Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_16-cv-00215/USCOURTS-casd-3_16-cv-00215-2/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:0405id Review of HHS Decision (SSID)

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1 FILED

2 17 JAN 23 PH M13

3 CiiRK. U.s. DISTRICT COURT

SOUTHCkN DISTRICT OF CAUFG.RNI t

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>fY: DEPOTC

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8 UNITED STATES DISTRICT COURT

9 SOUTHERN DISTRICT OF CALIFORNIA

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11 WALDO RENE MEDINA, Case No.: 16cv215-GPC(KSC)

12 Plaintiff, REPORT AND RECOMMENDA13 TION RE:

14 v. (I) CROSS-MOTIONS FOR

SUMMARY JUDGMENT [Doc. Nos.

26 and 32];

15 CAROLYN W. COLVIN, Acting

Commissioner of Social Security, 16

Defendant. 17 (2) DEFENDANT’S MOTION TO

DISMISS [Doc No. 25]; 18

19 (3) PLAINTIFF’S MOTION TO

EXCLUDE EVIDENCE [Doc. No. 30];

AND 20

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(4) PLAINTIFF’S EX PARTE

REQUEST TO SUPPLEMENT THE

RECORD [Doc. No. 28]

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1 Pursuant to Title 42, United States Code, Section 405(g), ofthe Social Security Act

("SSA"), plaintifffiled a Complaint to obtain judicial review of a final decision by the

Commissioner of Social Security ("Commissioner") denying him disability insurance

benefits.1 [Doc. No. 1.] Although plaintiff was represented by counsel while his

disability claim was pending before the Commissioner, he is unrepresented in this action

and is proceeding informa pauperis2 [Doc. No. 6.]

Presently before the Court are: (1) defendant's Motion for Involuntary Dismissal

[Doc. No. 25]; (2) defendant’s Motion for Summary Judgment [Doc. No. 26];

(3) plaintiffs Ex Parte Request to Supplement the Administrative Record [Doc. No. 28];

(4) plaintiffs Motion to Exclude Evidence [Doc. No. 30]; (5) plaintiffs Motion for

Summary Judgment [Doc. No. 32]; (6) defendant’s Response to plaintiff’s Motions [Doc.

No. 33]; (7) plaintiff’s Response to defendant’s Motion for Summary Judgment; and

(8) the Administrative Record (“AR”) [Doc. No. 10].

After careful consideration ofthe moving and opposing papers, as well as the

Administrative Record and the applicable law, it is RECOMMENDED that the District

Court affirm the ALJ’s decision to deny benefits by issuing an order DENYING

defendant’s Motion for Involuntary Dismissal; GRANTING defendant’s Motion for

Summary Judgment; DENYING plaintiff’s Motion for Summary Judgment; DENYING

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21 i Title 42, United States Code, Section 405(g), provides as follows: “Any individual,

after any final decision ofthe Commissioner of Social Security made after a hearing to

which he was a party ... may obtain a review of such decision by a civil action ...

brought in the district court ofthe United States.... The court shall have power to enter,

upon the pleadings and transcript ofthe record, a judgment affirming, modifying, or

reversing the decision ofthe Commissioner of Social Security, with or without

remanding the cause for a rehearing. The findings ofthe Commissioner... as to any fact,

if supported by substantial evidence, shall be conclusive...

2 District Courts are obligated to afford a certain amount of leeway to pro se litigants

and to construe their pleadings liberally. Hebbe v. Pliler, 627 F.3d 338, 342 (9th Cir.

2010).

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.” 42U.S.C. §405(g). 26

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1 plaintiffs Motion to Exclude Evidence; and DENYING plaintiff’s Ex Parte Request to

Supplement the Administrative Record.

I. Background and Procedural History.

On December 9, 2011, plaintiff applied for disability benefits claiming he was

unable to work as of August 10, 2002. [AR 180-181.] At this time, plaintiffreported that

he lived in a home or apartment and did not need help with personal care, hygiene,

upkeep of a home, or cooking. [AR 185.]

On January 23, 2014, plaintiff was notified that his application had been reviewed,

but he did not qualify for disability benefits because his medical condition was not severe

enough to prevent him from working. [AR 90-94.] Plaintiffrequested reconsideration of

this decision, but his request for benefits was denied once again on April 30, 2014. [AR

98-102.] On June 22, 2014, plaintiffrequested a hearing before an Administrative Law

Judge (“ALJ”). [AR 104-105.] A hearing was held on January 6, 2015. [AR 33, 126-

165.]

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15 On January 27, 2015, the ALJ concluded that plaintiff was not disabled within the

meaning of the SSA and did not qualify for disability insurance benefits. [AR 19-28.]

Plaintiff requested review of the ALJ’s decision by the Appeals Council. [AR 16.] After

considering additional evidence in the form of a representative brief, the Appeals Council

denied review of the ALJ’s decision on July 13, 2015. [AR 1-5.] Ifthe Appeals counsel

denies review, the decision ofthe ALJ becomes the final decision of the Commissioner.

20 C.F.R. § 404.981. The Complaint in this action was then filed on September 3, 2015

seeking review ofthe Commissioner’s final decision. [Doc. No. 1.]

Defendant’s Motion to Dismiss.

On October 19, 2016, defendant filed a Motion for Involuntary Dismissal for

Failure to Prosecute and for Failing to Follow This Court’s Amended Scheduling Order.

[Doc. No. 25.] In the Motion, defendant cited Federal Rule of Civil Procedure 41(b) and

argued that the action should be dismissed without a determination on the merits for

failure to prosecute, because plaintiff failed to comply with briefing orders that set a

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1 schedule for the parties to file cross-motions for summary judgment. [Doc. No. 25-1, at

2 pp. 2-3.]

3 Rule 41(b) authorizes an involuntary dismissal “[i]f the plaintiff fails to prosecute

or to comply with [the Federal Rules] or a court order..Fed.R.Civ.P. 41(b).

However, dismissal under Rule 41(b) “is so harsh a penalty it should be imposed as a

sanction only in extreme circumstances.” Lai v. California, 610 F.3d 518, 525 (9th Cir.

2010), quoting Dahl v. City ofHuntington Beach, 84 F.3d 363, 366 (9th Cir. 1996).

Here, based on a review the docket, it is apparent that plaintiff, who is prosecuting

this case pro se, did not proceed exactly as directed in the Court’s briefing orders and

may have neglected to serve defense counsel with some of the moving papers he

submitted to the Court for filing. Plaintiffs actions resulted in some confusion and a

brief delay in getting the case fully briefed for the Court’s consideration. [Doc. Nos. 13-

36.] These are hardly the type of “extreme circumstances” that would justify an

involuntary dismissal under Rule 41(b). It is therefore RECOMMENDED that the

District Court DENY defendant’s Motion for Involuntary Dismissal and consider

plaintiff’s Complaint on the merits. [Doc. No. 25.]

III. Standards ofReview -Final Decision ofthe Commissioner.

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18 The final decision ofthe Commissioner must be affirmed if it is supported by

substantial evidence and ifthe Commissioner has applied the correct legal standards.

Batson v. Comm’r ofthe Social Security Admin., 359 F.3d 1190, 1193 (9th Cir. 2004).

Under the substantial evidence standard, the Commissioner's findings are upheld if

supported by inferences reasonably drawn from the record. Id. If there is evidence in the

record to support more than one rational interpretation, the District Court must defer to

the Commissioner’s decision. Id. “Substantial evidence means such relevant evidence as

a reasonable mind might accept as adequate to support a conclusion.” Osenbrock v.

Apfel, 240 F.3d 1157,1162 (9th Cir. 2001). “In determining whether the

Commissioner's findings are supported by substantial evidence, we must consider the

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

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1 detracts from the Commissioner's conclusion.” Smolen v. Chater, 80 F.3d 1273, 1279

(9th Cir. 1996).

Pursuant to Federal Rule of Civil Procedure 56(a), "[t]he court shall grant summary

judgment ifthe movant shows that there is no genuine dispute as to any material fact and

the movant is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(a). "Summary

judgment motions, as defined by Fed.R.Civ.P. 56, contemplate the use of evidentiary

material in the form of affidavits, depositions, answers to interrogatories, and admissions.

In Social Security appeals, however, the Court may ‘look no further than the pleadings

and the transcript of the record before the agency,' and may not admit additional

evidence. Morton v. Califano, 481 F.Supp. 908, 914 n. 2 (E.D. Tenn.1978); 42 U.S.C.

§ 405(g). Therefore, although summary judgment motions are customarily used [in

social security cases], and even requested by the Court or Magistrate, such motions

merely serve as vehicles for briefing the parties' positions, and are not a prerequisite to

the Court's reaching a decision on the merits." Kenney v. Heckler, 577 F.Supp. 214, 216

(N.D. Ohio 1983).

IV. Evidence in the Administrative Record.

A. Forms Submitted bv Plaintiffto Support His Disability Claim.

A Disability Report prepared at the time plaintiffsubmitted his application states

that his ability to work is limited by the following conditions: (1) injury to left elbow and

right leg/knee; (2) shattered tibia and fibula (two steel plates); (3) transplanted anterior

crustate ligament with shattered tibia; (4) shattered radius and ulna (two more steel

plates); and (5) “Turrets” possibly due to anesthesia from broken leg surgery. [AR 197-

198.] The Disability Report also states that plaintiff has an Associate Degree in

architecture that he completed in June 1989. [AR 199.] The examiner who conducted a

face-to-face interview with plaintiff on December 9, 2011 noted that plaintiff did not

appear to have any difficulty hearing, reading, writing, understanding, speaking,

concentrating, sitting, standing, walking, or using his hands. [AR 207.]

