Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_18-cv-01845/USCOURTS-cand-3_18-cv-01845-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:405 Review of HHS Decision (SSID)

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Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

ANTONIA ANTOINETTE PARKER,

Plaintiff,

v.

ANDREW M. SAUL,

Defendant.

Case No. 18-cv-01845-JCS 

ORDER GRANTING PLAINTIFF’S

MOTION FOR SUMMARY 

JUDGMENT, DENYING 

DEFENDANT’S MOTION FOR 

SUMMARY JUDGMENT, REVERSING 

THE DECISION OF THE 

COMMISSIONER AND REMANDING 

FOR AWARD OF BENEFITS

Re: Dkt. No. 20

I. INTRODUCTION

Plaintiff Antonia Antoinette Parker seeks review of the final decision of Defendant 

Andrew M. Saul, Commissioner of Social Security (“the Commissioner”), denying her 

applications for disability insurance benefits and Supplemental Security Income benefits under 

Titles II and XVI of the Social Security Act. The parties have filed cross motions for summary 

judgment pursuant to Civil Local Rule 16-5. For the reasons stated below, the Court GRANTS 

Parker’s Motion for Summary Judgment, DENIES the Commissioner’s Motion for Summary 

Judgment, REVERSES the decision of the Commissioner and REMANDS the case to the Social 

Security Administration for award of benefits.

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II. BACKGROUND

A. Factual Background

Education and Employment Background

Parker was born on April 23, 1964. Administrative Record (“AR”) at 1172. She graduated 

from high school in 1982 and then joined the Army, where she worked as a secretary for two 

years. Id. at 1175. After she left the Army, she worked in customer service. Id. Parker 

 

1 The parties have consented to the jurisdiction of the undersigned magistrate judge pursuant to 28 

U.S.C § 636(c). 

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completed cosmetology school in 1990. Id. at 380. Parker received her cosmetology license in 

2001 and held various cosmetology jobs in New York. Id. at 1175. In 2008, she worked twenty 

hours a week as a spa attendant for six months. Id. at 381. In 2015, Parker worked 10 hours a 

week as a house monitor at Casa de Maria for a month. See id. at 73–74. Parker stopped working 

in this position because she “was always tired” and “did not have the energy” to do the work. Id.

at 74. 

Parker’s Medical History 

Parker alleges that she is unable to work because of both physical and mental impairments

as well as side effects from medication. See id. at 77. She was diagnosed with polycystic liver 

and kidney disease in 1998. Id. at 1404. In addition, she fell down a flight of stairs in 2008, 

sustaining spinal injuries and fracturing her clavicle and her “T5 and T6 spinous processes.” Id. 

She began having “nerve blocks” every three months after this accident. Id. 

Parker also has a history of physical and sexual abuse. Id. at 945. When she was a child, 

her grandparents stripped her naked and whipped her. Id. She was also raped in 2011, which she

reported to the police. Id. Parker is also a victim of domestic violence and suffered both physical 

and emotional abuse when she lived with her ex-husband. Id. As a result of her history of trauma, 

Parker suffers from panic attacks and nightmares. Id. at 1317. She also suffers from major 

depression and anxiety disorder and experiences confusion and other side effects of her 

medications. Id. at 77, 1089. 

Parker takes Morphine three times a day to manage her pain, which she says makes her 

drowsy. Id. at 79, 1174. She also takes Xanax for anxiety, Cymbalta for depression and to give 

her energy, Seroquel “for [her] mood and sleeping,” and Prozac for her mood as well. Id. at 1173-

74. Parker sees multiple doctors for treatment of her impairments. See id. The Court summarizes 

Parker’s relevant medical treatment below. 

a. Parker’s Polycystic Kidney Disease

Parker was diagnosed with polycystic kidney disease in 1998 after feeling “excruciating 

pain” in her back and stomach. Id. at 1404. Between 1998 and 2000, she had four surgeries to 

drain cysts on her liver and kidneys. Id. 

