Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-1_14-cv-00795/USCOURTS-caed-1_14-cv-00795-6/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:206 Social Security Benefits

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UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF CALIFORNIA

LENA M. LITTLE, 

Plaintiff,

v.

CAROLYN W. COLVIN, 

Acting Commissioner of Social Security,

Defendant.

____________________________________

Case No. 1:14-cv-00795-SKO

ORDER AFFIRMING THE ALJ'S 

DECISION

(Doc. No. 1)

INTRODUCTION

Plaintiff Lena M. Little ("Plaintiff") seeks judicial review of a final decision of the 

Commissioner of Social Security (the "Commissioner" or "Defendant") denying in part1her

application for Disability Insurance Benefits ("DIB") and Supplemental Security Income ("SSI") 

pursuant to Titles II and XVI of the Social Security Act. 42 U.S.C. §§ 405(g); 1383. The matter 

is currently before the Court on the parties' briefs, which were submitted, without oral argument, 

to the Honorable Sheila K. Oberto, United States Magistrate Judge.2

 

1

 The ALJ found Plaintiff disabled as of October 14, 2011, but not disabled prior to that date.

2

 The parties consented to the jurisdiction of a U.S. Magistrate Judge. (Docs. 5, 10.)

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FACTUAL BACKGROUND

Plaintiff filed an application for DIB and SSI on April 17, 2008, alleging disability 

beginning on March 13, 2007, caused by Post-Traumatic Stress Disorder ("PTSD") and bipolar 

disorder. (Administrative Record ("AR") 79, 84.) 

A. Relevant Evidence

On June 7, 2008, Plaintiff underwent a psychiatric examination and evaluation by Stefan 

Lampe, M.D., a Board Certified Psychiatrist. (AR 190-91.) Plaintiff reported she suffers from 

bipolar disorder, and she is often depressed and has no energy. (AR 190.) She has been in 

treatment since she suffered childhood trauma, and she has been hospitalized three times for 

suicide attempts.3 (AR 190.) Plaintiff reported her daily activities include meal preparation, 

dusting, mopping, dishes, and laundry, and she enjoys reading and watching television. (AR 190.) 

On examination, Dr. Lampe noted Plaintiff was pleasant, friendly, and cooperative with normal 

psychomotor functioning; she engaged well, her speech was spontaneous and within normal range, 

her affect was full range without lability or "expansivity"; her insight and judgment, however, 

were noted to be poor. (AR 190.) 

Dr. Lampe diagnosed Plaintiff with bipolar disorder and assigned her a Global Assessment 

of Functioning ("GAF") score of 65.4 (AR 191.) He provided the following discussion of 

Plaintiff's abilities:

From a psychiatric point of view, the claimant can relate and interact with 

supervisors and co-workers. She can understand, remember, and carry out simple 

as well as more technical instructions. She would not have difficulty dealing with 

the public. She is able to maintain concentration and attention for two-hour 

increments. From a psychiatric standpoint, whether or not the claimant could 

 

3

 As set forth below, Plaintiff has inconsistently reported her prior suicide attempts. The number of attempts she 

claims has vacillated over time from none to five. Compare, e.g., AR 190 (in 2008 reporting three prior suicide 

attempts) with AR 520 (in 2010 reporting no prior suicide attempts).

4 The GAF scale is a tool for "reporting the clinician's judgment of the individual's overall level of functioning." Am. 

Psychiatric Ass'n, Diagnosis & Statistical Manual of Mental Disorders 32 (4th ed. 2000). The clinician uses a scale of 

zero to 100 to consider "psychological, social, and occupational functioning on a hypothetical continuum of mental 

health- illness," not including impairments in functioning due to physical or environmental limitations. Id. at 34. A 

GAF score between 61 and 70 indicates some mild symptoms or some difficulty in social, occupational, or school 

functioning, but generally functioning pretty well. Id. 

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withstand the stress and pressures associated with an eight-hour workday on an 

ongoing basis would depend on whether or not her mood is stabilized adequately.

(AR 191.)

On July 11, 2008, state-agency physician A. Garcia, M.D., reviewed Plaintiff's records and 

completed a mental residual functional capacity assessment form. (AR 203-05.) He opined 

Plaintiff was moderately limited in her ability to understand, remember, and carry out detailed 

instructions. (AR 203.) In all other areas, he found Plaintiff "not significantly limited." (AR 203-

05.) He opined Plaintiff would be able to maintain concentration and attention for more than twohour increments; sustain an eight-hour per day, forty-hour workweek; relate to and accept 

direction from supervisors; remain socially appropriate with co-workers and the public without 

being distracted by them; and could travel, respond to change, and set realistic goals 

independently. (AR 204.) 

On October 25, 2007, Plaintiff was seen at the Tuolumne Me-Wuk Indian Health Center

("Tuolumne") by Nurse Practitioner Lorie Weldon ("Weldon"). (AR 234-35.) Plaintiff reported 

increased depression and pain in her right leg stemming from a fall, and it was noted she had been 

without pain medication for several months. (AR 234.) Plaintiff reported increased suicidal 

thoughts, but she denied at the examination that she wanted to hurt herself. (AR 234.) Plaintiff 

was noted to be anxious in the examination room, and she exhibited scattered thoughts and 

jumped from topic to topic. (AR 234.) She was diagnosed with depression and PTSD, and it was 

indicated she needed to restart antidepressants. (AR 235.) Plaintiff was encouraged to make an 

appointment at King's View to start psychiatric care and obtain counseling. (AR 235.) Effexor 

samples were provided to Plaintiff. (AR 235.)

Plaintiff was seen by Weldon at a follow-up appointment on November 26, 2007, where 

she stated she was responding well to the Effexor medication, and she denied any symptoms other 

than sinusitis. (AR 233.) On December 13, 2007, Plaintiff was again seen by Weldon for a recent 

knee injury and right knee pain. (AR 231.) She stated she was doing well on Effexor, but 

believed she would benefit from an increased dosage, which was prescribed. (AR 231.) 

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On February 12, 2008, Plaintiff was again seen by Weldon for skin abscesses and a fever. 

(AR 229.) She was prescribed an antibiotic, and she was prescribed an increased dosage of Xanax

for her anxiety. (AR 230.)

On March 4, 2008, Plaintiff was examined by Weldon upon reporting a motor vehicle 

accident the week prior to the examination. (AR 227.) Plaintiff reported increased feelings of 

depression, suicidal thoughts, and mood swings; she believed the Effexor was making her worse. 

(AR 227.) Two friends with whom she was living accompanied her to the examination and 

explained to Weldon that Plaintiff was experiencing mood swings and that they believed she may 

be having flashbacks from her past abuse. (AR 227.) Weldon indicated in her assessment that 

Plaintiff's increased suicidal thoughts and mood swings appeared to comprise a "bipolar picture," 

and that Weldon consulted with Dr. Johnson and Dr. Hoffmann, who agreed Plaintiff presented 

with a "bipolar picture." (AR 228.) The treatment plan included tapering off the Effexor, and 

Plaintiff was started on Seroquel. Her friends were instructed to seek immediate care for Plaintiff

if she became "more suicidal." (AR 228.)

At a follow-up appointment on April 2, 2008, post-gastric bypass surgery, Plaintiff 

reported doing well on Seroquel and that she was sleeping well. (AR 225.) She was still 

experiencing depressive symptoms during the day, and her friends who accompanied her to the 

appointment confirmed that Plaintiff appeared depressed, wanted to sleep more, and exhibited a 

lack of motivation. (AR 225.) Plaintiff was continued on Seroquel, and was started on Zoloft. 

Weldon also recommended Plaintiff follow-up with Physician's Assistant Cassie Blackwell

("Blackwell") for psychiatric management, to which Plaintiff agreed. (AR 226.) 

On March 11, 2009, state agency physician S. Tyutyulkova, M.D., reviewed Plaintiff's 

medical records and completed a psychiatric review technique form indicating that Plaintiff's 

psychiatric condition was non-severe. (AR 245-58.) Dr. Tyutyulkova noted that Plaintiff's 

symptoms were vague, and there was no evidence to support a diagnosis of bipolar disorder. 

(AR 245.)