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1 On February 4, 2012, plaintiff submitted a Work History Report stating that he had

worked as a clerk in a medical office from 1980 through August 2002 and as a laser

technician from September 1989 through May 1993. [AR 209.] As a clerk in a medical

office, plaintiff indicated he transcribed doctors’ voice recordings of medical files,

answered telephones, and retrieved files. [AR 210.] This job also involved sitting for six

to seven hours each work day and lifting and carrying expired file boxes weighing 20 to

30 pounds about once or twice per month. [AR 210.] Plaintiffs job as a laser technician

required him to repair laser printers at six or seven different sites per day. He lifted and

carried laser printers weighing about 20 to 75 pounds about three to four times per work

day. In this job, plaintiff was required to stand about seven hours per day. [AR 211-

212.] Because of “apparent nerve damages” in his left elbow, plaintiffstated in his Work

History Report that he can only type for 20 to 30 minutes before it becomes too painful.

[AR 220.] On “rare occasions,” plaintiffsuffers from “Turrets” caused by anesthesia.

[AR 220.]

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15 In a later Disability Report submitted on June 22,2012, plaintiffstated that the

condition of his knee was getting worse, and it had become too painful to walk, so he had

to use his bike as a walker when shopping. [AR 242.] At this time, plaintiff also

complained that he was examined at Seagate Medical Group in connection with his

disability claim, but the doctor did not review prior relevant medical records and did not

ask him about pain or other key symptoms. [AR 247-250.]

In another Disability Report, apparently submitted on February 14, 2013, plaintiff

reported that the pain in his right knee and shin had increased and he was having

difficulty cleaning his home, fixing meals, taking showers, doing laundry, showering, and

getting dressed. [AR 267, 270.] He also reported he could no longer walk short

distances. [AR270.]

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26 B. Chronological Summary ofMedical Records.

27 The earliest medical treatment records are from August 21, 2002, and were

28 prepared by Rodney D. Henderson, M.D., ten days after plaintiff had surgery to repair a

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“comminuted,3 right, tibial plateau fracture.”4 [AR 326.] At this time, plaintiff was

reportedly “doing well” and was “weaning off Vicodin.” [AR 326.] X-rays showed

“good alignment at the fracture site” and “hardware in good position.” [AR 326.] In

addition, Dr. Henderson reported that there was “no pain with passive motion.” [AR

326.]

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6 Thereafter, plaintiff had several follow-up appointments with Dr. Henderson. On

September 9, 2002, Dr. Henderson’s treatment notes state that: “He is doing well. He

denies any pain at rest. He does report some sensation of a bone moving when he moves

his legs.... There is atrophy ofthe quadriceps. There is really no swelling at the knee at

all, and the incision is completely healed.... AP and lateral radiographs of the tibia

show no change in the hardware position or alignment. There is still a little varus5 at the

proximal fragment, but this is unchanged from the original x-rays.” [AR 325.]

Dr. Henderson recommended that plaintiff “continue non-weightbearing and gentle range

of motion up to 90 degrees as tolerated....” [AR 325.]

On October 14, 2002, two months after surgery, Dr. Henderson reported that

plaintiff was “doing well” and “deniefd] any pain.” [AR 324.] At this time,

Dr. Henderson indicated plaintiff could begin to “toe-touch weight bear, and do straight

leg raises and quad sets.” [AR 324.] At the time of his follow-up appointment on

November 13, 2002, plaintiff reported he had been “trying to bear weight” but was

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3

“Comminuted” means “a fracture in which the bone is splintered or crushed into

numerous pieces.” Merriam-Webster Medical Dictionary, http://www.merriamwebster.com/medical/comminuted.

The “tibia” is “the inner and usually larger of the two bones ofthe vertebrate hind

or lower limb between the knee and ankle.” Merriam-Webster Dictionary,

http://www.merriam-webster.com/dictionarv/tibia. The “tibial plateau” is “the smooth

bony surface of... the tibia ....” Merriam-Webster Medical Dictionary,

http://www.merriam-webster.com/medical/tibial plateau.

5 “Varus” means “of, relating to, or being a deformity in which an anatomical part is

turned inward toward the midline ofthe body to an abnormal degree.” Merriam-Webster

Dictionary, http://www.merriam-webster.com/dictionarv/vams.

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1 having some pain in the knee joint. [AR 323.] Dr. Henderson indicated plaintiff could

“wean out of the brace,” “begin weightbearing,” and “use a stationary cycle as tolerated.”

[AR 323.] Plaintiff continued to progress as indicated in Dr. Henderson’s notes dated

December 16, 2002 [AR 322]; January 27, 2003 [AR 321]; and March 10, 2003 [AR

320].

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6 Plaintiff had his final follow-up appointment with Dr. Henderson on June 18,2003,

ten months after his surgery. [AR 319.] The treatment notes state that plaintiff “is doing

very well and over the last month his symptoms have markedly improved. He denies any

pain. His main problem that he reports, which is very minor, is some weakness when he

descends stairs. He has been cycling on a daily basis. [fJHis quadracep development has

improved. He has full flexion, full extension, and there is no effusion in the knee.

Clinically, there is just very mild varus compared to the opposite knee which is also at

slight varus.... I will release him from my care. I have recommended that he avoid

impact loading exercises. He is certainly safer in continuing cycling and swimming....”

[AR 319.]

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16 On July 28, 2007, plaintiff went to the emergency room at Scripps Memorial

Hospital after he fell off a bicycle and landed on his left side. He had a “significant

deformity to his left elbow.” [AR 205.] An X-ray revealed “a dislocation ofthe elbow

and radial head, with a fracture ofthe proximal ulna that is comminuted.” [AR 306.] His

fracture was “aligned and splinted while he was sedated.” [AR 306.] On July 29, 2007, a

detailed Operative Report indicates plaintiff had surgery on his left elbow because of a

“comminuted unstable Monteggia fracture dislocation.” [AR 302-304.] He was

discharged on July 31, 2007. [AR 301.] Prior to surgery, plaintiff was advised it was

unlikely he would have “return of full range of motion of his elbow and forearm.” [AR

309.]

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1 On August 3, 2007, shortly after the surgery on his elbow, plaintiff went to see

Dr. Henderson seeking “reassurance” and a “second opinion.” [AR 316.] Plaintiff was

known to Dr. Henderson, because he previously operated on plaintiff’s knee. [AR 316.]

At this time, plaintiffs main concern was that he had been told he “may be at risk for

dislocation in the future if his elbow comes out into terminal extension.” [AR 316.]

Dr. Henderson examined plaintiff and was able to review his x-rays. In addition,

Dr. Henderson reviewed postoperative radiographs, which showed “essentially anatomic

alignment with internal plate fixation with nice concentric joint alignment.” [AR 317.]

He reassured plaintiffthat his x-rays “look excellent.” [AR 317.] Dr. Henderson’s

written report also states as follows: “Theoretically, he is at risk for possible]

dislocation and extension secondary to the comminution ofthe comoid fragment;

however, in my opinion the more likely scenario would be postoperative stiffness

limiting full terminal extension which would most likely prevent any episodes of

dislocation.” [AR317.]

Nine days after his surgery, on August 6, 2007, plaintiff had a follow-up

appointment with Dr. Hackley. The treatment notes state that plaintiff was “healing

nicely.” [AR 330.] Dr. Hackley referred plaintiffto physical therapy to “work on range

of motion....” [AR 330.] On August 9, 2007, at the next appointment with

Dr. Hackley, plaintiff was “doing well” and his wound was “healing nicely.” [AR 329.]

Dr. Hackley adjusted the brace on plaintiff’s arm “to allow him to range from 45

[degrees] to full flexion.” [AR 329.] By the next visit on August 20, 2007, plaintiff

reported that he had not yet gone to physical therapy. He said he was dealing with some

“social issues” and had not had time to see the therapist. [AR 328.] He was still using a

brace and the range of motion for his elbow was “30-120 [degrees].” [AR 328.]

However, he had a full range of motion in his fingers and wrists. Dr. Hackley

encouraged plaintiffto see the physical therapist to work on range of motion exercises.

[AR 328.] Six weeks after surgery, on September 10, 2007, Dr. Hackley reported that

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1 plaintiff was still “doing well” and working on his range of motion. His x-rays showed

“further healing” with “[n]o evidence of subluxation6 on the static views.” [AR 327.]

Progress notes dated January 28, 2010 by Denise L. Parnell, M.D., Family Health

Centers of San Diego, indicate that plaintiff had a routine medical examination and

requested to have a form filled out for food stamps. [AR 379.] During the examination,

plaintiff reported that he still had pain in his elbow and leg, and his leg swelled if he

walked a mile. [AR 379.] He also said he had Tourette syndrome that was “mostly in

remission.” [AR379.]

On September 16, 2010, plaintiff had another routine medical examination at

Family Health Centers of San Diego and needed a form filled out for social services.

