Grabowski v. Colvin

Filing 26

ORDER that this case is reversed and remanded to the ALJ for further proceedings consistent with this Order. The Clerk shall enter judgment in favor of Plaintiff and against the Commissioner and shall terminate this case. Signed by Magistrate Judge Bridget S Bade on 5/16/14. (LSP)

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1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8 9 William L. Grabowski, Plaintiff, 10 11 ORDER v. 12 No. CV-13-01178-PHX-BSB Carolyn W. Colvin, 13 Defendant. 14 15 William L. Grabowski (Plaintiff) seeks judicial review of the final decision of the 16 Commissioner of Social Security (the Commissioner) denying his application for 17 disability insurance benefits under the Social Security Act (the Act). The parties have 18 consented to proceed before a United States Magistrate Judge under 28 U.S.C. § 636(b) 19 and have filed briefs in accordance with Local Rule of Civil Procedure 16.1. For the 20 following reasons, the Court reverses the Commissioner’s decision and remands for 21 further proceedings. 22 I. Procedural Background 23 On August 25, 2010, Plaintiff applied for disability insurance benefits and 24 supplemental security income under Titles II and XVI of the Act. (Tr. 9.)1 Plaintiff 25 alleged that he had been disabled since March 1, 2008. (Id.) After the Social Security 26 Administration (SSA) denied Plaintiff’s initial application and his request for 27 28 1 (Doc. 18.) Citations to “Tr.” are to the certified administrative transcript of record. 1 reconsideration, he requested a hearing before an administrative law judge (ALJ). After 2 conducting a hearing, the ALJ issued a decision finding Plaintiff not disabled under the 3 Act. (Tr. 9-22.) This decision became the final decision of the Commissioner when the 4 Social Security Administration Appeals Council denied Plaintiff’s request for review. 5 (Tr. 1-5); see 20 C.F.R. § 404.981 (explaining the effect of a disposition by the Appeals 6 Council.) Plaintiff now seeks judicial review of this decision under 42 U.S.C. § 405(g). 7 II. Medical Record 8 The record before the Court establishes the following history of diagnosis and 9 treatment related to Plaintiff’s health. The record also includes opinions from State 10 Agency Physicians who either examined Plaintiff or reviewed the records related to his 11 health, but who did not provide treatment. 12 A. Christopher Fleming, M.D. 13 In May 2007, Plaintiff sought treatment from Dr. Fleming. (Tr. 318.) Plaintiff 14 reported that he had injured his left knee, neck, and upper back in an accident at work, 15 and had multiple surgeries on his left knee. (Id.) Dr. Fleming noted that a May 2007 x- 16 ray and a June 2007 MRI confirmed “osteochondritis dissecans” in Plaintiff’s left knee. 17 (Id.) Plaintiff had arthroscopic surgery on his left knee on September 5, 2007. (Id.) 18 After that surgery, Plaintiff reported continuing pain in his left knee and that it 19 periodically “gave out.” (Id.) 20 X-rays and an MRI of Plaintiff’s left knee in early 2008 showed “no change in the 21 osteochondritis,” but showed mild degenerative changes in the left knee, including “full 22 thickness defects of articular cartilage and defect of the underlying bone.” (Tr. 318-19.) 23 In March and April 2008, Dr. Fleming noted that Plaintiff had had “a couple falls” and 24 had “failed conservative treatment.” (Tr. 307-08.) Plaintiff had a repeat arthroscopic 25 surgery on his left knee in August 2008. (Tr. 319.) Plaintiff continued to report left knee 26 pain after that surgery, and also reported left hip pain. (Tr. 319.) In November 2008, 27 Dr. Fleming noted that Plaintiff had “moderate-severe” atrophy of the left quadriceps and 28 had recently reinjured his left knee when getting up from the couch. (Tr. 287.) -2- 1 Dr. Fleming’s treatment notes from December 2008 diagnose chondromalacia 2 patella (also known as patellofemoral pain syndrome or “PFPS”). 3 Dr. Fleming found mild crepitation in both knees and a “positive patellar grind” on the 4 left knee. (Tr. 284-85.) Following a final orthopedic consultation, on December 14, 5 2009, Dr. Fleming summarized his findings in a report, noting that Plaintiff’s left knee 6 continued to be painful and periodically gave out, his left hip continued to be painful 7 from compensating for the left knee injury, and that similar compensatory overuse had 8 also caused his right knee to become symptomatic. (Tr. 317-24.) Dr. Fleming assessed 9 work restrictions including “[n]o prolonged standing and walking. 10 (Tr. 282-83). No running or jumping. No repetitive squatting or kneeling. [And n]o climbing.” (Tr. 323.) 11 B. G. Sunny Uppal, M.D. and Neil J. Halbridge, M.D. 12 Dr. Uppal began treating Plaintiff’ in December 2008. (Tr. 510.) He noted 13 Plaintiff’s complaints of bilateral knee pain, mid-back pain that radiated to both legs, left 14 hip pain, and insomnia. (Tr. 510.) Dr. Uppal noted that Plaintiff’s knee pain was 15 exacerbated by “[p]ushing, kneeling, squatting, repetitive use, prolonged standing, 16 walking, pulling, lifting, [and] bending.” (Tr. 511.) He diagnosed a posttraumatic left- 17 knee osteochondral defect. (Tr. 513.) 18 On December 3, 2009, Dr. Uppal found the presence of effusion in Plaintiff’s right 19 knee, a positive McMurray’s test, and that the range of motion (ROM) in flexion was 20 limited to 90 degrees. (Tr. 569.) Based on these findings, he diagnosed Plaintiff’s right 21 knee with the same osteochondral defect established in his left knee. (Id.) This diagnosis 22 was corroborated by an MRI of the right knee showing tears in the medial and lateral 23 meniscus. (Tr. 579.) 