On April 15, 2009, Weldon signed a letter, which was co-signed by Dr. Kenneth Renwick, 

a family physician, indicating that Plaintiff was unable to work due to her bipolar disorder, PTSD, 

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and an anxiety disorder. (AR 278.) Plaintiff was described as easily distracted with racing 

thought patterns that interfere with her ability to focus and interact with others in a social 

environment, and she was forgetful. (AR 278.) Plaintiff was encouraged to seek management for 

her bipolar disorder to help stabilize her condition. (AR 278.)

On July 9, 2009, Plaintiff followed-up with Weldon for medication refills. She reported 

experiencing increased stress and anxiety and had not been sleeping well. (AR 300.) She 

admitted she had not seen her psychiatrist or psychologist in several months, and acknowledged 

she needed to follow-up in regard to her medication and management for her bipolar disorder. 

(AR 300.) 

On August 20, 2009, Weldon and Dr. Hoffmann signed a questionnaire they completed 

regarding Plaintiff's impairments, which was sent to Dr. Renwick. (AR 280-87.) Weldon and Dr. 

Hoffmann indicated Plaintiff was diagnosed with bipolar disorder, depression, PTSD, anxiety, 

chronic pain caused by lumbar spondylosis and bulging discs, osteopenia, and allergic rhinitis. 

(AR 280.) They opined Plaintiff's impairments were affected by her anxiety in new and 

unfamiliar surroundings, her poor coping mechanisms, and they indicated her mood seemed to 

escalate her physical pain symptoms. (AR 285.) They opined she was capable of low stress, but 

that she would need breaks to rest at unpredictable intervals. Plaintiff's impairments were likely to 

produce good days and bad days, and, although they noted it was difficult to predict, they opined 

Plaintiff would miss work due to her impairments anywhere from one to three days per month. 

(AR 286.) 

On September 8, 2009, Plaintiff saw Weldon for a follow-up after an emergency room visit 

due to being struck in the face by another individual. (AR 294.) Her Xanax prescription was 

renewed and it was noted she had an appointment with Blackwell for management of her bipolar 

disorder. (AR 295.)

On November 5, 2009, Weldon completed a mental capacities worksheet setting forth her 

opinion of Plaintiff's functional abilities. (AR 331-32.) She noted Plaintiff had bipolar disorder, 

depression, and anxiety. (AR 331.) She reported Plaintiff had a difficult time focusing and found 

it difficult to complete tasks. (AR 331.) Plaintiff had difficulty dealing with others in a work 

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environment. (AR 331.) She described Plaintiff as self-conscious and who took certain actions of 

others personally, which created a greater degree of anxiety and depression. (AR 331.) Although 

Plaintiff could follow oral and written instructions, she might have difficulty focusing at times. 

(AR 331.)

In March 2010, Plaintiff was seen by Weldon for a follow-up after a visit to the ER where 

she was diagnosed with bronchitis. (AR 299.) No psychological symptoms were noted or 

discussed. (AR 399-400.)

In August 2010, a psychiatric questionnaire regarding Plaintiff's limitations was completed 

by a person at Tuolumne, but the document in the record is unsigned.5 (AR 406-12.) The form 

indicates Plaintiff had bipolar disorder and a mood disorder, marked by symptoms including sleep 

disturbances, mood disturbances, emotional lability, substance dependence, recurrent panic 

attacks, suicidal ideation, obsessions or compulsions, intrusive recollections of a traumatic 

experience, and generalized persistent anxiety. (AR 407.) Plaintiff was noted to be "markedly 

limited," which was defined as being precluded from performing activities in a normal, 40-hourper-week work environment. (AR 408.)

In September 2010, at an appointment with Blackwell, Plaintiff exhibited rapid talking and 

reported rapid thoughts with some difficulty falling asleep. (AR 510.) Her medication 

compliance was noted to be good and her appearance normal, but she was anxious, her speech was 

rapid, and her affect was expansive. She was diagnosed with bipolar disorder and PTSD. 

(AR 510.) Blackwell started Plaintiff on Lamictal, and continued her Seroquel and Xanax

prescriptions. (AR 510.) 

At another examination with Blackwell in March 2011, Plaintiff reported difficulty going 

to sleep. (AR 511.) Her medication compliance was noted to be fair, but she appeared unkempt 

and exhibited psychological agitation with rapid speech and a manic mood. (AR 511.) At another 

follow-up appointment at the end of March 2011, Plaintiff was "doing better" overall, but she was 

 

5 This document was discussed at the hearing before the ALJ, and Exhibit 21F was ascribed to Weldon. (See AR 897-

98.)

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still very distracted with racing thoughts. (AR 509.) She was noted to be anxious and her affect 

was constricted. (AR 509.) 

At a follow up appointment with Blackwell on August 1, 2011, Plaintiff reported she had 

lots of stress at home with which she was not dealing well. (AR 508.) She was experiencing 

racing thoughts and difficulty sleeping. (AR 508.) On examination, Plaintiff was noted to appear 

unkempt, and her affect was expansive. (AR 508.) She was noted to have poor impulse control, 

concentration and attention, and insight and judgment. (AR 508.) She was diagnosed with bipolar 

disorder, PTSD, and a personality disorder. (AR 508.)

On August 15, 2011, Blackwell completed a psychiatric impairment questionnaire about 

Plaintiff's functional abilities. (AR 512.) She indicated she began treating Plaintiff in June 2008, 

but the frequency of her treatment was sporadic and since March 2011 had been every 8 to 10 

weeks. (AR 512.) She diagnosed Plaintiff with PTSD, bipolar disorder, and a personality 

disorder. She assigned Plaintiff a GAF score of 50, and indicated her prognosis was poor for 

remission in the next 12 months. (AR 512.) In checkbox format, she noted Plaintiff had poor 

memory, sleep disturbances, personality changes, mood disturbances, emotional lability, recurrent 

panic attacks, anhedonia, psychomotor agitation, feelings of guilt, difficulty thinking or 

concentrating, suicidal ideation, oddities of thought, social withdrawal, manic syndrome, 

persistent irrational fears, intrusive recollections of a traumatic experience, persistent irrational 

fears, generalized persistent anxiety, somatization, and pathological dependence. (AR 513.) She 

listed Plaintiff's primary symptoms as pervasive anxiety, insomnia, mood instability, and poor 

concentration and focus. (AR 514.) 

She indicated Plaintiff's abilities were markedly limited in the following areas: 

remembering locations and work-like procedures, understanding and remembering detailed 

instructions, carrying out detailed instructions, maintaining attention concentration for extended 

periods, performing activities within a schedule and maintaining regular attendance, sustaining an 

ordinary routine without supervision, working in coordination with or proximity to others without 

being distracted by them, completing a normal workweek without interruptions from 

psychologically based symptoms, accepting instructions and responding appropriately to criticism 

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from supervisors, getting along with co-workers or peers without distracting them, maintaining 

socially appropriate behavior and adhering to basic standards of neatness and cleanliness, 

responding appropriately to changes in the work setting, and traveling to unfamiliar places or use 

of public transportation. (AR 515-17.) 

She also found Plaintiff moderately limited in the following abilities: understanding and 

remembering one- or two-step instructions, carrying out simple one- or two-step instructions, 

making simple work-related decisions, interacting appropriately with the general public, being 

aware of normal hazards and taking appropriate precautions, and setting realistic goals or making 

plans independently. (AR 515-17.) Blackwell indicated Plaintiff would be unable to tolerate even 

"low stress" in a work environment and would likely miss work more than three times per month. 

(AR 518-19.)

On October 14, 2011, Plaintiff saw Carol W. Fetterman, Ph.D., for a psychological testing 

evaluation. (AR 520-26.) Dr. Fetterman observed that Plaintiff presented in a friendly manner, 

made good eye contact, and her facial expressions were normal. (AR 520.) She was scattered and 

speedy, however. (AR 520.) She reported having no suicide attempts or psychiatric 

hospitalizations, completing the 11th grade, having a learning disability, and being placed in 

special education.6 (AR 520-21.) Dr. Fetterman listed a diagnostic impression of bipolar disorder 

by history, amnestic disorder, and assigned a GAF score of 60. (AR 522.) 

