Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_12-cv-01314/USCOURTS-azd-2_12-cv-01314-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:405 Review of HHS Decision (SSID)

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WO 

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Daena A. Reininger, 

Plaintiff, 

v. 

Carolyn W. Colvin, Acting Commissioner 

of the Social Security Administration, 

Defendant.

No. CV 12-01314-PHX-JAT

 ORDER 

 Pending before the Court is Plaintiff’s appeal from the Administrative Law 

Judge’s denial of Plaintiff’s application for disability insurance benefits under Title II and 

Title XVI of the Social Security Act. 

I. PROCEDURAL BACKGROUND 

 On August 13, 2008, Plaintiff Daena April Reininger filed Title II and XVI 

applications for a period of disability and disability insurance benefits and for 

supplemental security income with the Commissioner of the Social Security 

Administration (the “Commissioner”), alleging that her disability began on January 1, 

2002. (Record Transcript (“TR”) 19). Plaintiff’s claim was denied initially on 

September 4, 2009, and upon reconsideration it was denied again on March 12, 2010. 

(Id.). 

 Following the denials, on March 18, 2010, Plaintiff filed a request for a hearing 

with an Administrative Law Judge (“ALJ”). (Id.). Plaintiff appeared and testified before 

the ALJ on January 25, 2011. (Id.). On March 25, 2011, the ALJ issued a decision 

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finding that Plaintiff suffered from severe fibromyalgia, hypothyroidism, bipolar 

disorder, histrionic personality traits and opiate (methadone) dependence in a controlled 

setting and was unable to perform past relevant work. (TR 22; TR 31). However, the 

ALJ found that Plaintiff was not disabled under the Social Security Act because she 

retained the Residual Functional Capacity to perform jobs that exist in significant 

numbers in the national economy. (TR 31-32). 

 Following the ALJ’s denial of Plaintiff’s claim, Plaintiff requested review of the 

ALJ’s decision with the Appeals Council, Office of Hearings and Appeals, Social 

Security Administration. (TR 12). On May 8, 2012, the Appeals Council denied 

Plaintiff’s request for review. (TR 1). The Appeals Council adopted the ALJ’s decision 

as the final decision of the Commissioner. (Id.). 

 On June 19, 2012, Plaintiff filed her Complaint with this Court for judicial review 

of the Commissioner’s decision denying her claim, which is the subject of this appeal. 

(Doc. 1). Plaintiff has filed an opening brief (the “Brief”) seeking judicial review of the 

ALJ’s denial of her claim. (Doc. 10). In the Brief, Plaintiff argues that the Court should 

set aside the ALJ’s decision and award benefits because the ALJ’s decision contains legal 

error as it lacks substantial justification to support the ALJ’s conclusions. (Id. at 27). 

II. LEGAL STANDARD 

 As an initial matter, in making her argument that the Court should set aside the 

ALJ’s decision, Plaintiff conspicuously states that the standard of review is one where the 

ALJ’s “[d]ecision is to be based on the record as a whole and the Social Security Act is to 

be broadly construed and liberally applied in favor of disability.” (Doc. 10 at 13) 

(emphasis added). Plaintiff directly cites “Magallanes v. Bowen, 881 F.2d 747, 750 (9th 

Cir. 1989)”, for this bold proposition. (Id.). Plaintiff’s proposition, however, is a 

complete misstatement of the law. Page 750 of Magallanes makes no reference or 

implication whatsoever about broadly construing or liberally applying the Social Security 

Act. In case the wrong pincite was used, the Court notes nothing in the opinion as a 

whole asserts this standard either. In case Plaintiff cited the wrong case, the Court notes 

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that it has found no case in the Ninth Circuit asserting this proposition. The standard of 

review in the Ninth Circuit is in fact stated in Magallanes on page 750. However, as the 

Ninth Circuit Court of Appeals has repeatedly explained, the Commissioner’s decision to 

deny benefits will be overturned “only if it is not supported by substantial evidence or it 

is based on legal error.” Magallanes, 881 F.2d at 750 (quoting Brawner v. Sec’y of 

Health & Human Svcs., 839 F.2d 432, 433 (9th Cir. 1987), quoting in turn Green v. 

Heckler, 803 F.2d 528, 529 (9th Cir. 1986)). Substantial evidence is more than a mere 

scintilla, but less than a preponderance. Reddick v. Chater, 157 F.3d 715, 720 (9th Cir. 

1998). 

 “The inquiry here is whether the record, read as a whole, yields such evidence as 

would allow a reasonable mind to accept the conclusions reached by the ALJ.” Gallant 

v. Heckler, 753 F.2d 1450, 1453 (9th Cir. 1984) (citation omitted). In determining 

whether there is substantial evidence to support a decision, this Court considers the 

record as a whole, weighing both the evidence that supports the ALJ’s conclusions and 

the evidence that detracts from the ALJ’s conclusions. Reddick, 157 F.3d at 720. 

