Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_05-cv-02271/USCOURTS-azd-2_05-cv-02271-0/pdf.json

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

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IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Barbara A. (Dunne) Kohnert, 

Plaintiff, 

vs.

JoAnne B. Barnhart, Commissioner of

Social Security Administration, 

Defendant. 

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No. CV-05-2271-PHX-MHM

ORDER

Plaintiff Barbara A. (Dunne) Kohnert seeks judicial review of the Administrative Law

Judge's ("ALJ") decision denying her claim for Disability Insurance Benefits. 42 U.S.C. §

405(g).

PROCEDURAL HISTORY

Plaintiff applied for Disability Insurance Benefits ("DIB") under Title II of the Social

Security Act, 42 U.S.C. § 423 and Supplemental Security Income benefits under Title XVI

of the Social Security Act, 42 U.S.C. § 1382, alleging disability since August 21, 2001 due

to injuries in both hands, panic attacks, episodes of vertigo, and migraine headaches.

Plaintiff's application was denied initially and on reconsideration. Plaintiff requested a

hearing and a hearing was held on January 14, 2004 and April 15, 2004. On May 10, 2004,

the Administrative Law Judge ("ALJ") issued a decision finding that Plaintiff was disabled

and eligible for disability benefits for a period between August 21, 2001, through September

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18, 2002, but not from or after September 19, 2002. Thus, Plaintiff was entitled to a closed

period of disability and Disability Insurance Benefits under Section 216(i) and 223(a),

respectively, of the Social Security Act, and was eligible for a limited period of Supplemental

Security Income under Sections 1602 and 1614(a)(3)(A) of the Act. Plaintiff sought review

of the ALJ's decision. The Appeals Council did not grant Plaintiff’s request for review and

the decision became final. Plaintiff commenced an action for review in this Court pursuant

to 42 U.S.C. §§ 405(g) and 1383(c). 

Plaintiff timely filed a Complaint for judicial review in this Court. (Doc.1). Defendant

has filed an Answer and a certified copy of the transcript of record. (Doc. 4). Plaintiff has

filed a Motion for Summary Judgment (Doc. 12) supported by an attached Statement of Facts

and supporting Brief. Defendant has filed Response to Plaintiff's Motion for Summary

Judgment (Doc. 13), and a Cross-Motion for Summary Judgment (Doc. 14) supported by a

Statement of Facts (Doc. 15) and Memorandum of Points and Authorities (Doc. 16). Plaintiff

has filed a Response to Defendant's Cross-Motion for Summary Judgment and a Reply to

Defendant's Response to Plaintiff's Motion for Summary Judgment. (Doc. 25). 

STANDARD OF REVIEW

This Court must affirm the ALJ’s findings if they are supported by substantial

evidence and free from reversible legal error. Marcia v. Sullivan, 900 F.2d 172, 174 (9th Cir.

1990). Substantial evidence means "more than a mere scintilla" and "such relevant evidence

as a reasonable mind might accept as adequate to support a conclusion." Richardson v.

Perales, 402 U.S. 389, 401 (1971); Clem v. Sullivan, 894 F.2d 328, 330 (9th Cir. 1990).

In determining whether substantial evidence supports a decision, the Court considers

the record as a whole. Richardson, 402 U.S. at 401; Tylitzki v. Shalala, 999 F.2d 1411, 1413

(9th Cir. 1993). If there is sufficient evidence to support the ALJ’s determination, the Court

cannot substitute its own determination. Young v. Sullivan, 911 F.2d 180, 184 (9th Cir.

1990). Where evidence is inconclusive, "questions of credibility and resolution of conflicts

in the testimony are functions solely of the [Commissioner]." Sample v. Schweiker, 694 F.2d

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639, 642 (9th Cir. 1982). Therefore, if on the whole record before the Court, substantial

evidence supports the Commissioner’s decisions, this Court must affirm. Hammock v.

Bowen, 879 F.2d 498, 501 (9th Cir. 1989); 42 U.S.C. § 405(g). 

An ALJ determines an applicant’s eligibility for disability benefits through the

following five steps:

(1) determine whether the applicant is engaged in "substantial gainful

activity";

(2) determine whether the applicant has a "medically severe impairment or

combination of impairments";

(3) determine whether the applicant’s impairment equals one of a number

of listed impairments that the Commissioner acknowledges as so severe

as to preclude the applicant from engaging in substantial gainful

activity;

(4) if the applicant’s impairment does not equal one of the "listed

impairments," determine whether the applicant is capable of performing

his or her past relevant work;

(5) if the applicant is not capable of performing his or her past relevant

work, determine whether the applicant "is able to perform other work

in the national economy in view of his [or her] age, education, and

work experience."

Bowen v. Yuckert, 482 U.S. 137, 140-41 (1987) (citing 20 C.F.R. §§ 404.1520(b)-(f)). See

20 C.F.R. § 416.920. At the fifth step, the burden of proof shifts to the Commissioner. Penny

v. Sullivan, 2 F.3d 953, 956 (9th Cir. 1993). 

BACKGROUND 

I. GENERAL BACKGROUND

Plaintiff was born on August 16, 1956 and was 47 years of age at the time of the

administrative hearings (Transcription of the certified administrative record filed with this

Court by Defendant on January 3, 2006 (hereinafter "Tr.") 119). Plaintiff graduated from

high school and earned an Associate of Arts degree in Special Education and psychology (Tr.

345). Plaintiff's relevant past work includes that of a special education aide, a home care

provider, and a receptionist (Tr. 94). Plaintiff is left-hand dominant (Tr. 344). Plaintiff

alleges that she became disabled on August 21, 2001 and continues to be disabled because

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 "Ulnar" means "of or relating to the ulna – the "bone on the little-finger side of the

human forearm that forms with the humerus the elbow joint and serves as a pivot in rotation

of the hand." Medline Plus by Merriam-Webster (1995)

http://www2.merriam-webster.com/cgi-bin/mwmednlm?book=Medical&va=ulnar (last

visited January 16, 2007). 