24 On December 11, 2010, Dr. Uppal reported that the ROM in both of Plaintiff’s 25 knees was limited to 90 degrees of flexion, with “medial joint line tenderness” in the right 26 knee and a “[p]ositive patellar apprehension” test of the left knee. (Tr. 414.) He also 27 noted that Plaintiff’s past complaints of lower back pain were supported by findings at 28 that visit including observations of lower-back spasms, a ROM limited to ten degrees of -3- 1 extension, and straight-leg-raise tests positive for back, buttock, and leg pain. (Id.) 2 Dr. Uppal noted that a lumbar spine MRI confirmed his diagnosis of a 5-millimeter 3 herniated disc at L5-S1. (Id.) 4 Dr. Uppal also indicated that Plaintiff had been seeing a cardiologist for 5 congestive heart failure and cardiac dysrhythmia, and that he needed a total replacement 6 of his left knee. (Tr. 413.) Dr. Uppal wrote that Plaintiff was “applying for Social 7 Security Disability. [He felt that] if you add the right knee, left knee, [and] low back [to] 8 his restrictions . . . he would be limited to sedentary work only. 9 combined with his cardiac problem, he is unable to go to work and he would be a 10 However, when candidate for Social Security Disability.” (Tr. 414.) 11 On January 20, 2011, Dr. Uppal noted another positive McMurray’s test and lower 12 back spasms. (Tr. 462.) He diagnosed “right knee chondromalacia with medial meniscal 13 degenerative changes,” “left knee multiple arthroscopies,” and “lumbar radiculitis.” 14 (Tr. 463.) He again stated that “because of all these issues of the right knee, left knee, 15 low back pain, [and] cardiac dysfunction, the patient is a candidate for Social Security 16 Disability.” (Id.) In June 2012, Dr. Uppal reported that he had planned surgery for 17 Plaintiff’s right knee, but the cardiologist did not clear Plaintiff for surgery due to his 18 cardiac dysrhythmia. (Tr. 1212.) 19 symptoms in Plaintiff’s knees, including “swelling, clicking, locking, popping, grinding, 20 stiffness, weakness, and giving way,” were aggravated by prolonged standing and 21 walking, pushing, pulling, kneeling, squatting, bending, climbing stairs, and repetitive 22 use. (Tr. 466, 511.) He determined that Plaintiff was “precluded from doing heavy 23 lifting, prolonged weight bearing with the right and left knees and legs” (Tr. 478), “stair 24 climbing, and walking on uneven surfaces.” (Tr. 499.) In several treatment notes, Dr. Uppal indicated that 25 During this same period, Plaintiff also saw Dr. Halbridge. (Tr. 426.) During his 26 initial evaluation on July 28, 2009, Dr. Halbridge noted Plaintiff’s complaints of pain in 27 his mid-back, left hip, and bilateral knees, and that his lumbar spine ROM was limited to 28 ten degrees of extension and ten degrees of left lateral bending. (Tr. 430.) He diagnosed -4- 1 left-knee problems, and “5-millimeter disc herniation at L5-S1” based on a November 2 2009 lumbar spine MRI. (Tr. 325, 432.) Dr. Halbridge concluded that Plaintiff’s knee 3 pain was aggravated by prolonged standing and walking, climbing, running, squatting, 4 kneeling, and walking on inclined surfaces (especially descending stairs). (Tr. 432.) He 5 found Plaintiff precluded from “squatting, kneeling, climbing, prolonged standing, and 6 prolonged walking,” and from “frequent bending, stooping, lifting, and heavy pushing, 7 pulling, or lifting weight over 20 pounds,” due to his knee and hip pain. (Tr. 433-34.) 8 C. Chirag N. Amin, M.D. 9 In November 2011, Plaintiff saw Dr. Amin regarding his bilateral knee pain, lower 10 back pain, and shoulder pain. (Tr. 1055-74.) Dr. Amin’s examination revealed 11 tenderness and muscle spasms in Plaintiff’s thoracic/lumbar paravertebral muscles, a 12 “[m]arkedly decreased” lumbosacral ROM upon flexion, extension, and lateral bending 13 bilaterally, and positive straight-leg-raise tests. (Tr. 1058.) Dr. Amin also reviewed the 14 records of Plaintiff’s treatment with Dr. Uppal, Dr. Halbridge, and Dr. Fleming, and the 15 assessment of Plaintiff’s heart condition from Dr. Ramtin Anousheh. (Tr. 1058-61.) 16 On a Lower Extremity Impairment Questionnaire, Dr. Amin opined that Plaintiff 17 could sit for two hours in an eight-hour workday and stand/walk for “0 to 1” hours; 18 would need to be able to take a ten-minute break from sitting “to get up and move 19 around” every thirty minutes; could not stand/walk continuously in a work setting; could 20 lift up to twenty pounds occasionally and carry up to ten pounds occasionally; would 21 need to have his left leg elevated for ten minutes every one to two hours; would 22 frequently suffer pain, fatigue, or other symptoms that would interfere with his attention 23 and concentration; was capable of no more than “low stress” work; and should avoid 24 exposure to heights, pushing, pulling, kneeling, bending, and stooping. (Tr. 1069-73.) 25 D. Ramtin Anousheh, M.D. 26 Dr. Anousheh began seeing Plaintiff in March 2010 and completed a Cardiac 27 Impairment Questionnaire on October 3, 2011. (Tr. 1048-53.) He diagnosed Plaintiff 28 with non-ischemic cardiomyopathy and chronic systolic heart failure, characterized by -5- 1 shortness of breath, fatigue, and weakness, and exacerbated by physical exertion and hot 2 weather. 3 workday, Plaintiff could sit for “0 to 1” hours, stand/walk for “0 to 1” hours, and could 4 lift/carry up to twenty pounds occasionally. (Tr. 1050-51.) He also found that Plaintiff’s 5 symptoms would frequently interfere with his attention and concentration, that he could 6 only perform “low stress” work, and that he should avoid temperature extremes, 7 humidity, heights, pushing, pulling, kneeling, bending, and stooping. (Tr. 1051-52.) (Tr. 1048, 1050.) Dr. Anousheh further assessed that, in an eight-hour 8 E. Reynaldo Abejuela, M.D. 9 On February 26, 2011, Plaintiff saw State Agency consulting psychiatrist 10 Dr. Abejuela. (Tr. 616-23.) Plaintiff reported depression and anxiety, problems sleeping, 11 low energy, memory problems, and being socially withdrawn. (Tr. 617.) In his mental 12 status examination (MSE), Dr. Abejuela observed that Plaintiff spoke with a mildly 13 depressive tone, exhibited a mildly depressed and anxious affect, and was preoccupied 14 with his pain. (Tr. 619-20.) He diagnosed major depressive disorder (Tr. 620), and 15 assessed Plaintiff’s impairments in occupational and social functioning as “none to mild.” 16 (Tr. 621-22.) 17 persistence, and pace, his ability to understand, carry out, and to remember complex 18 instructions, his ability to respond to coworkers, supervisors, the public, and to respond to 19 usual work situations. (Tr. 622.) Dr. Abejuela stated that his “report should be correlated 20 with more recent psychiatric records available, as [he] d[id] not have any other records 21 for comparison.” (Tr. 617-18, 622.) Dr. Abejuela assessed slight impairments in Plaintiff’s concentration, 22 F. Paul Balson, M.D. and Barbara Smith, M.D. 23 On March 16, 2011, State Agency reviewing psychiatrist Dr. Balson completed a 24 Psychiatric Review Technique form based on his review of the record. (Tr. 794-807.) 