Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-4_07-cv-00280/USCOURTS-azd-4_07-cv-00280-0/pdf.json

Nature of Suit Code: 863
Nature of Suit: Social Security - DIWC/DIWW (405(g))
Cause of Action: 42:402 Social Security Benefits

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IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

CYNTHIA G. YACKS,

Plaintiff,

vs.

MICHAEL J. ASTRUE, Commissioner of

Social Security,

Defendant. __________________________________

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NO. CV 07-280-TUC-RCC (BPV)

REPORT AND RECOMMENDATION

Plaintiff filed this action for review of the final decision of the Commissioner for

Social Security pursuant to 42 U.S.C. §§ 405(g). The case has been referred to the United

States Magistrate Judge pursuant to the Rules of Practice of this Court.

Pending before the Court is a Motion for Summary Judgment filed by Plaintiff on

January 15, 2008 (Doc. No. 10), a Responsive Brief in Opposition to Plaintiff’s Motion for

Summary Judgment (Doc. No. 13) filed by Defendant on February 12, 2008, and a Reply to

Defendant’s Responsive Brief in Opposition to Plaintiff’s Motion for Summary Judgment

(Doc. No. 17), filed on March 31, 2008. For the following reasons, the Magistrate Judge

recommends that the ALJ’s decision be reversed and the matter remanded for further

proceedings consistent with this report. 

I. PROCEDURAL HISTORY

Plaintiff filed an Application for Social Security Disability Insurance Benefits

(“SSDIB”) under Title II of the Social Security Act (“SSA”) on December 10, 2003, alleging

that she had suffered from a disability since August 2003. (Transcript/Administrative Record

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(“Tr.”) 65-67) Plaintiff alleged she was disabled due to injuries suffered in an industrial

incident in 2003, which resulted in a head and neck injury, neck and back pain, and the

inability to hold objects. (Tr. 75)

The Social Security Administration (SSA) denied Plaintiff's Application initially, and

on reconsideration. (Tr. 37-43, 49-51) Plaintiff requested review (Tr. 52) and on September

19, 2005, appeared with counsel, and testified at a hearing before Administrative Law Judge

(“ALJ”) Milan Dostal. (Tr. 305-352). Michael Yacks, Plaintiff’s husband, and a vocational

expert, also testified at the hearing. (Tr. 28-32 ) The ALJ found Plaintiff was not disabled.

(Tr. 18-29) Plaintiff requested review of the decision by the Social Security Administration’s

Appeals Council. (Tr. 14) The Appeals Council denied review on April 19, 2007, making

the decision of the ALJ the final decision of the Commissioner. (Tr. 5-7) See 20 C.F.R. §§

404.981. Plaintiff timely filed the instant Complaint in U.S. District Court appealing the

Commissioner's final decision (Doc. No. 1). 

II. THE COMMISSIONER'S DECISION AND EVIDENCE PRESENTED

A. Plaintiff's Education and Work History

Plaintiff was born on November 30, 1961, and was forty-four years old on the ALJ’s

decision date. (Tr. 21, 65) She obtained a GED and completed about a year and a half of

college. (Tr. 81, 310) Plaintiff's past relevant work consists of floor sales at Wal-Mart,

nurses aid in a nursing home, bartending and waitressing, floor sales at Home Depot,

cashiering and managing at a store and gas station, sales in a women’s clothing store, and

working for Washington Mutual as a home loan clerk. (Tr. 76) 

B. Plaintiff's Testimony

On September 19, 2005, Plaintiff appeared before ALJ Dostal, with an attorney

representative. (Tr. 305-52) Exhibits 1A -10F were admitted into evidence. (Tr. 307)

Plaintiff testified that the last work she did was as at Home Depot in the design center. (Tr.

312) Plaintiff did not have to lift anything more than 20 pounds at Home Depot by herself.

(Tr. 313) Prior to Home Depot, Plaintiff worked at Washington Mutual for a few months

working with customers directly “straightening out” home loans on the phone. (Tr. 313)

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Prior to that she managed gas stations acting as cashier/manager. (Tr. 315) Before that, she

worked in a consignment clothing store marking and selling clothes. (Tr. 317) 

Plaintiff testified that she has pain in her upper back mostly, down her arms, and then

in the last year, in her hips and lower back. (Tr. 320) Plaintiff testified that on a daily basis

she takes her medications, gets out of bed to use the bathroom, and gets back in bed and

watches six or seven hours of TV a day. (Tr. 322) She approximates that she spends 22-24

hours a day in her room on her bed. (Tr. 324) She doesn’t drive and turned in her driver’s

license when she couldn’t turn her head all the way to the left or right. (Tr. 322) Plaintiff

has tried cooking, uses a microwave on occasion, but does not dust, sweep, or mop because

it hurts and her arms go numb, and she can’t stand for that long. (Tr. 322) She experiences

her back hurting, throbbing, and spasms, then her arms go numb within a few swipes of the

broom, so she returns to rest. (Tr. 324) Her friend comes to her room to visit. (Tr. 323) 

Plaintiff testified that she is depressed and feels useless because she can’t do anything

anymore. (Tr. 323) She used to do miniature wax coverings and small bead work but can’t

do it anymore. (Tr. 323) Her fingertips on her right hand are constantly numb, and if she

holds them a certain way, they go totally numb, cold, and she gets sharp electrifying and

burning pain down her arm. (Tr. 325) She also drops things. (Tr. 325) 

Plaintiff testified that a surgeon told her that it would be pointless to have surgery on

her vertebra because the discs above and below the problem area would deteriorate anyway.

(Tr. 325) Plaintiff testified that she has pain in her hips and her legs get tingly and numb,

with pain down to the back of her knee, but not real bad. (Tr. 325-36) 

Plaintiff testified that her medications help her get out of bed, but not for too long.

(Tr. 326) As a side effect she experiences dizziness, and is sleepy and tired, but has not had

any nausea. (Tr. 326) 

Michael Yacks, Plaintiff’s husband, testified at the hearing. (Tr. 332) Mr. Yacks

testified that a typical day for Plaintiff is spending most of the day in bed sleeping. (Tr. 333)

Mr. Yacks testified that Plaintiff gets depressed, tries to do things, but ends up in pain or not

being able to grip anything because of the numbness in her arms and fingers. (Tr. 333) Mr.

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Yacks calls Plaintiff throughout the day to make sure she’s okay, and she usually answers.

(Tr. 333) Because she doesn’t cook, he usually cooks, or they get fast food, but Plaintiff can’t

sit in a restaurant. (Tr. 333-34) Mr. Yack washes and braids her hair because Plaintiff can’t

keep her arms up. (Tr. 334) 

Ruth Van Fleet, a vocational expert, testified in response to questions asked by the

ALJ. (Tr. 336) Ms. Van Fleet provided the exertional and skill level involved in Plaintiff’s

past employment as a nurses aide - medium exertion level, semi-skilled, and with the job

specific requirement of lifting up to 100 pounds (which would increase the exertion level to

heavy or very heavy); floor sales at Wal-Mart - light exertion level, semi-skilled; bartending

and waitressing - light exertion level, semiskilled work, with the job specific requirement of

lifting up to 50 pounds (which would increase the exertion level to medium); Home Depot -

light exertion level, semiskilled to skilled; and cashier at gas station - light exertion level,

semiskilled to skilled, her job specific requirement working at Exxon required lifting 100

pounds would increase the exertion level to very heavy; and Washington Mutual Home

Loans by phone, sedentary exertion level, semi-skilled.