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of an injury to her right hand on that date, together with the residual effect of a 1996 injury

to Plaintiff's left hand, and on-going occurrences of migraine headaches, panic attacks, and

vertigo (Tr. 85, 347-48). Plaintiff voluntarily stopped driving three years before the hearing

due to panic attacks and vertigo (Tr. 344). 

Plaintiff was injured in a motor vehicle accident on May 24, 1996. (Tr. 225). The

Thunderbird Samaritan Medical Center emergency department records of the incident (Tr.

225-27) indicate that Plaintiff sustained "a minuscule chip fracture in an otherwise

undisturbed left fifth metacarpophalangeal [finger] joint" (Tr. 226). 

On July 1, 1996, Frederick Meyer, M.D., of Hand Surgery Associates, P.C., examined

Plaintiff and determined that Plaintiff appeared "to have multiple symptoms of ulnar1

 sided

wrist pain, but her area of maximum tenderness . . . [appeared] to be insertion of the extensor

carpi ulnaris." (Tr. 262). Dr. Meyer placed Plaintiff in a short arm cast with an outrig to

immobilize the three ulnar digits (Tr. 262). On July 22, 1996, Plaintiff returned to Dr. Meyer

due to experiencing "a great deal of pain." (Tr. 260). Dr. Meyer proscribed a removable

wrist splint, began Plaintiff on physical therapy, and referred her for an magnetic resonance

imaging scan ("MRI") bone scan (Id.). On September 23, 1996, Dr. Meyer informed Plaintiff

that the MRI was "basically normal," but scheduled an arthroscopy due to Plaintiff's

"moderate to marked amount of wrist pain." (Tr. 258). The arthroscopy was performed on

October 25, 1996, and it revealed ulnar osteochondral fragments, which were evacuated

without complications (Tr. 231). During this time, Planitiff was undergoing physical therapy

twice a week and working full time (Tr. 256).

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On December 16, 1996, Dr. Meyer determined that stressed x-rays showed a tendency

of ulnar to impact against her carpus (Tr. 256). Dr. Meyer assessed Plaintiff as having a 35

percent impairment rating of the [left] upper extremity (Tr. 255). On January 27, 1997,

Plaintiff returned to Dr. Meyer still experiencing pain in her [left] wrist, stating she took one

Naproxyn a day which helped relieve the pain (Tr. 254). Plaintiff also stated that she had

shoulder pain, which dated back to the 1996 auto accident (Tr. 254). Dr. Meyer did not

detect a shoulder sublux on examination, but assessed a possible rotator cuff tear in her left

shoulder, and ordered an MRI (Tr. 254). The shoulder MRI was essentially normal (Tr. 253).

On February 17, 197, Dr. Meyer found a ganglion cyst on Plaintiff's right dorsal wrist, which

he successfully aspirated (Tr. 253). 

On March 3, 1997, Mitchel Lipton, M.D., examined Plaintiff after she was referred

to him for insurance purposes relating to Plaintiff's 1996 auto accident (Tr. 246-51). Dr.

Lipton opined that Plaintiff was not stationary and should be weaned off her splint in an

effort to improve her 35 percent impairment rating. (Tr. 251). Dr. Lipton noted that Plaintiff

believed "her left wrist will not get better, and, frankly, if she continues to maintain that

belief, it probably won't get better" (Id.). Plaintiff was advised to establish a positive outlook

and recommended returning to the gym and suggested non-stressful strengthening activities,

such as swimming or tai chi, graduating to light resistance exercises as the left wrist pain

diminishes (Id.) On March 17, 1997, Dr. Meyer took note of Dr. Lipton's opinion (Tr. 253).

On August 18, 1997, Peter J. Campbell, M.D., an associate of Dr Meyer's at Hand

Surgery Associates, P.D., examined Plaintiff. (Tr. 252) Dr. Campbell aspirated the ganglion

cyst that had recurred on her right wrist (Id.). 

 On November 3, 1997, Leonard S. Bodell, M.D., examined Plaintiff's left wrist and

left shoulder (Tr. 156-59). Dr. Bodell found that Plaintiff had limited left wrist motion and

left forearm rotation with no obvious evidence of diastrophic changes (Tr. 157). Dr. Bodell

summarized Plaintiff's accident and surgical history, noting she had developed "the

equivalent of an ulnar impaction syndrome and perpetula pain and arthrofibrosis of the wrist"

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(Tr. 156-57). Dr. Bodell examined Plaintiff and found that she demonstrated limited left

wrist motion with significant limitation of forearm rotation and decreased grip strength (Tr.

157). Dr. Bodell noticed that Plaintiff's left shoulder defined an area of glenohumeral, not

subacromial, crepitus but did not sublux, which led Dr. Bodell to suspect a possible SLAP

lesion (pertaining to the scaphoidlunate ligament) (Id.). Dr. Bodell concluded that Plaintiff's

impairment was permanent, not expected to lessen over time, and more likely to become

magnified as "arthritic pain" as it progresses (Tr. 158). Dr. Bodell also stated that Plaintiff's

right wrist problems were likely caused secondarily by the 1996 auto accident, as Plaintiff

overused her right wrist to compensate for her limited-functioning left wrist (Id.). 