Dr. Fetterman administered several tests including the WAIS-IV, the WMS-IV, and the 

Bender-Gestalt-II. (AR 522.) Dr. Fetterman opined Plaintiff's ability to understand, remember, 

and carry out job instructions was markedly impaired as evidenced by performance on the mental 

status examination and on psychological testing. (AR 522.) Her ability to maintain attention, 

concentration, persistence and pace was assessed to be mildly impaired as was her ability to relate 

and interact with supervisors, co-workers, and the general public. (AR 523.) Her ability to adapt 

to day-to-day work activities, including attendance and safety was also mildly impaired. 

(AR 523.) Dr. Fetterman diagnosed Plaintiff with Amnestic Disorder. (AR 522.)

 

6 Contrarily, in her application for benefits, Plaintiff indicated she completed high school and she did not attend any 

special education classes. (AR 88.) She also testified at the hearing that she graduated from high school and 

completed post-secondary training as a certified CNA. (AR 822-23.)

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B. Administrative Proceedings

The Commissioner denied Plaintiff's application initially and again on reconsideration; 

consequently, Plaintiff requested a hearing before an Administrative Law Judge ("ALJ"). (AR 77-

102, 129-60, 185-89, 197-99.) A hearing was held on August 24, 2010, before an ALJ. (AR 818-

44.) The ALJ issued a decision on October 6, 2010, finding Plaintiff not disabled. (AR 416-27.) 

Plaintiff sought review of the ALJ's decision before the Appeals Council (AR 436), which was 

granted (AR 433-34). On July 12, 2011, the Appeals Council remanded the case to the ALJ for 

further consideration of Weldon's treatment records, to obtain additional evidence which could 

include a consultative mental status examination, give further consideration to Plaintiff's RFC 

during the entire period at issue providing rationale with specific references to the record in 

support of the assessed limitations, and obtain supplemental evidence from a vocational expert to 

clarify past relevant work and the effect of the assessed limitations on Plaintiff's occupational 

base. (AR 433-34.)

Upon remand, on February 21, 2012, the ALJ conducted a second hearing. (AR 845-71.) 

As Plaintiff required additional time to obtain outstanding medical records of an alleged suicide 

attempt, a third hearing was held June 5, 2012. (AR 872-921.) 

1. Plaintiff's Testimony at the August 2010 Hearing

Plaintiff testified about her symptoms and limitations at the hearing. She explained that 

she did not drive because she could not seem to focus or concentrate, but she also noted that her 

license had been suspended due to an outstanding traffic ticket she was unable to pay. (AR 831-

32.) She performs a few tasks around her parents' home where she lives, including setting the 

table, turning the television on, and walking two small dogs. (AR 830.) She watches television 

for about two hours at a time. (AR 833.) She has a cell phone, and she uses it to text. (AR 833.)

She stopped working at Tuolumne in 2007 because she was told her services were no 

longer needed. (AR 835.) She went to see her doctor at Tuolumne who told her she should not 

work because of a lower back problem and anxiety issues. (AR 835.) Her doctor also told her the 

reasons why she was fired because she worked at the same clinic where her doctor is located. 

(AR 835.) Plaintiff did not know all the reasons why her position was terminated; she was only 

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told that there was a patient's registration form in the wrong chart. (AR 836.) That was the first 

time she had mixed up the chart, and all her work had been satisfactory until that point. (AR 836.) 

However, her doctor told her that there had been numerous other filing mistakes although Plaintiff 

was never spoken to or written up for those mistakes. (AR 836.)

Plaintiff stated she had attempted suicide five times, and was hospitalized in February 

2007 or 2008 after one attempt. (AR 837.) She had been in a car accident, but she could not 

remember the exact date because her memory was "gone." (AR 838.) She sees Blackwell for 

treatment, and Blackwell is adamant that Plaintiff not work. (AR 839.)

2. Plaintiff's February 2012 Hearing Testimony

Plaintiff also testified at a second hearing in February 2012. (AR 845-71.) She stated she 

completed high school and some college. (AR 855.) She was a receptionist at Tuolumne until 

March 2007. (AR 856.) Her problems are mainly psychological, but she also experiences lower 

back pain from a fall. (AR 856.) She has bone spurs in her heels, arthritis in both shoulders, and a 

"messed up" right knee. (AR 857.) Her mental issues include an inability to focus or concentrate 

on the simplest task, no matter what it is. (AR 857.) She is unable to make appointments, focus 

on chart numbers, or anything to that effect. (AR 858.) Blackwell is her counselor, and Dr. 

Renwick writes her prescriptions. (AR 859.) She regularly experiences nightmares, and she takes 

Seroquel, Xanax, and pain medication. (AR 865.) She sometimes experiences "flashbacks" 

during the day, which put her "into a dark spot at least one to three times a week." (AR 865.) 

When she is in that "dark spot" she feels unloved, unwanted, and totally depressed. (AR 866.) 

She cries, stops speaking to everybody, and does not bathe or brush her teeth. (AR 866.) Her 

mother and her sister take care of her medication because Plaintiff is forgetful. (AR 867.) 

Although she watches television, sometimes she "space[s] out." (AR 868.) She thinks about 

suicide a lot, almost daily. (AR 868.) Her last suicide attempt was in 2008 or 2009.

Plaintiff is able to walk her sister's dogs, but usually she sits in the corner with a thousand 

thoughts going through her head. (AR 860.) She may get up and help her mother set the table or 

do something simple. (AR 860.) She has a cell phone on which she texts her daughters; she does 

not have a driver's license. (AR 861.) She stated she was in a "major wreck" in 2009, and she did 

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not get a ticket, but she has been afraid to drive since then as she experiences panic attacks. (AR 

861.) Also, her license was suspended due to a speeding ticket. (AR 861.) Plaintiff stated she 

does not drink alcohol, and the last drink she had was in 2006. (AR 862.) 

3. Plaintiff's Testimony at the June 2012 Hearing

Plaintiff testified that she completed high school, and holds CNA and RNA certificates, 

and is a certified activity director. (AR 855.) She worked at Tuolumne as a receptionist and in the 

medical records section. (AR 856.) She stopped working on March 13, 2007, due to 

psychological issues including an inability to focus, and pain in her lower back following a fall. 

(AR 856.) Her psychological issues render her unable to focus or concentrate "to do the simplest 

task, no matter what it is." (AR 857.) Her mind does not "comprehend the simplest thing, as 

number[s] or directions." (AR 858.) She has to write things down and re-write them. (AR 858.) 

At her last job, she was unable to make appointments, focus on chart numbers, or anything "to that 

effect." (AR 858.) She is receiving mental health therapy from Blackwell who is overseen by Dr. 

Renwick. (AR 859.)

She is currently living with her parents. On a normal day, she will walk her sister's dogs, 

and will sit in a corner thinking "a thousand thoughts." (AR 860.) She does not lie down during 

the day, but she watches about four hours of television. (AR 860.) She does not use a computer 

for anything, but she does own a cellphone and can use it for calls and texting. (AR 860.) She 

does not have a driver's license and is unable to drive due to panic attacks. (AR 861.) 

Plaintiff testified that her prescription medication causes her to be lightheaded, sleepy, her 

muscles jolt, and she is constantly tired. (AR 854.) 

4. Medical Expert Testimony at the June 5, 2012 Hearing

Shakil Mohammed, M.D., Ph.D., testified as a medical expert at the June 5, 2012, hearing. 

(AR 872-921.) Dr. Mohammed is board certified in psychiatry and was a former examiner for the 

American Board of Psychiatry. (AR 887.) From Plaintiff's medical records, Dr. Mohammed 

determined Plaintiff had been diagnosed with bipolar disorder, but he could find no documentation 

why it was labeled bipolar disorder as none of the medical records showed hypomanic phases. Dr. 

Mohammed felt there were insufficient findings to support a bipolar disorder diagnosis and would 

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label it a mood disorder instead. (AR 888.) Dr. Mohammed also identified a diagnosis for PTSD, 

anxiety disorder, a personality disorder, and amnestic disorder. (AR 888-89.) He opined the 

amnestic disorder was the most significant because it was documented by the various tests 

performed by Dr. Fetterman, and it appeared to be a valid diagnosis. (AR 890.) Although 

Plaintiff had complained of memory problems before her examination with Dr. Fetterman in 

October 2011, there was no prior objective documentation. (AR 890.) 

Dr. Mohammed agreed with Dr. Fetterman's diagnosis of amnestic disorder. (AR 890.) 

Amnestic disorder is a cognitive disorder, although it is not identified as a listed impairment. Dr. 

