Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-2_14-cv-01693/USCOURTS-caed-2_14-cv-01693-6/pdf.json

Parties Involved:
Sohaila Azizi
Plaintiff
Commissioner of Social Security
Defendant

Document Text:

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UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

SOHAILA AZIZI,

Plaintiff,

v.

CAROLYN W. COLVIN, Acting 

Commissioner of Social Security,

Defendant.

No. 2:14-cv-1693-CKD

ORDER

Plaintiff seeks judicial review of a final decision of the Commissioner of Social Security 

(“Commissioner”) finding plaintiff was not disabled for purposes of receiving Disability 

Insurance Benefits (“DIB”) under Title II of the Social Security Act (“Act”). For the reasons 

discussed below, the court will recommend that plaintiff’s motion for summary judgment be 

denied and that the Commissioner’s cross-motion for summary judgment be granted.

I. BACKGROUND

Plaintiff, born June 15, 1973, applied on February 2, 2011 for DIB, alleging disability 

beginning October 1, 2009. Administrative Transcript (“AT”) 172-78. Plaintiff alleged she was 

unable to work due to severe back pain, arm and leg pain, and headaches, among other issues. 

AT 231. In a decision dated January 29, 2013, the ALJ determined that plaintiff was not 

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disabled.

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 AT 21-32. The ALJ made the following findings (citations to 20 C.F.R. omitted):

1. The claimant meets the insured status requirements of the Social 

Security Act through December 31, 2014.

2. The claimant has not engaged in substantial gainful activity 

since October 1, 2009, the alleged onset date.

3. The claimant has the following severe impairments: lumbar 

degenerative disc disease, status post lumbar spine surgery, and 

depression.

4. The claimant does not have an impairment or combination of 

impairments that meets or medically equals the severity of one of 

the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 

1.

 

1 Disability Insurance Benefits are paid to disabled persons who have contributed to the 

Social Security program, 42 U.S.C. § 401 et seq. Supplemental Security Income is paid to 

disabled persons with low income. 42 U.S.C. § 1382 et seq. Both provisions define disability, in 

part, as an “inability to engage in any substantial gainful activity” due to “a medically 

determinable physical or mental impairment. . . .” 42 U.S.C. §§ 423(d)(1)(a) & 1382c(a)(3)(A). 

A parallel five-step sequential evaluation governs eligibility for benefits under both programs. 

See 20 C.F.R. §§ 404.1520, 404.1571-76, 416.920 & 416.971-76; Bowen v. Yuckert, 482 U.S. 

137, 140-142, 107 S. Ct. 2287 (1987). The following summarizes the sequential evaluation: 

Step one: Is the claimant engaging in substantial gainful 

activity? If so, the claimant is found not disabled. If not, proceed 

to step two. 

Step two: Does the claimant have a “severe” impairment? 

If so, proceed to step three. If not, then a finding of not disabled is 

appropriate. 

Step three: Does the claimant’s impairment or combination 

of impairments meet or equal an impairment listed in 20 C.F.R., Pt. 

404, Subpt. P, App.1? If so, the claimant is automatically 

determined disabled. If not, proceed to step four. 

Step four: Is the claimant capable of performing his past 

work? If so, the claimant is not disabled. If not, proceed to step 

five. 

Step five: Does the claimant have the residual functional 

capacity to perform any other work? If so, the claimant is not

disabled. If not, the claimant is disabled.

 

Lester v. Chater, 81 F.3d 821, 828 n.5 (9th Cir. 1995). 

The claimant bears the burden of proof in the first four steps of the sequential evaluation 

process. Bowen, 482 U.S. at 146 n.5, 107 S. Ct. at 2294 n.5. The Commissioner bears the 

burden if the sequential evaluation process proceeds to step five. Id.

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5. After careful consideration of the entire record, the undersigned 

finds that the claimant had the residual functional capacity to 

perform light work as defined in 20 C.F.R. § 404.1567(b) with the 

following limitations: The claimant is capable of standing and/or 

walking for a total of four hours during an eight-hour workday and 

sitting for a total of six hours. The claimant is capable of lifting 

and/or carrying 10 pounds frequently and 20 pounds occasionally. 

The claimant is capable of occasionally stooping, crouching, 

kneeling, squatting, and crawling. The claimant can occasionally 

push right leg foot controls. The claimant can rarely climbing [sic] 

ladders. The claimant is capable of performing unskilled work.

6. The claimant is unable to perform any past relevant work.

7. The claimant was born on June 15, 1973 and was 36 years old, 

which is defined as a younger individual age 18-49, on the alleged 

disability onset date.

8. The claimant has a limited education and is able to communicate 

in English.

9. Transferability of job skills is not material to the determination 

of disability because using the Medical-Vocational Rules as a 

framework supports a finding that the claimant is “not disabled,” 

whether or not the claimant has transferrable job skills.

