Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_12-cv-00068/USCOURTS-azd-2_12-cv-00068-0/pdf.json

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

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WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Kelvin Williams, 

Plaintiff, 

vs.

Michael J. Astrue, Commissioner of Social

Security, 

Defendant. 

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No. CV 12-00068-PHX-NVW

ORDER

Plaintiff Kelvin Williams seeks review under 42 U.S.C. § 405(g) of the final

decision of the Commissioner of Social Security (“the Commissioner”), which denied

him disability insurance benefits under sections 216(i), 223(d), and 1614(a)(3)(A) of the

Social Security Act. Because the decision of the Administrative Law Judge (“ALJ”) is

supported by substantial evidence and is not based on legal error, the Commissioner’s

decision will be affirmed.

I. Background

A. Factual Background

Williams was born in May 1963. He has at least a high school education and

previously worked as a warehouse worker, ramp agent, and audio/video equipment

installer. In August 2008, Williams fell while working as a custodian and suffered a

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shoulder injury and a closed head injury. He subsequently reported and was treated for

memory problems, headaches, and other symptoms that improved in the fall of 2010.

B. Procedural History

On June 16, 2009, Williams protectively applied for disability insurance benefits

and supplemental security income, alleging disability since October 8, 2008. On May 12,

2011, he appeared with his attorney and testified at a hearing before the ALJ. An

independent and impartial vocational expert and two independent and impartial medical

experts also testified. At the hearing, Williams moved to amend his application to a

closed period from October 8, 2008, through November 1, 2010.

On June 2, 2011, the ALJ issued a decision that Williams was not disabled within

the meaning of the Social Security Act. The Appeals Council denied Williams’ request

for review of the hearing decision, making the ALJ’s decision the Commissioner’s final

decision. On January 11, 2012, Williams sought review by this Court.

II. Standard of Review

The district court reviews only those issues raised by the party challenging the

ALJ’s decision. See Lewis v. Apfel, 236 F.3d 503, 517 n.13 (9th Cir. 2001). The court

may set aside the Commissioner’s disability determination only if the determination is not

supported by substantial evidence or is based on legal error. Orn v. Astrue, 495 F.3d 625,

630 (9th Cir. 2007). Substantial evidence is more than a scintilla, less than a

preponderance, and relevant evidence that a reasonable person might accept as adequate

to support a conclusion considering the record as a whole. Id. In determining whether

substantial evidence supports a decision, the court must consider the record as a whole

and may not affirm simply by isolating a “specific quantum of supporting evidence.” Id.

As a general rule, “[w]here the evidence is susceptible to more than one rational

interpretation, one of which supports the ALJ’s decision, the ALJ’s conclusion must be

upheld.” Thomas v. Barnhart, 278 F.3d 947, 954 (9th Cir. 2002) (citations omitted).

If the ALJ’s decision is not supported by substantial evidence or suffers from legal

error, the court has discretion to reverse and remand either for an award of benefits or for

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further administrative proceedings. Smolen v. Chater, 80 F.3d 1273, 1292 (9th Cir.

1996); Sprague v. Bowen, 812 F.2d 1226, 1232 (9th Cir. 1987). “Remand for further

proceedings is appropriate if enhancement of the record would be useful.” Benecke v.

Barnhart, 379 F.3d 587, 593 (9th Cir. 2004). “Conversely, where the record has been

developed fully and further administrative proceedings would serve no useful purpose,

the district court should remand for an immediate award of benefits.” Id. (citing Smolen,

80 F.3d at 1292). 

The ALJ is responsible for resolving conflicts in medical testimony, determining

credibility, and resolving ambiguities. Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir.

1995). In reviewing the ALJ’s reasoning, the court is “not deprived of [its] faculties for

drawing specific and legitimate inferences from the ALJ’s opinion.” Magallanes v.

Bowen, 881 F.2d 747, 755 (9th Cir. 1989). 

III. Issues Presented for Review

Williams has identified two issues for review: (1) whether the ALJ misinterpreted

evidence (i.e., medical source opinions) to the detriment of the claimant and (2) whether

the ALJ rejected the opinion of a treating source (i.e., a psychiatric nurse at Southwest

Behavioral Health) inappropriately. He does not claim disability from physical

limitations, only “disability from a psychological perspective.”