On December 5, 1997, Plaintiff visited Matthew Conklin, M.D., for an evaluation of

surgical treatment of Plaintiff's right wrist problems, including carpal tunnel syndrome and

a dorsal ganglion that had been aspirated twice (Tr. 326-27). Dr. Conklin advised Plaintiff

that a deeper structure, such as a scapholunate ligament (the ligament between the scaphoid

and lunate, or crescent, bones of the wrist) likely was causing her pain, and that rehabilitation

for carpal tunnel and ganglion excision contradict each other (Tr. 326). Nevertheless,

Plaintiff wished to proceed with both surgeries and advised that she would participate

diligently in the doctor's recommended rehabilitation program (Tr. 326-27). 

On December 12, 1997, Dr. Conklin performed a carpal tunnel release and dorsal

ganglion excision on Plaintiff's right wrist (Tr. 263-64). Upon release of the ligament, the

nerve appeared to be healthy, the carpal canal was intact, without specific pathology, and

there was no tenosynovitis, although, upon release, there was a generalized bulge to the

contents of the carpal canal (Tr. 263). In a December 16, 1997 followup visit, Dr. Conklin

reported that Plaintiff was doing very well and that both wounds were healing nicely (Tr.

325). Dr. Conklin stated that he would like Plaintiff to slowly but surely increase her activity

(Tr. 325). 

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On August 13, 2001, Dr. Conklin examined Plaintiff for complaints of left hand pain,

which he diagnosed as likely a volar ganglion (Tr. 324). An MRI confirmed a cyst, most

likely ganglion, along the volar radial survace of Plaintiff's left wrist (Tr. 328-29). 

On September 4, 2001, Judith W. Heath, M.D., Plaintiff's primary care physician,

examined Plaintiff after Plaintiff was hit by a wheelchair at work and fell on her tailbone and

both hands, mostly the right side, on August 22, 2001 (Tr. 304). Plaintiff was sore in both

hands and wrists (Tr. 304). Plaintiff also reported experiencing panic episodes and shortness

of breath and sighing (Id.). Dr. Heath found Plaintiff's right wrist was very tender in the

snuffbox with no swelling and Plaintiff's left wrist had a ganglion cyst. (Id.). Dr. Heath

prescribed Zoloft, Midrin, and BuSpar; and ordered an x-ray of Plaintiff's right wrist (Id.).

The x-ray revealed no fractures, particularly no scaphoid fracture, and the ulnar joints and

soft tissues appeared normal (Tr. 308). 

On September 17, 2001, Plaintiff visited Dr. Conklin for an evaluation of her

right wrist, which she reported was still injured due to her August 22, 2001 fall at work (Tr.

320). Dr. Conklin reported tenderness over the scapholunate interval of Plaintiff's right

sprain with evidence of radiocarpal and scapholunate sprain (Tr. 321). Regarding Plaintiff's

left wrist, Dr. Conklin advised Plaintiff to wait on the ganglion surgery for her right arm to

heal in order to have one healthy arm (Id.). For insurance purposes, Plaintiff chose to move

forward with surgery on her left wrist before her right wrist healed (Id.). That same day, Dr.

Conklin wrote a letter on Plaintiff's behalf to Nancy Oreshack at ASU West College of

Education explaining that Plaintiff was to undergo surgery on her left wrist, that there might

be a deeper pathology than the volar ganglion, that she was advised to avoid further stress

on her wrist, and that her recovery was expected to take six weeks to three months (Tr. 323).

On September 25, 2001, Dr. Conklin performed the excision of a volar ganglion from

Plaintiff's left wrist at Scottsdale Healthcare Osborn, while Plaintiff was under general

anesthesia (Tr. 278-79). Plaintiff was discharged later that same day (Tr. 280). 

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On October 1, 2001, Dr. Conklin examined Plaintiff's left wrist and found that the

surgical wound was healing well (Tr. 318). Dr. Conklin advised Plaintiff to continue to wear

a splint while sleeping or whenever she was at risk of trauma to her wrist (Id.). Dr. Conklin

released Plaintiff to work at a modified work status with no use of her left hand, limited use

as tolerated of her right hand, no climbing to unprotected heights, and no exposure of either

hand to power tools or pen active machinery (Id.). On October 10, 2001, Dr. Conklin again

examined Plaintiff and found her left wrist surgical wound healed enough to remove her

sutures (Tr. 317). Plaintiff was able to make a fist and she tolerated gentle range of motion

well (Id.). Plaintiff chose home therapy (Id.). 

On October 19, 2001, Dr. Heath examined Plaintiff's right wrist (Tr. 302). Dr. Heath

found small effusion but no obvious fracture; she suggested the possibility of subluxation of

the scaphoid and a question of some edema of the lunate (i.e., bone bruise) and slight

widening of the scapholunate joint (Id.). Dr. Heath recommended a wrist splint and followup appointment with a hand surgeon (Id.). 

On November 5, 2001, Plaintiff returned to Dr. Conklin for reassessment of her right

wrist pursuant to her August 21, 2001 fall at work (Tr. 316). Dr. Conklin ordered an MRI,

the results of which suggested a slight rotatory subluxation of the scaphoid and mild

scapholunate widening, consistent with scapholunate injury which could possibly be a partial

or complete tear, but did not indicate any sort of fracture (Id.). Dr. Conklin recommended

an arthrogram to rule out any sign of lunotriquetral tear, and then arthroscopy (Id.). Dr.

Conklin declined Plaintiff's request to render his opinion of her impairment rating for

worker's compensation purposes but Dr. Conklin declined the request because Plaintiff was

not stationary at that time (Id.). 