Ms. Van Fleet was presented with the following hypothetical by the ALJ: “...a

women who is 43 years of age and has one-and-a-half years of college education and has had

the work experience and the educational background that the Claimant ... has. ... [S]he would

be only able to lift frequently 10 pounds and 20 pounds on an occasion. And she would be

able to sit only about six hours during the workday with normal breaks. She would also need

those normal breaks with respect to any walking or standing. ... [T]his hypothetical person

can only occasionally climb, occasionally balance, occasionally stoop, occasionally kneel,

and should avoid crawling. She has problems with her arms so she should avoid working

above shoulder heights. She should also avoid working at unprotected heights ... particularly

ladders, ropes, or scaffolds and on or in moving machinery that would cause a hazard to

herself or others. ...[She] has some breathing problems so she should avoid working at places

where there are excessive amounts of gas, dust, and fumes. [She] ... has pain in various parts

of her body, including her head, her neck, her back, her arms and hips with occasionally

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tingling numbness in both her fingers and legs. ... [Her] pain level is of a slight nature and

has a slight effect on her ability to do basic work activities or that condition is or can be

controlled by appropriate medication without significant adverse side effects. ... [She] also

has some occasional dizziness and tiredness probably due to the medication but it would have

a slight effect on her ability to do basic work activities or it could be controlled by

appropriate medication without significant adverse side effects. ... [She] also has some mental

problems in the form of depression and anxiety with some decrease in memory, which would

have a slight effect on her ability to do basic work activities, or that condition is or could be

controlled by appropriate medication without significant adverse side effects. Based on that

hypothetical, could that hypothetical person with all those problems be able to do any of the

past work that was done by Claimant?” (Tr. 341-42) Ms. Fan Fleet responded that the

hypothetical person could return to the position such as the design center in Home Depot, or

Walmart. (Tr. 342-43) Additionally, if the numbness in her hands would not be such that

she’d still be able to perform working home loans by phone, then she could probably return

to a position such as that. (Tr. 343) 

The ALJ then proposed a second hypothetical, with all the same factors, except “the

pain is more severe. And it would be normally of a moderate nature and would normally

have a moderate effect on her ability to do basic work activities. However, that condition is

or still can be controlled by appropriate medication without significant adverse side effects.

So could hypothetical person number two with moderate with controlled pain be able to do

the work that was done as the design center clerk?” (Tr. 343-44) Ms. Van Fleet responded

affirmatively. (Tr. 344) 

The ALJ then proposed a third hypothetical, with all factors of the first hypothetical,

except “now the pain is severe. The pain is so severe that there is no amount of pain

medication that’ll help alleviate that pain. Or if it does alleviate the pain, then the side effects

of the pain medication are so significantly adverse that they would markedly interfere with

ability to maintain pace and concentration. So could hypothetical person number three, with

severe uncontrolled pain, be able to do any of the past work that was done by the

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Claimant...?” (Tr. 344) Ms. Van Fleet responded that she would probably be able to secure

a job but wouldn’t be able to maintain so it wouldn’t be in a competitive environment. (Tr.

345) 

The ALJ then asked if that was the case, if there were any other kind of work in the

national economy that this hypothetical person could do? (Tr. 345) Ms. Van Fleet responded

negatively. (Tr. 345) 

Plaintiff’s attorney proposed a fourth hypothetical, assuming the hypothetical person

“has severe stenosis in her neck and that as a result of that it causes her to have numbness in

her fingers to where even before she had an industrial accident, she had to give up a job

because she could not hold the phone or use the phone in any type of a constant manner or

use a keyboard in any type of repetitive manner. And further that she has a problem with

muscle lumbar spasm in her back ...[that] various doctors have had found neck spasm, that

she continues to have these problems unless she is taking medication and that she is on

Oxycodone, methadone, Percocet – or OxyContin, methadone, Percocet, and at times

Demerol. She also has, as a result of these, she gets ... very fatigued and sleepy. Assuming

those facts, is there any way she can keep any job on a competitive labor market?” (Tr. 346)

Ms. Van Fleet stated that the hypothetical person would not be able to maintain work in a

competitive labor market. (Tr. 346) 

Plaintiff’s attorney further asked if the hypothetical person has “[m]uscle spasm that

affects her legs and gives her numbness in her legs, makes it difficult for her to sit for long

periods or to stand or any type of length of time.... [I]f she sits for any longer than a half hour

or 45 minutes, she usually has to go lay down because she’s in muscle spasm pain and having

numbness down her legs and that her most comfortable position is reclining. Assuming that,

would there be any jobs on a competitive labor market?” The ALJ clarified that this

hypothetical included the same factors as hypothetical four except she could only sit and

stand for 45 minutes at a time and then has to lie down for 45 minutes. (Tr. 347-48) Ms. Van

Fleet responded that she couldn’t do any of her past work and she couldn’t do any other jobs

because that would need to be a selective position based on those limitations. (Tr. 348) 

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Ms. Van Fleet further opined that a slight cognitive limitation would not affect her

ability to get or keep work. (Tr. 349) Ms. Van Fleet also agreed that dropping items on an

ongoing basis would cause a problem with her ability to perform Plaintiff’s previous jobs,

and would affect her ability to get any jobs in the labor economy. (Tr. 349-50) 

C. Plaintiff’s Medical History - Physical Impairment

 On August 18, 2003, Plaintiff was examined at El Dorado Hospital’s Emergency

Department presenting complaints of back pain and arm numbness following heavy lifting

at work. (Tr. 161, 163) An MRI was performed on Plaintiff for clinical indications of

bilateral arm numbness and pain for greater than one year, getting progressively worse. The

MRI showed moderate to severe central spinal stenosis at C6-C7 with severe compromise

to the left neural foramen and moderate compromise to the right neural foramen secondary

to posterior ridging. (Tr. 166) The examining doctor noted a clinical impression of an acute

herniated disk at C6-C7. (Tr. 162) 

On August 23, 2003, after returning to work, Plaintiff was again seen at El Doroado

Hospital’s Emergency Department reporting a re-injury with complaints of neck, back, arm

and leg pain. (Tr. 158) The examining doctor’s clinical impression, after reviewing the MRI

taken previously, was an acute herniated disc. 

Jack Dunn, M.D., conducted a Neurosurgical Evaluation on Plaintiff, on December

17, 2003. (Tr. 172) Dr. Dunn’s report indicates that Plaintiff had initially injured herself on

July 28, 2003, at work, then re-injured herself on August 21. Dr. Dunn’s examination

revealed a “decreased range of motion and neck spasm, hypersensitivity in the posterior

cervical area and the instrascapular area. ... Tinel’s sign over the brachial plexus and the

axillary plexus ... decreased but present reflexes in all four extremities. ...No clonus, no

Babinski. [with] give-way so it’s difficult to get a good assessment of her normal strength

and her normal sensation is not reliable. She complains of the pain and dysesthesias going

into all five fingers on both hands now. She is able to stand and balance. Negative Romberg

but she has trouble balancing on her tiptoes.” (Tr. 172-73) Dr. Dunn recommended a collar

when she is active and a swimming exercise program, with re-evaluation in six weeks. (Tr.

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173) 

On December 31, 2003, Plaintiff was assessed with chronic pain at the Carondelet

Medical Group. Paul G. Koss, M.D., with Carondelet Medical Group, submitted a letter to

Plaintiff’s attorney, opining that his examination revealed mild right hand grip weakness,

with concerns that Plaintiff might have cervical radiculopathy and possibly cervical stenosis.