25 He opined that Plaintiff’s “psychiatric limitations range[d] from mild to none,” and that 26 his psychiatric problems were “non-severe.” (Tr. 807.) On July 14, 2011, psychiatrist 27 Barbara Smith affirmed Dr. Balson’s assessment. (Tr. 1020-24.) 28 -6- 1 G. V. Phillips, M.D. 2 On February 8, 2011, reviewing State Agency physician Dr. Phillips completed a 3 Physical Residual Functional Capacity (RFC) Assessment based on her review of the 4 record.2 (Tr. 609-15.) Dr. Phillips opined that Plaintiff could stand/walk for three hours 5 in an eight-hour workday due to his knee problems, had no limitations on sitting, and was 6 limited to occasionally pushing and/or pulling with his lower extremities because of his 7 knee problems. (Tr. 610.) She noted that Plaintiff was precluded from “prolonged 8 standing/walking, running or jumping, repetitive squatting, kneeling, or climbing.” 9 (Tr. 614.) She also found that Plaintiff’s history of cardiac problems did not restrict his 10 functional abilities. (Id.) 11 III. Administrative Hearing Testimony 12 Plaintiff was thirty-one years old and appeared with a non-attorney representative 13 at the administrative hearing. (Tr. 9, 20) Plaintiff testified that he suffered a back and 14 knee injury on the job in April 2007. (Tr. 34, 1055.) That injury worsened and he 15 stopped working in March 2008 due to knee problems. (Id.) While covered by workers’ 16 compensation related to the 2007 injury, Plaintiff had multiple arthroscopic surgeries on 17 his left knee. (Tr. 37.) He also testified that his physicians had concluded that he needed 18 a total left knee replacement, and that his right knee also required surgery. (Id.) Plaintiff 19 also testified that he has cardiac problems that have prevented him from being cleared for 20 knee surgery. (Id.) 21 Plaintiff testified that, in addition to physical problems, he has depression, anxiety, 22 and mood problems. (Tr. 38.) Plaintiff explained that his psychological problems make 23 him very irritable to the point of “flip[ping] out” over things such as his children arguing 24 or the dog barking. (Tr. 39.) These incidents make it hard for Plaintiff to concentrate or 25 socialize. (Id.) Plaintiff testified that these episodes occur once or twice a week and 26 typically disrupt his mood for an hour, but sometimes his emotional state does not 27 2 28 Although Dr. Phillips’s gender is not clear from the administrative record, Plaintiff refers to Dr. Phillips with feminine pronouns and the Court will do the same. (Doc. 19 at 13.) -7- 1 stabilize for the entire day. (Tr. 39-40.) In 2009, Plaintiff was hospitalized after 2 attempting to commit suicide by overdosing, because he “tired of hurting, tired of being 3 out of work, [and] not being to support [his] family financially.” (Tr. 44-45.) 4 Plaintiff stated that he lives with his wife and their five children, ages six to 14. 5 (Tr. 43.) He testified that his wife usually does the “physical” chores like grocery 6 shopping, but he drives his children to school and sometimes attends their baseball and 7 soccer practices and games. (Tr. 40-41.) Plaintiff stated that he uses a cane to walk two 8 blocks or more. (Tr. 32.) Plaintiff further testified that some of his medications cause 9 side effects including fatigue or lightheadedness that make it difficult for him to 10 concentrate on simple activities like reading a magazine or watching television. (Tr. 41- 11 42.) He stated that he experiences these issues every other day. (Id.) Plaintiff also 12 testified that he suffers from insomnia and occasionally cannot sleep for consecutive 13 days. (Tr. 42.) 14 Vocational expert Corrine J. Porter also testified at the administrative hearing. 15 (Tr. 46-51.) The ALJ asked her to consider a hypothetical individual with functional 16 impairments identical to those set forth by the ALJ in his July 2012 opinion. (Tr. 13, 47.) 17 The vocational expert testified that such an individual could not perform Plaintiff’s past 18 work, but could perform the jobs of check cashier, sewing machine operator, cashier, and 19 telephone quotation clerk.3 20 IV. The ALJ’s Decision 21 A claimant is considered disabled under the Social Security Act if he is unable “to 22 engage in any substantial gainful activity by reason of any medically determinable 23 physical or mental impairment which can be expected to result in death or which has 24 lasted or can be expected to last for a continuous period of not less than 12 months.” 25 42 U.S.C. § 423(d)(1)(A); see also 42 U.S.C. § 1382c(a)(3)(A) (nearly identical standard 26 for supplemental security income disability insurance benefits). To determine whether a 27 28 3 Plaintiff’s relevant past work includes cable installer, grocery manager, aircraft mechanic, and route delivery driver/sales person. (Tr. 20.) -8- 1 claimant is disabled, the ALJ uses a five-step sequential evaluation process. 2 See 20 C.F.R. §§ 404.1520, 416.920. 3 A. Five-Step Evaluation Process 4 In the first two steps, a claimant seeking disability benefits must initially 5 demonstrate (1) that he is not presently engaged in a substantial gainful activity, and 6 (2) that his disability is severe. 20 C.F.R. § 404.1520(a) (c). If a claimant meets steps 7 one and two, he may be found disabled in two ways at steps three through five. At step 8 three, he may prove that his impairment or combination of impairments meets or equals 9 an impairment in the Listing of Impairments found in Appendix 1 to Subpart P of 10 20 C.F.R. pt. 404. 20 C.F.R. § 404.1520(a)(4)(iii). If so, the claimant is presumptively 11 disabled. If not, the ALJ determines the claimant’s residual functional capacity (RFC). 