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Between 2000 and 2009, Parker was treated for abdominal pain from her kidney cysts at 

Alta Bates Summit Medical, in Oakland, California. Id. at 1278-1308. Philip Rich, M.D.,

conducted a transabdominal ultrasound on August 14, 2000 and found “[p]olycystic disease of the 

kidneys and liver.” Id. at 1308. Parker went to the Emergency Department at Alta Bates Summit

on December 15, 2008 complaining of constant abdominal pain she had been experiencing for 

approximately two weeks. Id. at 1286. She was treated by Ben Bonnes, M.D., who attributed 

Parker’s pain to “ovarian cyst” and “bacterial vaginitis.” Id. at 1290. On January 22, 2009, 

Patrick Perkins, M.D., took a CT of Parker’s abdomen and found that:

The liver exhibits multiple hypodensities which are all well defined and of various 

size from moderate to tiny. These are seen throughout the liver. The kidneys are 

enlarged by multiple cysts of varying size with a degree of parenchymal 

replacement less than usually seen with classic polycystic disease.

Id. at 1278. 

On March 27, 2013, Clifford Wong, M.D., evaluated Parker for renal insufficiency at St. 

Rose Hospital. Id. at 944. Dr. Wong diagnosed her with renal insufficiency with reported 

polycystic kidney disease, given a “very strong family history” and “suspect[ed] autosomal 

dominant polycystic kidney disease.” Id. at 945–6. 

Parker was also referred by her primary care physician to Varun Chawla, M.D., a 

nephrologist at Chabot Nephrology Medical Group. Id. at 741. Her first appointment with Dr. 

Chawla was on October 24, 2013. Id. Parker continued to see him through September 2015. Id.

at 1194–1240. Parker reported to Dr. Chawla that she had flank pain, “mostly right side, severe.” 

Id. at 741. Dr. Chawla confirmed Parker’s diagnosis of polycystic kidney disease when he 

examined her on October 24, 2013. Id. at 745. He further added that she suffers from 

“excruciating flank pain,” the cause of which he suspected was a “cyst bleed causing acute pain.” 

Id. at 746. Dr. Chawla also diagnosed Parker with chronic atrial fibrillation, anxiety and 

hypertension. Id. He recommended Vicodin for severe pain and Tylenol for mild to moderate 

pain. Id. However, he also noted that “no specific treatment has been proven to prevent or delay 

progression of autosomal dominant polycystic kidney disease.” Id. Parker saw Dr. Chawla for a 

follow-up on November 14, 2013. Id. at 738. Dr. Chawla confirmed the same diagnoses, adding 

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anemia and hypertension, and asked Parker to follow up in three to four months. Id. at 739. 

Parker saw Dr. Chawla again on March 28, 2014 for flank pain. Id. at 1205–07. He prescribed 

Percocet for severe pain. Id. at 1207. Dr. Chawla saw Parker again on July 1, 2014 and noted the 

same diagnoses. Id. at 1210. However, when he treated her on February 18, 2015, Dr. Chawla 

also diagnosed Parker with “[a]cute renal failure syndrome,” based on lab results showing that her 

creatinine had “jumped from baseline 1.0-1.2 to 1.6” and noted that “this could be [acute kidney 

injury] versus progression of [polycystic kidney disease].” Id. at 1212. He ordered a re-check in 

one to two weeks. Id. At a follow-up appointment on March 18, 2015, Dr. Chawla again 

diagnosed Parker with acute renal failure syndrome noting that on recheck her creatinine remained 

high at 1.5. Id. at 1228. He also diagnosed Parker with polycystic kidney disease and “chronic 

kidney disease, stage three.” Id. At Parker’s follow-up appointment on June 12, 2015, Dr. 

Chawla listed Parker’s diagnoses as “[p]olycystic kidney disease, adult type,” “[c]hronic kidney 

disease, stage 3,” “[e]ssential hypertension,” “[a]nxiety,” “[a]nemia,” and “[a]cute renal failure 

syndrome.” Id. at 1230. He prescribed Venofer by IV weekly for three weeks in his care plan to 

address Parker’s anemia. Id. Parker returned on July 17, 2015 and Dr. Chawla listed the same 

diagnoses as the previous visit. Id. at 1234. He referred Parker to a pain management specialist. 

