Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-1_09-cv-01002/USCOURTS-caed-1_09-cv-01002-3/pdf.json

Parties Involved:
Commissioner of Social Security
Defendant
Clifford L. Edwards
Plaintiff

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UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF CALIFORNIA

CLIFFORD L. EDWARDS, )

)

)

)

Plaintiff, )

)

v. )

)

MICHAEL J. ASTRUE, Commissioner )

of Social Security, )

)

)

Defendant. )

 )

1:09cv01002 DLB

ORDER REGARDING PLAINTIFF’S

SOCIAL SECURITY COMPLAINT

BACKGROUND

Plaintiff Clifford L. Edwards (“Plaintiff”) seeks judicial review of a final decision of the

Commissioner of Social Security (“Commissioner”) denying his application for disability

insurance benefits pursuant to Title II of the Social Security Act. The matter is currently before

the Court on the parties’ briefs, which were submitted, without oral argument, to the Honorable

Dennis L. Beck, United States Magistrate Judge.

FACTS AND PRIOR PROCEEDINGS1

Plaintiff filed his application on February 1, 2006, alleging disability since April 1, 2001,

due to previously broken hips and pancreatitis. AR 71-72, 91-98. After Plaintiff’s application

was denied initially and on reconsideration, he requested a hearing before an Administrative Law

References to the Administrative Record will be designated as “AR,” followed by the appropriate page

1

number.

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Judge (“ALJ”). AR 39-43, 45-48, 51. On April 16, 2008, ALJ Bernard A. Trembly held a

hearing. AR 18. He denied benefits on May 29, 2008. AR 10-17. The Appeals Council denied

review on April 9, 2009. AR 1-3. 

Hearing Testimony

On April 16, 2008, ALJ Trembly held a hearing in Bakersfield, California. Plaintiff

appeared with his attorney, Rosemary Abarca. AR 18.

Plaintiff testified that he was born in 1964 and graduated from high school. He is not

married and did not have children. Plaintiff last worked in June 2001 in landscaping. He had to

stop working when he injured his back and neck on the job. AR 22-23. Plaintiff also fractured

his hips in 1979 when he was roller skating. His hips still cause a lot of pain. AR 23. He also

still has problems with his back. AR 23. Plaintiff explained that he has the most pain in his

stomach from chronic pancreatitis, which began in April 2002 and required his hospitalization

for 29 days. AR 24. 

Plaintiff testified that he wanted to work, but he gets sick a lot. He can’t go for more than

a few weeks without waking up with a “real bad stomach ache and hurting.” When he is in that

much pain, he cannot work. AR 25. He tries to “be careful” with his pain medication, but he’s

in pain a lot. He explained that he cannot work because he doesn’t know what brings on the

pain, although he thinks it is stress related. AR 26. Plaintiff thought he would miss about three

to four days a month because of his pancreatitis. AR 28. 

Plaintiff also has diabetes, though he testified that for the last year and a half, when he

started insulin, his sugar levels have been under control. AR 26. He sometimes has to take

medication for triglycerides, and the medication makes him feel flush and itchy. AR 27.

When questioned by his attorney, Plaintiff explained that when his pancreatitis flares up,

he usually won’t seek treatment until he’s been in pain for a week because they often can’t do

anything to help him. AR 28-29. The longest flare-up, which was in December, lasted about two

weeks. He went to the emergency room and underwent testing. AR 29. His shortest flare-up

lasts for about a day to a day and a half. During a flare-up, he stays in bed unless he has to use

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the restroom. He takes Vicodin for the pain. AR 30. Although surgery has been recommended,

Plaintiff chose not to have surgery because of the chance that the pain could return. AR 32. 

Plaintiff has had an epidural in his hip and he does swimming therapy three days a week. 

AR 31. He also has back pain that he tries to ignore because the pain in his stomach is greater,

though he isn’t sure if the pain is from his back or stomach. AR 33. Plaintiff needs to lay down

everyday and testified that he spends most of the day lying down. AR 33. 

Medical Record

Plaintiff was diagnosed with diabetes mellitus in early 2001. In April 2001, Jorge E. del

Toro, M.D., noted that Plaintiff was placed on medication though he had not been checking his

blood sugars and had not been given instructions on how to do so. AR 346.

In August 2001, Plaintiff was having hypoglycemic episodes. Dr. del Toro adjusted his

medications. AR 344. 

In November 2001, Dr. del Toro noted that Plaintiff’s diabetes was extremely well

controlled. AR 343. 

