Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_04-cv-02312/USCOURTS-cand-3_04-cv-02312-0/pdf.json

Parties Involved:
Jo Anne B. Barnhart
Defendant
Kenneth Nong
Plaintiff

Document Text:

United States District Court

For the Northern District of California

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United States District Court

For the Northern District of California

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

KENNETH NONG,

Plaintiff,

 v

JO ANNE B BARNHART, Commissioner

of Social Security,

Defendant.

 /

No C 04-2312 VRW

 ORDER

Plaintiff Kenneth Nong appeals from the decision of the

Social Security Administration (SSA) denying his application for

social security income (SSI) under title XVI of the Social Security

Act (Act). The court has jurisdiction over the appeal pursuant to

42 USC § 405(g). The court now considers cross-motions for summary

judgment. For the reasons stated herein, the court DENIES

plaintiff’s motion and GRANTS defendant’s motion. 

\\

\\

Case 3:04-cv-02312-VRW Document 20 Filed 03/28/06 Page 1 of 11
United States District Court

For the Northern District of California

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I

Plaintiff was born on March 8, 1954, attended school

through the sixth grade in Vietnam, immigrated to the United States

in 1981 and performed no substantial gainful activity after that

date. He became a United States citizen in 1990. Plaintiff

testified to speaking Haga, a Chinese dialect, and reading Chinese

and Vietnamese. Administrative Record, Doc # 15 (AR) 43, 50, 55,

172-173, 175.

Medical records dating from before and during the

pendency of plaintiff’s disability application establish that

plaintiff underwent several medical tests, all of which were

essentially normal. A barium enema study dated March 30, 2001 was

“unremarkable.” An abdominal sonogram dated January 7, 2002 for

“right epigastric pain” was “unremarkable.” AR 97. A “biphasic

upper DI series and scout abdomen” study (more commonly known as a

barium swallow test) performed on May 31, 2002 revealed “normal

findings.” AR 100. Blood tests of the same date were negative for

hepatitis A, B and C but revealed the presence of helicobacter, AR

101, which was treated with medication, AR 114. A separate blood

panel revealed high levels of cholesterol, triglyceride and LDL. 

AR 108. A spine x-ray dated July 20, 2002 revealed “no acute

abnormalities.” AR 97. 

On July 23, 2002, plaintiff applied for SSI benefits

alleging an onset date of January 1, 1995. AR 43. His application

listed “depress [sic], lost memories, headaches, dizzyness [sic],

nightmare, back pain” as limiting his ability to work. AR 49. 

A letter dated August 14, 2002 to the Department of

Social Services by plaintiff’s treating physician Patrick Wong

Case 3:04-cv-02312-VRW Document 20 Filed 03/28/06 Page 2 of 11
United States District Court

For the Northern District of California

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assessed plaintiff as follows:

Mr Kenneth Nong has seen me on and off on several

occasions since January this year. His problem is

fatty liver and spastic colon syndrome. Recently,

he was found to have H pylori gastritis and I have

given him treatment with triple therapy. For my

stand point, I could not find any reason for his

disability.

AR 114. 

Plaintiff underwent an agency-ordered internal medicine

evaluation with William Steinsmith, MD at Bay View Medical Clinic.

A November 6, 2002 report from that evaluation relates that

plaintiff appeared with a professional translator. Findings for

all physiological systems were normal except for “History x 20-plus

years of moderate, stable, and uncomplicated chronic low back

syndrome, with moderate symptomatic/functional findings on * * *

exam, as noted.” AR 119. The report also noted “frequent tension

cephalgias and * * * episodic nonspecific light-headedness,”

presumably based on plaintiff’s report of symptoms. AR 117. An

accompanying radiology report from the Bay View Medical Clinic

found “disc narrowing at L5-S1" with “marginal anterior

hypertrophic spurring and minimal posterior hypertrophic lipping”

and “diffused minimal hypertrophic marginal lipping changes

throughout the lumbar spine.” AR 115. 