IV. Analysis

The two issues Williams has identified for appeal challenge how the ALJ

interpreted and weighed medical source evidence. 

A. Legal Standard for Weighing Medical Source Evidence

In weighing medical source opinions in Social Security cases, the Ninth Circuit

distinguishes among three types of physicians: (1) treating physicians, who actually treat

the claimant; (2) examining physicians, who examine but do not treat the claimant; and

(3) non-examining physicians, who neither treat nor examine the claimant. Lester v.

Chater, 81 F.3d 821, 830 (9th Cir. 1995). Generally, more weight should be given to the

opinion of a treating physician than to the opinions of non-treating physicians. Id. A

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treating physician’s opinion is afforded great weight because such physicians are

“employed to cure and [have] a greater opportunity to observe and know the patient as an

individual.” Sprague v. Bowen, 812 F.2d 1226, 1230 (9th Cir. 1987). Where a treating

physician’s opinion is not contradicted by another physician, it may be rejected only for

“clear and convincing” reasons, and where it is contradicted, it may not be rejected

without “specific and legitimate reasons” supported by substantial evidence in the record. 

Lester, 81 F.3d at 830. Moreover, the Commissioner must give weight to the treating

physician’s subjective judgments in addition to his clinical findings and interpretation of

test results. Id. at 832-33.

Further, an examining physician’s opinion generally must be given greater weight

than that of a non-examining physician. Id. at 830. As with a treating physician, there

must be clear and convincing reasons for rejecting the uncontradicted opinion of an

examining physician, and specific and legitimate reasons, supported by substantial

evidence in the record, for rejecting an examining physician’s contradicted opinion. Id. at

830-31. 

The opinion of a non-examining physician is not itself substantial evidence that

justifies the rejection of the opinion of either a treating physician or an examining

physician. Id. at 831. “The opinions of non-treating or non-examining physicians may

also serve as substantial evidence when the opinions are consistent with independent

clinical findings or other evidence in the record.” Thomas, 278 F.3d at 957. Factors that

an ALJ may consider when evaluating any medical opinion include “the amount of

relevant evidence that supports the opinion and the quality of the explanation provided;

the consistency of the medical opinion with the record as a whole; [and] the specialty of

the physician providing the opinion.” Orn, 495 F.3d at 631. 

Moreover, Social Security Rules expressly require a treating source’s opinion on

an issue of a claimant’s impairment be given controlling weight if it is well-supported by

medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent

with the other substantial evidence in the record. 20 C.F.R. § 404.1527(d)(2). If a

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treating source’s opinion is not given controlling weight, the weight that it will be given is

determined by length of the treatment relationship, frequency of examination, nature and

extent of the treatment relationship, relevant evidence supporting the opinion, consistency

with the record as a whole, the source’s specialization, and other factors. Id.

Finding that a treating physician’s opinion is not entitled to controlling weight

does not mean that the opinion should be rejected:

[A] finding that a treating source medical opinion is not wellsupported by medically acceptable clinical and laboratory diagnostic

techniques or is inconsistent with the other substantial evidence in the case

record means only that the opinion is not entitled to “controlling weight,”

not that the opinion should be rejected. Treating source medical opinions

are still entitled to deference and must be weighed using all of the factors

provided in 20 C.F.R. §404.1527. . . . In many cases, a treating source’s

medical opinion will be entitled to the greatest weight and should be

adopted, even if it does not meet the test for controlling weight.

Orn, 495 F.3d at 631-32 (quoting Social Security Ruling 96-2p). Where there is a

conflict between the opinion of a treating physician and an examining physician, the ALJ

may not reject the opinion of the treating physician without setting forth specific,

legitimate reasons supported by substantial evidence in the record. Id. at 632. 

B. The ALJ Did Not Err in Interpreting or Weighing Medical Source

Evidence.