Mohammed categorized it as an impairment fitting under Listing 12.02. He opined Plaintiff met 

Listing 12.02 for amnestic disorder as of October 14, 2011. He emphasized that particular onset 

date because, before that amnestic disorder was not diagnosed and any functional limitations were 

not clear. (AR 895.) The ALJ specifically questioned whether an earlier onset date for this 

disorder was possible, but Dr. Mohammed answered that before October 2011, there was little 

evidence of functional limitations in the record: limitation to Plaintiff's activities of daily living 

was mild, social functioning was only mildly limited, and Plaintiff's ability to maintain 

concentration, persistence, and pace was only moderately limited. Prior to the findings in the 

October 2011 report, there was insufficient evidence that Plaintiff met the Listing 12.02 for 

amnestic disorder, or functional limitation rendering her disabled. (AR 896.) 

Plaintiff's counsel questioned Dr. Mohammed whether, prior to October 2011, it would 

have been difficult for Plaintiff to maintain consistent attendance at work as a result of her PTSD, 

anxiety, and concentration problems. (AR 897.) Dr. Mohammed answered that there was no 

medical documentation to that effect, and the first documentation of amnestic disorder which 

affected concentration and social function was not documented until October 14, 2011. (AR 897.) 

Plaintiff's counsel asked whether those problems were in fact documented in the forms submitted 

by Weldon and Blackwell. (AR 897.) Dr. Mohammed answered that, as it pertained to Weldon, 

she was only a family nurse practitioner, not a psychiatric nurse, and not an acceptable medical 

source. (AR 898.) Blackwell also is not a psychologist or a medical doctor, so she is not an 

acceptable medical source. Neither report was co-signed by a medical doctor. (AR 898.) 

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Plaintiff's counsel asked whether it would matter if the reports were co-signed by a physician, and 

Dr. Mohammed said the reports would be more persuasive if they were signed by a psychiatrist, 

and a signature by a medical doctor would not be sufficient to carry persuasive weight if that 

person is not a specialist in psychiatric illness. (AR 902.) He also noted that, although Plaintiff 

complained of concentration problems prior to October 2011, those were not documented by 

objective tests showing that this was actually true. (AR 902.)

Dr. Mohammed was also questioned Plaintiff's hospitalization in February 2008. 

(AR 905.) Dr. Mohammed stated the notes only referred to a drug overdose; it was not actually a 

hospital admission but just overnight in the ER, which is a common phenomenon. (AR 907.) 

Plaintiff's counsel also asked whether Plaintiff's insomnia and anxiety problems would 

have created any limitations in her work ability prior to October 2011. (AR 907.) Dr. Mohammed 

responded that although Plaintiff had insomnia for many years, there is no indication of resulting 

functional limitation. (AR 908-09.) Prior to October 2011, Dr. Mohammed felt Plaintiff was only 

mildly to moderately limited in social functioning, concentration, persistence, and pace, and there 

were no episodes of decompensation. (AR 911.) Based on these mild limitations, Dr. Mohammed 

opined Plaintiff could perform simple tasks. (AR 911.) 

5. Testimony of Vocational Expert at the June 5, 2012 Hearing

The ALJ solicited testimony from a Vocational Expert ("VE") about Plaintiff's past work 

and her ability to perform other work. (AR 912-19.) The VE characterized Plaintiff's past work as 

office clerk typist, Dictionary of Occupational Titles ("DOT") 203.362-010, which is classified as 

sedentary, semi-skilled work with an SVP of 4 (AR 913); and a residential care provider, DOT 

354.377-014, which is classified as medium exertional work with an SVP of 3 (AR 914). She 

obtained transferrable skills from these jobs. (AR 914.)

The ALJ then posed a series of hypothetical questions, asking the VE to consider an 

individual of the same age and with the same education and work history as Plaintiff. (AR 915.) 

In the first hypothetical, the ALJ asked the VE to consider a person who could sit for six hours, 

but could stand or walk less than two hours each; lift and/or carry less than 10 pounds; never 

climb, balance, stop, kneel, crouch, crawl, or work around hazards; would not have sufficient 

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concentration for even simple, routine repetitive tasks; could have less than occasional public 

contact; and would need numerous unscheduled work breaks. (AR 915.) the VE testified that 

there was no full-time work that such a person could perform.

In the second hypothetical, the ALJ asked the VE to consider a person limited to jobs 

involving simple, routine, repetitive tasks; frequent but not constant contact with the public,

coworkers, or supervisors; could stand and/or walk six out of eight hours each with normal breaks; 

could lift and/or carry 50 pounds occasionally, 25 pounds frequently; frequently reach in all 

directions, handle, finger, feel, push, pull, or use the upper and lower extremities; occasionally 

climb ladders, ropes, scaffolds; occasionally balance, stoop, crouch, or crawl; frequently climb 

ramps or stairs; frequently work around unprotected heights or moving mechanical parts of 

machinery; occasionally operate a motor vehicle; occasionally work around dusts, odors, fumes, 

and pulmonary irritants; occasionally work around extreme cold, heat, and vibrations; frequently 

work around loud noises. (AR 915-16.) The VE testified such an individual would not be able to

perform Plaintiff's past work, but could perform other work: hand-packager, DOT 920.587-018; 

cafeteria attendant, DOT 311.477-014; and stock check apparel, DOT 299.667-014.

Plaintiff's counsel also posed a hypothetical for the VE to consider. (AR 918-19.) The VE 

was asked to take the second hypothetical and modify it to a person limited to sitting two out of 

eight hours per day, and standing and walking only two hours out of eight. (AR 918.) The VE 

testified such a person would be precluded from full-time work. (AR 919.)

In a third hypothetical, the VE was asked to consider a person who was precluded from 

maintaining attention or concentration for extended periods of time. (AR 919.) The VE testified 

such a person would be precluded from all work. (AR 919.) 

6. The ALJ's August 2012 Decision7

On August 14, 2012, the ALJ issued a decision finding Plaintiff disabled as of October 14, 

2011, but not disabled prior to that date. (AR 22-29.) Specifically, the ALJ found that Plaintiff

(1) had not engaged in substantial gainful activity since her alleged onset date of March 13, 2007

(AR 24); (2) Plaintiff had the following severe impairments as of March 13, 2007: depression, 

 

7 The prior decision which was reviewed by the Appeals Council is not summarized.

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anxiety, degenerative disc disease, and osteoarthritis; as of October 14, 2011, Plaintiff had the 

following severe impairments: depression, anxiety, amnestic disorder, degenerative disc disease, 

and osteoarthritis (AR 24); (3) prior to October 14, 2011, did not have an impairment or

combination of impairments that met or medically equaled one of the listed impairments in 20 

C.F.R. Part 404, Subpart P, Appendix 1 (AR 25); beginning on October 14, 2011, Plaintiff met 

the Listing 12.02 (AR 27); and (4) could not perform her past relevant work as of March 13, 2007; 

prior to October 14, 2011 had the residual functional capacity ("RFC") to perform medium work, 

with the ability to sit, stand, and walk six hours each during an eight-hour workday, and is limited 

to work involving simple, routine, and repetitive tasks with frequent public, co-worker, and 

supervisor contact (AR 25.) The ALJ found that, prior to October 14, 2011, Plaintiff retained the 

ability to perform other work such as hand packager, cafeteria attendant, and stock check apparel 

sorter. (AR 27). The ALJ concluded that Plaintiff was not disabled as defined by the Social 

Security Act prior to October 14, 2011, but became disabled as of October 14, 2011. (AR 29.) 

Plaintiff sought review by the Appeals Council on August 23, 2012. (AR 17.) The 

Appeals Council denied Plaintiff's request for review on March 28, 2014. (AR 8-12) Therefore, 

the ALJ's decision became the final decision of the Commissioner. 20 C.F.R. §§ 404.981; 

416.1481.

D. Plaintiff's Argument on Appeal

Although directed by the Appeals Council in 2011 to evaluate the opinions of Weldon and

Blackwell, the ALJ failed to do so upon remand. Instead, the ALJ impermissibly deferred to Dr. 

Mohammed's opinion that neither Weldon nor Blackwell was an acceptable medical source, and 

none of the physicians who co-signed Weldon or Blackwell's reports were mental health 

practitioners. Those opinions should have been considered and incorporated into Plaintiff's RFC. 

