Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_14-cv-01485/USCOURTS-casd-3_14-cv-01485-1/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:0205 Appointment of Surgeon General

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UNITED STATES DISTRICT COURT 

SOUTHERN DISTRICT OF CALIFORNIA 

VICENTE AGAPITO VEGA, 

Plaintiff, 

v. 

CAROLYN W. COLVIN., 

Commissioner of Social Security 

Defendant. 

Case No.: 14cv1485-LAB (DHB) 

REPORT AND RECOMMENDATION 

REGARDING CROSS-MOTIONS 

FOR SUMMARY JUDGMENT 

[ECF Nos. 16, 20] 

I. INTRODUCTION

 On June 18, 2014, Plaintiff Vicente Agapito Vega (“Plaintiff”) filed a complaint 

pursuant to 42 U.S.C. § 405(g) of the Social Security Act requesting judicial review of the 

final decision of the Commissioner of the Social Security Administration (“Commissioner” 

or “Defendant”) regarding the denial of Plaintiff’s claim for disability benefits. (ECF No. 

1.) On March 2, 2015, Defendant filed an answer and the administrative record (“A.R.”). 

(ECF Nos. 11, 12.) On May 7, 2015, Plaintiff filed a motion for summary judgment 

seeking reversal of Defendant’s denial and an award of disability benefits, or, alternatively, 

remand for further administrative proceedings. (ECF No. 16.) Plaintiff contends the 

Administrative Law Judge (“ALJ”) “committed reversible error by improperly considering 

the treating medical opinions.” (ECF No. 16-1 at 2:12-13.) On June 9, 2015, Defendant 

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filed a cross-motion for summary judgment and opposition to Plaintiff’s motion for 

summary judgment. (ECF Nos. 20, 21.) Despite a June 11, 2015 deadline to file a reply, 

Plaintiff did not file a reply. The Court took the matter under submission on July 13, 2015. 

(ECF No. 22.) 

 For the reasons set forth herein, after careful consideration of the parties’ arguments, 

the administrative record, and the applicable law, the Court hereby RECOMMENDS that 

Plaintiff’s motion for summary judgment be DENIED and that Defendant’s cross-motion 

for summary judgment be GRANTED. 

II. PROCEDURAL BACKGROUND

 On February 7, 2012, Plaintiff protectively filed an application for supplemental 

security income under Title XVI of the Social Security Act, alleging a disability beginning 

February 27, 2010. (A.R. at 24, 55, 157.) After a June 5, 2012 denial at the initial 

determination (id. at 82-85) and a January 25, 2013 denial on reconsideration (id. at 91-

96), Plaintiff filed a timely request for hearing before an ALJ. (Id. at 97-99.) Following 

an administrative hearing on October 18, 2013 (id. at 36-54), ALJ James S. Carletti denied 

Plaintiff’s application on November 4, 2013, after finding that Plaintiff was not disabled, 

as defined by the Social Security Act. (Id. at 24-31.) In reaching this conclusion, the ALJ 

determined that Plaintiff suffered from the severe impairment of paranoid schizophrenia, 

but that his residual functional capacity (“RFC”) permitted him to perform a full range of 

work at all exertional levels but with the following non-exertional limitations: simple and 

repetitive tasks with no public contact and minimal contact with co-workers and 

supervisors. (Id. at 26-27.) Plaintiff requested review by the Appeals Council. The 

Commissioner’s decision became final on April 23, 2014 when the Appeals Council denied 

Plaintiff’s request for review of the ALJ’s November 4, 2013 decision. (Id. at 1-3.) 

III. LEGAL STANDARDS 

A. Determination of Disability

 To qualify for benefits under the Social Security Act, a claimant must show two 

things: (1) he suffers from a medically determinable physical or mental impairment that 

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can be expected to last for a continuous period of twelve months or more, or would result 

in death; and (2) the impairment renders the claimant incapable of performing the work he 

previously performed or any other substantial gainful employment which exists in the 

national economy. 42 U.S.C. §§ 423(d)(1)(A), 423(d)(2)(A). A claimant must meet both 

requirements to be classified as “disabled.” Id.

 The Commissioner makes the assessment of disability through a five-step sequential 

evaluation process. If an applicant is found to be “disabled” or “not disabled” at any step, 

there is no need to proceed further. Ukolov v. Barnhart, 420 F.3d 1002, 1003 (9th Cir. 

2005) (quoting Schneider v. Comm’r of the Soc. Sec. Admin., 223 F.3d 968, 974 (9th Cir. 

2000)). The five steps are: 

1. Is claimant presently working in a substantially gainful activity? If so, 

then the claimant is not disabled within the meaning of the Social Security 

Act. If not, proceed to step two. See 20 C.F.R. §§ 404.1520(b), 

416.920(b). 

2. Is the claimant’s impairment severe? If so, proceed to step three. If 

not, then the claimant is not disabled. See 20 C.F.R. §§ 404.1520(c), 

416.920(c). 

3. Does the impairment “meet or equal” one of a list of specific 

impairments described in 20 C.F.R. Part 200, Appendix 1? If so, then the 

claimant is disabled. If not, proceed to step four. See 20 C.F.R. §§ 

404.1520(d), 416.920(d). 

4. Is the claimant able to do any work that he or she has done in the past? 

If so, then the claimant is not disabled. If not, proceed to step five. See 20 

C.F.R. §§ 404.1520(e), 416.920(e). 

5. Is the claimant able to do any other work? If so, then the claimant is 

not disabled. If not, then the claimant is disabled. See 20 C.F.R. §§ 

404.1520(f), 416.920(f). 

Bustamante v. Massanari, 262 F.3d 949, 954 (9th Cir. 2001) (citing Tackett v. Apfel, 180 

F.3d 1094, 1098-99 (9th Cir. 1999)). 

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 Although the ALJ must assist the claimant in developing a record, the claimant bears 

the burden of proof during the first four steps, while the Commissioner bears the burden of 

proof at the fifth step. Tackett, 180 F.3d at 1098 & n.3 (citing 20 C.F.R. § 404.1512(d)). 

At step five, the Commissioner must “show that the claimant can perform some other work 

that exists in ‘significant numbers’ in the national economy, taking into consideration the 

claimant’s residual functional capacity, age, education, and work experience.” Id. at 1100 

(quoting 20 C.F.R. § 404.1560(b)(3)). 

B. Scope of Review

 The Social Security Act allows unsuccessful claimants to seek judicial review of the 

Commissioner’s final agency decision. 42 U.S.C. §§ 405(g), 1383(c)(3). The scope of 

judicial review is limited. The Court must affirm the Commissioner’s decision unless it 

“is not supported by substantial evidence or it is based upon legal error.” Tidwell v. Apfel, 

161 F.3d 599, 601 (9th Cir. 1999) (citing Flaten v. Sec’y of Health & Human Servs., 44 

F.3d 599, 601 (9th Cir. 1995)); see also Bayliss v. Barnhart, 427 F.3d 1211, 1214 n.1 (9th 

Cir. 2005) (“We may reverse the ALJ’s decision to deny benefits only if it is based upon 

legal error or is not supported by substantial evidence.” (citing Tidwell, 161 F.3d at 601)). 