“Where evidence is susceptible of more than one rational interpretation, it is the ALJ’s 

conclusion which must be upheld; and in reaching his findings, the ALJ is entitled to 

draw inferences logically flowing from the evidence.” Gallant, 753 F.2d at 1453 

(citations omitted). If there is sufficient evidence to support the Commissioner’s 

determination, the Court cannot substitute its own determination. See Young v. Sullivan, 

911 F.2d 180, 184 (9th Cir. 1990). The ALJ is responsible for resolving conflicts in 

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

Shalala, 53 F.3d 1035, 1039 (9th Cir. 1995). Thus, if on the whole record before this 

Court, substantial evidence supports the Commissioner’s decision, this Court must affirm 

it. See Hammock v. Bowen, 879 F.2d 498, 501 (9th Cir. 1989); see also 42 U.S.C. § 

405(g). “[T]he key question is not whether there is substantial evidence that could 

support a finding of disability, but whether there is substantial evidence to support the 

Commissioner’s actual finding that claimant is not disabled.” Jamerson v. Chater, 112 

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F.3d 1064, 1067 (9th Cir. 1997). 

A. Definition of Disability 

 To qualify for disability benefits under the Social Security Act, a claimant must 

show among other things, that she is “under a disability.” 42 U.S.C. § 423(a)(1)(E). 

“The mere existence of an impairment is insufficient proof of a disability.” Matthews v. 

Shalala, 10 F.3d 678, 680 (9th Cir. 1993) (citing Sample v. Schweiker, 694 F.2d 639, 

642–43 (9th Cir. 1982)). Disability has “a severity and durational requirement for 

recognition under the [Social Security] Act that accords with the remedial purpose of the 

Act.” Flaten v. Sec’y of Health & Human Svcs., 44 F.3d 1453, 1459 (9th Cir. 1995). 

 The Social Security Act defines “disability” as the “inability to engage in any 

substantial gainful activity by reason of any medically determinable physical or mental 

impairment which can be expected to result in death or which has lasted or can be 

expected to last for a continuous period of not less than 12 months.” 42 U.S.C. § 

423(d)(1)(A). A person is “under a disability only if h[er] physical or mental impairment 

or impairments are of such severity that [s]he is not only unable to do h[er] previous work 

but cannot, considering h[er] age, education, and work experience, engage in any other 

kind of substantial gainful work which exists in the national economy.” Id. at § 

423(d)(2)(A). 

 “A claimant bears the burden of proving that an impairment is disabling.” 

Matthews, 10 F.3d at 680 (quoting Miller v. Heckler, 770 F.2d 845, 849 (9th Cir. 1985)). 

Thus, “[t]he applicant must show that [s]he is precluded from engaging in not only h[er] 

‘previous work,’ but also from performing ‘any other kind of substantial gainful work’ 

due to such impairment.” Id. (quoting 42 U.S.C. § 423(d)(2)(A)). 

B. Five-Step Evaluation Process 

 The Social Security regulations set forth a five-step sequential process for 

evaluating disability claims. 20 C.F.R. § 404.1520; see also Reddick, 157 F.3d at 721 

(describing the sequential process). A finding of “not disabled” at any step in the 

sequential process will end the ALJ’s inquiry and the claim will be denied. 20 C.F.R. § 

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404.1520(a)(4). The claimant bears the burden of proof at the first four steps, but the 

burden shifts to the ALJ at the final step. Reddick, 157 F.3d at 721. 

 The five steps are as follows: 

 First, the ALJ determines whether the claimant is “doing substantial gainful 

activity.” 20 C.F.R. § 404.1520(a)(4)(i). If so, the claimant is not disabled. 

 Second, if the claimant is not gainfully employed, the ALJ determines whether the 

claimant has a “severe medically determinable physical or mental impairment.” 20 

C.F.R. § 404.1520(a)(4)(ii). A severe impairment is one that “significantly limits [the 

claimant’s] physical or mental ability to do basic work activities.” Id. at § 404.1520(c). 

Basic work activities means the “abilities and aptitudes to do most jobs.” Id. at § 

404.1521(b). Further, the impairment must either be expected “to result in death” or “to 

last for a continuous period of twelve months.” Id. at § 404.1509 (incorporated by 

reference in 20 C.F.R. § 404.1520(a)(4)(ii)). The “step-two inquiry is a de minimis 

screening device to dispose of groundless claims.” Smolen v. Chater, 80 F.3d 1273, 1290 

(9th Cir. 1996). 

 Third, having found a severe impairment, the ALJ next determines whether the 

impairment “meets or medically equals the criteria of any of the listings in the Listing of 

Impairments in appendix 1, subpart P of 20 CFR part 404 (appendix 1).” SSR 12-2p, 

2012 WL 3104869 at *6 (July 25, 2012). If so, the claimant is found disabled without 

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

 Fibromyalgia (“FM”), however, cannot meet a listing in appendix 1 because FM is 

not a listed impairment. Therefore, at step 3 the ALJ determines whether FM medically 

equals a listing (for example, listing 14.09D in the listing for inflammatory arthritis), or 

whether it medically equals a listing in combination with at least one other medically 

determinable impairment. SSR 12-2p at *6. 

 When a claimant’s impairments do not meet or equal a listed impairment under 

appendix 1, the ALJ will assess a claimant’s Residual Functional Capacity (“RFC”). Id. 

The ALJ bases the RFC assessment on all relevant evidence in the case record. Id. The 

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ALJ considers the effects of all of the claimant’s medically determinable impairments, 

including impairments that are not severe. Id. For a person with FM, the ALJ will 

consider a longitudinal record whenever possible because the symptoms of FM can wax 

and wane so that a person may have bad days and good days. Id. 