[AR 378.] At this time, plaintiffreported that he could walk a mile before his knee

became painful. There was no swelling in his knee or elbow. [AR 378.] His next

appointment at Family Health Centers of San Diego was on October 6, 2010. At this

time, plaintiff was requesting “disability certification” because of his knee and elbow

injuries. [AR 377.] He was not taking any pain medication at this time. [AR 377.]

Plaintiff was advised that his records would be requested from Scripps to determine

whether he needed “a referral for ortho” and to assess whether he is disabled. [AR 377.]

In a later follow-up appointment at Family Health Centers of San Diego on June 24,

2011, plaintiff again requested disability certification for “chronic knee pain” and

reported he could walk a half a mile with difficulty. However, the attending physician,

Amish Chipwadia, M.D., reviewed plaintiff’s “ortho records” and “denied” disability.

[AR 375.]

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23 On April 2, 2012, plaintiff appeared for a psychiatric consultative examination by

Gregory M. Nicholson, M.D., a Board Certified Psychiatrist. [AR 337-342.]

Dr. Nicholson’s report says plaintiff’s “chief complaint” is anxiety. [AR 337.] Plaintiff

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6 Subluxation means “partial disclocation (as of one ofthe bones in a joint).”

Merriam-Webster Dictionary, http://www.merriam-webster.com/dictionary/subluxation.

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1 told Dr. Nicholson that he lives alone, and his activities of daily living include cooking

and laundry. He had no difficulty with dressing, bathing, or personal hygiene. Although

he did not drive because he did not have a vehicle, he was able to go out alone. He was

able to handle cash and bills appropriately. [AR 339.] The results of a mental status

examination were normal, but plaintiff’s mood and affect were anxious. He appeared to

be of average intelligence, and his memory was intact. His insight, judgment, and “fund

of knowledge w[ere] grossly intact.” [AR 340-341.]

Based on his examination of plaintiff, Dr. Nicholson concluded that plaintiff is

able to understand, remember, and carry out simple one or two-step job instructions as

well as detailed and complex instructions. [AR 341.] In addition, Dr. Nicholson

concluded plaintiff has an unlimited ability to accept instructions from a supervisor and

perform work activities without special supervision. [AR 342.] However, his ability to

relate and interact with co-workers and the public and his ability to maintain

concentration, attention, persistence, and pace are “mildly limited.” [AR 341.] His

ability to maintain regular attendance was also “mildly limited.” [AR 342.]

On April 10,2012, at the request ofthe Department of Social Services in

connection with plaintiff’s disability claim, plaintiff had x-rays and an orthopedic

consultation, which resulted in written reports by T. Divakaran, M.D., a Radiologist, and

Thomas J. Sabourin, M.D., a Board Certified Orthopedic Surgeon. [AR 344-349.]

Dr. Divakaran’s Radiology Report concludes as follows with respect to plaintiff’s left

elbow: “Internal fixation plate and screws in the proximal ulna with healed fracture.

Post-traumatic osteoarthritis ofthe elbow joint.” [AR 349.] With respect to plaintiff’s

right knee/leg, the Radiology Report concludes as follows: “Internal fixation plate and

screws in the proximal tibia with healed fracture which appears to have extended into the

lateral tibial plateau.” [AR 349.]

Dr. Sabourin’s report states that plaintiff “took a bike and bus to the evaluation

today.” [AR 344.] Plaintiffreported pain in his left elbow and right knee as a result of

“three significant bicycle accidents” which resulted in injuries to his right knee and left

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1 elbow that both needed surgical repair. [AR 344.] He said his right knee is painful when

he walks and his elbow is doing “relatively well,” but he “gets some pain” after typing

more than 20 minutes. [AR 344.] He was not receiving any medical treatment or using

assistance devices for these problems. [AR 344.] Dr. Sabourin completed a physical

examination and reported that plaintiff “sits and stands with normal posture;” “sits

comfortably during the examination;” “rises from a chair without difficulty;” “has no

assistance devices;” and has a normal gait and toe heel walking. [AR 345.] Dr. Sabourin

also noted that plaintiff had a normal range of motion in his spine, hips, shoulders, wrists,

hands, fingers, ankles, and feet. [AR 346-347.] A neurological examination was also

normal except for some decreased sensation near the surgical scar on plaintiffs right leg.

[AR 347.] However, Dr. Sabourin’s report states that: “There is a 2+ varus instability in

the right knee. He has some tenderness over the medial aspect ofthe right knee. There is

no redness, swelling, or gross effusion and there is no significant crepitus. He has a varus

deformity in the right knee.” [AR 346.] Dr. Sabourin also reviewed the x-rays that were

taken on the day ofthe appointment. [AR 347.]

Based on his examination, Dr. Sabourin concluded that plaintiff does have

“problems with his right knee and left elbow.” [AR 348.] Dr. Sabourin’s report also

states that: “The left elbow is not too significant [of a] problem. He seems to be getting

by with it quite well. The right knee, however, is significant and I feel it does give him

significant limitations.” [AR 348.] As a result, Dr. Sabourin concluded as follows:

I feel he could only lift and carry 20 pounds occasionally and 10

pounds frequently with this knee. He could stand and walk up to two hours

in an eight-hour workday and sit for six hours in an eight-hour workday.

Push and pull limitations will be equal to lift and carry limitations. He is

unable to walk on uneven terrain with that knee. He could climb, kneel and

crouch only occasionally with that knee. His left elbow is doing well

enough that I do not feel he has any significant manipulative limitations, but

he could do gross manipulation such as handling, torqu[e]ing, and grasping

with the left elbow only frequently. He does not use any assistive devices.

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During an appointment at Family Health Centers of San Diego on February 22,

2013, plaintiff complained of chronic pain in his right knee and left elbow, and x-rays

were ordered. [AR 364-365.] X-rays were completed on April 3, 2013 and were

reviewed by Derrick Allen, M.D., who prepared a detailed report of his findings. As to

plaintiff’s right knee, Dr. Allen’s x-ray findings and conclusion state as follows:

Intact orthopedic side plate [within the] lateral tibial plateau.

Marked irregularity involving the articular surface ofthe tibial

plateau.

Moderate size joint effusion.

Moderate to severe patellofemoral degenerative change.

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10 [AR 392.]

11 As to plaintiff’s elbow, Dr. Allen’s findings and conclusions for the x-rays

12 completed on April 3, 2013 state as follows:

13 FINDINGS:

Posterior olecranon plate is in place. There is a 2 mm lucency

between the plate and the posterior aspect of the olecranon. No definite

lucency surrounding the screws. Triangular-shaped density projects adjacent

to the radial head near the capitellum on the oblique view which could

potentially be a loose body within the joint space. No definite acute fracture

line is identified. Well-corticated tiny osseous fragment adjacent to the

radial head is also likely sequelae of prior trauma. Irregularity of the radial

notch ofthe ulna is likely sequela of old trauma....

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CONCLUSION:

Olecranon orthopedic plate as described above.

Triangular osseous density between the radial head and capitellum

could potentially represent a loose body. This finding is only

appreciable on the oblique view. Correlation with any prior

radiographs would be of benefit. CT scan may also be beneficial.

No acute fracture line or evidence ofjoint effusion.

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25 [AR 393.]

26 As a result ofthe x-rays completed on April 3,2013, Family Health Centers of San

Diego referred plaintiffto an orthopedic surgeon for a consultation. [AR 362-363, 359-

360.] At his next appointment at Family Health Centers of San Diego on October 15,

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1 2013, plaintiff indicated he did not know the results of his orthopedic consultation [AR

357], and the results do not appear to be a part ofthe Administrative Record. At this

time, plaintiff was taking medication to control high blood pressure, but there is nothing

to indicate he was taking any medication for chronic pain in his knee or elbow. [AR 357-

358.]

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6 On August 1, 2013, plaintiff had an appointment with Joel J. Smith, M.D., for a

disability evaluation based on his prior right knee and left elbow injuries.7 [AR 398.] At

this time, plaintiff complained of moderate to severe burning pain in his right knee which

varied from day to day. [AR 398.] Dr. Smith did acknowledge in the assessment section

of his report that plaintiffsuffered from joint pain. However, the results of his

examination were within normal ranges. [AR 398-399.] With respect to plaintiffs left

elbow, Dr. Smith noted that there were “no deformities of misalignment of bones,

swelling,” and no “signs of muscle atrophy.” [AR 398.] Dr. Smith also noted as follows:

“The carrying angle ofthe lower arms is symmetrical. The bony landmarks ofthe two

elbows are aligned.” [AR 399.] “Range of motion testing ofthe elbow reveals no

restriction or instability related to ligamentous laxity.” [AR 399.] “Range of motion in

flexion is approximately 130 degrees.” [AR 399.] “Range of motion in extension is

approximately 30 degrees.” [AR 399.]

With respect to plaintiffs right knee, Dr. Smith’s report states as follows: “The

alignment ofthe knee and patella are normal; there is no varus or valgus8 [misalignment

ofthe knee or rotational [mis]alignment ofthe patella.” [AR 399.] “Range of motion

testing ofthe knee reveals no restriction or instability related to ligamentous laxity.” [AR

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7 The record indicates that Dr. Smith’s disability evaluation was added to the record

as “additional evidence” on January 22, 2014, shortly after the December 11, 2013

hearing before the ALJ. [AR 277-278.]