 “Substantial evidence is more than a mere scintilla but less than a preponderance.” 

Tidwell, 161 F.3d at 601 (citing Jamerson v. Chater, 112 F.3d 1064, 1066 (9th Cir. 1997)). 

“Substantial evidence is relevant evidence which, considering the record as a whole, a 

reasonable person might accept as adequate to support a conclusion.” Flaten, 44 F.3d at 

1457 (citing Tylitzki v. Shalala, 999 F.2d 1411, 1413 (9th Cir. 1985)). In considering the 

record as a whole, the Court must weigh both the evidence that supports and detracts from 

the ALJ’s conclusions. Jones v. Heckler, 760 F.2d 993, 995 (9th Cir. 1985) (citing Vidal 

v. Harris, 637 F.2d 710, 712 (9th Cir. 1981); Day v. Weinberger, 522 F.2d 1154, 1156 (9th 

Cir. 1975)). The Court must uphold the denial of benefits if the evidence is susceptible to 

more than one rational interpretation, one of which supports the ALJ’s decision. Burch v. 

Barnhart, 400 F.3d 676, 679 (9th Cir. 2005) (“Where evidence is susceptible to more than 

one rational interpretation, it is the ALJ’s conclusion that must be upheld.” (citing Andrews 

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v. Shalala, 53 F. 3d 1035, 1039-40 (9th Cir. 1995))); Flaten, 44 F.3d at 1457 (“If the 

evidence can reasonably support either affirming or reversing the Secretary’s conclusion, 

the court may not substitute its judgment for that of the Secretary.” (citing Richardson v. 

Perales, 402 U.S. 389, 401 (1971)); Matney v. Sullivan, 981 F.2d 1016, 1019 (9th Cir. 

1992)). However, even if the Court finds that substantial evidence supports the ALJ’s 

conclusions, the Court must set aside the decision if the ALJ failed to apply the proper legal 

standards in weighing the evidence and reaching a conclusion. Benitez v. Califano, 573 

F.2d 653, 655 (9th Cir. 1978) (quoting Flake v. Gardner, 399 F.2d 532, 540 (9th Cir. 

1968)). 

IV. FACTUAL BACKGROUND

 Plaintiff alleges he became disabled on February 27, 2010.1

 (A.R. at 172.) Prior to 

his alleged disability, Plaintiff was employed as a general laborer2

 from May 2005 to April 

2009, as a sheet metal installer for an air conditioning installation business from May 2004 

to December 2004, and as an installation technician for a data wire installation business 

from September 2002 to May 2003. (Id. at 197.) Plaintiff claims he is not able to perform 

in any of his previous employment capacities due to schizophrenia and hypertension. (Id.

at 185.) 

/ / / 

/ / / 

/ / / 

/ / / 

                                                                

1

 Plaintiff completed a Disability Report (A.R. at 184-192) in which he stated that 

although he stopped working in April 2009 after being laid off, his mental condition 

became severe enough to keep him from working on February 27, 2010. (Id. at 185.) 

2

 Plaintiff described his job title as “general labor” in his Work History Report. (Id.

at 197.) However, Connie Guillory, the vocational expert, testified that after reviewing 

Plaintiff’s description of the work he performed, Plaintiff was, in fact, an inventory clerk. 

(Id. at 51.)

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A. Medical Evidence

1. Treating Medical Providers

 a. San Joaquin General Hospital 

 On February 26, 2010, Plaintiff was seen by Dr. Chykeetra Maltbia and others at 

San Joaquin General Hospital. Plaintiff’s mother brought him to the emergency room after 

he attempted suicide by stabbing himself in the neck with a foot-long metal rod. Plaintiff 

indicated he wanted to kill himself but his first attempt by cutting his wrist was 

unsuccessful. Plaintiff stated he thrice stabbed the metal rod into the side of his neck. 

Plaintiff’s mother informed Dr. Maltbia that Plaintiff had a history of depression but he 

had not been previously treated by a psychiatrist or physician because Plaintiff refused to 

take steps necessary to be properly evaluated. Plaintiff indicated he sometimes suffers 

from auditory hallucinations (people very angry and screaming) and visual hallucinations 

(unknown people and strange objects), and he reported suffering from auditory 

hallucinations when he attempted suicide. Plaintiff indicated he no longer had suicidal 

ideation and also did not have homicidal ideation, but he stated he was feeling “down.” 

(Id. at 426-429.) 

 Plaintiff was evaluated on February 27, 2010 by Dr. Abbegail Collantes for a 51503

hold, medically and surgically cleared, and transferred to San Joaquin County Behavioral 

Health Services. (Id. at 431-433.) 

 b. San Joaquin County Behavioral Health Services 

 Plaintiff was transferred to the Acute Psychiatric Treatment Unit of San Joaquin 

County Behavioral Health Services on February 27, 2010. A note from Kathy Hannah of 

Crisis Center stated: 

                                                                

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 Section 5150 of the California Welfare and Institutions Code authorizes certain 

individuals, including peace officers and medical providers, to detain a person in custody 

for up to seventy-two hours for assessment, evaluation, crisis intervention, or treatment, 

when that person “as a result of a mental health disorder, is a danger to others, or to himself 

or herself, or gravely disabled.” CAL. WEL. & INST. CODE § 5150(a). 

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Called to San Joaquin General Hospital second floor to assess male admitted 

on 2/26/10 for cut to right side of neck and wrist. Patient now medically 

cleared. Prior to admit to hospital, patient had not slept for two or more days 

due to increased auditory hallucinations, telling him he had to die. Family 

found him outside three days ago in underwear with no shoes, wandering. On 

evaluation, patient has through blocking, paranoid of others, looks over 

shoulder, not oriented to date, believes it’s 2007. Stabbed and cut self because 

voices told him to. Patient states, “I want to die”. Will not contract for safety. 

Complains of auditory hallucinations still telling him to die. Psychotic 

disorder, NOS, 311 Depressive disorder, NOS. 

(Id. at 372.) 

 Plaintiff was subsequently examined by psychiatrist Hilary Silver, M.D. Dr. Silver 

noted Plaintiff’s past psychiatric history included a visit to a medical provider, Charles 

Wood, on April 11, 2008 at which time he had been hearing voices for two years. Dr. 