Dr Steinsmith’s report concluded that plaintiff could

bear weight for four to six hours per day with

suitable interval breaks * * * occasionally bend

and kneel and grasp and elevate floor-level

weights of 25 pounds but may experience difficulty

performing activities requiring frequent bending,

kneeling or lifting or performing activities

requiring full brisk mobilities of the trunk on

the lumbopelvic axis * * * periodically ascend or

descend a flight of stairs and [] ambulate over

several city blocks * * * safely commute via

public transportation * * * sit in a chair for

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intervals of 30 minutes, alternating with brief

intervals of altered body posture for relief of

posturally exacerbated low back discomfort * * *

[and] perform table-top manual or clerical tasks

while retaining the seated position.

AR 119.

Plaintiff also underwent an agency-ordered psychiatric

exam at the Bay View Medical Clinic with Michael Dietrick, MD. The

November 8, 2002 report from the exam made note of plaintiff’s

reported “headaches and back pain,” but concluded that plaintiff

had “no psychiatric problems” and had a GAF of 85, well above the

range associated with disabling mental health problems. The report

assessed plaintiff’s functional capacity thus: “Plaintiff is able

to follow brief three part instructions immediately and repeats

them from memory in three minutes. He denies any problems in

object relations. He relates well to the interviewer and his

interpreter. His attention span is good and he has no difficulty

concentrating. He tolerates stress well and appears to be very

adaptable.” AR 120-22.

A Physical Residual Functional Capacity Assessment dated

December 16, 2002 by internal medicine physician John Chokatos found

no significant postural or exertional limitations. AR 131-39. 

A blood panel from June 26, 2003 showed elevated levels of

cholesterol, triglyceride and LDL, but at levels closer to normal

ranges than the previous blood panel. AR 158. A July 1, 2003

barium enema was “unremarkable.” AR 157. A colonoscopy conducted

August 12, 2003 prompted by abdominal pain, diarrhea and

intermittent rectal bleeding was normal except for diagnosis of

spastic colon and internal hemorrhoids. AR 153. 

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Case 3:04-cv-02312-VRW Document 20 Filed 03/28/06 Page 4 of 11
United States District Court

For the Northern District of California

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Finally, on January 13, 2004, plaintiff’s treating

physician Josephine Mak, MD, completed a Medical Assessment of

Ability to Do Work-Related Activities (Physical). AR 163-66. The

record contains numerous clinic treatment notes reflecting

plaintiff’s regular visits to Dr Mak in 2002 and 2003 for complaints

including headaches, backaches and abdominal pains. AR 125-30; 144-

51. Dr Mak’s medical assessment stated that plaintiff had a “bone

spur” that caused pain when plaintiff walked or stood. She checked

boxes indicating that plaintiff could tolerate less than one hour of

walking/standing and less than one hour of sitting, that he could

lift and carry less than five pounds frequently (her handwritten

note stated “after carry 3 lbs pt feels back/[illegible]”), was

partially restricted from climbing stairs, was restricted in

bending, required rest periods during the day, and could not work

full-time due to headaches and backaches, and did not possess the

residual functional capacity (RFC) even for sedentary work. 

Plaintiff’s application was denied initially and upon

reconsideration. AR 24-34. He submitted a timely request for a

hearing before an Administrative Law Judge (ALJ). AR 35. 

On January 27, 2004, The ALJ opened the hearing with

plaintiff, his attorney, an interpreter, medical expert (ME) Sergio

Bella, MD, and vocational expert (VE) Gerald D Belchik, PhD,

present. AR 167-211. Plaintiff testified that he had “constant”

pain in his back whenever he moved that became less severe when he

remained stationary, AR 178, headache and dizziness, AR 181, stomach

and/or abdominal pain, AR 183, 186, and frequent feelings of

fullness in his bowels, AR 185-86. 

