Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-3_04-cv-01639/USCOURTS-azd-3_04-cv-01639-0/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 (DIWC)

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WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Kathy M. Hill, 

Plaintiff, 

vs.

Jo Anne B. Barnhart, Commissioner of

Social Security, 

Defendant. 

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No. CV-04-1639-PHX-NVW

ORDER

The Court has before it Plaintiff's Motion for Summary Judgment, Doc. #17, Plaintiff's

Statement of the Case and Statement of Facts, Doc. #18, Defendant's Cross-Motion for

Summary Judgment and Response to Plaintiff's Motion for Summary Judgment, Doc. #24,

Defendant's Statement of Facts, Doc. #26, and Plaintiff's Reply to Defendant's Response

Motion, Doc. #29. 

Plaintiff Kathy M. Hill ("Hill") brought this action against the Commissioner Of

Social Security ("Commissioner") alleging that her application for Disability Insurance

Benefits ("DIB") and period of disability was wrongfully denied. Hill now moves for

reversal of the decision below and a remand for a new hearing or an award of benefits. The

Commissioner cross-moves for summary judgment. 

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I. Background

Kathy Hill ("Hill"), age fifty-one at the time of the hearing before the Administrative

Law Judge ("ALJ"), has approximately a tenth-grade education, and her past work

experiences include working as an office sales manager and as a fascimile technician. Hill

ceased working on April 16, 1999. 

Hill sought treatment for her migraines and seizures from three different doctors. She

saw Dr. Ferer between March 1999 and April 1999, Dr. Rosenthal between May 1999 and

September 1999, and Dr. Reeck between November 1999 and December 2002. Dr. Ferer

ordered an MRI of Hill's brain and an electroencephalogram. Plaintiff's Statement of the

Facts ("PSOF") at ¶¶ 4, 7. Neither test revealed any abnormalities. Id. at ¶¶ 6, 7. Dr.

Rosenthal ordered a contrast MRI and MRA, which revealed that an artery was traversing

Hill’s brainstem in a diagonal direction, rather than moving directly at the brainstem in the

midline. Id. at ¶ 10. Dr. Rosenthal stated that she was "uncertain as to the significance of

this finding." Id. The doctors prescribed a variety of drugs in an attempt to control Hill's

migraines and seizures. 

In August 2000, Hill filed a claim with the Social Security Administration ("SSA"),

asking for a period of disability and for Disability Insurance Benefits ("DIB"). Hill alleged

that she became disabled on July 28, 1999. The claim was denied initially by the SSA,

denied again after reconsideration by the SSA, and also denied by the Arizona Disability

Determination Service. Hill then requested a hearing before an ALJ, which was held on

December 19, 2002. In his Notice of Decision, the ALJ concluded that Hill had a history of

carpal tunnel syndrome in both upper extremities, migraine headaches, and a seizure

disorder. Tr. at 32. He also concluded that Hill could still perform her past work as an office

sales manager, and therefore she was not disabled within the meaning of the Social Security

Act. On June 27, 2004, the Appeals Council denied Hill's Request for Review, adopting the

ALJ's findings as the final decision of the Commissioner. Hill appeals the ALJ's findings in

this court. 

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Hill asserts that the ALJ erred in determining that Hill's testimony about her migraines

and seizures was not credible, and also claims that the ALJ improperly disregarded the

medical opinion of Dr. Reeck, her treating physician. The court addresses both arguments.

I. Standard of Review

The 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). In its review, the court "may set

aside a denial of disability benefits only if it is not supported by substantial evidence or if it

is based on legal error." Jamerson v. Chater, 112 F.3d 1064, 1066 (9th Cir. 1997) (citations

omitted); see Smolen v. Chater, 80 F.3d 1273, 1279 (9th Cir. 1996). "Substantial evidence

is relevant evidence which, considering the record as a whole, a reasonable person might

accept as adequate to support a conclusion." Flaten v. Sec’y of Health & Human Servs., 44

F.3d 1453, 1457 (9th Cir. 1995) (citations omitted). Such evidence is "more than a scintilla"

but "less than a preponderance." Smolen, 80 F.3d at 1279 (citations omitted). 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). 