 At steps 4 and 5, the ALJ uses the RFC assessment to determine whether the 

claimant is capable of doing any past relevant work (step 4) or any other work that exists 

in significant numbers in the national economy (step 5). Id.; 20 C.F.R. § 404.1520(a). If 

the person is able to do any past relevant work, the ALJ will find that he or she is not 

disabled. Id. If the person is not able to do any past relevant work or does not have such 

work experience, the ALJ determines whether he or she can do any other work. Id. The 

usual vocational considerations apply (age, education, and work experience). Id.; 20 

C.F.R. § 404.1520(g)(1). If the claimant can make an adjustment to other work, then she 

is not disabled. If the claimant cannot perform other work, she will be found disabled. 

As previously noted, the ALJ has the burden of proving the claimant can perform other 

substantial gainful work that exists in the national economy. Reddick, 157 F.3d at 721. 

 With regard to steps 1-5 in this case, the ALJ found that Plaintiff: (1) had satisfied 

the first step and had not engaged in substantial gainful activity since January 1, 2002 

(TR 21); and (2) had fulfilled the second step and shown that she suffered from the 

following severe impairments: FM, hypothyroidism, bipolar disorder, histrionic 

personality traits and opiate (methadone) dependence in a controlled setting. (TR 22). 

With regard to the third step (3), the ALJ found that Plaintiff did not have an impairment 

or combination of impairments specifically listed in the regulations. (Id.). Therefore, the 

ALJ determined Plaintiff’s RFC and found she had the capacity to perform light work as 

defined by the regulations with some restrictions and was limited to work involving 

simple repetitive tasks (TR 24). As a result of this analysis, the ALJ found at the fourth 

step (4) that Plaintiff is “unable to perform any past relevant work” as a behavioral health 

technician or waitress. (TR 31). At the last step (5), however, relying on the testimony 

of a vocational expert, the ALJ found that given Plaintiff’s age, education, work 

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experience, and RFC that Plaintiff is capable of making a successful adjustment to other 

work and performing jobs that exist in significant numbers in the national economy. (TR 

31-32). Thus, the ALJ found that Plaintiff was not disabled as defined in the Social 

Security Act. (TR 32). 

III. ANALYSIS 

Plaintiff makes four arguments for why the Court should set aside the ALJ’s 

decision. Specifically, Plaintiff argues that the ALJ committed procedural error by (1) 

rejecting the medical assessments of examining sources without substantial evidence 

(Doc. 10 at 13-17), (2) by failing to evaluate each of Plaintiff’s impairments (id. at 17-

21), (3) by misusing the vocational expert in determining that Plaintiff could perform 

other jobs that exist in the national economy (id. at 21-24), and (4) by rejecting Plaintiff’s 

symptom testimony without giving clear and convincing reasons (id. at 24-26). The 

Court will address each of Plaintiff’s arguments in turn. 

A. Whether the ALJ Properly Rejected the Medical Assessments of 

 Treating Sources 

 First, Plaintiff argues that (1) the ALJ failed to properly weigh the opinions of 

Plaintiff’s examining physicians and (2) failed to properly evaluate a report prepared by a 

psychiatric nurse practitioner. (Id. at 13-17). In reaching his decision, the ALJ explicitly 

considered medical opinion evidence consisting of the medical assessment performed by 

the state agency physician, Robert Quinones, D.O. (TR 400-407), separate assessments 

performed by Plaintiff’s treating physicians, Kevin Cleary, D.O. (TR 497-502), and Dr. 

Gramstad, D.O. (TR 511-513), the assessment of state agency psychologist, George 

Delong, Ph.D. (TR 408-413), and the mental impairment report prepared by psychiatric 

nurse practitioner Elaine New Moon (TR 503-509). Based on these assessments, 

Plaintiff’s daily living, and the medical evidence of the record as a whole, the ALJ 

concluded that Plaintiff was only limited to performing light work as defined by the 

regulations. (TR 24, 31). 

 1. The ALJ Properly Rejected the Opinions of Treating Physicians 

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 Plaintiff’s initial argument is that the ALJ did not offer substantial evidence, nor 

did substantial evidence exist, supporting the ALJ’s decision to give more credence to the 

assessment of the State agency examiner and reject the assessments of Plaintiff’s treating 

physicians. (Doc. 10 at 14-15). The basis of Plaintiff’s argument is that “there were no 

treating or examining physicians that rendered an opinion that the ALJ adopted or gave 

weight. The only medical opinion specifically adopted by the ALJ was the State agency 

reviewing physician’s opinion. Accordingly, substantial evidence does not exist 

sufficient to reject all treating and examining source opinions.” (Id.). 

 The ALJ is not required to adopt the opinion of any treating physicians. The ALJ 

is merely required to make a decision supported by substantial evidence. As stated 

above, see supra Section II, if substantial evidence supports the Commissioner’s 

decision, this Court must affirm it. See Hammock v. Bowen, 879 F.2d 498, 501 (9th Cir. 

1989); see also 42 U.S.C. § 405(g). The Court will set aside the ALJ’s decision “only if 

it is not supported by substantial evidence or it is based on legal error.” Magallanes, 881 

F.2d at 750. Substantial evidence is more than a mere scintilla, but less than a 

preponderance. Reddick, 157 F.3d at 720. 

