Smith v. Astrue
Filing
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ORDER, Defendant's administrative decision is affirmed; the Clerk is directed to enter judgment accordingly. Signed by Judge David G Campbell on 5/20/13. (REW)
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IN THE UNITED STATES DISTRICT COURT
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FOR THE DISTRICT OF ARIZONA
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Brenda J. Smith,
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No. CV12-8170 PCT DGC
Plaintiff,
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v.
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ORDER
Carolyn W. Colvin, Commissioner of
Social Security,
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Defendant.
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Plaintiff Brenda J. Smith applied for disability insurance benefits on
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November 16, 2007, claiming to have been disabled as of March 3, 2006. Tr. 144. Her
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claim was denied on April 17, 2008 (Tr. 85-88), and upon reconsideration on
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September 4, 2008 (Tr. 90-92). Plaintiff was granted a hearing in which she appeared
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before an Administrative Law Judge (“ALJ”) on May 13, 2010. Tr. 31. The ALJ
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determined that Plaintiff was not disabled within the meaning of the Social Security Act.
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Tr. 13-26. The ALJ’s decision became Defendant’s final decision when the Appeals
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Council denied review on June 27, 2012. Tr. 1-43. Plaintiff then commenced this action
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for judicial review pursuant to 42 U.S.C. § 405(g). Doc. 1. The Parties have not
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requested oral argument, and Plaintiff did not file a reply brief. For reasons that follow,
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the Court will affirm Defendant’s decision.
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I.
Standard of Review.
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Defendant’s decision to deny benefits will be vacated “only if it is not supported
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by substantial evidence or is based on legal error.” Robbins v. Soc. Sec. Admin., 466 F.3d
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880, 882 (9th Cir. 2006). “‘Substantial evidence’ means more than a mere scintilla, but
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less than a preponderance, i.e., such relevant evidence as a reasonable mind might accept
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as adequate to support a conclusion.”
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supported by substantial evidence, the Court must consider the record as a whole,
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weighing both the evidence that supports the decision and the evidence that detracts from
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it. Reddick v. Charter, 157 F.3d 715, 720 (9th Cir. 1998). The Court cannot affirm the
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decision “simply by isolating a specific quantum of supporting evidence.”
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Weinberger, 522 F.2d 1154, 1156 (9th Cir. 1975); see Robbins, 466 F.3d at 882.
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II.
Id.
In determining whether the decision is
Day v.
Analysis.
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For purposes of Social Security benefits determinations, a disability is “the
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inability to do any substantial gainful activity by reason of any medically determinable
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physical or mental impairment which can be expected to result in death or which has
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lasted or can be expected to last for a continuous period of not less than 12 months.”
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20 C.F.R. § 404.1505. Determining whether a claimant is disabled involves a five-step
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evaluation. The claimant bears the burden in steps one through four of showing that
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(1) she is not engaged in a substantial gainful activity, (2) she has a severe medically
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determinable physical or mental impairment, and (3) the impairment meets or equals a
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listed impairment or (4) her residual functional capacity (“RFC”) precludes her from
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performing her past work.1 If at any step the Commissioner determines that a claimant is
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or is not disabled, the analysis ends; otherwise it proceeds to step five.
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Commissioner bears the burden at step five of showing that the claimant has the RFC to
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perform other work that exists in substantial numbers in the national economy.
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See 20 C.F.R. §§ 404.1520(a)(4)(i)-(v) & 416.920(a)(4)(i)-(v).
The
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The ALJ found at step one that Plaintiff had not engaged in substantial activity
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since her alleged onset date. Tr. 15. At step two, the ALJ found that Plaintiff suffered
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from the following severe combination of impairments: complex regional pain syndrome
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RFC is the most a claimant can do in light of the limitations caused by her
impairments.