12 At step four, the ALJ determines whether a claimant’s RFC precludes him from 13 performing his past work. 20 C.F.R. § 404.1520(a)(4)(iv). If the claimant establishes 14 this prima facie case, the burden shifts to the government at step five to establish that the 15 claimant can perform other jobs that exist in significant number in the national economy, 16 considering the claimant’s RFC, age, work experience, and education. If the government 17 does not meet this burden, then the claimant is considered disabled within the meaning of 18 the Act. 19 B. The ALJ’s Application of Five-Step Evaluation Process 20 Applying the five-step sequential evaluation process, the ALJ found that Plaintiff 21 had not engaged in substantial gainful activity during the relevant period. (Tr. 11.) At 22 step two, the ALJ found that Plaintiff had the following severe impairments: 23 “degenerative joint disease of the bilateral knees, status post multiple knee surgeries, and 24 herniated lumbar disc.” (Id.) The ALJ also found that Plaintiff’s congestive heart failure, 25 hypertension, and major depressive disorder were not severe impairments. (Id.) At the 26 third step, the ALJ found that the severity of Plaintiff’s impairments did not meet or 27 medically equal the criteria of an impairment listed in 20 C.F.R. Part 404, Subpart P, 28 Appendix 1. (Tr. 18.) The ALJ next concluded that Plaintiff retained the RFC “to -9- 1 perform light work as defined in 20 C.F.R.§ 404.1567(b) and § 416.967(b).” (Tr. 13.) 2 He specifically found that Plaintiff could “lift and/or carry 20 pounds occasionally, and 3 10 pounds frequently; [and] stand and/or walk for six hours out of an eight-hour 4 workday, for one hour at a time.” (Id.) Additionally, the ALJ found that Plaintiff 5 “require[d] the use of a cane as needed; [was] unlimited in his ability sit; [could not] 6 kneel or crawl; [could not] climb ladders, ropes, or scaffolds; [could not] walk on uneven 7 surfaces; [but could] perform all other postural activities on an occasional basis.” (Id.) 8 Finally, the ALJ determined that Plaintiff “should avoid concentrated exposure to 9 extreme heat and humidity; and he should not work at heights.” (Id.) The ALJ 10 concluded that Plaintiff could not perform his past relevant work. (Tr. 20.) At step five, 11 the ALJ found that considering Plaintiff’s age, education, work experience, and RFC, he 12 could perform other “jobs existing in significant numbers in the national economy.” (Id.) 13 The ALJ concluded that Plaintiff was not disabled within the meaning of the Act. 14 (Tr. 21.) 15 V. Standard of Review 16 The district court has the “power to enter, upon the pleadings and transcript of 17 record, a judgment affirming, modifying, or reversing the decision of the Commissioner, 18 with or without remanding the cause for a rehearing.” 42 U.S.C. § 405(g). The district 19 court reviews the Commissioner’s final decision under the substantial evidence standard 20 and must affirm the Commissioner’s decision if it is supported by substantial evidence 21 and it is free from legal error. Ryan v. Comm’r of Soc. Sec. Admin., 528 F.3d 1194, 1198 22 (9th Cir. 2008); Smolen v. Chater, 80 F.3d 1273, 1279 (9th Cir. 1996). Even if the ALJ 23 erred, however, “[a] decision of the ALJ will not be reversed for errors that are 24 harmless.” Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir. 2005). 25 Substantial evidence means more than a mere scintilla, but less than a 26 preponderance; it is “such relevant evidence as a reasonable mind might accept as 27 adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 401 (1971) 28 (citations omitted); see also Webb v. Barnhart, 433 F.3d 683, 686 (9th Cir. 2005). In - 10 - 1 determining whether substantial evidence supports a decision, the court considers the 2 record as a whole and “may not affirm simply by isolating a specific quantum of 3 supporting evidence.” 4 quotation and citation omitted). Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007) (internal 5 The ALJ is responsible for resolving conflicts in testimony, determining 6 credibility, and resolving ambiguities. See Andrews v. Shalala, 53 F.3d 1035, 1039 (9th 7 Cir. 1995). “When the evidence before the ALJ is subject to more than one rational 8 interpretation, [the court] must defer to the ALJ’s conclusion.” Batson v. Comm’r of Soc. 9 Sec. Admin., 359 F.3d 1190, 1198 (9th Cir. 2004) (citing Andrews, 53 F.3d at 1041). 10 VI. Plaintiff’s Claims 11 Plaintiff asserts that the ALJ erred by (1) finding that his congestive heart failure 12 and major depressive disorder were not severe impairments at step two of the sequential 13 evaluation process, (2) rejecting the opinions of State Agency examining physicians 14 Dr. Anousheh and Dr. Amin, and by partially rejecting the opinions of treating physicians 15 Dr. Fleming, Dr. Uppal, and Dr. Halbridge, and (3) by implicitly rejecting Dr. Phillips’s 16 opinion regarding Plaintiff’s physical RFC without explanation.4 (Doc. 19 at 2, 21-23.) 17 Plaintiff further argues that the ALJ’s finding that Plaintiff’s subjective complaints are 18 not entirely credible is not supported by substantial evidence. (Doc. 19 at 2.) 19 A. Step-Two Determination 20 At step two of the sequential evaluation process, the ALJ determined that 21 Plaintiff’s congestive heart failure and major depressive disorder were not severe 22 impairments. (Tr. 11.) Plaintiff argues that the ALJ erred in this regard. (Doc. 19 at 11- 23 18.) In her response, the Commissioner opposes this assertion and argues that any error 24 was harmless because, although the ALJ did not find Plaintiff’s heart problems and 25 depression severe at step two, he considered those impairments in assessing Plaintiff’s 26 RFC. (Doc. 25 at 11-15.) Plaintiff has not filed a reply in support of his claims. 27 4 28 Although Plaintiff does not include his claim related to Dr. Phillips’s opinion in his Statement of the Issues on page one of his Opening Brief (Doc. 19 at 1), he raises this claim in Section B(2) of his Opening Brief. (Id. at 21-23.) - 11 - 1 The Court agrees with the Commissioner that, even assuming the ALJ erred in 2 failing to find Plaintiff’s congestive heart failure and major depressive disorder severe 3 impairments, that error was harmless. At step two of the sequential evaluation process, 4 the ALJ determines whether a claimant’s impairments, or combination of impairments, 5 are severe. 6 “significantly limit[s a claimant’s] physical or mental ability to do basic work activities.” 