Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_08-cv-02009/USCOURTS-azd-2_08-cv-02009-0/pdf.json

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

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NOT FOR PUBLICATION

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

LINDA L. CLEMENT, 

Plaintiff, 

vs.

MICHAEL J. ASTRUE, Commissioner of

Social Security, 

Defendant. 

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No. CV-08-2009-PHX-GMS

ORDER

Pending before the Court is the appeal of Plaintiff Linda L. Clement, which challenges

the Social Security Administration’s decision to deny benefits. (Dkt. # 16.) For the reasons

set forth below, the Court affirms that decision.

BACKGROUND

On April 13, 2005, Plaintiff applied for disability insurance benefits, alleging a

disability onset date of July 13, 2004. (R. at 47.) Plaintiff’s date last insured (“DLI”) for

disability insurance benefits was September 30, 2005. (Id.) Plaintiff’s claim was denied both

initially and upon reconsideration. (R. at 43-46; R. at 39-41.) Plaintiff then appealed to an

Administrative Law Judge (“ALJ”). (R. at 30.) The ALJ conducted a hearing on the matter

on December 6, 2006. (R. at 434-83.)

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1

The five-step sequential evaluation of disability is set out in 20 C.F.R. § 404.1520

(governing disability insurance benefits) and 20 C.F.R. § 416.920 (governing supplemental

security income benefits). Under the test:

A claimant must be found disabled if she proves: (1) that she is

not presently engaged in a substantial gainful activity[,] (2) that

her disability is severe, and (3) that her impairment meets or

equals one of the specific impairments described in the

regulations. If the impairment does not meet or equal one of the

specific impairments described in the regulations, the claimant

can still establish a prima facie case of disability by proving at

step four that in addition to the first two requirements, she is not

able to perform any work that she has done in the past. Once the

claimant establishes a prima facie case, the burden of proof

shifts to the agency at step five to demonstrate that the claimant

can perform a significant number of other jobs in the national

economy. This step-five determination is made on the basis of

four factors: the claimant’s residual functional capacity, age,

work experience and education.

Hoopai v. Astrue, 499 F.3d 1071, 1074-75 (9th Cir. 2007) (internal citations and quotations

omitted).

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RFC is the most a claimant can do despite the limitations caused by his impairments.

See S.S.R. 96-8p (July 2, 1996).

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In evaluating whether Plaintiff was disabled, the ALJ undertook the five-step

sequential evaluation for determining disability.1

 (R. at 12-21.) At step one, the ALJ

determined that Plaintiff had not engaged in substantial gainful activity since the alleged

onset date. (R. at 17.) At step two, the ALJ determined that Plaintiff suffered from the

severe impairments of “disorders of the back and neck, arthritis, mild obesity with recent

improvement, and hypothyroidism, currently stable.” (Id.) At step three, the ALJ determined

that none of these impairments, either alone or in combination, met or equaled any of the

Social Security Administration’s listed impairments. (Id.)

At that point, the ALJ made a determination of Plaintiff’s residual functional capacity

(“RFC”).2

 The ALJ concluded that Plaintiff could perform a range of light work. (Id.) The

ALJ concluded that Plaintiff could sit, stand, and walk for six hours per day, and had the

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3

Plaintiff was authorized to file this action by 42 U.S.C. § 405(g) (2004) (“Any

individual, after any final decision of the 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

. . . .”).

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capability to lift and carry ten pounds frequently and twenty pounds occasionally. (Id.) The

ALJ further concluded that Plaintiff had postural limitations of no more than occasional

bending, crouching, crawling, or climbing; needed to avoid concentrations of dust, fumes,

and gases; and needed to avoid temperature extremes. (Id.) The ALJ thus determined at step

four that Plaintiff retained the RFC to perform her past relevant work as a real estate agent,

real estate broker, real estate instructor, and administrative assistant. (R. at 21.) The ALJ

did not reach step five. (See id.) Given this analysis, the ALJ concluded that Plaintiff was

not disabled. (Id.)

The Appeals Council declined to review the decision. (R. at 4-6.) Plaintiff filed the

complaint underlying this action on November 3, 2008, seeking this Court’s review of the

ALJ’s denial of benefits.3

 (Dkt. # 1.) The case is now fully briefed before this Court. (Dkt.

## 16, 18, 19.)

DISCUSSION

I. Standard of Review

A reviewing federal court will only address the issues raised by the claimant in the

appeal from the ALJ’s decision. See Lewis v. Apfel, 236 F.3d 503, 517 n.13 (9th Cir. 2001).