See Rodriguez v. Bowen, 876 F.2d 759, 762 (9th Cir. 1989);
20 C.F.R. § 416.945 (a); SSR 96-8p, 1996 WL 374184 (July 2, 1996).
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vs. reflex sympathetic dystrophy of right lower extremity; status-post left knee
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arthroscopy with partial medial meniscectomy, and chondroplasty of patellofemoral
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compartment in June 2006; status-post right knee arthroscopy with partial medial
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meniscectomy and chondroplasty of the patellofemoral joint in July 2007; asthma; and
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obesity. Id. The ALJ determined at step three that none of these impairments or their
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combination met or equaled a listed impairment. Tr. 17. The ALJ then considered the
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entire record and determined that Plaintiff’s RFC included the following restrictions: sit
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for a total of six hours in an eight-hour workday, and for 30 minutes at one time; stand
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and/or walk for a total of two hours in an eight-hour workday, and for one to two hours at
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a time; lift up to 10 pounds frequently and up to 20 pounds occasionally; severe
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restrictions inability to squat, crawl, and climb, and inability to work at unprotected
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heights and around moving machinery; moderate restrictions inability stoop and bend,
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inability to drive automotive equipment, and inability to be exposed to dust, fumes and
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gases; mild limitations in concentration, in interpersonal relationships, and inability to
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cope with stress and consistency of effort or productivity. Tr. 18. At step four, the ALJ
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determined that Plaintiff was not disabled because she was capable of performing her
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past relevant work. Tr. 24. In the alternative, at step five, the ALJ concluded that
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Plaintiff was not disabled because she was capable of performing other work that existed
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in significant numbers in the national economy. Tr. 25-26.
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Plaintiff argues that the ALJ erred by improperly rejecting her allegations of
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disabling pain (Doc. 12 at 6-7), by rejecting the medical opinion of a treating source (id.
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at 8), and by misinterpreting evidence to the detriment of Plaintiff (id. at 5-6). The Court
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will address each argument in turn.
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A.
Plaintiff’s Subjective Testimony.
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Plaintiff testified that she is unable to drive, and that the last time she drove was in
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2007 or 2008. Tr. 39. Since then, Plaintiff’s family provides her with rides, including a
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ride to visit her husband in Oklahoma in September 2009 and a trip to Minnesota for a
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family reunion in 2008. Tr. 39-41. Plaintiff testified that in 2007 she helped her husband
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with his taxicab business by answering telephones. Tr. 59-60. Plaintiff testified that she
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tried driving for her husband both before and after her knee surgeries, but was unable to
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drive in both instances. Tr. 60.
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Plaintiff testified that Dr. Joel Rohrbough, M.D., performed surgery on her left
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knee in 2006 and her right knee in 2007. Tr. 43-44. Plaintiff testified that she has
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arthritis and swelling in both knees. Tr. 44. She stated that after the second surgery her
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right knee “ended up with some nerve damage or something going on with the nerves
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where as it was in constant pain or it just doesn’t work right. It swells tremendously, and
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simply stops me from lifting my leg and walking correctly.” Tr. 44. She stated that she
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has problems picking up both legs, for example stepping on a stool, and that standing or
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sitting for too long causes her to have major pain. Tr. 45. Plaintiff testified that she
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suffers from reflex sympathetic dystrophy (“RSD”), which causes swelling in her ankles,
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knees, and legs. Tr. 48. Plaintiff testified that the pain in her leg is constant, but
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sometimes it is not as severe. Tr. 45-46. Plaintiff also stated that in general, her pain is
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severe for the most of any given day. Tr. 48. Plaintiff testified that the pain causes
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difficulties with her concentration. Id.
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Plaintiff stated that she had injections after her second surgery to help alleviate the
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pain. Tr. 49. She stated that she did not notice a big difference from the injections. Id.
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Plaintiff testified that she takes Lyrica for her RSD. Tr. 44. As to her medication side
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effects, Plaintiff testified that Lyrica causes swelling, an increase in her appetite, and
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some confusion. Tr. 51. She stated that she was off Lyrica for a while when she ran out
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of it, and that her confusion improved some during this period. Tr. 51.
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Plaintiff testified that she has asthma, hearing loss, sleep problems, and allergies.