He also prescribed Percocet for “severe pain.” Id. Dr. Chawla saw Parker again on September 1, 

2015, and confirmed all previous diagnoses except for acute renal failure syndrome, which was no 

longer listed. Id. at 1239. 

b. Parker’s Chronic Back Pain

i. Alta Bates Summit

Parker went to Alta Bates Summit Medical Center emergency department on July 1, 2009 

after she was hit by a car. Id. at 555. Stephan D. Chin, M.D., treated Parker and took x-rays of 

her spine. Id. at 556–558. Dr. Chin concluded that Parker fractured her “distal right clavicle” but 

did not fracture her spine. Id. at 558. He instructed her to ice her clavicle and wear a sling until 

better. Id. at 559. Dr. Chin prescribed Ibuprofen, Vicodin, and Flexeril. Id. Parker went back to 

the emergency room on July 11, 2009, complaining of persistent back pain, and the attending 

doctor, Dr. Klemenson-Chau, ordered a CT of Parker’s spine. Id. at 546. Based on the CT and a 

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reevaluation of Parker’s back x-ray, Dr. Klemenson-Chau concluded that Parker did have a 

fracture of “T5 involving the spinous process,” and “[f]racture of T6 involving the spinous 

process.” Id. at 546. Dr. Klemenson-Chau instructed Parker to wear a fiberglass splint. Id. at 

547. Khalil Zahra, M.D., also consulted and confirmed “[a]cute fracture of the spinous process of 

T5, T6, and possibly T7.” Id. at 543. 

ii. Washington Hospital and Dr. Banh

Parker sought treatment for chronic back pain exacerbated by a fall on July 16, 2009 at the 

Washington Hospital emergency room. Id. at 670. Mohamed Nazari, M.D., her attending 

physician, diagnosed Parker with a back sprain but also noted “pain syndrome: chronic” and 

prescribed Vicodin. Id. at 674. On August 19, 2009, Parker returned to the Alta Bates emergency 

department and was evaluated by Ronn Berrol, M.D., who noted, “[r]eview of old records show a 

CT that did indeed show a spinus [sic] process [fracture] last month, [i]t appears well healed.” Id.

at 540. Parker went back to the Washington Hospital emergency department on August 29, 2009, 

seeking treatment for thoracic back pain, reporting that the symptoms began two months earlier. 

Id. at 658. David Orenburg, M.D., the attending physician, prescribed Norco for “acute back 

pain.” Id. On September 22, 2009, Dr. Banh at Mission Peaks Orthopedics to whom Parker was 

referred by her primary care physician, evaluated Parker’s back pain. Id. at 565. Parker reported 

that the pain in her back increased to nine out of ten. Id. Dr. Banh noted under assessments, 

“thoracic spine fracture,” “right distal clavicle fracture,” “right radial head fracture” and “right 

thoracic strain.” Id. at 566. Dr. Banh recommended “conservative” treatment of the thoracic 

fracture and referred Parker to a surgeon to consider surgery regarding her elbow fracture. Id. 

On January 9, 2011, Parker returned to Washington Hospital emergency department

seeking treatment for back pain, “right flank” and vomiting. Id. at 627. Leonard Popky, M.D., the 

attending physician, prescribed Vicodin and gave Parker “a lot of Zofran by IV.” Id. Parker 

returned to Washington Hospital emergency department two weeks later on January 22, 2011, 

again seeking treatment for chronic back pain and vomiting. Id. Dr. Nazari, the attending 

physician, prescribed Vicodin and set up a Zofran IV again. Id. at 615. Parker went to the

Washington Hospital emergency department on February 22, 2011 after suffering an assault which 

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exacerbated her back pain. Id. at 579. However, Dr. Halimi, the attending physician, found no 

“evidence of spine trauma.” Id. at 580. He prescribed Flexitril. Id. at 576. 

iii. St. Rose

Between July and November 2013, Parker went to St. Rose emergency department

multiple times for treatment of her chronic back pain. Id. at 791–932. On August 17, 2013, 

Parker went to the St. Rose emergency department after falling down a flight of concrete stairs. 