 The Court finds that the ALJ did base his decision on substantial evidence. The 

ALJ explained that he gave significant weight to the State agency physician because “it is 

consistent with the medical record.” (TR 29). The “opinion of a non-examining medical 

expert . . . may constitute substantial evidence when it is consistent with other 

independent evidence in the record.” Tonapetyan v. Halter, 242 F.3d 1144, 1149 (9th 

Cir. 2001) (citing Magallanes, 881 F.2d at 752). “Although a treating physician’s 

opinion is generally afforded the greatest weight in disability cases, it is not binding on an 

ALJ with respect to the existence of an impairment or the ultimate determination of 

disability.” Tonapetyan, 242 F.3d at 1148 (citing Magallanes, 881 F.2d at 751). “When 

there is a conflict between the opinions of a treating physician and an examining 

physician, as here, the ALJ may disregard the opinion of the treating physician only if he 

sets forth ‘specific and legitimate reasons supported by substantial evidence in the record 

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for doing so.’” Id. (quoting Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995)). “[T]he 

contrary opinion of a non-examining medical expert does not alone constitute a specific, 

legitimate reason for rejecting a treating or examining physician’s opinion, [however,] it 

may constitute substantial evidence when it is consistent with other independent evidence 

in the record.” Id. at 1149 (citing Magallanes, 881 F.2d at 752). 

 In this case, the State agency examiner’s opinion constituted substantial evidence 

because, as the ALJ explained, it was consistent with the record as a whole. See (TR 29). 

The ALJ’s explanation of the record as a whole throughout his analysis constituted the 

requisite specific and legitimate reasons for reaching his conclusion. First, the ALJ 

explained that the medical evidence showed “scant clinical evidence of fibromyalgia,” 

and then the ALJ supported this proposition by establishing all the points in the record 

where Plaintiff’s alleged FM was addressed. (TR 25-26). Next, the ALJ addressed the 

limited records in the medical evidence supporting Plaintiff’s alleged bipolar condition 

and pointed out the conflicting medical evidence that did exist in the record. (TR 26-27). 

Then the ALJ explained how Plaintiff was “generally noncompliant with her medical 

treatment, as indicated by her treating doctors,” and how Plaintiff’s daily activities 

undermined her claims of disability. (TR 27-28). Finally, the ALJ noted Plaintiff’s 

ability to work and travel, and Plaintiff’s history of inconsistent statements. (TR 28-29). 

 Social Security Ruling, SSR 12-2P, 2012 WL 3104869 (July 25, 2012), states, 

[a]s with any claim for disability benefits, before we find that 

a person with an MDI of FM is disabled, we must ensure 

there is sufficient objective evidence to support a finding that 

the person’s impairment(s) so limits the person’s functional 

abilities that it precludes him or her from performing any 

substantial gainful activity. 

SSR 12-2p at *2. 

If objective medical evidence does not substantiate the 

person’s statements about the intensity, persistence, and 

functionally limiting effects of symptoms, [the 

Commissioner] consider[s] all of the evidence in the case 

record, including the person’s daily activities, medications or 

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other treatments the person uses, or has used, to alleviate 

symptoms; the nature and frequency of the person’s attempts 

to obtain medical treatment for symptoms; and statements by 

other people about the person’s symptoms. 

Id. at *5. This is exactly the type of objective evidence that the ALJ relied on and 

articulated in making the determination that the State agency examiner’s opinion should 

be accorded more weight and ultimately in finding that Plaintiff was not disabled. 

 In addition to the objective evidence throughout the record that was consistent 

with the State agency physician’s assessment, the ALJ explained that his decision was 

influenced by the four specific and legitimate reasons he gave for assigning little weight 

to Dr. Cleary’s opinion, the four reasons he gave for rejecting Dr. Gramstad’s opinion, 

and the fact that Dr. Delong’s opinion was inconsistent with the medical evidence of 

record. (TR 29-30). 

 Thus, the Court finds the ALJ articulated specific and legitimate reasons for 

disregarding the assessments of Plaintiff’s treating physicians and he relied on substantial 

evidence (i.e. the State agency physician’s assessment consistent with the medical record) 

in reaching his conclusion. At the very least, the evidence cited by the ALJ was 

susceptible to more than one rational interpretation. Therefore, the ALJ’s conclusion 

must be upheld. See Gallant, 753 F.2d at 1453 (“Where evidence is susceptible of more 

than one rational interpretation, it is the ALJ’s conclusion which must be upheld; and in 

reaching his findings, the ALJ is entitled to draw inferences logically flowing from the 

evidence.”) (citations omitted). 

 2. The ALJ Properly Rejected Nurse Practitioner Moon’s Opinion 

 Plaintiff also argues that the ALJ failed to properly evaluate the mental 

impairment report prepared by psychiatric nurse practitioner Elaine New Moon. (Doc. 10 

at 15-17). Plaintiff contends that the ALJ “failed to provide any reason for rejecting Ms. 

Moon’s opinions, [therefore] they should be accepted as true.” (Id. at 17). Plaintiff goes 

on to make the argument that Ms. Moon is a third party lay witness and the ALJ was 

required to give germane reasons for rejecting her opinions. (Id.). 