A federal court may set aside a denial of disability benefits only if that denial is either

unsupported by substantial evidence or based on legal error. Thomas v. Barnhart, 278 F.3d

947, 954 (9th Cir. 2002). Substantial evidence is “more than a scintilla but less than a

preponderance.” Id. (quotation omitted). “Substantial evidence is relevant evidence which,

considering the record as a whole, a reasonable person might accept as adequate to support

a conclusion.” Id. (quotation omitted).

However, the ALJ is responsible for resolving conflicts in testimony, determining

credibility, and resolving ambiguities. See Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir.

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1995). “When the evidence before the ALJ is subject to more than one rational

interpretation, we must defer to the ALJ’s conclusion.” Batson v. Comm’r of Soc. Sec.

Admin., 359 F.3d 1190, 1198 (9th Cir. 2004). This is so because “[t]he [ALJ] and not the

reviewing court must resolve conflicts in evidence, and if the evidence can support either

outcome, the court may not substitute its judgment for that of the ALJ.” Matney v. Sullivan,

981 F.2d 1016, 1019 (9th Cir. 1992) (citations omitted).

II. Analysis

Plaintiff argues that the ALJ erred by: (A) improperly rejecting the opinion of Dr.

Bhalla, a treating physician (Dkt. # 16 at 16-22), (B) improperly rejecting Plaintiff’s

subjective complaint testimony (id. at 22-24), and (C) not awarding benefits based on the

vocational expert’s testimony (id. at 24-25). The Court will address each argument in turn.

A. Treating Physician Testimony

Plaintiff’s first argument is that the ALJ improperly rejected the opinion of her

treating physician, Dr. Bhalla. “The medical opinion of a claimant’s treating physician is

entitled to ‘special weight.’” Rodriguez v. Bowen, 876 F.2d 759, 761 (9th Cir. 1989)

(quoting Embrey v. Bowen, 849 F.2d 418, 421 (9th Cir. 1988)). Such an opinion is entitled

to controlling weight if it is “well-supported by medically acceptable clinical and laboratory

diagnostic techniques and is not inconsistent with the other substantial evidence in [the] case

record.” 20 C.F.R. § 404.1527(d)(2); 20 C.F.R. § 416.927(d)(2). If the opinion is not wellsupported by such techniques, or is inconsistent with other substantial evidence in the record,

then the opinion will be weighed in light of several factors: (1) the length of the treatment

relationship and the frequency of examination, (2) the nature and extent of the treatment

relationship, (3) supportability by explanation and reference to relevant evidence, (4)

consistency with the record as a whole, (5) specialization, and (6) any other factors tending

to support or contradict the opinion. 20 C.F.R. § 404.1527(d); 20 C.F.R.§ 416.927(d).

If the treating physician’s opinion is not contradicted by the opinion of another doctor,

it may be rejected only for clear and convincing reasons supported by substantial evidence

in the record. Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995). Likewise, the treating

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physician’s ultimate conclusions may only be rejected for clear and convincing reasons

supported by substantial evidence. Id. If the treating physician’s opinion is contradicted by

the opinion of another physician, it may be rejected upon specific and legitimate reasons

supported by substantial evidence in the record. Id. “The ALJ can meet this burden by

setting out a detailed and thorough summary of the facts and conflicting clinical evidence,

stating his interpretation thereof, and making findings.” Embrey, 849 F.2d at 421 (quotation

omitted).

An examining physician’s opinion can, in and of itself, constitute substantial evidence

to reject the opinion of a treating physician if the examining physician’s opinion is based on

independent clinical findings that differ from the findings of the treating physician. Orn, 495

F.3d at 632. If the examining physician relies on the same findings as the treating physician,

and differs only in his conclusions, then the examining physician’s opinion cannot inherently

be substantial evidence. Id. However, the “substantial evidence” threshold necessary to

reject the opinion of a treating physician can be reached by the opinion of even a nonexamining physician in concert with an abundance of evidence in the record. See Lester, 81

F.3d at 831.