Dr. Koss recommended further neurological or neurosurgical evaluation, and prescribed

Non-steroidal anti-inflammatory medication and a narcotic analgesic. (Tr. 179) Dr. Koss

opined that Plaintiff has been unable to work in any capacity since her work related injuries

in June and August 2003, that she had sustained exacerbation of spondylosis of the cervical

spine that resulted in neck pain, which radiated to the arms and hands as well as paresthesias

in the right hand. (Tr. 179) 

After presenting to the El Dorado’s emergency room on January 20, 2003,

complaining of shooting pain, worse with certain positions of her neck, Plaintiff was

discharged with a diagnosis of radiculopathy. (Tr. 166-168) Plaintiff was prescribed

Percocet, Motrin, and Norflex. (Tr. 168) 

Lloyd S. Anderson, M.D., completed an Independent Medical Exam of Plaintiff. (Tr.

216) Dr. Anderson conducted a physical exam and reviewed Plaintiff’s medical records. Dr.

Anderson concluded that Plaintiff had recovered from her industrial accident, but the

continuation of symptoms following her injury was most likely due to severe spinal stenosis

at C6-7, secondary to advanced degenerative changes at that level which antedated the

industrial injury. (Tr. 215-16) Dr. Anderson opined that Plaintiff’s cervical spondylosis and

spinal stenosis at C6-7 prevents her from returning to heavy manual labor or activities, which

involve significant or repetitive movements of the head or neck, or working above the

shoulder or head level, and that she may require surgical decompression at the C6-7 level.

(Tr. 216) 

Plaintiff was treated by Darrell Jessop, M.D., who specializes in family practice and

pain management, from May 2004 to August 2005 (Tr. 23-295) Dr. Jessop initially assessed

Plaintiff with cervical radiculopathy; secondary to central spinal stenosis and neuroforaminal

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stenosis, depression, left TMJ syndrome, and degenerative disc disease C-spine, and

prescribed Oxycontin, Methadone, Percocet, and Temazepam for pain, nighttime pain,

breakthrough pain, and insomnia. (Tr. 294-95) 

At Plaintiff’s first month follow-up examination with Dr. Jessop, Dr. Jessop reported

that pain control had been generally effective, sleep quality was adequate, and Plaintiff

denied side effects from the medication. (Tr. 289) In July, 2004, Plaintiff reported more

breakthrough pain, and Dr. Jessop adjusted her pain medications accordingly. (Tr. 284) In

August, 2004, Plaintiff reported complaints of parasthesias in both legs down to the distal

extremities, and that her depression had been worsening over the course of the last three

week. (Tr. 278) In September, 2004, Plaintiff reported that she had been experiencing sharp

pains in the right shoulder and right hip, which Dr. Jessop believed to be degenerative in

etiology, and increased her dosage of Oxycontin. (Tr. 274) In October, Plaintiff reported

intermittent tarsalgia bilaterally, and that she was still having considerable pain at night and

in the late afternoon. (Tr. 270) Dr. Jessop again increased the dosage of her Oxycontin

prescription, and adjusted her medications for insomnia. (Tr. 270) In January, 2005, Plaintiff

reported pain in the left and right knee and pain in her hips. (Tr. 255) Dr. Jessop considered

the possibility of degenerative changes, but could not confirm the diagnosis with an x-ray

investigation because Plaintiff was without insurance and could not afford to pay for an xray. (Tr. 255) Dr. Jessop again increased her Oxycontin dosage, and began Plaintiff on

Demerol, Medrol and Phenergan for pain, inflammation, and nausea. (Tr. 255) In February,

2005, Dr. Jessop noted that Plantiff was “quite stiff with ambulation; it is particularly

difficult for her to get started in the morning.” (Tr. 250) Dr. Jessop increased her dosage of

Oxycontin, although he noted that he was “getting close to the point where I am beginning

to feel uneasy about the dose of medication...” but that a “titration today may be in order.”

(Tr. 250) In August, 2005 Plaintiff reported continued significant intervals of pain at night.

(Tr. 224) Dr. Jessop was reluctant to titrate her Oxycontin dosage any further, instead

increasing her evening dosage of Methadone. (Tr. 224) 

On October 18, 2005, Dr. Jessop submitted a letter to Plaintiff’s attorney regarding

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his management of Plaintiff’s chronic pain. (Tr. 297) He noted the diagnosis as listed

previously, and, in addition tarsalgia, hypertension, hyperlipidemia, and chronic hip pain

secondary to osteoarthritic degeneration. (Tr. 297) Dr. Jessop provided his subjective

assessment of Plaintiff, noting that as a result of degenerative processes in the neck, Plaintiff

experiences numbness and weakness in the arms and hands, with symptoms worsened with

abduction of the upper extremities over the head. (Tr. 297) Dr. Jessop noted that her grip

strength and fine motor control was also compromised, making self-care activities extremely

difficult. (Tr. 297) Dr. Jesson reported that Plaintiff had also been experiencing radiating

lower back pain, extending into the posterior aspect of both legs to the ankles when severe,

although Dr. Jessop noted that no radiological tests had been performed to determine the

cause of this pain. (Tr. 297) Dr. Jessop summarized Plaintiff’s functional capacity as

follows: 

...personal care is limited. The patient cannot nor should not lift anything over

two or three pounds and even this should be limited to only a few times a day.

She has been advised not to drive, climb, work around machinery or work in

high places. Any repetitive activities involving the upper arms and extremities

should be avoided. She is unable to sit or stand for more than 15 minutes at

a time. Changes in position would be required to prevent muscular spasm. 

Cognitive capacity and concentration may be limited and/or compromised as

a result of her medications.

(Tr. 298) 

Dr. Jessop’s overall assessment was that Plaintiff was “effectively disabled and is

incapable of performing any meaningful and employable work. She will most likely remain

on a medical regimen for her pain which would also limit her employability in terms of the

intolerance of controlled substances in the workplace.” (Tr. 299) 

Plaintiff was evaluated by a Disability Determinations Services doctor, Randy Soo

Hoo, M.D., on November 1, 2004. Dr. Soo Hoo, noting that radiographs of Plaintiff had

been requested but were still pending, concluded that Plaintiff was capable of the following

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work-related activities:

Lift/carry 20 pounds occasionally and 10 pounds frequently. Stand/walk at

least six hours per an eight-hour workday. Sit at least six hours per an eighthour workday. Climb ramps and stairs, never ladders, ropes and scaffolding.

No restrictions are noted for balancing and crouching. She can occasionally

stoop, kneel and never crawl. She can reach in all directions except for

overhead. No restrictions for handling, fingering and feeling. There are no

restrictions noted for hearing, seeing, and speaking. 

(Tr. 183) 

On November 29, 2004, Plaintiff was evaluated by David Mullon, M.D. (Tr. 39, 186-

193) Dr. Mullon reviewed Plaintiff’s medical records from Dr. Koss, and El Dorado

Hospital, and concluded that Plaintiff could lift and/or carry 20 pounds occasionally, 10

pounds frequently; stand and/ or walk and sit with normal breaks for 6 hours in an 8-hour

workday; she could climb, balance, stoop, kneel, crouch and crawl occasionally, but could

never climb a ladder, rope or scaffolds. (Tr. 187-188) No manipulative limitations were

established with the exception of limited reaching in all direction and “frequent” overhead

lifting. (Tr. 189) No other limitations were noted except for avoiding concentrated exposure

of fumes, odors, dusts, gases, and poor ventilation, and hazards such as machinery, heights,

etc. (Tr. 189-90) Dr. Mullon concluded that Plaintiff’s symptoms were attributable to a

medically determinable impairment, but that the severity or duration of the symptoms were

disproportionate to the expected severity or expected duration on the basis of Plaintiff’s

medically determinable impairments. (Tr. 191) 

D. Plaintiff’s Medical History - Mental Impairment

On December 1, 2004, Plaintiff’s mental status was evaluated by Paul Tangeman,

Ph.D. (Tr. 194-207) Dr. Tangeman, a psychologist, concluded that Plaintiff had no medically

determinable psychological impairment, and that no further development was necessary. (Tr.