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United States District Court

For the Northern District of California

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Dr Bella testified that while further testing could have

been conducted regarding plaintiff’s back condition, the medical

evidence in the record “doesn’t indicate anything” and contained

“no objective information” in support of plaintiff’s claim of

disability. AR 198. “The abdominal pain,” he testified further,

“while kind of tricky, I also believe is [] a mild condition.” AR

198-99. He opined that the gastritis (presumably caused by

helicobacter) had likely resolved with antibiotics, AR 199, and

that plaintiff’s bowel symptoms could be managed through behavior

modification and, possibly, nutrition changes and were “a very

treatable problem.” AR 199-200. Dr Bella responded to questioning

from plaintiff’s attorney about whether his stated opinion that

plaintiff’s impairments were “non-severe” was intended to have the

same meaning as in the legal context for social security cases. AR

200-01. The ALJ then posed the following question: “Non-severe

impairments are, by regulation, defined as an impairment or

combination of impairments is not severe if it does not

significantly limit your physical or mental ability to do basic

work activities. Does that capsulate what you’re undertaking to

say?” to which the ME answered, “Thank you, yes.” AR 201. 

The VE testified that based on plaintiff’s lack of work

experience and education, with non-severe impairments he could

perform “numerous jobs” including “assembler” and “production

packing and packaging,” both of which could be performed at the

sedentary, light and medium exertional levels. AR 206-07.

Plaintiff’s attorney then elicited from the VE testimony that: an

individual who could not sit for more than thirty minutes could not

perform sedentary work; that there are no light work jobs “that

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don’t require some body movement”; and that taking ten to fifteen

unscheduled breaks per month would be inconsistent with maintaining

employment. AR 208-09.

On February 3, 2004, the ALJ issued a decision finding

plaintiff not disabled because he had no severe impairments. AR

11-16. Applying the five-step sequential disability analysis set

forth at 20 CFR § 416.920 (infra), the ALJ found that plaintiff had

engaged in no substantial gainful activity since the alleged onset

date (step one) and that he had no severe impairment or combination

of impairments — that is, that “significantly limits an

individual’s physical or mental ability to do basic work

activities” (step two). AR 12. Having found no severe impairment,

the ALJ found plaintiff not disabled. The decision stated that the

medical record provides “no objective evidence that the claimant

has significant limits on his physical or mental ability to do

basic work activities,” and contained a detailed recital of all the

medical reports previously mentioned above. AR 12-14. 

The ALJ discounted the one medical report — by treating

physician Dr Mak — that found him disabled and also discounted

plaintiff’s own testimony. Regarding Dr Josephine Mak’s RFC

assessment, the ALJ commented that there is “no objective medical

evidence on which to base these opinions” and that it appeared to

be advocacy. AR 14. In support of his finding that “claimant’s

allegations and subjective complaints are not totally credible and

not supported by substantial medical evidence,” AR 12, the ALJ

noted that plaintiff drove his son to school, walked twenty minutes

per day and shopped, activities “inconsistent with his testimony

that he is only able to stand for 10 minutes at a time.” AR 14. 

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The Appeals Council declined review, making the ALJ's

decision final. AR 4-6. Plaintiff timely requested judicial

review. 

II

In appealing the SSA’s final decision, plaintiff contends

the ALJ erred in discounting his own testimony and Dr Mak’s

assessment and contends that the ALJ failed to assess his

impairments alone or in combination, failed to assess his

subjective complaints of pain properly and improperly rejected the

testimony of the VE. The court disagrees with these contentions. 

On the contrary, the ALJ applied the SSA’s regulations governing

disability determinations correctly. Because his conclusions are

supported by substantial evidence, the court affirms his decision. 

The court's jurisdiction is limited to determining

whether the SSA's denial of benefits is supported by substantial

evidence in the administrative record. 42 USC § 405(g). A

district court may overturn a decision to deny benefits only if the

decision is not supported by substantial evidence or if the

decision is based on legal error. See Andrews v Shalala, 53 F3d

1035, 1039 (9th Cir 1995); Magallanes v Bowen, 881 F2d 747, 750

(9th Cir 1989). The Ninth Circuit defines "substantial evidence"

as "more than a mere scintilla but less than a preponderance; it is

such relevant evidence as a reasonable mind might accept as

adequate to support a conclusion." Andrews, 53 F3d at 1039. 

The SSA’s regulations specify in detail how an ALJ is to

approach the task of determining whether a claimant is disabled. 