In this case, Dr. Bhalla completed a residual functional capacity questionnaire

discussing Plaintiff’s impairments. (R. at 424-28.) In the questionnaire, Dr. Bhalla

diagnosed Plaintiff as having rheumatoid arthritis, osteoarthritis of the hand, and

degenerative disc disease, with a prognosis of “chronic disease.” (R. at 424.) Dr. Bhalla

provided that Plaintiff’s symptoms included pain, swelling of the joints, and stiffness, and

that the pain was “severe during flare ups,” which are unpredictable. (Id.) Dr. Bhalla listed

joint warmth, redness, swelling, and a reduced range of motion in the hands as Plaintiff’s

positive objective signs. (Id.) Dr. Bhalla further stated that, although Plaintiff’s experience

of pain “often” was severe enough to interfere with her attention and concentration, Plaintiff

was still “capable of [working in] low stress jobs.” (R. at 425.) Dr. Bhalla then estimated

that Plaintiff could sit for one hour at a time before needing to stand up, could stand for

twenty minutes at a time before needing to sit down, and could sit and stand in total for less

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than two hours in an eight-hour workday. (R. at 426.) Dr. Bhalla opined that Plaintiff could

lift and carry up to twenty pounds occasionally, but nevertheless had significant limitations

in repetitive reaching, handling, and fingering. (R. at 427-28.) Dr. Bhalla concluded by

estimating that Plaintiff would miss more than four days of work per month as a result of her

impairments. (R. at 428.)

The ALJ explained Dr. Bhalla’s opinion in great detail in his decision order,

recapitulating essentially all of what appears in the RFC questionnaire. (R. at 20.) The ALJ

gave Dr. Bhalla’s opinion some weight, but he ultimately concluded that it was not entitled

to greater weight than that of other physicians. (Id.) The ALJ so reasoned because Dr.

Bhalla failed to substantiate the functional restrictions he assigned to Plaintiff, because Dr.

Bhalla’s own treatment notes were inconsistent with the limitations he imposed on Plaintiff’s

ability to use her fingers, and because the greater objective record did not elsewhere suggest

such limitations. (R. at 20-21.)

The ALJ’s reasoning in this regard was not erroneous. The RFC questionnaire asked

Dr. Bhalla to explain how long during a workday Plaintiff would be able to use her hands,

fingers, and arms in various activities, but Dr. Bhalla declined to provide such supporting

information. (R. at 428.) Dr. Bhalla also declined to provide requested specifying

information on whether Plaintiff would need to take breaks or how far Plaintiff could walk

without experiencing severe pain. (R. at 426-27.) Finally, when asked to “explain the

reasons for [his] conclusion” regarding how much work stress Plaintiff could tolerate, Dr.

Bhalla again provided no explanation. (R. at 425.) The RFC questionnaire is otherwise just

a checklist with little to no explanation even requested. (See R. at 424-28.) The ALJ’s

conclusion that Dr. Bhalla “failed to substantiate the functional restrictions he assigned

[Plaintiff]” (R. at 20) is therefore reasonable.

The record likewise supports the ALJ’s conclusion that the limited treatment notes

from Dr. Bhalla were inconsistent with the limitations he provided in the RFC questionnaire.

As the ALJ discussed, although Plaintiff reported joint swelling, Dr. Bhalla’s treatment notes

report that there was no swelling of the fingers and joints. (R. at 401, 402, 404, 405; see also

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R. at 407-09, 413-15.) The notes also report the general absence of symptoms, including

neurological symptoms, and that the neurological system was “normal.” (See id.) Thus, the

ALJ’s conclusion that the treatment notes did not fully support Dr. Bhalla’s conclusion in the

RFC questionnaire was reasonable.

So too was it reasonable for the ALJ to conclude that the opinions of other doctors

were entitled to greater weight than Dr. Bhalla’s opinion. (R. at 20.) For instance, the ALJ

gave greater weight to the opinion of Dr. Fernando, a state agency examining physician. (See

id.) Dr. Fernando attested that Plaintiff could lift up to twenty pounds occasionally and up

to ten pounds frequently, and could stand and/or walk for six to eight hours in an eight-hour

workday. (R. at 130.) Dr. Fernando further explained that Plaintiff had no limitations in

sitting, but did need to alternate sitting and standing every forty-five minutes. (R. at 131.)

Dr. Fernando also noted that Plaintiff had limitations in climbing, balancing, stooping,

kneeling, crouching, and crawling, but he specifically observed that Plaintiff had no

restrictions in reaching, handling, fingering, or feeling. (Id.) Dr. Fernando supported his

conclusions with a detailed examination report, including a questionnaire specifically

devoted to clarifying Plaintiff’s manipulative abilities (reaching, handling, fingering, and

feeling). (R. at 120-29.)