Wood diagnosed Plaintiff with psychosis, not otherwise specified, and Plaintiff was sent 

to “Last Chance for speed and alcohol.” Plaintiff did not follow up on that diagnosis until 

February 27, 2010. Dr. Silver noted that Plaintiff was alert and oriented, and he had 

decreased speech and movement, dysphoric mood, and very blunted affect. Dr. Silver also 

noted Plaintiff’s thoughts were sparse but coherent, and he was still complaining about 

auditory hallucinations. Dr. Silver diagnosed Plaintiff with paranoid schizophrenia, 

polysubstance dependence, and personality disorder not otherwise specified. Plaintiff was 

placed on anti-psychotic medication following which he showed marked improvement. 

Plaintiff was prescribed Risperdal and discharged to his mother on March 10, 2010. (Id.

at 369-376.) 

 Plaintiff continued treatment at San Joaquin County Behavioral Health Services on 

a monthly, outpatient basis from April 30, 2010 to June 22, 2010. Over the course of this 

treatment, Plaintiff was noted to be fairly groomed and appropriately dressed. He 

cooperated during his interviews, and his speech was clear. Plaintiff presented as euthymic 

and had a constricted affect. Plaintiff denied suicidal and homicidal ideations and 

delusions. Plaintiff initially had visual hallucinations of “white lights flying” but he did 

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not complain of those after his first outpatient visit. Plaintiff continually complained of 

auditory hallucinations which “come and go” and range from a “‘freeway’ sound” to “noise 

now and then.” On May 27, 2010, Plaintiff felt “depressed, emptiness.” Plaintiff denied 

any side effects from his medication, but on April 30, 2010 he indicated he had “ran out of 

pills,” and on June 22, 2010, he stated that his medication is “working” but he sometimes 

forgets to take his medication. (Id. at 358-363, 366-368.) 

 c. Paradise Valley Hospital 

 On November 5, 2011, Plaintiff was seen by Dr. Samuel Kugel at Paradise Valley 

Hospital. Dr. Kugel’s notes state that Plaintiff presented “with a history of schizophrenia 

that once more had been decompensated.” Dr. Kugel noted that Plaintiff was paranoid and 

that Plaintiff stated, “People are after me. I can’t sleep because they’re going to hurt me.” 

Plaintiff also indicated he was starting to hear voices and he was not taking his psychiatric 

medication. Dr. Kugel noted the following mental status examination: “The patient is alert, 

awake, and oriented to time, place, and person. Speech is coherent and clear. The patient 

is expressing auditory hallucinations. Delusions with paranoid content are present. The 

patient denies harm to self or others. Insight and judgment are seen as poor. Memory 

appears intact.” Dr. Kugel diagnosed Plaintiff with chronic paranoid schizophrenia. 

Plaintiff was admitted to Paradise Valley Hospital to prevent self-harm and begin 

psychopharmacotherapy. (Id. at 305-307.) 

 d. Project Enable 

 i. Treatment History

 Plaintiff was a patient at Neighborhood House Association’s Project Enable, a 

program funded by the County of San Diego Health & Human Services Agency, from 

November 14, 2011 to September 24, 2013, roughly on a monthly basis. (Id. at 317-333, 

377-415.) Plaintiff was seen during his initial visit by David F. Flanagan, M.D., at which 

time Plaintiff had been off his medication for three days with no return of symptoms. (Id.

at 332.) 

/ / / 

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 Plaintiff missed his initial appointment following his psychiatric intake, but he was 

seen on December 6, 2011 by Dr. Flanagan. Plaintiff reported some improvement with 

elimination of all paranoia and improved sleep, but he reported daily auditory 

hallucinations without commands, “just angry stuff.” Plaintiff denied feeling unsafe or 

having urges to harm himself. He requested an increase in his Risperdal which he had 

previously taken at a higher level with good results. (Id.at 330.) 

 On December 13, 2011, Plaintiff saw registered nurse Maylie Austria and reported 

that his medications were helpful and caused no side effects. Plaintiff also reported visual 

hallucinations, i.e., “seeing black and white spot floating around.” (Id. at 328.) 

 On December 20, 2011, Plaintiff reported to Dr. Flanagan that he had significant 

improvement but that he was experiencing low-grade hallucinations, i.e., “whispering 

voices.” (Id. at 327.) On February 14, 2012, Plaintiff reported to Dr. Flanagan that he 

experienced “residual auditory hallucinations without commands which can be diminished 

by turning attention to television or task completion.” (Id. at 325.) On March 13, 2012, 

Plaintiff reported to Dr. Flanagan “persistent auditory hallucinations without any 

commands” that are worse when he forgets his morning medication. Dr. Flanagan noted 

that “[p]roblems of noncompliance persist.” (Id. at 321.) 

 On March 27, 2012, Plaintiff was seen by registered nurse Marina Duyongco. 

Plaintiff reported experiencing auditory hallucinations but they were “mild and not 

bothersome.” (Id. at 319.) 

 On April 10, 2012, Plaintiff reported to Dr. Flanagan “continued gradual 

improvement with full compliance with his medication.” Plaintiff also reported “reduced 

auditory hallucinations which are difficult to understand. There are no commands.” 

Plaintiff also reported “some tingling in [his] forearms after taking the medication.” Dr. 

Flanagan noted that Plaintiff’s mood was “content with no expression of depression or 

despair. Associations are in tact [sic]. Thought content showsno [sic] sign of internal 

stimulation but the patient reports persistent vague hallucinations.” (Id. at 318.) On May 

22, 2012, Plaintiff visited Dr. Flanagan and denied auditory hallucinations. Dr. Flanagan 

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noted “progressive improvement with no complaints of side effects.” (Id. at 415.) 

 On August 14, 2012, Plaintiff visited Dr. Oscar Jaurigue and reported feeling 

depressed. (Id. at 412-413.) Plaintiff also visited Dr. Jaurigue on October 16, 2012, 

December 10, 2012, and February 4, 2013. (Id. at 404-410.) 

 On April 16, 2013, Plaintiff visited nurse practitioner Christine Johnson and reported 

intermittent auditory hallucinations but denied visual hallucinations or delusions. (Id. at 

399-400.) Plaintiff again visited Ms. Johnson on May 21, 2013 with similar symptoms. 

(Id. at 396.) On July 2, 2012, Plaintiff visited Ms. Johnson and denied auditory or visual 

hallucinations. (Id. at 393.) On August 13, 2013, Plaintiff visited Ms. Johnson and 

reported “increased mood swings/angry outburst. [I]ncreased derogatory [auditory 

hallucinations] which cause him to be more angry -non-command.” (Id. at 387-388.) On 

September 5, 2013, Plaintiff reported to Ms. Johnson that he “continues to hear derogatory 

[non-command auditory hallucinations,] depressed mood.” (Id. at 385.) 

 ii. Mental Impairment Residual Functional Capacity Questionnaire

 On September 9, 2013, Ms. Johnson completed a Mental Impairment Residual 

Functional Capacity Questionnaire.4

 (Id. at 377-382.) She noted that Plaintiff had changes 

in medications over the previous three to four months due to increased symptoms. She 

noted clinical findings demonstrating the severity of Plaintiff’s mental impairment 

included hallucinations, paranoia, poor concentration, and depressed mood. Ms. Johnson 

checked the following boxes of a check-the-box list of symptoms: pervasive loss of interest 

in most activities; decreased energy; blunt, flag, or inappropriate affect; feelings of guilt or 

worthlessness; mood disturbance; difficulty thinking and concentrating; emotional 

                                                                

4

 Although Ms. Johnson completed and signed the September 9, 2013 Questionnaire, 

the word “Agree” accompanied by a checkmark is handwritten on the last page. (A.R. 