Dr. Conklin examined Plaintiff again on January 28, 2002 (Tr. 173-75). Dr. Conklin

assessed Plaintiff as capable of working at a modified work duty status with limited use as

tolerated of the right hand, no pinching with the right thumb, no repetitive use of the right

hand, no lifting nor force greater than one pound with the right hand, no climbing to

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unprotected heights, and no exposure of either hand to power tools or open active machinery

(Tr. 175). On February 20, 2002, Dr. Conklin noted tenderness with scapholunate testing,

but no crepitus and no swelling of the wrist, but scchymosis consistent with her recent

arthrogram (Tr. 172). Dr. Conklin stated that the results of the arthrogram were consistent

with scaphonuate ligament tear and mild widening (Id.). Dr. Conklin recommended

scapholunate ligament reconstruction surgery but Plaintiff was hesitant to proceed because

she felt that her left wrist was markedly compromised following her auto accident (Tr. 172).

On April 10, 2002, Plaintiff was still undecided about having surgery on her right wrist (Tr.

168). Dr. Conklin released Plaintiff for modified work status with limited use of her right

hand as tolerated (Tr. 168). 

On June 20, 2002, Plaintiff underwent arthrosporic surgery for debridement of partial

tear of her right wrist scapholunate ligament and partial synovectomy, right wrist, radiocarpal

joint, which was performed by Dr. Conklin (Tr. 163-65). Following the surgery, Plaintiff

attended nine physical therapy sessions at Desert Hand Therapy between July 8, 2002 and

July 25, 2002 (Tr. 281-89). On July 21, 2002, Plaintiff's grip strength in her right hand was

reported to be fifteen pounds greater than before she participated in therapy (Tr. 282). 

On September 4, 2002, Plaintiff underwent a Functional Capacity Evaluation,

performed by Murray Palmer at the Center for Musculoskeletal Medicine (Tr. 290-95). Mr.

Palmer assessed Plaintiff as capable of performing work at the light physical demand level,

defined by the U.S. Department of Labor as occasional lifting up to twenty pounds, frequent

lifting (up to two-thirds of the time) up to ten pounds, and constantly lifting up to negligible

force of movement (Tr. 291).

On September 18, 2002, Dr. Conklin wrote an ICA Medical Discharge Report, noting

that Plaintiff reported she was back to her school activities and felt that she was comfortable

with the ICA discharge (Tr. 314). Dr. Conklin found that Plaintiff had reached stationary

status, and had a permanent impairment secondary to mild loss of motion of her right wrist

(Tr. 314). Based on the functional capacity evaluation provided by the Musculoskeletal

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Medical Center, Dr. Conklin assessed Plaintiff as capable of working at a modified work

status with no lifting or force greater than twenty pounds occasionally and ten pounds

frequently (Tr. 314). 

On September 20, 2002, Plaintiff was seen by her primary care physician, Dr. Judith

Heath, during which time, Plaintiff conveyed that she was doing well (Tr. 298). Plaintiff

reported that she was newly married after divorcing her third husband; she was back in

school at ASU West and doing better; her panic was well-controlled, but her migraines were

more frequent since school started (Tr. 298). On December 20, 2002, Plaintiff returned to

Dr. Heath for a well woman examination and pap smear (Tr. 296-97). During this visit,

Plaintiff reported that she had withdrawn from school due to panic attacks and vertigo in

class (Tr. 296). 

On October 18, 2002, Plaintiff was examined by Keith W. Cunningham, M.D.,

internal medicine specialist (Tr. 176-78). Dr. Cunningham described Plaintiff as somewhat

agitated and at times condescending (Tr. 177). The examination was cut short when Dr.

Cunningham asked Plaintiff to leave due to her failure to cooperate with him while he tried

to obtain her medical history (Tr. 176).

On November 26, 2002, Plaintiff was examined by Atul Patel, M.D. (Tr. 179-83).

During that examination, Plaintiff relayed to Dr. Patel that her last episode of vertigo, basilar

type of migraine was six weeks earlier (Tr. 179). Plaintiff was unable to specify the number

of migraine attacks she had experienced but did report that her present status was reasonably

controlled (Tr. 179). Plaintiff stated that stress caused her attacks and referred to her failed

attempt to attend college that fall (Tr. 179). Dr. Patel found that Plaintiff had full functional

range of motion in her shoulders, elbows, wrists, intrinsic joints, hips, knees, and ankles (Tr.

180). Dr. Patel concluded that Plaintiff had a history of bilateral hand and wrist injuries,

basilar migraines, and panic disorder (Tr. 181). In light of Plaintiff's panic disorder, Dr. Patel

recommended a psychological evaluation (Id.). 

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On January 22, 2003, Plaintiff underwent a consultative metal status examination by

Carl C. Mansfield, Ph.D. (Tr. 184-87). After the examination, Dr. Mansfield assessed

Plaintiff as having panic disorder with mild agoraphobic symptoms (Tr. 185). 

In the Medical Source Statement of Ability to Do Work appended to his narrative

report, Dr. Mansfield indicated that Plaintiff's condition was "fair: seriously limited but not

precluded" for the following subcategories under the main category, Making Occupation

Adjustments: relate to co-workers; deal with the public; interact with supervisors; deal with

work stresses; function independently; maintain attention/concentration (Tr. 186). Dr.

Mansfield checked the "Good: limited but satisfactory" box for the following subcategories

in that section: follow work rules; use judgment (Tr. 186). 

In the category, Making Performance Adjustments, Dr. Mansfield rated Plaintiff as

"good" in the category "understand, remember and carry out simple job instructions, and

maintain personal appearance; and demonstrate reliability (Tr. 187). In that same category,

Dr Mansfield rated Plaintiff "fair" in the following areas: understand, remember and carry

out complex job instructions; understand, remember and carry detailed, but not complex job

instructions; behave in an emotionally stable manner; and relate predictably in social

situations (Id.). 