In February 2002, Dr. del Toro noted that Plaintiff’s diabetes was well controlled and his

hypertension was well controlled with exercise. AR 343. 

On April 9, 2002, Plaintiff was admitted to Mercy Hospital in Bakersfield after

complaining of stomach pain with nausea, vomiting and fever. He was admitted with a diagnosis

of acute pancreatitis and diabetic ketoacidosis. On the second day of hospitalization, Plaintiff

was notably lethargic and confused. He was intubated secondary to respiratory failure thought to

be secondary to sepsis. By the fourth day of hospitalization, his diabetic ketoacidosis and

pancreatitis began to improve. Plaintiff was extubated on the ninth day, though he remained

confused and feverish. A CT scan of his abdomen showed a pseudocyst. Plaintiff improved and

was released after 21 days of hospitalization. He was instructed to eat a low fat, low cholesterol

diet, take his medications, have a follow up CT scan, see surgeon regarding possible internal

drainage and follow up with his primary care physician. AR 125-129.

On May 9, 2002, Plaintiff returned to Dr. del Toro. He continued to have weakness and

bloating, as well as difficulty eating and associated nausea. His glucose appeared to be well

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controlled. It was very difficult to palpate Plaintiff’s abdomen because of his obesity, though Dr.

del Toro noted tenderness in the epigastric area. Dr. del Toro ordered additional testing. AR

341-342. 

On May 20, 2002, Plaintiff saw Dr. del Toro in follow-up. He reported that his eating

and strength had improved and that he was feeling much better. Dr. del Toro indicated that

Plaintiff needed to see a gastroenterologist. AR 337.

On July 11, 2002, Plaintiff reported that he felt uncomfortable whenever he ate. Overall,

he was eating a lot better. There was no organomegaly or tenderness in his abdomen. AR 339. 

On July 25, 2002, Plaintiff told Dr. del Toro that he was feeling better than he had in a

“substantial period of time.” There were no masses or tenderness in his abdomen. A CT scan

revealed a very large pancreatic pseudocyst extending into the left pericolic gutter. AR 338, 395.

On August 23, 2002, Plaintiff reported to Dr. del Toro that he was doing extremely well. 

He was eating better and feeling better. His diabetes was well controlled and his pancreatic

pseudocyst was asymptomatic. AR 336. 

Plaintiff underwent a Qualified Medical Examination on October 15, 2002. Plaintiff told

Mohinder Nijjar, M.D., that he injured his back while he was trying to put a heavy container into

a trash compacter. On examination, Plaintiff’s spine showed a slightly straightened curvature

and mild to moderate paraspinal muscle spasm. There was slight tenderness over the cervical

spine area and range of motion was limited. There was also straightening of the lumbar spine

with slight tenderness over L4-S1. Plaintiff had paraspinal muscle spasms in the lumbar spine

and slight tenderness over the sacroiliac joints on both sides. He was able to walk without a limp

and stand on his toes and heels. He had difficulty stabilizing in both positions, however. 

Plaintiff also had difficulty squatting. AR 214-219.

Dr. Nijjar diagnosed cervical strain with residual restricted range of motion and lumbar

strain with residual stiffness, both of which resulted from Plaintiff’s work accident in June 2001. 

Dr. Nijjar believed that Plaintiff was permanent and stationary. He further opined that Plaintiff

could not perform heavy work and that he lost 50 percent of his pre-injury capacity to bend,

stoop, lift, pull, push or climb. Dr. Nijjar believed that Plaintiff would need anti-inflammatory

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medication from time to time. If his symptoms greatly worsened, Dr. Nijjar noted that Plaintiff

may be a candidate for physical therapy. Plaintiff was not a candidate for surgery. AR 219-220. 

On November 8, 2002, Dr. del Toro noted that the CT scan showed that although the

pseudocyst had decreased in size, it was still quite sizable. He recommended a surgery

consultation. Plaintiff’s diabetes was well controlled. AR 335. 

On January 10, 2003, Plaintiff saw Dr. del Toro, who noted that his pseudocyst was stable

and totally asymptomatic and his diabetes was very well controlled. Dr. del Toro noted that the

surgeon did not perform surgery since Plaintiff was asymptomatic. He decided to continue to

observed Plaintiff. AR 332. 

On January 27, 2003, Plaintiff saw Alan Sanders, M.D., for a Qualified Medical

Examination. Plaintiff reported that his neck was his worst problem, followed by his back. On

examination, Plaintiff had a normal gait, could toe and heel walk and could squat fully. There

was no tenderness to palpation in his lower back and he had full range of motion. Plaintiff had

no tenderness to palpation in his cervical spine and had full range of motion. There was a

negative response to compression/distraction tests of the cervical spine and a valsalva maneuver

failed to produce symptoms. Plaintiff complained of discomfort and pain on the extremes of

motion of the hips. Dr. Sanders diagnosed chronic residual cervical and lumber spondylosis as

per Plaintiff’s history. He had not reviewed any medical records. Dr. Sanders believed that

Plaintiff had been permanent and stationary since October 2001and did not believe that physical

therapy was providing any benefit. AR 270-280.

On April 11, 2003, Plaintiff saw Dr. del Toro and indicated that he had no symptoms

related to the pseudocyst. His diabetes was out of control and Dr. del Toro changed his

medication. AR 335. 

On May 8, 2003, Plaintiff saw Dr. del Toro in follow-up. A CT scan showed a slight

decrease in the size of the pancreatic pseudocyst. Plaintiff’s diabetes was out of control, though

asymptomatic. Dr. del Toro increased Plaintiff’s Glucophage. AR 331, 398.

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On July 9, 2003, Plaintiff told Dr. del Toro that his abdominal pain has been increasing. 

He was eating well and had no fever, diarrhea, nausea or vomiting. On examination, there was

very slight epigastric tenderness subjectively. Dr. del Toro ordered testing. AR 331. 

On July 16, 2003, Plaintiff returned Dr. del Toro for reevaluation. Plaintiff noted that the

pain had decreased. His labs were normal. Dr. del Toro found that his pseudocyst was under

control. AR 330. 

On August 21, 2003, Plaintiff presented to Dr. del Toro with elevated blood glucose

levels. Dr. del Toro believed that the elevated levels were secondary to the epidural injections he

was receiving. AR 330. 

On January 20, 2004, Plaintiff began treatment at Kaiser Permanente, with Nurse

Practitioner Eileen McDermott. Plaintiff complained of stomach pain for the past few days that

was now very severe. He also complained of nausea and elevated blood sugars. On

examination, Plaintiff had tenderness to palpation at the mid of the gastric area and mid

abdomen. Plaintiff was diagnosed with diabetes and abdominal or mid epigastric pain, possible

PUD rule out cholelithiasis. Laboratory testing was ordered and he was given medication. AR

494-495.

Plaintiff returned to Nurse McDermott on January 27, 2004, for follow-up. Plaintiff

continued to have soreness in the upper left quadrant and he was referred to a GI specialist. He

was also diagnosed with diabetes, hypertriglyceridemia, hyperlipidemia and chest pain. AR 498-

499. 

On September 3, 2004, Plaintiff saw Nurse McDermott and indicated that he had a few

episodes of epigastric pain with radiation to his pack. Plaintiff had been released to return to

work but he did not feel like he could perform his job. On examination, his abdomen was obese

and soft, with some tenderness in the mid abdomen just above the umbilicus. There were no

appreciable masses, no organomegaly, no guarding and no rebound. Degrasia Howard, M.D.,

noted that Plaintiff’s pancreatic pseudocyst is decreasing, down to 6.7 cm in diameter from 10

cm in diameter. Plaintiff’s episodes of epigastric pain may well be related to this, especially if

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his triglycerides go up. Dr. Howard put Plaintiff on pancreatic enzymes and encouraged him to

contact state human resources to find out about training for different jobs. AR 510-511. 

On May 31, 2004, Plaintiff returned to Kaiser and complained of a stomach ache for the

past three days. 

An October 29, 2004, CT scan showed a very slight decrease in the size of the

pseudocyst. AR 490. 

On January 26, 2005, Plaintiff saw Nurse McDermott for a diabetes follow-up and

complained of chronic stomach pain. Plaintiff’s abdomen was soft with generalized tenderness

overall. He was diagnosed with diabetes, hyperlipidemia, lightheadedness, microalbuminuria

and constipation. AR 515-516. 

