Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_16-cv-00799/USCOURTS-azd-2_16-cv-00799-0/pdf.json

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

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WO 

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Kathleen Cathy Muhammad,

Plaintiff, 

v. 

Carolyn W. Colvin, 

Defendant.

No. CV-16-00799-PHX-BSB

ORDER 

 Plaintiff Kathleen Cathy Muhammad seeks judicial review of the final decision of 

the Commissioner of Social Security (the Commissioner) denying her application for 

benefits under the Social Security Act (the Act). The parties have consented to proceed 

before a United States Magistrate Judge pursuant to 28 U.S.C. § 636(b), and have filed 

briefs in accordance with Rule 16.1 of the Local Rules of Civil Procedure. As discussed 

below, the Court reverses the Commissioner’s decision and remands for further 

proceedings. 

I. Procedural Background 

 In February 2012, Plaintiff filed applications for disability insurance benefits and 

supplemental security income benefits under Titles II and XVI of the Act. (Tr. 12.)1

 

Plaintiff alleged a disability onset date of February 10, 2012. (Id.) After the Social 

Security Administration (SSA) denied Plaintiff’s initial application and her request for 

reconsideration, she requested a hearing before an administrative law judge (ALJ). (Id.) 

 

1

 Citations to Tr. are to the certified administrative transcript of record. (Doc. 14.) 

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After conducting a hearing, the ALJ issued a decision finding Plaintiff not disabled under 

the Act. (Tr. 12-23.) This decision became the final decision of the Commissioner when 

the Social Security Administration Appeals Council denied Plaintiff’s request for review. 

(Tr. 1-6.) See also 20 C.F.R. § 404.981 (explaining the effect of a disposition by the 

Appeals Council). Plaintiff now seeks judicial review of this decision pursuant to 

42 U.S.C. § 405(g). 

II. Administrative Record 

 The record before the Court establishes the following history of diagnoses and 

treatment related to Plaintiff’s alleged impairments. The record also includes several 

medical opinions. 

A. Medical Treatment Evidence 

 1. First Medical Plus 

 In July 2011, Plaintiff began treatment at First Medical Plus (FMP) for injuries she 

sustained in a car accident earlier that month. (Tr. 331.) Dr. Lucinda R. Michel, D.O., 

provided most of Plaintiff’s treatment before the disability onset date. She diagnosed 

headaches, neck and back pain and strain, and upper and lower radiculopathy. (Tr. 321-

30.) In February 2012, Plaintiff complained of worsening headaches, spinal symptoms, 

and pain or parasthesias in her upper extremities. (Tr. 320.) Dr. Michel gave Plaintiff a 

Toradol injection and prescribed medication. (Tr. 302, 545, 1238.) 

 In May 2012, Nurse Practitioner (NP) Laura Coe assumed Plaintiff’s care at FMP. 

(Tr. 304.) Plaintiff complained of headaches, neck and back pain, pain in her upper and 

lower extremities, and right shoulder pain. (Tr. 304.) On examination, NP Coe assessed 

Plaintiff with parasthesias, hand weakness, cervical, thoracic and lumbar pain, arm and 

hand pain, shoulder pain, and sleep disturbances. (Id.) At that time, Plaintiff was 

pregnant and declined medications. (Id.) NP Coe continued to treat Plaintiff during the 

relevant period and frequently recorded similar observations of Plaintiff’s condition. 

(Tr. 303, Jun. 21, 2012; Tr. 458, July 2012 (“not pregnant,” medications continued, with 

the addition of Vicodin); Tr. 455-56, Aug. 10, 2012; Tr. 453-54, Aug. 24, 2012; Tr. 451-

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52, Sept. 21, 2012; Tr. 449-50, Oct. 4. 2012; Tr. 496-97, Dec. 14, 2012; Tr. 855-56, Feb. 

19, 2013; Tr. 851-52, Apr. 5, 2013; Tr. 845-46, June 14, 2013; Tr. 833-34, Sept. 27, 

2013; Tr. 825-26, Oct. 25, 2013; Tr. 822-23, Dec. 30, 2013; Tr. 820-21, Feb. 28, 2014; 

Tr. 817-18, Apr. 25, 2014; Tr. 812-13, May 30, 2014; Tr. 809-10, June 16, 2014.) 

However, other treatment notes include limited findings and do not mention Plaintiff’s 

back or shoulder pain. (Tr. 853-54, Mar. 5, 2013 (no pedal edema in lower extremities, 

elevated blood pressure); Tr. 849-50, Apr. 19, 2013 (no edema in lower extremities, 

hypertension (HTN)); Tr. 847-48, May 10, 2013 (HTN); Tr. 843-44, June 28, 2013 (no 

edema in lower extremities, HTN); Tr. 841-42, July 19, 2013 (pain in big toe, no edema, 

HTN); Tr. 839-40, Aug. 1, 2013 (no edema, big toe pain, HTN); Tr. 829-30, Oct. 4, 2013 

(pelvic density x-ray showed increased density over sacrum, hip pain).) 

 2. Sonoran Pain Management 

 In 2011, Dr. Michel referred Plaintiff to Dr. Minesh Zaveri, D.O., at Sonoran Pain 

Management. (Tr. 236-38.) On examination, Dr. Zaveri noted that Plaintiff walked with 

a painful gait and had tenderness throughout her cervical and lumbar spine. (Id.) 

Plaintiff had full strength in her upper and lower extremities and a normal range of 

motion in her lumbar spine. (Tr. 237.) Dr. Zaveri diagnosed cervical and lumbar 

degenerative disc disease and spondylosis. (Id.) Dr. Zaveri gave Plaintiff lumbar 

epidural steroid injections on December 20, 2011 (Tr. 232), and lumbar medial branch 

nerve blocks on April 10 and 24, 2012. (Tr. 220, 218.) During a May 9, 2012 

appointment, Plaintiff reported that the injections provided pain relief for twelve hours. 