Plaintiff also argues the ALJ improperly assigned her onset date as October 14, 2011, and failed to 

adequately consider her lay testimony.

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SCOPE OF REVIEW

The ALJ's decision denying benefits "will be disturbed only if that decision is not 

supported by substantial evidence or it is based upon legal error." Tidwell v. Apfel, 161 F.3d 599, 

601 (9th Cir. 1999). In reviewing the Commissioner's decision, the Court may not substitute its 

judgment for that of the Commissioner. Macri v. Chater, 93 F.3d 540, 543 (9th Cir. 1996). 

Instead, the Court must determine whether the Commissioner applied the proper legal standards 

and whether substantial evidence exists in the record to support the Commissioner's findings. See

Lewis v. Astrue, 498 F.3d 909, 911 (9th Cir. 2007). "Substantial evidence is more than a mere 

scintilla but less than a preponderance." Ryan v. Comm'r of Soc. Sec., 528 F.3d 1194, 1198 (9th 

Cir. 2008). "Substantial evidence" 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) 

(quoting Consol. Edison Co. of N.Y. v. NLRB, 305 U.S. 197, 229 (1938)). The Court "must 

consider the entire record as a whole, weighing both the evidence that supports and the evidence 

that detracts from the Commissioner's conclusion, and may not affirm simply by isolating a 

specific quantum of supporting evidence." Lingenfelter v. Astrue, 504 F.3d 1028, 1035 (9th Cir. 

2007) (citation and internal quotation marks omitted).

APPLICABLE LAW

An individual is considered disabled for purposes of disability benefits if he or she is 

unable to engage in any substantial, gainful activity by reason of any medically determinable 

physical or mental impairment that can be expected to result in death or that has lasted, or can be 

expected to last, for a continuous period of not less than twelve months. 42 U.S.C. 

§§ 423(d)(1)(A), 1382c(a)(3)(A); see also Barnhart v. Thomas, 540 U.S. 20, 23 (2003). The 

impairment or impairments must result from anatomical, physiological, or psychological 

abnormalities that are demonstrable by medically accepted clinical and laboratory diagnostic 

techniques and must be of such severity that the claimant is not only unable to do her previous 

work, but cannot, considering her age, education, and work experience, engage in any other kind 

of substantial, gainful work that exists in the national economy. 42 U.S.C. §§ 423(d)(2)-(3), 

1382c(a)(3)(B), (D).

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The regulations provide that the ALJ must undertake a specific five-step sequential 

analysis in the process of evaluating a disability. In the First Step, the ALJ must determine 

whether the claimant is currently engaged in substantial gainful activity. 20 C.F.R. §§ 

404.1520(b), 416.920(b). If not, in the Second Step, the ALJ must determine whether the claimant 

has a severe impairment or a combination of impairments significantly limiting her from 

performing basic work activities. Id. §§ 404.1520(c), 416.920(c). If so, in the Third Step, the ALJ 

must determine whether the claimant has a severe impairment or combination of impairments that 

meets or equals the requirements of the Listing of Impairments ("Listing"), 20 C.F.R. 404, 

Subpart P, App. 1. Id. §§ 404.1520(d), 416.920(d). If not, in the Fourth Step, the ALJ must 

determine whether the claimant has sufficient residual functional capacity despite the impairment 

or various limitations to perform her past work. Id. §§ 404.1520(f), 416.920(f). If not, in the Fifth 

Step, the burden shifts to the Commissioner to show that the claimant can perform other work that 

exists in significant numbers in the national economy. Id. §§ 404.1520(g), 416.920(g). If a 

claimant is found to be disabled or not disabled at any step in the sequence, there is no need to 

consider subsequent steps. Tackett v. Apfel, 180 F.3d 1094, 1098-99 (9th Cir. 1999); 20 C.F.R. §§ 

404.1520, 416.920.

DISCUSSION

A. ALJ's Consideration of Medical Evidence

In considering the medical evidence received from Weldon and Blackwell, the ALJ 

concurred with the hearing testimony supplied by Dr. Mohammed and gave these records and 

opinions no evidentiary weight. (AR 29.) Specifically, the ALJ explained as follows:

Dr. Mohammed fully articulated how both Exhibit 22F8and Exhibit 23F completed 

by Lori Weldon and Cassie Blackwell are to be given no weight as they are by nonacceptable medical sources, without the necessary education, experience and 

expertise to properly assess, diagnose, treat or formulate any mental health 

impairment that the claimant may have. Therefore, as Dr. Mohammed's expertise 

and experience is far more persuasive in mental health matters, the undersigned 

similarly gives no weight to these opinions as they are in conflict with and 

inconsistent with the other evidence of record as a whole. 

(AR 29.) 

 

8 The ALJ appears to have mistakenly referred to Exhibit 22F rather than 21F. (AR 897-902.)

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1. Plaintiff's Argument

Plaintiff argues the ALJ erred in assigning no weight to this evidence. (Doc. 21.) Plaintiff 

contends wholly rejecting these records because they were not submitted by an acceptable medical 

source or co-signed by a mental health specialist is not legally sufficient reasoning. Plaintiff 

argues records from medical sources not considered "acceptable" for social security purposes may 

nonetheless be given weight. In this case, Weldon and Blackwell's opinions, despite not being 

rendered by acceptable medical sources, should have been given weight by the ALJ. They were 

Plaintiff's sole treating sources throughout the relevant period, they conducted formal mental 

status evaluations that yielded clinical findings, and they dispensed psychiatric medications, 

observed her responses to medications, and adjusted them accordingly. There are no other 

acceptable medical sources who have examined and treated Plaintiff with the regularity and 

frequency of these medical professionals. Moreover, the records from Weldon and Blackwell

were endorsed by medical doctors at the Tuolumne clinic. Although these family practitioners 

who co-signed the records from Weldon and Blackwell may not have been specialists in the 

mental health field, that fact alone does not render all their findings of no value or evidentiary 

weight. Plaintiff argues this evidence should have been given consideration and weight by the 

ALJ.

2. Commissioner's Argument

The Commissioner argues the ALJ supplied legally sufficient reasons for rejecting the 

records from Weldon and Blackwell based on the testimony of Dr. Mohammed, who specifically 

reviewed and addressed that evidence. Dr. Mohammed noted the limitation-opinions submitted by 

Blackwell and Weldon were not actually co-signed by a physician and neither had a specialty in 

psychiatry. Dr. Mohammed explained this was important because he did not find objective testing 

or other sufficient evidence to support their opinions. In addition to crediting Dr. Mohammed's 

opinion in this regard, the ALJ also noted that the records were in conflict with the other medical 

evidence in the record, and did not reflect any interaction, evaluation, or treatment with the family 

practitioner overseeing Weldon and Blackwell. According to the Commissioner, this is precisely 

the type of germane reasoning sufficient to reject this type of medical evidence under Britton v. 

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Colvin, 787 F.3d 1011 (9th Cir. 2015) and complied fully with the requirements set forth in Social 

Security Ruling ("SSR") 96-2p, 1996 WL 372188. 

3. Analysis 

An ALJ is required to provide specific and legitimate reasons to reject the testimony of a 

medically acceptable treating source whose opinion is contradicted. Valentine, 574 F.3d 692. 

Only licensed physicians and certain other qualified specialists are considered "[a]cceptable 

medical sources" under the regulations. 20 C.F.R. § 404.1513(a). Physician's assistants and 

nurses are considered "other sources" under § 404.1513(d), and are not entitled to the same 

deference as licensed physicians. 20 C.F.R. § 404.1527; SSR 06-03p. The ALJ may discount 

testimony from those "other sources" by giving reasons germane to each witness. See Turner v. 

Comm'r of Soc. Sec., 613 F.3d 1217, 1224 (9th Cir. 2010) (quoting Lewis v. Apfel, 236 F.3d 503, 

511 (9th Cir. 2001)). 

