Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-4_04-cv-00323/USCOURTS-azd-4_04-cv-00323-0/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 (DIWW)

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1

Plaintiff is named in the Complaint as: Elvia Medequari and this matter is captioned

accordingly. Review of the record indicates the following spelling of Plaintiff's last name:

Medeguari.

2

On February 12, 2007, Michael J. Astrue was sworn in as the Commissioner of

Social Security. Pursuant to Rule 25(d)(1) of the Federal Rules of Civil Procedure, Michael

J. Astrue is substituted as the defendant in this action.

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Elvia Medequari,1

Plaintiff, 

vs.

Michael J. Astrue,2

 Commissioner of

Social Security, 

Defendant. 

 

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No. CV 04-323-TUC-JMR (HCE)

REPORT & RECOMMENDATION

On June 23, 2004, Plaintiff, through counsel, filed the instant action seeking review

of the final decision of the Commissioner of Social Security pursuant to 42 U.S.C. § 405(g).

On that same date, Plaintiff's case was assigned to the Honorable William D. Browning,

United States Senior District Judge and was referred to the Honorable Nancy Fiora, United

States Magistrate Judge pursuant to the Rules of Practice of this Court. On June 21, 2005,

the reference to the Magistrate Judge was withdrawn. On July 22, 2005, the matter was

reassigned to the Honorable John M. Roll, United States Chief District Judge. On September

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15, 2005 this matter was referred to the undersigned Magistrate Judge for a Report and

Recommendation. 

Pending before the Court are the parties' Cross-Motions for Summary Judgment. For

the following reasons, the Magistrate Judge recommends that the District Court grant

Plaintiff's Motion for Summary Judgment (hereinafter "Plaintiff's MSJ") and deny

Defendant's Cross-Motion for Summary Judgment (hereinafter "Defendant's XMSJ").

I. PROCEDURAL HISTORY

On July 12, 2002, Plaintiff submitted to the Social Security Administration

(hereinafter "SSA") an application for disability insurance. (TR. 79–93) Plaintiff indicated

that she had been unable to work since April 16, 2002 due to "continuous back, neck,

shoulder pain currently on anti-depression 'zoloft' medication." (TR. 85) Plaintiff's

application was denied. (TR. 59-63) Plaintiff’s request for reconsideration of the decision

was also denied. (TR. 65-68) 

Plaintiff then requested a hearing before an administrative law judge (hereinafter

"ALJ") and the matter came on for hearing on November 19, 2003 before ALJ Lauren R.

Mathon. (TR. 69-70, 25-53) Plaintiff was not represented by counsel at the hearing. (TR. 26)

She was the only witness to testify. On December 3, 2003, the ALJ found that Plaintiff was

not disabled as defined in the Social Security Act. (TR. 11-18)

Plaintiff requested that the Appeals Council review the ALJ’s decision. (TR. 10) The

Appeals Council, after considering additional evidence submitted by Plaintiff, denied

Plaintiff's request for review thereby rendering the ALJ's December 3, 2003 decision the final

decision of the Commissioner. (TR. 6-8) Plaintiff then initiated the instant action.

II. THE RECORD ON APPEAL

A. Plaintiff's general background and Plaintiff's statements in the record

Plaintiff was born on July 8, 1958. (TR. 79) On the alleged onset date of April 16,

2002, Plaintiff was 43 years of age. In December 2003, when the ALJ ruled on Plaintiff's

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claim, Plaintiff was 45 years of age. Plaintiff is divorced, the mother of two grown children,

and, at the time of the November 19, 2003 hearing, lived with her boyfriend. (TR. 28-29)

Plaintiff completed school through the ninth grade and later obtained a GED. (TR.

91) She attended two years of college. (TR. 91) In 1988, she became a licensed

cosmetologist. (TR. 30, 91) Plaintiff worked as a cosmetologist from1988 to 1992, an officer

manager from 1996 to 1998, and lastly, as a programs specialist from 1998 to 2002 for the

City of Douglas, Arizona, where her duties included interviewing applicants for low-income

housing. (TR. 32, 86, 98 ) Plaintiff stopped working her last job as a programs specialist on

her alleged onset date of April 16, 2002. (TR. 85)

Plaintiff was injured in September of 2000 when she fell from her chair at work and

strained her right side. (TR. 35, 85) As the result of the fall, Plaintiff saw a chiropractor and

went to physical therapy. (TR. 35) Plaintiff testified that during this time, her supervisor

"started sending me memos that I was abusing sick time and that if this continued I would

be...disciplined and I could lose my job. And the whole time that I went to the doctor for my

injury they made me use my sick pay." (TR. 35) Plaintiff eventually complained to the

union. (TR. 35) 

In April 2002, Plaintiff's back spasms were so severe that she thought she was having

a heart attack. (TR. 37) Plaintiff testified that she left work on medical leave that same

month because "[m]y back was going into muscle spasms...I was placed on muscle relaxers

and pain killers and I'm still on them...it's hard to function on those types of pills." (TR. 37)

Plaintiff suffers from chronic back and neck pain that is "always there" even when she

takes medication. (TR. 42; see also TR. 43 (indicating she feels pain 24 hours a day, every

day); TR. 107 ("I have a lot of pain and even sleeping will cause my neck and back

discomfort. Usually will have to take muscle relaxers, pain pills on a daily basis.")) Plaintiff

rates her constant pain as a nine on a scale from one to ten with one being mild and ten

"being the absolute excruciating pain that would" cause her to go to the emergency room.

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(TR. 44) Exercises and manipulation do not help with the pain or stiffness that she

experiences. (TR. 43) 

Plaintiff also has trouble sleeping at night. (TR. 42) The muscle relaxers begin to take

effect around 3:00 a.m. which "knock me out and then in the morning, I just–I can't wake up

when I'm supposed to." (TR. 42) Plaintiff takes sleeping pills to help her sleep. (TR. 44)

Plaintiff also suffers from anxiety or panic attacks. (TR. 44, 46) The frequency of

these attacks "depends on...the situation" but they usually occur once a month. (TR. 46)

During such an attack, Plaintiff experiences shortness of breath, her arms and legs become

numb, and she cries. (TR. 46) Plaintiff is not taking medication specifically for these attacks.

(TR. 46) However, Plaintiff takes zoloft for depression and it helps to calm her. (TR. 44)

Plaintiff's symptoms of depression include fatigue, inability to sleep, and lack of desire to go

anywhere. (TR. 45) 

She only drives when necessary and her boyfriend does all the shopping because she

does not go to the store. (TR. 45) She has "[t]errible" concentration; can be watching a

movie and not know "what has gone on"; forgets what she says to family members; and

cannot concentrate on one thing too long. (TR. 45; see also TR. 106 ("sometimes have

trouble remembering if I spoke with an individual. I have to write things down.")) She

blames her medication for her lack of concentration. (TR. 45) 

Plaintiff can sit in a chair for "about half an hour"; can stand for "[a]n hour or so"; and

can walk "less than a mile" twice a week. (TR. 46-47) She also testified that she "tried to

walk on a regular basis but it takes a lot out of my...back, the pain that I have...." (TR. 46)

Plaintiff can lift up to three pounds comfortably and although she is able to lift a gallon of

milk, " it takes a lot...out of my back." (TR. 48) Plaintiff sometimes experiences numbness

in her right hand. (TR. 48) 

Plaintiff's daily activities include rising at approximately 10:30 a.m., brushing her hair,

resting on the couch, and showering after noon. (TR. 49) Blow drying her hair "causes

severe pain in my shoulder, neck, back." (TR. 106) She continually experiences back

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It appears that Plaintiff was referred to physical therapy by "Dr. Padilla." (TR. 185)

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spasms. (TR. 106) She does the dishes, tries to do the laundry, but housekeeping takes her

a "long time." (TR. 50, 107) Plaintiff occasionally uses a sewing machine for mending. (TR.

50) She can sit at the sewing machine for "[p]robably about half an hour." (TR. 51) Her

hobbies include walking, sewing and watching television. (TR. 109) She is "always stressed

out with a lot of back, neck, shoulder pain. Pain medication also causes drowsiness." (TR.