(Tr. 366.) On examination, Plaintiff had a positive straight leg raise test, full strength in 

her upper and lower extremities, tenderness in her cervical, thoracic and lumbar spine, 

and a painful gait. (Tr. 367-68.) 

3. Dr. Bogdan Anghel 

 On referral from Dr. Michel, Plaintiff sought treatment from Dr. Bogdan Anghel 

at Pain Management and Rehabilitation Medicine Center for shoulder pain in October 

2012. (Tr. 785.) Dr. Anghel reviewed an MRI that showed evidence of a rotator cuff 

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tear. (Id.) Plaintiff reported that she had received physical therapy and pain management 

for her shoulder pain and that the treatment was unsuccessful. (Id.) On examination, 

Plaintiff’s shoulder was positive for pain. (Id.) Neer and Hawkins range-of-motion tests 

were positive for a rotator cuff tear on the right side. (Id.) Plaintiff had spine tenderness 

and a positive Spurling test. (Id.) Plaintiff had weakness on abduction and external 

rotation of her right arm. (Id.) Dr. Anghel diagnosed right shoulder rotator cuff 

tendinopathy. (Id.) He administered a steroid injection and referred Plaintiff to 

Dr. Jeffrey S. Levine, M.D. (Tr. 785-86.) 

 On January 17, 2013, Plaintiff returned to Dr. Anghel for low back and hip pain. 

(Tr. 779-80.) Plaintiff reported that lumbar epidural steroid injections in May 2012 had 

provided some relief, but the pain had returned. (Id.) On examination, Plaintiff had a 

normal gait, weakness, decreased sensation in her lateral thighs, calves and feet, and a 

restricted range of motion. (Id.) Dr. Anghel diagnosed lumbar spondylosis with facet 

pain, mechanical back pain, and lumbosacral radiculitis. (Tr. 780.) 

 On January 28, 2013, Dr. Anghel gave Plaintiff lumbar injections of Kenalog and 

Marcaine. (Tr. 777.) In February 2013, Plaintiff reported that she was “improving.” 

(Tr. 733.) Dr. Anghel noted that the injections resolved Plaintiff’s low back pain, but not 

her neck pain. (Id.) On examination, Plaintiff had right shoulder pain and a decreased 

range of motion in her cervical spine. (Id.) In February 2013, Dr. Anghel administered 

Kenalog and Marcaine injections in the cervical spine. (Tr. 772.) 

 In May 2013, Dr. Anghel examined Plaintiff for recurrent pain in the right cervical 

and lumbar spine. (Tr. 769.) He found that Plaintiff had an antalgic gait, tenderness and 

pain in her head and neck, and a limited range of motion in her neck and back. (Tr. 769.) 

Plaintiff had no pain on palpation of her hips or extremities, had full range of motion in 

her upper and lower extremities, and had full muscle strength in her hips and upper and 

lower extremities. (Tr. 770.) Dr. Anghel concluded that prior pain control treatments 

were ineffective. (Tr. 770.) Later that month, Dr. Anghel administered Kenalog and 

Marcaine injections for cervical and lumbar spondylosis. (Tr. 767, 765.) During a May 

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21, 2013 appointment, Dr. Anghel noted that the spinal injections did not provide 

Plaintiff significant pain relief. (Tr. 763.) He opined that Plaintiff’s pain was likely 

generated in the musculature and, therefore, recommended trigger point injections on a 

bi-weekly basis. (Id.) On examination, Plaintiff had a limited range of motion in her 

cervical and lumbar spine, tenderness on palpation of the cervical and lumbar paraspinals, 

and pain in the lumbar and cervical paraspinals. (Id.) She had normal muscle strength 

and reflexes. (Id.) 

 4. Jeffery S. Levine, M.D. 

 As noted above, while Plaintiff was receiving treatment from Dr. Anghel, he 

referred Plaintiff to Dr. Levine for right shoulder pain. (Tr. 758.) Dr. Levine examined 

Plaintiff on November 2, 2012. (Tr. 758-60.) Plaintiff reported that she had neck, right 

shoulder, and low back pain. (Id.) She also reported that a recent corticosteroid injection 

to her right shoulder improved her pain, but she remained symptomatic. (Tr. 758.) On 

examination, Plaintiff had a full range of motion in her cervical spine, a “full range of 

motion of passive motion” in the right shoulder, and positive impingement signs in the 

right shoulder. (Tr. 759.) Dr. Levine diagnosed cervical strain and “symptomatic right 

partial tear of rotator cuff with the possibility of concomitant labral pathology.” (Id.) 

Dr. Levine noted that Plaintiff was pregnant at the time, therefore, he did not prescribe 

injections and recommended against the use of anti-inflammatories and narcotics. (Id.) 

 During a December 12, 2012 appointment with Dr. Levine, Plaintiff reported 

significant pain in her right shoulder. (Tr. 757.) She reported that a cortisone injection 

resulted in a “substantial decrease in her symptoms,” but the pain had returned. (Id.) 

Plaintiff also reported neck pain. (Id.) On examination, Plaintiff had a full range of 

motion of the neck, a “relatively full range of motion of the right shoulder,” and positive 

impingement signs. (Id.) Dr. Levine diagnosed symptomatic partial tear of the rotator 

cuff and possible labral pathology of the right shoulder. (Id.) Dr. Levine recommended 

and administered a corticosteroid injection to Plaintiff’s right shoulder. (Tr. 757.) 