Dr. Fernando’s opinion was essentially the same as the opinions of the state agency

reviewing physicians. (See R. at 110-18, 176-83.) They each testified that Plaintiff could

lift and carry up to twenty pounds occasionally and ten pounds frequently, that she could

stand and/or walk for about six hours in an eight-hour workday, and that she could sit for

about six hours in an eight-hour workday. (R. at 112, 177.) The state agency physicians

further testified that Plaintiff had no limitations in her upper extremities, and both provided

explanatory statements for their conclusions. (R. at 112-13, 177.) Although both provided

some limitations on Plaintiff’s ability to climb, balance, stoop, kneel, crouch, and crawl (R.

at 113, 178), both likewise concluded that Plaintiff’s manipulative abilities were either

unlimited (R. at 114) or only somewhat limited (R. at 179).

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Based on these factors, the ALJ had a proper basis on which to reject the opinion of

Dr. Bhalla. See Connett v. Barnhart, 340 F.3d 871, 875 (9th Cir. 2003) (holding that it is

appropriate to reject the opinion of a treating physician if it is inconsistent with other doctors’

opinions, other evidence in the record, and the doctor’s own treatment notes); Meanel v.

Apfel, 172 F.3d 1111, 1113-14 (9th Cir. 1999) (affirming the ALJ’s rejection of a treating

physician’s opinion because that opinion was “conclusory and unsubstantiated by relevant

medical documentation”) (quoting Johnson v. Shalala, 60 F.3d 1428, 1432 (9th Cir. 1995)).

The ALJ therefore did not err in affording Dr. Bhalla’s opinion less weight than the opinions

of the other physicians.

B. Subjective Complaint Testimony

Plaintiff next argues that the ALJ erred by rejecting her subjective complaint

testimony. “Pain of sufficient severity caused by a medically diagnosed ‘anatomical,

physiological, or psychological abnormality’ may provide the basis for determining that a

claimant is disabled.” Light v. Soc. Sec. Admin., 119 F.3d 789, 792 (9th Cir. 1997) (quoting

42 U.S.C. § 423(d)(5)(A) (2006)). “Once a claimant produces objective medical evidence

of an underlying impairment, an ALJ may not reject a claimant’s subjective complaints based

solely on [the] lack of objective medical evidence to fully corroborate the alleged severity

of [those symptoms].” Moisa v. Barnhart, 367 F.3d 882, 885 (9th Cir. 2004). Rather, the

ALJ must determine whether the impairment or combination of impairments “could

reasonably be expected to produce [the] pain or other symptoms.” Batson, 359 F.3d at 1196

(quotation omitted). “[U]nless an ALJ makes a finding of malingering based on affirmative

evidence thereof, he or she may only find [the claimant] not credible by making specific

findings as to credibility and stating clear and convincing reasons for each.” Robbins v. Soc.

Sec. Admin., 466 F.3d 880, 883 (9th Cir. 2006). The ALJ may consider “at least” the

following factors when weighing the claimant’s credibility:

[the] claimant’s reputation for truthfulness, inconsistencies

either in [the] claimant’s testimony or between her testimony

and her conduct, [the] claimant’s daily activities, her work

record, and testimony from physicians and third parties

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concerning the nature, severity, and effect of the symptoms of

which [the] claimant complains.

Thomas, 278 F.3d at 958-59 (internal quotations omitted). The ALJ’s findings must be

“sufficiently specific to permit the court to conclude that the ALJ did not arbitrarily discredit

[the] claimant’s testimony.” Id. at 958.

In this case, Plaintiff testified that she suffered from pain and swelling in her legs and

knees, specifically the left leg and knee (R. at 456), stiffness and aches in her back (R. at

457), and pain in her hands making it difficult to grip and squeeze (R. at 461). Plaintiff

testified that her pain interferes with a variety of different activities, including work-related

activities, and that her medication dulls her concentration. (R. at 455-70.)