III. Legal Standard

Part 404.1520 of the Code Of Federal Regulations describes the five-step sequential

evaluation process used in determining whether a claimant is disabled. The five steps are 1)

whether the claimant is currently working, 2) whether the impairment is severe, 3) whether

the impairment meets or equals an impairment in Appendix 1 of Subpart P of the regulations,

4) whether the claimant can perform work performed in the past, and 5) whether the claimant

has the ability to perform other work. 20 C.F.R. § 404.1520(a)(4)(i-v). The questions are

addressed in order; certain responses to these questions will lead to automatic eligibility or

ineligibility. See id. The ALJ in Hill's case made his decision at step four of the analysis by

determining that "claimant's medically determinable impairments do not prevent the claimant

from performing her past relevant work." Tr. at 33. At the fourth step, the burden is still on

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the claimant to demonstrate that she is disabled. Burch v. Barnhart, 400 F.3d 676, 679 (9th

Cir. 2005).

IV. Credibility Determinations

At the hearing, when referring to Hill, the ALJ stated that "[i]f I accept all of her

testimony, I would have to find that she cannot work." The ALJ cited objective medical

tests, doctor notes and statements, the fact that Hill could perform some household chores,

and damaging testimony as reasons to discount the credibility of Hill's testimony about the

severity of her migraines and seizures and the limitations caused by them. The ALJ therefore

concluded that Hill could still perform her past job as an office sales manager. 

 In weighing a claimant's credibility, the ALJ may consider various factors, including

the claimant's daily activities, the claimant's reputation for truthfulness, inconsistencies either

in her testimony or between her testimony and her conduct, her work record, and testimony

from physicians and third parties concerning the nature, severity, and effect of the symptoms

of which he complains. Smolen, 80 F.3d at 1284. If the ALJ finds particular testimony of

the claimant not credible, he must provide clear and convincing reasons for rejecting it.

Vertigan v. Halter, 260 F.3d 1044, 1049 (9th Cir. 2001) ("[A]bsent affirmative evidence of

malingering, an ALJ cannot reject a claimant's testimony without giving clear and convincing

reasons.")(citations omitted). The ALJ also "must specifically identify the testimony she or

he finds not to be credible and must explain what evidence undermines the testimony."

Holohan v. Massanari, 246 F.3d 1195, 1208 (9th Cir. 2001) (citations omitted). "General

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

what evidence undermines the claimant's complaints." Lester v. Chater, 81 F.3d 821, 834

(9th Cir. 1996). 

A. The ALJ's Evidence Questioning Hill's Credibility

1. Medical Tests

The ALJ cited medical tests performed on Hill–x-rays, an electroencephalogram,

MRIs, and an EEG–as evidence supporting his conclusion that Hill's migraines and seizures

were not as severe as Hill testified, stating that those tests did not "explain the claimant's

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alleged migraine headaches and accompanying seizures and visual disturbances." Tr. at 27.

Hill argues that the ALJ improperly relied upon these medical findings because "objective

findings are not required when there simply can be no objective verification of a particular

medical condition." Doc. # 19 at 4. While objective findings of a medical impairment may

not be necessary to demonstrate a condition, an ALJ may still use objective evidence to

assess the intensity and persistence of a claimant's symptoms. See 20 CFR §

404.1429(c)(2)("We must always attempt to obtain objective medical evidence and, when

it is obtained, we will consider it in reaching a conclusion as to whether you are disabled.

However, we will not reject your statements about the intensity and persistence of your pain

or other symptoms or about the effect your symptoms have on your ability to work solely

because the available objective medical evidence does not substantiate your statements.").

See also Rollins v. Massanari, 261 F.3d 853, 857 (9th Cir. 2001)("While subjective pain

testimony cannot be rejected on the sole ground that it is not fully corroborated by objective

medical evidence, the medical evidence is still a relevant factor in determining the severity

of the claimant's pain and its disabling effects."). The ALJ did not rely solely on objective

medical findings to discount Hill's credibility, and therefore properly used Hill’s medical

tests as a reason to discount her credibility. 

2. Dr. Rosenthal's Statement

The ALJ also cited a statement by Dr. Rosenthal as a reason to discount Hill's

testimony. Specifically, the ALJ stated that "the claimant's own treating physician, J.L.

Rosenthal, M.D., indicated that he had serious doubts about he claimant's credibility with

regard to her migraine headaches, seizures, and visual disturbances as MRI's and EEG's

showed no physical explanations for her symptoms." Tr. at 27. After evaluating Hill a

second time, Dr. Rosenthal provided in her report that "[i]t is somewhat possible that these

are factitious symptoms, or exaggerated symptoms . . . ." Tr. at 27. 

Hill argues that Dr. Rosenthal's statement about factitious or exaggerated symptoms

pertained only to her seizures, and was thus not a general statement about her migraines.

Hill's interpretation of Dr. Rosenthal's statement appears correct – Dr. Rosenthal engaged in

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an illness-by-illness analysis of how Hill's medical conditions should be treated. Dr.