106)

Plaintiff has continued to look for administrative and clerical work but she does not

believe that she can perform such work because of her lack of concentration. (TR. 51) 

B. Medical Evidence

1. Plaintiff's Physicians

a. Physical Impairment

July 2001 records from Southeast Arizona Medical Center Rehabilitation Department

reflect a physical therapy treatment plan for Plaintiff whose primary diagnosis was shoulder

bursitis with a March 1, 2001 onset date.3

 (TR. 185) Such plan included patient education,

joint mobilization, stretching exercises, and aquatic therapy. (TR. 185)

On December 12, 2001, Certified Nurse Practitioner Diana Comaduran (hereinafter

"C.N.P. Comaduran") who works under Plaintiff's primary care provider David Knapp, M.D.,

noted that Plaintiff's chief complaints were: (1) anxiety attacks; (2) hypoglycemia; and (3)

history of abnormal labs. (TR. 172; Plaintiff's Statement of Facts, p.2) C.N.P. Comaduran's

assessment was: 

1. history of hyperlipidemia

2. anxiety attacks. 

(TR. 172) C.N.P. Comaduran's plan for treatment included zoloft for six months to one year,

counseling for anxiety, and diet counseling. (TR. 172)

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A December 12, 2001magnetic resonance imaging study (hereinafter "MRI") of

Plaintiff's right shoulder revealed "[m]inor degenerative callus formation is seen involving

the right AC joint." (TR. 140) No evidence of complete or partial rotator cuff tendon tear

was identified. The impression was: "small amount of fluid seen within the subacromial

bursa, perhaps related to subacromial bursitis." (TR. 140)

On January 9, 2002, Jose A. Padilla, M.D., of Cochise Orthopaedic Clinic, examined

Plaintiff and reviewed an MRI which he described as showing "just a little subacromial fluid

but is otherwise completely normal." (TR. 279) In response to Plaintiff's complaints of

intermittent numbness in her hand, Dr. Padilla explained that such numbness is "a common

finding with shoulder bursitis." (TR. 279) Dr. Padilla noted that Plaintiff "can expect to

always have a little bit of pain in her shoulder. She seems very frustrated with this and has

asked about medications." (TR. 279) Dr. Padilla concluded that Plaintiff "is permanent and

stationary, and I would expect in the future she may need 1-2 visits per year and the use of

anti-inflammatories...." (TR. 279) Dr. Padilla prescribed Ibuprofen. (TR. 279)

On April 1, 2002, C.N.P. Comaduran examined Plaintiff upon Plaintiff's complaints

of neck pain. (TR. 167) C.N.P. Comaduran's examination revealed that Plaintiff had full

range of motion in her neck, back, and shoulders "with mild tenderness of bilateral superior

trapezius and supra- and infrascapular areas." (TR. 167) Upon examining Plaintiff's

extremities, C.N.P. Comaduran found "[f]lattening of the upper T spine." (TR. 167) C.N.P.

Comaduran's assessment included:

1. upper trapezius strain

2. hyperlipidemia

3. mild obesity

(TR. 167) C.N.P. Comaduran's treatment plan was:

1. McKenzie exercises with handout and demonstration.

2. "Vioxx 50 mg. #14, 1 qd versus ibuprofen."

3. lipids and LFTs within the next month.

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The record does not reflect the medical provider who authored these treatment notes.

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4. continue diet.

5. OSHA handout on computer positioning.

(TR. 167)

Medical records from April 16, 2002 through June 11, 2002 reflect Plaintiff's

complaints of anxiety and back pain and back spasms.4

 (TR. 163-166) Plaintiff was

prescribed zoloft. (TR. 163-166) The record indicates that Plaintiff continued on zoloft

through at least December 2003. (TR. 236-237, 239, 255-256, 286, 291)

Beginning in April 2002 through at least August 2002, Plaintiff underwent physical

therapy at Southeast Arizona Medical Center Rehabilitation Department with Physical

Therapist Assistant Melissa Binkerd (hereinafter "PTA Binkerd"). (TR. 175-182, 263, 263-

275) The April 19, 2002 initial physical therapy "evaluation and plan of treatment" indicated

that Plaintiff's physician was Diana Comaduran and that Plaintiff "had been seen by this PT

clinic in 2001 for same problems [with] little improvement. P[atient] has continued to work

until 4-16-02 when she was placed on medical leave, citing stress/conflict [with] immediate

supervisor [at] work." (TR. 182, 263) Physical Therapy progress notes from April 2002

through June 2002 reflected Plaintiff's complaints of pain and shoulder stiffness, that Plaintiff

was feeling better at times and feeling stiff and sore at other times, and that Plaintiff would

benefit from continued physical therapy. (TR. 264-268) 

At a June 27, 2002 follow-up visit, C.N.P. Comaduran noted Plaintiff's complaints

included severe neck and shoulder pain, stress, depression, anxiety, and fatigue. (TR. 162)

Plaintiff reported stress at work, that she could not return to work because of neck pain "with

any type of flexion," and that she did get some relief with zoloft. (TR. 162) C.P.N.

Comaduran's assessment indicated a worsening condition since April 1, 2002:

1. severe upper back pain, supra- and infraspinatous, and superior trapezius

regions, minimal improvement

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2. minimal improvement with outpatient physical therapy 

3. severe occupational stress/anxiety.

(TR. 162) C.P.N. Comaduran's recommendations included: continuing with outpatient

physical therapy for one month; arranging a consult with Dr. Carey for evaluation, treatment

and pain management; and no work for one month. (TR. 162) 

A June 2002 x-ray of Plaintiff's lumbar spine revealed no spondylolysis,

spondylolisthesis, or bony destructive process. (TR. 160) The impression was "mild loss of

intervertebral disk space height seen at L3-L4." (TR. 160) 

A July 5, 2002 x-ray of Plaintiff's cervical spine indicated: 

[m]oderate loss of intervertebral disk space height is seen at C5-C6 and mild

to moderate loss of intervertebral disk space height is seen at C6-C7. Mild

encroachment upon both C6 and the left C7 neural canals are seen secondary

to posterior osteophytes primarily arising from the uncovertebral joints. The

prevertertebral soft tissues appear normal...A partially visualized left convexity

upper thoracic scoliotic curve is seen. 

(TR. 161) The impression was: "degenerative changes seen within the lower cervical

spine..." (TR. 161)

On July 11, 2002, Guy Cary, III., M.D., performed a neurological exam of Plaintiff.

(TR. 156-157). Dr. Cary's impression was:

1. Irritative cervical radiculopathy

2. Torticollis, unspecified.

3. Lumbar somatic dysfunction, likely musculoskeletal.

4. Bilateral knee pain.

(TR. 157) Dr. Cary's recommendations included: low back and neck exercises and water

aerobics, further diagnostic films and evaluations, zanaflex as a "centrally acting muscle

relaxer", and "alfa 2 agonist" and neurontin as pain modulators. (TR. 157) 

A July 19, 2002 MRI showed: "Fairly severe disk degeneration and dehydration...at

C4-C5, C5-C6 and C6-C7";"C5-C6 mild to moderate spinal stenosis eccentric toward the

right"; "C6-C7 moderate spinal stenosis midline"; and "a significant scoliosis of the thoracic

spine." (TR 144)

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Also by July 2002, Plaintiff was using bracing tape to hold her spine and ribs neutral

and she had begun aquatic therapy. (TR. 269) However, PTA Binkerd was "perplexed as

how to help" her. (TR. 271) Plaintiff's right "T spine remains quite prom R as well as assoc.

ribs and does not respond to tx to 'unstick.'" (TR. 271) 

On August 2, 2002, C.P.N. Comaduran completed a Medical Source Statement of

Ability To Do Work-Related Activities (Physical). (TR. 152-153) C.P.N. Comaduran

indicated that Plaintiff could lift up to 10 pounds occasionally and less than 10 pound

frequently; she could stand and/or walk for about 2 hours in an 8-hour workday; she could

sit less than 6 hours in an 8-hour workday; she could never climb or crawl, frequently

balance, and occasionally stoop, kneel and crouch; and she was limited in reaching, handling,

and fingering. (TR. 153) C.P.N. Comaduran also indicated restrictions regarding heights and

moving machinery. (TR. 153)

At physical therapy throughout August 2002, Plaintiff was tense and continued to

complain of back pain. (TR. 272) Physical therapy progress notes during this time reflect

that Plaintiff continued with the exercise regimen. (TR. 272) Plaintiff's September 11, 2002

"Out-Patient Progress/Discharge Summary" from physical therapy reflected that:

[Plaintiff] con't to have multiple dysfunctions that did not improve [with] PT.