194) 

E. Lay Testimony

Plaintiff’s husband, Michael Yacks, submitted an affidavit stating that his wife has

tried to take less medication and she was in such severe pain she was crying due to the pain

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in her neck and back going down her arms and legs, and that if she takes the medication she

sleeps much of the time, and if she doesn’t take the medication, she doesn’t sleep but is in

such pain that she cannot function. (Tr. 153-54) 

F. The Commissioner's Decision

On March 23, 2006, the ALJ made the following findings:

1. The claimant meets the nondisability requirements for a period of disability

and Disability Insurance benefits set forth in section 216(i) of the Social

Security Act and is insured for benefits through the date of this decision.

2. .The claimant has not engaged in substantial gainful since the alleged onset of

disability.

3. The claimant’s back pain, neck pain, hip pain, TMJ syndrome, hypertension,

hyperlipidemia, and depression/anxiety impairments are considered “severe”

based on the requirements in the Regulations 20 CFR § 404.1520(c)).

4. These medically determinable impairments do not meet or medically equal one

of the listed impairments in Appendix 1, Subpart P, Regulation No. 4.

5. The [ALJ] finds the claimant’s allegations regarding her limitations are not

totally credible for the reasons set forth in the body of the decision.

6. Based upon a careful examination of the medical evidence, the testimony of

the claimant and all the other evidence in the record, the [ALJ] finds that the

claimant retains the following residual functional capacity on a routine and

sustained basis to: occasionally lift and carry up to 20 pounds and frequently

lift and carry 10 pounds; sit, stand, and walk for 6 hours in an 8-hour workday

with normal breaks; occasionally climb, balance, stoop, and kneel; avoid

crawling; avoid climbing ladder/rope/scaffolds; avoid work above shoulder

heights; avoid work at unprotected heights and around moving machinery; and

avoid work with excessive dust, fumes, gases. The claimant has pain in

various parts of her body including her head, neck, back, arms (with occasional

tingling/numbness on fingers), and hips, which is of moderate-level and would

normally have a moderate effect on her ability to do work-related activities;

however, that pain is controlled by appropriate medication without any

significant adverse side effects. The claimant also has occasional tiredness,

which has a slight effect on her ability to do work-related activities. The

claimant has depression and anxiety with decrease in memory, which have a

slight effect on her ability to do basic work-related activities. 

7. The claimant’s past relevant work as a floor salesperson, design center clerk,

and home loan clerk did not require the performance of work-related activities

precluded by her residual functional capacity (20 CFR § 404.1565). 

8. The claimant’s medically determinable impairments do not prevent the

claimant from performing her past relevant work as a floor salesperson, design

center clerk, and home loan clerk. This finding is based upon vocational

expert evidence.

9. The claimant was not under a “disability” as defined in the Social Security

Act, at any time through the date of the decision (20 CFR § 404.1520(f)). 

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(Tr. 30-31)

The ALJ noted that, although Plaintiff has medically determinable impairments that

could be expected to result in her alleged symptoms and functional limitations, the “medical

evidence and other evidence in the record do not entirely substantiate the intensity and

persistence of symptoms as alleged by the claimant, nor by the effect her impairments have

on her ability to perform work-related activities.” (Tr. 23) 

 The ALJ noted that in terms of functional status related to her mental impairments,

the evidence showed a slight restriction of activities of daily living, slight difficulties in

maintaining social functioning, and slight difficulties in maintaining concentration,

persistence and pace. (Tr. 23) 

The ALJ commented that Dr. Jessop’s treatment notes from May 2004 through August

2005 indicated that throughout her treatment, Plaintiff’s pain control was “generally

effective” on her analgesic regimen; that she had no side effects from her medications; and

that she was satisfied with her current treatment. She constantly appeared well-groomed and

in mild distress, and her gait was entirely normal requiring no assistive device. Her sleep

quality was adequate and bowel function was normal. Her daily physical functioning was

adequate, and her mental status was normal. Plaintiff was treated in the emergency room on

August 19, 2003 for upper back and right upper extremity pain secondary to a work-related

injury in July 2003. The attending physician noted that the claimant’s quality and severity

of pain was dull and moderate. On August 23, 2003, when she was seen again at the

emergency room with complaints of pain, it was noted that she was still working, and was

prescribed pain medication and discharged in stable condition. (Tr. 23) The ALJ indicated

that Dr. Jessop noted that Plaintiff had a great deal of improvement in her overall pain level

and functionality, and that she was responding by increasing her physical activity level

substantially. (Tr. 24-25) 

The ALJ gave no weight to Dr. Jessop’s opinion in a letter dated October 18, 2005,

that she was disabled and unable to work due to her conditions. (Tr. 25) The ALJ rejected

the opinion as conclusory and unsupported by the medical evidence of record, and also noted

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that the letter appeared to contain inconsistencies, which rendered his opinion less

persuasive. (Tr. 25) 

The ALJ found Plaintiff’s testimony as to the severity of her pain and limitations to

be “extreme as to appear implausible.” (Tr. 25) Noting that Plaintiff’s husband testified

similar to the Plaintiff, the ALJ found the allegations of pain and side effects from her

medication, as well as her severe depression to be inconsistent with the treatment records,

and that her allegations were considered not fully credible. (Tr. 25-26) The ALJ noted that

Plaintiff’s reported limited daily activities are considered to be outweighed by the other facts

previously discussed, that she has received treatment for her allegedly disabling impairment,

but that it had been essentially routine and/or conservative in nature, and that Plaintiff had

been generally successful in controlling her symptoms. (Tr. 26) Additionally, although

Plaintiff testified that she had side effects from the use of her medications, the treatment

records did not support this finding. (Tr. 26) 

The ALJ also found the residual functional capacity conclusions reached by the state

disability doctors also supported a finding of “not disabled”, although they were nonexamining, and their opinions did not deserve as much weight as an examining or treating

physician. (Tr. 26) The ALJ also found that the opinions of Drs. Dunn, Anderson and Soo

Hoo also supported a finding of “not disabled.” 

The ALJ found Plaintiff retained the residual functional capacity as noted in ¶ 6,

supra. (Tr. 26) Relying on the vocational expert’s testimony, the ALJ found that the

Plaintiff was capable of performing her past relevant work as a floor salesperson, design

center clerk, and home loan clerk, and therefore was not under a disability as defined in the

Social Security Act at any time through the date of the decision. (Tr. 27-28) 

G. Additional Evidence Presented to the Appeals Council

Following the adverse decision by the ALJ, the Plaintiff submitted a letter of

contention, raising several errors in the ALJ’s decision to the Appeals Council, however, no

further medical evidence was submitted. (Tr. 8, 300-304) The Appeals Council denied

review without comment. (Tr. 8-10) 

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III. ISSUES

A. Plaintiff's Position

Plaintiff asserts that the ALJ erred by (1) rejecting Plaintiff’s doctors’ opinions

contrary to law; (2) improperly rejecting Plaintiff’s testimony as not credible; (3) posing an

incomplete hypothetical to the vocational expert. Plaintiff submits that the decision of the

Commissioner should be reversed, and Plaintiff found disabled. 

B. Defendant's Position

Defendant contends that the ALJ (1) properly assessed Plaintiff’s RFC; (2) properly

assessed Plaintiff’s credibility; and (3) properly determined that Plaintiff did not establish

that she could no longer perform her past work. 