On January 30, 2003, State Disability Determination Specialist ("DDS") psychologist

Francis A. Enos, Ph.D. reviewed Plaintiff's medical records and completed a Psychiatric

Review Technique Form (PRTF) (Tr. 188-200) and a Mental Residual Functional Capacity

Assessment (MRFCA). Dr. Enos determined that Plaintiff had a medically determinable

impairment, panic disorder with mild agoraphobia (Tr. 188, 193). Dr. Enos concluded that

Plaintiff's condition was mild (Id.). 

On April 14, 2003, Jane George, Ph.D., a psychological consultant for the DDS,

completed a PRTF (Tr. 206-19) and a MRFCA (Tr. 220-22). Dr. George reported that the

record reflected evidence of anxiety-related disorders (Tr. 206, 211). Dr. George reported

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evidence of anxiety-related disorder but found that it only mildly restricted activities of daily

living (Tr. 206, 216). 

II. THE HEARING TESTIMONY 

During the initial hearing on January 14, 2004, Plaintiff testified that she is lefthanded (Tr. 344). Plaintiff testified that she stopped driving approximately three years before

the hearing because of panic attacks and vertigo (Id.). Plaintiff stopped working on August

21, 2001, after she injured her right hand in an accident at work (Tr. 347). Plaintiff had

previously injured her left wrist in a 1996 motor vehicle accident (Id.). 

Plaintiff returned to work after Dr. Meyer performed surgery on her left wrist (Tr.

348), however, Plaintiff was not able to use her left hand "normally" due to "extreme pain"

when bending or twisting her wrist (Id.). Plaintiff testified that she was not able to lift

cooking pots and she used two hands to pick up a coffee cup or a soda can (Tr. 351). 

Plaintiff testified that she experienced vertigo several times a week, with no known

precipitating factors (Tr. 353). When she experienced a vertigo episode, she had to hold onto

something to prevent falling down (Id.). Plaintiff believed she began experiencing problems

with vertigo after her 1996 vehicle accident (Id.). 

Plaintiff was no longer able to perform household chores such as dusting, sweeping,

making beds, and doing laundry (Tr. 355). She often received help from her mother for these

tasks (Id.). In fact, Plaintiff's mother, who lived about ten minutes away, helped Plaintiff

with chores a couple time per week (Tr. 361). Plaintiff no longer would grocery shop by

herself because she did not drive and she worried about having a panic attack and vertigo

because of the people around (Tr. 356). Plaintiff used to work out but could no longer run

on a treadmill because of a weak balance system (Tr. 356). In fact, she sometimes had

trouble walking (Tr. 357). 

Plaintiff enjoyed recreational reading and watching television (Tr. 357). She no

longer could counter cross-stitch because it required fine motor skills in her hands (Id.).

Plaintiff stated that she and her husband do not go out to eat, they rent movies and rarely go

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out to a movie theater (Tr. 361). She said that she rarely leaves the house and she does not

socialize with friends (Tr. 361). 

When asked about the September 2002 Functional Capacity Evaluation by Mr.

Palmer, Plaintiff stated that she did not recall picking up a bucket with a handle using only

her right hand (Tr. 399-401). Plaintiff further did not remember putting dots in a one-eighth

inch diameter circle (Tr. 401). Plaintiff stated that Mr. Palmer told her at the end of the test

that he was reporting that she could perform "light capacity" even though he knew it was not

true, because otherwise, in the future, no one would hire her (Tr. 405). Plaintiff stated that

Mr. Palmer's summary "totally false" (Tr. 405). 

At the supplemental hearing on April 15, 2004, Plaintiff testified that her symptoms

had not improved in the year and a half since Dr. Health noted that Plaintiff withdrew from

classes at ASU West (Tr. 407). Nor had there been any significant change since the January

2004 hearing three months earlier (Tr. 405-06). Plaintiff stated that she tried to take classes

at Arizona State University West, but had to withdraw due to panic attacks and vertigo. 

A. MEDICAL EXPERTS

Clifford J. Harris, M.D., testified at the first hearing on January 14, 2004 and

completed a medical expert Questionnaire. Defendant objected to Dr. Harris' testimony

because he testified without having reviewed Plaintiff's complete medical records. 

Neurologist Hershel Goren, M.D., was on standby to testify telephonically at the

supplemental hearing on April 15, 2004. Plaintiff's attorney objected to Dr. Goren's

testimony on the ground that he was not an orthopedic specialist. 

Without ruling on the validity of counsel's arguments, the ALJ declined to have the

medical expert testify. Instead, the ALJ decided the case without considering the testimony

of either medical expert. The ALJ also struck from the record the medical expert

Questionnaire completed by Dr. Harris and the medical expert Questionnaire completed by

Dr. Goren. 

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B. VOCATIONAL EXPERTS

Vocational Expert ("VE") Maude Prall testified at the first hearing on January 14,

2004. VE Prall testified that Plaintiff's past work as a special education teacher's aide was

heavy work as Plaintiff described it but only light, semiskilled work as it is described in the

Dictionary of Occupational Titles ("DOT"). VE Prall stated that Plaintiff's past work as a

receptionist with special education kids could reach into medium work, but primarily it

would be considered sedentary, semiskilled work. Finally, home care provider would be

light, semiskilled work as the DOT describes it and medium to heavy as Plaintiff described

performing it. Only the skills acquired during Plaintiff's clerical work and her work with

children would be transferable. 