Most notable are: R rib cage posterior; R thoracic vert - rotated to R; R scap

winged; R scap. musculature tender to palpation appearance reveals R thoracic

spine, scap are prominantly [sic] post. in position.

(TR. 275) PTA Binkerd recommended that Plaintiff "see a D.O. that specializes in

manipulative tech. Referred to Dr. Katherine Worden, D.O. in Tucson." (TR. 275)

On September 24, 2002, Plaintiff had her initial appointment with Katherine Worden,

D.O. (TR. 37, 125) Dr. Worden's September 24, 2002 assessment was:

1. Somatic dysfunction globally secondary to

2. Myofascial pain syndrome with

3. Underlying cervical, thoracic, rib, lumbosacral, upper extremity and

cranial strains.

4. Mild right thoracic outlet syndrome with late effects with a significant

myofascial strain.

(TR. 128) Dr. Worden opined that the

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symptoms that the patient describes as well as the objective findings today

support her history of ICA-related injury. She certainly did not appear to reach

a stationary state. As this is primarily a soft tissue, i.e., fascial, muscle,

ligamentous and tendinous type injury, she would benefit from soft tissue work

that an osteopathic physician can provide. Certainly, the muscle spasm in the

back was recognized to be severe enough to rotate the back to the right such

that scoliosis diagnosis was entertained. 

(TR. 128) Dr. Worden recommended that Plaintiff be treated with osteopathic manipulation

as well as attend an "exercise teaching series...which helps teach...how to stay in alignment

and self stabilize." (TR. 128) Dr. Worden observed that Plaintiff "appears to be sincerely

interested in returning to work, has been living with moderately severe pain which has been

exacerbated by work stress and situational depression affecting relationships at home." (TR.

128)

On October 7, 2002, Dr. Worden completed a "Medical Source Statement (Mental),"

which is designed to determine Plaintiff's ability to perform work related activities on a dayto -day basis in a regular work setting. (TR. 259-261) Dr. Worden indicated that Plaintiff

was "unlimited/very good" in her ability to: follow work rules; relate to co-workers; deal

with the public; use judgment; and understand, remember and carry out simple job

instructions. (TR. 259-260) Plaintiff had a "good" ability to: interact with supervisors; deal

with work stresses; function independently; maintain attention/concentration; understand,

remember and carry out complex and detailed job instructions; and maintain personal

appearance. (TR. 259-260) Because Dr. Worden had only evaluated Plaintiff once, she was

unable to assess Plaintiff's ability to behave in an emotionally stable manner, relate

predictably in social situations, or demonstrate reliability. (TR. 260) 

On October 7, 2002, Dr. Worden completed a Physical Capacities Evaluation wherein

she indicated that Plaintiff: in an eight hour work day is able to sit, stand and walk for one

hour at a time; in an eight hour work day is able to sit for a total of two hours a day, and

stand and walk for a total of one hour per day; is able to lift up to 10 pounds occasionally but

is unable to lift anything heavier than 10 pounds; is able to use her right and left hands for

simple grasping and fine manipulation; is able to use her left hand for pushing and pulling

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Plaintiff later complained that the robaxin muscle relaxer "made her feel like she was

on fire, sweating and itching." (TR. 288)

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of arm controls but is unable to use her right hand for such action; is able to use her right foot

for pushing and pulling leg controls and is unable to use her left for such action; is able to

occasionally bend, crawl, and reach; is unable to squat and climb; and has mild restrictions

with unprotected heights and moderate restrictions driving automotive equipment. (TR. 262)

Dr. Worden's notes from Plaintiff's follow-up visits on October 10, 2003, October 31,

2003, November 14, 2003, November 24, 2003, and December 11, 2003 consistently reflect

that: Plaintiff's mood was depressed and/or anxious with chronic pain facies (TR. 257, 286,

288, 289, 291); Plaintiff's exams revealed somatic dysfunction; decreased range of motion

in standing/seated/lying positions; shoulder girdle muscle imbalance with multiple small joint

dysfunctions in hand wrist and elbow greater in the right than the left; mild convexity in the

lower thoracic area; and major muscle spasm and trigger points in the trapezius, SCM,

scalenes, levator scapulae, pectorals, latissimus dorsi, serratus posterior, superior and inferior

and subscapularis. (TR. 257, 286, 288, 289, 291) Dr. Worden's assessments during this

period included:

C somatic dysfunction cervical, thoracic, rib, lumbar, pelvis, sacrum, upper extremity

and abdomen secondary to ICA injury with myofascial pain syndrome or acute reexacerbation of chronic myofascial pain syndrome. (TR. 257, 286, 288, 291)

C Underlying cervical, thoracic, rib, lumbar, upper extremity strain. (TR. 257, 286, 288,

291)

C muscle tension cephalgia (TR. 289)

C anxiety (TR. 286 ("[s]ituational anxiety"), 289 ("[a]nxiety"), 291 ("[p]anic/anxiety")

C situational depression (TR. 286, 289, 291)

Also during this period, Dr. Worden prescribed pamelor, flexeril, robaxin,5

 neurontin,

nortriptyline, motrin, ibuprofen, self stabilization exercises, stretching of the upper

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extremities using one-to-two pound weights, and home cervical traction using two-to-five

pound weights. (284, 287, 288, 289, 291) Dr. Worden also directed that Plaintiff continue

on zoloft. (TR. 291)

Additionally, on November 24, 2003, Dr. Worden wrote that since her first

examination of Plaintiff on September 24, 2002, it has been and continues to be her opinion

that Plaintiff:

has been totally medically disabled from work due to physical limitations of

muscle spasm and pain, at least since the time that I first saw her. The date

of the incident in question was 09/27/00. 

(TR. 290)

The record also reflects that on January 2, 2004, Plaintiff had emergency care for a

"bad reaction to neurontin (cronic [sic] pain)" prescribed by Dr. Worden. (TR. 284) Plaintiff

had trouble breathing, high blood pressure, anxiety attack, and uncontrollable shaking. (TR.

284)

b. Mental Impairment

On May 2, 2002, Plaintiff saw counselor G. Giangregorio, M.A., who recorded that

Plaintiff's mood was depressed and anxious; she had no impairment in memory, orientation,

thinking, perception, speech, or motor activity; she had fair judgment and insight; she had

good impulse control and appearance; her attitude was poor; she suffered from sleep

disturbance and withdrawal; she had problems at work; and was negative for substance abuse

or chemical dependency. (TR. 276) Counselor Giangregorio's diagnosis was:

Axis I: 309.0 (adjustment disorder with depressed mood)

Axis II: Illegible

Axis III: Back Probs.

Axis IV: Employment

Axis V: Current Global Assessment of Functioning (hereinafter "GAF"): 67

Highest GAF past year: 75 

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Plaintiff explained that "her female boss" sexually harassed her and Plaintiff "feels

that the boss retaliated against her for being injured, refusing to do sexual favors, and for

going to the union." (TR. 187)

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(TR. 276) Counselor Giangregorio's treatment plan included stress management, relaxation

hypnosis, and coping strategies. (TR. 276) On May 20, 2002, Counselor Giangregorio noted

Plaintiff's complaints concerning her conflict with her supervisor, that Plaintiff was taking

zoloft, and that Plaintiff suffered from back pain and muscle spasms on the left side. (TR.