IV. DISCUSSION

A. Standard of Review

An individual is entitled to Title II Social Security Disability Insurance benefits

("SSDIB") if the individual is insured for those benefits, has not attained retirement age, has

applied for those benefits, and is disabled. 42 U.S.C. § 423(a)(1). The definition of

disability is the "inability to engage in any substantial gainful activity by reason of any

medically determinable physical or mental impairment which can be expected to result in

death or which has lasted or can be expected to last for a continuous period of not less than

12 months." 42 U.S.C. § 423(d)(1)(A).

The Ninth Circuit has stated that "'a claimant will be found disabled only if the

impairment is so severe that, considering age, education, and work experience, that person

cannot engage in any other kind of substantial gainful work which exists in the national

economy.'" Penny v. Sullivan, 2 F.3d 953, 956 (9th Cir. 1993) (quoting Marcia v. Sullivan,

900 F.2d 172, 174 (9th Cir. 1990)). 

The claimant has the burden to establish a prima facie case showing an inability to

engage in previous occupations. Thompson v. Schweiker, 665 F.2d 936, 939 (9th Cir. 1982).

The burden then shifts to the Commissioner to show that other substantial work, for which

the claimant is qualified, exists in the national economy. Id. (citing Hall v. Secretary of

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HEW, 602 F.2d 1372, 1375 (9th Cir. 1979); Cox v. Califano, 587 F.2d 988, 990 (9th Cir.

1978)).

The court will set aside a denial of benefits only if the Commissioner's findings are

based on legal error or are not supported by substantial evidence in the record as a whole. 

Kail v. Heckler, 722 F.2d 1496, 1497 (9th Cir. 1984) (citing Sample v. Schweiker, 694 F.2d

639, 642 (9th Cir.1982), Thompson v. Schweiker, 665 F.2d 936, 939 (9th Cir.1982)); 42

U.S.C. § 405(g)). In determining whether there is substantial evidence, the Court must

consider the evidence as a whole, weighing both the evidence that supports and the evidence

that detracts from the Commissioner's conclusion. Jones v. Heckler, 760 F.2d 993, 995 (9th

Cir. 1985). 

Substantial evidence is "more than a scintilla," Richardson v. Perales, 402 U.S. 389,

401 (1971), but "less than a preponderance." Sorenson v. Weinberger, 514 F.2d 1112, 1119

n.10 (9th Cir. 1975); Desrosiers v. Secretary of Health and Human Servs., 846 F.2d 573,

576 (9th Cir. 1988). Substantial evidence is "'such relevant evidence as a reasonable mind

might accept as adequate to support a conclusion.'" Richardson, 402 U.S. at 401 (quoting

Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229 (1938)).

The Commissioner, not the court, is charged with the duty to weigh the evidence,

resolve material conflicts in the evidence and determine the case accordingly. Reviewing

courts must consider the evidence that supports as well as detracts from the examiner's

conclusion. Day v. Weinberger, 522 F.2d 1154, 1156 (9th Cir. 1975). Moreover, "if the

evidence can support either outcome, the court may not substitute its judgment for that of the

ALJ." Matney v. Sullivan, 981 F.2d 1016,1019 (9th Cir. 1992).

Disability claims are evaluated pursuant to a five-step sequential process. 20 C.F.R.

§§404.1520, 416.920; Baxter v. Sullivan, 923 F.2d 1391, 1395 (9th Cir. 1991). The first step

requires a determination of whether the claimant is engaged in substantial gainful activity.

20 C.F.R. §§ 404.1520(b). If so, then the claimant is not disabled under the Act and benefits

are denied. Id. If the claimant is not engaged in substantial gainful activity, the ALJ then

proceeds to step two which requires a determination of whether the claimant has a medically

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severe impairment or combination of impairments. 20 C.F.R. §§ 404.1520(c). In making a

determination at step two, the ALJ uses medical evidence to consider whether the claimant's

impairment more than minimally limits or restricts the claimant's physical or mental ability

to do basic work activities. Id. If the ALJ concludes that the impairment is not severe, the

claim is denied. Id. Upon a finding of severity, the ALJ proceeds to step three which

requires a determination of whether the impairment meets or equals one of several listed

impairments that the Commissioner acknowledges are so severe as to preclude substantial

gainful activity. 20 C.F.R. §§ 404.1520(d); 20 C.F.R. Pt. 404, Subpt. P, App.1. If the

claimant's impairment meets or equals one of the listed impairments, then the claimant is

presumed to be disabled and no further inquiry is necessary. If a decision cannot be made

based on the claimant's then current work activity or on medical facts alone because the

claimant's impairment does not meet or equal a listed impairment, then evaluation proceeds

to the fourth step. The fourth step requires the ALJ to consider whether the claimant has

sufficient residual functional capacity ("RFC") to perform past work. 20 C.F.R. §§

404.1520(e). If the ALJ concludes that the claimant has RFC to perform past work, then the

claim is denied. Id. However, if the claimant cannot perform any past work due to a severe

impairment, then the ALJ must move to the fifth step, which requires consideration of the

claimant's RFC to perform other substantial gainful work in the national economy in view

of claimant's age, education, and work experience. 20 C.F.R. §§ 404.1520(f). At step five,

in determining whether the claimant retained the ability to perform other work, the ALJ may

refer to Medical Vocational Guidelines ("grids") promulgated by the SSA. Desrosiers, 846

F.2d at 576-577. The grids are a valid basis for denying claims where they accurately

describe the claimant's abilities and limitations. Heckler v. Campbell, 461 U.S. 458, 462, n.5

(1983). However, because the grids are based on exertional or strength factors, where the

claimant has significant nonexertional limitations, the grids do not apply. Penny, 2 F.3d at

958-959; Reddick v. Chater, 157 F.3d 715, 729 (9th Cir. 1998). Where the grids do not apply,

the ALJ must use a vocational expert in making a determination at step five. Desrosiers, 846

F.2d at 580.

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A denial of Social Security benefits will be set aside if the Commissioner fails to

apply proper legal standards in weighing the evidence even though the findings may be

supported by substantial evidence. Winans v. Bowen, 853 F.2d 643, 644 (9th Cir. 1987).

When the ALJ has applied an incorrect legal standard in reaching a decision, we must

remand unless, as a matter of law, the result could not be affected. See NLRB v. Enterprise

Assoc., 429 U.S. 507, 522 n.9 (1977); Sagebrush Rebellion, Inc. V. Hodel, 790 F.2d 760, 765

(9th Cir. 1986) (agency may rely on harmless error rule only when its mistake had no bearing

on the substance of the decision).

B. Analysis - Rejection of Treating Physician’s Opinion

The Ninth Circuit distinguishes among the opinions of three types of physicians: (1)

those who treat the claimant (treating physicians); (2) those who examine but do not treat

the claimant (examining physicians); and (3) those who neither examine nor treat the

claimant (nonexamining physicians). Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995), as

amended (Apr. 9, 1996). 

"By rule, the Social Security Administration favors the opinion of a treating physician

over non-treating physicians." See Orn v. Astrue, 495 F.3d 625, 631 (9th Cir.2007) (citing

C.F.R. § 404.1527). "Generally, a treating physician's opinion carries more weight than an

examining physician's, and an examining physician's opinion carries more weight than a

reviewing physician's." Holohan v. Massanari, 246 F.3d 1195, 1202 (9th Cir. 2001) (citing

Lester, 81 F.3d at 830; 20 C.F.R. § 404.1527(d). In addition, the regulations give more

weight to opinions that are explained than to those that are not and more weight to the

opinions of specialists concerning matters relating to their specialty over that of

nonspecialists. Holohan, 246 F.3d at 1202 (citing 20 C.F.R. §§ 404.1527(d)(5) and

404.1527(d)(3)). Under the regulations, if a treating physician's medical opinion is supported

by medically acceptable diagnostic techniques and is not inconsistent with other substantial

evidence in the record, the treating physician's opinion is given controlling weight. Id.