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Tr. 50. Plaintiff testified that she has problems hearing people over the telephone and has
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to ask people to repeat themselves several times. Tr. 52. Plaintiff stated that she has
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tendinitis in her hands (Tr. 48), and that the tendinitis causes her hands to swell after
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doing anything for too long, including, for example, writing a full paragraph (Tr. 53-54).
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Plaintiff testified that using a cane and a walker has caused additional problems because
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those devices require the continuous use of her hands. Tr. 54.
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Plaintiff testified that she last saw her treating orthopedist, Dr. John Ledington,
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M.D., in 2008, and that she last saw her other treating orthopedist, Dr. Rohrbough, in
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April 2009. Tr. 57-58. Since April 2009, Plaintiff testified that Dr. Bigler is the only
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physician she has been seeing, and that she has seen her about two to three times a year
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since May 2008. Tr. 58-59. Plaintiff testified that she does not have insurance and has
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been paying out-of-pocket to see Dr. Bigler. Tr. 40.
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The ALJ found that Plaintiff’s statements concerning the intensity, persistence,
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and limiting effects of her symptoms were not credible to the extent they are inconsistent
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with the RFC assessment. Tr. 19. In reaching this conclusion, the ALJ evaluated
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Plaintiff’s testimony using the two-step analysis established by the Ninth Circuit.
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See Smolen v. Chater, 80 F.3d 1273, 1281 (9th Cir. 1996). Applying the test of Cotton v.
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Bowen, 799 F.2d 1403 (9th Cir. 1986), the ALJ first determined that Plaintiff’s
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impairments could reasonably produce the symptoms alleged.
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conclusion, and because there is no evidence of malingering, the ALJ was required to
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present “specific, clear and convincing reasons” for finding Plaintiff not entirely credible.
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Smolen, 80 F.3d at 1281. This clear and convincing standard “is the most demanding
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required in Social Security cases.” Moore v. Comm’r of SSA, 278 F.3d 920, 924 (9th Cir.
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2002).
Tr. 19.
Given this
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“An ALJ’s finding that a claimant generally lacked credibility is a permissible
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basis to reject excess pain testimony, . . . a finding that the claimant lacks credibility
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cannot be premised wholly on a lack of medical support for the severity of the pain.”
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Light v. SSA, 119 F.3d 789, 792 (9th Cir. 1997) (citations omitted). General assertions
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that the claimant’s testimony is not credible are insufficient.
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481 F.3d 742, 750 (9th Cir.2007). The ALJ must identify “what testimony is not credible
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and what evidence undermines the claimant’s complaints.” Id. (quoting Lester v. Chater,
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81 F.3d 821, 834 (9th Cir. 1995)). In weighing a claimant’s credibility, the ALJ may
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consider some of the following factors:
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See Parra v. Astrue,
claimant’s reputation for truthfulness,
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inconsistencies either in claimant’s testimony or between her testimony and her conduct,
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unexplained or inadequately explained failure to seek treatment or to follow a prescribed
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course of treatment, claimant’s daily activities, claimant’s work record, and the
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compatibility of claimant’s testimony with the medical evidence. Thomas v. Barnhart,
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278 F.3d 947, 958-59 (9th Cir. 2002); Lee v. Astrue, 472 Fed. Appx. 553, 555 (9th Cir.
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2012).
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The ALJ rejected Plaintiff’s testimony on three grounds. First, the ALJ examined
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the objective evidence of record and concluded that it did not support the extreme
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limitations alleged. Tr. 19-21. Plaintiff argues that the ALJ improperly rejected her
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subjective pain testimony due to a lack of supporting objective medical evidence
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(Doc. 12 at 6-7), and that the ALJ ignored objective evidence showing “continuing,
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consistent complaints of severe pain.” Doc. 12 at 6. In general, Plaintiff argues that the
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ALJ’s “[c]iting of periods of improvement with medical care when that improvement is
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shown, in the medical records, to be short lived is not a legitimate reason [to reject her
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pain complaints].” Doc. 12 at 7.