382.) This notation is accompanied by the handwritten name of a Project Enable physician. 

It is not entirely legible, but it appears to be “Dr. Doug Duvall.” While the last name is not 

entirely clear, it is clear that this doctor’s name and license number are not consistent with 

those of Dr. Flanagan or Dr. Jaurigue. 

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withdrawal or isolation; hallucinations or delusions; motor tension; easy distractibility; 

memory impairment; and sleep disturbance. (Id. at 377-378.) 

 Ms. Johnson opined that Plaintiff was unable to meet competitive standards in the 

following areas of mental abilities and aptitudes needed to do unskilled work: maintain 

regular attendance and be punctual within customary, usual strict tolerances; carry out short 

and simple instructions; sustain an ordinary routine without special supervision; work in 

coordination with or proximity to others without being unduly distracted; make simple 

work-related decisions; complete a normal workday and workweek without interruptions 

from psychologically based symptoms; perform at a consistent pace without an 

unreasonable number and length of rest periods; respond appropriately to changes in a 

routine work setting; and deal with normal work stress. Ms. Johnson also opined that 

Plaintiff was seriously limited, but not precluded, from the following: understand and 

remember short and simple instructions; maintain attention for two hour segments; ask 

simple questions or request assistance; accept instructions and respond appropriately to 

criticism from supervisors; get along with co-workers or peers without causing them undue 

distraction or exhibiting behavioral extremes; and be aware of normal hazards and take 

appropriate precautions. Ms. Johnson noted that medical findings that support these 

opinions include poor memory, poor concentration, auditory hallucinations, and 

distractibility. Ms. Johnson also noted Plaintiff had one or two episodes of decompensation 

within a twelve month period, each at least two weeks in duration. Ms. Johnson also noted 

Plaintiff suffered from marked difficulties in maintaining concentration, persistence, or 

pace. Ms. Johnson opined Plaintiff would be absent from work more than four days per 

month as a result of his impairments or treatment. Based on these same limitations, Ms. 

Johnson opined that Plaintiff was unable to meet competitive standards with respect to 

understanding, remembering, and carrying out detailed instructions; setting realistic goals; 

dealing with stress of semiskilled and skilled work; and making plans independently of 

others. (Id. at 379-380.) 

/ / / 

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 Ms. Johnson also opined that due to Plaintiff’s paranoia, auditory hallucinations, 

distractibility, and poor memory and concentration, he would be unable to meet 

competitive standards with respect to maintaining socially appropriate behavior, and 

seriously limited but not precluded from interacting appropriately with the general public; 

adhering to basic standards of neatness and cleanliness; and travelling in unfamiliar places. 

She also opined that Plaintiff had limited but satisfactory capacity to use public 

transportation. (Id. at 380.) 

 Ms. Johnson also opined that Plaintiff had moderate restrictions of activities of daily 

living; moderate difficulties in maintaining social functioning; marked difficulties in 

maintaining concentration, persistent, or pace; and one or two episodes of decompensation 

within a twelve months period, each of at least two weeks duration. (Id. at 381.) 

 Ms. Johnson anticipated that Plaintiff’s impairments or treatment would cause him 

to be absent from work more than four days per month. (Id. at 382.) 

 2. Psychiatric Consultative Examination

 On January 7, 2013, at the request of the Department of Social Security Disability 

& Adult Programs, Dr. Gregory M. Nicholson, a board certified psychiatrist, completed a 

Comprehensive Psychiatric Evaluation. Plaintiff’s chief complaint was depression. 

Plaintiff indicated he had schizophrenia and he heard voices commanding him to kill 

himself. Plaintiff also stated he had experienced paranoia and suicidal thoughts in the past 

but not recently. Plaintiff indicated he had attempted suicide once by cutting himself. 

Plaintiff expressed depressed mood, insomnia, decreased appetite and energy, trouble 

concentrating, and decreased interest in normal activities. Plaintiff denied having 

symptoms related to mania or anxiety disorders. Plaintiff also indicated he had last worked 

in 2009 when he was responsible for shipping and receiving in a warehouse, but that he 

stopped working because of hallucinations. (Id. at 351-353.) 

 Dr. Nicholson diagnosed Plaintiff with psychotic disorder based on Plaintiff’s 

history of hallucinations and paranoia, and depressive disorder based on Plaintiff’s history 

of depressed mood, dysphoric affect, and neurovegetative symptoms of depression, and he 

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assigned Plaintiff a Global Assessment of Functioning (“GAF”) score of 55. Dr. Nicholson 

opined that from a psychiatric standpoint, Plaintiff’s condition was expected to improve 

within twelve months with active treatment. Dr. Nicholson concluded that Plaintiff was 

able to understand, remember, and carry out simple one- or two-step job instructions and 

do detailed and complex instructions, but that Plaintiff had mild limitations in the following 

areas: (1) ability to relate and interact with co-workers and the public; (2) maintaining 

concentration and attention, persistence, and pace; and (3) performing work activities 

without special or additional supervision. Dr. Nicholson further opined that Plaintiff was 

not limited in his ability to accept instructions from supervisors, maintain regular 

attendance in the work place, and perform work activities on a consistent basis. (Id. at 354-

356.) 

B. The October 18, 2013 Hearing

1. Plaintiff’s Testimony

 The ALJ held an administrative hearing on October 13, 2013. (Id. at 36-54.) 

Plaintiff testified at the hearing. Plaintiff is a high school graduate. He testified that in the 

previous fifteen years, he worked as a general laborer for a staffing agency, a sheet metal 

installer for an air conditioning company, and an installation technician for a data wire 

company. Plaintiff testified that at the time of the hearing he was taking Trazodone, 

Fluoxetine, Risperidone, Benztropine, and Prozac, which were all prescribed to him by 

Project Enable. The medications caused Plaintiff to have blurred vision and muscle nerve 

pain. The Prozac helped Plaintiff with anger issues. (Id. at 39-42.) 