(citing 20 C.F.R. S 404.1527(d)(2); Social Security Ruling (SSR) 96-2p). 

More weight is given to a treating physician's opinion than to the opinion of a

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nontreating physician because a treating physician "is employed to cure and has a greater

opportunity to know and observe the patient as an individual." Andrews v. Shalala, 53 F.3d

1035, 1041 (9th Cir. 1995) (quoting Magallanes v. Bowen, 881 F.2d 747, 751 (quoting

Sprague v. Bowen, 812 F.2d 1226, 1230 (9th Cir. 1987))). "Likewise, greater weight is

accorded to the opinion of an examining physician than a non-examining physician."

Andrews v. Shalala, 53 F.3d 1035, 1041 (9th Cir. 1995)(citing 20 C.F.R. § 416.927(d)(1);

Pitzer v. Sullivan, 908 F.2d 502, 506 n.4 (9th Cir. 1990). 

The ALJ may reject the opinion of a treating physician, whether or not controverted;

however, the ALJ may reject an uncontroverted opinion of a treating physician only for clear

and convincing reasons. Andrews, 53 F.3d at 1041. To meet this burden, the ALJ must set

out a detailed and thorough summary of the facts and conflicting clinical evidence, state his

interpretation of the facts and evidence, and make findings. Magallanes v. Bowen, 881 F.2d

747, 751 (9th Cir. 1989). To reject the opinion of a treating physician which conflicts with

that of an examining physician, the ALJ must "'make findings setting forth specific,

legitimate reasons for doing so that are based on substantial evidence in the record.' " 

Winans v. Bowen, 853 F.2d 643, 647 (9th Cir.1987), (quoting Sprague, 812 F.2d at 1230);

see also Murray v. Heckler, 722 F.2d 499, 502 (9th Cir.1983) (adopting this rule). "The ALJ

can meet this burden by setting out a detailed and thorough summary of the facts and

conflicting clinical evidence, stating his interpretation thereof, and making findings." Cotton

v. Bowen, 799 F.2d 1403, 1408 (9th Cir.1986). 

Although an ALJ is not bound by the uncontroverted opinions of a treating physician

on the ultimate issue of disability, the ALJ must set out clear and convincing reasons for

doing so. Reddick v. Chatter, 157 F.3d 715, 725 (1998). A treating physician’s opinion on

disability, if controverted, can be rejected only with specific and legitimate reasons supported

by substantial evidence in the record. Lester, 81 F.3d at 830. In the absence of other

evidence to undermine the credibility of a medical report, the purpose for which the report

was obtained does not provide a legitimate basis for rejecting it. Reddick.157 F.3d at 726.

The Social Security Adminstration has explained that an ALJ's finding that a treating

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source medical opinion is not well-supported by medically acceptable evidence or is

inconsistent with substantial evidence in the record means only that the opinion is not entitled

to controlling weight, not that the opinion should be rejected. See Orn, 495 F.3d at 632

(citing § 404.1527). Treating source medical opinions are still entitled to deference and, in

many cases, 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 632; see also Murray v. Heckler, 722

F.2d 499, 502 (9th Cir.1983) ("If the ALJ wishes to disregard the opinion of the treating

physician, he or she must make findings setting forth specific, legitimate reasons for doing

so that are based on substantial evidence in the record.")

The ALJ provided two reasons for rejecting Dr. Jessop’s disability opinion, that the

opinion was “conclusory and unsupported by the medical record” and that the letter appeared

to contain inconsistencies. Although an ALJ need not accept the opinion of any physician,

including a treating physician, if that opinion is brief, conclusory and inadequately supported

by clinical findings, see Thomas v. Barnhart, 278 F.3d 947, 957 (9th Cir. 2002), the ALJ did

not support her contention that Dr. Jessop’s opinion was not supported by the medical record

with an interpretation of conflicting medical evidence supported by substantial evidence in

the record. 

The ALJ, however, provided specific examples of the reported inconsistencies

between Dr. Jessop’s disability report and his treatment notes: “For instance, throughout the

claimant’s treatment ..., the doctor repeatedly noted that the claimant had no side effects from

her medications. Yet, the doctor now indicates that the claimant has somnolence and fatigue

as side effects. He even noted, throughout the claimant’s treatment, that her sleep was

adequate. He also indicated in the letter that the claimant’s personal care was limited, that

she had significant physical limitations, and that her cognitive capacity/concentration was

limited and/or compromised as a result of her medications. Yet, throughout her treatment,

there was no indication of same. In fact the doctor repeatedly noted that the claimant’s daily

functioning was adequate, that her gait was entirely normal requiring no assistive device, that

her mental status was normal, and that her physical examinations continued to remain

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unchanged from her previous evaluations ... . It was even noted at one point that she

experienced a great deal of improvement in her overall pain level and functionality and was

responding by increasing her physical activity level substantially ... .” (Tr. 25) 

Additionally, the ALJ opined that “the possibility always exists that a doctor may

express an opinion in an effort to assist a patient with whom he or she sympathizes for one

reason or another. Another reality which should be mentioned is that patients can be quite

insistent and demanding in seeking supportive notes or reports from their physicians, who

might provide such a note in order to satisfy their patient’s requests and avoid unnecessary

doctor/patient tension. While it is difficult to confirm the presence of such motives, they are

more likely in situations where the opinion in question departs substantially from the rest of

the evidence of record, as in the current case.” (Tr. 25) 

The ALJ’s concern over the possibility that Dr. Jessop’s opinion might lack credibility

because the opinion letter was solicited by Plaintiff’s attorney is not supported by the record

in this case. Furthermore, “the mere fact that a medical report is provided at the request of

counsel or, more broadly, the purpose for which an opinion is provided, is not a legitimate

basis for evaluating the reliability of the report.” Reddick v. Chater, 157 F.3d 715, 726 (9th

Cir. 1998); see also Lester, 81 F.3d at 833 (“The treating physician's continuing relationship

with the claimant makes him especially qualified to evaluate reports from examining doctors,

to integrate the medical information they provide, and to form an overall conclusion as to

functional capacities and limitations, as well as to prescribe or approve the overall course of

treatment.”). There is, however, a sufficient basis to accept the ALJ’s ultimate decision to

reject the disability opinion as “[e]vidence of the circumstances under which the report was

obtained and its consistency with other records, reports, or findings could ... form a legitimate

basis for evaluating the reliability of the report.” Reddick v. Chater, 157 F.3d 715, 726 (9th

Cir. 1998). Where medical testimony is conflicting it is the ALJ's role to determine

credibility and to resolve the conflict. Sample v. Schweiker, 694 F.2d 639, 642 (9th Cir.1982).

The reasons given are specific and legitimate, and supported by substantial evidence, as the

ALJ pointed to concrete examples of inconsistencies between the letter and Dr. Jessop’s own

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treatment notes. Thus, the ALJ did not err in rejecting Dr. Jessop’s ultimate opinion that

Plaintiff was disabled and unable to work due to her condition. 

C. Plaintiff's Credibility

"An ALJ is not required to believe every allegation of disabling pain or other

nonexertional impairment." Orn v. Astrue, 495 F.3d 625, 635 (9th Cir. 2007) (internal

quotation marks and citation omitted). When a medical impairment has been established,

however, the ALJ must provide “specific, cogent reasons for the disbelief” and may not

discredit a claimant’s testimony as to subjective symptoms merely because they are

unsupported by objective evidence. Lester, 81 F.3d at 834. While an ALJ is responsible for

determining the credibility of a claimant, an ALJ cannot reject a claimant's testimony without

giving clear and convincing reasons. Holohon v. Massanari, 246 F.3d 1195, 1208 (9th Cir.