Id. at 931. Tan Nguyen, M.D., noted her back pain but found no fracture of Parker’s thoracic 

spine. Id. at 932. Dr. Nguyen administered Morphine and Zofran intravenously and gave Parker 

Vicodin and Clonidine. Id. at 933. Parker returned a week later, with continuing back pain. Id. at 

911. Attending physician, Dimpi Kalira, M.D., noted no fracture of the thoracic spine, but ordered 

Morphine and Zofran and prescribed Norco for treatment of severe pain. Id. at 920. On 

November 4, 2013, Parker went back to St. Rose emergency department, complaining of constant

right flank pain that had lasted more than four months and had worsened in the last few days, 

reaching a level of eight out of ten. Id. at 836. Dr. Nguyen administered Morphine and Zofran 

and prescribed Norco. Id. at 838, 843. Further, she notes “you have back pain, which is likely 

related to your polycystic kidney disease.” Parker returned to the St. Rose emergency department 

two weeks later, on November 18, 2013, complaining of continued abdominal and back pain, and 

attending physician, Alia Kim, M.D., gave her Morphine again. Id. at 817, 821.

Parker went to the St. Rose emergency department on December 2, 2013 for 

lightheadedness “[a]ssociated with chest pain, [a]ssociated with tremors, dizziness.” Id. at 806. 

Parker’s triage notes indicate “patient here for chest pain and severe headache . . . was doing 

errands when chest pain happened with diaphoresis.” Id. at 810. Parker was inpatient from 

December 2, 2013 to December 6, 2013 and her attending physician is listed as Prasad Ghimire, 

M.D. Id. at 747. When Parker was first admitted on December 2, 2013, Zarah Napuli, RN, noted 

that Parker’s speech was slurred, and she was “complaining of severe headache.” Id. at 811. 

David Wei, M.D., ordered a CT scan “[without] [c]ontrast” and Michael Faer, M.D., a radiation 

oncologist, read the results, noting “[n]o acute findings” and “[n]o signs of intracranial 

hemorrhage, hematoma, hydrocephalus, acute infarct, large mass, mass effect, or fracture.” Id. at 

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784, 808–809. Dr. Wei also ordered a chest x-ray using a portable x-ray machine to determine the 

cause of Parker’s chest pain. Id. at 808. Dr. Faer conducted the exam and found “[r]educed lung 

volumes with elevation of the hemidiaphragms compressing the lung bases, accentuating the 

cardiovascular mediastinal size and producing bibasilar decreased acration.” Id. at 780. Dr. Faer 

also found “vascular crowing and compressional atelectasis.” Id. Dr. Faer recommended 

“repeat[ing] evaluation in full inspiration for clarification” as to what was causing the basilar areas 

of decreased aeration. Id. Dr. Wei performed an EKG and found “[heart rate] 52,” “sinus 

[bradycardic].” Id. at 808. Dr. Wei ordered a CT of Parker’s chest, abdomen and pelvis as well. 

Id. at 782. Dr. Faer read the results and found “[n]o evidence for aortic aneurysm nor dissection” 

and “[n]o signs of central pulmonary embolism.” Id. at 783. Dr. Faer also noted “[b]ilateral 

layering pleural effusions/compressional atelectasis, small.” Id. At the end of the day, Dr. 

Ghimire, Parker’s attending physician, summarized the results from her tests. Id. at 750. In 

addition to the above findings, Dr. Ghimire included “[h]ypertension,” “[a]nemia,” 

“[h]ypokalemia,” and “[g]astrointestinal bleeding by history.” Id. He made a further note to 

“[c]heck occult blood and GI workup.” Id. Dr. Ghimire noted “[r]ecent CT is negative for any 

bleeding and headache improved at the moment.” Id. 

On December 3, 2013, Dr. Ghimire requested a consultation by Bhupinder Bhandari, 

M.D., for Parker’s [a]nemia, anterior abdominal discomfort, nausea and vomiting.” Id. at 751. 

Based on his evaluation of Parker, Dr. Bhandari recommended “[u]pper GI endoscopy” and 

“colonoscopy” if endoscopy is “nonrevealing.” Id. at 752. 

On December 4, 2013, Dr. Bhandari performed the upper GI endoscopy “with biopsy.” Id.

at 761. The test revealed “mild gastritis,” but otherwise findings were normal. Id. On the same 

day, Dr. Kumar assessed Parker for chest pain at the request of Dr. Ghimire. Id. at 759. He noted 

that “[c]hest pain appears atypical” and planned to “check an echocardiogram” and “check stress 

thallium test for coronary ischemia.” Id. at 760. On the same day, December 4, 2013, Qi Che, 

M.D., ordered an MR Angiogram of Parker’s head “without contrast.” Id. at 790. