Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_07-cv-00338/USCOURTS-caed-2_07-cv-00338-2/pdf.json

Parties Involved:
Commissioner of Social Security
Defendant
Kathleen R. Johnson
Plaintiff

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IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

KATHLEEN R. JOHNSON, No. CIV S-07-0338-CMK

Plaintiff, 

vs. MEMORANDUM OPINION AND ORDER

COMMISSIONER OF SOCIAL 

SECURITY,

Defendant.

 /

Plaintiff, who is proceeding pro se, brings this action for judicial review of a final

decision of the Commissioner of Social Security under 42 U.S.C. § 405(g). Pursuant to the

consent of the parties, this case is before the undersigned for final decision on plaintiff’s motion

for summary judgment (Docs. 40, 43) and defendant’s cross-motion for summary judgment (Doc.

41). 

I. PROCEDURAL HISTORY

Plaintiff applied for social security benefits on October 12, 2004. In her

application, plaintiff claims that her disability began on October 1, 2004. Plaintiff claims her

disability consists of a combination of breathing problems due to chronic obstructive pulmonary

disease (COPD), and leg and back pain. Plaintiff’s claim was initially denied. Following denial

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of her request for reconsideration, plaintiff requested an administrative hearing, which was held

on May 9, 2006, before Administrative Law Judge (“ALJ”) John M. Bodley. In his October 25,

2006, decision, the ALJ made the following findings:

1. The claimant filed applications for a Period of Disability,

Disability Insurance Benefits, and Supplemental Security Income

(SSI) benefits on October 12, 2004, alleging “disability,” beginning

on October 1, 2004.

2. Examination of the claimant’s earnings record discloses that she

was insured for Title II Disability Insurance Benefits on October 1,

2004, the alleged onset of “disability” date, and remains so insured

through at least December 31, 2010.

3. The claimant has not engaged in substantial gainful activity (SGA)

since October 1, 2004. Her current part-time work as a home

telemarketer is not generating earnings sufficient to raise the

presumption of SGA (see text).

4. The claimant’s “severe” impairment is chronic obstructive

pulmonary disease (COPD). It is agree[d] with the State Agency

Medical Consultant (and Dr. Beech) that there is no medicallydeterminable impairment of record to explain complaints of leg

pain. In addition, despite the claimant’s rather bizarre missives,

there is no evidence of any medically-determinable mental

impairment (see Exhibit 9E).

5. The claimant has no impairment or combination of impairments

meeting or equaling in severity any impairment set forth in the

Listing of Impairments in Appendix 1, Subpart P, Regulations 

No. 4.

6. I[t] is found that the claimant retains the following residual

functional capacity (RFC): From an exertional standpoint, she is

limited to “light” work activities, as defined at 20 CFR

404.1567(b), 416.967(b) (see also SSR 96-8p), with the proviso

that the claimant should avoid concentrated exposure to fumes,

odors, dusts, gases, and poor ventilation. There are no other nonexertional limitations (20 CFR 404.1545, 416.945). The

claimant’s symptom allegations to the contrary are not credible or

reliable for the reasons set forth in the body of this decision. The

testimony of the lay witnesses was contrived, biased, and basically

a repetition of the claimant’s allegations which are grossly

exaggerated and not at all credible.

7. The claimant reported that she is now 49 years old, received a high

school education, is literate, and has past relevant work (PRW) as a

landscaper, motel maid, and home telemarketer.

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8. Given the above-noted RFC, it is agreed with the State Agency that

the claimant has failed to meet the burden of showing that her

pulmonary impairment prevents her from doing her PRW as a

home telemarketer. She admittedly is able to do this job part-time,

and no reason is seen in this record why she cannot do the job on a

full-time basis. It is therefore found that the claimant [is] “not

disabled” at the fourth sequential step (20 CFR 404.1520(f),

416.920(f)).

9. The claimant was not under a “disability” within the meaning of

the Act at any time on or before the date of this decision.

(CAR at 19). After the Appeals Council declined review on January 24, 2007, this appeal

followed.

II. SUMMARY OF THE EVIDENCE

The certified administrative record (“CAR”) contains the following: 

(1) Medical records dated November 4, 2003 from Northern California

Research Corporation (CAR 196-206); 

(2) Medical records covering the period from December 3, 2003 to January 6,

2004 from Med 7 Urgent Care Facility (CAR 207-13); 

(3) Internal Medicine Consultive Examination dated November 29, 2004 by

MDSI Physician Group, Jenna Beech, M.D. (CAR 214-18); 

(4) Medical report dated January 13, 2005 by Marvin Gatz, M.D. (CAR 

219-24);

(5) Residual Functional Capacity Assessment-Physical (DDS) dated

December 14, 2004 (CAR 225-34);

(6) Medical records dated March 29, 2005 from Donald Rifas, M.D. (CAR

235-38); and 

(7) Medical records dated May 16, 2006 from the UC Davis Medical Center

(CAR 239-239A). 

Relevant Medical Records:

2003

On November 4, 2003, plaintiff had a Pulmonary Function Test. The report

indicates a moderate obstructive pulmonary impairment, “indicated by the finding of a moderate

reduction in the forced expired volume in one second as a [percentage] of the forced vital

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capacity (FEV1/FVC). The degree of functional impairment reflected by the reduction in forced

expired volume in the first second (FEV1) is found to be mild.” (CAR at 196). 

Plaintiff was seen on December 3, 2003 at the Urgent Care Center by Dr. Dean

Kim. Dr. Kim noted that plaintiff brought in a pulmonary function test, which indicated mild

Chronic Obstructive Pulmonary Disease (COPD). Dr. Kim diagnosed plaintiff with COPD, but

did not indicate any treatment, follow-up, or limitations. Plaintiff was simply instructed to

recheck as needed. 

2004

There are medical records indicating that plaintiff was seen on January 6, 2004 at

the Urgent Care Center by Dr. Kim, but there are no medical notes from that visit. The medical

record simply states her chief complaint was “PP” and “COLD,” and gives plaintiff’s weight. 

The only other notation, beyond Dr. Kim’s signature, is “VOID.” 

On November 29, 2004, plaintiff had a comprehensive internal medicine

evaluation by Dr. Jenna Beech. Plaintiff’s chief complaints were breathing and leg pain. Dr.

Beech noted she had a copy of the pulmonary function test from November 2003. Petitioner

indicated that she has become increasingly short of breath over the past 20 years, including the

inability to walk distances further than two blocks, and becoming short of breath when talking. 

She also indicated increased leg pain, “right greater than left calf pain” which is worse with

standing and better with sitting. Plaintiff stated she was able to do her own hygiene, cook, do

dishes, vacuum, and laundry with frequent breaks. All of plaintiff’s medications were over-thecounter, and she was not on any prescription medication. Dr. Beech noted plaintiff did not speak

with significantly shortened sentences. On examination, Dr. Beech found plaintiff’s “chest wall

shows bilateral equal extension. The lungs have diminished breath sounds, but no wheezing or

crackles. There is no increased expiratory phase.” (CAR at 215). Dr. Beech diagnosed plaintiff

with:

/ / /

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The court notes that although Dr. Beech indicated she was ordering a repeat 1

pulmonary function test, there is no repeat test in the record pursuant to Dr. Beech’s referral, and

it appears that Dr. Beech’s opinion was rendered without the repeated pulmonary function test. 

However, as discussed infra, plaintiff did have a new pulmonary function test completed on

January 13, 2005 by Dr. Gatz.

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COPD with pulmonary function testing in November 2003. This

demonstrated moderate obstructive pulmonary impairment. The

claimant feels her symptoms have progressed and I have ordered a

repeat pulmonary function testing to be obtained. Of note, she is

not currently on treatment. Even though this is a chronic

progressive illness, she is not being treated, in terms of oxygen and

inhaler treatments.

(CAR at 217) . 

1

Dr. Beech’s functional assessment of plaintiff is that she 

can be expected to stand and/or walk for two hours during an eighthour workday. This is secondary to her shortness of breath. The

claimant can be expected to sit without limitations. [Dr. Beech

does] not believe that the claimant has any medical necessity for an

assistive device for short distances and for level terrain. She does

require a wheelchair for distances beyond her reported limitation of

two blocks. The claimant can lift and carry 20 pounds occasionally

and 10 pounds frequently. She is limited by her shortness of

breath. The claimant has postural limitations and can perform

bending, stooping, and crouching occasionally. This is based on

her shortness of breach. She has no manipulative limitations. The

claimant does, by history, have a communicative limitation, in that

she is unable to speak for long periods of time secondary to her

dyspnea. I was not able to confirm this on my evaluation. She has

no visual or workplace environmental limitations. 

(Id.)

On December 14, 2004, plaintiff had a physical RFC assessment. Dr. Clancey

found plaintiff could frequently lift 10 pounds; could stand and/or walk about six hours in an

eight-hour workday; sit about six hours in an eight-hour workday; had the unlimited ability to

push and/or pull; had no postural, manipulative, or visual communicative limitations; the only

environmental limitations was to avoid concentrated exposure to fumes, odors, gases, etc. 

/ / /

/ / /

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2005

Plaintiff was seen by Dr. Marvin Gatz on January 13, 2005 on a self-referral. 

Plaintiff’s chief complaint was increased shortness of breach, and she was requesting an

evaluation and treatment of her COPD. Plaintiff indicated her only medications were herbal

medicines. Dr. Gatz’s review stated plaintiff had “increasing dyspnea with exertion, increased

difficulty doing housework. Fatigue, dizziness, occasional cough, increased mucous secretions.” 

(CAR at 222). On examination, Dr. Gatz noted plaintiff’s blood pressure was 118/70, pulse was

76, respirations were 16, weight was 121 pounds, her oxygen saturation was 100%, her chest was

clear and she had a regular heart rate and rhythm. Dr. Gatz performed a pulmonary function test,

the results of which were normal. The interpretation of the pulmonary function test, dated

January 13, 2005, was “NORMAL SPIROMETRIC VALUES indicate the absence of any

significant degree of obstructive pulmonary impairment and/or restrictive ventilatory defect.” 