10. Considering the claimant’s age, education, work experience, 

and residual functional capacity, there are jobs that exist in 

significant numbers in the national economy that the claimant can

perform.

11. The claimant has not been under a disability, as defined in the 

Social Security Act, from October 1, 2009, through the date of this 

decision.

AT 23-31.

II. ISSUES PRESENTED

Plaintiff argues that the ALJ committed the following errors in finding plaintiff not 

disabled: (1) failed to find that plaintiff meets Listing 1.04A, Disorders of the Spine; (2) failed to 

call a medical expert at the hearing; (3) improperly assessed the medical opinion evidence in the 

record when determining plaintiff’s residual functional capacity (“RFC”); (4) improperly found 

plaintiff’s testimony to be not credible; (5) posed a hypothetical to the vocational expert (“VE”) 

at step five of the analysis that failed to take into consideration all of plaintiff’s impairments.

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III. LEGAL STANDARDS

When previously granted benefits are terminated by the Commissioner, the burden of 

proof ordinarily shifts. Rather than resting on a current recipient of disability benefits to prove 

that he or she is disabled, the burden rests on the Commissioner to prove that the applicant is no 

longer disabled. “Once a claimant has been found to be disabled, . . .a presumption of continuing 

disability arises in [his] favor[, and the Commissioner] bears the burden of producing evidence 

sufficient to rebut this presumption of continuing disability.” Bellamy v. Secretary of Health & 

Human Serv., 755 F. 2d 1380, 1381 (9th Cir. 1985); see also Saltzman v. Apfel, 125 F. Supp. 2d 

1014 (C.D. Cal. 2000) (same). This evidence then is reviewed under the substantial evidence 

standard. Saltzman, 125 F. Supp. 2d at 1019 (citing Murray v. Heckler, 722 F.2d 499, 500 (9th 

Cir. 1983)). 

Substantial evidence means more than a mere scintilla of evidence, but less than a 

preponderance. Saelee v. Chater, 94 F.3d 520, 521 (9th Cir. 1996) (citing Sorenson v. 

Weinberger, 514 F.2d 1112, 1119 n.10 (9th Cir. 1975)). “It means such evidence as a reasonable 

mind might accept as adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 

402, 91 S. Ct. 1420 (1971) (quoting Consolidated Edison Co. v. N.L.R.B., 305 U.S. 197, 229, 59 

S. Ct. 206 (1938)). The record as a whole must be considered, Howard v. Heckler, 782 F.2d 

1484, 1487 (9th Cir. 1986), and both the evidence that supports and the evidence that detracts 

from the ALJ’s conclusion weighed. See Jones v. Heckler, 760 F.2d 993, 995 (9th Cir. 1985). 

The court may not affirm the ALJ’s decision simply by isolating a specific quantum of supporting 

evidence. Id.; see also 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 

finding of either disability or nondisability, the finding of the ALJ is conclusive, see Sprague v. 

Bowen, 812 F.2d 1226, 1229-30 (9th Cir. 1987), 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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IV. ANALYSIS

A. The ALJ did Not Err in Determining that Plaintiff’s Impairments did Not Meet the 

Criteria of Listing 1.04A

Plaintiff contends she meets Listing 1.04 (disorders of the spine) because of her 

degenerative disc disease and spinal stenosis. Plaintiff asserts that the ALJ erred by finding that 

plaintiff’s impairments did not meet the requirements for this listing.

At step three, the ALJ determines whether “a claimant’s impairment meets or equals an 

impairment listed in [20 C.F.R. part 404, subpart P, appendix 1].” Tackett v. Apfel, 180 F.3d 

1094, 1099 (9th Cir. 1999). The Listing of Impairments describes specific impairments of each 

of the major body systems “which are considered severe enough to prevent a person from doing 

any gainful activity.” Id. (citing 20 C.F.R. § 404.1525). If a claimant meets or equals a listed 

impairment he or she will be found disabled at this step without further inquiry. Tackett, 180 

F.3d at 1099 (citing 20 C.F.R. § 404.1520(d)).

A claimant bears the burden of proving that his or her impairments satisfy all the criteria 

of a particular listing. Tackett, 180 F.3d at 1099 (“[Claimant] had to establish that he [or she] met 

or equaled each of the following characteristics of a listing.”). “For a claimant to show that his 

[or her] impairment matches a listing, it must meet all of the specified medical criteria. An 

impairment that manifests only some of those criteria, no matter how severely, does not qualify.” 

Sullivan v. Zebley, 493 U.S. 521, 530 (1990) (emphasis in original). If a claimant’s impairment 

or combination of impairments meets or exceeds a “listing,” no specific finding is necessary as to 

the claimant’s ability to perform his or her past relevant work or any other jobs. 20 C.F.R. § 

404.1520(d). 