Blackwell completed a form indicating, among other things, that Plaintiff was incapable of 

work involving even "low stress," Plaintiff would experience deterioration or decompensation in 

work or work-like settings and would likely be absent from work more than three times per month 

due to her mental impairments. (AR 518-19.) Weldon completed a form in September 2010 

indicating Plaintiff had bipolar disorder and a mood disorder which caused her to experience low 

energy, insomnia, and anxiety. (AR 408.) She found Plaintiff markedly limited in her ability to 

perform activity over a normal workday and workweek on an on-going basis in a competitive 

work environment; understand and remember detailed instructions; maintain attention and 

concentration; and work in coordination with or proximity to others without being distracted by 

them. (AR 409.) She indicated Plaintiff was moderately to markedly limited in her ability to 

accept instructions and respond appropriately to criticism from a supervisor; get along with coworkers without distracting them or exhibiting behavior extremes; respond appropriately to 

changes in the work setting; and set realistic goals or make plans independently. (AR 410.) She 

indicated Plaintiff could not tolerate even "low stress" in the workplace. (AR 412.) Neither of 

these opinions was co-signed by a physician. (See AR 412, 519.)

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In Britton, the claimant presented evidence from a nurse practitioner, Michael Keith 

("Keith"), who opined the plaintiff could not work due to fibromyalgia. 787 F.3d at 1013. The 

ALJ discounted Keith's testimony in favor of testimony offered by a medical expert who testified 

at the hearing that the plaintiff was capable of light work. Id. The ALJ noted the plaintiff's daily 

activities, including home-schooling her children, discredited Keith's opinion. Id. The appellate 

court found these germane reasons to discount Keith's opinion. Id. The plaintiff also argued that, 

pursuant to Gomez v. Chater, 74 F.3d 967, 971 (9th Cir. 1996), Keith's testimony should have 

been accorded deference as medical testimony because Keith worked closely with two doctors. 

However, the appellate court noted nothing in the record indicated Keith worked so closely with 

any doctor as to be considered an agent of a physician, as required under Gomez. Id. Instead, the 

record reflected the doctors did not know Keith because he worked in a different group, suggesting 

Keith did not work closely at all with those doctors. The court concluded the ALJ properly 

considered the records from Keith. Id.

Like the nurse practitioner in Britton, Weldon and Blackwell are not acceptable medical 

sources, and their opinions are not entitled to controlling weight. Britton, 787 F.3d at 1013. The 

ALJ was still required, however, to consider their opinions and could reject them only by stating 

germane reasons for doing so. Molina v. Astrue, 674 F.3d 1104, 1111 (9th Cir. 2012). Although 

Plaintiff claims the ALJ rejected the opinions of these medical providers only because they were 

not acceptable medical sources, the ALJ's decision and the testimony of Dr. Mohammed refute 

this characterization of the ALJ's reasoning. In June 2012, Plaintiff's counsel specifically 

questioned Dr. Mohammed about Weldon and Blackwell's form opinions. (AR 897-902.) Dr. 

Mohammed noted that Weldon is a family nurse practitioner, and not only are nurse practitioners 

not "acceptable medical sources," Weldon was not even a psychiatric nurse practitioner who 

would have experience with the type of cognitive issues Plaintiff was experiencing. (AR 898.) 

Similarly, Blackwell was not a psychologist or a medical doctor, and thus she was not an 

"acceptable medical source." (AR 898.) Dr. Mohammed testified the opinions would have been 

more persuasive had they been signed by a psychiatrist. (AR 902.) Even had they been signed by 

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a medical doctor, because Plaintiff's condition was psychiatric in nature, only a psychiatrist would 

be able to offer a persuasive opinion on Plaintiff's psychiatric conditions. (AR 902.) 

In considering the opinions of these medical sources, the ALJ noted that Dr. Mohammed 

had explained Weldon and Blackwell were not acceptable medical sources, and did not have the 

education, experience, and expertise to properly assess, diagnose, or treat mental health matters. 

In contrast, the ALJ noted Dr. Mohammed, who rendered an opinion contrary to the 2010 opinions 

of Blackwell and Weldon, was more experienced and had greater expertise; thus his opinion was 

"far more persuasive in mental health matters." (AR 29.) 

The ALJ's decision reflects rejection of Blackwell and Weldon's opinions because, in 

addition to being unacceptable medical sources, they did not have expertise and experience in the 

mental health field whereas Dr. Mohammed was a specialist in this area. Favoring the opinion of 

a specialist is legitimate. Andrews v. Shalala, 53 F.3d 1035, 1042 (9th Cir. 1995) (citing 20 

C.F.R. § 416.927(d)(5) ("We give more weight to the opinion of a specialist about medical issues 

related to his or her area of specialty than to the opinion of a source who is not a specialist.")). 

This is a germane reason to reject Blackwell and Weldon's opinions, and it goes beyond the 

observation they were not acceptable medical sources under the regulations. As Dr. Mohammed 

noted, even a medical doctor would not necessarily have the experience and expertise to diagnose 

Plaintiff's mental conditions or treat them – even to the extent that frequently occurs in the day-today medical world. And although Dr. Renwick co-signed a letter regarding Plaintiff's condition, 

there is no evidence he himself actually treated Plaintiff beyond prescribing medication on the 

recommendation of Weldon and Blackwell or that he had the opportunity to examine or observe 

Plaintiff. The ALJ was entitled to discount the opinions in the face of a specialist who disagreed, 

albeit a non-examining one. See Andrews v. Shalala, 53 F.3d 1035, 1042 (9th Cir. 1995) (citing 

Torres v. Sec'y of Human & Health Servs., 870 F.2d 742, 744 (1st Cir. 1989) (greater weight may 

be given to opinion of nonexamining expert who testifies at hearing subject to crossexamination)). 

The ALJ also stated the opinions of Blackwell and Weldon were not consistent with other 

medical evidence, which is supported by the record. Their functional limitation opinions

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contrasted with the opinions of Dr. Lampe (AR 190-91), Dr. Garcia (AR 203-05), Dr. 

Tyutyulkova (AR 245), Dr. Fetterman (AR 520-26), and Dr. Mohammed (AR 896), all of whom 

are mental health specialists. This too was a germane reason to discount the opinions of Blackwell 

and Weldon. 

B. Substantial Evidence Supports the October 2011 Onset Date

Plaintiff contends the ALJ failed to consider the reasons for her termination from her 

employment in March 2007 as directed by the Appeals Council, and wrongly relied on Dr. 

Fetterman's diagnosis of Plaintiff's amnestic disorder in October 2011 to determine her disability

onset date. According to Plaintiff, the evidence of her termination reflects that she became 

disabled in March 2007 when she was fired because she had many job-performance issues related 

to her mental condition. Additionally, after her termination, her doctor told her she should not 

work because of symptoms stemming from her anxiety problems. 

The Commissioner argues the October 2011 onset date determined by the ALJ was 

properly supported by the testimony of Dr. Mohammed. The Commissioner contends Plaintiff is

urging the Court to impermissibly reweigh the evidence to determine the onset date should be 

March 2007 instead. The only relevant question, according to the Commissioner, is whether the 

onset date determined by the ALJ is supported by substantial evidence.

The ALJ's determination of a claimant's disability onset date must be supported by 

substantial evidence. Swanson v. Sec'y of Health & Human Servs., 763 F.2d 1061, 1064 (9th Cir. 

1985). Although Plaintiff claims the onset of her disability began in March 2007, the ALJ 

determined Plaintiff's disability did not begin until October 2011, when she met the criteria for 

Listing 12.02.

Social Security Regulation ("SSR") 83-20 (1983) provides the following, in relevant part:

[i]n determining the date of onset of disability, the date alleged by the individual 

should be used if it is consistent with all the evidence available . . . [T]he 

established onset date must be fixed based on the facts and can never be 

inconsistent with the medical evidence of record.

. . . 

In some cases, it may be possible, based on the medical evidence to reasonably 

infer that the onset of a disabling impairment(s) occurred some time prior to the 

date of the first recorded medical examination, e.g., the date the claimant stopped 

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working. How long the disease may be determined to have existed at a disabling 

level of severity depends on an informed judgment of the facts in the particular 

case. This judgment, however, must have a legitimate medical basis. At the 

hearing, the [ALJ] should call on the services of a medical advisor when onset must 

be inferred. If there is information in the file indicating that additional medical 

evidence concerning onset is available, such evidence should be secured before 

inferences are made.