(CAR at 224). Dr. Gatz’s impression was “[questionable] asthma/reactive airways state. 

However, she does have normal pulmonary function test, I doubt any significant degree of

underlying COPD.” (CAR at 223). Dr. Gatz recommended a trial of Advair and Albuterol, and

suggested a follow up in two weeks. 

On January 30, 2005, plaintiff was seen in the emergency room, with complaints

of breathing difficulties. The report/discharge instructions notes that all of plaintiff’s labs and xrays were all essentially normal. Plaintiff was given Albuterol and Atrovent for her shortness of

breach. She was instructed to return to the ER for chest pain or difficulty breathing, and to get

established with a doctor to be seen in seven days. 

Relevant Hearing Testimony:

At the hearing Plaintiff was without council and after repeated efforts by the ALJ

to convince Plaintiff to obtain council, plaintiff chose to continue the hearing without council. 

Plaintiff testified on her own behalf, and had witnesses Rhonda Danielle Johnson (plaintiff’s

daughter) and Karen Chapman (plaintiff’s friend) testify on her behalf. 

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Plaintiff testified that she was forty-nine and a half, has a twelfth grade education,

has received training in medical transcription but is not certified, and at one time took a journalist

course, which she did not complete. Plaintiff stated that at the time of the onset of her alleged

disability, she had “two phone work jobs,” a part time job working for an insurance company,

and “yard work jobs.” (CAR at 310-11). In October 2004, she quit her part time job with the

insurance company, and had to cut back her hours in her other jobs due to her breathing trouble. 

At the time of the hearing, plaintiff was working about 20 hours a week, making $800.00 per

month on a contract, working for the “Sacramento Association Retarded.” (CAR at 311). She

testified that she gets “real dizzy, sir, from talking. My oxygen level is low.” (Id.) 

Plaintiff explained that her current physician was Dr. Jennifer Lee at UC Davis

Medical Center. She had an appointment with Dr. Lee on May 25, 2006. Previously, plaintiff

had seen Dr. Rifus, who took some x-rays which showed white spots on her lungs. She was

taking Advair and Combivent at the time, and she was told that in order to obtain an accurate

reading, she only had to wait four to six hours after taking the medication to have the tests run. 

However, she testified that she later found out that information was incorrect, and the medication

could stay in her system for 48 hours. So, when Dr. Rifus “gave a PFT and FEV went way up. 

They said there was nothing wrong with me. And then he showed me the x-rays again and there

was hardly a spot on there. It was really strange.” (CAR at 314). She stated she had a doctor

friend give her a PulseOx 5500 in order for her to check her own oxygen levels, which have been

in the 80's and inconsistent with her physician’s readings. She also testified that due to her low

oxygen levels, she is “having trouble breathing and the meds aren’t working.” (CAR at 315). 

Plaintiff thought her doctor’s machines were very old and needed to be calibrated. 

Plaintiff’s 13-year old daughter, Rhonda, testified that she does a lot of the

housework, and she pushed her mother in a wheelchair before she got an electric one. Rhonda

stated that she does a lot of the cooking and housecleaning because plaintiff can hardly do it.

/ / / 

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Plaintiff’s friend Karen Chapman also testified. Ms. Chapman testified that

plaintiff’s health has deteriorated over the past nine years, she now struggles to do things she

used to be able to do (like singing and walking), and plaintiff had to be rushed to emergency

because she wasn’t breathing. 

III. STANDARD OF REVIEW

The court reviews the Commissioner’s final decision to determine whether it is: 

(1) based on proper legal standards; and (2) supported by substantial evidence in the record as a

whole. See Tackett v. Apfel, 180 F.3d 1094, 1097 (9th Cir. 1999). “Substantial evidence” is

more than a mere scintilla, but less than a preponderance. See Saelee v. Chater, 94 F.3d 520, 521

(9th Cir. 1996). It is “. . . such evidence as a reasonable mind might accept as adequate to

support a conclusion.” Richardson v. Perales, 402 U.S. 389, 402 (1971). The record as a whole,

including both the evidence that supports and detracts from the Commissioner’s conclusion, must

be considered and weighed. See Howard v. Heckler, 782 F.2d 1484, 1487 (9th Cir. 1986); Jones

v. Heckler, 760 F.2d 993, 995 (9th Cir. 1985). The court may not affirm the Commissioner’s

decision simply by isolating a specific quantum of supporting evidence. See Hammock v.

Bowen, 879 F.2d 498, 501 (9th Cir. 1989). If substantial evidence supports the administrative

findings, or if there is conflicting evidence supporting a particular finding, the finding of the

Commissioner is conclusive. See Sprague v. Bowen, 812 F.2d 1226, 1229-30 (9th Cir. 1987). 

Therefore, where the evidence is susceptible to more than one rational interpretation, one of

which supports the Commissioner’s decision, the decision must be affirmed, see Thomas v.