 Plaintiff testified his schizophrenia affected his ability to work because he had anger 

issues, nerve pain, sadness, hopelessness, depression, and unusual thoughts. Plaintiff also 

stated he had trouble with his memory and concentration, and he forgets things he just 

learned. Plaintiff testified he feels anxiety most of the time which causes him to become 

scared and nervous. He also stated he has difficulty being around others because he has 

delusional thoughts that they are coming after him or talking about him. Plaintiff testified 

he hears voices every day and the voices bring him down and tell him to kill himself. 

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Although he admits to attempting suicide once in 2009, he stated he does not experience 

suicidal thoughts when on medication. He also feels sad and hopeless three or four times 

a day until he takes his medication. Plaintiff stated he did not believe he was improving 

since going to Project Enable. Plaintiff testified that nurse practitioner Christine Johnson 

was the person Plaintiff normally saw at Project Enable. (Id. at 42-46.) 

 2. Medical Expert’s Testimony 

 A medical expert, Robert McDevitt, M.D., also testified at the hearing before the 

ALJ. (Id. at 47-50.) Dr. McDevitt testified that Plaintiff has been treated for paranoid 

schizophrenia but that his medical records indicate he turns down support, misses 

appointments, and loses medication. However, while on medication, Plaintiff is euthymic 

and does not suffer many symptoms other than auditory hallucinations. (Id. at 47-48.) 

 Dr. McDevitt opined that while stable on medication Plaintiff “could do more than 

he’s doing. But there hasn’t been any attempt to rehabilitate him or to get him into any 

kind of job activity.” Dr. McDevitt noted that Plaintiff has not had a change in medication 

since he began treatment with Project Enable other than changes to the dosage of Risperdal 

to counter side effects of the medication. The most recent dosage of Risperdal was two 

and one-half milligrams per day, which, according to Dr. McDevitt, “is sort of selftherapeutic in a sense but stable enough.” Dr. McDevitt also stated that he “would suspect 

that if [Plaintiff] had appropriate treatment he could improve more, but we’re stuck again 

with [Dr. Nicholson’s] consultation on January of 2013 that indicates at least a reasonable 

RFC.” (Id. at 48-49.) 

Dr. McDevitt opined that Plaintiff could take care of his personal needs and socialize 

and that “[t]here’s no compelling evidence that he has problems with concentration, 

although that’s at least from [Dr.] Nicholson’s evaluation that if he don’t [sic] get 

medicated he’s another individual who’s stable on medicine and -- but hasn’t moved 

beyond taking medication. He could possibly do some simple repetitive work, non-public 

of course with his history of -- the hallucinations are not very well.” Dr. McDevitt testified 

that Plaintiff has not recovered from his illness and has not had much treatment except 

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medications for approximately two years. (Id. at 49-50.) 

3. Vocational Expert’s Testimony

 Vocational expert Connie Guillory also testified at Plaintiff’s hearing before the 

ALJ. Ms. Guillory testified that Plaintiff’s prior work experience is described in the 

Dictionary of Occupational Titles as (1) a “cable wiring installer and repair,” which 

involved medium exertion with a specific vocational preparation (“SVP”) time of 8, but 

Plaintiff did not perform the job long enough to obtain that SVP level, so she believed it 

was probably performed at a semi-skilled, SVP level 4; (2) “sheet metal installer,” which 

involved heavy exertion with an SVP time of 8, but Plaintiff did not perform the job long 

enough to obtain that SVP level, so she believed it was probably performed as a training, 

SVP level 4; and (3) “inventory clerk,” which involved medium exertion at SVP level 4. 

(Id. at 51.) 

 The ALJ asked Ms. Guillory to consider a hypothetical claimant with the same age, 

education, and past work as Plaintiff who is limited to performing simple, repetitive tasks 

in a non-public work environment with minimal interaction with co-workers and 

supervisors. Ms. Guillory testified that such a hypothetical claimant would not be able to 

perform Plaintiff’s past work, but that such a hypothetical claimant could perform 

“unskilled, non-public, non-production type of positions.” She also testified that a 

significant number of jobs existed in the national economy that the hypothetical person 

could perform, including packager, cleaner, and laundry worker. (Id. at 52.) 

 Plaintiff’s counsel asked Ms. Guillory whether the hypothetical claimant could 

perform any of these jobs if the person were to miss four or more days of work per month, 

and she responded that he would not be able to sustain competitive employment given that 

additional information. (Id. at 53.) 

C. The ALJ’s Findings

1. Step One

 After consideration of all the evidence, the ALJ concluded that Plaintiff has not been 

under a disability, as defined by the Social Security Act, from February 7, 2012, the date 

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Plaintiff’s application was filed. (Id. at 30.) Specifically, at step one of the sequential 

evaluation process, the ALJ concluded Plaintiff has not engaged in substantial gainful 

activity since February 7, 2012. (Id. at 26.) 

2. Step Two

 At step two, the ALJ concluded Plaintiff has the following severe impairment: 

paranoid schizophrenia manifested by paranoia and sleep disturbance. (Id.) The ALJ noted 

that when Plaintiff is not taking his medications he experiences auditory hallucinations and 

delusions with paranoid content, but when he is compliant with his medications the 

progress notes document improvement of symptoms, sleep, and mental functioning. (Id.) 

3. Step Three

 At step three, the ALJ concluded Plaintiff does not have an impairment or 

combination of impairments that meet or exceed the impairments contained in the Listing 

of Impairments. In assessing whether Plaintiff satisfies the “paragraph B” criteria with 

respect to the severity of his mental impairments, the ALJ concluded Plaintiff’s mental 

impairments did not result in at least two of the following: marked restriction of activities 

of daily living; marked difficulties in maintaining social functioning; marked difficulties 

in maintaining concentration, persistence, or pace; or repeated episodes of 

decompensation, each of an extended duration. The ALJ also concluded that no evidence 

establishes the presence of “paragraph C” criteria. (Id. at 26-27.) 

4. Residual Functional Capacity

 Prior to considering step four, the ALJ determined Plaintiff has the RFC to perform 

a full range of work at all exertional levels, but with the following non-exertional 

limitations: (1) simple and repetitive tasks; (2) no public contact; and (3) minimal contact 

with co-workers and supervisors. In making this assessment, the ALJ concluded Plaintiff’s 

medically determinable impairments could reasonably be expected to cause Plaintiff’s 

symptoms (including paranoid schizophrenia), but Plaintiff’s statements concerning the 

intensity, persistence, and limiting effects of these symptoms are not fully credible. (Id. at 

27.) 

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 First, the ALJ found Plaintiff had been persistently non-compliant with prescribed 

medications and scheduled medical appointments. Further, Plaintiff had turned down 

offers of support, such as group therapy, which weighed against Plaintiff’s sincerity of his 

allegations of severe impairment. (Id.) 

 Second, the ALJ noted that when Plaintiff was compliant with his medications, the 

objective medical evidence showed the medications were relatively effective in controlling 

Plaintiff’s symptoms. The ALJ also noted Plaintiff’s residual auditory hallucinations could 

be attenuated or diminished, or even completely resolved, by directing Plaintiff’s attention 

to television or task completion. (Id.) 