“Valgus” means “of, relating to, or being a deformity in which an anatomical part

is turned outward away from the midline ofthe body to an abnormal degree.” MerriamWebster Dictionary, http://www.merriam-webster.com/dictionarv/valgus.

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399.] “Strength testing ofthe major motor muscles ofthe knee is graded at 5/5.” [AR

399.]

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3 c. Administrative Hearing Held on December 11, 2013.

Plaintiff was represented by counsel at the hearing on December 11, 2013. [AR

29.] At the outset ofthe hearing, the ALJ stated on the record that plaintiff’s “date last

insured for disability insurance purpose[s] is September 30, 2007.” [AR 29.]

1. Plaintiff.

Plaintifftestified that he was fifty-four years old and had attended college.

Although he went to college long enough to obtain an Associate Degree, he said he

“didn’t collect the degree” even though he “did all ofthe work for it.” [AR 30.] Over the

past ten to eleven years, plaintiff said he had been living in rental property owned by his

parents and received “general relief and food stamps.” [AR 31.] He had also recently

been approved for health insurance through Medicare or MediCal. [AR 31.]

Plaintiff confirmed that he previously worked as a clerk in a medical office, where

he did some typing and filing. He also had to move file boxes when they were ready to

be placed in storage. He said he stopped working at this job when he was injured and

could not return to thisjob because he was unable to lift boxes or stay on his feet. He

also said he is unable to sit for an eight-hourjob because his leg stiffens and he has to get

up every few hours. It also takes him a long time to get up and he can then stand for

about 10 or 15 minutes. [AR 34-35, 37.] Prior to working as a clerk in a medical office,

plaintifftestified that he repaired laser printers and computers. [AR 34.]

Plaintiff testified he was taking medication to control his blood pressure, but when

asked if he was taking pain medications, he replied, “I avoid them like the plague.” [AR

35.] Plaintiff further testified that he lives alone and is able to do his own grocery

shopping. He does not drive but uses buses for transportation. When using the bus

system, plaintiff gets on the bus “downhill” from his home and gets offthe bus “uphill”

from his home, because uphill riding causes pain. On level surfaces, he can ride his

bicycle. He also uses the bicycle as a walker when he goes to the grocery store and he

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1 puts the groceries in a basket on the handlebars. [AR 36-37.] Because his right leg is

“unstable,” plaintiff testified that he loses his balance on a daily basis and has trouble

with bathing, shower, and getting dressed. [AR 39-40.]

According to plaintiff, he must limit his errands. He can do two errands in one

day, but if he does two errands on three days in a row, he will be unable to walk for a day

or two and must scoot around on the carpet inside his home to get from place to place.

[AR 37-38.] When he is not out doing errands, plaintifftestified he usually sits or

reclines with his leg elevated and does digital painting on a computer using one hand and

no keyboard. [AR 38.]

Plaintiff also testified he developed Tourette syndrome when he stopped taking

pain medications in 2003. Initially, he had five to seven episodes a day, but they began to

taper off in 2010 and it has been a few months since his last episode. [AR 41-42.]

In addition, plaintiff testified that his left arm, which previously required surgery,

begins to hurt after typing for five or ten minutes. The pain feels like the “nerve kind of

damage” he has experienced in his knee and he has to stop after 15 minutes when using

his arm for fine motor skills, such as typing. [AR 48.] When he needs to lift something

that weighs 10 to 15 pounds, plaintiff said he has to “favor the other arm.” [AR 49.] In

other words, he is right handed, so his right hand and arm bear the weight and he uses his

left hand as a guide. [AR 49.]

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20 2. Medical Expert-Anthony E. Francis, M.D.9

21 In preparation for his testimony, Dr. Francis reviewed medical records submitted in

support of plaintiff’s disability claim through and including April 3, 2013. At this time,

Dr. Smith’s disability evaluation from August 1, 2013 was not in the record. [AR 42,

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26 9 According to his Curriculum Vitae, Dr. Francis is experienced in orthopedic

surgery and emergency medicine. He also has an extensive educational history in

medicine, as well as a Juris Doctorate and a Legum Doctorate with emphasis in legal

medicine. [AR 171.]

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277-278.] Based on the record, Dr. Francis testified plaintiff had several musculoskeletal

“pathologies or traumas” and a “tic disorder” {i.e., Tourette syndrome). [AR 42.] Based

on plaintiffs testimony, Dr. Francis noted that the tic disorder was “getting better.” [AR

43.] With respect to plaintiffs musculoskeletal traumas, Dr. Francis testified there was

insufficient evidence to conclude plaintiffs condition would meet or equal a listing prior

to the date he was last insured {i.e., September 30, 2007) or thereafter. [AR 42-44.]

Referring to Listing 1.02A,10 Dr. Francis reasoned there was some evidence that plaintiff

suffered from degenerative arthritis, which can develop after the type of fracture he had

in his leg in 2002. In addition, there was evidence to indicate plaintiff had “dysfunction

of a major weight-bearing joint” {i.e., his knee). [AR 44.] However, there was

insufficient evidence in the record to indicate plaintiff was “unable to ambulate

effectively;” [AR 44.] With respect to plaintiffs elbow fracture, Dr. Francis testified:

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10 Listing 1.02, Major Dysfunction of a Joint: “Characterized by gross anatomical

deformity {e.g., subluxation, contracture, bony or fibrous ankylosis, instability) and

chronic joint pain and stiffness with signs of limitation of motion or other abnormal

motion of the affected joint(s), and findings on appropriate medically acceptable imaging

of a joint space narrowing, bony destruction, or ankylosis of the affected joint(s). With:

A. Involvement of one major peripheral weight-bearing joint {i.e., hip, knee, or ankle),

resulting in inability to ambulate effectively as defined in 1.00B2b; or B. Involvement of

one major peripheral joint in each upper extremity {i.e., shoulder, elbow, or wrist-hand),

resulting in inability to perform fine and gross movements effectively, as defined in

1.00B2c.” 20 C.F.R. Part 404, Subpart P, Appendix 1, Listing 1.02. “Inability to

ambulate effectively means an extreme limitation ofthe ability to walk; i.e., an

impairment(s) that interferes very seriously with the individual’s ability to independently

initiate, sustain, or complete activities. Ineffective ambulation is defined generally as

having insufficient lower extremity functioning (see 1.00J) to permit independent

ambulation with the use of a hand-held assistive device(s) that limits the functioning of

both upper extremities....” 20 C.F.R. Part 404, Subpart P, Appendix 1, Listing

1.00B2b(l). “To ambulate effectively, individuals must be capable of sustaining a

reasonable walking pace over a sufficient distance to be able to carry out activities of

daily living. They must have the ability to travel without companion assistance to and

from a place of employment or school....” 20 C.F.R. Part 404, Subpart P, Appendix 1,

Listing 1.00B2b(2).

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“[I]t looks like that was handled well” and “I didn’t see a lot of problems after that. So I

don’t know ifthat led to any significant impairment.” [AR 45.]

Based on his review of all ofthe available records, Dr. Francis testified he was

unable to locate evidence indicating plaintiff’s residual functional capacity to work was

“less than sedentary” prior to his date last insured or at any other time, with the exception

of the times he needed to recuperate from fractures. [AR 45-46.] Dr. Francis also

commented that results were missing for an orthopedic consultation that was completed

sometime after the most recent x-rays of April 3, 2013. [AR 45, referring to AR 357-

363.] However, he did not believe these results would make a difference to his analysis.

[AR 45.]

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11 3. Vocational Expert Bonnie Sinclair, M.S.. C.R.C.11

12 On a Work History form, plaintiff indicated he worked as “clerk” in a medical

office from 1980 to August 2002. [AR 209.] He described this job as follows:

“Transcribe and type Dr.’s voice record of medical files, file & retrieve said files. Some

phone work.” [AR 210, 47.] He also indicated he was required to lift and carry “boxes

of expired files for disposal weighing approx. 20 to 30 lbs, about twice a month or so.”

[AR 210, 47.]

Ms. Sinclair testified that plaintiff’s past relevant work as a stenographer/

transcriber is generally considered “skilled sedentary work” and requires a person to sit

six to seven hours per day to write, type, or handle small objects. [AR 46-47.] However,

the particularjob that plaintiff previously held fits in the category of light work, because

he was required to lift file boxes weighing 20 to 30 pounds about twice per month. On

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26 ii According to her Curriculum Vitae, Ms. Sinclair has a Master of Science Degree in

Vocational Rehabilitation Counseling. She has many years of experience in this field and

also has a number of other credentials in the area of vocational rehabilitation and

counseling. [AR 167-169.]

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the other hand, it was Ms. Sinclair’s view that this type ofjob would no longer require

lifting of file boxes because of advancements in electronics. [AR 46-47.]

Plaintiff’s counsel asked Ms. Sinclair if an individual who was only able to

perform fine motor movements 50 percent of the day would be able to perform the job of

transcriber. Ms. Sinclair responded that the job oftranscriber requires reaching,

handling, and fingering frequently (/.<?., between 33 and 66 percent ofthe work day).