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It is legal error for an ALJ to discount a claimant’s pain testimony “solely because
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it is not corroborated by medical findings[,]” but a court may “evaluate the claimant’s
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testimony in other ways.” Chavez v. Dep’t of Health and Human Servs., 103 F.3d 849,
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853 (9th Cir. 1996); see also Light, 119 F.3d at 792 (“An ALJ may not discredit a
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claimant’s subjective testimony [because no objective medical evidence supports it]. To
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find the claimant not credible the ALJ must rely either on reasons unrelated to the
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subjective testimony (e.g., reputation for dishonesty), on conflicts between his testimony
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and his own conduct, or on internal contradictions in that testimony.”). Accordingly, the
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Court will review the ALJ’s other reasons for discounting Plaintiff’s pain testimony
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before determining whether this basis constitutes legal error.
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The ALJ’s second reason for rejecting Plaintiff’s pain testimony was her course of
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treatment. Tr. 21. Because Plaintiff “has not generally received the type of medical
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treatment one would expect for a totally disabled individual,” the ALJ concluded that
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“[Plaintiff]’s symptoms may not have been as serious as has been alleged.” Id. Plaintiff
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contends that the ALJ erred in rejecting her pain symptom testimony because she was
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unable to afford the same level of care after losing her insurance. Doc. 12 at 7. The ALJ
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acknowledged Plaintiff’s loss of medical insurance, but noted that when Plaintiff did
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elect to pay for treatment it did not concern her allegedly disabling impairments; instead,
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the treatment was for mouth sores, medical refills, and urinary tract infections. Id. (citing
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Tr. 863-63). This analysis does not constitute legal error. See Lee, 472 Fed. Appx. at
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555 (citing See Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989) (finding that an
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“unexplained, or inadequately explained, failure to seek treatment or follow a prescribed
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course of treatment” is a valid basis to reject claimant testimony)). The ALJ reasonably
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could conclude that Plaintiff would have chosen to obtain care related to her disabling
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impairments, rather than these other matters, if the impairments were as severe as she
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claims.
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Third, the ALJ noted several inconsistencies in Plaintiff’s statements:
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(1) inconsistent reports about her functional limitations; (2) inconstant statements about
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medication side-effects; (3) use of a cane without medical evidence suggesting one is
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necessary; and (4) inconsistent statements about operating a motor vehicle. Tr. 21-22.
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Plaintiff does not argue that the ALJ erred in considering these inconsistencies in
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rejecting Plaintiff’s subjective pain testimony, and the Court does not find error.
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See Thomas, 278 F.3d at 958-59.
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In light of these legally sufficient grounds for discrediting Plaintiff’s subjective
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pain testimony, the Court need not consider whether the ALJ erred in concluding that her
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testimony was also inconsistent with objective medical evidence. See Batson v. Comm’r
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of SSA, 359 F.3d 1190, 1197 (9th Cir. 2004) (“Because the ALJ considered the claimant’s
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testimony to be contradictory and unsupported by either the objective medical evidence
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or any persuasive reports of his doctors, the district court did not err in affirming the
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ALJ’s determinations about [the claimant]’s credibility.”). The ALJ provided clear and
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convincing reasons, supported by substantial evidence, for discounting Plaintiff’s
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testimony.
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B.
Medical Opinion Evidence.
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“The ALJ must consider all medical opinion evidence.” Tommasetti v. Astrue,
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533 F.3d 1035, 1041 (9th Cir. 2008); see 20 C.F.R. § 404.1527(c); SSR 96-5p, 1996 WL
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374183, at *2 (July 2, 1996). The ALJ may reject the opinion of a treating or examining
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physician by making “findings setting forth specific legitimate reasons for doing so that
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are based on substantial evidence in the record.” Thomas, 278 F.3d at 957 (citation
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omitted). “The ALJ can meet this burden by setting out a detailed and thorough summary
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of the facts and conflicting clinical evidence, stating h[er] interpretation thereof, and
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making findings.” Id. “The opinions of non-treating or non-examining physicians may
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also serve as substantial evidence when the opinions are consistent with independent
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clinical findings or other evidence in the record.” Id. Further, “[t]he ALJ need not accept
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the opinion of any physician, including a treating physician, if that opinion is brief,
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conclusory, and inadequately supported by clinical findings.” Id.