277) He confirmed his diagnosis of adjustment disorder with depressed mood. (TR. 277)

On July 30, 2002, Counselor Giangregorio's progress notes reflected that Plaintiff's

supervisor "wants her terminated" and that Plaintiff complained of constant physical pain.

(TR. 278) His assessment was "work related stress...depression" and he recommended that

she continue on zoloft. (TR. 278) Plaintiff discontinued treatment with Counselor

Giangregorio because she did not "have any insurance." (TR. 41)

On November 29, 2002, Plaintiff was examined by Alice F. Chang, Ph.D., Licensed

Clinical Psychologist. (TR. 186-188) Dr. Chang noted that Plaintiff cried during their

interview, was "explosive", "angry about something that happened to her at work"6

, and

"tended to wear her emotions on her sleeve." (TR. 186) On mental status exam, Plaintiff 

rated a 28/30 on the Folstein Mini-Mental Status exam. She was aware of

person, place, date and time. She was not able to subtract by 7 from 100, but

was able to spell WORLD backwards without hesitation. She did not know

the season, and was unable to follow three simple consecutive commands. She

was able to recall three objects on delayed recall, and was familiar with current

events.

(TR. 186) Dr. Chang noted that Plaintiff "appears to be labile in affect and have uncontrolled

reactive mood swings...She appears to have pain, both physical and emotional and reports

that she is unmotivated to do anything. She is able to manage her own finances." (TR. 188)

Dr. Chang's diagnoses was:

Axis I: 309.28 Adjustment Disorder with mixed anxiety and depressed

mood

Axis V: 162.20 Occupational Problem

Axis III: Deferred to medical reports

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Dr. Chang did not indicate a diagnosis for Axis II or IV.

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(TR. 188)7

 

In April 2003, Plaintiff began psychological treatment with Kenny E. Miller, ACSE,

CISW, at the Chiricahua Community Health Center. (TR. 243) In June 5, 2003, Mr. Miller's

diagnosis was:

Axis I: Major depressive disorder, single episode and anxiety disorder NOS

Axis II: No diagnosis

Axis III: Multiple muscle spasms, severe neck and back pain

Axis IV: Current: 5, severe; by history: 3, moderate

Axis V: GAF: current: 60; past year: 65

(TR. 244) Mr. Miller noted Plaintiff's complaints of pain and difficulty sleeping, gagging

from severe anxiety over her future, and panic attacks. (TR. 244) Mr. Miller opined that

Plaintiff 

presents with all of the symptoms of a Major Depressive episode, including the

inability to concentrate, the everyday experience of fatigue and loss of energy,

the loss of pleasure in daily activities, sleep disturbance, psychomotor

retardation, as well as a struggle to complete the Activities of Daily

Living...The physical impairment of her neck, back and other muscle spasms,

in combination with the mental impairment of the Major Depressive Episode

described above, leave her in my mind as decidedly unable to sustain a living

for herself at the current time. In the history of my 18 years of practice I have

rarely seen a formerly high functioning person reduced to such a severe

impairment of her functional ability.

(TR. 245)(emphasis in original) Mr. Miller found that Plaintiff was "earnest in her desires

to help herself." (TR. 245) His work with Plaintiff included "techniques in stress

reduction...which she can practice for herself in her home or office environment..." (TR.

245) Mr. Miller stated that "[t]he baseline support provided by a disability income, in

combination with the psychotherapy she is currently seeking, make her an excellent

candidate to break the negative spiral she has experienced." (TR. 245) 

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Additional records from Chiricahua Community Health Center dated in December

2002 and July through August 2003 reflect that one Nurse Hick's diagnosed Plaintiff with

depression and noted Plaintiff's complaints of vertigo and trouble sleeping. (TR. 204, 207,

236, 255) Plaintiff was advised to continue on zoloft and zanaflex was also prescribed. (TR.

207, 236, 255)

2. State-Agency Non-Examining Physicians

a. Physical Impairment

A Physical Residual Functional Capacity Assessment of Plaintiff was completed on

October 30, 2000 by a state physician, whose name is illegible. (TR. 130-137; see also TR.

2) That assessment reflected that Plaintiff could lift up to 20 pounds occasionally and up

to 10 pounds frequently. (TR. 131) She could stand and/or walk about 6 hours in an 8-hour

work day and she could sit about 6 hours in an 8-hour work day with normal breaks. (TR.

131). Plaintiff had no limitations in pushing and/or pulling. (TR. 121) While she should

never climb ladders, ropes or scaffolds, she could frequently climb ramps or stairs. (TR. 132)

The physician further stated that Plaintiff "is partially credible or her condition is not fully

supported in regards to severity. She is able to do" activities of daily living. (TR. 135)

A March 11, 2003 Physical Residual Functional Capacity Assessment reflected that

Plaintiff could lift up to 20 pounds occasionally and up to 10 pounds frequently. (TR. 209)

She could stand and/or walk about 6 hours in an 8-hour work day and she could sit about 6

hours in an 8-hour work day with normal breaks. (TR. 209). Plaintiff had no limitations in

pushing and/or pulling. (TR. 209) While she should never climb ladders, ropes or scaffolds,

she could occasionally climb ramps or stairs. (TR. 210) Plaintiff could occasionally balance,

stoop, kneel, crouch, and crawl. (TR. 210) Plaintiff should also "avoid even moderate

exposure" to heights due to vertigo. (TR. 212) Plaintiff was found to be "partially credible.

She is able to do" activities of daily living. (TR. 213) 

Case 4:04-cv-00323-JMR Document 22 Filed 02/28/07 Page 15 of 33
- 16 -

b. Mental Impairment

On December 4, 2002, state agency physician Jack A. Marks, M.D., completed a

Psychiatric Review Technique wherein he indicated that Plaintiff suffered from adjustment

disorder with anxiety and depression and that such impairment was "severe but not expected

to last 12 months" and, thus, the condition should be "nonsevere by 4/03." (TR. 189) He

noted Plaintiff's decreased energy, feelings of guilt or worthlessness or hopelessness and her

difficulty concentrating or thinking. (TR. 192) Dr. Marks found Plaintiff's mental

impairments resulted in mild restriction of activities of daily living; mild difficulties in

maintaining social functioning; and mild difficulties in maintaining concentration,

persistence or pace. (TR. 199) Dr. Marks also noted that Plaintiff was "[p]artially credible,

findings consistent to partial support of allegations." (TR. 201)

On March 7, 2003 Dr. Paul Tangeman completed a Psychiatric Review Technique

wherein he indicated that Plaintiff suffered from adjustment disorder and that such

impairment was "not severe." (TR. 216) He found that Plaintiff's mental impairment resulted

in mild restriction of activities of daily living; mild difficulties in maintaining social

functioning; and mild difficulties in maintaining concentration, persistence or pace. (TR.

226) Dr. Tangeman also noted that Plaintiff's cognitive abilities were "adequate, social skills

are appropriate, [Plaintiff] is independent in all" activities of daily living, and "her functional

limitations appear less than severe." (TR. 228) Dr. Tangeman further stated that his findings

were consistent with "partial support of [Plaintiff's] allegations." (TR. 228)

 C. The ALJ’s Findings

1. Claim Evaluation

SSA regulations require the ALJ to evaluate disability claims pursuant to a five-step

sequential process. 20 CFR §§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 CFR §§ 404.1520(b), 416.920(b). If so, then the claimant

is not disabled under the Act and benefits are denied. Id. If the claimant is not engaged in

Case 4:04-cv-00323-JMR Document 22 Filed 02/28/07 Page 16 of 33
8

Residual functional capacity is defined as that which an individual can still do despite

his or her limitations. 20 CFR § 404.1545.

- 17 -

substantial gainful activity, the ALJ then proceeds to step two which requires a determination

of whether the claimant has a medically severe impairment or combination of impairments.

20 CFR §§ 404.1520(c), 416.920(c). In making a determination at step two, the ALJ uses

medical evidence to consider whether the claimant’s impairment more than minimally limited

or restricted his or her 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. If the ALJ makes 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 CFR §§

404.1520(d), 416.920(d); 20 CFR 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”)8

 to perform past work. 20 CFR §§ 404.1520(e), 416.920(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 CFR §§ 404.1520(f). 416.920(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 v.