Therefore, it “would be cutting it a little close” for a person to do this job if he could only

perform fine motor skills for 50 percent ofthe day. [AR 50.] Such a person would be

able to do the job if it did not require “constant” transcribing. [AR 50.] However,

Ms. Sinclair further testified that that such an individual would be unable to sustain the

job oftranscriber if he missed four or more days of work per month because of pain

limitations. [AR 50-51.]

Insured Status Requirements.

Plaintiff claimed he was disabled beginning on August 10, 2002 and did not file his

application for disability benefits until December 9, 2011. The ALJ therefore considered

whether plaintiff met the insured status requirements under the Social Security Act and

made the following finding: “The claimant’s earnings record shows that the claimant has

acquired sufficient quarters of coverage to remain insured through September 30, 2007.

Thus, the claimant must establish disability on or before that date in order to be entitled

to a period of disability and disability insurance benefits,

challenge this finding.

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24 12 See, e.g., Johnson v. Shalala, 60 F.3d 1428, 1432 (9th Cir. 1995) (stating that the

claimant “must prove that [he or] she was either permanently disabled or subject to a

condition which became so severe as to disable her prior to the date upon which her

disability insured status expires.”)

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1 VI. The ALl’s Five-Stev Disability Analysis.

2 To qualify for disability benefits under the SSA, an applicant must show that he or

she is unable to engage in any substantial gainful activity because of a medically

determinable physical or mental impairment that has lasted or can be expected to last at

least 12 months. 42 U.S.C. § 423(d). The Social Security regulations establish a fivestep sequential evaluation for determining whether an applicant is disabled under this

standard. 20 C.F.R. § 404.1520(a); Tackett v. Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999).

At step one, the ALJ must determine whether the applicant is engaged in

substantial gainful activity. 20 C.F.R. § 404.1520(a)(4)(I). In this case, the ALJ

concluded that plaintiff had not engaged in substantial gain activity since August 10,

2002, the date he alleged his disability began. [AR 15.]

At step two, the ALJ must determine whether the applicant is suffering from a

"severe" impairment within the meaning of Social Security regulations from the date he

was last insured. 20 C.F.R. § 404.1520(a)(4)(ii). “An impairment or combination of

impairments is not severe if it does not significantly limit [the applicant's] physical or

mental ability to do basic work activities.” 20 C.F.R. § 404.1521(a). For example, a

slight abnormality or combination of slight abnormalities that only have a minimal effect

on the applicant's ability to perform basic work activities will not be considered a

“severe” impairment. Webb v. Barnhart, 433 F.3d 683, 686 (9th Cir. 2005). Examples of

basic work activities include walking, standing, sitting, lifting, pushing, pulling, reaching,

carrying, handling, seeing, hearing, speaking, understanding, carrying out and

remembering simple instructions, use ofjudgment, responding appropriately to

supervision, co-workers and usual work situations, and dealing with changes in a routine

work setting. 20 C.F.R. § 404.1521(b)(l)-(6). “Ifthe ALJ finds that the claimant lacks a

medically severe impairment, the ALJ must find the claimant not to be disabled.” Webb

v. Barnhart, 433 F.3d at 686.

Here, the ALJ found at step two that plaintiff had severe impairments, including a

“Tic disorder/Tourette’s Syndrome;” “status post” reconstmction of his right knee;

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“status post” fracture of his left elbow; “residual medial instability of the right knee;” and

“moderate degenerative joint disease ofthe right knee.” [AR 15-16.] Although the ALJ

acknowledged there was evidence in the record indicating plaintiffsuffered from anxiety,

the ALJ concluded it was “non-severe,” because it did not “cause more than minimal

limitation in [his] ability to perform basic mental work activities.” [AR 16.]

Ifthere is a severe impairment, the ALJ must then determine at step three whether

it meets or equals one of the listings of impairments in the Social Security regulations.

20 C.F.R. § 404.1520(a)(4)(iii). Ifthe applicant's impairment meets or equals a listing,

he or she must be found disabled. Id.

In this case, the ALJ concluded at step three that plaintiff does not have an

impairment or combination of impairments that meets or medically equals the severity of

one ofthe listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1. [AR 17.]

The ALJ reasoned that the testifying medical expert and state agency physicians opined

that plaintiff’s medical condition does not meet or equal a listing and no treating or

examining physician made findings that would satisfy the severity requirements in the

Listing of Impairments. [AR 17.]

If an impairment does not meet or equal a listing, the ALJ must make a step four

determination ofthe claimant's residual functional capacity based on all impairments,

including impairments that are not severe. 20 C.F.R. § 404.1520(e), § 404.1545(a)(2).

"Residual functional capacity" is "the most [an applicant] can still do despite [his or her]

limitations." 20 C.F.R. § 404.1545(a)(1). The ALJ must determine whether the applicant

retains the residual functional capacity to perform his or her past relevant work.

20 C.F.R. § 404.1520(a)(4)(iv). The ALJ’s determination is made “based on all the

relevant medical and other evidence in [the claimant’s] case record.” 20 C.F.R.

§ 404.1520(e). A claimant is not disabled if he or she can still do his or her past relevant

work. 20 C.F.R. § 404.1520(a)(4)(iv).

Here, the ALJ concluded plaintiff does not qualify for disability benefits, because

he has the residual functional capacity to perform a full range of sedentary work. [AR

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17-22.] According to the ALJ, plaintiff is able to perform his past relevant work as a

stenographer/transcriber, which is considered skilled sedentary work as it is performed in

the national economy, because he can lift and carry ten pounds, and sit, walk, or stand for

six hours in an eight-hour workday. [AR 21-22.] In reaching this conclusion, the ALJ

discredited plaintiffs testimony indicating he could not perform sedentary work because

of disabling pain in his left arm and right leg. [AR 20-22.]13

VII. Discussion.

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8 A. The Parties’ Cross-Motions for Summary Judgment.

In his Motion for Summary Judgment, plaintiff attempts to enlarge and embellish

the testimony he gave at the hearing before the ALJ to convince the Court that the ALJ’s

denial of his disability claim is erroneous, because he has long suffered from disabling

pain caused by injuries and severe deformities in his knee and elbow [Doc. No. 32, at pp.

1-25] and from a disabling mental illness (Tourette syndrome) that renders him unable

“to function or discern reality.” [Doc. No. 32, at p. 28.] However, the Court is unable to

consider additional testimony or evidence that was not presented at the hearing before the

ALJ. “In the context ofjudicial review of a decision ofthe Commissioner regarding SSI

disability benefits, evidence outside the administrative record generally is precluded from

consideration by the court.” Baker v. Barnhart, 457 F.3d 882, 891 (8th Cir. 2006).

Plaintiffs Motion for Summary Judgment also attacks the written medical

opinions in the record for various reasons, such as the doctors’ alleged failure to ask him

any questions about pain. [Doc. No. 32, at p. 4-5.] However, in Meanel v. Apfel, 172

F.3d 1111 (9th Cir. 1999), the Ninth Circuit explained that “appellants must raise issues at

their administrative hearings in order to preserve them on appeal.” Id. at 1115. Plaintiff

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26 Since the ALJ concluded plaintiff was not disabled at step four, he did not reach

step five ofthe disability analysis, which requires a determination as to whether the

applicant can perform any other work in the national economy. 20 C.F.R.

§ 404.1520(a)(4)(g),(v); 20 C.F.R. § 404.1545(e); 20 C.F.R. § 416.929.

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was represented by counsel at the hearing before the ALJ. Through his counsel, plaintiff

did not object to the state ofthe record or to any ofthe challenged physician reports. As

a result, plaintiff waived any argument that the reports by these physicians are deficient

in any significant manner. It is therefore RECOMMENDED that the District Court

DENY plaintiffs Motion for Summary Judgment, because he has not shown that the

ALJ’s decision to deny benefits is not supported by substantial evidence or that the ALJ

failed to apply the correct legal standards.

Defendant argues that the ALJ’s decision to deny plaintiffs disability claim should

be affirmed, because substantial evidence supports the ALJ’s determination that plaintiff

was not disabled on or before September 30, 2007, his date last insured. Defendant also

argues that the ALJ’s decision should be affirmed, because it is free from legal error.

[Doc. No. 26-1.]

As noted above, the final decision of the Commissioner must be affirmed if it is

supported by substantial evidence and ifthe Commissioner has applied the correct legal

standards. Batson v. Comm’r ofthe Social Security Admin., 359 F.3d at 1193. Based on

a careful review ofthe record, it is this Court’s view that the ALJ’s decision is supported

by substantial evidence. First, the ALJ’s decision that plaintiff has the residual functional

capacity for sedentary work is supported by the treatment records and the opinions of

several medical professionals, including treating and examining physicians, and the

testifying medical expert, all of which are summarized above. There is no objective

medical evidence in the record to support a conclusion that plaintiff qualifies for

disability benefits, because he suffered a disability under the SSA on or before

September 30, 2007, his date last insured.