Barnhart, 278 F.3d 947, 954 (9th Cir. 2002), and may be set aside only if an improper legal

standard was applied in weighing the evidence, see Burkhart v. Bowen, 856 F.2d 1335, 1338 (9th

Cir. 1988). 

/ / /

/ / /

/ / /

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See 20 C.F.R. Pt. 404, Subpt. P, App. 1. 2

If a claimant is found to have an impairment which meets or equals one of the 3

listed impairments, a conclusive presumption of disability applies and the claimant is entitled to

benefits. See Marcia v. Sullivan, 900 F.2d 172, 174 (9th Cir. 1990) (citing Williams v. Bowen,

853 F.2d 643, 647 (9th Cir. 1987); Key v. Heckler, 754 F.2d 1545, 1548 (9th Cir. 1985).

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IV. DISCUSSION

In her motion for summary judgment, plaintiff argues that the ALJ erred in

determining that she was not disabled. Specifically, plaintiff argues: (1) the ALJ erred in finding

her not disabled; (2) the ALJ improperly rejected her testimony as not credible; and (3) the ALJ

improperly rejected or ignored the medical opinions of her treating physicians. Plaintiff has also

submitted new evidence to support her contention that she is disabled. 

A. FIVE-STEP DISABILITY EVALUATION

To achieve uniformity of decisions, the Commissioner has promulgated

regulations which contain, inter alia, a five-step sequential disability evaluation to determine

whether a claimant is physically or mentally disabled. 20 C.F.R. §§ 404.1520 (a)-(f) and

416.920(a)-(f). If during any point of this review, it is determined that the claimant is not

disabled, the claim is not to be considered further. 20 C.F.R. §§ 404.1520(a) and 416.920(a). 

The five-step process is summarized as follows:

1. Determination of whether the claimant is engaged in substantial gainful

activity, and if so engaged, the claimant is not presumed disabled and the analysis ends;

2. If not engaged in substantial gainful activity, determination of whether the

claimant has a severe impairment; if the claimant does not, the claimant is not presumed disabled

and the analysis ends;

3. If the claimant has a severe impairment, determination of whether any such

severe impairment meets any of the impairments listed in the regulations; if the claimant does 2

have such an impairment, the claimant is disabled and the analysis ends;3

/ / /

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At this stage of the analysis, the ALJ should consider the demands of the 4

claimant’s past work as compared with his or her present capacity. Villa v. Heckler, 797 F.2d

794, 797 (9th Cir. 1986) (citations omitted); 20 C.F.R. § 416.945(a).

At this stage of the analysis, the ALJ should consider the claimant’s residual 5

functional capacity and vocational factors such as age, education and past work experience. 20

C.F.R. §§ 404.1520(f) and 416.920(f).

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4. If the claimant’s impairment is not listed, determination of whether the

impairment prevents the claimant from performing his or her past work; if the impairment does 4

not, the claimant is not presumed disabled and the analysis ends; and

5. If the impairment prevents the claimant from performing his or her past work,

determination of whether the claimant can engage in other types of substantial gainful work that

exist in the national economy; if the claimant can, the claimant is not disabled and the analysis 5

ends.

To qualify for benefits, a claimant must establish that he or she is unable to

engage in substantial gainful activity due to a medically determinable physical or mental

impairment which has lasted or can be expected to last for a continuous period of not less than 12

months. 42 U.S.C. § 1382c(a)(3)(A). A claimant must show that he or she has a physical or

mental impairment of such severity that he or she is unable to do his or her previous work and

cannot, considering his or her age, education and work experience, engage in any other kind of

substantial gainful work which exists in the national economy. Quang Van Han v. Bower, 882

F.2d 1453, 1456 (9th Cir. 1989).

The claimant has the initial burden of proving the existence of a disability within

the meaning of the Act. Terry v. Sullivan, 903 F.2d 1273, 1275 (9th Cir. 1990). The claimant

establishes a prima facie case of disability by showing that a physical or mental impairment

prevents him from engaging in his previous occupation (steps 1 through 4 noted above). Gallant

v. Heckler, 753 F.2d 1450, 1452 (9th Cir. 1984); 20 C.F.R. §§ 404.1520(f) and 416.920(f). 

However, once the claimant establishes a prima facie case of disability, the burden of going

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For any given combination of factors (residual functional capacity, age, education, 6

and work experience), the guidelines direct a conclusion of disability or nondisability when they

accurately describe a claimant’s particular limitations.

However, the mere allegation of the presence of a non-exertional impairment is

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not sufficient to preclude application of guidelines. Such non-exertional impairment must be

found to significantly limit the range of work permitted by a claimant’s exertional limitations

before the Commissioner will be required to obtain expert vocational testimony regarding the

availability of other work. See, e.g., Polny v. Bowen, 864 F.2d 661, 663 (9th Cir. 1988);

Burkhart v. Bowen, 856 F.2d 1335, 1340 (9th Cir. 1988); Razey v. Heckler, 785 F.2d 1426, 1430

(9th Cir. 1986) (modified 794 F.2d 1348 (1986)); Perminter v. Heckler, 765 F.2d 870, 872 (9th

Cir. 1985). Pain has been recognized as a non-exertional limitation which can significantly limit

ability to perform basic work skills. See Perminter, 765 F.2d at 872.