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Plaintiff argues that the ALJ failed to consider the opinion of her primary care
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physician, Dr. Bigler. Doc. 12 at 8. On May 17, 2010, Dr. Bigler completed a medical
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disability form indicating, among other limitations, that Plaintiff could sit a total of six
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hours in an eight-hour workday, but had to elevate her legs and walk around every 15-20
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minutes. Tr. 868. The ALJ gave Dr. Bigler’s opinion little weight for three reasons:
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(1) the assessment lacked medically sufficient diagnostic bases for the limitations
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assessed; (2) Dr. Bigler’s assertion that Plaintiff must elevate her legs was without any
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support in the medical records; and (3) most of Plaintiff’s care involving her knees and
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complex regional pain syndrome was with Dr. Rohrbough, and his reports did not reflect
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such limitations. Tr. 24. Plaintiff argues that “[a]lthough [Dr. Bigler]’s records do not
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specifically discuss the lower extremity issues with regard to the need for leg elevation,
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the doctor does have access to the prior treatment records.” Doc. 12 at 8. Plaintiff also
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asserted that the medical records “consistently discuss complex regional pain syndrome,”
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and that a May 2008 note from Dr. Bigler indicating that Plaintiff’s swelling had greatly
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decreased establishes that “the patient was having swelling prior to that note” and that
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“[i]t is medically reasonable with lower extremity swelling and complex regional pain
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syndrome that one would need stronger circulatory performance in the lower extremities,
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hence requiring leg elevation during prolonged sitting.” Id. That Dr. Bigler’s opinion
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may be “medically reasonable” does not mean it was error for the ALJ to have rejected
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the opinion. The ALJ rejected Dr. Bigler’s opinion based on three specific and legitimate
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reasons, including a lack of supporting clinical findings. This does not constitute legal
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error. See Thomas, 278 F.3d at 957.
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C.
Misinterpretation of Evidence.
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Plaintiff argues that the ALJ erred in interpreting and applying Dr. Rohrbough’s
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opinions, to which the ALJ gave controlling weight. Doc. 12 at 5 (citing Tr. 23). In May
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2008, Dr. Rohrbough opined that “[i]f any more improvement is realized, [Plaintiff]
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would be able to return to desk work only.” Tr. 824. In October 2008, Dr. Rohrbough
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examined Plaintiff and his notes indicate that Plaintiff “continues to be plagued with
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classic signs of reflex sympathetic dystrophy/complex regional pain syndrome.” Tr. 852.
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The notes include an assessment of Plaintiff’s lumbar sympathetic block treatment with
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Dr. Ledington, and opine that “[i]t is extremely unusual and unfortunate for the patient to
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have a poor response to additional blocks after having such an excellent response to the
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first block. I don’t have a good explanation for this at this time. . . . Active treatment
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options should be aggressively pursued in my opinion. If the dorsal column stimulator
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does not help, I would recommend referral to another pain specialist who does lumbar
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sympathetic injunctions, to see if we can get a better response.” Id.
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Plaintiff argues that “[t]hese statements would suggest that the doctor did not
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believe, at least through late 2008, that his patient [had] the capacity to return to any
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work.” Doc. 12 at 5. But Plaintiff concedes that Dr. Rohrbough opined that Plaintiff was
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not able to work for a period less than one year because, in April 2009, Dr. Rohrbough
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completed a work capacities and limitations assessment indicating that Plaintiff was
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capable of performing some work. Tr. 848-49. This evidence does not meet the 12-9-
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month duration requirement for an award of benefits. See Barnhart v. Walton, 535 U.S.