7 See 20 C.F.R. § 404.1521(a). Because the ALJ must consider the combined effects of all 8 impairments, severe and non-severe, the critical question at step two is whether a 9 claimant has any severe impairment, not whether a particular impairment is severe. See 10 20 C.F.R. § 404.1545 (a)(2) (an ALJ must consider both severe and non-severe 11 impairments when assessing RFC); Lewis v. Astrue, 498 F.3d 909, 911 (9th Cir. 2007) 12 (finding harmless error when ALJ did not discuss the claimant’s bursitis at step two, but 13 discussed it later in the sequential evaluation process and included relevant restrictions in 14 determining the claimant’s RFC). See 20 C.F.R. § 404.1520(a)(4)(ii). An impairment is severe if it 15 Here, although the ALJ did not find Plaintiff’s heart problems and depression 16 severe impairments at step two, he later assessed an RFC that limited Plaintiff to a range 17 of light work that took those impairments into account. (Tr. 13.) The ALJ stated that, 18 even though he did not consider Plaintiff’s heart problems and depression severe, he 19 considered them in his RFC assessment. (Tr. 11-12 (referring to his RFC assessment as 20 “Finding 5”).) The ALJ specifically noted evidence of Plaintiff’s heart problems and 21 depression when he explained his RFC assessment. (Tr. 14 (discussing chest pain and 22 depression), Tr. 15 (discussing chest pain), Tr. 17 (discussing echocardiogram results and 23 cardiology notes), Tr. 18 (discussing diagnoses of heart problems), Tr. 19 (discussing 24 medical opinions that found Plaintiff’s depression non-severe).) 25 Because the ALJ considered Plaintiff’s severe and non-severe impairments in 26 determining Plaintiff’s RFC, any error at step two, based on his determination that 27 Plaintiff’s heart problems and depression were non-severe, was harmless. See Johnson v. 28 Astrue, 303 Fed. App’x 543, 546 (9th Cir. 2008) (ALJ did not err in assessing the - 12 - 1 claimant’s RFC when he considered the combined effects of the claimant’s impairments 2 and included limitations associated with severe and non-severe impairments); Lewis, 498 3 F.3d at 911 (holding that any step two error was harmless because the ALJ discussed the 4 purportedly omitted impairment in the RFC analysis). 5 B. Weight Assigned to Medical Opinion Evidence 6 In weighing medical source evidence, the Ninth Circuit distinguishes between 7 three types of physicians: (1) treating physicians, who treat the claimant; (2) examining 8 physicians, who examine but do not treat the claimant; and (3) non-examining physicians, 9 who neither treat nor examine the claimant. Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 10 1995). Generally, more weight is given to a treating physician’s opinion. Id. The ALJ 11 must provide clear and convincing reasons supported by substantial evidence for 12 rejecting a treating or an examining physician’s uncontradicted opinion. Id.; Reddick v. 13 Chater, 157 F.3d 715, 725 (9th Cir. 1998). An ALJ may reject the controverted opinion 14 of a treating or an examining physician by providing specific and legitimate reasons that 15 are supported by substantial evidence in the record. Bayliss v. Barnhart, 427 F.3d 1211, 16 1216 (9th Cir. 2005); Reddick, 157 F.3d at 725. 17 Opinions from non-examining medical sources are entitled to less weight than 18 treating or examining physicians. Lester, 81 F.3d at 831. Although an ALJ generally 19 gives more weight to an examining physician’s opinion than to a non-examining 20 physician’s opinion, a non-examining physician’s opinion may nonetheless constitute 21 substantial evidence if it is consistent with other independent evidence in the record. 22 Thomas v. Barnhart, 278 F.3d 947, 957 (9th Cir. 2002). When evaluating medical 23 opinion evidence, the ALJ may consider “the amount of relevant evidence that supports 24 the opinion and the quality of the explanation provided; the consistency of the medical 25 opinion with the record as a whole; [and] the specialty of the physician providing the 26 opinion . . . .” Orn, 495 F.3d at 631. 27 28 - 13 - 1. 1 Weight Assigned Dr. Amin’s and Dr. Anousheh’s Opinions 2 Dr. Amin evaluated Plaintiff and opined that he was “incapable of attaining 3 gainful employment,” and was “100% permanently disabled.” (Tr. 1062.) Dr. Amin also 4 opined that Plaintiff could stand or walk for zero to one hours in an eight-hour workday. 5 (Tr. 1069.) The ALJ gave little weight to Dr. Amin’s opinion because he only saw 6 Plaintiff one time, and because his opinion was inconsistent with Plaintiff’s activities of 7 daily living and with the treating sources who opined that Plaintiff retained the ability to 8 work with restrictions. (Tr. 15, 19.) The ALJ further noted that Dr. Amin’s opinion that 9 Plaintiff was disabled is an issue that is reserved to the Commissioner. (Tr. 19.) 10 Dr. Anousheh completed a Cardiac Questionnaire opining that Plaintiff could sit, 11 stand, and/or walk between zero and one hours per eight-hour workday and that he had 12 other postural limitations. (Tr. 1048-53.) The ALJ gave little weight to Dr. Anousheh’s 13 opinion because he only saw Plaintiff twice and because his opinion was inconsistent 14 with Plaintiff’s activities of daily living and with the opinions of the treating physicians.5 15 (Tr. 19.) 16 The ALJ gave legally sufficient reasons for assigning little weight to Dr. Amin’s 17 and Dr. Anousheh’s opinions. The duration of the treatment relationship and frequency 18 of 19 C.F.R. § 404.1527(c)(2)(i) (stating an ALJ should consider whether a treating source has 20 seen a claimant “a number of times and long enough to have obtained a longitudinal 21 picture” of the claimant’s impairment); Benton v. Barnhart, 331 F.3d 1030, 1038-39 (9th 22 Cir. 2003) (duration of treatment relationship and frequency and nature of contact 23 relevant in weighing opinion). contact is relevant to weighing medical opinion evidence. See 20 24 25 26 27 28 5 To the extent that the ALJ gave Dr. Anousheh’s opinion little weight because he offered an opinion on an issue reserved to the Commissioner (Tr. 19), that reason does not support the ALJ’s assessment of Dr. Anousheh’s opinion because, unlike Dr. Amin, he did not opine that Plaintiff was disabled. (Tr. 1048-53.) However, any error was harmless because the ALJ offered other legally sufficient reasons for assigning little weight to Dr. Anousheh’s opinion. - 14 - 1 Additionally, the ALJ properly considered the inconsistencies between the 2 extreme limitations that Dr. Amin and Dr. Anousheh assessed and Dr. Fleming’s and 3 Dr. Uppal’s opinions that Plaintiff could work with some restrictions (Tr. 323, 499) and 4 with evidence that Plaintiff’s daily activities included caring for his five children. 