Listing 12.02 relates to Organic Mental Disorders, under which Plaintiff was found 

disabled. The required severity for these disorders is met when the requirements of both A and B 

are satisfied, or when the requirements in C are satisfied:

A. Demonstration of a loss of specific cognitive abilities or affective changes and the 

medically documented persistence of at least one of the following:

1. Disorientation to time and place; or

2. Memory impairment, either short-term (inability to learn new information), 

intermediate or long-term (inability to remember information that was known sometime 

in the past); or

3. Perceptual or thinking disturbances (e.g., hallucinations, delusions); or

4. Change in personality; or

5. Disturbance in mood; or

6. Emotional lability (e.g., explosive temper outbursts, sudden crying, etc.) and 

impairment in impulse control; or

7. Loss of measured intellectual ability of at least 15 I.W. points from premorbid levels or 

overall impairment index clearly within the severely impaired range on neuropsychological testing, e.g., the Luria-Nebraska, Halstead-Reitan, etc.

AND

B. Resulting in at least two of the following:

1. Marked restriction of activities of daily living; or

2. Marked difficulties in maintaining social functioning; or

3. Marked difficulties in maintaining concentration, persistence, or pace; or

4. Repeated episodes of decompensation, each of extended duration.

Dr. Mohammed testified Plaintiff met element (2) under category A because Plaintiff has 

complained about memory impairment, which was demonstrated by clinical testing done by Dr. 

Fetterman in October 2011. (AR 891.) He testified Plaintiff also met elements (4) and (5) under 

category A based on the testing results during Plaintiff's examination with Dr. Fetterman (AR 891 

("Okay, so again, memory impairment, which she has complained about and also documented in 

24F by testing, so that will be number 2. Change in personality, number 4, disturbance in mood, 

number 5.").) Dr. Fetterman opined Plaintiff had marked limitation in the ability to make 

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judgments about complex work-related matters, and in her ability to understand, remember, and 

carry out complex instructions, which related to category B. (AR 524.) Given these marked 

limitations, Dr. Mohammed determined Plaintiff met the criteria of Listing 12.02 as of October 14, 

2011, the date when there was evidence of concrete limitations and a diagnosis by Dr. Fetterman

of amnestic disorder. (AR 895.) The ALJ specifically asked Dr. Mohammed whether an earlier 

onset date should be assigned, but Dr. Mohammed explained that prior to the October 2011 

examination with Dr. Fetterman, Plaintiff's functional limitation was not clear. (AR 895.) In the 

previous records, Dr. Mohammed also found only mild limitations in activities of daily living, 

social function, and concentration, persistence, and pace. 

Plaintiff contends her termination from work in March 2007 is sufficient evidence of 

limitation in Plaintiff's functional abilities to assign an earlier onset date, and was a factual matter 

the Appeals Council specifically required the ALJ to consider. In its decision, the Appeals 

Council stated the ALJ was to consider "that the claimant apparently worked professionally at the 

clinic until the alleged onset date" in March 2007. Plaintiff contends "[t]he implication of that 

directive is clear: that [] the reasons for Ms. Little's termination from her employment warrant 

exploration, as those reasons may have been related to her psychiatric impairments, which would 

favor March 13, 2007, as the proper onset date of her disability." (Doc. 21, 20:11-15.) The 

question presented, however, is not whether or how well the ALJ complied with the Appeals 

Council's remand order – even if it could be interpreted to require the ALJ to conduct explicit 

consideration of Plaintiff's termination in considering an onset date. The question before a 

reviewing court is whether there is substantial evidence to support the ALJ's selected onset date. 

Swanson, 763 F.2d at 1065. 

In Swanson, the claimant developed a nerve disorder in October 1977 and underwent 

surgery in January 1978. 763 F.2d at 1063. Over the next few years, Swanson continued to suffer 

from a variety of disorders including a nerve disorder similar to that which caused her initial 

surgery. Id. Although she complained of severe pain, her physicians were at a loss to explain her 

problems in light of negative test results which led them to conclude her complaints were 

primarily subjective. Id. Her treating physician since May 1979 was of the opinion that she had 

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been disabled for the entire period he treated her, as did another physician who provided a report 

on her behalf. Id. However, several other doctors, both before and after 1980 were unable to find 

any significant problems with Swanson and concluded she was not disabled. Id. In considering 

the conflicting evidence, the ALJ concluded Swanson was not disabled prior to August 1980, and 

the appellate court affirmed holding the ALJ's conclusion was supported by substantial evidence. 

Id. at 1065. 

The Swanson court noted the first tests indicating a severe, disabling condition were EKG 

and treadmill test results on August 19, 1980. However, the court noted that Swanson's multiple 

hospitalizations and subjective complaints of pain indicated she suffered some impairment prior to 

August 1980. Yet, prior to 1980, there were a "large number" of negative test results coupled with 

Swanson's admission that she improved after surgical procedures and had stopped medication 

indicating her impairment was not so severe as to render her disabled before August 19, 1980. 

The court emphasized the ALJ could have chosen an earlier onset date based on the conflicting 

evidence, but the issue was "whether the chosen onset date [was] supported by substantial 

evidence, not whether an earlier date could have been supported." Id. The appellate court 

provided a caveat, however, that the date a condition is diagnosed is not dispositive to onset date: 

"the critical date is the date of onset of disability, not the date of diagnosis." Id. at 1065. The 

court emphasized Swanson's record contained substantial evidence that the date of onset and the 

diagnosis coincided to justify selection of the onset date selected.

This case is similar to Swanson as there is evidence suggesting limitation prior to the date 

Plaintiff was diagnosed with amnestic disorder by Dr. Fetterman. Although amnestic disorder was 

not diagnosed until October 2011, that alone is not controlling for selection of onset date. The 

question is whether there was functional limitation prior to that date that would have rendered 

Plaintiff disabled at an earlier time than the date she met Listing 12.02. The evidence here is 

susceptible to two reasonable conclusions.

 On the one hand, Plaintiff's termination from work due to her inability to file items 

correctly and stay focused, combined with treating notes show Plaintiff suffered a lack of 

motivation (AR 225-26), insomnia (AR 223-24), suicidal thoughts (AR 234), and forgetfulness at 

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various points prior to 2011 is evidence that suggests she was suffering functional limitation. The 

degree to which Plaintiff was limited, however, is not documented. While Weldon and Blackwell 

provided their opinions as to Plaintiff's concrete functional limitations, those opinions were 

rejected for sufficiently germane reasons. 

On the other hand, having reviewed the medical records, Dr. Mohammed opined Plaintiff 

did not exhibit specific functional limitation until examined in 2011, and he repeatedly opined 

Plaintiff did not meet the criteria of Listing 12.02 prior to October 2011. (AR 890-902.) Several 

other examining and non-examining state agency psychiatrists also agreed that Plaintiff was not 

more than mildly to moderately limited in functional abilities before October 2011. (See AR 190-

91 (examining psychiatrist Dr. Lampe noted no functional limitations in June 2008); AR 203-05 

(Dr. Garcia noted only moderate limitation in Plaintiff's ability to remember, understand, and carry 

out complex instructions in 2008); AR 245 (Dr. Tyutyulkova noted no more than minimal 

limitations in Plaintiff's functional abilities in March 2009).) Dr. Mohammed's view of Plaintiff's 

functional abilities was supported by the opinions of several physicians who examined Plaintiff, 

and was credited by the ALJ. 

Dr. Mohammed's opinion regarding Plaintiff's symptomatology is substantial evidence on 

which the ALJ was entitled to rely in selecting Plaintiff's October 14, 2011, onset date. In sum, 

although Plaintiff presents a reasonable view of the evidence, the Court cannot supplant the ALJ's 

reasoning and conclusion which is reasonable and supported by substantial evidence. 

C. The ALJ's Consideration of Plaintiff's Symptom Testimony

In evaluating the credibility of a claimant's testimony regarding subjective pain, an ALJ 

must engage in a two-step analysis. Vasquez v. Astrue, 572 F.3d 586, 591 (9th Cir. 2009). First, 

the ALJ must determine whether the claimant has presented objective medical evidence of an 

underlying impairment that could reasonably be expected to produce the pain or other symptoms 

alleged. Id. The claimant is not required to show that her impairment "could reasonably be 

expected to cause the severity of the symptom she has alleged; she need only show that it could 

reasonably have caused some degree of the symptom." Id. (quoting Lingenfelter, 504 F.3d at 

1036). If the claimant meets the first test and there is no evidence of malingering, the ALJ can 

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only reject the claimant's testimony about the severity of the symptoms if he gives "specific, clear 

and convincing reasons" for the rejection. Id. As the Ninth Circuit has explained:

The ALJ may consider many factors in weighing a claimant’s credibility, 

including (1) ordinary techniques of credibility evaluation, such as the claimant’s 

reputation for lying, prior inconsistent statements concerning the symptoms, and 

other testimony by the claimant that appears less than candid; (2) unexplained or 

inadequately explained failure to seek treatment or to follow a prescribed course of 

treatment; and (3) the claimant’s daily activities. If the ALJ’s finding is supported 

by substantial evidence, the court may not engage in second-guessing.