2001) (citing Reddick, 157 F.3d at 722.) In addition, the ALJ must specifically identify the

testimony she or he finds not to be credible and must explain what evidence undermines the

testimony. Id. The findings made in rejecting the pain complaints must be specific to provide

the court enough information to determine that the ALJ did not reject the claim arbitrarily,

but based his decision on permissible factors. Orteza v. Shalala, 50 F.3d 748, 750 (9th Cir.

1995); Bunnell v. Sullivan, 947 F.2d 341, 345- 46 (9th Cir.1991) (en banc ). The evidence

upon which the ALJ relies must be substantial. Id. In assessing the claimant's credibility,

the ALJ may consider ordinary techniques of credibility evaluation, such as the claimant's

reputation for lying, prior inconsistent statements about the symptoms, and other testimony

from the claimant that appears less than candid; unexplained or inadequately explained

failure to seek or follow a prescribed course of treatment; the claimant's daily activities; the

claimant's work record; observations of treating and examining physicians and other third

parties; precipitating and aggravating factors; and functional restrictions caused by the

symptoms. Smolen, 80 F.3d at 1284. See also Robbins, 466 F.3d at 884 ("To find the

claimant not credible, the ALJ must rely either on reasons unrelated to the subjective

testimony (e.g., reputation for dishonesty), on conflicts between his testimony and his own

conduct; or internal contradictions in that testimony.")

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D. Analysis - Plaintiff’s Credibility

The ALJ concluded that the Plaintiff has medically determinable impairments that

could be expected to result in her alleged symptoms and functional limitations (Tr. 23), but

stated the following reasons for rejecting the Plaintiff’s testimony regarding the severity of

her pain and limitations (Tr. 25-26).

1. Daily Activities

The ALJ rejected Plaintiff’s testimony regarding her limitation in daily activities to

be “outweighed by the other factors discussed in this decision.” (Tr. 26) The ALJ provided

no examples of what other evidence would outweigh Plaintiff’s testimony, and, as there was

no evidence of malingering, the ALJ failed to specifically identify the testimony she finds

not to be credible and specifying what evidence undermines the testimony. Hollohan, supra.

Thus, this Court finds that the ALJ’s reasons for rejecting Plaintiff’s testimony is not

supported by clear and convincing evidence as to her daily activities. 

2. Treatment history

The ALJ noted that the second reason for rejecting the Plaintiff’s allegations was that

Plaintiff’s treatment had been “essentially routine and/or conservative in nature, and has been

generally successful in controlling her symptoms [as noted previously in the ALJ’s opinion].”

An ALJ may permissibly infer that pain is not as limiting as reported when there is evidence

of minimal or conservative treatment. Tommasetti v. Astrue, 533 F.3d 1035, 1039 (2008)

(citing Meanel v. Apfel, 172 F.3d 1111, 1114 (9th Cir. 1999); Parra v. Astrue, 481 F.3d 742,

750-51 (9th Cir. 2007)). 

Although an unexplained or inadequately explained failure to seek treatment may be

the basis for an adverse credibility finding, a claimant’s failure to receive medical treatment

during the period when the claimant had no medical insurance cannot support an adverse

credibility finding. Orn v. Astrue, 495 F.3d 625, 638 (9th Cir. 2007). 

Initially, Dr. Jessop, Plaintiff’s treating physician, mentioned that it might be “quite

possible that neural blockade or other such interventions may be of benefit...however, these

are not possible at this time as the patient cannot afford them and she has no insurance.” (Tr.

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295) After Dr. Jessop began treatment of Plaintiff with pain medications, he noted that

Plaintiff “continues to do well on their current analgesic regimen” and did not refer Plaintiff

for further diagnostics and/or consults. (Tr. 224-25, ) 

Upon review of the records, Dr. Jessop’s in particular, despite his initial consideration

of the use of a neural blockade, there was no recommendation that Plaintiff would have

benefitted from more aggressive treatment, and no indication that Plaintiff could not avail

herself of recommended interventions due to lack of insurance. Although one examining

doctor had reported that Plaintiff might require surgical decompression at the C6-7 level (Tr.

216), Dr. Dunn, who saw Plaintiff for a Neurosurgical Evaluation, considered Plaintiff’s

degenerative disease and foraminal and central stenosis, and recommended Plaintiff wear a

collar when she is active, and pursue a swimming exercise program, and did not recommend

surgical intervention. (Tr. 173) 

Thus, there is substantial evidence to support the ALJ’s conclusion that pain is not as

limiting as reported when there is evidence of minimal or conservative treatment. 

3. Inconsistent and unpersuasive description of symptoms

The ALJ states as a third reason for discrediting Plaintiff, that “[t]he description of the

symptoms and limitations which the claimant has provided throughout the record has

generally been inconsistent and unpersuasive.” (Tr. 26) Again, the ALJ failed to identify

specifically what descriptions provided by the Plaintiff were inconsistent and unpersuasive.

Hollohan, supra. 

4. Medication Side Effects

The ALJ states as another reason for rejecting Plaintiff’s credibility that Plaintiff has

testified that she has side effects from the use of her medications, but the treatment records

show different as noted in the records obtained from Dr. Jessop. (Tr. 26) The Plaintiff

testified at the hearing that her medications make her “sleepy and tired”; that “[e]very once

in a while” she gets dizzy when she stands up, or she missteps and trips. (Tr. 326) The

medication does not cause her to have any nausea. (Tr. 326) Plaintiff is not sure if it is the

pain, the medication, or her depression which causes her to be so sleepy and tired. (Tr. 326)

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Plaintiff does experience dry mouth, and she has trouble with her memory, as a result of side

effects caused by the medication. (Tr. 326-25) 

Dr. Jessop’s treatment records, on the other hand, noted that Plaintiff’s daily physical

functioning was adequate, and that Plaintiff denied side effects from her medication. (Tr.

225) There is substantial evidence in the record to support the ALJ’s conclusion that her

testimony regarding side effects from the medication is inconsistent with her treatment

records. (Tr. 26) 

In sum, though the ALJ failed to support her reasons for finding Plaintiff not credible

based on Plaintiff’s description of daily activities and inconsistent and unpersuasive

description of symptoms, the ALJ properly supported her assertions that Plaintiff’s treatment

has been essentially routine and/or conservative in nature, and has been generally successful

in controlling her symptoms, and that Plaintiff’s testimony as to side effects differs from

what the treatment records demonstrate, as noted in the records obtained from Dr. Jessop.

The ALJ’s properly supported assertions for finding Plaintiff not credible are supported by

substantial evidence, are clear and convincing, and . 

E. Hypothetical Proposed to Vocational Expert

The testimony of a vocational expert cannot constitute substantial evidence to support

an ALJ’s findings if the hypothetical does not include allegations of persistent disabling pain

that are supported by the medical evidence. Gallant v. Heckler, 753 F.2d 1450 (9th Cir.

1984). The ALJ proposed a hypothetical in which Plaintiff’s pain, moderate in nature, is

“controlled by appropriate medication without significant adverse side effects.” (Tr. 343)

The vocational expert clarified, as she had with the previous hypothetical, that the ALJ

intended to hypothesize that everything could be controlled with appropriate medications.

(Tr. 344) 

The testimony of the vocational expert in this case cannot constitute substantial

evidence to support the ALJ’s findings because the vocational expert’s testimony in a

disability benefits proceeding “is valuable only to the extent that it is supported by medical

evidence.” Gallant v. Heckler 753 F.2d 1450, 1456 (9th Cir. 1984) (quoting Sample v.