5 (Tr. 19, 40-41.) See 20 C.F.R. § 404.1527(c)(4) (stating an ALJ must consider whether 6 an opinion is consistent with the record as a whole); Fisher v. Astrue, 2011 WL 1575449, 7 at *3 (9th Cir. Apr. 27, 2011) (inconsistency between a treating physician’s opinion and a 8 claimant’s daily activities and school attendance was a specific and legitimate reason for 9 giving little weight to the opinion). 10 Finally, Dr. Amin’s opinion that Plaintiff was disabled is not entitled to any 11 special significance because that issue is reserved for the Commissioner. See 20 C.F.R. 12 § 404.1527(d)(1)-(3) (treating source opinions on issues that are reserved to the 13 Commissioner are never entitled to any special significance); Tonapetyan v. Halter, 242 14 F.3d 1144, 1149 (9th Cir. 2001) (“Although a treating physician’s opinion is generally 15 afforded the greatest weight in disability cases, it is not binding on an ALJ with respect to 16 the existence of an impairment or the ultimate determination of disability.”) (citation 17 omitted)). 18 Dr. Amin’s and Dr. Anousheh’s opinions. The ALJ gave legally sufficient reasons for assigning little weight to 2. 19 Dr. Uppal’s, Dr. Halbridge’s, and Dr. Fleming’s Opinions 20 The ALJ gave “considerable weight” to the opinions of treating physicians 21 Dr. Uppal, Dr. Halbridge, and Dr. Fleming finding their statements “precluding [Plaintiff] 22 from heav[y] work or heavy lifting; and precluding [Plaintiff] from prolonged standing 23 and walking; no running or jumping; no repetitive squatting or kneeling; and climbing” 24 are “well-supported by clinical and diagnostic findings and are not inconsistent with the 25 other substantial evidence of record.”6 (Tr. 19, Tr. 323, 432-33, 511.) The ALJ’s 26 27 28 6 Although Plaintiff generally argues that the ALJ erred by implicitly rejecting portions of Dr. Fleming’s opinions, he does not specifically identify the portions of Dr. Fleming’s opinions that the ALJ allegedly rejected. (Doc. 19 at 1, 21-23.) Accordingly, the Court does not further address this claim. - 15 - 1 assessment of Plaintiff’s RFC includes many of these restrictions, including that Plaintiff 2 could only lift up to twenty pounds. (Tr. 13.) a. 3 Dr. Uppal’s Opinion 4 Plaintiff contends that the ALJ erred because he implicitly rejected 5 Dr. Uppal’s opinion (Tr. 466, 511) that Plaintiff should avoid pushing or pulling with his 6 lower extremities by failing to include that limitation in his RFC and in hypothetical 7 questions posed to the vocational expert.7 (Doc. 19 at 23.) In support of this assertion, 8 Plaintiff cites Dr. Uppal’s treatment notes from December 11, 2008 and September 1, 9 2010, which indicate that Plaintiff’s bilateral knee pain and symptoms of “swelling, 10 clicking, locking, popping, stiffness, weakness, [and] giving away,” were worse with, 11 among other functions, “pushing” and “pulling.” (Doc. 19 at 23 (citing Tr. 466, 511).) 12 Although two of Dr. Uppal’s treatment notes indicate that pushing and pulling 13 exacerbated Plaintiff’s bilateral knee pain, he did not offer an opinion that Plaintiff was 14 precluded from pushing or pulling with his lower extremities. 15 restrictions” included “no weight bearing, no stair climbing, no walking on uneven 16 surfaces”; Tr. 592, “work restrictions” included no “heavy lifting, no prolonged weight 17 bearing with right and left knees and legs.”) Accordingly, the ALJ could not have erred 18 by rejecting an opinion that Dr. Uppal did not give. b. 19 (Tr. 499, “work Dr. Halbridge’s Opinions 20 In support of his claim that the ALJ erred by implicitly rejecting Dr. Halbridge’s 21 opinion that Plaintiff should avoid pushing and pulling with his lower extremities, 22 Plaintiff cites Dr. Halbridge’s July 18, 2009 orthopedic evaluation of Plaintiff. (Doc. 19 23 at 23.) Dr. Halbridge concluded that, due to Plaintiff’s “left hip, [he] should have work 24 restrictions precluding him from frequent bending, stooping, lifting, and heavy pushing, 25 pulling or lifting weights greater than 20 pounds.” (Tr. 434.) The ALJ stated that he gave 26 27 28 7 Although Plaintiff generally argues that the ALJ erred by implicitly rejecting portions of Dr. Fleming’s opinions, he does not specifically identify the portions of Dr. Fleming’s opinions that the ALJ allegedly rejected. (Doc. 19 at 1, 21-23.) Accordingly, the Court does not further address this claim. - 16 - 1 “considerable weight to the exertional assessment[] of . . . Dr. Halbridge,” which found 2 Plaintiff precluded from “prolonged standing and walking,” “running or jumping”, 3 “repetitive squatting or kneeling, and no climbing.” (Tr. 19.) The ALJ, however, did not 4 mention Dr. Halbridge’s conclusion that Plaintiff was precluded from pushing or pulling 5 weights greater than twenty pounds. (Tr. 19.) Plaintiff argues that the ALJ erred by 6 failing to explain his “silent[]” rejection of this limitation. (Doc. 19 at 23.) 7 The Commissioner asserts that the ALJ was not required to accept all of the 8 limitations found by the various physicians in the record. (Doc. 25 at 19 n.7.) The 9 Commissioner further argues that the ALJ stated that he assigned “considerable weight” 10 to Dr. Halbridge’s opinions and adopted many of his assessed limitations. (Id.) The 11 Commissioner, however, does not address whether the ALJ erred by failing to explain his 12 implicit rejection of Dr. Halbridge’s pushing/pulling limitation. 13 Here, because the ALJ stated that he assigned “considerable weight” to treating 14 physician Dr. Halbridge’s opinions, but then failed to mention the pushing or pulling 15 restriction, the ALJ implicitly rejected that limitation without explanation. 