Plaintiff saw Dr. Howard on February 14, 2005. Dr. Howard noted that Plaintiff’s cyst

has been stable with a slight decrease in size, though the probability of it totally resolving was

very small. Plaintiff had intermittent abdominal pain and sometimes has acute bouts of severe

abdominal pain. On examination, Plaintiff was frustrated because he has bouts of significant

pain two to three times a week that make it difficult for him to hold down a job. Dr. Howard

noted that it is not uncommon for patients with chronic relapsing pancreatitis to have these

abdominal episodes. Plaintiff was tender in the epigastric area over the pancreatic area. There

was no appreciable mass and no guarding or rebound. Dr. Howard diagnosed Plaintiff with

chronic pancreatic pseudocyst with enzyme abnormality of the pancreas, related to his chronic

relapsing pancreatitis. Dr. Howard noted that this is all related to his elevated triglycerides. He

also noted that Plaintiff’s chronic relapsing condition makes it difficult for him to be employed. 

Dr. Howard ordered a CT scan and suggested that an ultrasound may be necessary to determine

whether a drainage procedure would be beneficial. AR 517-518. 

A February 21, 2005, CT scan showed that Plaintiff’s pseudocyst was stable. AR 489. 

On October 5, 2005, Plaintiff saw Nurse McDermott and complained of continuing

abdominal pain as well as nausea and vomiting on and off. He described muscle-cramping pain

in the upper right quadrant. Plaintiff had generalized tenderness over the abdomen. His diabetes

was not controlled. Nurse McDermott indicated that she needed to speak with Dr. Howard for

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Plaintiff’s abdominal pain, decreased appetite and 10 pound weight loss in February. AR 519-

520.

Plaintiff saw Dr. Howard on October 10, 2005. Plaintiff reported some difficulty finding

work or keeping work because of his abdominal pain and frequent bouts of severe pain. Plaintiff

had lost 12 to 15 pounds, which may or may not be related to his pancreatitis. Plaintiff noted his

level of pain at a 1 to 2 out of 10. Plaintiff was tender in the left and right flank and in the

midepigastric area. Dr. Howard ordered a CT scan and encouraged Plaintiff to think about

disability. Dr. Howard listed Plaintiff’s other medical problems and believed that this was “as

improved as he can get.” AR 521-522. 

An October 13, 2005, CT scan of Plaintiff’s abdomen showed that the pseudocyst slightly

decreased in size. AR 488. 

Plaintiff saw Nurse McDermott on December 13, 2005. His diabetes was better

controlled. AR 526-527. 

Plaintiff returned to Dr. Howard on February 2, 2006. Plaintiff’s triglycerides showed a

“marked improvement” and his diabetes was under better control. Plaintiff still had abdominal

pain and nausea at times and Dr. Howard noted that some of his symptoms sounded like gastric

emptying problems. On examination, Plaintiff had some epigastric tenderness, more towards the

right than the left. Dr. Howard believed that his pancreatitis and pseudocyst may improve given

his improved hypertriglyceridemia. AR 528-529. 

A February 15, 2006, gastric emptying study was normal. AR 585. 

An April 21, 2006, x-ray of Plaintiff’s hips showed mild bilateral hip osteoarthritis. AR

486. 

On May 2, 2006, Plaintiff saw Alan Inocentes, M.D., for exacerbation of bilateral hip

pain. AR 618-619. On examination, Plaintiff had active range of motion in both hips with

mildly positive Fabere’s bilaterally. Dr. Inocentes diagnosed chronic bilateral hip pain secondary

to underlying degenerative arthritis. Mild L5-S1 degenerative disc disease may have caused the

radiating pain down the left lower extremity. Dr. Inocentes recommended that Plaintiff be

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encouraged to start an exercise program. He could taken Vicodin as needed for pain. AR 618-

619. 

Plaintiff returned to Dr. Howard on May 3, 2006. His diabetes was in much better control

since he started on insulin. Plaintiff was doing good overall, though he still has episodes of

severe abdominal pain and discomfort that kept him from sleeping. He takes one Vicodin at

bedtime and sometimes during the day on a bad day. The most he ever takes is four a day. 

Plaintiff had some right lower quadrant tenderness. Dr. Howard noted that Plaintiff’s cyst has

been progressively getting smaller and that he has been stable. AR 620-621. 

On May 18, 2006, State Agency physician K. M. Quint, M.D., completed a Physical

Residual Capacity Assessment form. Dr. Quint opined that Plaintiff could lift 20 pounds

occasionally, 10 pounds frequently, stand and/or walk for about six hours and sit for about six

hours. Plaintiff had no further limitations. Dr. Quint noted that Plaintiff’s pain was not severe

and that his weight gain indicates that his GI tract is working well. Dr. Quint also noted that

Plaintiff’s activities were likely more limited by his weight than his pancreas. AR 468-475. This

assessment was affirmed on January 10, 2007. AR 646. 