Listing 1.04A requires:

Evidence of nerve root compression characterized by neuro-anatomic distribution 

of pain, limitation of motion of the spine, motor loss (atrophy with associated 

muscles weakness or muscle weakness) accompanied by sensory or reflex loss 

and, if there is involvement of the lower back, positive straight-leg raising test 

(sitting and supine).

20 C.F.R. pt. 404, subpt. P, app. 1, § 1.04A. In other words, evidence of both motor loss (i.e., 

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muscle weakness or atrophy associated therewith) and sensory or reflex loss, in addition to 

limitation of motion of the spine, is required. Furthermore, “a report of atrophy should be 

accompanied by measurement of the strength of the muscle(s) in question generally based on a 

grading system of 0 to 5, with 0 being complete loss of strength and 5 being maximum strength.” 

Id. § 1.00E(1).

The ALJ adequately and accurately summarized the medical records and noted that

“the medical evidence of record does not support a finding that the claimant’s impairments result 

in compromise of a nerve root or the spinal cord, as required under Listing 1.04. Additionally, no 

treating or examining physician has recorded findings equivalent in severity to the criteria of any 

listed impairment, nor does the evidence show medical findings that are the same or equivalent to 

those of any listed impairment.” AT 24. The ALJ was not required to address in more detail why 

plaintiff did not meet or equal a Listing. See Gonzalez v. Sullivan, 914 F.2d 1197, 1201 (9th Cir. 

1990).

More importantly, the ALJ’s determination that plaintiff did not meet all of the 

requirements of Listing 1.04A was supported by substantial evidence in the record. While there 

is evidence in the record of moderate nerve root compression, see, e.g., AT 465-66, 552, 554, and 

that plaintiff had spinal range of motion limitations, see, e.g., AT 325, 341, 452, there was 

substantial medical evidence suggesting that plaintiff did not have muscle weakness and sensory 

or reflex loss as required by Listing 1.04A. In particular, while there is some evidence that 

plaintiff suffered minor motor loss on her right side, AT 338, 343, 346-47, the bulk of the medical 

findings in the record note that plaintiff suffered no muscle weakness, e.g., AT 400 (“Motor 

strength 5/5 in all extremities.”), 451-52 (finding “no evidence of muscle atrophy or spasm” with 

regard to any portion of plaintiff’s body, including lower back and extremities), 453 (finding 

motor strength limitations, but determining that the limitations were “secondary to effort and pain 

and do[ ] not represent a true neurologic insult”), 464 (“Tone, bulk, and strength are normal in all 

muscle groups.”). Similarly, the medical evidence generally demonstrates that plaintiff had intact 

sensation, with normal reflexes. E.g., AT 330, 345 (“Sensory exam is intact.”), 346 (“Sensation 

is intact.”), 453 (noting normal sensation and reflexes in all extremities).

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While plaintiff asserts that some of the medical findings in the record support a 

determination that she meets the Listing 1.04A muscle weakness and sensory or reflex loss

requirements, it was the ALJ’s prerogative to resolve the conflict between this evidence and the

above evidence that indicated that plaintiff did not meet these requirements. Molina v. Astrue, 

674 F.3d 1104, 1111 (9th Cir. 2012) (“Even when the evidence is susceptible to more than one 

rational interpretation, we must uphold the ALJ’s findings if they are supported by inferences 

reasonably drawn from the record.”). The ALJ addressed and weighed the above medical 

findings from the record and came to the reasonable conclusion that plaintiff’s impairments did 

not meet or equal the requirements of Listing 1.04A. Indeed, as noted above, there was 

substantial evidence to support the ALJ’s conclusion that plaintiff’s spinal impairment was not 

limiting in a way that satisfied all of the requirements of Listing 1.04A. Even if there may have 

some been evidence in the record indicating to the contrary, the court is required to adopt the 

ALJ’s rational interpretation of the evidence, which demonstrates that plaintiff’s impairments did 

not meet all of the requirements of Listing 1.04. See Molina, 674 F.3d at 1111.

Given the above medical findings in the record, there was substantial evidence upon 

which the ALJ could draw her conclusion that plaintiff’s impairments did not meet or equal the 

requirements of Listing 1.04A. Accordingly, the ALJ did not err in finding that plaintiff did not 

meet a listing at step three.

B. The ALJ’s Decision to Not Call a Medical Expert to Testify at the Hearing

was Not Erroneous

Plaintiff next contends that the ALJ erred by not obtaining the testimony of a medical 

expert regarding whether plaintiff’s impairments met or equaled the criteria of Listing 1.04A. 

Plaintiff claims that an unspecified “longstanding policy” required the ALJ to obtain “expert 

opinion evidence from a physician . . . designated by the Commissioner on the issue of 

equivalence.” ECF No. 21 at 14.