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 During a January 2013 appointment, Plaintiff reported persistent pain in her right 

shoulder. (Tr. 753.) On examination, Plaintiff had a drooping right shoulder, positive 

impingement signs, and positive labral loading signs. (Id.) Dr. Levine noted that MRI 

results showed “evidence of labral pathology which is chronic in nature involving both a 

complete tear and degeneration,” along with “evidence of rotator cuff tendinopathic 

changes.” (Id.) Dr. Levine diagnosed “[s]capular dyskinesia of the right shoulder with 

evidence of labral pathology.” (Tr. 753.) Dr. Levine advised Plaintiff that she had two 

treatment options: (1) a corticosteroid injection to the shoulder and a strengthening 

program; or (2) surgical reconstruction of the labrum. (Id.) Plaintiff elected the injection 

and strengthening program. (Id.) Dr. Levine informed Plaintiff that if she did not 

improve, surgery would be the only other means of treatment. (Id.) Plaintiff told 

Dr. Levine that she would “consider surgery.” (Id.) Dr. Levine administered a right 

shoulder steroid injection and noted that after the procedure, Plaintiff’s “pain was 

completely abolished and her drooping shoulder was no longer present.” (Id.) 

 During an April 18, 2013 appointment with Dr. Levine, Plaintiff reported that she 

had seen Dr. Anghel and had a spinal block. (Tr. 752.) Plaintiff stated she did not 

experience pain relief, but “her radicular pain seem[ed] to be somewhat improved.” (Id.) 

Plaintiff reported ongoing right shoulder pain. (Id.) On examination Plaintiff had a 

limited range of motion in her neck, drooping of the right shoulder, and pain with 

impingement. (Id.) Dr. Levine noted that Plaintiff had evidence of referred pain from 

discogenic cervical disease into the right scapular region. (Id.) He also noted evidence 

of a right labral tear and a partial rotator cuff tear. (Tr. 752.) However, because Plaintiff 

experienced pain relief after a trigger point injection, Dr. Levine opined, “surgery is still 

not indicated with respect to the shoulder itself.” (Id.) 

 During an April 29, 2013 appointment, Plaintiff reported her shoulder pain had 

dramatically improved as a result of trigger point injections to her neck. (Tr. 750.) On 

examination, Plaintiff had a full range of motion in her neck, a full range of motion in her 

right shoulder, no gross motor weakness in her right shoulder, positive impingement 

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signs, and negative labral loading. (Tr. 750.) Dr. Levine recommended trigger point 

injections in the cervical spine. He stated that if Plaintiff continued to respond, then he 

would not recommend additional treatment. (Id.) However, Dr. Levine noted that he 

would recommend a more aggressive treatment plan for Plaintiff’s shoulder if she did not 

respond. (Id.) 

 During Plaintiff’s last recorded visit with Dr. Levine on May 20, 2013, she 

reported that her shoulder and arm pain had markedly improved. (Tr. 749.) However, 

she continued to have pain when lying on her right shoulder and reported symptoms that 

suggested ongoing C6 radiculopathy. (Id.) She reported pain in her right arm with 

repetitive overhead use, but it was “quite moderate.” (Id.) Plaintiff had instability 

symptoms in the right shoulder. (Id.) On examination Plaintiff had a full range of 

motion in her neck and in both shoulders. (Id.) She had no motor weakness. (Id.) 

Dr. Levine found evidence of a minor tendinopathy of the right shoulder with partial tears 

of the rotator cuff, and “evidence of resolving cervical radiculopathy post block.” (Id.) 

He advised Plaintiff that if her pain “markedly worsen[ed] she [was] a candidate for a 

diagnostic arthroscopy and either repair or debridement of the cuff.” (Id.) Dr. Levine 

released Plaintiff to follow-up on an as needed basis. (Id.) 

B. Medical Opinions 

 1. Jerry Thomas, M.D.

 As part of the initial disability determination, state agency reviewer Dr. Jerry 

Thomas, M.D., completed a physical capacities assessment form. (Tr. 269-76.) 

Dr. Thomas’s assessment was based on the mistaken belief that Plaintiff was last insured 

for disability insurance benefits through December 31, 2005. (Tr. 269.); see Lester v. 

Chater, 81 F.3d 821, 825 (9th Cir. 1996) (stating that a claimant seeking disability 

insurance benefits must establish that she was disabled prior to the date last insured). 

Plaintiff’s date late insured was September 30, 2016. (Tr. 14, 129.) Dr. Thomas assessed 

physical capacities consistent with light work. (Tr. 270.) Specifically, he determined 

that Plaintiff could occasionally lift and carry twenty pounds, frequently lift and carry ten 

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pounds, stand or walk about six hours in an eight-hour workday, and sit for about six 

hours in an eight-hour work day. (Tr. 270.) He found no limitations in Plaintiff’s 

abilities to push and pull, “other than as shown for lift and/or carry,” and no limitations in 

her manipulative abilities. (Tr. 271-72.) He also found no limitations in Plaintiff’s 

abilities to climb, balance, stoop, kneel, crouch, and crawl. (Tr. 271.) Dr. Thomas cited 

medical records from January to April 2012 to support his findings. (Tr. 276.) 

 2. Bill F. Payne, M.D. 

 In December 2012, Dr. Bill Payne, M.D., completed a case analysis as part of the 

reconsideration determination. (Tr. 486.) Dr. Payne mistakenly believed that Plaintiff’s 

date last insured was December 31, 2005. (Tr. 486.) Based on that belief, he concluded 

there was no available medical evidence of record covering the period on or before that 

date. (Id.) Therefore, he determined there was “insufficient evidence to rate the Title II 

claim as of the [date last insured]. (Id.) 