Rosenthal had already concluded her section discussing treatment for Hill's chronic, mild

headaches and her section devoted to Hill's frequent migraines before she began discussing

Hill's seizure episodes. It was at the end of the report, where Dr. Rosenthal was still

discussing Hill's seizures, that Dr. Rosenthal stated that Hill’s symptoms may be factitious

or exaggerated. There is no indication that Rosnethal's statement was made in reference to

Hill's migraines. However, Rosenthal's statement, as a treating physician, is relevant in

evaluating the severity of Hill's seizures. 

3. Dr. Reeck's Statement to Dr. Kahn

 The ALJ cited a conversation between Dr. Kahn, a state employee, and Dr. Reeck

as a reason to discount Hill's credibility. According to the ALJ, Dr. Reeck told Dr. Kahn that

Hill's "seizure disorders were well controlled with the use of medications by September 2000

and that they should not pose a significant problem for her." Tr. at 27. See Tr. 250 for Dr.

Kahn's statement. Dr. Kahn also noted that Hill had not seen Dr. Reeck for nearly nine

months. Hill argues that Dr. Reeck's statement, if it even occurred, only establishes that

Hill's seizures were under control and has no bearing on Hill's migraines. Kahn's report

makes no reference to Hill's migraines other to say that "the seizures may be a manifestation

of the migraine headaches." Id. Hill therefore correctly argues that Reeck's statement only

addressed the severity of Hill's seizure episodes. However, the fact that Hill had not seen Dr.

Reeck in nine months is probative in determining the credibility of Hill's testimony regarding

the severity of both her seizures and migraines. 

4. Hill's Daily Activities 

The ALJ cited the hearing and Hill's Activities and Daily Living Questionnaire as

evidence that Hill could still perform many daily activities, including light housekeeping,

making beds, watering plants, cooking meals, washing dishes, dusting, washing clothes,

vacuuming, decorating her home, performing light gardening, and visiting frequently with

relatives. Tr. at 31. Hill argues that the ALJ's statement failed to acknowledge or mention

that at the hearing and on the Questionnaire, Hill provided specific, limiting information

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about her ability to perform those daily activities. Hill's argument is circuitous. The ALJ

cited Hill's performance of numerous daily activities as a reason supporting his conclusion

to discredit Hill's testimony about the severity of her migraines and the limitations caused by

the conditions. This is precisely the testimony that Hill is arguing the ALJ did not include

when he discussed Hill's ability to perform daily activities. But the ALJ did not include that

testimony because he did not believe it. Instead, the ALJ focused on the fact that Hill

performs a number of daily activities. The correct inquiry therefore is whether the ALJ

improperly cited the fact that Hill could perform daily activities as a reason discounting her

credibility. 

It is proper for an ALJ to consider a claimant's daily activities. Burch, 400 F.3d at 681

("The ALJ was permitted to consider daily living activities in his credibility analysis.").

However, the fact that a claimant can perform some daily activities does not mean that she

is not disabled. Vertigan, 260 F.3d at 1050 ("This court has repeatedly asserted that the mere

fact that a plaintiff has carried on certain daily activities, such as grocery, shopping, driving

a car, or limited walking for exercise, does not in any detract from her credibility as to her

overall disability. One does not need to be ‘utterly incapacitated’ in order to be disabled.").

The Vertigan court reversed the ALJ's decision because the ALJ discounted the claimant's

testimony by citing only the claimant's daily activities. In this case, the ALJ treated the fact

that Hill can perform some daily activities as one factor, see Smolen, 80 F.3d at 1284,

supporting his ultimate conclusion that Hill was not disabled. While not overly probative on

the question of Hill's credibility, the fact that Hill performs some daily activities supports the

ALJ's conclusion to discredit Hill's testimony. 

5. Hill's Testimony

The ALJ also explained that he discounted Hill’s credibility because she testified, at

the hearing, that she quit her job because her husband retired and because she needed to take

care of him. Tr. at 32. In addition, Dr. Armstrong recorded Hill as stating that she "[q]uit

when her husband retired and they moved to Arizona, 'plus I had carpal tunnel surgery and

started having seizures.'" Tr. at 291. On redirect by Hill’s attorney, Hill stated that the

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migraines and seizures would have prevented her from working even if her husband had not

retired. Tr. at 382. The ALJ suggested that the motivating reason behind Hill's request for

DIB was that her ailing husband needed someone to care for him at home. In this

proceeding, neither party has addressed this reason provided by the ALJ. 

B. Clear and Convincing Reasons

As discussed above, when an ALJ does not believe a claimant's testimony, the ALJ

must demonstrate that there is clear and convincing evidence for reaching such a conclusion.