20 C.F.R. § 404.1527(e)(2)(3) provides that the ALJ “may also ask for and consider 

opinions from medical experts on the nature and severity of [the claimant’s] impairment(s) and on 

whether [the claimant’s] impairment(s) equals the requirements of any impairment listed in 

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appendix 1 to [subpart P].” “When [the ALJ] consider[s] these opinions, [the ALJ] will evaluate 

them using the rules [that are used to weigh other medical opinions].” 20 C.F.R. § 

404.1527(e)(2)(3). As stated in this regulation, and contrary to plaintiff’s assertion, the ALJ in 

this case was permitted to obtain and consider the opinion of a medical expert on the subject of 

whether plaintiff’s impairments met or equaled a listing, but was not mandated to do so. As noted 

above, there was sufficient medical opinion evidence in the record, which included the opinions 

of plaintiff’s treating physicians, consultative examining physicians, and non-examining 

physicians who reviewed plaintiff’s medical records, on which the ALJ could and did draw her 

step three conclusion. Accordingly, plaintiff’s contention lacks merit.

C. The ALJ Properly Assessed the Medical Opinion Evidence

Third, plaintiff asserts that the ALJ erred by giving “little weight” to the medical opinion 

of Dr. Bahandari, one of plaintiff’s treating physicians, and “great weight” to the opinion of Dr. 

Pon, an examining physician.

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

treating, examining, or non-examining professionals. Lester v. Chater, 81 F.3d 821, 830 (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. Id.; Smolen v. Chater, 80 

F.3d 1273, 1285 (9th Cir. 1996). 

To evaluate whether an ALJ properly rejected a medical opinion, in addition to 

considering its source, the court considers whether (1) contradictory opinions are in the record, 

and (2) clinical findings support the opinions. An ALJ may reject an uncontradicted opinion of a 

treating or examining medical professional only for “clear and convincing” reasons. Lester, 81 

F.3d at 831. In contrast, a contradicted opinion of a treating or examining professional may be 

rejected for “specific and legitimate” reasons that are supported by substantial evidence. Id. at 

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

contradicted by a supported examining professional’s opinion (e.g., supported by different 

independent clinical findings), the ALJ may resolve the conflict. Andrews v. Shalala, 53 F.3d 

1035, 1041 (9th Cir. 1995) (citing Magallanes v. Bowen, 881 F.2d 747, 751 (9th Cir. 1989)). In 

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any event, the ALJ need not give weight to conclusory opinions supported by minimal clinical 

findings. Meanel v. Apfel, 172 F.3d 1111, 1113 (9th Cir.1999) (treating physician’s conclusory, 

minimally supported opinion rejected); see also Magallanes, 881 F.2d at 751. The opinion of a 

non-examining professional, without other evidence, is insufficient to reject the opinion of a 

treating or examining professional. Lester, 81 F.3d at 831.

Here, Dr. Bhandari issued a medical source statement regarding the impact plaintiff’s 

physical impairments had on her ability to perform work-related activities on November 29, 2011. 

AT 558-61. In this report, Dr. Bhandari noted that he had been plaintiff’s treating physician since 

April of 2005. AT 558. He diagnosed plaintiff with degenerative disc disease of the lumbar 

region of the cervical spine, depression, osteoarthritis of the hands and right knee, and a disc 

bulge at L3-4. Id. Dr. Bhandari further noted that these impairments caused plaintiff to suffer 

from lower back pain that radiates into her right leg and that increases in intensity when she 

stands, walks, or bends down. Id. He also noted that plaintiff suffered knee pain and mental 

stress and depression and would become easily fatigued. Id. Furthermore, he noted that plaintiff 

had a reduced range of motion in her lumbar area and had a positive straight leg raise test at 30 

degrees for her right leg. Id. at 559. He also stated that an MRI of plaintiff’s back taken on April 

22, 2010 “showed disc bulge at L3-4” and “spinal stenosis at L1-L2.” Id. at 558.

With regard to the impact plaintiff’s impairments had on her ability to perform workrelated functions, Dr. Bhandari opined that plaintiff could walk no more than 3 blocks without 

needing rest or suffering severe pain. Id. at 559. He further opined that plaintiff could sit for no 

more than 20 minutes and stand for no more than 10 minutes at a time. Id. He also opined that 

plaintiff could sit, stand, and walk for less than 2 hours total in an 8-hour workday. Id. However, 

he found that plaintiff’s impairments not require a job that permits shifting from sitting, standing, 

and walking positions at will. Id. Furthermore, he determined that plaintiff needed to walk every 

20 minutes for 5 minutes at a time. Id. at 560. He also found that plaintiff would need to take 

unscheduled work breaks every 20 to 30 minutes for an average of 20 minutes at a time. Id. He 

further opined that while plaintiff did not need to have her legs elevated when sitting for 

prolonged periods, she would need a cane when engaging in occasional standing and walking. Id. 