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 The ALJ addressed Ms. Moon’s opinions and did in fact explain germane reasons 

why he gave little weight to her opinion. The ALJ stated that “[t]his opinion is given 

little weight . . . . [because] [t]he nurse practitioner saw the claimant only on [ ] one 

occasion [ ] and there are no additional medical records provided for comparison.” (TR 

31). Further, the ALJ explained that Ms. Moon “is not an acceptable medical source” 

under “20 C.F.R. §§ 404.1513, 416.913.” (Id.). These reasons are valid and consistent 

with the regulations and case law. See 20 C.F.R. § 404.1527(c)(2)(i) (identifying the 

length of treatment relationship and the frequency of examination as factors to be 

considered when weighing medical opinions); see also Orn v. Astrue, 495 F.3d 625, 631 

(9th Cir. 2007) (if a treating physician’s opinion is not given controlling weight, the ALJ 

considers the length of treatment, frequency of examination, and the nature and extent of 

the treatment relationship to determine how much weight to give the opinion.). Plaintiff 

may not agree with the reasons the ALJ gave for rejecting Ms. Moon’s opinions, but the 

argument that the ALJ “failed to provide any reason for rejecting Ms. Moon’s opinions” 

is inaccurate and unpersuasive. Accordingly, the ALJ did not err in how he rejected Ms. 

Moon’s opinion. 

B. Whether the ALJ Sufficiently Evaluated Plaintiff’s Impairments 

 Next, Plaintiff argues that the ALJ failed to evaluate Plaintiff’s major depressive 

disorder, generalized anxiety disorder, borderline personality disorder, childhood sexual, 

emotional, and physical abuse, and chronic fatigue syndrome (“CFS”) at step 2 of the 

sequential process where the ALJ determines the claimant’s severe medically 

determinable physical or mental impairments. (Doc. 10 at 18). Further, Plaintiff argues 

that the ALJ failed to address these impairments while determining her RFC. (Id.). 

 As with Plaintiff’s misstatement of the legal standard governing review of the 

ALJ’s decision, see supra Section II, Plaintiff misstates the law governing the 

consideration of multiple impairments. Plaintiff asserts, by directly citing 20 C.F.R. § 

404.1523, that “[o]nce a severe impairment exists, as here, all medically determinable 

impairments must be considered.” (Doc. 10 at 18). However, the regulations clearly 

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state “[i]f we do find a medically severe combination of impairments, the combined 

impact of the impairments will be considered throughout the disability determination 

process.” 20 C.F.R. § 404.1523 (emphasis added). Plaintiff’s argument is based on the 

assertion that each individual impairment must be considered separately and addressed, 

yet, this is not what the law requires. 

 While Plaintiff begins her argument with the allegation that the ALJ failed to 

address her major depressive disorder, generalized anxiety disorder, borderline 

personality disorder, and childhood sexual, emotional, and physical abuse, Plaintiff does 

not address a single one of these impairments in her argument. Instead, Plaintiff would 

have the Court find that the ALJ was required to address Plaintiff’s “morbid obesity in 

combination with her foot problem.” (Doc. 10 at 19). Further, Plaintiff argues that the 

ALJ failed to comply with policy and evaluate Plaintiff’s alleged CFS. (Id.). Finally, 

Plaintiff argues that the ALJ also failed to comply with policy in evaluating the severity 

of Plaintiff’s FM. (Id.). 

 The ALJ explicitly stated that Plaintiff’s obesity was considered during his 

determination of her RFC. See (TR 22). Further, Plaintiff did not establish that her foot 

problem prevented substantial gainful activity for twelve months or longer in accordance 

with 20 C.F.R. § 404.1509. Plaintiff’s plantar fasciitis and heel spur were transient 

problems. 

 Plaintiff’s alleged CLS was a part of the analysis. The ALJ made it clear that the 

“entire record” was considered. (TR 21). The ALJ did address that Plaintiff was 

“diagnosed” with CLS by Dr. Ratcliffe. (TR 25). However, Dr. Ratcliffe’s report was 

made regarding a single consultation and indicated that he merely had an “impression” of 

Plaintiff that included CFS. (TR 345). Dr. Cleary opined that Plaintiff exhibited CFS 

(TR 497), but this was not a definitive diagnosis and the ALJ gave little weight to Dr. 

Cleary’s opinion anyway for the host of reasons the ALJ articulated (TR 29). 

 Finally, the ALJ thoroughly addressed Plaintiff’s FM in his evaluation and 

determination of Plaintiff’s RFC. The ALJ found Plaintiff suffered from severe FM. (TR 

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22). He then determined the limitations caused by Plaintiff’s FM in considering the 

credibility of her subjective complaints. See (TR 25-26). As explained above, see supra

Section III.A, SSR 12-2P states, 

[a]s with any claim for disability benefits, before we find that 

a person with an MDI of FM is disabled, we must ensure 

there is sufficient objective evidence to support a finding that 

the person’s impairment(s) so limits the person’s functional 

abilities that it precludes him or her from performing any 

substantial gainful activity. 

SSR 12-2p at *2. 

If objective medical evidence does not substantiate the 

person’s statements about the intensity, persistence, and 

functionally limiting effects of symptoms, [the 

Commissioner] consider[s] all of the evidence in the case 

record, including the person’s daily activities, medications or 

other treatments the person uses, or has used, to alleviate 

symptoms; the nature and frequency of the person’s attempts 

to obtain medical treatment for symptoms; and statements by 

other people about the person’s symptoms. 

