected plaintiff’s testimony because “the 

claimant’s statements concerning the intensity, persistence, and limiting effects of [her] 

symptoms are not entirely consistent with the medical evidence and other evidence in the 

record for the reasons explained in the decision.” [AR 24]. The ALJ also considered 

plaintiff’s testimony regarding her daily activities and her discontinuing use of Plavix in 

making his credibility determination. [AR 23-24; 26]. 

As stated, supra, plaintiff argues that the ALJ failed to cite either specific testimony 

or cite specific reasons for discounting plaintiff’s testimony. 

When rejecting pain and symptom testimony, an ALJ may not do so by making 

general findings; rather, the ALJ must identify what testimony is not credible and what 

evidence undermines the claimant’s complaints. Colvin, 806 F.3d at 493. Upon review, an 

ALJ’s decision cannot merely conclude the claimant was not credible and summarize the 

medical evidence supporting his determination. Id. The specific reasons must be readily 

 

5 The Commissioner disputes this standard of review. The Commissioner states that it is 

inconsistent with the deferential substantial evidence standard set forth in 42 U.S.C. § 405(g), and with 

agency regulations and rulings specifying the rationale its adjudicators should provide in support of their 

findings. However, the Ninth Circuit has rejected this argument in Burrell v. Colvin, 775 F.3d 1133, 

1136–37 (9th Cir. 2014) (holding that the “clear and convincing” requirement actually predated Burrell

and was not “excised” by it). Burrell therefore forecloses the Commissioner's argument. 

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identifiable by a reviewing court to ensure that the claimant’s testimony was not arbitrarily 

discredited. Id. The clear and convincing standard is “the most demanding required in 

Social Security Cases.” Moore v. Commissioner of Social Sec. Admin., 278 F.3d 920, 924 

(9th Cir. 2009). The ALJ’s findings must be sufficiently specific to allow a reviewing court 

to conclude the adjudicator rejected the claimant’s testimony on permissible grounds and 

did not “arbitrarily discredit a claimant’s testimony regarding pain.” Bunnell v. Sullivan, 

947 F.2d 341, 345-46 (9th Cir. 1991). The ALJ met this burden.

The ALJ noted in his decision that, at the hearing, plaintiff “asserted that she became 

fatigued with walking; she had really bad hot flashes and dizzy spells; she had exhaustion; 

she had anxiety; and she had numbness and pain.” [AR 23]. In discounting the testimony,

the ALJ explained that “the claimant’s statements concerning the intensity, persistence, 

and limiting effects of these symptoms are not entirely consistent with the medical evidence 

and other evidence in the record for the reasons explained in the decision” [AR 24], and 

“the consistency of the claimant’s allegations regarding the severity of her symptoms and 

limitations is diminished because those allegations are greater than expected in light of the 

objective evidence of record. The positive objective clinical and diagnostic findings since 

the alleged onset date detailed above do not support more restrictive functional limitations 

than those assessed herein.” [AR 26]. The ALJ then proceeded to provide a detailed, threepage analysis of the medical evidence that undermined plaintiff’s specifically identified

pain and symptom testimony. [AR 24-27]. This included a detailed description of the 

relevant chronological medical history, a review of the findings of state agency reviewers, 

a review of two consultative examiners, and a careful parsing of the oral testimony 

provided by a medical expert. [AR 26-27]. Based on these findings, the ALJ concluded 

that the plaintiff’s testimony was not credible as it related to her subjective pain and 

symptoms. [AR 24]. 

After identifying the specific evidence undermining plaintiff’s pain and symptom 

testimony, the ALJ continued, “despite [plaintiff’s] allegations of disability, the claimant 

acknowledged that she was able to keep up with general cleaning at home; she could shop 

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for necessities; she could sweep for about 15 to 20 minutes; she could prepare simple meals 

like hamburger helper; she was able to go to her sister’s house.” [AR 23-24].

Thus, as required, the ALJ specifically identified the statements he found not to be

credible and the evidence that undermined them. Colvin, 806 F.3d at 493. The ALJ’s 

specificity and analysis is consonant with the clear and convincing standard. Thus, the 

Court finds the ALJ met his burden. 

B. Whether the ALJ improperly relied on medical evidence in support of his 

findings.

The Court now turns to plaintiff’s second argument that the ALJ improperly relied 

on medical evidence in support of his findings. 6

In relying on medical evidence, an ALJ does not provide specific, clear, and 

convincing reasons for rejecting a claimant’s testimony by simply reciting the medical 

evidence in support of his or her residual functional capacity determination. Brown-Hunter, 

806 F.3d at 489. He must provide clear and convincing reasons, supported by the evidence 

in the record, to reject a claimant’s testimony. Id. This standard is identical to that laid out 

 

6 Plaintiff also argues the ALJ improperly dismissed plaintiff's pain testimony and cites to Smolen v. 

Chater, 80 F.3d 1273 (9th Cir. 1996) and Dodrill v. Shalala, 12 F.3d 915 (9th Cir. 1993) for support. 