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forward with the evidence shifts to the Commissioner. Burkhart v. Bowen, 856 F.2d 1335, 1340

(9th Cir. 1988); Hoffman v. Heckler, 785 F.2d 1423, 1425 (9th Cir. 1986). The Commissioner

has the burden to establish the existence of alternative jobs available to the claimant, given his or

her age, education, and medical-vocational background (step 5 noted above). In an appropriate

case, the Secretary may meet this burden through application of the medical-vocational

guidelines set forth in the regulations. See 20 C.F.R. Pt. 404, Subpt. P, App. 2; Heckler v. 6

Campbell, 461 U.S. 458 (1983); Olde v. Heckler, 707 F.2d 439, 440 (9th Cir. 1983). If the

guidelines do not accurately describe a claimant’s limitations, the Commissioner may not rely on

them alone to show availability of jobs for the claimant. See Desrosiers v. Sec’y of Health &

Human Servs., 846 F.2d 573, 577 (9th Cir. 1988).7

Here, plaintiff submitted a minimal amount of evidence in support of her

contention that she had a medical condition so serious she was unable to engage in her previous

employment. In support of her assertion that she is disabled, she provided to the Commissioner

an unsigned pulmonary function test from November 2003, which showed she had a mild

impairment. She also submitted notes from Dr. Kim which indicated she was diagnosed with

mild COPD, but there was no follow-up or additional treatment from Dr. Kim. The only other

relevant medical records plaintiff provided was from her visit with Dr. Gatz in January 2005. 

After conducting another pulmonary function test, which was normal, Dr. Gatz found plaintiff

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may be suffering from asthma, but doubted any significant degree of COPD. Plaintiff did not

provide the Commissioner any medical opinion which found plaintiff was limited to any degree

by her medical condition.

The ALJ found plaintiff’s COPD was a severe impairment, but found plaintiff was

capable of performing her past relevant work as a home telemarketer and therefore was not

considered disabled. Plaintiff argues that she is unable to perform her past work as a

telemarketer due to her inability to breath adequately. She essentially argues that her COPD

causes her to be short of breath, and without the ability to breath adequately, she is not able to

talk on the phone for any significant length of time, which is required as a telemarketer. 

Plaintiff has submitted additional evidence in support of her contention, which is

discussed below. However, given the lack of medical evidence available to the ALJ, the court

cannot find the ALJ erred. Plaintiff failed to meet her burden of proof that she has a medical

condition severe enough that she is not able to perform her past relevant work.

B. DUTY TO DEVELOP THE RECORD

The ALJ has an independent duty to fully and fairly develop the record and assure

that the claimant’s interests are considered. See Tonapetyan v. Halter, 242 F.3d 1144, 1150 (9th

Cir. 2001). When the claimant is not represented by counsel, this duty requires the ALJ to be

especially diligent in seeking all relevant facts. See id. This requires the ALJ to “scrupulously

and conscientiously probe into, inquire of, and explore for all the relevant facts.” Cox v.

Califano, 587 F.2d 988, 991 (9th Cir. 1978). Ambiguous evidence or the ALJ’s own finding that

the record is inadequate triggers this duty. See id. The ALJ may discharge the duty to develop

the record by subpoenaing the claimant’s physicians, submitting questions to the claimant’s

physicians, continuing the hearing, or keeping the record open after the hearing to allow for

supplementation of the record. See id. (citing Tidwell v. Apfel, 161 F.3d 599, 602 (9th Cir.

1998)). 

/ / /

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Plaintiff argues the results of this test were skewed due to her medications. 8

However, she has not submitted any evidence or medical opinion to support her contention. 

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Plaintiff proceeded in this matter without counsel. Therefore, the ALJ had a duty

to be especially diligent in seeking all relevant facts. In accordance with his duty, the ALJ

ordered a consultative examination. Plaintiff was examined by Dr. Beech in November 2004. 

On examination, Dr. Beech found plaintiff did not have difficulty speaking, had diminished

breath sounds but no wheezing or crackles, and no increased expiratory phase. Dr. Beech

reviewed plaintiff’s November 2003 pulmonary function test, and found it demonstrated

moderate obstructive pulmonary impairment. Dr. Beech noted she ordered a repeat pulmonary

function test. Although there is no repeat pulmonary function test from Dr. Beech, plaintiff saw

Dr. Gatz in January 2005 who performed a pulmonary function test. Dr. Gatz, plaintiff’s own

physician, found the pulmonary function test results were normal. 