1. The ALJ’s Evidentiary Findings

Williams contends that the ALJ erred by misinterpreting evidence from Dr. Steven

Savlov, Dr. Valerie Kemper, Dr. Michael Rabara, and Dr. Edward Jasinski. 

a. Dr. Savlov, Examining Neuropsychologist

The ALJ summarized the assessment completed by Dr. Savlov as follows:

Steven Savlov, Ph.D. completed a neuropsychological assessment in April

2009. Dr. Savlov indicated the claimant’s results of a client effort test most

likely represented a significant underestimation of his current cognitive

abilities, and as such, should be treated with extreme caution. Dr. Savlov

stated that in terms of assessing the claimant’s cognitive complaints, his

assessment was particularly unrevealing in that the claimant did not put

forth adequate effort for him to assess the claimant’s cognitive strengths

and relative weaknesses. Dr. Savlov did not give a primary diagnosis of the

claimant (Exhibit 4).

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Williams contends that the ALJ erred by concluding that Dr. Savlov did not give a

primary diagnosis and that in fact he stated diagnoses in November 2008 and June 2009. 

However, the ALJ correctly stated that Dr. Savlov did not give a primary diagnosis in

Exhibit 4 cited by the ALJ, which is the April 2009 “In-Depth Neurological and

Behavioral Medicine Consultation Assessment.” 

During the April 2009 assessment, prior to cognitive testing, Williams completed a

test of client effort, which he failed. Dr. Savlov observed that Williams’ results “most

likely represent a significant underestimation of his current cognitive abilities, and, as

such, should be interpreted with extreme caution.” Under the heading “Clinical and

Diagnostic Impressions,” Dr. Savlov stated, in part, in bold:

In terms of assessing the patient’s cognitive complaints, this assessment was

particularly unrevealing in that the patient did not put forth adequate effort

for this provider to assess his cognitive strengths and relative[] weaknesses. 

. . . Although this may be due to a variety of reasons (one of them which

may be the financial incentive for disability) it is clear that the patient may

also be having significant psychiatric distress, including (but not limited to)

depression, anxiety, or psychosis. Unfortunately, this provider is unable to

speak to the patient’s current level of cognitive status.

Dr. Savlov hypothesized that Williams was depressed, but overemphasized his level of

depression. 

In November 2008, Dr. Savlov made some initial diagnoses that he said would be

barriers to his return to his regular duties at the time, but recommended treatment and

further evaluation. In June 2009, Dr. Savlov met with Williams to review the results of

the April 2009 assessment. In his report regarding that office visit, Dr. Savlov stated that

Williams had a schizoaffective disorder with delusional psychotic symptomalogy with

paranoid features and dementia due to schizoaffective disorder with paranoid and

delusional symptoms. The report also states that Williams “could have a psychiatric

problem” and needs neuropsychological testing. It includes a number of

recommendations for Williams, including lifestyle management strategies and getting

back on his medication for schizophrenia and mood disorders. 

b. Dr. Kemper, Examining Psychologist

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Williams contends the ALJ erred in interpreting the evidence because he said he

gave Dr. Kemper’s opinion great weight but did not accept her Global Assessment of

Functioning score of 40, which indicates an inability to sustain work. However, the ALJ

did not state that he gave Dr. Kemper’s opinion controlling weight, and he expressly gave

great weight to her opinion that Williams’ test results were invalid due to his lack of

effort. Dr. Kemper stated:

This evaluation appears to represent a questionable assessment of Mr.

Williams’ current psychological functioning as his results on the

comprehensive testing were diverse. Also, on memory tests, Mr. Williams

displayed a higher than expected rate of forgetting, given his immediate

memory performance.

. . . .

Mr. Williams demonstrates significant impairment in multiple areas

of functioning that compromise his ability to gain and/or retain

employment; however, it is questionable as to whether he provided his best

effort consistently. Therefore, it is uncertain as to whether he is entirely

precluded from seeking gainful employment and it is difficult to assess his

actual level of impairment and work capabilities.

c. Dr. Rabara, Examining Psychologist

Dr. Rabara concluded:

[M]any of his reported symptoms were vague and not entirely plausible. He

was clearly putting forth a poor effort during the testing and his current

scores are not considered valid. Overall, considering the fact that he was

gainfully employed prior to his injury, records refer to essentially normal

neurological imaging findings, and current test results show poor effort, it is

the opinion of this examiner that he is exaggerating his deficits for the

secondary gain of financial benefit from disability benefits and should he

choose to put forth the effort, he seems capable of more than he reports.