A June 13, 2006, CT scan of Plaintiff’s abdomen showed a marginal decrease in the size

of the pseudocyst. It was still contiguous with the posterior aspect of his stomach. AR 484. 

Plaintiff returned to Dr. Inocentes on June 22, 2006. Plaintiff was taking prescription

Motrin three times a week and Vicodin about three to four times per week. He was taking part in

an aquatics program which has helped overall. Plaintiff indicated that he was better, though he

still had occasional exacerbation of pain that required medication. Dr. Inocentes instructed

Plaintiff to continue the aquatics program and medication as needed. AR 622-623.

On July 17, 2006, Plaintiff saw Dr. Howard with complaints of periodic abdominal pain. 

If Plaintiff tries to push himself to do anything, he usually has significant pain. Plaintiff’s hips

cause pain if he stands too long and he has occasional spasms in his back if he moves or turns in

a certain way. Plaintiff did not think he had the stamina to do any significant amount of work. 

Plaintiff had some tenderness over the area of the tail of the pancreas, but there were no

appreciable masses or fullness in that area. Dr. Howard noted that Plaintiff has a short duration

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of energy or stamina for prolonged standing, sitting, lifting or moving. Plaintiff could not do

very much lifting because of his back and hips. His pseudocyst has not changed very much in

size. Plaintiff was instructed to continue with his current treatment regimen. AR 624-625. 

On October 26, 2006, Plaintiff saw Thin Thin Han, M.D., in follow-up after seeing Dr.

Han in urgent care a few days ago for abdominal pain. Currently, Plaintiff’s abdominal pain was

getting better. He advised Plaintiff to follow-up with Dr. Howard. AR 627-628.

Plaintiff saw Dr. Howard on October 30, 2006. Plaintiff’s triglycerides were improving

though he was still having intermittent brief bouts of pancreatitis. Plaintiff’s diabetes was under

better control though he still had decreased stamina overall. On examination, Plaintiff had

tenderness in the epigastric and right upper quadrant area of the tail of the pancreas. Dr. Howard

noted that Plaintiff was “starting to feel some better” and used his pain medications very

sparingly. Plaintiff’s poor stamina was probably related to his diabetes and hip and low back

problems, which were not improving. AR 629-630.

On August 30, 2007, Plaintiff underwent a left hip steroid injection. AR 748

Plaintiff saw Dr. Howard on October 8, 2007, for complaints of lower abdominal pain

that has been increasing over the past month. He has back pain related to the abdominal pain and

his pain medication was not providing relief. Plaintiff rated the pain at an 8 out of 10, sometimes

higher. Plaintiff was tender in the right upper quadrant and the left lower quadrant. AR 681. Dr.

Howard noted that Plaintiff’s pseudocyst could be aggravated by his gall stones and that the

tenderness in the left lower quadrant may be diverticulosis. AR 681-682. 

A September 20, 2007, abdominal ultrasound showed diffuse fatty infiltration of the liver

and gall stones. AR 752. 

An October 16, 2007, CT scan showed diffuse fatty infiltration of the liver and an

unchanged pseudocyst. AR 745. 

On December 11, 2007, Plaintiff was seen in the emergency room for stomach pain, chest

pain and depression. AR 650-659.

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Plaintiff saw Dr. Howard on February 20, 2008. Plaintiff was having less subjective pain

but was still quite tender in the right upper quadrant. He was doing much better overall. AR

670-671. 

On February 25, 2008, Plaintiff saw Kaiser physician Mark Mishkind, M.D., for

complaints of abdominal pain. Plaintiff had tenderness in the right and left upper quadrant, but

no mass, rigidity or rebound. Plaintiff was walking with a cane. Dr. Mishkind recommended

that Plaintiff’s gallbladder be removed because of the risk of it causing more pancreatitis. He

also recommended surgical drainage of the pseudocyst. AR 666

ALJ’s Findings

The ALJ determined that Plaintiff had the severe impairments of pancreatitis secondary to

a pancreatic pseudocyst, insulin dependent diabetes mellitus and previous bilateral hip fracture. 

AR 12. Despite these impairments, the ALJ found that Plaintiff could perform the full range of

sedentary work. AR 12. With this RFC, Plaintiff could not perform his past work but could

perform a significant number of jobs in the national economy. AR 16-17.