Tommasetti v. Astrue, 533 F.3d 1035, 1039 (9th Cir. 2008) (citations and internal quotation marks 

omitted); see also Bray v. Comm’r of Soc. Sec. Admin., 554 F.3d 1219, 1226-27 (9th Cir. 2009); 

20 C.F.R. §§ 404.1529, 416.929. Other factors the ALJ may consider include a claimant's work 

record and testimony from physicians and third parties concerning the nature, severity, and effect 

of the symptoms of which he complains. Light v. Soc. Sec. Admin., 119 F.3d 789, 792 (9th Cir. 

1997).

Plaintiff argues that in considering her subjective lay testimony, the ALJ merely stated she 

was not credible and supplied no reasoning. Specifically, the ALJ's decision recites only that 

Plaintiff's statements concerning the intensity, persistence, and limiting effects of Plaintiff's 

symptoms were not credible prior to October 14, 2011, to the extent they were not consistent with 

the ALJ's RFC assessment. Plaintiff contends that such a conclusory statement falls short of 

satisfying the ALJ's obligation to discuss the evidence and supply the reason or reasons upon 

which the ultimate determination is based. Plaintiff contends the Ninth Circuit recently rejected 

the identical conclusory boilerplate in Treichler v. Commissioner of Social Security 

Administration, 775 F.3d 1090, 1102 (9th Cir. 2014).

The Commissioner does not directly address Plaintiff's argument or discuss the similarities 

of the ALJ's reasoning in this case with those provided in Treichler. Rather, the Commissioner 

supplies citation to evidence in the record that she asserts contradicts and detracts from the weight 

of Plaintiff's lay statements.

In Treichler, the ALJ rejected the claimant's subjective symptom testimony by making a 

single general statement: "the claimant's symptoms concerning the intensity, persistence and 

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limiting effects of these symptoms are not credible to the extent they are inconsistent with the 

above residual functional capacity assessment." Id. at 1102-03. The court held this was error. Id.

at 1103. The Commissioner argued the error was harmless because the ALJ summarized the 

evidence supporting the RFC, and it could be inferred that the ALJ rejected the claimant's 

testimony to the extent it conflicted with that medical evidence. Id. The court rejected this 

reasoning noting it could not substitute its conclusion in place of the ALJ's or speculate as to the 

grounds for the ALJ's conclusion. Id.

Here, like Treichler, the ALJ supplied only the introductory phrase that Plaintiff's lay 

testimony was discredited to the extent it was not consistent with the RFC. Although the 

Commissioner offers examples from the medical evidence and Plaintiff's daily activities that seem 

to support the ALJ's discounting of Plaintiff's credibility, this was not reasoning offered by the 

ALJ in the first instance. The ALJ erred in failing to supply clear and convincing reasons to 

discount Plaintiff's lay testimony prior to October 14, 2011. Treichler, 775 F.3d at 1103.

However, in this case, the error is not prejudicial. See Molina, 674 F.3d at 1121-22 (no 

presumption of prejudicial error operates, and the error must be considered in light of the 

circumstances of the case). Even crediting Plaintiff's statements about her limitations prior to 

October 14, 2011, there remains substantial evidence to support the ALJ's pre-October 2011 RFC 

assessment. Prior to October 2011, the ALJ found Plaintiff had mild restriction in activities of 

daily living, moderate difficulties in maintaining social functioning, moderate difficulties in 

maintaining concentration, persistence or pace, and no episodes of decompensation. (AR 25.) 

The ALJ formulated the following RFC: Plaintiff retained the ability to perform medium 

exertional work, with the ability to sit, stand, and walk 6 hours each in an eight-hour day; limited 

to work involving simple, routine, and repetitive tasks, with frequent public, coworker, and 

supervisor contact. (AR 25.) 

In May 2008, Plaintiff described her limitations. (AR 100-07.) She stated that some days 

she was able to go to her doctors' appointments, play with her niece, and take her daughter to 

school. However, "most of the time" there were so many thoughts in her head which she could not 

control, and this led her to cry, isolate herself, and blames herself for the actions of others. 

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(AR 100.) She cares for her daughter with her family's help, but she stated she was unable to 

concentrate, communicate, or remember things, and she often felt like everyone was against her. 

(AR 101.) She noted she was very forgetful, but she was able to take care of all her daily personal 

needs such as bathing and feeding herself. (AR 101.) She stated she could not remember to take 

her medication, and she forgets appointments; she cannot cook because she forgets to turn off the 

stove burners. She likes to work in the yard, and she shops for personal needs whenever someone 

else is going and is able to give her a ride. (AR 103.) She is able to pay bills, count change, and 

handle both a checking and savings account. (AR 103.) She spends time with others, she attends 

church when she receives a ride, and she watches television. (AR 104.) She can only pay 

attention for a minute or two, and she struggles to follow written or spoken directions. (AR 105.) 

She cannot handle stress "at all," and it causes her mood to change. (AR 106.) 

At the hearings in 2010 and 2012, she made similar statements of her limitations. 

Synthesizing these statements and accepting them as true, prior to 2011 Plaintiff has impaired 

concentration and memory, but she was able to handle her own finances, watch television, play 

with her niece, and take her daughter to school. She retreats and withdraws from others when her 

mood changes or she experiences unspecified stress, but she is able to enjoy activities with her 

family and attends church regularly. Plaintiff does not explain, nor does the Court discern, how 

these limitations and abilities undercut the ALJ's RFC limiting Plaintiff to simple, repetitive tasks. 

Plaintiff states she has difficulty with stress and she has a resulting impulse to withdraw and blame 

herself for the actions of others, but does not specify how often she suffers these feelings or how 

often they disturb her ability to interact with others. She is limited to only frequent as opposed to 

constant contact with co-workers, supervisors, and the public which appears to account for her 

difficulty interacting with others.

Such symptoms as forgetfulness and Plaintiff's limited ability to concentrate – which she 

reported at various times to treating medical personnel – appear to be features of her amnestic 

disorder diagnosed by Dr. Fetterman, which suggests Plaintiff's amnestic disorder existed earlier 

than 2011. However, for purposes of Listing 12.02, her memory loss was not "medically 

documented" on objective testing until October 2011, which is required under Listing 12.02. 

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Thus, Plaintiff's lay reporting of her symptoms prior to 2011 does not establish an earlier onset 

date for the Listing, and Dr. Mohammed found there was no concrete evidence of memory 

impairment prior to Dr. Fetterman's examination. More importantly, Plaintiff's reported symptoms 

do not show the degree of her functional impairment. Although she experienced mood swings, 

there is no statement how often she experienced them or how they affected her relationships other 

than she experienced them and they caused her to withdraw. While she said her concentration 

problem prohibited her from focusing for more than one or two minutes, she maintained she could 

handle her own finances, watch television, and read. In considering those statements, how her 

concentration difficulties affected her ability to perform simple, repetitive tasks is unclear. This is 

distinguishable from Treichler where the claimant testified to concrete physical limitations from 

pain that were directly contrary to the RFC determination by the ALJ. Crediting Treichler's 

statements as true would have clearly affected the disability decision, which is not the case here. 

Stout v. Comm'r of Soc. Sec. Admin., 454 F.3d 1050, 1055 (9th Cir. 2006) (error is harmless if it is 

inconsequential to the disability determination). 

In sum, crediting Plaintiff's statements alone does not establish concrete functional 

impairment greater than assessed by the ALJ. 

CONCLUSION

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

evidence. Accordingly, the Court AFFIRMS the ALJ's decision. The Clerk of the Court is 

DIRECTED to enter judgment in favor of Carolyn Colvin, Acting Commissioner of Social 

Security and against Plaintiff Lena Little.

IT IS SO ORDERED.

Dated: January 26, 2016 /s/ Sheila K. Oberto 

UNITED STATES MAGISTRATE JUDGE

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