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Dr. Bhandari also determined that plaintiff could rarely lift less than 10 pounds, twist, or climb 

ladders or stairs, and could never stoop, crouch, or squat. Id. He also determined that plaintiff 

had mild-to-moderate limitations regarding reaching, handling, and fingering activities. Id. at 

560-61. He further opined that plaintiff’s symptoms would cause plaintiff to likely be “off task” 

while at work for up to 10% of the time. Id. 561. Finally, Dr. Bhandari opined that plaintiff is 

“incapable of performing even ‘low stress’ work” due to her continuous lower back pain and 

depression. Id.

The ALJ assigned “little weight” to Dr. Bhandari’s opinion for the following reasons: 

Dr. Bhandari’s opinion is inconsistent with the medical evidence of record. He 

diagnosed the claimant with spinal stenosis at the L1-2 level, and disc bulge at the 

L3-4 level, which was contradicted by the MRIs taken in July 2012. Additionally, 

Dr. Bhandari identified limitations secondary to right knee pain that are not 

supported by the record, as the claimant only complained of right knee pain in 

December 2012, and Dr. Bhandari did not perform regular testing to demonstrate 

these limitations. Furthermore, while Dr. Bhandari supposedly prescribed a 

walker in July 2012, there are no treatment notes during the summer of 2012 

mentioning a walker. Based on the treatment record, it appears the claimant 

initially requested a walker in December 2012.

AT 28 (citations to the record omitted). As discussed below, these were proper reasons for 

discounting Dr. Bhandari’s opinion that were based on substantial evidence from the record.

First, the ALJ correctly noted that Dr. Bhandari’s diagnosis of spinal stenosis at the L1-2 

level and disc bulge at the L3-4 level is contradicted by the MRI results in the record. Indeed, on 

September 24, 2009, an MRI was taken of plaintiff’s back, which demonstrated “no evidence of 

canal stenosis” at the L1-2 level and “normal” findings for a person of plaintiff’s age at the L3-4 

level. AT 383-84. On April 22, 2010, a second MRI result showed that there was”[n]o 

substantial or foraminal stenosis . . . present” at the L1-2 level and a “minimal broad-based 

posterior disc bulge” at the L3-4 level. AT 327. However, a third MRI taken on April 4, 2011 

indicated that plaintiff did not have a disc bulge at L3-4 and “slight discal narrowing” at L1-2 that 

did not cause nerve root compression. AT 466. A final MRI result taken after Dr. Bhandari 

issued his opinion indicated that the discal narrowing at L1-2 had become “moderate” and that a 

“mild posterior disc bulge” was present at the L3-4 level. AT 552.

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While there is evidence of a disc bulge at the L3-4 level in the MRI dated April 22, 2010, 

neither of the other two MRIs that had been taken prior to Dr. Bhandari’s opinion provided such a 

finding. Moreover, none of the MRIs in the record showed that plaintiff suffered from spinal 

stenosis at the L1-2 level. While there was some narrowing indicated at this level, the MRI 

results specifically noted that there was no nerve root compression, which is necessary for a 

diagnosis of spinal stenosis. Dr. Bhandari specifically stated in his opinion that the April 22, 

2010 MRI showed that plaintiff had spinal stenosis at the L1-2 level despite the MRI report 

stating that there was ”[n]o substantial or foraminal stenosis . . . present” at this level. AT 327, 

558. The ALJ properly resolved the conflict between Dr. Bhandari’s opinion and the MRI results 

in the record by reasonably determining that Dr. Bhandari’s opinion was entitled to only reduced 

weight. See Andrews, 53 F.3d at 1039 (9th Cir.1995) (noting that it is the responsibility of the 

ALJ to resolve conflicts and ambiguities in the medical record and determine the credibility of 

medical sources). 

Plaintiff asserts that this contradiction should not be sufficient to discount Dr. Bhandari’s 

opinion because it is possible that Dr. Bhandari merely mislabeled the location of the disc bulge 

and stenosis on plaintiff’s spine, which does not diminish the limitations he opined. This 

argument is without merit, however, because plaintiff provides no evidence demonstrating that 

this was the case. The ALJ reasonably interpreted the evidence that was before her to determine 

that Dr. Bhandari’s opinion conflicted with the objective medical findings contained in plaintiff’s 

MRI reports, thus entitling it to diminished weight.

Second, the ALJ’s determination that the limitations secondary to knee pain opined by Dr. 