16 Lingenfelter v. Astrue, 504 F.3d 1028, 1038 n.10 (9th Cir. 2007) (“Of course, an ALJ 17 cannot avoid these requirements [to state specific, legitimate reasons] simply by not 18 mentioning the treating physician’s opinion and making findings contrary to it.”). That 19 implicit rejection “violated the elementary requirement that [ALJs] not only state their 20 findings but explicate the reasons for their decision” and was error. Brown v. Bowen, 794 21 F.2d 703, 708 (D.C. Cir. 1986). See 22 While Dr. Halbridge’s pushing or pulling findings translate into functional 23 limitations that would impact Plaintiff’s ability to work and sustain full-time 24 employment, the ALJ did not provide any reason, for rejecting that aspect of the treating 25 physician’s opinion. See Rollins v. Massanari, 261 F.3d 853, 856 (9th Cir. 2001) (“The 26 ALJ may not reject the opinion of a treating physician, even if it is contradicted by the 27 opinions of other doctors, without providing ‘specific and legitimate reasons’ supported 28 - 17 - 1 by substantial evidence in the record.”) (citation omitted). As discussed in section VI(d) 2 below, this error was not harmless. 3 c. Dr. Phillips’s Opinions 4 Plaintiff further argues that the ALJ erred by purporting to assign “significant 5 weight” to non-examining physician Dr. Phillips’s opinion that Plaintiff “retain[ed] the 6 ability to perform a light range of work with standing and walking limitations,” but 7 rejecting without explanation Dr. Phillips’s opinion restricting Plaintiff to standing and/or 8 walking for no more than three hours in an eight-hour workday due to bilateral knee 9 degenerative joint disease, and her opinion restricting Plaintiff to no more than occasional 10 pushing or pulling with his lower extremities. (Doc. 19 at 21, 23 (citing Tr. 610).) The 11 Commissioner’s response does not address this argument. (Tr. 25 at 19-20.) 12 Dr. Phillips completed a physical RFC assessment on February 8, 2011. (Tr. 609- 13 15.) She opined that Plaintiff was limited to standing or walking three hours in an eight- 14 hour day due to degenerative joint disease. (Tr. 610.) She also opined that Plaintiff was 15 limited to “occasional” pushing and pulling with his lower extremities due to 16 degenerative joint disease in his knees. (Id.) The ALJ stated that he gave “great weight” 17 to Dr. Phillips’s opinion that Plaintiff “retain[ed] the ability to perform a range of light 18 work with standing and walking limitations.” (Tr. 19 (citing Admin. Hrg. Ex. 12F).) 19 Dr. Phillips, however did not opine that Plaintiff could perform “light work.” (Tr. 609- 20 15.) Additionally, the ALJ found that Plaintiff could stand or walk for six hours in an 21 eight hour day, for one hour at a time, and does not explain his implicit rejection of 22 Dr. Phillips’s opinion that Plaintiff was limited to three hours of standing or walking. 23 (Tr. 13-21.) Similarly, the ALJ’s RFC assessment does not include any limitations on 24 Plaintiff’s ability to push or pull with his lower extremities (Tr. 13), and the ALJ does not 25 explain his implicit rejection of Dr. Phillips’s opinion that Plaintiff was limited to 26 occasional pushing or pulling with his lower extremities. (Tr. 13-21.) 27 The Social Security Regulations provide that, although ALJs “are not bound by 28 any findings made by [non-examining] State agency medical or psychological - 18 - 1 consultants, or other program physicians or psychologists,” they must “consider [their] 2 findings and other opinions . . . as opinion evidence, except for the ultimate determination 3 about whether [a claimant is] disabled,” because such specialists are regarded as “highly 4 qualified . . . experts 5 §§ 404.1527(f)(2)(i), 416.927(f)(2)(i). in Social Security disability evaluation.” 20 C.F.R. 6 “Unless a treating source’s opinion is given controlling weight, the [ALJ] must 7 explain in the decision the weight given to the opinions of a State agency medical or 8 psychological consultant or other program physician, psychologist, or other medical 9 specialist.” 20 C.F.R. §§ 404.1527(f)(2) (ii), 416.927(f)(2)(ii); see also Social Security 10 Ruling8 (SSR) 96-6p, 1996 WL 374180, at *2 (findings by State agency or other program 11 physicians and psychologists “about the nature and severity of an individual’s 12 impairment(s)” must be treated as expert opinion evidence of non-examining sources, and 13 ALJs “may not ignore these opinions and must explain the weight given to the opinions 14 in their decisions”). 15 An ALJ “may reject the opinion of a non-examining physician by reference to 16 specific evidence in the medical record.” Sousa v. Callahan, 143 F.3d 1240, 1244 (9th 17 Cir. 1998) (citations omitted); see Benavidez v. Colvin, 2014 WL 1245643, at *6-7 18 (N.D. Cal. Mar. 25, 2014) (ALJ erred by failing to explain why he rejected non- 19 examining physician’s opinions); Haislip v. Colvin, 2013 WL 5476428, at *10 (E.D. Cal. 20 Sept. 30, 2013) (ALJ must provide specific and legitimate reasons supported by 21 substantial evidence in the record for rejecting non-examining physician’s opinions). 22 Here, the ALJ stated that he gave “great weight” to Dr. Phillips’s opinion, but his 23 RFC determination did not account for the sitting or standing and pushing or pulling 24 limitations that Dr. Phillips assessed, and did not explain his apparent rejection of those 25 26 27 28 8 Social Security Rulings are binding on ALJs. See Terry v. Sullivan, 903 F.2d 1273, 1275 n.1 (9th Cir. 1990). - 19 - 1 limitations.9 (Tr. 19-20.) The ALJ’s failure to provide any reason for rejecting those 2 opinions of Dr. Phillips constitutes error. See Benavidez 2014 WL 1245643, at *6-7; 3 Haislip, 2013 WL 5476428, at *10. Having found error, the Court next determines 4 whether the error was harmless. d. 5 Whether the ALJ’s Errors were Harmless 6 An ALJ’s error is harmless when such error is inconsequential to the ultimate non- 7 disability determination. See Stout v. Comm’r of Soc. Sec., 454 F.3d 1050, 1055 (9th Cir. 8 2006); see also Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir. 2005) (“A decision of the 9 ALJ will not be reversed for errors that are harmless.”); Curry v. Sullivan, 925 F.2d 1127, 10 1131 (9th Cir. 1991) (harmless error rule applies to review of administrative decisions 11 regarding disability). As discussed below, the Court concludes that the ALJ’s error for 12 failing to discuss his implicit rejection of portions of Dr. Halbridge’s and Dr. Phillips’s 13 opinions was not harmless to the overall disability determination. See Stout, 454 F.3d at 14 1055 (an ALJ’s error is harmless when it is “irrelevant to the ALJ’s ultimate disability 15 conclusion.”). 