The ALJ is required to fully develop the record, including ordering a consultative

examination when necessary. The ALJ fulfilled his duty in this case. Plaintiff submitted a

pulmonary function test from 2003 which indicated she suffered from mild COPD. The ALJ

ordered a consultative examination, which occurred. In furtherance of the record, Dr. Beech

found a new pulmonary function test was needed. Plaintiff obtained this on her own in 2005, the

results of which were normal. In addition, plaintiff had indicated at the hearing that she had 8

additional medical appointments scheduled. The ALJ then held the hearing open for plaintiff to

supplement the record by providing the ALJ with copies of any test results that were done

through the end of May 2006. The ALJ thus provided her the means to submit any additional

reports to support her application. However, she did not provide any additional evidence within

the allotted time, nor did she ask for additional time to submit the supplemental medical reports. 

The court finds the ALJ adequately discharged his duty.

/ / /

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C. MEDICAL EVIDENCE

The weight given to medical opinions depends in part on whether they are

proffered by treating, examining, or non-examining professionals. See Lester v. Chater, 81 F.3d

821, 830-31 (9th Cir. 1995). Ordinarily, more weight is given to the opinion of a treating

professional, who has a greater opportunity to know and observe the patient as an individual,

than the opinion of a non-treating professional. See id.; Smolen v. Chater, 80 F.3d 1273, 1285

(9th Cir. 1996); Winans v. Bowen, 853 F.2d 643, 647 (9th Cir. 1987). The least weight is given

to the opinion of a non-examining professional. See Pitzer v. Sullivan, 908 F.2d 502, 506 & n.4

(9th Cir. 1990).

In addition to considering its source, to evaluate whether the Commissioner

properly rejected a medical opinion the court considers whether: (1) contradictory opinions are

in the record; and (2) clinical findings support the opinions. The Commissioner may reject an 

uncontradicted opinion of a treating or examining medical professional only for “clear and

convincing” reasons supported by substantial evidence in the record. See Lester, 81 F.3d at 831. 

While a treating professional’s opinion generally is accorded superior weight, if it is contradicted

by an examining professional’s opinion which is supported by different independent clinical

findings, the Commissioner may resolve the conflict. See Andrews v. Shalala, 53 F.3d 1035,

1041 (9th Cir. 1995). A contradicted opinion of a treating or examining professional may be

rejected only for “specific and legitimate” reasons supported by substantial evidence. See Lester,

81 F.3d at 830. This test is met if the Commissioner sets out a detailed and thorough summary of

the facts and conflicting clinical evidence, states her interpretation of the evidence, and makes a

finding. See Magallanes v. Bowen, 881 F.2d 747, 751-55 (9th Cir. 1989). Absent specific and

legitimate reasons, the Commissioner must defer to the opinion of a treating or examining

professional. See Lester, 81 F.3d at 830-31. The opinion of a non-examining professional,

without other evidence, is insufficient to reject the opinion of a treating or examining

professional. See id. at 831. In any event, the Commissioner need not give weight to any

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Plaintiff testified to an examination by Dr. Rifus, and the CAR indicates medical 9

records from a Dr. Rifus at CAR 235-38. However, the court does not find any medical records

from Dr. Rifus at CAR 235-38 or anywhere in the CAR. The records at CAR 235-35 are

duplicate medical records from Urgent Care Center and her pulmonary function test from

November 2003.

15

conclusory opinion supported by minimal clinical findings. See Meanel v. Apfel, 172 F.3d 1111,

1113 (9th Cir. 1999) (rejecting treating physician’s conclusory, minimally supported opinion);

see also Magallanes, 881 F.2d at 751. 

Here, there was no opinion from plaintiff’s treating physician regarding her

limitations. The only supporting medical evidence plaintiff submitted was a diagnosis from Dr.

Kim as to her COPD. Her only other treating physician, Dr. Gatz, found plaintiff perhaps had

asthma, but doubted any significant degree of COPD. Giving the limited medical evidence as to 9

plaintiff’s limitations, the ALJ obtained a consultative examination from Dr. Beech. Dr. Beech

found plaintiff capable of standing and/or walking for two hours, secondary to her shortness of

breath, and sitting without limitation. Dr. Beech found plaintiff required a wheelchair to assist

her with mobility beyond walking two blocks, capable of lifting and carrying 20 pounds

occasionally and 10 pounds frequently, and bending, stooping and crouching occasionally, again

limited by her shortness of breath. Dr. Beech also found plaintiff may have a communication

limitation in being unable to speak for long periods of time secondary to her dyspnea, but she

was not able to confirm this on examination. 

The ALJ also a had residual functional capacity assessment from a State Agency

Medical Consultant. This non-examining medical professional found plaintiff capable of lifting

10 pounds, and stand/walk/sit for about six hours. No other limitations were found, except to

avoid concentrated exposure to fumes, odors, gases, etc. 

The ALJ, giving plaintiff the benefit of doubt, found her COPD severe. However, 

he found her RFC included the ability to perform light work, but avoiding fumes, etc. The ALJ

agreed with the State Agency’s physician that plaintiff does not need to use a wheelchair for

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“Light work” involves lifting no more than 20 pounds at a time with frequent 10

lifting or carrying of objects weighing up to 10 pounds; it may require a good deal of walking or

standing; if it involves sitting most of the time, it usually involves some pushing and pulling of

arm or leg controls. See 20 C.F.R. §§ 404.1567(b) and 416.967(b).