Bhandari were not supported by the medical record established prior to the time he issued his 

opinion was proper and well supported by the record. Plaintiff argues that this determination is 

incorrect because the record supports Dr. Bhandari’s opinion regarding the existence of plaintiff’s 

knee pain at the time of Dr. Bhandari’s opinion. However, the portions of the record plaintiff 

refers to in support of her argument do not actually indicate that plaintiff specifically suffered 

from the knee pain opined by Dr. Bhandari. For instance, plaintiff references medical records 

that were issued prior to Dr. Bhandari’s opinion that indicate that plaintiff had difficulties walking 

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on her heels and toes and had positive straight leg raise tests. E.g., AT 363. However, there is no 

indication from these records that any of these complications caused plaintiff to experience knee 

pain or resulted from the knee pain Dr. Bhandari opined. Furthermore, a review of the medical 

record, including Dr. Bhandari’s own treating notes, from the period prior to Dr. Bhandari’s 

opinion does not generally reveal findings that would support Dr. Bhandari’s opinion that 

plaintiff suffered limitations secondary to knee pain. See, e.g., AT 484 (noting only complaints 

of “back pain from shoulder to hip”), 486-87 (lower back pain), 489-90 (pain in back, left foot, 

and right heel). But see AT 485 (noting plaintiff’s complaint of right knee pain). Indeed, as the 

ALJ noted in her decision, the record indicates that plaintiff herself did not complain specifically 

to Dr. Bhandari about her knee pain until December of 2012, AT 545, well after Dr. Bhandari 

issued his opinion. Accordingly, the ALJ properly relied on the specific finding that Dr. 

Bhandari’s opinion that plaintiff suffered limitations secondary to knee pain was not sufficiently 

supported by the medical findings in the record as an additional reason for assigning diminished 

weight to Dr. Bhandari’s opinion. See Batson v. Comm’r of Soc. Sec. Admin., 359 F.3d 1190, 

1195 (9th Cir. 2004) (“[A]n ALJ may discredit treating physicians’ opinions that are conclusory, 

brief, and unsupported by the record as a whole . . . or by objective medical findings.”) (citations 

omitted).

Finally, the ALJ highlighted that while Dr. Bhandari’s treatment notes state that he 

prescribed plaintiff a walker in July of 2012, those same notes indicate that plaintiff first 

requested a walker in December of 2012. Plaintiff argues that this apparent inconsistency does 

not support the ALJ’s conclusion to give Dr. Bhandari’s opinion reduced weight because there is 

no indication in the record as to why plaintiff waited until December of 2012 to fill the 

prescription for a walker Dr. Bhandari issued in July of 2012. Regardless, it was within the 

ALJ’s power to resolve this apparent conflict in Dr. Bhandari’s treatment notes. See Meanel v. 

Apfel, 172 F.3d 1111, 1113 (9th Cir. 1999) (citing Andrews, 53 F.3d at 1039) (“The ALJ is 

responsible for determining credibility, resolving conflicts in medical testimony, and for resolving 

ambiguities.”). She did so by reasonably determining that this discrepancy in Dr. Bhandari’s 

treatment notes undermined the credibility of his opinion. Therefore, the ALJ did not err in citing 

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this discrepancy in support of her determination that Dr. Bhandari’s opinion was entitled to 

reduced weight.

In sum, the inconsistencies the ALJ noted between Dr. Bhandari’s opinion and the rest of 

the medical record were supported by substantial evidence and properly supported the ALJ’s 

determination that Dr. Bhandari’s opinion was entitled to only “little weight” in the ALJ’s 

consideration of plaintiff’s RFC. Accordingly, the ALJ did not err in addressing Dr. Bhandari’s 

opinion in the manner that she did.

Similarly, the ALJ did not err in assigning “great weight” to the medical opinion of Dr. 

Pon. The ALJ’s RFC determination largely paralleled Dr. Pon’s opinion regarding the extent of 

plaintiff’s functional limitations. See AT 25, 507. The ALJ reasoned that Dr. Pon’s opinion was 

entitled to great weight because it was largely consistent with the record as a whole and, in 

particular, with the evidence showing that plaintiff had only “mild” disc narrowing in the lumbar 

spine and could ambulate effectively without the use of an assistive device. AT 28. The ALJ 

also highlighted the fact that Dr. Pon based his opinion on his own medical examination of 

plaintiff. Id. Plaintiff argues, however, that Dr. Pon’s medical findings actually support Dr. 

Bhandari’s opinion regarding the extent of plaintiff’s limitations because Dr. Pon’s clinical 

findings showed that plaintiff exhibited pain inhibition weakness in her lower right extremity, a 

sensory impairment in her right foot, and had positive straight leg raising tests in both the supine 

and sitting positions. However, the ALJ properly assigned diminished weight to Dr. Bhandari’s 

opinion for the reasons stated above and a review of the record shows that the ALJ reasonably 

determined that Dr. Pon’s opinion is generally consistent with the overall medical evidence in the 

record, including Dr. Pon’s own examination findings. Accordingly, plaintiff fails to show that 

the ALJ erred in considering Dr. Pon’s opinion when determining plaintiff’s RFC.

D. The ALJ Properly Assessed Plaintiff’s Credibility

Fourth, plaintiff argues that the ALJ erred by finding plaintiff’s testimony to lack 

credibility with regard to the intensity, persistence, and limiting effects of her impairments.

