United States District Court, D. Arizona
Luke Paulk seeks judicial review of the denial of his
application for disability insurance benefits under the
Social Security Act, 42 U.S.C. § 405(g).
argues that the Administrative Law Judge (“ALJ”)
erred by: (1) according inadequate weight to the opinions of
Plaintiff's treating providers; (2) failing to consider
Plaintiff's carpal and cubital tunnel syndromes as
medically determinable impairments; and (3) rejecting
Plaintiff's subjective complaints.
person is considered “disabled” for the purpose
of receiving social security benefits if he or she is unable
to “engage in any substantial gainful activity by
reason of any medically determinable physical or mental
impairment which can be expected to result in death or which
has lasted or can be expected to last for a continuous period
of not less than 12 months.” 42 U.S.C. §
423(d)(1)(A). The Social Security Administration's
decision to deny benefits should be upheld unless it is based
on legal error or is not supported by substantial evidence.
Ryan v. Comm'r of Soc. Sec., 528 F.3d 1194, 1198
(9th Cir. 2008). “Substantial evidence is more than a
mere scintilla but less than a preponderance.”
Bayliss v. Barnhart, 427 F.3d 1211, 1214
n.1 (9th Cir. 2005) (citation omitted). “It means such
relevant evidence as a reasonable mind might accept as
adequate to support a conclusion.” Richardson v.
Perales, 402 U.S. 389, 401 (1971) (citation omitted).
The Court must review the record as a whole and consider both
the evidence that supports and the evidence that detracts
from the ALJ's determination. Jones v. Heckler,
760 F.2d 993, 995 (9th Cir. 1985).
argues that the ALJ accorded inadequate weight to the
opinions of Plaintiff's treating providers Nurse
Practitioner Martha Benavides, Dr. Tushar Modi, Dr. Srinivasa
Palnati, and Dr. Kulbashan Paul. In particular, Plaintiff
notes that Nurse Practitioner Benavides, Dr. Modi, Dr.
Palnati, and Dr. Paul all opined that Plaintiff can sit,
stand, and walk less than one hour each during an eight-hour
work day (AR 469, 510, 617-618).
To reject an uncontradicted opinion of a treating or
examining doctor, an ALJ must state clear and convincing
reasons that are supported by substantial evidence. If a
treating or examining doctor's opinion is contradicted by
another doctor's opinion, an ALJ may only reject it by
providing specific and legitimate reasons that are supported
by substantial evidence.
Bayliss, 427 F.3d at 1216 (internal citation
omitted). “The ALJ can meet this burden 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) (citation omitted).
the ALJ accorded little weight to the combined medical
opinion of Nurse Practitioner Benavides and Dr. Modi because
their assessments of Plaintiff's ability to sit, stand,
and walk “are overly restrictive given the minimal
positive findings on the physical examinations, ” and
because “despite the claimant's allegations of back
and leg pain, the findings from the physical examinations
generally documented normal gait” (AR 38). An ALJ may
consider the supportability of a medical opinion as a factor
in determining its weight, giving more weight to opinions
that cite more relevant evidence, “particularly medical
signs and laboratory findings.” 20 C.F.R. §
reviewing the record, the Court finds a lack of substantial
evidence to support the ALJ's assertion of minimal
objective findings to support Nurse Practitioner Benavides
and Dr. Modi's opinion. Their records repeatedly note
objective findings that Plaintiff suffered limited flexion
and extension of the lumbar spine, hypersensitivity in the
sacroiliac joints and lumbar paraspinous areas, and, at
times, sacroilitis (AR 390, 395, 398, 401, 404, 407, 410,
414, 418, 422, 478, 481, 485, 491, 494). Their records
further include Plaintiff's MRI results showing
“left paracentral and left lateral recess disc
extrusion at ¶ 4-L5 which causes prominent mass effect
on the transiting left L5 nerve root” (AR 421).
support her conclusion, the ALJ cited Dr. Paul's repeated
notes that Plaintiff was able to ambulate without an
assistive device (AR 38). The ALJ, however, has not explained
how these findings of normal gait are inconsistent with the
limitations assessed by Nurse Practioner Benavides and Dr.
Modi. In fact, the same medical reports on which the ALJ
relied also noted repeatedly that Plaintiff was
“[u]nable to sit down” (AR 541, 544, 547, 549,
551, 554, 557, 561, 565, 569, 573, 576). The Court thus finds
the ALJ lacked a specific and legitimate reason to discount
the opinion of Nurse Practitioner Benavides and Dr. Modi.
See Elgrably v. Comm'r of Soc. Sec. Admin., No.
CV-17-04760-PHX-JAT, 2018 WL 5264074, at *7 (D. Ariz. Oct.
23, 2018) (finding broad statement that a claimant showed
normal gait was not a specific and legitimate reason for
giving medical opinions little weight).
the ALJ accorded little weight to Dr. Palnati's medical
opinion in part because “[s]he only examined the
claimant a small number of times over a relatively brief
period, ” and “the treating relationship did not
last long enough for Dr. Palnati to have obtained a
longitudinal picture of the claimant's medical
condition” (AR 38). An ALJ may give a treating
physician's medical opinion little weight “if the
treating physician has not seen the patient long enough to
‘have obtained a longitudinal picture' of the
patient's impairments.” Holohan v.
Massanari, 246 F.3d 1195, 1202 n.2 (9th Cir. 2001)
(quoting 20 C.F.R. § 404.1527(c)(2)(i)). The Court finds
the ALJ properly weighed Dr. Palnati's medical opinion
based on the short length of the treating relationship.
the ALJ accorded little weight to Dr. Paul's medical
opinion because “it is conclusory and unsupported by
the record” (AR 39). In reviewing the record, however,
the Court finds a lack of substantial evidence to support the
ALJ's assertion. Dr. Paul documented Plaintiff's
reduced range of motion in a positive supine straight leg
raising test, reflex loss, muscle spasms, and muscle weakness
(AR 617). Dr. Paul cited Plaintiff's MRI results and
repeatedly noted a diagnosis of “[d]egeneration of
lumbar or lumbosacral intervertebral disc” (AR 557;
see also AR 545, 547, 549, 552, 554, 561, 566, 570,
574, 577, 616). Dr. Paul also indicated repeatedly that
Plaintiff was “[u]nable to sit down” at his
examinations (AR 541, 544, 547, 549, 551, 554, 557, 561, 565,
569, 573, 576). In addition to Dr. Paul's records, the
ALJ cited the medical records of Nurse Practitioner Benavides
and Dr. Modi to assert that there were minimal clinical
findings to support Dr. Paul's opinion (AR 39). However,
as discussed above, the Court finds ample objective evidence
in the record to support the opinion of Nurse Practitioner
Benavides and Dr. Modi, which was in accord with Dr.
Paul's opinion as to Plaintiff's ability to sit,
stand, and walk for less than one hour each during an
eight-hour workday (AR 469, 618). Thus, the Court finds the
ALJ lacked a specific and legitimate reason to discount the
opinion of Dr. Paul.
CARPAL AND ...