SCOPE OF REVIEW

Congress has provided a limited scope of judicial review of the Commissioner’s decision

to deny benefits under the Act. In reviewing findings of fact with respect to such determinations,

the Court must determine whether the decision of the Commissioner is supported by substantial

evidence. 42 U.S.C. 405 (g). Substantial evidence means “more than a mere scintilla,”

Richardson v. Perales, 402 U.S. 389, 402 (1971), but less than a preponderance. Sorenson v.

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

reasonable mind might accept as adequate to support a conclusion.” Richardson, 402 U.S. at

401. The record as a whole must be considered, weighing both the evidence that supports and

the evidence that detracts from the Commissioner’s conclusion. Jones v. Heckler, 760 F.2d 993,

995 (9th Cir. 1985). In weighing the evidence and making findings, the Commissioner must

apply the proper legal standards. E.g., Burkhart v. Bowen, 856 F.2d 1335, 1338 (9th Cir. 1988). 

This Court must uphold the Commissioner’s determination that the claimant is not disabled if the

Secretary applied the proper legal standards, and if the Commissioner’s findings are supported by

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substantial evidence. See Sanchez v. Sec’y of Health and Human Serv., 812 F.2d 509, 510 (9th

Cir. 1987). 

 REVIEW

In order to qualify for benefits, a claimant must establish that he 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 has a physical or mental impairment of

such severity that he is not only unable to do her previous work, but cannot, considering his age,

education, and work experience, engage in any other kind of substantial gainful work which

exists in the national economy. Quang Van Han v. Bowen, 882 F.2d 1453, 1456 (9th Cir. 1989). 

The burden is on the claimant to establish disability. Terry v. Sullivan, 903 F.2d 1273, 1275 (9th

Cir. 1990).

In an effort to achieve uniformity of decisions, the Commissioner has promulgated

regulations which contain, inter alia, a five-step sequential disability evaluation process. 20

C.F.R. §§ 404.1520 (a)-(f), 416.920 (a)-(f) (1994). Applying this process in this case, the ALJ

found that Plaintiff: (1) had not engaged in substantial gainful activity since the alleged onset of

his disability; (2) has an impairment or a combination of impairments that is considered “severe” 

(pancreatitis secondary to a pancreatic pseudocyst, insulin dependent diabetes mellitus and

previous bilateral hip fracture) based on the requirements in the Regulations (20 CFR §§

416.920(b)); (3) does not have an impairment or combination of impairments which meets or

equals one of the impairments set forth in Appendix 1, Subpart P, Regulations No. 4; (4) cannot

perform his past relevant work; but can (5) perform a substantial number of jobs in the national

economy. AR 12-17. 

Here, Plaintiff argues that the ALJ (1) erred in failing to give controlling weight to Dr.

Howard’s opinion; and (2) did not properly analyze his subjective complaints. 

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DISCUSSION

A. Dr. Howard’s Opinion

Plaintiff first argues that the ALJ failed to provide sufficient reasons to reject Dr.

Howard’s opinion that Plaintiff suffered from pancreatic attacks two to three times per week and

that he would therefore be precluded from work. 

The opinions of treating doctors should be given more weight than the opinions of

doctors who do not treat the claimant. Reddick v. Chater, 157 F.3d 715, 725 (9th Cir.1998);

Lester v. Chater, 81 F.3d 821, 830 (9th Cir.1995). Where the treating doctor’s opinion is not

contradicted by another doctor, it may be rejected only for “clear and convincing” reasons

supported by substantial evidence in the record. Lester, 81 F.3d at 830. Even if the treating

doctor’s opinion is contradicted by another doctor, the ALJ may not reject this opinion without

providing “specific and legitimate reasons” supported by substantial evidence in the record. Id.

(quoting Murray v. Heckler, 722 F.2d 499, 502 (9th Cir.1983)). This can be done by setting out

a detailed and thorough summary of the facts and conflicting clinical evidence, stating his

interpretation thereof, and making findings. Magallanes v. Bowen, 881 F.2d 747, 751 (9th

Cir.1989). The ALJ must do more than offer his conclusions. He must set forth his own

interpretations and explain why they, rather than the doctors’, are correct. Embrey v. Bowen, 849

F.2d 418, 421-22 (9th Cir.1988). Therefore, a treating physician’s opinion must be given

controlling weight if it is well-supported and not inconsistent with the other substantial evidence

in the record. Lingenfelter v. Astrue, 504 F.3d 1028 (9th Cir. 2007). 