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The ALJ determines whether a disability applicant is credible, and the court defers to the 

ALJ’s discretion if the ALJ used the proper process and provided proper reasons. See, e.g., 

Saelee v. Chater, 94 F.3d 520, 522 (9th Cir. 1995). If credibility is critical, the ALJ must make an 

explicit credibility finding. Albalos v. Sullivan, 907 F.2d 871, 873-74 (9th Cir. 1990); Rashad v. 

Sullivan, 903 F.2d 1229, 1231 (9th Cir. 1990) (requiring explicit credibility finding to be 

supported by “a specific, cogent reason for the disbelief”). 

In evaluating whether subjective complaints are credible, the ALJ should first consider 

objective medical evidence and then consider other factors. Bunnell v. Sullivan, 947 F.2d 341, 

344 (9th Cir. 1991) (en banc). If there is objective medical evidence of an impairment, the ALJ 

then may consider the nature of the symptoms alleged, including aggravating factors, medication, 

treatment and functional restrictions. See id. at 345-47. The ALJ also may consider: (1) the 

applicant’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, and (3) the applicant’s daily activities. Smolen v. Chater, 80 F.3d 

1273, 1284 (9th Cir. 1996); see generally SSR 96-7P, 61 FR 34483-01; SSR 95-5P, 60 FR 55406-

01; SSR 88-13. Work records, physician and third party testimony about nature, severity and 

effect of symptoms, and inconsistencies between testimony and conduct also may be relevant. 

Light v. Social Security Administration, 119 F.3d 789, 792 (9th Cir. 1997). A failure to seek 

treatment for an allegedly debilitating medical problem may be a valid consideration by the ALJ 

in determining whether the alleged associated pain is not a significant nonexertional impairment. 

See Flaten v. Secretary of HHS, 44 F.3d 1453, 1464 (9th Cir. 1995). The ALJ may rely, in part, 

on his or her own observations, see Quang Van Han v. Bowen, 882 F.2d 1453, 1458 (9th Cir. 

1989), which cannot substitute for medical diagnosis. Marcia v. Sullivan, 900 F.2d 172, 177 n.6 

(9th Cir. 1990). “Without affirmative evidence showing that the claimant is malingering, the 

Commissioner’s reasons for rejecting the claimant’s testimony must be clear and convincing.” 

Morgan v. Commissioner of Social Sec. Admin., 169 F.3d 595, 599 (9th Cir. 1999).

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Here, the ALJ gave the following reasons for finding plaintiff’s testimony less than 

credible:

After careful consideration of the evidence, the undersigned finds that the claimant’s 

medically determinable impairments could reasonably be expected to cause the 

alleged symptoms; however the claimant’s statements concerning the intensity, 

persistence and limiting effects of these symptoms are not entirely credible for the 

reasons explained in this decision. The claimant’s reports regarding the frequency 

of her medical treatment is not supported by the record. The claimant’s account of 

the frequency of assistance received from her sister is also inconsistent with her 

sister’s reports. The claimant alleges side effects from medication, but the medical 

evidence does not support this allegation. In addition, during the claimant’s 

consultative psychological examination, she engaged in “behaviors suggestive [of]

decreased motivation and effort.”

AT 30 (citations the record omitted).

First, the ALJ reasoned that plaintiff’s statements regarding the frequency she received 

medical treatment from certain physicians and family members were inconsistent with the other 

evidence in the record regarding these visits. The ALJ determined that these inconsistencies 

demonstrated that plaintiff’s statements were less than credible. This determination was proper 

and was supported by substantial evidence. Indeed, while plaintiff testified that she was treated 

by Dr. Bhandari at least once a month, and sometimes twice a month, AT 47, and by Dr. David 

once per month, AT 49, plaintiff’s treatment records demonstrate that plaintiff was treated by 

these physicians on a far more sporadic basis, see, e.g., AT 534-38. Similarly, plaintiff testified 

that her sister came to assist her 2-to-4 times per week, AT 50, but her sister’s report states that 

she came to assist plaintiff “almost every day,” AT 248. These inconsistencies substantially 

supported the ALJ’s adverse credibility determination. See Thomas v. Barnhart, 278 F.3d 947, 

959 (9th Cir. 2002) (holding that the ALJ could rely on the inconsistencies between plaintiff’s

testimony and the record as substantial evidence in support of the ALJ’s adverse credibility 

determination). 

Furthermore, the ALJ’s determination that plaintiff was less than credible based on 

evidence in the record that plaintiff exhibited behaviors suggestive of decreased motivation and 

effort was also a proper reason for discounting plaintiff’s testimony. See Mohammad v. Colvin, 

595 F. App’x 696, 697 (9th Cir. 2014) (“Evidence of malingering is also sufficient to support a 

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negative credibility finding.”). As noted by the ALJ, Dr. Tobias, a consulting psychologist, 

determined that the psychological testing he administered to plaintiff was invalidated by 

plaintiff’s “behaviors suggestive of decreased motivation and effort.” AT 501. Indeed, Dr. 