Nothing in the ALJ's opinion is inconsistent with the rulings in either case. In Smolen, the Ninth Circuit 

explained that to satisfy requirements for presenting subjective symptom evidence, a claimant seeking 

disability benefits must only produce objective medical evidence of impairment or impairments, and that

that impairment, or combination of impairments, could reasonably be expected to produce some degree 

of the symptoms. Smolen, 80 F.3d at 1281. A claimant need not produce objective medical evidence of 

pain or fatigue itself, or severity thereof, nor must a claimant produce objective medical evidence of a 

causal relationship between a medically determinable impairment and symptom. Id. And in Dodrill, the 

Ninth Circuit explained that ALJ must provide clear and convincing reasons for rejecting pain and 

symptom testimony, absent evidence of malingering. Dodrill, 12 F.3d at 918. Further, the ALJ must state 

which testimony is not credible and what evidence undermines it. Id. Here, the ALJ found that the medical 

evidence supported a finding of an underlying impairment that could be reasonably expected to cause her 

alleged symptoms. [AR 24]. This Court finds the ALJ did provide clear and convincing reasons for 

discounting the testimony, and pinpointed which testimony he found not credible and what evidence 

undermined it. Therefore plaintiff's argument is unavailing. 

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in Section A(1), supra. The Court agrees with defendant that the ALJ properly relied on 

the opinions of physicians and properly cited to objective medical evidence.

Here, the ALJ did not simply recite the medical evidence in rejecting plaintiff’s 

testimony; rather, he compared the medical evidence with the testimony, and gave reasons 

for rejecting the testimony in light of the inconsistent medical evidence. First, the ALJ 

found that plaintiff’s subjective pain and symptom testimony was not credible because her

testimony was not consistent with the medical and other evidence in the record. [AR 24]. 

The ALJ then found, after identifying the medical evidence that was inconsistent with 

plaintiff’s testimony, that plaintiff’s allegations of her symptoms were “greater than 

expected in light of the objective evidence of record. The positive objective clinical and 

diagnostic findings since the alleged onset date detailed above do not support more 

restrictive functional limitations than those assessed herein.” [AR 26]. The Court finds the 

ALJ provided clear and convincing reasons for relying on the medical evidence to discount 

plaintiff’s testimony. 

C. Whether the ALJ improperly considered plaintiff’s activities of daily living in 

discounting her pain testimony.

Plaintiff also asserts, in her third argument, that the ALJ improperly considered her

activities of daily living in discounting her pain testimony. In considering plaintiff’s daily 

activity testimony, the Ninth Circuit has “repeatedly warned that ALJs must be especially 

cautious in concluding that daily activities are inconsistent with testimony about pain, 

because impairments that would unquestionably preclude work and all the pressures of a 

workplace environment will often be consistent with doing more than merely resting in bed 

all day.” Garrison v. Colvin, 759 F.3d 1016 (9th Cir. 2014). However: 

[w]hile a claimant need not ‘vegetate in a dark room’ in order to be eligible 

for benefits, Cooper v. Bowen, 815 F.2d 557, 561 (9th Cir. 1987) (quoting 

Smith v. Califano, 637 F.2d 968, 971 (3d Cir. 1981)), the ALJ may discredit 

a claimant's testimony when the claimant reports participation in everyday 

activities indicating capacities that are transferable to a work setting, see

Morgan v. Comm'r Soc. Sec. Admin., 169 F.3d 595, 600 (9th Cir. 1999); Fair, 

885 F.2d at 603. Even where those activities suggest some difficulty 

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functioning, they may be grounds for discrediting the claimant's testimony to 

the extent that they contradict claims of a totally debilitating impairment. See 

Turner v. Comm'r of Soc. Sec., 613 F.3d 1217, 1225 (9th Cir. 2010); Valentine 

v. Comm'r Soc. Sec. Admin., 574 F.3d 685, 693 (9th Cir. 2009).

Molina v. Astrue, 674 F.3d 1104, 1112–13 (9th Cir. 2012) (emphasis added). Here, the ALJ 

specifically noted that plaintiff’s testimony regarding her daily activities was inconsistent 

with disabling functional limitations, and thus contradicted her pain and symptom 

testimony. [AR 23-24]. Further, the ALJ concluded that such everyday activities “were 

the same as those needed to obtain and maintain employment.” [AR 24]. The Ninth Circuit 

has provided that “[i]f, despite [her] claims of pain, a claimant is able to perform household 

chores and other activities that involve many of the same physical tasks as a particular type 

of job, it would not be farfetched for an ALJ to conclude that the claimant's pain does not 

prevent the claimant from working.” Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989); see 

also Thomas v. Barnhart, 278 F.3d 947, 959 (9th Cir. 2002) (upholding ALJ’s negative 

credibility determination where claimant’s testimony was at odds with her ability “to 

perform various household chores such as cooking, laundry, washing dishes, and 

shopping”). The Court finds the ALJ was justified in considering plaintiff’s daily activity 

in discounting her pain testimony.