Second, the ALJ appropriately rejected plaintiff’s testimony that he is unable to

work at a sedentary job because he suffers from disabling pain. In Light v. Social

Security Administration, 119 F.3d 789 (9th Cir. 1997), the Ninth Circuit held that an ALJ

cannot discredit or reject subjective claims of “excess pain” based solely on a lack of

objective medical support in the record. Id. at 792-793. “In assessing the credibility of a

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claimant's testimony regarding subjective pain or the intensity of symptoms, the ALJ

engages in a two-step analysis. [Citation omitted.] First, the ALJ must determine whether

there is ‘objective medical evidence of an underlying impairment which could reasonably

be expected to produce the pain or other symptoms alleged.’ [Citations omitted.] Ifthe

claimant has presented such evidence, and there is no evidence of malingering, then the

ALJ must give ‘specific, clear and convincing reasons’ in order to reject the claimant's

testimony about the severity ofthe symptoms. [Citations omitted.] At the same time, the

ALJ is not ‘required to believe every allegation of disabling pain, or else disability

benefits would be available for the asking, a result plainly contrary to 42 U.S.C. §

423(d)(5)(A).’ [Citation omitted.] In evaluating the claimant’s testimony, the ALJ may

use ‘ordinary techniques of credibility evaluation.’ [Citation omitted.] For instance, the

ALJ may consider inconsistencies either in the claimant's testimony or between the

testimony and the claimant’s conduct, [such as]... ‘whether the claimant engages in

daily activities inconsistent with the alleged symptoms.’ [Citation omitted.] While a

claimant need not ‘vegetate in a dark room’ in order to be eligible for benefits, [citation

omitted], the ALJ may discredit a claimant’s testimony when the claimant reports

participation in everyday activities indicating capacities that are transferable to a work

setting. [Citation omitted.] Even where those activities suggest some difficulty

functioning, they may be grounds for discrediting the claimant’s testimony to the extent

that they contradict claims of a totally debilitating impairment. [Citation omitted.]”

Molina v. Astrue, 674 F.3d 1104,1112-1113 (9th Cir. 2012

Under Social Security regulations, factors to be considered in evaluating the

intensity, persistence, and limiting effects of a claimant’s symptoms include: (i) daily

activities; (ii) the location, duration, frequency, and intensity of pain or other symptoms;

(iii) precipitating and aggravating factors; (iv) the type, dosage, effectiveness, and side

effects of any medication taken to alleviate pain or other symptoms; (v) treatment to

relieve pain or symptoms other than medication; (vi) any measures used to relieve pain or

other symptoms (e.g., lying flat, standing for 15 to 20 minutes every hour, sleeping on a

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1 board, etc.); and (vii) functional limitations and restrictions due to pain or other

symptoms. 20 C.F.R. § 404.1529(c)(3); 20 C.F.R. § 416.929(c)(3); Social Security

Regulation 16-3p.

“A finding that a claimant’s testimony is not credible ‘must be sufficiently specific

to allow a reviewing court to conclude the adjudicator rejected the claimant’s testimony

on permissible grounds and did not arbitrarily discredit a claimant’s testimony regarding

pain.’ [Citation omitted.] General findings are insufficient; rather, the ALJ must identify

what testimony is not credible and what evidence undermines the claimant’s complaints.

[Citation omitted.]” Brown-Hunter v. Colvin, 806 F.3d 487, 493 (9th Cir. 2015). The

Court is “constrained to review the reasons the ALJ asserts.” Brown-Hunter, 806 F.3d at

492. On the other hand, “there is no rigid requirement that the ALJ specifically refer to

every piece of evidence in his decision.” Reid v. Comm’r ofSocial Sec., 769 F.3d 861,

865 (4th Cir. 2014), quoting Dyer v. Barnhart, 395 F.3d 1206, 1211 (11th Cir. 2005).

Here, the ALJ acknowledged the existence of objective evidence indicating

plaintiff has impairments that could reasonably be expected to produce the alleged

symptoms. However, based on the evidence submitted, the ALJ concluded that

plaintiff’s “statements concerning the intensity, persistence, and limiting effects ofthese

symptoms are not entirely credible for the reasons explained in this decision.” [AR 25.]

The ALJ stated several reasons for this conclusion, each of which is discussed separately

below.

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21 1. Lack ofObjective Medical Evidence.

22 The ALJ’s first reason for rejecting plaintiff’s testimony is that the objective

medical evidence does not show that plaintiff’s symptoms are frequent or severe enough

to significantly interfere with his ability to work. [AR 20.] In support ofthis reason, the

ALJ cited substantial objective evidence in the record. For example, the ALJ noted that

neurological examinations “have revealed no significant focal deficits.” [AR 20.]

Plaintiff’s medical records show he can walk in a satisfactory manner and there is nothing

to indicate he suffers from muscle weakness, loss of muscle control, muscle atrophy, or

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wasting in the arms and legs due to nerve damage. [AR 20.] Treating source opinions

indicate plaintiff “experienced excellent results postoperatively.” [AR 21.] Other

physicians who examined plaintiff and/or reviewed his medical records have concluded

he remains capable of performing full time work on a sustained basis. [AR 21.] The ALJ

gave these opinions significant weight, because they contain detailed clinical findings and

narratives explaining and supporting the medical opinions. [AR 21.] However, as noted

above, an ALJ cannot “reject a claimant’s subjective complaints based solely on a lack of

medical evidence to fully corroborate the alleged severity of pain.” Burch v. Barnhart

(9th Cir. 2005) 400 F.3d 676, 680 (9th Cir. 2005). As a result, the ALJ’s first reason,

standing alone, is not enough to discredit plaintiffs testimony that he is totally disabled

by pain and inability to ambulate effectively.

Conservative Course of Treatment.

The ALJ’s next reason for rejecting plaintiff’s testimony is that the record indicates

he had only conservative care for his elbow and knee following surgery and recovery.

More specifically, the record indicates plaintiff did take medications postoperatively, and

they were effective in controlling his pain. Following recovery, the record indicates

plaintiff’s was not taking medication to control pain in his arm or leg. [AR 20.] The

Court notes also that when asked during the hearing whether he was taking pain

medications, plaintiff replied, “I avoid them like the plague.” [AR 35.]

“Impairments that can be controlled effectively with medication are not disabling.”

Warre v. Commissioner ofSocial Sec. Admin., 439 F.3d 1001, 1006 (9th Cir. 2006).

Evidence of “conservative treatment” can be sufficient to discredit a claimant’s testimony

about the severity of an impairment. Johnson v. Shalala, 60 F.3d 1428, 1434 (9th Cir.

1995). For example, “over-the-counter pain medication” is considered “conservative

treatment” that is sufficient to discount a claimant’s testimony. Parra v. Astrue, 481 F.3d

742, 751 (9th Cir. 2007). An ALJ may also infer that a claimant’s “response to

conservative treatment undermines [his] reports regarding the disabling nature of his

pain.” Tommasetti v. Astrue, 533 F.3d 1034,1039-1040 (9th Cir. 2008).

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1 As noted above, the ALJ may use “ordinary techniques of credibility evaluation.”

Molina v. Astrue, 61A F.3d at 1112-1113. The ALJ is also entitled to draw inferences

“logically flowing from the evidence.” Maori v. Chater, 93 F.3d 540, 544 (9th Cir. 1996).

On the record before the Court, the ALJ could reasonably discount plaintiffs claims of

disabling pain, because the record indicates he was not taking any medications to treat his

alleged disabling pain after he recovered from the surgeries on his left elbow and right

knee. [AR 344, 357-358, 377.] Thus, it is this Court’s view that the ALJ has stated a

clear and convincing reason for discrediting plaintiff’s testimony that he is totally

disabled by pain.

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10 3. Physical Limitations and SpecialAccommodations.

11 The ALJ’s third reason for rejecting plaintiff’s testimony is that the record does not

show plaintiffsuffered from any physical limitations indicative of a total disability or that

he required any special accommodations (e.g., special breaks or positions) to relieve his

pain. For example, the ALJ noted plaintiff did not exhibit any significant atrophy, loss of

strength, or difficulty moving that are indicative ofsevere and disabling pain. Although

he alleged loss of balance, he had a normal gait and did not require any assistive devices

to ambulate. [AR 26-27.]

The ALJ’s conclusions in this regard are supported by substantial evidence in the

record. First, Dr. Sabourin, who completed an orthopedic examination of plaintiff on

April 10, 2012, stated in his written report that plaintiff has a normal gait, normal posture,

and normal “[t]oe heel walking.” [AR 345.] He also reported that plaintiff did not have

any assistance devices, has a relatively normal range ofmotion, and could rise from a

chair without difficulty. [AR 345-346.] Dr. Sabourin did acknowledge that plaintiff has

some problems with his right knee and left elbow, but concluded he did not have “any

significant manipulative limitations” in his left elbow and could “walk up to two hours in

an eight-hour workday” and “lift and carry 20 pounds occasionally and 10 pounds

frequently with this knee.” [AR 348.] Similar results were expressed by Dr. Smith, who

examined plaintiff on August 1, 2013. Dr. Smith’s report states that plaintiff did not have

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1 any swelling or signs of muscle atrophy and had normal strength and range of motion.

[AR 398-399.] It is true that plaintifftestified he uses his bicycle as a walker when he

does his grocery shopping [AR 36-37], but there is no evidence in the record to indicate

he needed or used any medically prescribed assistive devices to ambulate. Thus, it is this

Court’s view that the ALJ has stated a clear and convincing reason for discrediting

plaintiffs testimony that he is totally disabled by pain.

Routine Daily Activities.

The ALJ’s decision further states as follows: “Additionally, there is no indication

in the evidence ofrecord that the claimant is unable to attend to routine daily activities.