 Third, the ALJ also found that the weight of the evidence did not support Plaintiff’s 

claimed disabling limitations to the degree Plaintiff alleged. The ALJ noted that Plaintiff 

had not generally received the type of medical treatment expected for a totally disabled 

individual, and Plaintiff’s course of treatment since his alleged disability onset generally 

reflected a conservative approach. (Id.) 

 Finally, the ALJ found that Plaintiff’s allegations of significant limitations were not 

borne out of his description of his daily activities. Plaintiff was independent in his daily 

living activities and lived alone, even though at the time of the hearing Plaintiff lived with 

a friend. The ALJ also noted that none of Plaintiff’s physicians had opined that he was 

totally and permanently disabled from any kind of work. (Id. at 27-28.) 

 With respect to the opinion evidence, the ALJ gave little weight to nurse practitioner 

Johnson’s September 9, 2013 assessment. The ALJ stated that, by regulation, nurses and 

social workers are not acceptable medical sources, and their diagnoses are insufficient to 

establish a medically determinable impairment at step two. As such, their opinions are 

evaluated as “other medical” opinions and are never entitled to controlling weight. Rather, 

the ALJ stated that such an opinion “is entitled only to such weight as is warranted after 

consideration of multiple factors including testing and consultative evaluations by 

specialists; supportability, including the degree of explanation and support by objective 

evidence; consistency with the record as a whole; degree of specialization in the area of 

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medicine involved; other factors, including awareness of other evidence in the record, and 

understanding of social security disability programs and requirements.” The ALJ stated 

that although he did not ignore Ms. Johnson’s opinion, he did not give it much weight 

because it was contradicted by progress notes showing Plaintiff’s symptoms were stable as 

long as he was compliant with prescribed therapy and he stays clean and sober. The ALJ 

also noted that Plaintiff turned down offers of support such as group therapy. Further, the 

ALJ found that Ms. Johnson’s opinion was undermined by the findings and opinions of 

consulting psychiatrist, Dr. Nicholson. Dr. Nicholson evaluated Plaintiff on January 7, 

2013, conducted a complete mental status examination, and presented a detailed report in 

the required format. Thus, the ALJ rejected Ms. Johnson’s opinion. (Id. at 28.) 

 The ALJ also considered the opinion Dr. McDevitt, the medical expert that testified 

during the hearing, and gave it significant weight. The ALJ noted: (1) Dr. McDevitt is 

board-certified in psychiatry and had the opportunity to review the entire record and hear 

Plaintiff’s testimony; (2) Dr. McDevitt’s opinion took into consideration Plaintiff’s history 

of schizophrenia with periods of non-compliance with prescribed treatments resulting in 

the exacerbation of symptoms contrasting with stability when Plaintiff is compliant with 

prescribed therapy; (3) Dr. McDevitt noted that Plaintiff’s medications had not been 

changed in years; and (4) Dr. McDevitt’s opinion was consistent with other opinions in the 

record, including that of Dr. Nicholson. In sum, the ALJ gave Dr. McDevitt’s opinion 

significant weight. (Id. at 28-29.) 

 The ALJ concluded that Plaintiff’s RFC assessment was supported by evidence of 

paranoid schizophrenia that is stable as long as Plaintiff is compliant with prescribed 

medications and, when compliant, Plaintiff is able to perform simple and repetitive tasks, 

subject to the additional restrictions to avoid public contact and have limited co-worker 

and supervisor interaction. (Id. at 29.) 

 5. Step Four

At step four of the sequential evaluation process, the ALJ credited the vocational 

expert’s testimony that Plaintiff is unable to perform any of his past relevant work, either 

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as actually done or as generally done in the national economy. The ALJ also found that 

Plaintiff has no transferable job skills. (Id.) 

6. Step Five

The ALJ considered Plaintiff’s age, education, work experience, and RFC, and 

found that there are jobs that exist in significant numbers in the national economy that 

Plaintiff can perform. The ALJ noted that Plaintiff’s ability to perform work at all 

exertional levels was compromised by non-exertional limitations. The ALJ concluded 

Plaintiff would be capable of making a successful adjustment to other work that exists in 

significant numbers in the national economy, including occupations such as a weigher/hand 

packer, cleaner, and laundry worker. (Id. at 30.) 

Therefore, the ALJ found that Plaintiff was not disabled as defined by the Social 

Security Act. (Id.) 

V. DISCUSSION

 In his motion for summary judgment, Plaintiff contends the ALJ “committed 

reversible error by improperly considering the treating medical opinions.” (ECF No. 16-1 

at 2:12-13.) Plaintiff contends the ALJ failed to articulate a legally sufficient rationale for 

rejecting the treating opinion from Project Enable. (Id. at 3:6-9.) Specifically, Plaintiff 

contends the ALJ’s opinion was required to set forth specific and legitimate reasons 

supported by substantial evidence in the record in order to reject the opinions of nurse 

practitioner Johnson from Project Enable. (Id. at 3:14-4:21.) Plaintiff further contends the 

ALJ improperly rejected Ms. Johnson’s opinions because, although she is a nurse, her 

opinions were reviewed and approved by a medical doctor. (Id. at 4:22-5:2.) Plaintiff also 

contends that the error is material because the vocational expert testified during the hearing 

that an individual assumed to be absent for four or more days per month (i.e., Ms. Johnson’s 

opinion as to Plaintiff) would be unable to sustain competitive employment. (Id. at 5:22-

6:3.) 

 As discussed below, Plaintiff’s argument that the ALJ was required to set forth 

specific and legitimate reasons for rejecting Ms. Johnson’s September 2013 opinions is 

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based on a misunderstanding of the relevant case law and Social Security regulations. 

 It is true that the opinion of a treating physician is generally entitled to deference. 

See 20 C.F.R. § 416.927(c)(2) (“Generally, we give more weight to opinions from your 

treating sources, since these sources are likely to be the medical professionals most able to 

provide a detailed, longitudinal picture of your medical impairment(s) and may bring a 

unique perspective to the medical evidence that cannot be obtained from the objective 

medical findings alone or from reports of individual examinations. . . .”); Morgan v. 

Comm’r of the Soc. Sec. Admin., 169 F.3d 595, 600 (9th Cir. 1999) (“The opinion of a 

treating physician is given deference because ‘he is employed to cure and has a greater 

opportunity to know and observe the patient as an individual.’” (quoting Sprague v. Bowen, 

812 F.2d 1226, 1230 (9th Cir. 1987))); Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995)

(“As a general rule, more weight should be given to the opinion of a treating source than 

to the opinion of doctors who do not treat the claimant.” (citing Winans v. Bowen, 853 F.2d 

643, 647 (9th Cir. 1987))). Moreover, “where [a] treating doctor’s opinion is not 

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

Lester, 81 F.3d at 830 (quoting Baxter v. Sullivan, 923 F.2d 1391, 1396 (9th Cir. 1991)). 