In this case, while some of the ALJ’s proffered reasons for discounting Hill’s credibility are

not too persuasive, many others support his conclusion. In particular, the ALJ has cited

objective medical tests that failed to corroborate the severity of Hill's condition, Dr.

Rosenthal's statement that the seizures may be factitious or exaggerated, Dr. Reeve's

statement to Dr. Kahn that Hill's seizures were controlled, the fact that Hill performs some

daily activities, and testimony hinting that the reason behind Hill's request for disability is

because she wants to be at home with her husband. Furthermore, "[w]e give great weight to

an ALJ's credibility assessment.” Brawner v. Secr'y of Health and Human Serv., 839 F.2d

432, 433 (9th Cir. 1988). Because the ALJ has articulated clear and convincing reasons for

his conclusion that Hill's testimony regarding her pain and limitations was not fully credible,

he has satisfied the standard articulated in Vertigan. 

V. Dr. Reeck's Medical Opinion

Hill asserts that the ALJ did not accord Dr. Reeck's statement, that of a treating

physician, proper weight. "[W]here the treating doctor's opinion is not contradicted by

another doctor, it may be rejected only for 'clear and convincing' reasons." Lester, 81 F.3d

at 830. The ALJ must set forth his conclusion in proper detail. Embrey v. Bowen, 849 F.2d

418, 422 (9th Cir. 1988). Because the ALJ did not identify any other doctors' conflicting

opinions regarding Hill's alleged disability, he must therefore demonstrate that he had clear

and convincing reasons for disregarding Dr. Reeck's medical opinion. 

On December 18, 2002, Dr. Reeck submitted a statement to the ALJ in which he

stated that he was Hill's primary caregiver and that Hill’s headaches "have been severe and

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frequent to the extent that regular and reliable work has been problematic." Tr.at 316. The

ALJ provided three reasons why he disregarded Dr. Reeck's medical opinion: (1) objective

evidence did not support Dr. Reeck's opinion; (2) a conversation between Dr. Reeck and Dr.

Kahn, a state employee, on May 1, 2001, during which Dr. Reeck informed Dr. Kahn that

he last saw Hill in September 2000 and that Hill's seizures were controlled and not a

significant problem; and (3) Dr. Reeck's progress notes about Hill's doctor visits, which

failed to support Dr. Reeck's December 18, 2002 medical opinion. 

A. Objective Medical Evidence

An ALJ cannot reject a doctor's medical conclusion solely because there is no

objective medical evidence of the impairment. See Embrey, 849 F.2d at 421-22 (determining

that an ALJ erred in disregarding a doctor's conclusion about Embrey's condition when the

ALJ relied on a lack of objective evidence to support the doctor's conclusion). Furthermore,

"[t]he subjective judgments of treating physicians are important, and properly play a part in

their medical evaluations." Id. at 422. Therefore, the ALJ cannot properly disregard Dr.

Reeck's testimony based solely on the fact that objective evidence fails to support his medical

opinion. 

B. Dr. Reeck's Statement to Dr. Kahn

As discussed above, Dr. Kahn contacted Dr. Reeck to discuss Hill's medical condition.

In his report, Dr. Kahn wrote that Dr. Reeck "feels [the] seizure condition is controlled and

not a significant problem. [He] [a]lso tells me [that] the seizures may be a manifestation of

her migraine headaches." Tr. at 250. Dr. Kahn also wrote that Dr. Reeck had not seen Hill

since September 2000. Tr. at 250. The ALJ interpreted Dr. Kahn's report as showing that

Dr. Reeck "believed that the claimant's headaches were not severe enough to prevent her

from working." Tr. at 27. Dr. Kahn made only vague reference to Hill's migraines when Dr.

Kahn wrote that he contacted Dr. Reeck to discuss Hill's "medical condition," and when he

wrote that Dr. Reeck informed him that Hill's migraines may be causing her seizures. While

Dr. Kahn’s report primarily focused on Hill’s seizures, the fact that Hill had not sought

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medical attention in nearly nine months is probative in determining the severity of Hill’s

migraines. 

C. Dr. Reeck's Progress Reports

The ALJ cited three exhibits–Exhibit 8F, 13F, and 16F–as evidence supporting his

decision to reject Dr. Reeck's December 18, 2002 medical opinion. Tr. at 27. Because all

three exhibits are progress reports from Dr. Reeck, they will be treated together. In the three

exhibits, there are a total of twelve progress reports written by Dr. Reeck. In five of the

progress reports, Dr. Reeck discussed Hill's migraines and seizures. In the other seven

progress reports, Dr. Reeck only discussed the reason why Hill came in for a visit, such as

a follow-up visit for a hurt knee, a twisted ankle, lower-extremity swelling, high cholesterol,

or the flu. Even though the ALJ's decision does not clearly articulate why he pointed to these

three exhibits as evidence not in accord with Dr. Reeck's Dec. 18, 2002 diagnosis,

presumably he believed that Dr. Reeck's failure to mention the migraines and seizures in

every meeting demonstrated that those two conditions could not be too severe. 