Id. at *5. No objective evidence existed to support Plaintiff’s allegations of FM, thus, the 

ALJ was left to consider all of the evidence in the record and this is exactly what he did 

throughout the course of his analysis. 

 Accordingly, the ALJ did not commit procedural error and properly considered all 

of Plaintiff’s impairments in determining her RFC. Specifically, the ALJ sufficiently 

addressed the three limitations Plaintiff argues that the ALJ failed to evaluate. 

C. Whether the ALJ Properly Utilized the Vocational Expert’s Testimony 

 Plaintiff contends that the ALJ erred by accepting the vocational expert’s (“VE”) 

testimony. (Doc. 10 at 21-24). Specifically, Plaintiff argues that (1) the ALJ offered a 

hypothetical to the VE that failed to include all of Plaintiff’s alleged limitations and (2) 

the ALJ erred in not resolving an alleged conflict between the VE’s testimony and the 

Dictionary of Occupational Titles (“DOT”). 

 Plaintiff asserts that the ALJ erred by presenting a hypothetical to the VE that 

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failed to include Plaintiff’s non-exertional limitations of pain and fatigue, her physical 

limitation caused by her ankle impairment, and her moderate limitation in concentration, 

persistence, and pace. The hypothetical that the ALJ posed to the VE contained all of the 

limitations that the ALJ found credible and supported by substantial evidence in the 

record. The hypothetical was based on Plaintiff’s determined RFC. As explained above, 

see supra Section III.B, the ALJ properly considered all of Plaintiff’s impairments while 

determining her RFC. The ALJ’s reliance on testimony the VE gave in response to the 

hypothetical therefore was proper. Bayliss v. Barnhart, 427 F.3d 1211, 1217-18 (9th Cir. 

2005) (finding ALJ could rely on testimony of VE in social security disability 

proceeding, even though hypothetical presented to VE did not include all of claimant’s 

alleged limitations, where hypothetical contained all limitations that ALJ found credible 

and supported by substantial evidence.) 

 Next Plaintiff argues that the VE’s testimony considered non-exertional 

limitations such as difficulty functioning due to mental impairments and difficulty 

concentrating, yet Plaintiff contends that the DOT does not address non-exertional 

limitations, therefore a conflict existed between the VE’s testimony and the DOT. Under 

SSR 00-4p, 2000 WL 1898704, at *1 (Dec. 4, 2000), the ALJ must identify and have the 

VE reasonably explain any conflicts between a VE’s testimony and the DOT. In this 

case, the ALJ stated that the VE’s testimony was consistent with the DOT. (TR 32). 

 Plaintiff’s argument that an unaddressed conflict exists is unpersuasive because 

the DOT does address mental and non-exertional limitations in the context of assigning 

different skill levels to different occupations. See SSR 00-4p, at *3 (explaining that the 

DOT uses the skill level definitions in 20 C.F.R. §§ 404.1568, 416.968). Accordingly, 

the Court disagrees with Plaintiff’s claim that the VE’s testimony was inconsistent with 

the DOT. 

D. Whether the ALJ Properly Rejected Plaintiff’s Symptom Testimony

 Finally, Plaintiff argues that the ALJ erred in finding her testimony was not 

credible. (Doc. 10 at 24-26). Plaintiff argues that the ALJ must give clear and 

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convincing reasons for rejecting her testimony and finding it not credible. (Id. at 24). 

Plaintiff contends that “[t]he ALJ asserted reasons for rejecting [her] credibility, but none 

[were] clear and convincing supported by substantial evidence as required.” (Id. at 25). 

To reject the subjective testimony of a claimant, however, the ALJ is not required to give 

clear and convincing reasons. As Plaintiff notes this is the most demanding standard 

required in Social Security cases. (Id. at 24) (quoting Moore v. Comm’r of Soc. Sec. 

Admin., 278 F.3d 920, 924 (9th Cir. 2002)). Rather, the ALJ must make specific findings 

based on the record. The District Court of California has addressed this issue in a wellreasoned opinion and this Court has adopted that Court’s reasoning before in concluding 

that, to the extent there is actually any principled distinction between the two standards, 

the ALJ must make specific findings supported by the record to explain his credibility 

evaluation.1

 

1

 The District Court of California set forth its reasoning as follows: 

In Bunnell, the court addressed confusion regarding the 

standard for evaluating the credibility of subjective 

complaints and endorsed the standard set forth in Cotton v. 

Bowen, 799 F.2d 1403 (9th Cir.1986), Varney v. Secretary of 

Health and Human Services, 846 F.2d 581, 583–584 (9th 

Cir.1988) and Gamer v. Secretary of Health and Human 

Services, 815 F.2d 1275, 1279 (9th Cir.1987). Bunnell, 949 

F.2d at 345. The so-called “Cotton standard” requires the 

claimant to produce objective medical evidence of an 

underlying impairment that is reasonably likely to be the 

cause of the alleged pain. Once that evidence is produced, the 

adjudicator may not reject a claimant’s subjective complaints 

based solely on a lack of objective medical evidence fully 

corroborating the alleged severity of the pain. Bunnell, 949 

F.2d at 343, 345 (citing Cotton, 799 F.2d at 1407). Rather, 

the adjudicator must “specifically make findings which 

support this conclusion. These findings, properly supported 

by the record, must be sufficiently specific to allow a 

reviewing court to conclude the adjudicator rejected the 

testimony on permissible grounds and did not arbitrarily 

discredit a claimant’s testimony regarding pain.” Bunnell, 

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949 F.2d at 345–46 (internal citation and quotation omitted). 