Moreover, the claimant’s routine activities establish a level of functioning greater than

that alleged. The claimant’s activities of daily living include the ability to cook his own

meals and do laundry. He is able to go out alone and he can handle bills and handle cash

appropriately without assistance.” [AR 21.] This evidence about plaintiff’s daily

activities is from a report prepared by Dr. Nicholson, the Board Certified Psychiatrist

who examined plaintiff on April 2, 2012. [AR 337-342.]

In addition to the daily activity information in Dr. Nicholson’s report, plaintiff

testified at the hearing that he is able to use buses for transportation to do errands, can

ride his bicycle on level surfaces, and do his grocery shopping while using his bicycle as

a walker and the basket on his bicycle as grocery carrier. [AR 36-37.]

“While a claimant need not ‘vegetate in a dark room’ in order to be eligible for

benefits, the ALJ may discredit a claimant’s testimony when the claimant reports

participation in everyday activities indicating capacities that are transferable to a work

setting. Even where those activities suggest some difficulty functioning, they may be

grounds for discrediting the claimant’s testimony to the extent that they contradict claims

of a totally debilitating impairment. Molina v. Astrue, 674 F.3d 1104, 1112-13 (9th Cir.

2012).

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pain or impairment. Orn v. Astrue, 495 F.3d 625, 636 (9th Cir. 2007). However, the ALJ

may not discredit a claimant’s testimony about the extent of his or her pain and

impairment based solely on “daily activities, such as grocery shopping, driving a car, or

limited walking for exercise.” Vertigan v. Halter, 260 F.3d 1044, 1050 (9th Cir. 2001).

An ALJ may reject a claimant’s testimony about the extent of his or her pain or

impairment if ‘“a claimant is able to spend a substantial part of [the] day engaged in

pursuits involving the performance of physical functions that are transferable to a work

setting.’” Orn, 495 F.3d at 639 (internal citation omitted).

Although plaintiff did testify that his daily activities are significantly limited by

pain in his arm and knee, the ALJ had reason to question this testimony based on

Dr. Nicholson’s report and the other credibility factors discussed above. It is true that the

evidence about plaintiff’s daily activities, standing alone, is not enough to discredit his

testimony that he is disabled by pain. However, this evidences does lend some support to

the ALJ’s decision to reject plaintiff’s testimony that he suffers from disabling pain.

Based on the foregoing, it is this Court’s view that the ALJ’s decision denying

plaintiff’s claim for disability benefits is supported by specific, clear, and convincing

reasons for rejecting plaintiff’s testimony about the severity of his pain. In addition, it is

also this Court’s view that the ALJ’s decision to deny disability benefits is supported by

substantial evidence and free from legal error.

B. Plaintiff’s Motion to Exclude Evidence FDoc. No. 301

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21 In his Motion to Exclude Evidence [Doc. No. 30], plaintiff argues that the Court

should exclude the “expert testimony” of the following non-treating, examining

physicians for “failure to meet the Daubert standard”: [Doc. No. 30, at p. 1.]

(1) Dr. Nicholson, M.D.; (2) Dr. Sabourin, M.D.; and (3) Dr. Smith, M.D. [Doc. No. 30,

at p. 1.] As outlined more fully above, Dr. Nicholson is a Board Certified Psychiatrist,

who completed a consultative examination of plaintiff on April 2, 2012 and prepared a

written report. [AR 337-342.] Dr. Sabourin is a Board Certified Orthopedic Surgeon

who examined plaintiff on April 10, 2012 and prepared a written report. [AR 344-349.]

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1 Dr. Smith, M.D., examined plaintiff on August 1, 2013 and prepared a disability report.

[AR 398-399.] None ofthese physicians testified at plaintiffs hearing.

Essentially, plaintiff argues that the Court should not consider the reports prepared

by these physicians, because they failed to adequately address key issues that are relevant

to plaintiffs disability claim, and, as a result, they failed “to meet the Daubert standard.”

[Doc. No. 30, at p. 1.] According to plaintiff, Dr. Nicholson’s report should be excluded,

because he failed to address plaintiff’s allegation that he suffers from a mental health

condition known as Tourette syndrome. [Doc. No. 30, at p. 1.] With respect to

Dr. Sabourin’s report, plaintiff argues that it should be excluded because he avoided and

failed to discuss “the central issue of pain.” [Doc. No. 30, at pp. 1-2.] Finally, plaintiff

points to a blank form in the record [AR 396] and argues that Dr. Smith’s report should

be excluded, because he reported reviewing x-rays but did not fill out the form to obtain

any x-rays. Plaintiff believes this is evidence of “false testimony.” [Doc. No. 30, at pp.

6-7.] However, plaintiff’s argument is nonsensical. A review ofthe record does not

support plaintiff’s interpretation ofthe cited documents, and Dr. Smith’s report indicates

that his disability evaluation is based on a physical examination of plaintiff without

reference to x-rays. [AR 394-399.]

It is this Court’s view that plaintiff’s Motion to Exclude Evidence should be

rejected for at least four reasons. First, plaintiff’s reliance on Daubert v. Merrell Dow

Pharmaceuticals, Inc., 509 U.S. 579 (1993) is misplaced. “The Federal Rules of

Evidence do not apply to the admission of evidence in Social Security administrative

proceedings. See 42 U.S.C. § 405(b)(1); 20 C.F.R. §§ 404.950(c), 416.1450(c) (‘The

administrative law judge may receive evidence at the hearing even though the evidence

would not be admissible in court under the rules of evidence used by the court.’);

Richardson v. Perales, 402 U.S. 389,400, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971)

(‘[S]trict rules of evidence, applicable in the courtroom, are not to operate at social

security hearings so as to bar the admission of evidence otherwise pertinent....’).” Bayliss

v. Barnhart, 427 F.3d 1211,1218 (9th Cir. 2005).

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1 Second, in Meanel v. Apfel, 172 F.3d 1111 (9th Cir.1999), the Ninth Circuit

explained that “appellants must raise issues at their administrative hearings in order to

preserve them on appeal.” Id. at 1115. Plaintiff was represented by counsel at the

hearing before the ALJ. Through his counsel, plaintiff did not object to the state of the

record or to any of the challenged physician reports. As a result, plaintiff waived any

argument that the reports by these physicians are deficient in any significant manner.

Third, as noted above, plaintiff had the burden of proving eligibility at steps one

through four of the five-step disability analysis. Celaya v. Halter, 332 F.3d at 1180. To

the extent he disagreed with the opinions of any of the physicians who examined him in

connection with his disability claim, plaintiff could have presented contrary evidence by

a treating or other physician but failed to do so.

Finally, even if plaintiff objected to consideration ofthe challenged reports during

the administrative hearing before the ALJ on the grounds stated in his Motion to Exclude

Evidence, there is nothing to indicate the ALJ would have sustained any such objection.

The challenged reports include relevant, objective medical evidence by three physicians

who examined plaintiff and then prepared written reports with clear, detailed

explanations for the medical opinions they expressed. As a result, the ALJ was entitled

to consider these reports even though they do not say what plaintiff would have liked

them to say.

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20 For the foregoing reasons, there is no basis for granting plaintiffs request to

exclude reports by Dr. Nicholson, Dr. Sabourin, and Dr. Smith for “failure to meet the

Daubert standard” [Doc. No. 30, at p. 1] or for any other reason. It is therefore

RECOMMENDED that the District Court DENY plaintiffs Motion to Exclude

Evidence. [Doc. No. 30.]

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1 c. Plaintiffs Ex Parte Request to Supplement the Administrative Record

2 IDoc. No. 281.

On November 3, 2016, plaintiffsubmitted a letter addressed to the Court, which

has been construed as a renewed Ex Parte Request to Supplement the Administrative

Record.14 [Doc. No. 28.] In this Ex Parte Request, plaintiff argues that x-ray images

material to the ALJ’s disability determination were erroneously omitted from the record.

According to plaintiff, he only became aware that these x-ray images were omitted when

he received a copy of the record for use in this proceeding. The allegedly omitted x-ray

images date back as far as his initial injury on August 10, 2002. Plaintiff believes these

x-ray images were erroneously omitted from the record even though he took all necessary

steps to release all of his medical records for submission in support of his disability

claim. [Doc. No. 28, at pp. 1-3.] Plaintiff argues that these x-ray images should have

been included in the record all along for review by the ALJ and by this Court, because

they show the severity of his injuries. He speculates that a lay person with “an

elementary school protractor” would be able to measure “the degree of painful bending in

the bones.” [Doc. No. 28, at p. 3-4.] In addition, plaintiff contends these x-rays can be

compared to show “the progressive and chronic nature” of his injuries. [Doc. No. 28, at

p. 4.]

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19 As plaintiff acknowledges, however, the record does include x-ray reports and/or

20 written observations by several physicians who reviewed actual x-ray images. [Doc. No.

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14 Plaintiff essentially raised the same issue in a prior letter to the Court that was filed

on June 17, 2016. [Doc. No. 19.] The Court construed plaintiffs letter as a Motion to

Continue to Present New Evidence. [Doc. No. 23.] The letter requested to continue the

case so that plaintiff could obtain x-rays “since 2002” because he believed this evidence

would show “an inaccurate diagnosis” that affected the outcome of his disability claim.