The fact that Hill sought treatment from her primary-care physician for medical

conditions other than seizures and migraines is not dispositive on the question of the severity

of her migraines and seizures. However, the fact that Hill only sought medical consultation

for those two conditions on five occasions over a period of nearly three years undermines the

severity of the alleged impairments, and also undermines Dr. Reeck's conclusion that Hill

could not perform regular and reliable work. For example, other plaintiffs alleging disabling

migraines have produced much more extensive medical history of doctor visits. See, e.g.,

Giles v. Barnhart, 368 F. Supp.2d 924, 926-939 (N.D. Iowa 2005)(plaintiff continually

sought medical attention for her migraines); Ash v. Sullivan, 748 F. Supp. 804, 806-07 (D.

Kan. 1990)(plaintiff sought emergency room treatment for her headaches on an average of

four times a month). While Hill did not need to visit Dr. Reeck with the frequency of the

plaintiffs in Giles or Ash, the presence of only five visits over three years during which Hill's

migraines or seizures were discussed does not support Dr. Reeck's medical opinion that Hill

could not perform regular and reliable work. 

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 D. Clear and Convincing Standard

In sum, the three reasons that the ALJ provided supporting his conclusion to reject Dr.

Reeck's medical opinion–a lack of objective medical evidence, Dr.Kahn's notes about a

conversation between Dr. Reeck and Dr. Kahn regarding Hill's seizures, and Dr. Reeck's

progress reports that did not make reference to Hill's migraines or seizures–satisfy the

standard enunciated in Embrey. 849 F.2d at 422. The ALJ properly relied upon the objective

medical tests as evidence undermining Dr. Reeck’s December 18, 2002 medical opinion

because the ALJ did not solely rely on those medical tests in making his decision to disregard

the opinion. In addition, Dr. Kahn’s progress notes support the ALJ’s decision to disregard

Dr. Reeck’s opinion because he told Dr. Kahn that the seizures were under control and that

Hill had not sought medical attention in approximately nine months. Finally, Dr. Reeck’s

progress notes reflect that Hill only sought medical attention for her migraines and seizures

five times in three years. These progress notes clearly undermine Dr. Reeck’s opinion as to

the severity of Hill’s seizures and migraines. The ALJ provided the necessary detail for the

court to evaluate his decision. In addition, he provided clear and convincing reasons for his

decision to disregard Dr. Reeck's December 18, 2002 medical opinion that Hill could not

perform regular and reliable work. 

VI. Substantial Evidence

The only inquiry left before the court is whether the ALJ's decision "is supported by

substantial evidence." See Jamerson, 112 F.3d at 1066. Hill's argument for why the ALJ did

not have substantial evidence rested on her assertions that the ALJ improperly discredited

Hill's testimony and disregarded Dr. Reeck's medical conclusion that Hill could not sustain

regular and reliable work. Hill's assertions are incorrect, and as discussed in the preceding

two sections, the ALJ had clear and convincing reasons for his decision to discredit Hill’s

testimony and to disregard Dr. Reeck’s December 18, 2002 medical opinion. The ALJ

provided numerous reasons–objective medical evidence, Dr. Reeck’s progress notes, Dr.

Kahn’s notes, Dr. Rosenthal’s statement that Hill’s seizures may be factitious or exaggerated,

Hill’s testimony regarding the reason she quit her job, and her daily activities–supporting his

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conclusion that Hill was not disabled. Hill has not provided any additional legal arguments

for her position that the ALJ did not have substantial evidence supporting his conclusion;

therefore, the ALJ had substantial evidence supporting his decision that Hill was not disabled

within the SSA. 

The ALJ's decision is affirmed. 

IT IS THEREFORE ORDERED that plaintiff Hill's Motion for Summary Judgment,

Doc. #17, is denied. 

IT IS FURTHER ORDERED that Defendant's Response to Plaintiff's Motion for

Summary Judgment and Cross-Motion for Summary Judgment, Doc.# 24, is granted. The

clerk is directed to terminate this case.

IT IS FURTHER ORDERED that the clerk enter judgment in favor of Defendant and

that Plaintiff take nothing.

DATED this 23rd day of November, 2005.

 

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