Secretary, 846 F.2d 573, 576-577 (9th Cir. 1988). The grids are a valid basis for denying

Case 4:04-cv-00323-JMR Document 22 Filed 02/28/07 Page 17 of 33
- 18 -

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 v. Sullivan, 2 F.3d 953, 958-959 (9th Cir. 1993); 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.

2. The ALJ's Decision 

In her December 3, 2003 Decision, the ALJ made the following findings:

1. The claimant has not engaged in substantial gainful activity

since the alleged onset date of disability.

2. The claimant has an impairment or a combination of

impairments considered "severe" based on the requirements of

20 CFR 404.1520(b).

3. These medically determinable impairments do not meet or

medically equal one of the listed impairments in Appendix 1,

Subpart P, Regulation No. 4. 

4. The undersigned finds that the claimant's allegations regarding

her limitations are partially credible for reasons stated above. 

5. The undersigned has carefully considered all the medical

opinions in the record regarding the severity of the claimant's

impairments (20 CFR 404.1527) 

6. The claimant has the residual functional capacity to do a full

range of light-level exertional work with postural limitations.

She cannot frequently climb, balance, stoop, kneel, crouch, and

crawl and cannot climb ladders/ropes/scaffolds. The claimant

also has limited ability to push and/or pull in her upper

extremities and must avoid hazards such as machinery and

heights. She has no non-exertional mental limitations.

7. The claimant's past relevant work as a low-income housing

placement worker did not require the performance of workrelated activities precluded by her residual functional capacity

(20 CFR 404.1565).

8. The claimant's medically determinable degenerative disc disease

and chronic back pain do not prevent the claimant from

performing her past relevant work. 

Case 4:04-cv-00323-JMR Document 22 Filed 02/28/07 Page 18 of 33
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9. The claimant was not under a "disability," as defined by the

Social Security Act, at any time through the date of the decision

(20 CFR 404.1520(e)).

DECISION

It is the decision of the Administrative Law Judge that, based on the

application filed July 12, 2002, the claimant is not entitled to a period of

disability or disability insurance benefits under Sections 216(l) and 223,

respectively, of the Social Security Act. 

(TR. 16-17)

In adopting the state non-examining physicians' conclusion that Plaintiff could

perform light work, the ALJ rejected Dr. Worden's October 2002 opinion that Plaintiff could

not work. The ALJ gave "minimal weight" to Dr. Worden's finding for the following

reasons: Dr. Worden reached this conclusion "after having seen the claimant only twice"; Dr.

Worden's conclusion is contradicted by the medical evidence and the record as a whole; "[i]f

the physical limitations set forth by Dr. Worden were accurate, the claimant would have to

spend most of the day lying down which she does not do" based on Plaintiff's testimony and

interview with Dr. Chang; and Plaintiff consistently looks for sedentary-level employment

despite Dr. Worden's opinion that she cannot work. (TR. 16)

The ALJ also rejected Nurse Comaduran's August 2, 2002 assessment of Plaintiff's

work limitations because Nurse Comaduran, as a "family nurse practitioner," is "not an

acceptable medical source under 20 CFR 404.1513, and is contradicted by the medical

evidence." (TR. 16)

When assessing Plaintiff's allegation of psychiatric limitations, the ALJ "rejected"

Kenneth Miller's conclusion that Plaintiff suffers from major depressive and anxiety

disorders and thus cannot work. The ALJ gave "no weight" to Mr. Miller's opinion and

treatment notes because: "Mr. Miller is a social worker and not a psychologist or

psychiatrist" and therefore he is not an acceptable medical source; Mr. Miller's findings are

inconsistent with the GAF scores of 60 and 65 which he assessed; apart from medication to

help her sleep, Plaintiff does not take medication for her alleged mental impairments;

Case 4:04-cv-00323-JMR Document 22 Filed 02/28/07 Page 19 of 33
- 20 -

Plaintiff "does not seek medical treatment for her alleged mental impairments"; and Mr.

Miller's findings are contradicted by Dr. Chang and two state agency doctors. (TR. 15-16)

The ALJ further found that Plaintiff did not have a medically determinable impairment

that could reasonably be expected to produce her subjective symptoms. To support this

conclusion, the ALJ pointed out that "[t]he medical evidence indicates the claimant's

symptoms respond to therapy and medication, though she is likely to always have some

pain...She alleged no difficulty performing activities of daily living...The claimant noted that

she cooks and shops for herself and that she can do housework, such as washing the dishes

and laundry. She reports no side effects from the medication...claimant reported that she

sometimes uses a sewing machine." (TR. 17) The ALJ also found Plaintiff "only partially

credible with respect to her impairments" due to Plaintiff's testimony that "her back and neck

pain never lets up and [Plaintiff] rated the intensity of the pain at 9, on a scale of 1 to 10, with

10 being excruciating pain that would compel a visit to the emergency room. Her demeanor

during the 30-minute hearing was entirely inconsistent with such a level of pain, and no

examining source noted such discomfort." (TR. 17) The ALJ found that Plaintiff's continued

search for sedentary work also undermined Plaintiff's credibility. (TR. 17)

III. ARGUMENT

Plaintiff contends that "[a]ll of the Commissioner's offered reasons for rejecting Dr.

Worden's opinion fail to meet specific and legitimate standards." (Plaintiff's MSJ, p.10) 

Plaintiff also takes issue with the ALJ's rejection of Nurse Comaduran's and Mr.

Miller's opinions. Plaintiff points out that the regulations allow the Commissioner to

consider other medical sources which can include nurse practitioners. (Id. citing 20 CFR §

404.1513(d)) Plaintiff also argues that, contrary to the ALJ's assertion, the record does not

contradict either provider's opinions. 

Plaintiff argues that the ALJ's stated reasons for finding Plaintiff only partially

credible are not supported by the record. Plaintiff stresses that she has consistently taken

Case 4:04-cv-00323-JMR Document 22 Filed 02/28/07 Page 20 of 33
9

Defendant incorrectly indicates that Dr. Worden's disability determination was made

on October 7, 2003. (Defendant's XMSJ, p.4 citing TR. 262) The date of that determination

is October 7, 2002. (TR. 262)

- 21 -

zoloft, that she had no medical coverage for mental health treatment, and that she had in fact

experienced side effects from her medication. (Id. at pp. 12-13)

Defendant argues that the ALJ gave sufficient reasons for rejecting Dr. Worden's

opinion. Defendant also maintains that Dr. Worden cannot be considered a treating source

because she only saw Plaintiff once prior to making her October 2002 disability

determination.9

 Further, according to Defendant, Dr. Worden's conclusion is contradicted

by her own medical finding and Plaintiff's testimony. (Defendant's XMSJ, p.4) 

Defendant also argues that contrary to Plaintiff's assertion that the ALJ failed to

consider Nurse Comaduran's and Mr. Miller's opinions, the ALJ in fact considered and

properly rejected such opinion by establishing that they were contradicted by other evidence

in the record. Defendant further contends that the ALJ set forth proper reasons for her

credibility determination.

IV. STANDARD OF REVIEW

Pursuant to 42 U.S.C. § 423(d)(1)(A), an insured individual is entitled to disability

insurance benefits if he or she demonstrates, through medically acceptable clinical or

laboratory standards, an inability to engage in substantial gainful activity due to a physical

or mental impairment that can be expected to last for a continuous period of at least twelve

months. 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, 2 F.3d at 956 (quoting Marcia v. Sullivan, 900 F.2d 172, 174 (9th Cir.

1990)).

To establish a prima facie case of disability, the claimant must demonstrate an

inability to perform his or her former work. Gallant v. Heckler, 753 F.2d 1450, 1452 (9th Cir.

Case 4:04-cv-00323-JMR Document 22 Filed 02/28/07 Page 21 of 33
- 22 -

1984). Once the claimant meets that burden, the Commissioner must come forward with

substantial evidence establishing that the claimant is not disabled. Fife v. Heckler, 767 F.2d

1427, 1429 (9th Cir. 1985).