20 CFR § 416.920 sets forth a five-step sequential analysis for

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ALJs to use in evaluating claims of disability: (1) first, the ALJ

considers whether the claimant is currently employed in substantial

gainful activity; (2) if not, the second step asks whether the

claimant has a severe impairment; (3) in step three, the ALJ

determines whether the claimant has a condition which meets or

equals any listed condition according to the criteria set forth in

the Listings of Impairments in Appendix 1, Subpart P of Part 404;

(4) if the claimant does not have such a condition, step four asks

whether the claimant can perform his past relevant work; (5) if

not, in step five the ALJ considers whether the claimant has the

ability to perform other work which exists in substantial numbers

in the national economy. 20 CFR § 416.960(c). The ALJ’s analysis

of plaintiff’s disability stopped at step two with a determination

that he has no severe impairment or combination of impairments. 

In addition, the regulations cover in detail how

different types of evidence are to be weighed against each other. 

Several provisions are directly on point in this case. 20 CFR §

416.929(b), entitled “how we evaluate symptoms, including pain,”

effectively disposes of plaintiff’s challenges to the ALJ’s

handling of his pain testimony: 

Your symptoms, such as pain * * * will not be found

to affect your ability to do basic work activities

unless medical signs or laboratory finding show

what a medically determinable impairment(s) is

present. Medical signs and laboratory findings,

established by medically acceptable clinical or

laboratory diagnostic techniques, must show the

existence of a medical impairment(s) which results

from anatomical [or] physiological * * *

abnormalities and which would reasonably be

expected to produce the pain or other symptoms

alleged.

Substantial evidence in the record supports the ALJ’s conclusion

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that the required medical signs and laboratory findings that would

require him to give credence to plaintiff’s pain testimony are

absent. The ME observed that other tests were available to assess

plaintiff’s back, but that the evidence in the record showed only

“minimal” changes. AR 198, 202-03. The clear thrust of the ME’s

testimony was that the changes noted on plaintiff’s x-ray could not

“reasonably be expected to produce the pain or other symptoms

alleged.”

20 CFR § 416.927(d), in the regulation entitled

“evaluating opinion evidence,” covers “how we weigh medical

opinions.” It explains that the ALJ evaluates every medical

opinion and generally gives more weight to treating sources. A

treating physician’s opinion is given “controlling weight” only if

“well-supported by medically acceptable clinical and laboratory

diagnostic techniques and not inconsistent with the other

substantial evidence” in the record. In this case, the ALJ

properly gave controlling weight to the opinion of Dr Wong, but did

not do so with the opinion of Dr Mak. If an ALJ does not give

controlling weight to a treating source, he must consider other

factors, including length of the treatment relationship and

frequency of examination, nature and extent of the treatment

relationship, supportability, consistency, specialization and other

factors. § 416.927(d)(2)-(6). Regarding supportability, the

regulation provides: “[t]he more a medical source presents relevant

evidence to support an opinion, particularly medical signs and

laboratory findings, the more weight we will give that opinion.” 

§ 416.927(d)(3). This disposes of plaintiff’s challenge to the

ALJ’s decision to discount the opinion of Dr Mak, as her opinion

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was not supported by medical signs and laboratory findings and was

contrary to substantial other evidence in the record. Moreover,

“[a] physician’s opinion of disability ‘premised to a large extent

upon the claimant’s own accounts of his symptoms and limitations’

may be disregarded where those complaints have been ‘properly

discounted.’” Morgan v Comm’r of Soc Sec Admin, 169 F3d 595, 602

(9th Cir 1999), quoting Fair v Bowen, 885 F2d 597, 603 (9th Cir

1989). The ALJ is responsible for resolving conflicts in medical

testimony and resolving ambiguity. Morgan, 169 F3d at 603. 

The ALJ’s decision specifies in detail the weight he gave

to the testimony or opinion of each witness or opining medical

doctor. The ALJ’s weighing of the evidence is well-supported by

substantial evidence in the record. The ALJ’s failure to discuss

the VE’s testimony was not error because substantial evidence

supported his determinations that plaintiff did not have any severe

impairment or combination of impairments and was not disabled. 

 The clerk is directed to enter judgment in favor of

defendant and against plaintiff. The clerk is further directed to

close the file and terminate all pending motions. 

IT IS SO ORDERED.

 

VAUGHN R WALKER

United States District Chief Judge

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