However, “if the treating doctor’s opinion is contradicted by another doctor, the 

Commissioner may not reject this opinion without providing ‘specific and legitimate 

reasons’ supported by substantial evidence in the record for so doing.” Id. (quoting Murray 

v. Heckler, 722 F.2d 499, 502 (9th Cir. 1983)). 

 These principles, however, pertain to the deference accorded treating physicians. 

Here, Ms. Johnson is not a treating physician; rather, she is a nurse practitioner. Nurse 

practitioners are not considered “acceptable medical sources” under 20 C.F.R. § 416.913.5

 

                                                                

5

 “Acceptable medical sources” include licensed physicians, psychologists, 

optometrists, podiatrists, and qualified speech-language pathologists. 20 C.F.R. 

§ 416.913(a)(1)-(5). The Commissioner “need[s] evidence from acceptable medical 

sources to establish whether [a claimant] ha[s] a medically determination impairment(s).” 

20 C.F.R. § 416.913(a). 

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Instead, nurse practitioners are considered “other sources.” See 20 C.F.R. § 416.913(d)(1) 

(listing medical sources that are considered “other sources,” including nurse practitioners, 

physicians’ assistants, naturopaths, chiropractors, audiologists, and therapists). Thus, Ms. 

Johnson’s opinions are not entitled to special weight. The ALJ may reject the opinions of 

“other sources” by giving “reasons germane to each witness for doing so.” Lewis v. Apfel, 

236 F.3d 503, 511 (9th Cir. 2001); see also Molina v. Astrue, 674 F.3d 1104, 1111 (9th 

Cir. 2012); Turner v. Comm’r of Soc. Sec. Admin., 613 F.3d 1217, 1224 (9th Cir. 2010). 

 Plaintiff contends that although Ms. Johnson is a nurse practitioner, the form 

containing her opinions clearly indicates that it was reviewed and agreed with by a medical 

doctor. In so doing, Plaintiff relies on Taylor v. Comm’r of Soc. Sec. Admin., 659 F.3d 

1228 (9th Cir. 2011), in which the Ninth Circuit recognized that “nurse practitioners are 

listed among the examples of ‘medical sources’” contained in the regulations. Taylor, 659 

F.3d at 1234. The Ninth Circuit then found that “[t]o the extent [the] nurse practitioner . . 

. was working closely with, and under the supervision of [the doctor], her [i.e., the nurse 

practitioner] opinion is to be considered that of an ‘acceptable medical source.’” Id. (citing 

Gomez v. Chater, 74 F.3d 967, 971 (9th Cir. 1996)). This finding was based on the Ninth 

Circuit’s prior decision in Gomez, which involved a nurse practitioner, Debra Blaker, 

which had consulted with the treating doctor, Dr. Kincade, regarding Gomez’s treatment 

“numerous times over the course of her relationship with Gomez. NP Blaker worked 

closely under the supervision of Dr. Kincade and she was acting as an agent of Dr. Kincade 

in her relationship with Gomez. Her opinion was properly considered as part of the opinion 

of Dr. Kincade, an acceptable medical source.” Gomez, 74 F.3d at 971. 

 Here, there are no opinions from any of the physicians at Project Enable that Ms. 

Johnson’s opinion could properly be considered a part of. Moreover, there is no evidence 

in the record suggesting that Ms. Johnson consulted with or worked closely under the 

supervision of any of the Project Enable physicians, let alone the doctor that agreed with 

her September 2013 report. In fact, as noted above, see supra note 4, although Ms. 

Johnson’s opinion contains a handwritten note from a doctor expressing agreement with 

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her report, it is unclear who this doctor was. What is clear is that this doctor was neither 

Dr. Flanagan nor Dr. Jaurigue, the two doctors at Project Enable that had also treated 

Plaintiff. Thus, the principle set forth in Gomez and Taylor that a nurse practitioner’s 

opinions may be considered as part of a treating physician’s opinion based on that 

physician’s close supervision with the nurse practitioner does not apply in this case. See 

Farnacio v. Astrue, No. 11-CV-065-JPH, 2012 U.S. Dist. LEXIS 130913, at *18-19 (E.D. 

Wash. Sept. 12, 2012) (finding Gomez inapplicable where “there is no evidence that 

[physician’s assistant] consulted with or worked as closely with any other physician as the 

evidence reflected in Gomez.”) 

 The Gomez decision was also based on the Ninth Circuit’s reading of 20 C.F.R. 

§ 416.913(a)(6), which at the time of the decision provided that “[a] report of an 

interdisciplinary team that contains the signature of an acceptable medical source is also 

considered acceptable medical evidence.” Gomez, 74 F.3d at 971. The Ninth Circuit went 

on to state that “[w]hile nowhere in the regulations is the term ‘interdisciplinary team’ 

expressly defined, a plain reading . . . indicates that a nurse practitioner working in 

conjunction with a physician constitutes an acceptable medical source, while a nurse 

practitioner working on his or her own does not.” Id. However, as numerous district courts 

in the Ninth Circuit have recognized, both before and after Taylor, the regulation relied on 

in Gomez regarding “interdisciplinary teams” involving “other sources” such as nurse 

practitioners and physician assistants has since been amended, and “interdisciplinary 

teams” are no longer considered “acceptable medical sources.” See, e.g., Harrison v. 

Comm’r of Soc. Sec. Admin., No. 3:13-cv-8177-HRH, 2014 U.S. Dist. LEXIS 52623, at 

*17-18 (D. Ariz. April 16, 2014) (“[T]here is nothing in the record that indicates that Dr. 

Sadowski supervised [physician assistant] Barnes or was involved in plaintiff’s mental 

health treatment in any way. Dr. Sadowski’s signature on the mental capacities form does 

not transform Barnes’ opinion into evidence from an ‘acceptable medical source’ because 

the opinion was based on Barnes’ treatment of plaintiff, not Dr. Sadowski’s treatment of 

plaintiff.” (citing Garcia v. Astrue, No. 1:10-CV-00542-SKO, 2011 U.S. Dist. LEXIS 

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98299, at *15 (E.D. Cal. Sept. 1, 2011) (doctor’s signature on reports authorized by 

physician assistant did not transform reports into evidence from an “acceptable medical 

source” when the physician assistant prepared the reports following his examination of 

claimant))); Wellington v. Colvin, No. 1:11-cv-00008-REB, 2014 U.S. Dist. LEXIS 45786, 

at *22-25 (D. Idaho Mar. 31, 2014) (rejecting argument that opinion of physician’s 

assistant working in conjunction with physician constitutes “acceptable medical source” 

and stating that “[a]lthough the Court recognizes that there are good reasons for 

recognizing the opinion of a physician’s assistant who provides regular treatment to a 

patient, the regulations at this time do not require an ALJ to treat a physician assistant’s 

medical opinion the same as that of a treating physician.”); Curtis v. Colvin, No. CV 12-

00396-TUC-JGZ (DTF), 2014 U.S. Dist. LEXIS 20510, at *15-16 n.3 (D. Ariz. Jan. 24, 

2014) (“[T]he Gomez rationale was based on a regulatory provision that was repealed in 

2000.”); Olney v. Colvin, No. 12-CV-0547-TOR, 2013 U.S. Dist. LEXIS 122105, at *10-

11 (E.D. Wash. Aug. 27, 2013) (recognizing that, following 2000 amendment to 20 C.F.R. 