Pursuant to 42 U.S.C. §405(g), the findings of the Commissioner are conclusive and

courts may overturn the decision to deny benefits “only if it is not supported by substantial

evidence or it is based on legal error.” Matney v. Sullivan, 981 F.2d 1016, 1019 (9th Cir.

1992)(citations omitted). Therefore, the Commissioner's determination that a claimant is not

disabled must be upheld if the Commissioner applied the proper legal standards and if the

record as a whole contains substantial evidence to support the decision. Clem v. Sullivan,

894 F.2d 328, 330 (9th Cir. 1990) (citing Desrosiers, 846 F.2d at 575-76; Delgado v.

Heckler, 722 F.2d 570, 572 (9th Cir. 1983)). Substantial evidence is defined as such relevant

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

Jamerson v. Chater, 112 F.3d 1064, 1067-68 (9th Cir. 1997); Winans v. Bowen, 853 F.2d

643, 644 (9th Cir. 1988). However, substantial evidence is less than a preponderance.

Matney, 981 F.2d at 1019. 

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. Id. However,

when applying the substantial evidence standard, the court should not mechanically accept

the Commissioner's findings but should review the record critically and thoroughly. Day v.

Weinberger, 522 F.2d 1154 (9th Cir. 1975). Reviewing courts must consider the evidence

that supports as well as detracts from the examiner's conclusion. Id. at 1156.

In evaluating evidence to determine whether a claimant is disabled, the opinions of

treating physicians are entitled to great weight. Magallanes v. Bowen, 881 F.2d 747, 751 (9th

Cir. 1989). However, even a treating physician’s opinion is not necessarily conclusive on

either the issue of a physical condition or the ultimate issue of disability. Id. When resolving

a conflict between the opinion of a treating physician and that of an examining or

nonexamining physician, the opinion of the treating physician is entitled to greater weight

Case 4:04-cv-00323-JMR Document 22 Filed 02/28/07 Page 22 of 33
10At the time the ALJ made her decision, the following documents authored by Dr.

Worden were in the record: September 24, 2002 Initial Osteopathic Evaluation (TR. 125-

128), October 7, 2002 "Medical Source Statement (Mental)" (TR. 259-261), and October 7,

2002 "Physical Capacities Evaluation" (TR. 262). Plaintiff testified at the November 19,

2003 hearing that she first saw Dr. Worden in September 2002 and that she was still seeing

her. (TR. 37-38. 43)

- 23 -

and may be rejected only on the basis of findings setting forth specific legitimate reasons

based on substantial evidence of record. Magallanes, 881 F.2d at 751. Moreover, the

Commissioner may reject the treating physician’s uncontradicted opinion as long as the

Commissioner sets forth clear and convincing reasons for doing so. Magallanes, 881 F.2d

at 751.

Further, when medical reports are inconclusive, questions of credibility and resolution

of conflicts in the testimony are functions solely of the Commissioner. Magallanes, 881 F.2d

at 751 (citations omitted). However, the Commissioner’s finding that a claimant is less than

credible must have some support in the record. See Light v. Social Security Administration,

119 F.3d 789 (9th Cir. 1997); Connett v. Barnhart, 340 F.3d 871 (9th Cir. 2003).

V. DISCUSSION

Plaintiff challenges the ALJ's rejection of Dr. Worden's determination that Plaintiff

is disabled. 

The record reflects that Dr. Worden's records from October 31, 2003 to December 11,

2003, were not among the records submitted to the ALJ, but were subsequently made "part

of the record" upon their submission to the Appeals Council.10 (TR. 9) In denying Plaintiff's

request for review of the ALJ's decision, the Appeals Council, considered inter alia Plaintiff's

additional evidence including Dr. Worden's 2003 records, and determined that such

"information does not provide a basis for changing the Administrative Law Judge's decision."

(TR. 6-7) Defendant, in his XMSJ does not contend that the Appeals Counsel considered

Dr. Worden's 2003 records in error. Nor does Defendant contend that this Court should not

consider that information. In fact, Defendant does not address the 2003 records at all.

Case 4:04-cv-00323-JMR Document 22 Filed 02/28/07 Page 23 of 33
11Defendant states: "Although the ALJ found that Dr. Worden saw Plaintiff only twice

before expressing her opinion (TR. 16), the record reveals that she had seen Plaintiff only

once." (Defendant's XMSJ, p.4)

- 24 -

The Ninth Circuit has held that under such circumstances, "we consider on appeal

both the ALJ's decision and the additional material submitted to the Appeals Council."

Ramirez v. Shalala, 8 F.3d 1449, 1452 (9th Cir. 1993) (citing 20 CFR § 404.970(b)); See also

20 CFR § 404.970(b) (providing that the Appeals Council shall evaluate the record including

new and material evidence predating the ALJ's hearing decision and shall review the decision

of the ALJ if the ALJ's actions, findings, or conclusions of law are contrary to the weight of

the evidence in the record); (TR. 6 (the Appeals Council will review a case for any of the

following reasons: the administrative law judge appears to have abused his or her discretion;

there is an error of law; the decision is not supported by substantial evidence; there is a broad

procedural issue that may affect the public interest; the Appeals Council receives new and

material evidence and the decision is contrary to the weight of all the evidence now in the

record.)) Therefore, Dr. Worden's 2003 records submitted to the Appeals Council are

properly considered herein. See Ramirez, 8 F.3d at 1452.

Defendant argues that "Dr. Worden's opinion was not entitled to the great weight that

is given to the opinion of a treating physician" because Dr. Worden had seen plaintiff only

once11 prior to rending her October 2002 opinion that Plaintiff was unable to work.

(Defendant's XMSJ, pp. 3-4) 

It is well settled that the opinions of treating physicians are entitled to greater weight

than the opinions of examining or non-examining physicians. Andrews v. Shalala, 53 F.3d

1035, 1040-1041 (9th Cir. 1995). Therefore, "[a] treating physician's opinion on disability

even if controverted can be rejected only with specific and legitimate reasons supported by

substantial evidence in the record." Reddick, 157 F.3d at 725 (citing Lester v. Chater, 81

F.3d 821, 830 (9th Cir. 1995)). See also Holohan v. Massanari, 246 F.3d 1195, 1202-1203

(9th Cir. 2001). "We afford greater weight to a treating physician's opinion because he is

Case 4:04-cv-00323-JMR Document 22 Filed 02/28/07 Page 24 of 33
- 25 -

employed to cure and has a greater opportunity to know and observe the patient as an

individual." Magallanes, 881 F.2d at 751. Defendant is correct to the extent that "[u]nder

certain circumstances, a treating physician's opinion on some matter may be entitled to little

if any weight. This might be the case for instance, if the treating physician has not seen the

patient long enough to 'have obtained a longitudinal picture' of the patient's impairments, 20

CFR § 404.1527(d)(2)(i), offers an opinion on a matter not related to his or her area of

specialization, see id. § 404.1527(d)(5), and presents no support for her or his opinion on the

matter. see id. § 404.1527(d)(3)." Holohan, 246 F.3d at 1202 n.2. However, even if Dr.

Worden is considered as an "examining physician" rather than a "treating physician," her

opinion would still be entitled to greater weight than the opinion of a "nonexamining"

physician. Lester, 81 F.3d at 830. "And like the opinion of a treating doctor, the examining

doctor, even if contradicted by another doctor, can only be rejected for specific and

legitimate reasons that are supported by substantial evidence in the record." Id. at 830-831

(this standard also applies when the ALJ rejects opinions from the examining physician in

favor of the nonexamining physician).

To support her position, Defendant relies on Matney v. Sullivan, wherein the Ninth

Circuit approved of the ALJ's determination that the treating doctor's opinion was entitled

to little weight because he had examined Plaintiff only one time, "produced a brief report",

and "[t]he diagnosis was based primarily upon the medical history and subjective complaints

as related by" the plaintiff. Matney, 981 F.2d at 1020. The instant case is distinguishable

from Matney.