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212, 217-19 (2002) (recognizing a claimant is not disabled if “within 12 months after the
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onset of an impairment . . . the impairment no longer prevents substantial gainful
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activity.” (quotation marks and citations omitted)).
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In April 2009, Dr. Rohrbough’s assessment form indicates that Plaintiff can sit for
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“6” hours and stand for “0” hours in an eight-hour workday. Tr. 848. The form also
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indicates that Plaintiff can sit 30 minutes at a time, and that she can stand in one place
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and walk for one to two hours at a time. Id. The ALJ interpreted the form as indicating
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that Plaintiff could stand and/or walk for two hours in an eight-hour workday. Tr. 23.
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Plaintiff argues that the ALJ erred in rejecting Dr. Rohrbough’s opinion that Plaintiff
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could stand for “0” hours in an eight-hour workday and submits that “[t]he ALJ does not
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differentiate, apparently between standing and walking. . . . [and that] walking and
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standing are actually two different functions causing different impacts on the body.”
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Doc. 12 at 5. The Court cannot find that the ALJ’s interpretation of the evidence was
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error given Dr. Rohrbough’s subsequent indication on the same assessment form that
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Plaintiff could stand in one place for one to two hours at a time.
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Plaintiff also argues that the “ALJ fails to consider that the improvements were
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very short lived” and that “[t]he record is replete with complaints of ongoing pain from
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onset through 2010.” Doc. 12 at 6. Specifically, Plaintiff points to a February 8, 2008,
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assessment by Kimberly Sargent, P.A.-C., releasing her to light duty work on March 10,
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2008 (id. (citing Tr. 469)), and then a removal from that work release on April 4, 2008
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(id. (citing T.R. 450)). Additionally, Plaintiff points to February 15, 2007, industrial
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injury medical evaluation performed by Dr. James C. Nauman, M.D., Dr. Ernie Riffer,
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M.D., and Dr. Gerald Schwartzberg, M.D., in which the doctors opine that Plaintiff “is
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capable of returning to her usual and customary occupation with the only relatively minor
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restriction of avoiding repetitive kneeling and squatting.” Id. (citing Tr. 599). Plaintiff
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argues that the ALJ must not have considered “that four months later [Plaintiff]
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underwent another knee surgery with the onset of RSD shortly thereafter.” Id. This may
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be true, but again, Plaintiff has failed to point to any error in the ALJ’s reasoning and
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interpretation of the evidence. Besides Dr. Bigler’s opinion, Plaintiff has pointed to no
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medical source opinion supporting her allegation that she has been disabled since March
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2006. Instead of establishing disability, short-lived improvements can establish that a
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claimant was not disabled for a continuing 12-month period, and the ALJ’s interpretation
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of the evidence in this manner does not constitute legal error.
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D.
ALJ’s Duty to Develop the Record.
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Plaintiff also asks the Court to “remand the case for additional evidence to
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determine continuing pain issues and additional vocational expert testimony on that pain
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evidence as well as testimony concerning the need to have elevation of legs which was
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not offered at hearing due to the assessment of Dr. Bigler being submitted post hearing.”
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Doc. 12 at 9. “The ALJ has a duty to develop the record . . . even when the claimant is
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represented by counsel.” DeLorme v. Sullivan, 924 F.2d 841, 849 (9th Cir. 1991). The
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ALJ’s duty to develop the record further is triggered only when there is ambiguous
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evidence or when the record is inadequate to allow for proper evaluation of the evidence.
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Mayes v. Massanari, 276 F.3d 453, 459-460 (9th Cir. 2001) (citing Tonapetyan v. Halter,
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242 F.3d 1144, 1150 (9th Cir. 2001)). Plaintiff has not pointed to any ambiguous
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evidence, nor has Plaintiff established how the record is inadequate to allow for a proper
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disability determination. This does not constitute legal error.
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IT IS ORDERED:
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1.
Defendant’s administrative decision is affirmed.
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2.
The Clerk is directed to enter judgment accordingly.
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Dated this 20th day of May, 2013.
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