The ALJ posed a series of hypothetical questions to VE Prall. When VE Prall was

asked about a person who could lift twenty pounds occasionally, ten pounds frequently, sit,

stand, and/or walk six hours in an eight-hour day with no exposure to hazards, VE Prall ruled

out work as a receptionist but found that work as a teacher aide or a special home care

provider would be appropriate. When the hypothetical changed to limit a person to lifting

less than ten pounds occasionally or frequently, sitting, standing, and/or walking six hours

in an eight-hour day; and again, restricting exposure to hazards, VE Prall excluded work as

a teacher's aide but allowed work as a receptionist. When the hypothetical added lower stress

work, production quotas but not high production quotas, and minimum contact with the

public, VE Prall excluded work as a receptionist and a teacher's aide. Finally, when the

hypothetical changed to allow a person to miss four or more days a month, or a person could

not complete assigned tasks in an eight-hour day four or more days a month, VE Prall

responded that no work would be available without special accommodation. VE Prall stated

that her testimony was consistent with the DOT. 

At the supplemental hearing on April 15, 2004, David Janus, VE, testified. In

response to a series of hypothetical questions posed to him by the ALJ, VE Janus stated that

Plaintiff's limitations restricted her from performing any of her previous work. VE Janus

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opined that Plaintiff could work as a parking lot attendant or a counter clerk. When asked

about an individual missing four or more days of work per month or cannot complete

assigned tasks in an eight-hour day, four or more days per month, VE Janus stated that there

would be no work available. On cross-examination, VE Janus testified that a counter clerk

position would require bilateral manual dexterity, but a parking lot attendant position would

not. VE Janus testified that a counter clerk position requires an adequate pace and fairly

moderate pace, which is not realistic for a person with a moderate limitation in ability to

maintain concentration, persistence or pace. 

III. THE ALJ'S CONCLUSIONS

The ALJ initially noted that Plaintiff filed an application for Disability Insurance

Benefits and Supplemental Security Income on April 2, 2002, alleging an inability to work

since August 21, 2001. The ALJ then noted that records indicate that Plaintiff has not

engaged in substantial gainful activity at any time since she was first disabled on August 21,

2001. 

The medical evidence indicates that Plaintiff has remote left wrist disorder, right wrist

disorder, mild panic disorder, and history of vertigo and headaches. These medically

determinable impairments are considered to be severe under the Social Security Act and

Regulations. The ALJ stated that although Plaintiff has impairments that are considered to

be severe, the impairments are not attended with the specific findings required to meet or

equal an impairment listed is Appendix 1 of the Regulations (20 CFR, Part 404, Subpart P,

Appendix 1). The ALJ made this determination after it considered the opinions of the State

agency medical consultants who evaluated this issue at the initial and reconsideration levels

of the administrative review process. 

As summarized by the ALJ, Plaintiff previously injured her left wrist in October 1996.

However, Plaintiff's subsequent MRI of her left wrist was normal. Plaintiff underwent an

arthroscopy of the left wrist in October 1996. Plaintiff was diagnosed with traumatic

cartilage loss off the carpus on the left wrist. Plaintiff had a second MRI of her left wrist on

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August 31, 2001 to evaluate a ganglion, which needed to be removed. The MRI showed

Plaintiff's carpal tunnel and Guyon's canal were normal. In September 2001, Plaintiff

underwent surgery to remove a ganglion from her left wrist. 

The ALJ further summarized Plaintiff's medical history as follows. The Plaintiff

injured her right wrist at work on August 21, 2001, when she fell and hurt her back and

hands. She had a prior right carpal tunnel release on December 12, 1997. Preoperative

imaging and work up was consistent with right wrist scapholunate ligament sprain. On June

20, 2002, Plaintiff underwent arthroscopic surgery on her right wrist. A progress report on

July 29, 2002 indicated that the surgery wound was healing nicely. 

The ALJ noted that Plaintiff has a history of experiencing vertigo and headaches.

Medical records in October 1999 showed Plaintiff's brain MRI was unremarkable. Plaintiff

cannot tolerate even a low dose of Procardia or other migraine medications. There are no

current treatment records for these conditions. 

The ALJ noted that Plaintiff has not had any mental health treatment since her alleged

onset of disability despite her complaints of having a panic disorder. At the State's request,

Plaintiff underwent a consultative psychological evaluation on January 22, 2003 with

Licensed Clinical Psychologist Dr. Mansfield. Plaintiff reported that she began having panic

attacks after her involvement in a motor vehicle accident in 1996. Plaintiff stated that any

type of stress could instigate a panic attack. Plaintiff also experiences vertigo, which has

caused Plaintiff to fall when she has walked unassisted. Dr. Mansfield diagnosed Plaintiff

with panic disorder and mild agoraphobic symptoms. 

The ALJ found that the objective medical evidence and abnormal clinical findings

from August 21, 2001 to September 18, 2002 (the "closed period") support the residual

functional capacity limitation such that she could perform a limited range of "sedentary"

exertional work. Specifically, Plaintiff could lift and carry no more than ten pounds at a time

occasionally and frequently; walk and/or stand about six hours in an eight-hour workday; and

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sit for six hours out of an eight-hour workday. Moreover, she could not work near hazards

and is limited to occasional fine and gross manipulation. 

The ALJ noted and accepted the VE testimony that Plaintiff's residual functional

capacity during the closed period precluded Plaintiff from performing her past work as a

special education aide (light semi-skilled work); a home care provider (medium semi-skilled

work); and as a receptionist (sedentary semi-skilled work). The ALJ also accepted the VE's

finding that Plaintiff could not perform any other work in the national economy during the

closed period. Thus, the ALJ found Plaintiff was disabled during the period between August

21, 2001 and September 18, 2002. 

The ALJ found that the record reflects a decrease in Plaintiff's medical signs and

symptoms and an increase in her ability to perform work-related activities beginning 

September 19, 2002. In fact, the ALJ determined that Plaintiff regained the residual

functional capacity to perform "light" exertional work as of September 19, 2002.

Specifically, the ALJ found that Plaintiff could lift twenty pounds occasionally and ten

pounds frequently; sit for six hours total in an eight-hour day; and stand/walk for six hours

in an eight-hour day. Plaintiff is precluded from hazards and frequent fine and gross

manipulations but has no mental limitations. 