Prior to Dr. Worden's October 7, 2002 opinion that Plaintiff was unable to work, Dr.

Worden completed an Initial Osteopathic Evaluation of Plaintiff on September 24, 2002.

(TR. 125-129) In Dr. Worden's four-page report memorializing her September 24, 2002

evaluation of Plaintiff, Dr. Worden documents Plaintiff's treatment history including

Plaintiff's completion of several courses of physical therapy, visits to Dr. Tyson, D.C. for

"some massage, electric stim.", Plaintiff's complaints of pain, and that muscle relaxers had

Case 4:04-cv-00323-JMR Document 22 Filed 02/28/07 Page 25 of 33
- 26 -

been prescribed for Plaintiff. (TR. 125) Dr. Worden performed her own physical examination

of Plaintiff which included: general observations; Plaintiff's vitals; assessment of Plaintiff's

neurologic, osteopathic, and postural condition; and assessment of Plaintiff's sacrum, lower

extremities, abdomen, lumbar and cervical spine, and head. Additionally, Dr. Worden

considered the following medical records which Plaintiff brought to the examination:

C patient progress notes from Dr. Knapp's office and Dr. Padilla's office;

C a May 30, 2001 IME done by Dr. Robert Schumacher; and

C a letter from Dr. Schumacher making reference to a December 12, 2001 MRI of

Plaintiff's right shoulder.

Upon review of these records, Dr. Worden noted that the records "support the history that

[Plaintiff] gave" her, that they show that Plaintiff "had good compliance in follow through

and that even Dr. Schumacher was considering a shoulder decompressive surgery at that

time." (TR. 128) Thus, unlike the brief report in Matney that was based primarily on the

plaintiff's subjective complaints and rendition of his medical history, Dr. Worden completed

the October 7, 2002 Physical Capacities Evaluation after she had performed a thorough

physical exam and after she had reviewed Plaintiff's prior medical records which she

determined supported Plaintiff's history as related by Plaintiff.

Further, Dr. Worden saw Plaintiff again one year later on October 10, 2003 and

continued to treat Plaintiff on October 31, 2003, November 14, 2003, November 24, 2003,

and December 11, 2003. On November 24, 2003, Dr. Worden stated that Plaintiff "has been

totally medically disabled from work due to physical limitations of muscle spasm and pain"

since at least September 24, 2002 when Dr. Worden first examined her. (TR. 290) Despite

the submission of Dr. Worden's 2003 records, including the November 24, 2003 opinion that

Plaintiff remained disabled, the Appeal's Council saw no reason to disturb the ALJ's rejection

of Dr. Worden's opinion that Plaintiff was disabled. The decision to accept the nonexamining doctor's opinion over Dr. Worden's opinion must be supported by specific and

Case 4:04-cv-00323-JMR Document 22 Filed 02/28/07 Page 26 of 33
12Defendant points out that the ALJ was mistaken regarding the number of times that

Dr. Worden saw Plaintiff before completing the October 7, 2002 Physical Capacities

Evaluation: "Although the ALJ found that Dr. Worden had seen Plaintiff twice before

expressing her opinion (TR. 16), the record reveals that she had seen Plaintiff only once."

(Defendant's XMSJ, p.4) In light of the Appeal Council's consideration of additional

treatment records from Dr. Worden, including Dr. Worden's November 24, 2003 opinion that

Plaintiff continued to be disabled, rejection of Dr. Worden's opinion for the reason that she

had only seen Plaintiff once, or twice, is no longer valid.

- 27 -

legitimate reasons which in turn are supported by substantial evidence in the record. See

Holohan, 246 F.3d at 1201-1203; Lester, 81 F.3d at 830-831.

The ALJ rejected Dr. Worden's opinion because "it is contradicted by the medical

evidence and the record as a whole" and under "the physical limitations set forth by Dr.

Worden...[Plaintiff] would have to spend most of the day lying down, which she does not do"

given that she watches television, washes dishes, cares for herself, walks for a hobby and

consistently looks for sedentary-level employment. (TR. 16) The ALJ also pointed out that

"Dr. Worden reached her conclusion after having seen...[Plaintiff] only twice."12 (TR. 16)

To bolster the ALJ's finding, Defendant stresses that radiological reports revealed only

mild to moderate abnormalities, that Dr. Worden's clinical findings did not show Plaintiff

could perform less than a light range of work, and that Dr. Worden indicated Plaintiff had

"only a soft tissue issue that would improve with treatment." (Defendant's XMSJ, p.4) The

substantial evidence in the record does not support Defendant's characterization.

By the time Plaintiff first visited Dr. Worden in September 2002, Plaintiff had

completed a course of physical therapy for shoulder bursitis in 2001 and as of 2001 Dr.

Schumacher had considered shoulder decompressive surgery. In early 2002, Dr. Padilla had

informed Plaintiff that her complaints were common with shoulder bursitis; that she should

use anti-inflammatories; and that she could expect to always have shoulder pain. Throughout

2002, Plaintiff complained numerous times to her primary care provider's certified nurse

practitioner about constant back pain, neck pain and back spasms. Plaintiff was prescribed

muscle relaxers, ibuprofren, and zoloft. Radiological reports dated June 20, 2002 and July

Case 4:04-cv-00323-JMR Document 22 Filed 02/28/07 Page 27 of 33
- 28 -

5, 2002 indicated "mild loss of intervertebral disk space height...at L3-L4" and "degenerative

changes...within the lower cervical spine" including moderate loss of intervetrebral disk

space height at C5-C6, mild to moderate loss of disk space height at C6-C7, mild

encroachment upon C6-C7 neural canals. (TR. 160, 161) A July 19, 2002 MRI revealed

"[f]airly severe disk degeneration and dehydration" at C4-C5, C5-C-6, and C6-C7 in addition

to mild to moderate stenosis at C5-C6, moderate spinal stenosis at C6-C7, and significant

scoliosis of the thoracic spine. (TR. 144) Additionally, in July 2002, neurologist Cary

diagnosed irritative cervical radiculopathy, torticollis, and "[l]umbar somatic dysfunction,

likely musculoskeletal." (TR. 157)

Also prior to her first visit to Dr. Worden, Plaintiff completed a second course of

physical therapy to no avail. It was the lack of success with this course of physical therapy

that prompted referral to Dr. Worden in the hope that a "D.O. that specializes in manipulative

tech" could help Plaintiff. (TR. 275) ("Pt. con't to have multiple dysfunctions that did not

improve with Pt. Most notable are: R rib cage posterior: R thoracic vert rotated to R: R scap

winged: R scap. musculature tender to palpation appearance reveals R thoracic spine, scap

are prominently post. in position.") Dr. Worden's notes reflect that Plaintiff also underwent

electric stimulation to no avail and that Plaintiff declined cortisone shots to her shoulder. By

November 24, 2003, Plaintiff had not improved despite undergoing osteopathic manipulative

treatments with Dr. Worden and despite trying various medications. (See TR. 290)

Plaintiff aptly points out that Defendant's characterization of the radiological reports

as showing only mild to moderate abnormalities overlooks the July 19, 2002 MRI indicting

"[f]airly severe disk degeneration and dehydration" at the cervical spine. (Plaintiff's Reply,

p.3; see also TR. 144) There is no dispute that Dr. Worden's examinations of Plaintiff

revealed that Plaintiff suffered from soft tissue issues, including chronic myofascial pain

syndrome. Dr. Worden consistently diagnosed underlying cervical, thoracic, rib, lumbar, and

upper extremity strain and found that Plaintiff did not improve despite osteopathic

Case 4:04-cv-00323-JMR Document 22 Filed 02/28/07 Page 28 of 33
- 29 -

manipulative therapy and changes in medication. Dr. Worden's opinion is supported by her

own treatment records in addition to the medical evidence as a whole.

Further, nothing in Plaintiff's testimony is inconsistent with Dr. Worden's finding. Dr.