 3. Nurse Practitioner Coe 

 Nurse Practitioner (NP) Coe completed several assessments of Plaintiff’s physical 

functional abilities. (Tr. 353-55, 746.) On October 12, 2012, NP Coe completed her first 

Medical Assessment of Ability to Do Work Related Physical Activities. (Tr. 353-55.) 

She opined that Plaintiff could lift or carry less than ten pounds, stand or walk less than 

two hours out of an eight-hour day, and sit for less than six hours out of an eight-hour 

day. (Tr. 353.) NP Coe concluded that these limitations were due to insertional tears of 

the right shoulder and disc protrusions of the cervical and lumbar spines. (Tr. 353.) 

 On October 12, 2013, NP Coe completed a pain assessment. (Tr. 351.) She 

opined that Plaintiff had moderately severe pain, defined as pain that “seriously affects 

ability to function.” (Id.) NP Coe found that the degree of pain could reasonably be 

expected to result from objective clinical or diagnostic findings, documented by her own 

treatment notes or elsewhere in the medical records. (Tr. 351.) NP Coe also opined that 

pain would constantly interfere with attention and concentration, with constant 

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deficiencies of concentration, persistence, or pace, resulting in failure to complete tasks 

in a timely manner. (Tr. 351-52.) 

 On June 16, 2014, NP Coe completed updated assessments. (Tr. 746.) She found 

that Plaintiff could lift and carry less than ten pounds, stand and walk less than two hours 

in an eight-hour day, and sit less than six hours in an eight-hour day. (Id.) NP Coe 

identified Plaintiff’s diagnosed impairments as right shoulder pain from insertional tears 

and cervical and lumbar disc protrusions. (Id.) NP Coe opined that Plaintiff had 

moderately severe pain, which “seriously affects ability to function,” constantly interferes 

with attention and concentration, and causes constant deficiencies of concentration, 

persistence, or pace, resulting in failure to complete tasks in a timely manner. (Tr. 744-

45.) NP Coe explained that the degree of pain could reasonably be expected to result 

from objective clinical or diagnostic findings, documented in her own treatment notes or 

elsewhere in the medical records. (Tr. 744.) 

III. The Administrative Hearing

 Plaintiff was fifty-years old as of the alleged disability onset date. (Tr. 39.) She 

had a ninth-grade education and past relevant work as a custodian. (Tr. 39-40.) At the 

administrative hearing, Plaintiff testified she could not work because of pain and muscle 

spasms in her neck and shoulders, and headaches. (Tr. 42-43.) Plaintiff testified that she 

also had chronic low back pain. (Tr. 44.) Plaintiff testified that although injections 

helped relieve her pain, it returned within hours. (Tr. 46-47.) Plaintiff testified that she 

could stand for up to twenty minutes and sit for up to forty minutes. (Tr. 47.) Plaintiff 

stated that in a typical day, she needed to lay down for about two to three hours. (Tr. 49.) 

 Vocational expert Scott Nielson testified at the administrative hearing. (Tr. 54.) 

The ALJ asked Nielson to assume a hypothetical claimant who could lift and carry 

twenty pounds occasionally and ten pounds frequently, could stand or walk for six out of 

eight hours, sit for six out of eight hours, and for whom reaching overhead on the right 

side was limited to occasional. (Tr. 54.) In response, the vocational expert testified that 

such a claimant could not perform Plaintiff’s past relevant work, but could perform 

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unskilled jobs at the light exertional level including cashier II, marker, and routing clerk. 

(Tr. 54-55.) The ALJ relied on those jobs to conclude that Plaintiff was not disabled. 

(Tr. 22.) 

 The vocational expert concluded that an individual with the limitations in 

NP Coe’s November 2014 assessment (Admin. Hrg. Ex. 25F), would be unable to 

perform any full-time work. (Tr. 55.) The vocational expert also found that an individual 

with the limitations in NP Coe’s October 2012 assessment would be unable to perform 

full-time work. (Tr. 56.) The vocational expert further testified that the limitations to 

which Plaintiff testified, including the need to lie down for two to three hours during an 

eight-hour day, precluded sustained full-time work. (Id.) 

IV. The ALJ’s Decision

 A claimant is considered disabled under the Social Security Act if she is unable 

“to engage in any substantial gainful activity by reason of any medically determinable 

physical or mental impairment which can be expected to result in death or which has 

lasted or can be expected to last for a continuous period of not less than 12 months.” 

42 U.S.C. § 423(d)(1)(A); see also 42 U.S.C. § 1382c(a)(3)(A) (nearly identical standard 

for supplemental security income disability insurance benefits). To determine whether a 

claimant is disabled, the ALJ uses a five-step sequential evaluation process. 

See 20 C.F.R. §§ 404.1520, 416.920. 

A. The Five-Step Sequential Evaluation Process 

 In the first two steps, a claimant seeking disability benefits must initially 

demonstrate (1) that she is not presently engaged in a substantial gainful activity, and 

(2) that her medically determinable impairment or combinations of impairments is severe. 

20 C.F.R. §§ 404.1520(b) and (c), 416.920(b) and (c). If a claimant meets steps one and 

two, there are two ways in which she may be found disabled at steps three through five. 

At step three, she may prove that her impairment or combination of impairments meets or 

equals an impairment in the Listing of Impairments found in Appendix 1 to Subpart P of 

20 C.F.R. Part 404. 20 C.F.R. §§ 404.1520(a)(4)(iii) and (d), 416.920(d). If so, the 

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claimant is presumptively disabled. If not, the ALJ determines the claimant’s residual 

functional capacity (RFC). 20 C.F.R. §§ 404.1520(e), 416.920(e). At step four, the ALJ 

determines whether a claimant’s RFC precludes her from performing her past relevant 

work. 20 C.F.R. §§ 404.1520(f), 416.920(f). If the claimant establishes this prima facie 

case, the burden shifts to the government at step five to establish that the claimant can 

perform other jobs that exist in significant number in the national economy, considering 

the claimant’s RFC, age, work experience, and education. 20 C.F.R. §§ 404.1520(g), 

416.920(g). If the government does not meet this burden, then the claimant is considered 

disabled within the meaning of the Act. 