The ALJ stated that Plaintiff's medical records indicate that Plaintiff was discharged

from medical care for her right wrist on September 18, 2002. In fact, Plaintiff's treating

physician, Dr. Conklin, reported that Plaintiff's right wrist had reached a stationary status.

The ALJ stated that after September 18, 2002, there are no current treatment records of

Plaintiff's left wrist, nor complaints of vertigo or migraine headaches. The ALJ states that

the dearth of medical records after September 18, 2002 indicates that Plaintiff's limitations

and problems are not as severe as alleged. 

The ALJ found that during Plaintiff's residual functional evaluation at the Center for

Musculoskeletal Medicine, it was determined that Plaintiff's perception of her pain was 100

percent greater than the degree to which it limited function as tested on the numeric pain

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scale and visual analog pain scale. The ALJ found that this incongruence serves to lessen

Plaintiff's credibility regarding her pain level. 

After reviewing this evidence, the ALJ concluded that Plaintiff has only mild

restrictions in her activities of daily living and mild difficulties in maintaining social

functioning. The ALJ noted that Plaintiff is independent in her self care and housekeeping,

and that she helped her husband care for his teenage autistic daughter three days a week. The

ALJ further stated that Plaintiff testified that she 

The ALJ found Plaintiff's description of her physical functional limitations during the

period from August 21, 2001 to September 19, 2002 consistent with the record and generally

credible during this closed period. The ALJ found Plaintiff's treating physician Dr. Conklin's

opinion to be credible. Whereas the ALJ was not persuaded by the Center for

Musculoskeletal Medicine's determination of Plaintiff's residual functional capacity

determination, finding it to be inconsistent with the evidence as a whole. 

In sum, the ALJ concluded that Plaintiff was disabled from August 21, 2001 to

September 18, 2002 and was entitled to Disability Insurance Benefits for that period of time

only. Further, the ALJ found that, as of September 19, 2002, Plaintiff's medical condition

improved to the point that she was able to perform her past work. Therefore, the ALJ found

that Plaintiff was only eligible for benefits for the closed period of August 21, 2001 to

September 18, 2002.

DISCUSSION

Plaintiff contends that the ALJ did not accurately and lawfully account for all of

Plaintiff's medical problems, did not properly assess Plaintiff's realistic overall ability to

function, and did not properly analyze Plaintiff's capacity for employment. Furthermore,

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Plaintiff asserts that this Court must determine whether Plaintiff received a full and fair

hearing because – after Dr. Harris' testimony was disallowed at the first hearing and Dr.

Goren's did not testify at the second hearing – the ALJ made his determination without

hearing testimony from a medical expert.

Defendant asserts that the ALJ's determination that Plaintiff could perform her past

relevant work after September 18, 2002 was supported by substantial evidence and free of

error. Defendant argues that the ALJ properly resolved the medical evidence; that the ALJ

provided clear and convincing reasons, supported by substantial evidence, for discounting

Plaintiff's pain complaints after September 18, 2002, and that substantial evidence supported

the ALJ's finding that Plaintiff could perform her past relevant work. 

I. THE ALJ'S RESOLUTION OF THE MEDICAL EVIDENCE

Plaintiff contends that the ALJ did not resolve conflicts between the medical evidence

presented by Drs. Meyer, Bodell, Lipton, Conklin, and Patel regarding Plaintiff's limited use

of her left hand. Plaintiff cites Widmark v. Barnhart, 454 F.3d 1063, 1066 (9th Cir. 2006),

citing Lester v. Charter, 81 F.3d 821, 830-31 (9th Cir. 1995), to argue that "the opinion of an

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." 

The ALJ has authority to resolve conflicting or ambiguous medical evidence.

Andrews v. Shalala, 1035 F.3d 1039-40 (9th Cir. 1995). In reporting it's decision, the ALJ

need not discuss every piece of evidence. Howard ex rel. Wolff v. Barnhart, 241 F.3d 1006,

1012 (9th Cir. 2003). The ALJ need only explain why he rejected significant, probative

evidence. Vincent ex rel. Vincent v. Heckler, 739 F.3d 1393, 1394-95 (9th Cir. 1984). 

Here, the ALJ was not required to address evidence outside the relevant time frame,

such as the reports from Drs. Meyer and Bodell issued in 1996 and 1997, respectively, when

determining Plaintiff's medical status in 2002. Furthermore, the ALJ did consider Plaintiff's

treating physician's opinion and found that on September 18, 2002, Dr. Conklin reported that

Plaintiff's condition had reached stationary status. The ALJ also considered that, based on

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the evaluation provided by the Musculoskeletal Medical Center, Dr. Conklin also reported

that Plaintiff was capable of working at a modified work status with no lifting or force

greater than twenty pounds occasionally and ten pounds frequently. Therefore, the Court

does not find compelling Plaintiff's argument that the ALJ's opinion must be reversed merely

because he did not address evidence from Drs. Meyers and Bodell. Nor is the Court

convinced by Plaintiff's argument that the ALJ erred by not considering the opinion of

Plaintiff's treating doctor, which the Court finds that the ALJ did consider. 

With regard to Plaintiff's shoulder injury, Defendant asserts that Plaintiff bore the

burden of producing evidence of a disabling impairment and she failed to carry her burden

with regard to a sustained shoulder injury. During Steps I through IV of the determination,

Plaintiff bore the burden. Bowen, 482 U.S. at 140-41 (citing 20 C.F.R. §§ 404.1520(b)-(f)).