Plaintiff complains about her shortness of breath. None of the physicians render 11

an opinion regarding her ability to talk for a significant amount of time based on objective

clinical findings. The ALJ found she is capable of performing her past relevant work as a home

telemarketer. It would appear to the court that this occupation would require the ability to talk

for a significant amount of time. As this matter will be remanded for further proceedings, it is

not necessary for the court to address this issue. However, on remand the Commissioner is

advised that it may be necessary to address this alleged limitation.

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mobility, citing the lack of medical evidence for such limitation. There was no opinion from a

treating physician for the ALJ to utilize. Without a treating physician’s opinion, the next best

source is an examining physician, in this case Dr. Beech. Dr. Beech found plaintiff more limited

than the non-examining State Agency’s physician. The main difference between these two

professionals was in plaintiff’s ability to stand and/or walk. Dr. Beech found plaintiff limited in

her ability to stand and/or walk, and limited her to about two hours. The State Agency’s

physician found plaintiff had the ability to stand and/or walk for six hours. 

The ALJ agreed with the State Agency’s physician’s limitations, finding plaintiff

capable of performing light work. He did so citing to the lack of medical evidence of a need for 10

a wheelchair, and the lack of ER treatment records, hospitalization records, or doctor’s office

notes. The court notes that Dr. Beech’s limitations are based on plaintiff’s subjective complaints,

not on any clinical findings. Accordingly, although minimal, the ALJ’s reasons for agreeing with

the non-examining physician’s limitations are sufficient to resolve the conflict. 

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D. PLAINTIFF’S CREDIBILITY

The Commissioner determines whether a disability applicant is credible, and the

court defers to the Commissioner’s discretion if the Commissioner used the proper process and

provided proper reasons. See Saelee v. Chater, 94 F.3d 520, 522 (9th Cir. 1995). An explicit

credibility finding must be supported by specific, cogent reasons. See Rashad v. Sullivan, 903

F.2d 1229, 1231 (9th Cir. 1990). General findings are insufficient. See Lester, 81 F.3d at 834.

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The court notes, however, that one of the ALJ’s reasons for finding plaintiff not 12

completely credible is the lack of treating medical evidence. As plaintiff has submitted

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Rather, the Commissioner must identify what testimony is not credible and what evidence

undermines the testimony. See id. Moreover, unless there is affirmative evidence in the record

of malingering, the Commissioner’s reasons for rejecting testimony as not credible must be

“clear and convincing.” See id.

If there is objective medical evidence of an underlying impairment, the

Commissioner may not discredit a claimant’s testimony as to the severity of symptoms merely

because they are unsupported by objective medical evidence. See Bunnell v. Sullivan, 947 F.2d

341, 347-48 (9th Cir. 1991) (en banc). The Commissioner may, however, consider the nature of

the symptoms alleged, including aggravating factors, medication, treatment, and functional

restrictions. See id. at 345-47. In weighing credibility, the Commissioner may also consider: (1)

the claimant’s reputation for truthfulness, prior inconsistent statements, or other inconsistent

testimony; (2) unexplained or inadequately explained failure to seek treatment or to follow a

prescribed course of treatment; (3) the claimant’s daily activities; (4) work records; and (5)

physician and third-party testimony about the nature, severity, and effect of symptoms. See

Smolen v. Chater, 80 F.3d 1273, 1284 (9th Cir. 1996) (citations omitted). 

Here, the ALJ found plaintiff’s testimony not credible 

given the pervasive evidence of symptom exaggeration and

symptom embellishment in this record; the inconsistencies in the

record . . . ; the almost total lack of treating medical evidence; the

claimant’s admitted activities of daily living as set forth in Dr.

Beech’s report . . . ; and the claimant’s admitted ability to work

part-time as a home telemarketer (20 CFR 404.1529, 416.929, SSR

96-7p).

(CAR at 18).

The reasons the ALJ provides for rejecting plaintiff’s testimony are clear and

convincing. The ALJ used the proper process and provided proper reasons, and the court

therefore defers to his opinion. 

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additional evidence in support of her claim, as discussed below, the ALJ is advised that it may

also be necessary to reassess plaintiff’s credibility.

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E. WITNESS CREDIBILITY

In determining whether a claimant is disabled, an ALJ generally must consider lay

witness testimony concerning a claimant's ability to work. See Dodrill v. Shalala, 12 F.3d 915,

919 (9th Cir. 1993); 20 C.F.R. §§ 404.1513(d)(4) & (e), 416.913(d)(4) & (e). Indeed, “lay

testimony as to a claimant's symptoms or how an impairment affects ability to work is competent

evidence . . . and therefore cannot be disregarded without comment.” See Nguyen v. Chater, 100

F.3d 1462, 1467 (9th Cir. 1996). Consequently, “[i]f the ALJ wishes to discount the testimony

of lay witnesses, he must give reasons that are germane to each witness.” Dodrill, 12 F.3d at

919. The ALJ, however, need not discuss all evidence presented. See Vincent on Behalf of

Vincent v. Heckler, 739 F.2d 1393, 1394-95 (9th Cir. 1984). Rather, he must explain why

“significant probative evidence has been rejected.” Id. (citing Cotter v. Harris, 642 F.2d 700, 706

(3d Cir.1981)). 