 B. The ALJ’s Application of the Five-Step Evaluation Process

 Applying the five-step sequential evaluation process, the ALJ found that Plaintiff 

had not engaged in substantial gainful activity since the alleged disability onset date. 

(Tr. 14.) At step two, the ALJ found that Plaintiff had the following severe impairments: 

“[d]egenerative changes of the cervical and lumbar spine and right shoulder, obesity, and 

headaches (20 CFR 404.1520(c) and 416.920(c).” (Id.) At step three, the ALJ found that 

Plaintiff did not have an impairment or combination of impairments that met or equaled 

the severity of a listed impairment. (Tr. 15.) 

 The ALJ found that Plaintiff had the residual functional capacity (RFC) to 

“perform light work as defined in 20 CFR 404.1567(b) and 416.967(b).” (Tr. 16.) 

However, the ALJ found that Plaintiff has the following limitations: she “can lift and 

carry 20 pounds occasionally and ten pounds frequently; can stand or walk for six hours 

out of eight; sit for six hours out of eight; occasionally climb stairs and ramps, ropes, 

ladders and scaffolds; occasionally balance, stoop, kneel, crouch, and crawl; occasionally 

reaching overhead with her right arm; [and she] should avoid concentrated exposure to 

unprotected heights, moving and dangerous machinery, and vibration.” (Id.) 

 The ALJ concluded that Plaintiff could not perform her past relevant work. 

(Tr. 21.) However, considering Plaintiff’s age, education, work experience, and RFC, the 

ALJ found that she could perform other jobs that exist in significant numbers in the 

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national economy. (Tr. 22.) The ALJ determined that Plaintiff had not been under a 

disability, as defined in the Act, from February 10, 2012, through the date of his decision. 

(Tr. 23.) Therefore, the ALJ denied Plaintiff’s application for a period of disability and 

disability insurance benefits and her application for supplemental security income. (Id.) 

V. Standard of Review 

 The district court has the “power to enter, upon the pleadings and transcript of 

record, a judgment affirming, modifying, or reversing the decision of the Commissioner, 

with or without remanding the cause for a rehearing.” 42 U.S.C. § 405(g). The district 

court reviews the Commissioner’s final decision under the substantial evidence standard 

and must affirm the Commissioner’s decision if it is supported by substantial evidence 

and it is free from legal error. Smolen v. Chater, 80 F.3d 1273, 1279 (9th Cir. 1996); 

Ryan v. Comm’r of Soc. Sec. Admin., 528 F.3d 1194, 1198 (9th Cir. 2008). Even if the 

ALJ erred, however, “[a] decision of the ALJ will not be reversed for errors that are 

harmless.” Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir. 2005). 

 Substantial evidence means more than a mere scintilla, but less than a 

preponderance; it is “such relevant evidence as a reasonable mind might accept as 

adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 401 (1971) 

(citations omitted); see also Webb v. Barnhart, 433 F.3d 683, 686 (9th Cir. 2005). In 

determining whether substantial evidence supports a decision, the court considers the 

record as a whole and “may not affirm simply by isolating a specific quantum of 

supporting evidence.” Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007) (internal 

quotation and citation omitted). The ALJ is responsible for resolving conflicts in 

testimony, determining credibility, and resolving ambiguities. See Andrews v. Shalala, 

53 F.3d 1035, 1039 (9th Cir. 1995). “When the evidence before the ALJ is subject to 

more than one rational interpretation [the court] must defer to the ALJ’s conclusion.” 

Batson v. Comm’r of Soc. Sec. Admin., 359 F.3d 1190, 1198 (9th Cir. 2004) (citing 

Andrews, 53 F.3d at 1041). 

/ / / 

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VI. Plaintiff’s Claims 

 Plaintiff raises the following claims: (1) the ALJ erred by assigning little weight to 

NP Coe’s opinion of Plaintiff’s functional abilities; (2) the ALJ erred by rejecting 

Plaintiff’s symptom testimony; and (3) the ALJ erred by determining Plaintiff’s RFC 

“without any articulated support in the record.” (Doc. 23 at 1.) The Commissioner 

asserts that the ALJ’s decision is free from harmful error and is supported by substantial 

evidence. (Doc. 24.) As set forth below, the Court concludes that the ALJ erred by 

rejecting NP Coe’s opinions and that this error was not harmless. Based on this error, the 

Court reverses the Commissioner’s decision. Therefore, the Court does not address 

Plaintiff’s other claims. 

A. The ALJ’s Reasons for Assigning Little Weight to NP Coe’s Opinion 

 As stated in Section II.A.1, NP Coe provided assessments of Plaintiff’s physical 

functional limitations. The ALJ noted that NP Coe completed four RFC assessments and 

offered an opinion of Plaintiff’s functional abilities. (Tr. 19.) The ALJ gave NP Coe’s 

opinion little weight because she is not an acceptable medical source, the assessments 

were based on Plaintiff’s subjective complaints, and they were inconsistent with 

Dr. Thomas’s assessment.2

 (Tr. 19, 20.) Plaintiff argues that these are not legally 

sufficient reasons for rejecting NP Coe’s opinions. The ALJ also stated that he gave NP 

Coe’s opinion little weight because it was “not consistent with the record. Other records 

show that the claimant can do much more than this report assessed.” (Tr. 20.) Plaintiff 

does not specifically challenge this last rationale for the ALJ’s decision. (Doc. 23 at 19-

22; Doc. 25 at 3-5.) Similarly, the Commissioner mentions this rationale, but does not 

specifically discuss it. (Doc. 24 at 7.) 