D. Whether the ALJ erred in considering plaintiff’s failure to follow her 

prescribed course of treatment

The Court addresses plaintiff’s fourth and final argument, namely that the ALJ 

improperly considered plaintiff’s failure to take a prescribed medication. Failure to follow 

a prescribed course of treatment may support a finding that the subjective pain complaint 

is unjustified or exaggerated. Chaudhry v. Astrue, 688 F.3d 661, 672 (9th Cir. 2012). 

However, an ALJ may not rely on a failure to follow a prescribed course of treatment as a 

basis to discount a claimant’s testimony if the claimant has a “good reason” for not doing 

so. Fair, 885 F.2d at 603. Plaintiff argues “her noncompliance with Plavix following the 

stent placement was due to Pena’s preoccupation and depression related to her breast 

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cancer diagnosis . . .” and is, therefore, a “good reason” for discontinuing Plavix.7[Doc. 

No. 19, at p. 3]. The Court disagrees.

The Code of Federal Regulations provides an illustrative list of “good reasons” for 

not following a prescribed course of treatment:

(c) Acceptable reasons for failure to follow prescribed treatment. We will 

consider your physical, mental, educational, and linguistic limitations 

(including any lack of facility with the English language) when determining if 

you have an acceptable reason for failure to follow prescribed treatment. The 

following are examples of a good reason for not following treatment:

(1) The specific medical treatment is contrary to the established teaching 

and tenets of your religion;

(2) The prescribed treatment would be cataract surgery for one eye, 

when there is an impairment of the other eye resulting in a severe loss 

of vision and is not subject to improvement through treatment;

(3) Surgery was previously performed with unsuccessful results and the 

same surgery is again being recommended for the same impairment;

(4) The treatment because of its magnitude (e.g., open heart surgery), 

unusual nature (e.g., organ transplant), or other reason is very risky for 

you; or

(5) The treatment involves amputation of an extremity, or a major part 

of an extremity.

20 C.F.R. § 404.1530(c). See also Fair, 885 F.2d at 603 (“While there are any number of 

good reasons for not doing so, see, e.g., 20 C.F.R. § 404.1530(c) . . . a claimant's failure 

to assert one, or a finding by the ALJ that the proffered reason is not believable, can cast 

doubt on the sincerity of the claimant's pain testimony”); Gallant v. Heckler, 753 F.2d 

 

7 As indicated on page 5, supra, plaintiff also discontinued the use of Tamoxifen due to abnormal 

uterine bleeding. However, neither plaintiff nor defendant brought up this point in their briefs, and the 

ALJ did not indicate in his decision that he considered plaintiff’s discontinuance of Tamoxifen in 

making his determination to deny benefits. 

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1450, 1454 (9th Cir. 1984) (finding an ALJ improperly considered claimant’s failure to 

take pain medication because claimant’s doctor recommended claimant cease taking it). 

Here, the list of adequate reasons above does not suggest preoccupation with a 

medical diagnosis is a reasonable basis for failure to follow prescribed treatment. 

Moreover, plaintiff was neither advised to stop taking Plavix by her doctor at that time, nor 

is it apparent from the record that she was motivated by physical or mental symptoms or 

side effects caused by the drug. The Court therefore finds that plaintiff did not have a 

sufficient basis for discontinuing Plavix, and the ALJ properly considered the

discontinuance in his disability determination.

In sum, for the reasons stated above, the ALJ properly found plaintiff's subjective 

pain and symptom testimony less than fully credible because he provided specific, clear 

and convincing reasons supported by substantial evidence in making his determination.8

Accordingly, the Court RECOMMENDS that defendant’s motion be GRANTED

and plaintiff’s motion be DENIED.

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8 Plaintiff places reliance on Social Security Ruling 16-3-p, which requires an ALJ to articulate specific 

and legitimate reasons for rejecting pain and limitation testimony. As the ALJ provided clear and 

convincing reasons for the rejection, the Court finds the ALJ satisfied this Ruling.

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CONCLUSION

Based on the foregoing, IT IS HEREBY RECOMMENDED THAT THE 

DISTRICT COURT: 

1. GRANT defendant’s Cross-Motion for Summary Judgment [Doc. No. 14]. 

2. DENY plaintiff’s Motion for Summary Judgment [Doc. No. 17]. 

This Report and Recommendation of the undersigned Magistrate Judge is submitted 

to the United States District Judge assigned to this case, pursuant to the provisions of 28 

U.S.C. § 636(b)(1) and Civil Local Rule 72.1(d). Within fourteen (14) days after being 

served with a copy of this Report and Recommendation, “any party may serve and file 

written objections.” 28 U.S.C. § 636(b)(1)(B)&(C). The document should be captioned 

“Objections to Report and Recommendation.” The parties are advised that failure to file 

objections within this specific time may waive the right to raise those objections on appeal 

of the Court’s order. Martinez v. Ylst, 951 F.2d 1153, 1156-57 (9th Cir. 1991). 

IT IS SO ORDERED.

Dated: July 30, 2018

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