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Schweiker, 694 F.2d 639, 643-44 (9th Cir.1982)). The hypothetical proposed to the

vocational expert, whose determinations the ALJ relied on, was based on the ALJ’s incorrect

determination of Plaintiff’s residual functional capacity (“RFC”) as to the limiting effects of

pain. The ALJ determined that Plaintiff had pain in various parts of her body, which “is of

moderate-level and would normally have a moderate effect on her ability to do work-related

activities; however, that pain is controlled by appropriate medication without any significant

adverse side effects.” (Tr. 26)(emphasis added) There is no basis in the record for the ALJ

to reject all of Plaintiff’s allegations of pain. Although this Court agrees that the ALJ

properly discredited Dr. Jessop’s ultimate opinion as to disability, over one year of treatment

records from Dr. Jessop make evident that Plaintiff’s pain was not “controlled” as the ALJ

used that term in both her determination of the RFC and the hypothetical proposed to the

vocational expert. Dr. Jessop’s treatment notes from May and June, 2004, indicate that,

when she first began seeing him, her pain level was a 6 of 10, averaging 6 of 10 over her first

month of treatment. (Tr. 289) For several months after treatment, her pain increased to 7 out

of 10, and Dr. Jessop responded accordingly by increasing/changing her medications. (Tr.

264, 268, 271, 274, 278, 285) At the beginning of January, 2005, Plaintiff reported that her

“good days outnumber the bad” and that her pain was a 6 out of 10. (Tr. 260) By the end of

January, 2005, Plaintiffs pain increased, and she was again at a 7 out of 10 on the pain scale,

and remained at that level for another month. (Tr. 250, 255) By the end of February, 2005,

her pain level had again been reduced to a 6 out of 10, and remained at that level for another

month. (Tr. 243, 247) By April, 2005, Plaintiff was reporting pain of 4 out of 10. (Tr. 239)

In May, it again returned to 6 out of 10. (Tr. 234) In June, Plaintiff reported an average pain

level of 4 out of 10 over the last month, and in July, rising again to 5 out of 10. (Tr. 226,

231) Finally, in the last treatment record from Dr. Jessop, she reported a pain level of 4 out

of 10, with “significant intervals of pain at night.” (Tr. 224) Throughout Dr. Jessop’s

treatment of Plaintiff, he reported that Plaintiff “continues to do well on their current

analgesic regime.” (Tr. 224-289) To the extent the ALJ interpreted this to mean that

Plaintiff’s pain was controlled, that statement is taken entirely out of context with the rest of

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Dr. Jessop’s treatment records which indicate a constant level of pain which from time to

time increases or decreases slightly, and is at best a 4 out of 10. Furthermore, for the time

period for which records are available, there does not appear to be a plateau in the level of

pain reached by Plaintiff for a given change in her medication. In other words, Plaintiff

maintained her pain level (or experienced temporary fluctuations, both higher and lower, and

slight in nature) at ever increasing dosages of medications. There is no indication from the

record that Plaintiff reached a completely satisfactory, static condition, in which no further

changes in her pain medications were required. In fact, Dr. Jessop explained to Plaintiff

during her initial assessment that “complete freedom from pain may not be possible” and that

the goal was “an improvement in daily functional ability and a decrease in pain.” (Tr. 295)

To the extent Plaintiff’s pain was minimized, she was, in fact, doing well on her regime.

This did not mean, however, that she was “pain free”, and this was never the goal for

Plaintiff with her pain treatment. 

The assumption in the hypothetical that Plaintiff’s pain “was controlled with

medication” is not supported by the record, and the opinion of the vocational expert is

therefore meaningless. Here the vocational expert was instructed to assume that Plaintiff’s

pain, which would have been moderate without medication, was controlled with medications

with no side effects. The medical record simply does not support this. Even with

medication, Plaintiff’s pain was at best a 4 out of 10, and more often than not, was a 7 out

of 10. This is not what the ALJ conveyed with her description of Plaintiff’s pain in the

hypothetical. The ALJ implied that Plaintiff had no limitations whatsoever, or at best, only

limitations of a slight nature, caused by her pain. This is inconsistent with Plaintiff’s

treatment records. 

F. Remand/Reverse

The district court has discretion to remand for further proceedings or to award

benefits. McAllister v. Sullivan, 888 F.2d 599, 603 (9th Cir.1989). Remand for an award of

benefits is appropriate where:

(1) the ALJ failed to provide legally sufficient reasons for rejecting the

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evidence; (2) there are no outstanding issues that must be resolved before a

determination of disability can be made; and (3) it is clear from the record that

the ALJ would be required to find the claimant disabled were such evidence

credited.

Benecke v. Barnhart, 379 F.3d 587, 593, (9th Cir. 2004) (citations omitted). Where the test

is met, "we will not remand solely to allow the ALJ to make specific findings...Rather we

take the relevant testimony to be established as true and remand for an award of benefits."

Id. (citations omitted); see also Lester, 81 F.3d at 834.

The ALJ erred in determining that Plaintiff’s pain was controlled by medication. The

vocational expert testified that Plaintiff would not be able to work if she experienced severe

pain, or pain that was only controlled by medications that resulted in side effects that were

so significantly adverse that they would interfere with Plaintiff’s ability to maintain pace and

concentration. This third hypothetical, however, does not accurately describe Plaintiff’s pain

as reported by Dr. Jessop. 

The fourth hypothetical included limitations regarding Plaintiff’s ability to use her

fingers, and additional problems with muscle lumbar spasm and neck spasm. (Tr. 345-46)

Additionally, the hypothetical included a number of medications Plaintiff was taking and the

resulting side effect of fatigue and sleepiness. (Tr. 346) The vocational expert then assumed

that the fourth hypothetical was similar to the third hypothetical. (Id.) This assumption was

not accurate, however, in that the fourth hypothetical did not address Plaintiff’s level of pain

in addition to functional limitations associated with her finger numbness and back and neck

spasms. Although not entirely evident, it appears that the vocational expert adopted the

limitations of the third hypothetical in addition to the limitations proposed by the fourth

hypothetical, and thus the vocational expert was not provided an accurate depiction of

Plaintiff’s level of pain with the use of medication. 

The ALJ failed to provide an accurate hypothetical to the vocational expert, and thus

the ALJ’s decision to deny benefits is not supported by substantial evidence in the record.

The Magistrate Judge recommends that the appropriate remedy is to remand the case to the

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Commissioner of Social Security with instruction to require the ALJ to propose a

hypothetical that takes into consideration the level of pain Plaintiff experiences with the use

of medication, along with relevant side effects, as Dr. Jessop’s treatment records indicate,

taking such further evidence as is required to determine Plaintiffs eligibility for benefits

under the current law, and making appropriate findings consistent with this report. 

V. RECOMMENDATION

For the foregoing reasons, it is the recommendation of this Court that the District

Judge, after his independent review and consideration, GRANT Plaintiff’s Motion for

Summary Judgment (Doc. No. 10), and remand the case for further proceedings consistent

with this report. 

Pursuant to 28 U.S.C. §636(b), any party may serve and file written objections within

ten days after being served with a copy of this Report and Recommendation. A party may

respond to another party's objections within ten days after being served with a copy thereof.

Fed.R.Civ.P. 72(b). If objections are filed, the parties should use the following case number:

CV 07-280-TUC-RCC.

If objections are not timely filed, then the parties' right to de novo review by the

District Court may be deemed waived. See United States v. Reyna-Tapia, 328 F.3d 1114,

1121 (9th Cir.) (en banc). 

DATED this 27th day of January, 2009.

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