 

2

 The Commissioner’s brief includes additional rationale in support of the ALJ’s rejection of NP Coe’s assessments, including that those assessments are on check box 

forms. The ALJ did not include this reason in his opinion. (Doc. 24 at 9.) This Court’s review is limited to “reasons and factual findings offered by the ALJ not post hoc rationalizations that attempt to intuit what the adjudicator may have been thinking.” Bray v. Comm’r Soc. Sec. Admin., 554 F.3d 1219, 1225-26 (9th Cir. 2009). Accordingly, the Court limits its analysis to the rationale and facts that the ALJ relied upon in support of his decision. 

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 1. Not an Acceptable Medical Source 

 The ALJ gave NP Coe’s RFC assessments little weight because she was not an 

“acceptable medical source.” (Tr. 19, 20.) Nurse practitioners are not considered 

“acceptable medical sources” under the Social Security Regulations (SSRs). See 20 

C.F.R. §§ 404.1513(d)(1), 416.913(d)(1). Rather, nurse practitioners are considered 

“other sources.” Id. Other sources can provide evidence regarding the severity of a 

claimant’s impairments and how they affect a claimant’s ability to work. Garrison v. 

Colvin, 759 F.3d 995, 1013. (9th Cir. 2014). In determining whether a claimant is 

disabled, an ALJ must consider that evidence. See 20 C.F.R. § 404.1513 (explaining that 

evidence may come from “other sources” that do not qualify as “acceptable medical 

sources.”) 

 Opinions from other medical sources “may be based on special knowledge of the 

individual and may provide insight into the severity of the impairment(s) and how it 

affects the individual’s ability to function.” SSR 06–03p, 2006 WL 2329939, at *2 (Aug. 

9, 2006). “The fact that a medical opinion is from an ‘acceptable medical source’ is a 

factor that may justify giving that opinion greater weight than an opinion from” an “other 

medical source” because “‘acceptable medical sources’ ‘are the most qualified health 

care professionals.’” Id. at *5. However, an opinion from an “other medical source” 

may outweigh the opinion of an “‘acceptable medical source,’” including the medical 

opinion of a treating source.” Id. An ALJ may reject evidence from other sources if the 

ALJ gives germane reasons for doing so. See Molina v. Astrue, 674 F.3d 1104, 1111 (9th 

Cir. 2012). 

 Here, the ALJ erred by rejecting PA Coe’s opinions on the basis that she was not 

an “acceptable medical source,” because an ALJ must consider evidence from “other 

medical sources,” including nurse practitioners, and give germane reasons for rejecting 

opinions from “other medical sources.” See SSR 06–03p, 2006 WL 2329939, at *2; 

Molina, 674 F.3d at 1111 (citing Lewis v. Apfel, 236 F.3d 503, 511 (9th Cir. 2001)). The 

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ALJ’s statement that he rejected NP Coe’s opinions because she is not an acceptable 

medical source is legally insufficient. 

 2. Opinions based on Plaintiff’s Subjective Complaints 

 The ALJ also gave NP Coe’s RFC assessments little weight based on his 

conclusion that her assessments “were based on what [Plaintiff] told the nurse 

practitioner on three different occasions.” (Tr. 19.) The ALJ’s opinion does not cite to 

evidence in the record to support that conclusion. However, during the administrative 

hearing, the following exchange with Plaintiff took place: 

 Q [ALJ]. As far as Nurse [sic] Koe [sic] is concerned, have you had some conversations with her as far as what you felt you could do and couldn’t do, how long you could sit, stand, lift, that sort of thing? 

 A [Plaintiff]. Yes. 

 Q. It appears from the record that there are probably three different times where you brought paperwork in for her to fill out, is that 

correct? 

 A. Yes. . . . 

 Q [Counsel]. So did Nurse Koe [sic] ask you the questions on the form? 

 A. She will go back to whatever she, in her notes or something, she will refer back to that. And then she will ask me certain questions, but she will always go back to – then she remember she had it on file already, so she will repeat whatever she have. 

 Q. She filled out some in the past? 

 A. Yes. 

 Q. Some assessments, and then she filled out some just very recently? 

 A. Yes. 

 Q. Okay. So she referred to her records, is that what you’re saying? 

 A. Yes. 

 Q. Okay. Did she ask you the specific questions that were on the 

forms and then fill out the form after each question, after you answered? 

A. Well some of them, and then she did whatever she had asked me in 

between, and then she would look at her records and stuff. 

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(Tr. 52-53.) 

 The record does not support the ALJ’s conclusion that NP Coe’s RFC assessments 

were based solely “on what [Plaintiff] told her on three different occasions.” (Tr. 19.) 

Plaintiff’s testimony at the administrative hearing indicates the she brought NP Coe RFC 

assessment forms to complete “three different times.” (Id.) Plaintiff testified that 

NP Coe “asked her the questions on the form[s]” and consulted her treatment notes. (Id.) 

As discussed in Section II.A.1, the administrative record includes numerous treatment 

notes from NP Coe. Considering NP Coe’s treatment history with Plaintiff and Plaintiff’s 

testimony that NP Coe referred to her notes or records when completing the RFC 

assessment forms, the record does not support the ALJ’s conclusion that NP Coe’s 

opinions were based solely on Plaintiff’s subjective complaints. 