Some subsequent decisions have stated that, unless there 

is affirmative evidence that a claimant is malingering, the 

ALJ must articulate “clear and convincing” reasons for 

rejecting subjective complaints. See, e.g., Morgan v. 

Commissioner of the Social Security Administration, 169 F.3d 

595, 599 (9th Cir.1999); Regennitter v. Commissioner of the 

Social Security Administration, 166 F.3d 1294, 1296 (9th 

Cir.1999); Reddick, 157 F.3d at 722; Light, 119 F.3d at 792; 

Lester v. Chater, 81 F.3d 821, 834 (9th Cir.1995); Smolen, 80 

F.3d at 1284; Johnson v. Shalala, 60 F.3d 1428, 1433 (9th 

Cir.1995); Dodrill v. Shalala, 12 F.3d 915, 918 (9th 

Cir.1993). Other decisions state that the ALJ must make 

specific findings based on the record, but do not use the 

“clear and convincing” formula. See, e.g., Meanel v. Apfel, 

172 F.3d 1111, 1113–14 (9th Cir.1999); Sousa v. Callahan, 

143 F.3d 1240, 1244 (9th Cir.1998); Chavez v. Department of 

Health and Human Services, 103 F.3d 849, 853 (9th 

Cir.1996); Byrnes v. Shalala, 60 F.3d 639, 641–42 (9th 

Cir.1995); Moncada, 60 F.3d at 524; Orteza v. Shalala, 50 

F.3d 748, 749–50 (9th Cir.1995) (per curiam); Flaten v. 

Secretary of Health and Human Services, 44 F.3d 1453, 1464 

(9th Cir.1995). 

The “clear and convincing” language appears to have been 

derived from Swenson v. Sullivan, 876 F.2d 683 (9th 

Cir.1989), which states that “[t]he Secretary’s reasons for 

rejecting excess symptom testimony must be clear and 

convincing if medical evidence establishes an objective basis 

for some degree of the symptom and no evidence 

affirmatively suggests that the claimant was malingering.” 

Swenson, 876 F.2d at 687 (citing Gallant v. Heckler, 753 F.2d 

1450, 1455 (9th Cir.1984)). In Gallant, however, the court 

did not hold, or even affirmatively state, that an ALJ is 

required to provide “clear and convincing” reasons for 

rejecting excess pain testimony whenever there is no evidence 

of malingering. Instead, the court merely observed that no 

witness had testified that the claimant was malingering, that 

“[n]o clear and convincing reasons were provided by the 

ALJ” for his rejection of the claimant’s testimony, and that 

the evidence relied on by the ALJ for his credibility 

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 Turning to the ALJ’s decision in this case, the Court finds the ALJ did in fact 

make specific findings supported by the record in explaining why he disregarded 

Plaintiff’s subjective complaints. First, the ALJ found Plaintiff’s subjective complaints 

about FM were not supported by the medical evidence. (TR 24). While an ALJ may not 

reject a claimant’s subjective complaints based solely on lack of objective medical 

evidence to fully corroborate the alleged severity of pain, see Rollins, 261 F.3d at 856-57; 

Fair, 885 F.2d at 602, the lack of objective medical evidence supporting the claimant’s 

claims may support the ALJ’s finding that the claimant is not credible. See Batson v. 

Comm’r of the Soc. Sec. Admin., 359 F.3d 1190, 1197 (9th Cir. 2003). While Plaintiff 

claimed she had a history of FM, the first documentation of FM was by Dr. Ratcliffe in 

2009 where Plaintiff claimed she had been diagnosed with FM several years earlier. (TR 

25). The ALJ noted Plaintiff has never proffered documentation to support this claim. 

(Id.). Dr. Ratcliffe diagnosed Plaintiff with FM, however, Plaintiff never returned for 

 

evaluation was “insubstantial.” Gallant, 753 F .2d at 1455, 

1456. 

Bunnell did not cite either Gallant or Swenson, and neither 

Bunnell nor the cases it did cite with approval (that is, Cotton, 

Varney, and Gamer) use the “clear and convincing” formula. 

It thus appears that the “clear and convincing” standard is an 

unwarranted elaboration of the substantial evidence standard 

of review, and that it was not part of the Cotton test adopted 

in Bunnell, where the en banc court attempted to clarify the 

law. Any difference between the standards may be more 

apparent than real. There does not appear to be any 

principled distinction between the two standards as they have 

been applied. To the extent that there is or may be a conflict, 

however, Bunnell must control since it was an en banc 

decision. Accordingly, this Court will adhere to Bunnell’s

requirement that the ALJ make “specific findings” supported 

by the record to explain his credibility evaluation, rather than 

imposing the arguably more exacting “clear and convincing” 

requirement suggested by Morgan and its predecessors. 