Tobias noted that plaintiff “stall[ed] on timed tasks, . . . provided approximate responses, and at 

times . . . failed to correctly complete simple test items.” Id. The ALJ reasonably drew from this 

evidence of decreased effort to determine that plaintiff’s testimony regarding the extent of her 

limitations and pain was less than credible.

Plaintiff asserts that the ALJ’s reliance on Dr. Tobias’ opinion is misplaced because the 

behaviors plaintiff exhibited when taking Dr. Tobias’ cognitive tests were attributable to the fact 

that plaintiff did not obtain her childhood education in the United States and did not speak 

English as her first language, rather than due to the decreased motivation and effort Dr. Tobias

opined. However, as Dr. Tobias noted in his opinion, plaintiff is bilingual in Farsi and English

and spoke English during Dr. Tobias’ psychological examination, AT 501, which indicates that 

plaintiff was not excessively limited in her ability to complete the tests Dr. Tobias administered in 

English. 

Plaintiff further asserts that it is possible to interpret Dr. Tobias’ statement that plaintiff is 

“bilingual” to mean only that she is able to speak English fluently; not that she is able to 

effectively read, write, and comprehend written instructions in English. However, the mere fact 

that this is a possible interpretation that could explain why plaintiff engaged with Dr. Tobias’

psychological tests in a stalled and incomplete manner does not invalidate the ALJ’s 

determination. The ALJ’s interpretation of the evidence, that plaintiff’s behavior indicated 

malingering, was in the very least equally justified by the record. Accordingly, the court is 

required to uphold the ALJ’s rational interpretation of this evidence. Tommasetti v. Astrue, 533 

F.3d 1035, 1038 (9th Cir. 2008); Molina, 674 F.3d at 1111. In sum, ALJ’s reliance on Dr. 

Tobias’ notes regarding plaintiff’s behavior during examination to determine that plaintiff was 

less than credible was proper and well supported by the record.

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E. The Hypothetical the ALJ Posed to the Vocational Expert Properly Accounted for 

Plaintiff’s Impairments

Finally, plaintiff contends the ALJ failed to include all of plaintiff’s limitations in the 

hypotheticals posed to the VE when determining that there were a significant number of jobs that

plaintiff can perform. In particular, plaintiff argues that the ALJ failed to account for plaintiff’s 

limitations resulting from her overactive bladder and the impact of her pain.

Hypothetical questions posed to a vocational expert must set out all the substantial, 

supported limitations and restrictions of the particular claimant. Magallanes, 881 F.2d at 756. If 

a hypothetical does not reflect all the claimant’s limitations, the expert’s testimony as to jobs in 

the national economy the claimant can perform has no evidentiary value. DeLorme v. Sullivan, 

924 F.2d 841, 850 (9th Cir. 1991). While the ALJ may pose to the expert a range of hypothetical 

questions, based on alternate interpretations of the evidence, the hypothetical that ultimately 

serves as the basis for the ALJ’s determination must be supported by substantial evidence in the 

record as a whole. Embrey v. Bowen, 849 F.2d 418, 422-23 (9th Cir. 1988).

Here, the ALJ posed hypotheticals to the VE that included the limitations expressed in the 

ALJ’s RFC determination. As the ALJ noted in her decision, the RFC determination was based 

on a consideration of “all symptoms and the extent to which th[ose] symptoms can reasonably be 

accepted as consistent with the objective medical evidence and other evidence.” AT 26. While 

plaintiff contends that the ALJ failed to include any limitations caused by overactive bladder, the 

only evidence in the record of the existence of such a condition came from Dr. Bhandari and 

plaintiff, both of whom the ALJ properly discounted for the reasons stated above. Furthermore, 

as the ALJ noted in her discussion at step two, plaintiff’s overactive bladder condition was nonsevere, meaning that it had less than a minimal impact on plaintiff’s ability to perform work 

related activities. Indeed, nothing in the record suggests that this condition caused any limitations 

beyond those the ALJ described in her hypotheticals posed to the VE. See AT 24. With respect 

to plaintiff’s argument regarding the impact her pain has on her ability to do work, the ALJ 

addressed plaintiff’s subjective statements and properly determined that they were not credible to 

the extent they did not comport with the ALJ’s RFC determination for the reasons discussed 

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above. Accordingly, plaintiff’s contention that the ALJ posed improper hypotheticals to the VE 

at step five is not well taken.

V. CONCLUSION

For the reasons stated herein, IT IS HEREBY ORDERED that:

1. Plaintiff’s motion for summary judgment (ECF No. 21) is denied;

2. The Commissioner’s cross-motion for summary judgment (ECF No. 24) is granted; 

and 

3. Judgment is entered for the Commissioner.

Dated: June 22, 2015

11 Azizi.ss

_____________________________________

CAROLYN K. DELANEY

UNITED STATES MAGISTRATE JUDGE

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