It is not until Step V that the burden shifts to Defendant. Penny v. Sullivan, 2 F.3d 953, 956

(9th Cir. 1993). Plaintiff presented evidence of a shoulder injury at its onset in August 2001

but she does not provide more recent evidence to show that her shoulder continues to cause

her pain and disability. This is the case despite numerous doctor visits including to

orthopedic specialists. Fair inferences may be drawn from the evidence. Orteza v. Shalala,

50 F.3d 748, 750 (9th Cir. 1995). Having found no post-1997 evidence of shoulder problems,

this Court finds that the ALJ appropriately found that Plaintiff's shoulder was not an

impairment after the closed period. Thus, the Court finds that Plaintiff has not overcome her

burden of proving disability with regard to her shoulder injury. 

Regarding the opinion of consultative examiner Dr. Mansfield, Plaintiff contends that

the ALJ improperly rejected Dr. Mansfield's opinion regarding Plaintiff's mental

impairments. As stated above, Dr. Mansfield concluded that Plaintiff has a panic disorder

with mild agoraphobic symptoms (Tr. 185). The ALJ found that despite Plaintiff's claims

of experiencing panic attacks, and vertigo she has not undergone any mental health treatment

since the alleged 1996 onset date. Defendant asserts that Dr. Mansfield's opinion was not

based on clinical findings but on Plaintiff's subjective complaints of experiencing pain. 

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Contrary to the ALJ's finding and to Defendants assertion, this Court finds sufficient

evidence of Plaintiff's ongoing fight with panic disorder and vertigo, and that Plaintiff sought

treatment for her panic disorder. In fact, on December 20, 2002, Plaintiff's primary care

physician, Dr. Heath, reported that Plaintiff dropped out of school due to panic attacks and

vertigo in class (Tr. 296). Further evidence comes from Dr. Patel on November 26, 2002,

when he found Plaintiff suffered from a panic disorder (Tr. 181). In fact, Dr. Patel

recommended a psychological evaluation to address Plaintiff's disorder, which was the

impetus for Dr. Mansfield examining Plaintiff (Id.). As stated above, Dr. Mansfield

examination resulted in a diagnosis that Plaintiff has a panic disorder with mild agoraphobic

symptoms (Tr. 185). The Court finds that the record includes corroborating evidence from

doctors in addition to Dr. Mansfield who found that Plaintiff suffers from panic attacks,

caused by stress. Therefore, the Court finds that the ALJ improperly disregarded Dr.

Mansfield's assessment of Plaintiff's panic disorder with mild agoraphobic symptoms. 

Furthermore, the ALJ stated that Plaintiff's testimony was not convincing because,

despite her pain, Plaintiff was able to socialize with her family, drive, and go to the movies,

among other things. The ALJ also reported that Plaintiff attended classes at ASU, which, the

ALJ states, suggests, contrary to her allegations, that she can deal with people without feeling

anxiety. The ALJ further stated that after September 18, 2002, there are no current treatment

records of Plaintiff's left wrist, nor complaints of vertigo or migraine headaches. The ALJ

also found that the dearth of medical records after September 18, 2002 indicates that

Plaintiff's limitations and problems are not as sever as alleged. 

However, the Court disagrees with these assessments and findings. In fact, Plaintiff

reported to her doctors and at the hearing that she did not socialize, nor drive, nor go to the

movies. Though Plaintiff reports that her mother visits twice a week, the purpose for the

visits is to help Plaintiff with household chores, not to socialize. Further, Plaintiff's son

sometimes drives her places but, again, this is more out of necessity rather than as a social

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outing. The ALJ also overlooked that, though Plaintiff began attending colleges classes, she

was forced to withdraw due to panic attacks and vertigo. 

The Court also disagrees with the ALJ's assertion that the absence of medical records

after September 18, 2002 indicates that Plaintiff's limitations and problems are not as severe

as alleged. On that date, Dr. Conklin found that Plaintiff's wrists had reached stationary

status. In other words, there was no more that doctors could do to improve Plaintiff's wrists,

despite the impairment. Therefore, it was no longer necessary for Plaintiff to visit the doctor

as regularly because the damage was permanent. Thus, it is understandable that the number

of doctor's visits would diminish. For the forgoing reasons, the Court finds that the ALJ's

decision was against the substantial evidence in the record and improperly terminated

Plaintiff's benefits award. 

II. PLAINTIFF'S OVERALL ABILITY TO FUNCTION AND HER CAPACITY FOR

EMPLOYMENT 

Plaintiff asserts that the ALJ committed material errors of fact and law by concluding

that Plaintiff had regained the capacity to perform her past work as a receptionist after

September 18, 2002. The Court agrees that the evidence of limitations reported by Dr.

Mansfield and Dr. George, along with the vocational opinions of VEs Prall and Janus

indicating impairments that restrict Plaintiff's ability to work at any of her previous positions

or any other position without special accommodations. 

III. CONCLUSION

The Court concludes that the ALJ improperly ended Plaintiff's benefits award on

September 22, 2002. The Court finds that Plaintiff continues to be disabled due to her panic

disorder with mild agoraphobic symptoms as diagnosed by Dr. Mansfield and supported by

substantial evidence in the record. Accordingly,

IT IS ORDERED that Plaintiff's Motion for Summary Judgment (Doc. 12) is

granted.

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IT IS FURTHER ORDERED that Defendant's Cross-Motion for Summary

Judgment (Doc. 14) is denied.

IT IS FURTHER ORDERED that Plaintiff's request for oral argument is denied. 

IT IS FURTHER ORDERED that the ALJ's decision to deny benefits for the period

of after September 18, 2002 is reversed and this matter is remanded for calculation and

payment of benefits in a manner consistent with this Order.

IT IS FURTHER ORDERED that Judgment shall be entered consistent with this

Order. 

 DATED this 26th day of March, 2007.

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