Ballard v. Apfel, No. CV 99-2195-AJW, 2000 WL 1899797, at *2 (C.D. Cal. Dec. 19, 

2000). 

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treatment from Dr. Ratcliffe and aside from Dr. Ratcliffe’s report the ALJ notes that there 

is “scant clinical evidence of FM.” (Id.). Plaintiff never sought out or received treatment 

from a specialist for FM and was not diagnosed with FM by a rheumatologist. (Id.). All 

of her limited treatment for FM was done by general practitioners. (Id.). 

 Second, the ALJ found Plaintiff was consistently noncompliant with treatment for 

her alleged conditions. Plaintiff’s allegations of a bipolar condition were not supported 

by the record because there were few records establishing consistent treatment for a 

mental condition. (TR 26). Plaintiff’s treating doctors for her medical conditions 

indicated that she was generally noncompliant with their treatment as well. (TR 27). 

“[U]nexplained, or inadequately explained, failure to seek treatment or follow a 

prescribed course of treatment” is a relevant factor in assessing credibility of testimony. 

Bunnell v. Sullivan, 947 F.2d 341, 346 (9th Cir.1991); see also Meanal v. Apfel, 172 F.3d 

1111, 1114 (9th Cir. 1999) (ALJ may consider Social Security disability claimant’s 

failure to follow treatment advice as a factor in assessing Social Security disability 

claimant’s credibility). 

 Plaintiff failed to appear for several counseling sessions and was noted to exhibit 

poor attendance history throughout treatment by the NOVA clinic. (TR 26). Ultimately, 

Plaintiff was discharged from the clinic for noncompliance. (Id.). She next sought 

treatment two years later from Family Service Agency, where her chief complaint was 

that she needed to continue psychotropic medications. (Id.). She was given medications 

and told to return in four weeks for medication review. (TR 27). Plaintiff failed to show 

for the next two scheduled appointments and only showed after her medication refills 

were denied at the pharmacy. (Id.). Plaintiff’s record at the agency also notes that she 

was not compliant with treatment. (Id.). Further, Plaintiff’s Global Assessments of 

Functioning showed she was progressively improving with time and the ALJ noted that 

medications were effective in controlling Plaintiff’s mental symptoms. (Id.). 

“Impairments that can be controlled effectively with medication are not disabling for the 

purpose of determining eligibility for [disability] benefits.” Warre v. Comm’r of Soc. 

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Sec. Admin., 439 F.3d 1001, 1006 (9th Cir. 2006) (citing Brown v. Barnhart, 390 F.3d 

535, 540 (8th Cir. 2004)); Lovelace v. Bowen, 813 F.2d 55, 59 (5th Cir. 1987); Odle v. 

Heckler, 707 F.2d 439, 440 (9th Cir. 1983) (affirming a denial of benefits and noting that 

the claimant’s impairments were responsive to medication)). 

 Third, the ALJ found Plaintiff’s daily activities undermined her subjective 

complaints (TR 28). See Matthews, 10 F.3d at 679-80 (Ninth Circuit Court of Appeals 

upheld ALJ’s rejection of claimant’s subjective complaints where ALJ found claimant’s 

performance of daily activities like housecleaning, light gardening, and shopping 

undermined claimant’s assertion of disabling pain.). The ALJ noted that Plaintiff assists 

in caring for her granddaughter and nephew, which included walking three blocks to her 

granddaughter’s school three times a week. (TR 28). Further, Plaintiff told her 

psychiatric nurse practitioner that she takes care of her disabled friend and has an active 

life. (Id.). Plaintiff testified that she does the dishes, laundry, and sometime goes to the 

store as well as at least one household chore daily. (Id.). The ALJ explained that 

Plaintiff’s subjective allegations of disabling pain were undermined by her ability to 

spend a substantial part of the day engaged in activities involving the performance of 

various physical and mental functions. (Id.). 

 Fourth, the record also contained evidence of exaggeration. In weighing 

credibility, the ALJ may consider evidence that a claimant exaggerated her symptoms 

when evaluating the claimant’s subjective complaints of pain. See Hall v. Astrue, No. 

CV 12-3494 JC, 2012 WL 3779080, at *4 (C.D. Cal. Aug. 31, 2012); Jones v. Callahan, 

122 F.2d 1148, 1152 (8th Cir. 1997). As the ALJ expressly noted in his decision, the 

record “suggests that [Plaintiff] is able to lift and carry more than alleged and is generally 

more active than alleged.” (TR 28). Further, the record also contained evidence that 

Plaintiff works and travels. (Id.). 

 Finally, the record reflected a series of inconsistent statements as explained by the 

ALJ. (TR 28-29). 

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the evidence and was supported by substantial evidence in the record, accordingly, “it is 

not [the Court’s] role to second-guess it.” Rollins, 261 F.3d at 857 (citing Fair, 885 F.2d 

at 604). Therefore, the ALJ did not err in rejecting Plaintiff’s subjective complaints. 

IV. CONCLUSION 

 Accordingly, the ALJ did not err in finding that Plaintiff was not disabled within 

the meaning the Social Security Act. 

 Based on the foregoing, 

IT IS ORDERED that the decision of the Administrative Law Judge is 

AFFIRMED. 

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

accordingly. The judgment will serve as the mandate of this Court. 

 Dated this 9th day of July, 2013. 

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