Worden found that Plaintiff could sit for one hour at a time for a total of two hours, stand for

one hour at a time for a total of one hour and walk for one hour at a time for a total of one

hour during an 8-hour workday. (TR. 262) Plaintiff testified that she can sit in a chair "about

half an hour." (TR. 46) As a hobby, she uses a sewing machine for mending and she is able

to sit at the sewing machine for "[p]robably about half an hour." (TR. 50-51) Plaintiff also

testified that she is unable to stand more than "[a]n hour or so" because she "get[s]...a

pinched nerve back here." (TR. 46) Although she tries to walk on a regular basis, "it takes

a lot out of...my back, the pain that I have..." and as a result she walks "less than a

mile...[a]bout twice a week." (TR. 46-47) Plaintiff's statements in the record reflect that she

spends much of the day at home watching television. There is no evidence in the record

describing Plaintiff's body position while she is watching televison or whether or how often

she has to change positions during this activity. 

Dr. Worden found that Plaintiff could lift up to 10 pounds occasionally and should

never lift anything heavier. Plaintiff testified that she has difficulty lifting bags of groceries

and even though she can lift a gallon of milk, "it takes a lot...out of my back." (TR. 48) 

The Ninth Circuit 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 way detract from her credibility as to her overall disability. One

does not need to be 'utterly incapacitated' in order to be disable." Vertigan v. Halter, 260

F.3d 1044, 1050 (9th Cir. 2001) (quoting Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989));

see also Vick v. Commissioner of the Social Security Admin., 57 F.Supp.2d 1077, 1086 (D.

Or. 1999) ("if a claimant's activity is in harmony with her disability, the activity does not

necessarily indicate an ability to work.") The question is whether the plaintiff spends a

"'substantial part of his [or her] day engaged in pursuits involving the performance of

Case 4:04-cv-00323-JMR Document 22 Filed 02/28/07 Page 29 of 33
13This same rationale undercuts the ALJ's reliance on Plaintiff's search for

employment as a reason for discrediting Plaintiff's credibility. (See TR. 17) Further, the

ALJ's finding that Plaintiff "herself does not believe that her impairments and symptoms

prevent her from doing the kind of work she has done in the past" (TR. 17) is undermined

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physical functions that are transferrable to a work setting...' Thus, if a claimant is capable of

performing activities including household chores, 'that involve many of the same physical

tasks as a particular type of job, it would not be farfetched for an ALJ to conclude that the

claimant's pain does not prevent the claimant from working.'" Vick, 57 F.Supp.2d at 1085-

1086 (quoting Fair, 885 F.2d at 602)(emphasis in original).

Contrary to the ALJ's finding, Plaintiff's statements concerning her activities and

abilities to sit, stand, walk. and lift are consistent with, as opposed to contradictory to, the

limitations set forth by Dr. Worden. The evidence of record does not support the conclusion

that Plaintiff spends a substantial part of her day engaged in pursuits that would require a

functional capacity different from that identified from Dr. Worden. 

Plaintiff also persuasively argues that the ALJ improperly relied on evidence that

Plaintiff continues to look for work. Although Plaintiff testified that she continues to look

for administrative or clerical work, she stresses that she also testified that she did not think

she could do that type of work. (TR. 51) Plaintiff points out that social security applicants

may look for work because they are stubborn and refuse "to acknowledge an inability to

work, sometimes they are required to look for work by some other agency such as workers

compensation in this case and sometimes the work that they are looking for is so limited that

it could not be considered substantial gainful activity in the eyes of the Social Security

Administration. One or all of these issues were behind Plaintiff's acknowledgment..." that

she had looked for work "but the ALJ did not ask." (Plaintiff's Reply, p.4) Plaintiff herein

was not represented by counsel at the hearing before the ALJ. Plaintiff's undeveloped

testimony that she looked for work despite her belief that she was unable to perform such

work, does not in and of itself contradict Dr. Worden's opinion.13 Accordingly, for the

Case 4:04-cv-00323-JMR Document 22 Filed 02/28/07 Page 30 of 33
by Plaintiff's testimony that although she has looked for work she did not think that she could

perform that work. Moreover, despite the ALJ's finding that Plaintiff could return to her

previous work, there is scant evidence in the record concerning the requirements and duties

of that work. Nor did the ALJ refer to the Dictionary of Occupational Titles or other sources

for such information. See e.g. Johnson v. Shalala, 60 F.3d 1428, 1432 & n. 6 (9th Cir. 1995)

(recognizing that the Dictionary of Occupational Titles is the Commissioner's "primary

source of reliable job information" and that the Commissioner "regularly relies" on job

descriptions contained therein).

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foregoing reasons, Defendant has failed to establish that the ALJ provided "legally sufficient

reasons for rejecting" Dr. Worden's opinion. Benecke v, Barnhart, 379 F.3d 587, 593 (9th

Cir. 2004). Where the ALJ failed to provide legally sufficient reasons for rejecting a treating

physician’s opinion, the Ninth Circuit credits that opinion as true. Id. at 594. 

Remand for an award of benefits is appropriate where:

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

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.

Id. at 593 (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. As set forth above, the ALJ failed to set forth legally sufficient reasons for rejecting

Dr. Worden's disability finding which Dr. Worden reaffirmed in November 2003. The record

is complete and there are no outstanding issues that must be resolved before a disability

finding can be made. There is no dispute that the restrictions specified by Dr. Worden when

credited as true, require a finding of disability under the Social Security Act Therefore, the

requirements for remand for an award of benefits have been met. 

It has been over four years since Plaintiff applied for benefits. The Ninth Circuit has

recognized that "[r]emanding a disability claim for further proceedings can delay much

needed income for claimants who are unable to work and are entitled to benefits, often

subjecting them to 'tremendous financial difficulties while awaiting the outcome of their

Case 4:04-cv-00323-JMR Document 22 Filed 02/28/07 Page 31 of 33
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appeals and proceedings on remand.'" Benecke, 379 F.3d at 595 (quoting Varney v. Secretary

of Health and Human Services, 859 F.2d 1396, 1398 (9th Cir. 1988); see also Terry v.

Sullivan, 903 F.2d 1273 (9th Cir. 1990) (remanding for an award of benefits where the

plaintiff applied almost four years prior); Erickson v. Shalala, 9 F.3d 813 (9th Cir. 1993)

(remanding for an award of benefits where plaintiff, who was disabled under the Act, "has

been waiting for well over four years for his disability benefits"). On the instant record,

where the ALJ failed to provide adequate reason for rejecting the opinion of Plaintiff's

treating physician and where Plaintiff has satisfied all three factors in favor of a remand for

an award of benefits, "[r]emanding for further administrative proceedings would serve no

useful purpose and would unnecessarily extend...[Plaintiff's] long wait for benefits."

Benecke, 379 F.3d at 595. See also. Regennitter v. Commissioner, 166 F.3d 1294, 1300 (9th

Cir. 1999) (where the court "conclude[s] that...a doctor's opinion should have been credited

and, if credited, would have led to a finding of eligibility, we may order the payment of

benefits."); Pitzer v. Sullivan, 908 F.2d 502, 506 (9th Cir.1990) (remanding for payment of

benefits where the Secretary did not provide adequate reasons for disregarding examining

physician’s opinion); Winans, 853 F.2d at 647 (same). Therefore, Plaintiff's Motion for

Summary Judgment should be granted and this matter should be remanded for an award of

benefits. 

VI. RECOMMENDATION

For the foregoing reasons, the Magistrate Judge recommends that the District Court

grant Plaintiff's Motion for Summary Judgment (Doc. No. 6), deny Defendant's CrossMotion for Summary Judgment (Doc. No. 11), and remand this action for an award of

benefits.

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. If objections

are filed, the parties should use the following case number: CV 04-323-TUC-JMR. A party

Case 4:04-cv-00323-JMR Document 22 Filed 02/28/07 Page 32 of 33
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may respond to another party's objections within ten days after being served with a copy

thereof. See Fed.R.Civ.P. 72(b).

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), cert. denied, 540 U.S. 900 (2003). 

DATED this 28th day of February, 2007.

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