 Therefore, the ALJ’s conclusion that NP Coe’s RFC assessments were based on 

Plaintiff’s subjective complaints is not a legally sufficient reason for discounting NP 

Coe’s opinions because the ALJ’s conclusion is not substantiated by the record. See 

Widmark v. Barnhart, 454 F.3d 1063, 1067-68 (9th Cir. 2006) (rejecting the ALJ’s 

rationale when “such an inference cannot reasonably be drawn from the relevant facts in 

the record”); but see Molina, 674 F.3d at 1111 (affirming the ALJ’s rejection of a 

physician assistant’s [PA] opinion when the ALJ gave “several germane reasons for 

discounting [the PA’s opinions] in favor of the conflicting testimony of Dr. Yost, and 

these reasons were substantiated by the record.”). 

 3. Inconsistent with Dr. Thomas’s Opinion 

 The ALJ also gave NP Coe’s opinions little weight because he found that those 

opinions were inconsistent with the Dr. Thomas’s opinions. (Tr. 19.) Dr. Thomas, a 

non-examining physician, reviewed the medical records and completed an RFC 

assessment on June 20, 2012. (Tr. 269-76.) In contrast to the restrictive functional 

limitations that NP Coe assessed (Tr. 351-55l, Tr. 695-97, Tr. 744-48), Dr. Thomas 

assessed functional limitations consistent with light work. (Tr. 270-73.) He opined that 

Plaintiff could occasionally lift or carry twenty pounds, frequently lift or carry ten 

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pounds, stand or walk six hours in and eight-hour day, and sit six hours in an eight-hour 

day. (Tr. 270.) He also found that Plaintiff was unlimited in her abilities to push and 

pull, reach, handle, finger, and feel. (Tr. 270, 272.) He found that Plaintiff was unlimited 

in her abilities to climb, balance, stoop, kneel, crouch, or crawl. (Tr. 271.) He further 

found that Plaintiff had no environmental limitations. (Tr. 273.) Although Dr. Thomas 

incorrectly identified Plaintiff’s date last insured as December 31, 2005, the comments 

supporting his opinions indicate that he considered medical records after that date, 

including records from January to April 2012.3

 (Tr. 269, 276.) 

 The ALJ found NP Coe’s functional assessments inconsistent with the medical 

opinion of reviewing physician Dr. Thomas. (Tr. 19.) The Commissioner argues that as 

an acceptable medical source, Dr. Thomas’s opinion warranted “greater weight.” 

(Doc. 24 at 8 (citing SSR 06-03p, 2006 WL 2329939, at *5)). The Commissioner cites 

SSR 06-03p to support this argument. That regulation provides that “[t]he fact that a 

medical opinion is from an ‘acceptable medical source’ is a factor that may justify giving 

that opinion greater weight.” SSR 06–03p, 2006 WL 2329939 at *5. However, it also 

emphasizes that opinions from all medical sources must be weighed “depending on the 

particular facts in a case, and after applying the factors for weighing opinion 

evidence . . . For example, it may be appropriate to give more weight to the opinion of a 

medical source who is not an ‘acceptable medical source’ if he or she has seen the 

individual more often than the treating source and has provided better supporting 

evidence and a better explanation for his or her opinion.” Id. 

 Other medical source NP Coe, treated Plaintiff from 2012 to 2014. (Tr. 303, 

Tr. 458, Tr. 451-56, Tr. 449-50, Tr. 496-97, Tr. 855-56, Tr. 851-52, Tr. 845-46, Tr. 833-

 

3

 Plaintiff asserts that the ALJ rejected the opinion of non-examining physician Dr. Payne because he incorrectly identified Plaintiff’s date last insured and argues that similar rationale applies to Dr. Thomas’s opinion because he also misidentified the date 

last insured. (Doc. 23 at 22.) Both Dr. Payne and Dr. Thomas misidentified the date last 

insured as December 31, 2005. However, unlike Dr. Payne, Dr. Thomas considered current medical evidence that was in the record at the time he prepared his functional assessments in 2012. (Tr. 269-76.) Therefore, Dr. Thomas’s misidentification of the date 

last insured did not materially affect his opinion. 

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34, Tr. 825-26, Tr. 820-23, Tr. 817-18, Tr. 812-13, Tr. 809-10.) In contrast, Dr. Thomas 

never treated or examined Plaintiff, and only considered medical evidence up to the date 

of his opinion in July 2012, two years before the ALJ issued his decision. See Lester, 81 

F.3d at 831 (“[t]he opinion of a non-examining physician cannot by itself constitute 

substantial evidence that justifies the rejection of the opinion of either an examining or a 

treating physician”). 

 The ALJ rejected NP Coe’s opinions in favor of Dr. Thomas’s without considering 

these factors for weighing “other source” opinions. (Tr. 19, 20); see 2006 WL 2329939, 

at *5. Therefore, the Court finds the ALJ did not provide a germane reason for rejecting 

NP Coe’s opinion in favor of non-examining physician Dr. Thomas’s opinion. But see 

Molina, 674 F.3d at 1111 (concluding that the ALJ permissibly rejected the opinion of a 

physician assistant on the ground that it was inconsistent with the opinion of an 

examining physician who was a specialist in psychiatry, the field relevant to the 

plaintiff’s alleged disabling condition.) Dr. Thomas’s status as an acceptable source 

alone is not a germane reason for discounting NP Coe’s opinions. See 2016 WL 

2329939, at *5. 

 4. Inconsistency with the Record 

 Finally, after discussing NP Coe’s 2014 functional assessment, the ALJ stated that 

he gave NP Coe’s 2014 opinion little weight because it was “not consistent with the 

record. Other records show that the claimant can do much more than this report 

assessed.” (Tr. 20.) Neither Plaintiff nor the Commissioner specifically addresses this 

rationale. (Doc. 23 at 19-22; Doc. 25 at 3-5; Doc. 24 at 7.) Aside from Dr. Thomas’s 

opinion, the ALJ did not specifically identify how NP Coe’s 2014 opinion was 

inconsistent with any evidence in the record. (Tr. 19, 20.) Thus, in stating that “[o]ther 

records” showed that Plaintiff could do more than what NP Coe assessed, the ALJ may 

be referring again to Dr. Thomas’s opinion. (See Doc. 23 at 19-22, Doc. 24 at 7-9.) 