Here, there were two witnesses who testified at the hearing, plaintiff’s daughter

and friend. Plaintiff’s daughter testified that she did most of the house work and cooking, and

that she pushed her mother in a wheelchair before she got an electric one. Plaintiff’s friend

testified that she has witnessed plaintiff’s health deteriorate and that plaintiff now struggles to do

the things she used to be able to do. Plaintiff’s friend also testified that she took plaintiff to the

emergency room due to plaintiff’s inability to breath. The ALJ discussed the witnesses’

testimony and found both witnesses’ testimony “contrived, biased, and basically a repetition of

the claimant’s allegations which are found grossly exaggerated and not at all credible.” (CAR at

16, 17). In addition, the ALJ found no record of the emergency room visit. 

/ / /

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The ALJ did not ignore or silently disregard this evidence. The ALJ found it not

credible, controverted by the available medical evidence, and provided proper reasons for

rejecting it. The court defers to the ALJ’s discretion in finding the lay witness testimony not

credible.

F. NEW EVIDENCE

Plaintiff has submitted additional medical records and asks this court to consider

these records in determining whether the matter should be remanded to the Commissioner. The

new evidence consists of records and reports from Victor A. Kyaw, M.D. and Mary Jean Ailarey,

P.T. In a medical report for the California Department of Health and Human Services, dated

June 19, 2007, Dr. Kyaw states plaintiff has been diagnosed with COPD (with an onset date of

October 2004), is on oxygen, and is physically incapacitated and does not have the ability to

work. (See Request for Remand (Doc. 30) at 6). Plaintiff also submitted an evaluation from her

physical therapist who has recommended the use of a power wheelchair. (See id. at 3). 

A case may be remanded for the consideration of new evidence if the evidence is

material and good cause exists for the absence of the evidence from the prior record. Sanchez v.

Sec’y of Health & Human Servs., 812 F.2d 509, 511-12 (9th Cir. 1987). In order for new

evidence to be “material,” the court must find that, had the Secretary considered this evidence,

the decision might have been different. The court need only find a reasonable possibility that the

new evidence would have changed the outcome of the case. Booz v. Sec’y of Health & Human

Servs., 734 F.2d 1378, 1380-81 (9th Cir. 1984).

Defendant objects to this new evidence as a basis for remand because it “is

immaterial to the instant case and does not warrant remand.” (Defendant’s Motion (Doc. 41) at

8). He argues that the records do not cover the period covered by the ALJ’s decision and do not

support plaintiff’s medical problems, but may speak to “alleged new medical problems.” (Id.) 

/ / /

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The court does not agree with defendant’s contentions. The new evidence

plaintiff has submitted supports her position that she suffers from severe COPD. Dr. Kyaw’s

statement indicates plaintiff has been diagnosed with COPD, the medical condition she alleged in

her application. In addition, Dr. Kyaw notes that the onset date of her condition was October

2004, the exact time frame that was before the ALJ. The ALJ specifically found a lack of

treatment and a lack of medical records contributed to his findings. The new evidence not only

supports plaintiff’s contention that she suffers from COPD, but it also indicates that plaintiff has

some severe limitations from that diagnosis. Given that the new evidence is from plaintiff’s

treating physician, there is a reasonable possibility that this new evidence may have changed the

outcome of the case. Providing there was good cause for the absence of this evidence, plaintiff

should have an opportunity to present this new evidence, as her treating physician’s opinion, to

the Commissioner in support of her application. 

“The good cause requirement often is liberally applied, where . . . there is no

indication that a remand for consideration of new evidence will result in prejudice to the

Secretary.” Burton v. Heckler, 724 F.2d 1415, 1417-18 (9th Cir. 1984) (citing Johnson v.

Schweiker, 656 F.2d 424, 425-27 (9th Cir. 1981)). Defendant does not indicate any prejudice

will result upon remand for consideration of this evidence. This evidence did not exist at the

time of the ALJ’s decision. When the evidence did not exist at the time of the ALJ’s decision, 

good cause can be found for plaintiff’s failure to introduce it. See id. Accordingly, the

undersigned finds a remand for further proceedings is appropriate for plaintiff to be able to

produce this new evidence in support of her application. 

V. CONCLUSION

For the foregoing reasons, this matter will be remanded under sentence four of 42

U.S.C. § 405(g) for further development of the record and/or further findings addressing the

deficiencies noted above. 

/ / /

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Accordingly, IT IS HEREBY ORDERED that:

1. Plaintiff’s motion for summary judgment is granted;

2. The Commissioner’s cross motion for summary judgment is denied;

3. This matter is remanded for further proceedings consistent with this order;

and

4. The Clerk of the Court is directed to enter judgment and close this file.

DATED: September 15, 2008

______________________________________

CRAIG M. KELLISON

UNITED STATES MAGISTRATE JUDGE

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