§ 416.913(a), Gomez’s conclusion that a physician assistant who works in conjunction with 

a physician constitutes an acceptable medical source “is no longer good law.”); Casner v. 

Colvin, 958 F. Supp. 2d 1087, 1097 (C.D. Cal. 2013); Farnacio, 2012 U.S. Dist. LEXIS 

130913, at *6 (“The subsection of the regulation which was the basis of the Gomez finding 

regarding nurse practitioners as acceptable medical sources when part of an 

interdisciplinary team was deleted by amendment in 2000. 65 Fed. Reg. 34950, 34952 

(June 1, 2000). . . . There is [currently] no provision for a physician assistant to become an 

acceptable medical source when supervised by a physician or as part of an interdisciplinary 

team.” (citation omitted)); Hudson v. Astrue, No. CV-11-0025-CI, 2012 U.S. Dist. LEXIS 

154871, at *13 n.4 (E.D. Wash. Oct. 29, 2012) (recognizing that regulations underscoring 

Gomez finding “have been amended since the Gomez decision, and the Commissioner no 

longer includes ‘interdisciplinary team,” under the definition of acceptable medical 

sources.”); Reynolds v. Astrue, No. CV-09-0213-CI, 2010 U.S. Dist. LEXIS 92701, at *21 

(E.D. Wash. Sept. 3, 2010). 

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 The Court agrees with the conclusions of the many courts that have considered 

Gomez’s continuing validity in light of the 2000 amendment to 20 C.F.R. § 416.913(a). 

Accordingly, the Court finds that Ms. Johnson’s September 2013 report does not rise to the 

level of an “acceptable medical source” due to the handwritten note of agreement from an 

unidentifiable physician.6

 As a result, the ALJ was only required to identify germane 

reasons for not fully crediting Ms. Johnson’s assessment, and the ALJ satisfied this 

requirement. 

 In his opinion, the ALJ gave the following reasons for disregarding Ms. Johnson’s 

assessment: 

While I have not ignored the opinion of Ms. Johnson, I have not given it much 

weight. Her opinion is contradicted by progress notes showing stability of the 

claimant’s symptoms and improvement of functioning as long as he is 

compliant with the prescribed therapy and stays clean and sober. It is also 

noteworthy that the claimant has turned down other offers of support such as 

group therapy. 

Her opinion is undermined by the findings and opinions of consulting 

psychiatrist Gregory Nicholson, M.D., who evaluated the claimant on January 

7, 2013 (Exhibit 7F). He conducted a thorough examination of the claimant 

including a complete mental status examination, required by the Regulations 

and presented a report in the format and with the detail also required. For the 

foregoing reasons, I reject the opinion of Ms. Johnson. 

 

(A.R. 28.) 

                                                                

6

 In an effort to convince the Court otherwise, Plaintiff cites to a California regulation 

requiring that a physician assistant be supervised by the physician. See 16 CAL. CODE 

REGS. § 1399.545. Plaintiff argues this state requirement “compels the conclusion that the 

physician assistant’s expressions are imputed to the physician absent repudiation by the 

licensed physician.” (ECF No. 16-1 at 5:19-20.) However, this regulation is, by its terms, 

applicable only to physician assistants. Plaintiff has not cited, nor has the Court found, any 

parallel supervision requirement applicable to nurse practitioners, or any authority 

extending the supervision requirement for physician assistants to the acts of nurse 

practitioners such as Ms. Johnson. Moreover, even if the state required supervision of 

nurse practitioners, the record in this case does not demonstrate such supervision occurred. 

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Inconsistency with medical evidence is a germane reason sufficient to permit an ALJ 

to reject “other source” opinions. See Lewis, 236 F.3d at 511. Further, factors used to 

evaluate the weight of a nurse practitioner’s opinion include, among others, the degree of 

explanation and support by objective evidence and understanding of social security 

disability programs and requirements. 20 C.F.R. § 416.927(d). Thus, the ALJ’s decision 

to give more weight to Dr. Nicholson’s opinion than to Ms. Johnson’s opinion is another 

germane reason. In short, the Court finds substantial evidence in the record supporting the 

ALJ’s reasoning. 

Moreover, even if the ALJ was required to set forth specific and legitimate reasons 

for rejecting Ms. Johnson’s report, as Plaintiff urges, the ALJ satisfied this heightened 

requirement when specifically describing the inconsistencies between Ms. Johnson’s report 

and her progress notes. See Jones v. Colvin, No. 1:12-cv-1283- BAM, 2013 U.S. Dist. 

LEXIS 143425, at *16 (E.D. Cal. Sept. 30, 2013) (“The Ninth Circuit has found that when 

a doctor’s conclusions are not consistent with his own findings, that is a specific and 

legitimate reason for rejecting that opinion.” (citing Young v. Heckler, 803 F.2d 963, 968 

(9th Cir. 1986) (per curiam))). 

For these reasons, the ALJ properly rejected Ms. Johnson’s assessment. 

V. CONCLUSION

 After a thorough review of the record in this matter, and based on the foregoing 

analysis, this Court RECOMMENDS Plaintiff’s motion for summary judgment be 

DENIED and Defendant’s cross-motion for summary judgment be GRANTED. 

 This Report and Recommendation of the undersigned Magistrate Judge is submitted 

to the United States District Judge assigned to this case, pursuant to the provisions of 28 

U.S.C. § 636(b)(1) and Civil Local Rule 72.1(d). 

 IT IS HEREBY ORDERED that no later than November 30, 2015, any party may 

file and serve written objections with the Court and serve a copy on all parties. The 

documents should be captioned “Objections to Report and Recommendation.” 

/ / / 

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 IT IS FURTHER ORDERED that any reply to the objections shall be filed and 

served no later than ten days after being served with the objections. 

 The parties are advised that failure to file objections within the specific time may 

waive the right to raise those objections on appeal of the Court’s order. Martinez v. Ylst, 

951 F.2d 1153, 1156-57 (9th Cir. 1991). 

 IT IS SO ORDERED. 

Dated: November 12, 2015 

DAVID H. BARTICK 

United States Magistrate Judge 

 

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