 Additionally, the Commissioner’s brief states that the ALJ gave “at least one 

germane reason for discounting” NP Coe’s opinion and then asserts that Dr. Thomas’s 

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status as an acceptable medical source was a germane reason for accepting his opinion 

over NP Coe’s. (Doc. 24 at 7-8.) The Commissioner identifies the ALJ’s second 

germane reason for discounting NP Coe’s opinion as the ALJ’s conclusion that the 

opinion was based on Plaintiff’s subjective complaints. (Id. at 9.) Therefore, the Court 

considers that ALJ’s statement that NP Coe’s assessment was inconsistent with the record 

to mean that NP Coe’s 2014 assessment was inconsistent with Dr. Thomas’s opinion. As 

discussed in Section VI.A.3, that is not a legally sufficient reason for discounting NP 

Coe’s opinion.4

 

B. Remand for Further Proceedings 

 The Court concludes the ALJ erred by discounting NP Coe’s opinions. This error 

was not harmless because the vocational expert testified that an individual with the 

limitations NP Coe assessed would be unable to perform sustained work. (Tr. 55-56) 

Plaintiff requests that the Court credit NP Coe’s opinion as true and remand this matter 

for an immediate award of benefits. (Doc. 23 at 29.) 

 Remand for an award of benefits is appropriate when: (1) the record has been fully 

developed and further administrative proceedings would serve no useful purpose; (2) the 

ALJ has failed to provide legally sufficient reasons for rejecting evidence, whether the 

rejected evidence is claimant’s testimony or medical opinions; and (3) if the improperly 

discredited evidence were credited as true, the ALJ would be required to find the 

claimant disabled on remand. Garrison v. Colvin, 759 F.3d 995, 1020 (9th Cir. 2014) 

(footnote and citations omitted); see also Treichler v. Comm’r of Soc. Sec. Admin., 775 

F.3d 1090, 1103 (9th Cir. 2014) (when evaluating whether further administrative 

proceedings would be useful, “we consider whether the record as a whole is free from 

conflicts, ambiguities, or gaps, whether all factual issues have been resolved, and whether 

the claimant’s entitlement to benefits is clear under the applicable legal rules.”). When 

 

4

 To the extent the ALJ rejected NP Coe’s opinions as inconsistent with other evidence in the record, the Court finds that rationale legally insufficient because the ALJ 

did not identify the information in the record that with which NP Coe’s opinion was inconsistent. 

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this test is met, the Ninth Circuit “take[s] the relevant testimony to be established as true 

and remand[s] for an award of benefits[,]” Benecke v. Barnhart, 379 F.3d 587, 593 (9th 

Cir. 2004) (citations omitted), unless “the record as a whole creates serious doubt as to 

whether the claimant is, in fact, disabled within the meaning of the Social Security Act.” 

Garrison, 759 F.3d at 1021 (citations omitted). 

 In this case, the Court finds that remand for an immediate award of benefits is 

inappropriate. As to NP Coe’s opinions regarding the limiting effects of Plaintiff’s 

impairments, “an ALJ’s failure to provide sufficiently specific reasons for rejecting the 

testimony of a claimant or other witness does not, without more, require the reviewing 

court to credit the claimant’s testimony as true.” Treichler, 775 F.3d at 1106. Thus, 

“only where ‘there are no outstanding issues that must be resolved before a determination 

of disability can be made,’ do we have discretion to credit a claimant’s testimony as true 

and remand for benefits, and only then where ‘it is clear from the record that the ALJ 

would be required to find [the claimant] disabled’ were such evidence credited.” Id.

(quoting Moisa v. Barnhart, 367 F.3d 882, 887 (9th Cir. 2004)). 

 Here, Defendant has pointed to inconsistencies in Plaintiff’s reports about the 

effectiveness of treatment to relieve her pain. (Doc. 24 at 6); see Treichler, 775 F.3d 

1090 (remanding for further proceedings where the record reflected inconsistences 

related to the claimant's credibility and it was not clear on the record that the claimant 

was disabled). During the administrative hearing, Plaintiff testified that pain relief from 

trigger point injections only last until she got home from Dr. Levine’s office, or about an 

hour. (Tr. 46-47.) However, in April 2013, Plaintiff told Dr. Levine that “her shoulder 

pain dramatically improved with trigger point injections.” (Tr. 750.) She also reported 

that she was able to use her arm “much more proficiently than previously.” (Id.) 

Similarly, in May 2013, Plaintiff told Dr. Levine that after an injection the pain in her 

shoulder and arm was “markedly improved.” (Tr. 749.) Considering these 

inconsistences in Plaintiff’s testimony that bear on her severity of her symptoms, remand 

for an immediate award of benefits is inappropriate. 

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VII. Conclusion 

 The Court finds that the ALJ erred in rejecting NP Coe’s opinion and that error 

was not harmless. Therefore, the Court remands this matter for further proceedings to 

reassess NP Coe’s opinion concerning the limitations caused by Plaintiff’s impairments. 

The ALJ may also reconsider Plaintiff’s symptom testimony, the record as whole, and 

may reassess whether Plaintiff’s RFC is appropriate. 

 Accordingly, 

IT IS ORDERED that the Commissioner’s decision is reversed and this matter is 

remanded for further proceedings consistent with this order. 

IT IS FURTHER ORDERED that the Clerk of Court shall enter judgment in 

favor of Plaintiff and terminate this case. 

 Dated this 27th day of January, 2017. 

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