The ALJ thoroughly summarized Plaintiff’s subjective complaint testimony. (R. at

18.) The ALJ agreed that Plaintiff’s medically determinable impairments could reasonably

be expected to produce her alleged symptoms, but the ALJ concluded that Plaintiff’s

statements concerning the intensity, persistence, and limiting effects of those symptoms were

not entirely credible. (Id.) The ALJ based this conclusion on the following facts: (1)

Plaintiff had been able to tolerate a trip involving frequently getting into and out of a vehicle

and climbing steps (R. at 145); (2) Plaintiff made use of only over-the-counter pain

medication like Advil and Ibuprofen (R. at 145, 412); (3) Plaintiff’s knee complaints were

assessed as “mild” and Plaintiff’s treating physician did not prescribe medication for them

(R. at 140); (4) after just two physical therapy sessions, Plaintiff reported complete relief of

thoracic/lumbar pain (R. at 393); (5) Plaintiff has made three long-distance trips from

Arizona to Pennsylvania and back since July of 2004, both driving and flying (R. at 470); (6)

Plaintiff does water aerobics two hours every day and occasionally volunteers as an assistant

for additional water exercise classes (R. at 78, 471); (7) Plaintiff drives a car and a golf cart

regularly (R. at 471); (8) Plaintiff was sewing, crocheting, using small tools, and cutting glass

in 2004-05, despite her allegations of disabling hand pain (R. at 78, 452-54); (9) Plaintiff is

independent at home, does light cleaning, fixes her own meals, and uses the computer (R. at

76, 472-73); and (10) Plaintiff requires no ambulatory devices, despite her allegations of

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disabling lower back, leg, and sciatic pain (R. at 471). The ALJ also relied on a variety of

medical evidence regarding Plaintiff’s impairments. (R. at 19-20.) For instance, the ALJ

pointed out that Plaintiff’s mild median wrist neuropathies, as well as her neck complaints,

improved with a short course of physical therapy. (R. at 356-59.) Plaintiff was

recommended for only non-surgical treatment (R. at 269), and although various MRIs and

x-rays did show degenerative joint disease of the lumbar spine, progress notes indicated

normal gait and station, including heal/toe and tandem walking, normal alignment and

mobility of the head and neck, and intact neurological sensation (R. at 289).

Plaintiff disputes three of the ALJ’s points, arguing that: (1) her use of over-thecounter pain medication was simply part of a doctor-directed, conservative course of

treatment; (2) Plaintiff had pain during the three trips to Pennsylvania and she stopped to

stretch frequently; and (3) daily water aerobics, while a conservative treatment, is less

vigorous than other forms of exercise, and thus is actually an indication that Plaintiff is

disabled. Plaintiff does not challenge the notion that an ALJ may rely on such evidence in

evaluating subjective complaint testimony. See Tommasetti v. Astrue, 533 F.3d 1035, 1040

(9th Cir. 2008) (affirming the ALJ’s rejection of subjective complaint testimony where the

ALJ interpreted evidence of long-distance travel as being inconsistent with claims of

disabling pain); Osenbrock v. Apfel, 240 F.3d 1157, 1165-66 (9th Cir. 2001) (affirming the

ALJ’s rejection of the claimant’s subjective complaint testimony and relying on the fact that

“the claimant has not been using [] strong Codeine or Morphine based analgesics that are

commonly prescribed for severe and unremitting pain”); Johnson, 60 F.3d at 1434 (holding

that a claimant’s being “prescribed only ‘conservative treatment’” suggested “a lower level

of both pain and functional limitation,” and thus affirming the ALJ’s rejection of subjective

complaint testimony). Plaintiff’s argument, rather, is simply that the ALJ came to the wrong

conclusion from the evidence. However, the ALJ’s interpretation of the evidence was

reasonable; taking long-distance trips, doing water aerobics daily, and using conservative

pain medication all can be taken to suggest that Plaintiff is not totally disabled by her pain.

Because the ALJ’s conclusions on these factors were reasonable, and because Plaintiff has

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not challenged the other factors on which the ALJ relied, this Court will not second-guess

the ALJ’s determination. See Andrews, 53 F.3d at 1039; Batson, 359 F.3d at 1198; Matney,

981 F.2d at 1019. There is no error on this point.

C. Vocational Expert’s Testimony

Plaintiff argues that, had the ALJ credited Dr. Bhalla’s opinion and Plaintiff’s

subjective complaint testimony, the vocational expert’s testimony would require a finding

of disability. Because the ALJ did not err in declining to credit the evidence to which

Plaintiff refers, there is no error on this point. See Rollins v. Massanari, 261 F.3d 853, 857

(9th Cir. 2001) (holding that an ALJ did not err in excluding properly-rejected limitations

from hypothetical questions posed to the vocational expert).

CONCLUSION

The ALJ made no error of law and there is substantial evidence to support the ALJ’s

denial of benefits.

IT IS THEREFORE ORDERED that the ALJ’s decision is AFFIRMED.

IT IS FURTHER ORDERED that the Clerk of the Court is directed to

TERMINATE this action.

DATED this 9th day of June, 2009.

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