[Doc. No. 23, at p. 1, citing Doc. No. 17, at p. 1.] Plaintiffs letter request was denied

without prejudice, because he did not show that this “new evidence” is material or that

there was “good cause” for failure to include this evidence in the administrative

proceeding. [Doc. No. 23, at pp. 3-4.]

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1 28, at p. 5, referring to the omitted x-rays and stating that “[o]nly written observance is

mysteriously included.”] For example, the earliest reference to an x-ray in the record was

made in treatment notes by Dr. Henderson from August 21, 2002, “ten days” after

plaintiffs knee surgery. [AR 320.] Dr. Henderson’s treatment notes include a section

entitled “X-Rays,” which states as follows: “AP and lateral radiographs show good

alignment at the fracture site [and] hardware in good position.” [AR 326.] As

summarized more fully above, the record also includes several other detailed x-ray

reports. [See, e.g., AR 392-393.] Dr. Henderson’s treatment notes from plaintiff’s final

follow up appointment on June 18, 2003 do not refer to x-ray images but state that

plaintiff “has full flexion, full extension, and there is no effusion in the knee. Clinically,

there is just very mild vams compared to the opposite knee which is also at slight varus.”

[AR 319.] However, when Dr. Sabourin later reviewed x-rays taken on April 10, 2012,

he concluded that plaintiff had “a significant vams deformity” in his right knee. [AR

347-348.] As a result, he concluded plaintiff had “problems with his right knee” that

required “significant limitations.” [AR 348.] Among other limitations, Dr. Sabourin

concluded plaintiff could only lift and carry 20 pounds occasionally and 10 pounds

frequently because ofthe condition of his knee. [AR 348.]

“In the context ofjudicial review of a decision ofthe Commissioner regarding SSI

disability benefits, evidence outside the administrative record generally is precluded from

consideration by the court.” Baker v. Barnhart, 457 F.3d 882, 891 (8th Cir. 2006). In this

regard, Title 42, United States Code, Section 405(g), states in pertinent part as follows:

“The court shall have power to enter, upon the pleadings and transcript of the record,

judgment affirming, modifying, or reversing the decision ofthe Commissioner of Social

Security, with or without remanding the cause for rehearing.” 42 U.S.C. § 405(g)

(emphasis added).

When new evidence that is not part ofthe administrative record is presented for the

first time to the District Court, Section 405(g) allows the District Court to remand the

case to the Social Security Administration for consideration if, and only ifthere is “a

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showing” that the new evidence is “material” and that there is “good cause for the failure

to incorporate such evidence into the record in a prior proceeding....” 42 U.S.C.

§ 405(g); Brewes v. Commissioner ofSocial Sec. Admin., 682 F.3d 1157, 1164 (9th Cir.

2012).

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5 “Good cause” exists ifthe claimant can provide a reasonable explanation as to why

new evidence was unavailable earlier. Mayes v. Massanari, 276 F.3d 453, 463 (9th Cir.

2001). For example, “[n]ew medical evidence that becomes available due to

improvements in technology meets the good cause standard, and shall be considered if it

also meets the materiality requirement.” Wainwright v. Sec'y ofHealth & Human Servs.,

939 F.2d 680, 683 (9th Cir. 1991). “A claimant does not meet the good cause

requirement by merely obtaining a more favorable report once his or her claim has been

denied.” Mayes v. Massanari, 276 F.3d at 463. Without more, a simple assertion “that

the evidence only turned up later” is also not enough to satisfy the “good cause” standard.

Clem v. Sullivan, 894 F.2d 328, 332 (9th Cir. 1990).

New evidence is “material” if there is a reasonable possibility that it would have

changed the outcome ofthe claim for disability benefits. Booz v. Sec’y ofHealth and

Human Servs., 734 F.2d 1378, 1380-1381 (9th Cir. 1984). The new evidence must be

probative ofthe claimant’s condition as it existed during the relevant time period and

prior to the disability hearing. Sanchez v. Sec’y ofHealth and Human Servs., 812 F.2d

509, 511-512 (9th Cir. 1987). New evidence of “later-acquired disabilities or subsequent

deterioration of a previously non-disabling condition” are not “material.” Jones v.

Callahan, 122 F.3d 1148, 1154 (8th Cir. 1997). In Sanchez v. Secretary ofHealth and

Human Services, 812 F.2d 509, for example, the Ninth Circuit concluded that the

claimant’s new evidence was not material because “at most, [it showed] deterioration

after the hearing, which would be material to a new application but not probative of [the

claimant’s] condition at the hearing.” Id. at 512.

Based on the arguments in his Ex Parte Request, plaintiff’s position is that there is

“good cause” to supplement the record with x-ray images because they were part ofthe

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1 medical records he released to support his disability claim and should have been included

in the record all along. However, ifthe x-ray images should have been included all

along, plaintiff does not explain why his counsel failed to object to the state of the record

during the administrative proceedings, particularly when plaintiff had the burden at that

time to prove he was disabled. Plaintiff has therefore not shown good cause for failing to

include the x-ray images in the record during the administrative proceeding and has

waived any argument that the record is deficient because the x-ray reports conflict with

the actual x-ray images.

Plaintiff’s Ex Parte Request also takes the position that the x-ray images are

material to the disability analysis, because the x-ray reports do not accurately portray the

extent of post-surgical deformity in his right knee and left elbow which has resulted in

disabling pain. Despite plaintiff’s speculative argument that a lay person with “an

elementary school protractor” would be able to look at the x-ray images and measure “the

degree of painful bending in the bones,” the x-ray images are not material to the ALJ’s

disability analysis.

An ALJ is generally “not qualified to interpret raw medical data in functional

terms” and must rely on the opinions of qualified medical professionals. Nguyen v.

Chater, 172 F.3d 31, 35 (1st Cir. 1999). See also Rivera-Torres. v. Sec. ofHealth and

Human Svcs., 837 F.2d 4, 6-7 (1st Cir. 1988) (concluding that “the ALJ, a lay factfinder,

lacks sufficient expertise to conclude claimant has the ability to be on his feet all day

Rather, an explanation of claimant’s functional capacity from a doctor is needed.”);

Berrios v. Sec. ofHealth and Human Svcs., 796 F.2d 574, 576 (1st Cir. 1986) (stating that

“[w]e do not think the Appeals Council, composed of lay persons, was competent to

interpret and apply .. . raw, technical medical data.”); Day v. Weinberger, 522 F.2d 1154,

1156 (9th Cir. 1975) (stating that “the Hearing Examiner, who was not qualified as a

medical expert, should not have gone outside the record to medical textbooks for the

purpose of making his own exploration and assessment as to claimant's physical

condition”). More significantly, it would not be appropriate for an ALJ to reject a

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1 physician’s assessment of a claimant’s ability to work based on his own interpretation of

an x-ray. Naranjo v. Astrue, 2010 WL 1277974,151 Soc. Sec.Rep.Serv. 661 (D. Colo.

2010).

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4 Here, the ALJ reached his conclusions about plaintiff’s residual functional capacity

for sedentary work based on the opinions of medical professionals who were qualified to

interpret x-rays of plaintiff’s elbow and knee and other pertinent medical data. Thus,

even if x-ray images were included in the record, it would not be appropriate for the ALJ

to reject the opinions of qualified medical professionals based on his own interpretation

ofthe x-ray images. Under these circumstances, it is not reasonably possible that

supplementing the record with x-ray images would have any effect whatsoever on the

outcome of plaintiff’s disability claim. In other words, the x-ray images are not material

to the ALJ’s disability analysis. Therefore, IT IS RECOMMENDED that the District

Court DENY plaintiff’s Ex Parte Request to Supplement the Administrative Record

[Doc. No. 28].

VIII. Conclusion.

Based on a thorough review ofthe Administrative Record, this Court concludes

that substantial evidence supports the ALJ’s decision that plaintiff does not qualify for

disability benefits because he is not disabled and retains the residual functional capacity

to perform his past relevant work as a transcriber/stenographer. In addition, the ALJ set

forth specific, clear, and convincing reasons for discrediting plaintiff’s testimony that he

is disabled by pain and did not arbitrarily reject this testimony.

IT IS THEREFORE RECOMMENDED THAT THE DISTRICT COURT:

1. GRANT defendant’s Motion for Summary Judgment [Doc. No. 26] and

DENY plaintiffs Motion for Summary Judgment [Doc. No. 32];

2. DENY defendant’s Motion to Dismiss [Doc. No. 24];

3. DENY plaintiff’s Motion to Exclude Evidence [Doc. No. 30]; and

4. DENY plaintiff’s Request to Supplement the Record [Doc. No. 28].

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1 This Report and Recommendation is submitted to the United States District Judge

assigned to this case, pursuant to the provisions of 28 U.S.C. § 636(b)(1) and Civil Local

Rule 72.1(d). Within fourteen (14) days after being served with a copy ofthis Report and

Recommendation, “any party may serve and file written objections.” 28 U.S.C. §

636(b)(l)(B)&(C). The document should be captioned “Objections to Report and

Recommendation.” The parties are advised that failure to file objections within this

specific time may waive the right to raise those objections on appeal ofthe Court’s order.

Martinez v. Ylst, 951 F.2d 1153, 1156-57 (9th Cir.1991).

IT IS SO ORDERED.

Dated: January 2$. 2017

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Hon. Karen Crawford

United States Magistrate Judge 12

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