16 Here, after concluding that Plaintiff could not perform his past relevant work, the 17 ALJ relied on the vocational expert’s testimony to determine whether Plaintiff was 18 capable of performing other work that existed in significant numbers in the national 19 economy. (Tr. 20-21.) However, when questioning the vocational expert, the ALJ did 20 not include Dr. Phillips’s opinion that Plaintiff was limited to three hours of standing or 21 walking in an eight-hour day, Dr. Phillips’s opinion that Plaintiff was limited to 22 occasional pushing or pulling with his lower extremities, or Dr. Halbridge’s opinion that 23 Plaintiff was precluded from pushing or pulling weights greater than twenty pounds. 24 (Tr. 46-51.) 25 hypothetical that accurately reflected Plaintiff’s physical RFC. See Valentine v. Comm’r 26 of Soc. Sec. Admin., 574 F.3d 685, 690 (9th Cir. 2009) (“The hypothetical an ALJ poses The ALJ should have provided the vocational expert with a complete 27 9 28 The ALJ’s RFC assessment did not include any limitations on Plaintiff’s ability to push and pull with his lower extremities and found Plaintiff limited to six, not three, hours, of standing or walking. (Tr. 13.) - 20 - 1 to a vocational expert, which derives from the RFC, ‘must set out all the limitations and 2 restrictions of a particular claimant.’”) (citing Embrey v. Bowen, 849 F.2d 418, 422 (9th 3 Cir. 1988)); see also Matthews v. Shalala, 10 F.3d 678, 681 (9th Cir. 1993) (“If a 4 vocational expert’s hypothetical does not reflect all of the claimant’s limitations, then the 5 expert’s testimony has no evidentiary value to support a finding that the claimant can 6 perform jobs in the national economy.”) (internal quotation marks and citation omitted). 7 These limitations may have elicited different testimony from the vocational 8 expert.10 For example, Dr. Phillips found that Plaintiff could only perform occasional 9 pushing and pulling with his lower extremities, but the definition of light work, which the 10 ALJ concluded Plaintiff could perform (Tr. 13), requires the ability to engage in frequent 11 lifting or carrying, or exerting force, which includes pushing and pulling upon at least a 12 minimal amount of weight. Specifically, light work requires “lifting no more than 20 13 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds.” 14 20 C.F.R. §§ 404.1567(b), 416.967(b); SSR 83-10, 1983 WL 31251, at *5. Additionally, 15 “the full range of light work requires standing and walking, off and on, for a total of 16 approximately 6 hours of an 8-hour workday.” 20 C.F.R. §§ 404.1567(b), 416.967(b); 17 SSR 83-10, 1983 WL 31251, at *6. “[A] job is also in this category [light work] when it 18 requires a good deal of walking or standing, or when it involves sitting most of the time 19 with some pushing and pulling of arm or leg controls,” which require greater exertion 20 than sedentary work. See 20 C.F.R. §§ 404.1567(b), 416.967(b); SSR 83-10, 1983 WL 21 31251, at *5. 22 23 10 24 25 26 27 28 The vocational expert testified that Plaintiff could perform several jobs classified as light work and some jobs classified as sedentary work. (Tr. 47-51.) Although the ALJ noted that the vocational expert testified that Plaintiff could perform the job of telephone quotation clerk, classified as sedentary work, it is not clear whether the ALJ’s final disability determination was based on Plaintiff’s ability to perform that sedentary position, or his ability to perform less than “the full range of light work.” (Tr. 21 (stating that although Plaintiff cannot perform a full range of light work, considering [his] age, education and transferrable work skills, a finding of ‘not disabled’ is appropriate . . . .”).) Additionally, the vocational expert’s testimony regarding sedentary work was based on a hypothetical that did not incorporate all of the limitations that Dr. Halbridge and Dr. Phillips assessed. - 21 - 1 Here, because the ALJ failed to properly evaluate Dr. Halbridge’s and 2 Dr. Phillips’s opinions and either explain his rejection of their pushing or pulling 3 limitations and Dr. Phillips’s standing or walking limitations, or include those limitations 4 in the RFC and in the questions to the vocational expert, the vocational expert’s 5 testimony does not constitute substantial evidence to support the ALJ’s findings. 6 Therefore, the Court remands this case to allow the ALJ an opportunity to re-examine the 7 record and Dr. Halbridge’s and Dr. Phillips’s opinions. The ALJ must incorporate any 8 limitations that are supported by the substantial evidence into the RFC and hypotheticals 9 posed to the vocational expert.11 10 Because the Court finds error with the ALJ’s consideration of Dr. Halbridge’s 11 Dr. Phillips’s opinions and remands this case for renewed consideration of the medical 12 evidence, the Court does not analyze the ALJ’s assessment of Plaintiff’s credibility. 13 Consideration of Plaintiff’s credibility is linked to conclusions regarding the medical 14 evidence. See 20 C.F.R. § 416.929. Thus, the re-evaluation of the medical evidence may 15 impact the ALJ’s findings as to Plaintiff’s credibility. 16 Accordingly, 17 IT IS ORDERED that this case is reversed and remanded to the ALJ for further 18 proceedings consistent with this Order. The Clerk of Court shall enter judgment in favor 19 of Plaintiff and against the Commissioner and shall terminate this case. 20 Dated this 16th day of May, 2014. 21 22 23 24 25 26 11 27 28 Although treating physician Dr. Uppal did not specifically opine that Plaintiff was precluded from pushing and pulling, his treatment notes from December 11, 2008 and September 1, 2010 stating that Plaintiff’s bilateral knee pain and related symptoms were aggravated by pushing and pulling (Tr. 466, 511) are consistent with Dr. Phillips’s pushing and pulling limitations. - 22 -

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