If a treating physician’s opinion is not given controlling weight because it is not well

supported or because it is inconsistent with other substantial evidence in the record, the ALJ is

instructed by Section 404.1527(d)(2) to consider the factors listed in Section 404.1527(d)(2)-(6)

in determining what weight to accord the opinion of the treating physician. Those factors include

the “[l]ength of the treatment relationship and the frequency of examination” by the treating

physician; and the “nature and extent of the treatment relationship” between the patient and the

treating physician. 20 C.F.R. 404.1527(d)(2)(i)-(ii). Other factors include the supportablility of

the opinion, consistency with the record as a whole, the specialization of the physician, and the

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extent to which the physician is familiar with disability programs and evidentiary requirements. 

20 C.F.R. § 404.1527(d)(3)-(6). Even when contradicted by an opinion of an examining

physician that constitutes substantial evidence, the treating physician’s opinion is “still entitled to

deference.” SSR 96-2p; Orn v. Astrue, 495 F.3d 625, 632-633 (9th Cir. 2007). “In many cases, a

treating source’s medical opinion will be entitled to the greatest weight and should be adopted,

even if it does not meet the test for controlling weight.” SSR 96-2p; Orn, 495 F.3d at 633. 

However, to be given controlling weight, a medical opinion must concern an area of

proper consideration. Medical opinions are defined as “statements from physicians and

psychologists or other acceptable medical sources that reflect judgments about the nature and

severity of your impairment(s), including your symptoms, diagnosis and prognosis, what you can

still do despite impairment(s), and your physical or mental restrictions.” 20 C.F.R. §

404.1527(a)(1). Where the statement involves an issue reserved to the Commissioner, the

statement is not entitled to controlling weight. SSR 96-5p. For example, a treating source’s

opinion as to whether a claimant is “disabled” or “unable to work” is never entitled to controlling

weight or given special significance. SSR 96-5p. It is beyond a physician’s expertise to say

whether or not a claimant seeking disability benefits can or cannot work. 20 C.F.R. §§

404.1527(e)(1), 416.927(e)(1) (“We are responsible for making the determination or decision

about whether you meet the statutory definition of disability. In so doing, we review all of the

medical findings and other evidence that support a medical source’s statement that you are

disabled. A statement by a medical source that you are ‘disabled’ or ‘unable to work’ does not

mean that we will determine that you are disabled.”)

Therefore, Dr. Howard’s opinion that Plaintiff could not work because of his episodes of

pancreatitis was not entitled to controlling weight. The ALJ correctly noted that the opinion

“concern[ed] issues specifically reserved to the Commissioner.” AR 16. Thomas v. Barnhart,

278 F.3d 947, 956 (9th Cir.2002) (“In Morgan, we held that ‘the opinion of the treating physician

is not necessarily conclusive as to either the physical condition or the ultimate issue of

disability.”)

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Moreover, Dr. Howard’s opinion was little more than a reiteration of Plaintiff’s

subjective complaints. During his February 15, 2005, visit, Plaintiff told Dr. Howard that he

“has at least two to three times a week bouts of significant pain that make it difficult for him to

be able to go and hold down a job.” AR 517. Later in the report, Dr. Howard states that Plaintiff

“will have flares of severe pain, making it difficult for him to be employed.” AR 517. 

Objectively, although Plaintiff complained of pain on palpation, Dr. Howard described Plaintiff’s

cyst as “clinically stable with slight change in size, getting smaller on the last evaluation.” AR

517. Indeed, Dr. Howard’s most recent notes from February 2008 state that although Plaintiff

was “quite tender in the right upper quadrant,” he had less subjective pain and was doing “much

better overall.” AR 670-671. 

The ALJ’s rejection of Dr. Howard’s opinion was supported by substantial evidence and

free of legal error.

B. Plaintiff’s Subjective Complaints

Finally, Plaintiff argues that the ALJ failed to provide clear and convincing reasons for

rejecting his testimony.

In Orn v. Astrue, 495 F.3d 625, 635 (9th Cir. 2007), the Ninth Circuit summarized the

pertinent standards for evaluating the sufficiency of an ALJ’s reasoning in rejecting a claimant’s

subjective complaints:

An ALJ is not “required to believe every allegation of disabling pain” or other

non-exertional impairment. See Fair v. Bowen, 885 F.2d 597, 603 (9th Cir.1989). 