Williams contends that the ALJ erred by giving great weight to Dr. Rabara’s opinion

because “Dr. Rabara’s opinion of no 12 months impairment seems to be totally contrary

to the evidence of record.” However, the ALJ correctly stated that Dr. Rabara’s opinion

was supported by the other medical opinions that Williams’ test results were invalid due

to his lack of effort. 

d. Dr. Jasinski, Psychological Expert

Having reviewed all the medical evidence of record, Dr. Jasinski testified at the

administrative hearing that anyone who had done an objective assessment of Williams

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had concluded that Williams was malingering or exaggerating symptoms. His overall

opinion was that Williams did not have any limitations affecting his ability to work

because of the possibility of malingering. Williams contends that the ALJ erred by giving

great weight to Dr. Jasinski’s opinion because his testimony was inconsistent and because

Dr. Jasinski stated there had been a diagnosis of malingering when no such diagnosis had

been made. It is true that the record does not show that any medical provider reached a

final diagnosis of malingering, but many said malingering needed to be ruled out and/or

another diagnosis could not be reached because Williams’ lack of effort and exaggeration

of symptoms invalidated the assessments. The record demonstrates that Williams’

participation in assessments lacked credibility. Thus, Dr. Jasinski’s opinion is consistent

with the evidence of record.

Therefore, the ALJ did not err by misinterpreting evidence from Dr. Steven

Savlov, Dr. Valerie Kemper, Dr. Michael Rabara, and Dr. Edward Jasinski. 

2. Psychiatric Nurse Practitioner at Southwest Behavioral Health

Williams contends that the ALJ erred by rejecting the December 2009 opinion of

the psychiatric nurse practitioner, Sharon Lorraine Paul, Doctor of Nursing Practice, at

Southwest Behavioral Health. Evidence from nurse practitioners may be considered to

show the severity of a claimant’s impairment and how it affects his ability to work, but

may be discounted if the ALJ states “reasons germane to each witness for doing so.” See

20 C.F.R. § 404.1513(a), (d); Molina v. Astrue, 674 F.3d 1104, 1111 (9th Cir. 2012). 

Williams began treatment at Southwest Behavioral Health in July 2009. In

December 2009, Dr. Paul assessed Williams as having extreme limitations (“no useful

ability to function”) in his ability to carry out short, simple instructions; make judgments

on simple work-related decisions; interact appropriately with the public; interact

appropriately with supervisors; interact appropriately with co-workers; and respond

appropriately to work pressures in a usual work setting. She assessed him as having

marked limitations (“severely limited”) in his ability to understand and remember short,

simple instructions; understand and remember detailed instructions; and respond

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appropriately to changes in a routine work setting. Dr. Paul reported that her assessment

was supported by her findings of psychotic symptoms, mood instability, and paranoid

ideation and opined that Williams’ condition was likely chronic and lifelong.

In April 2011, DNP Paul assessed his limitations as “none” or “slight,” except that

his ability to respond appropriately to work pressures in a usual work setting was

“moderate.” She commented that Williams’ mood disorder was cyclic in nature, and

when his mood was stable, his responses were within normal limits. She opined,

however, that he had “potential to become unstable and psychotic without medication, at

which time he is not able to function appropriately in any social settings.” 

The ALJ’s hearing decision stated:

The opinion of Sharon Paul, DNP, is given little weight as she opined in

December 2009 that the claimant is disabled and his mental impairments

were chronic and lifelong and then in April 2011, she opined that when the

claimant is on his medication, he responds appropriately []. Not only does

she give[] conflicting opinions, but other professional medical sources

throughout the record conflict with her opinion, such as the opinions of Dr.

Kemper and Dr. Rabara, as well as the mental health medical expert, Dr.

Jasinski. Her professional qualifications are simply not on par with those of

the other medical experts. In addition, the claimant had a global assessment

functioning equal to 65, which indicates only some difficulty in social,

occupational, or school functioning and conflicts with Sharon Paul’s

opinion that the claimant is disabled []. Also, the determination concerning

whether or not the claimant is disabled is reserved for the Commissioner.

Thus, the ALJ has provided reasons germane to DNP Paul for discounting her assessment

of Williams.

IT IS THEREFORE ORDERED that the final decision of the Commissioner of

Social Security is affirmed. The Clerk shall enter judgment accordingly and shall

terminate this case. 

DATED this 6th day of September, 2012.

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