However, to discredit a claimant’s testimony when a medical impairment has been

established, the ALJ must provide “‘specific, cogent reasons for the disbelief.’” Morgan,

169 F.3d at 599 (quoting Lester, 81 F.3d at 834). The ALJ must “cit[e] the reasons why

the [claimant's] testimony is unpersuasive.” Id. Where, as here, the ALJ did not find

“affirmative evidence” that the claimant was a malingerer, those “reasons for rejecting the

claimant’s testimony must be clear and convincing.” Id.

Social Security Administration rulings specify the proper bases for rejection of a

claimant’s testimony. . . An ALJ’s decision to reject a claimant’s testimony cannot be

supported by reasons that do not comport with the agency’s rules. See 67 Fed.Reg. at

57860 (“Although Social Security Rulings do not have the same force and effect as the

statute or regulations, they are binding on all components of the Social Security

Administration, ... and are to be relied upon as precedents in adjudicating cases.”); see

Daniels v. Apfel, 154 F.3d 1129, 1131 (10th Cir.1998) (concluding that ALJ’s decision at

step three of the disability determination was contrary to agency regulations and rulings

and therefore warranted remand). Factors that an ALJ may consider in weighing a

claimant’s credibility include reputation for truthfulness, inconsistencies in testimony or

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between testimony and conduct, daily activities, and “unexplained, or inadequately

explained, failure to seek treatment or follow a prescribed course of treatment.” Fair,

885 F.2d at 603; see also Thomas, 278 F.3d at 958-59.

Here, the ALJ first cited objective evidence that contradicted Plaintiff’s allegation that he

could not work primarily because of his stomach pain. For example, as Dr. Quint explained, 

Plaintiff’s weight gain indicated that his gastrointestinal tract was working well. AR 16. 

Additionally, Plaintiff’s cyst was decreasing over time. Elsewhere in the opinion, the ALJ

explained that Plaintiff’s cyst was often described as stable and asymptomatic. AR 14. The ALJ

may consider the objective evidence so long as it is not the sole factor in discrediting a claimant’s

testimony. Lester v. Chater, 81 F.3d 821, 834 (9th Cir. 1996).

Similarly, despite Plaintiff’s allegation that he has to lay down most of the day, the ALJ

noted that Plaintiff’s neurological examination showed normal muscle tone, normal sensation,

normal strength and normal reflexes. See eg. Meanel v. Apfel, 172 F.3d 1111, 1115 (9th Cir.

1999) (explaining that a likely consequence of debilitating pain is inactivity, and a likely

consequence of inactivity is muscle atrophy). 

The ALJ next explained that Plaintiff uses his pain medications “very sparingly and only

to control his symptoms.” AR 16. Plaintiff’s diabetes was well controlled with his current

medication regimen, which has not changed significantly over the years. An ALJ may consider

the type and effectiveness of medication in assessing a claimant’s credibility. 20 C.F.R. §

404.1529(c)(3)(iv). 

As to Plaintiff’s hip pain, which he also alleged as a disabling condition, the ALJ noted

that it has been treated primarily with exercises and an aquatic program. Parra v. Astrue, 481

F.3d 742, 750 (9th Cir. 2007) (evidence of “conservative treatment,” such as a claimant’s use of

only over-the-counter pain medication, is sufficient to discount a claimant’s testimony regarding

severity of an impairment). 

In his opening brief, Plaintiff contends that there is no evidence that additional treatment

would have resolved his pain. He also argues that he sought “years of treatment, including

hospitalizations, to help relieve his pain.” Opening Brief, at 13. Although Plaintiff may interpret

the evidence differently, it is the province of the ALJ to analyze the testimony. The ALJ’s

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credibility finding was sufficient to allow the Court conclude that the ALJ did not arbitrarily

discredit his testimony. Thomas v. Barnhart, 278 F.3d 947, 958 (9th Cir. 2002).

The ALJ’s credibility analysis is supported by substantial evidence and free of legal error.

CONCLUSION

Based on the foregoing, the Court finds that the ALJ’s decision is supported by

substantial evidence in the record as a whole and is based on proper legal standards. 

Accordingly, this Court DENIES Plaintiff’s appeal from the administrative decision of the

Commissioner of Social Security. The clerk of this Court is DIRECTED to enter judgment in

favor of Defendant Michael J. Astrue, Commissioner of Social Security and against Plaintiff,

Clifford Edwards.

IT IS SO ORDERED. 

Dated: July 22, 2010 /s/ Dennis L. Beck 

3b142a UNITED STATES MAGISTRATE JUDGE

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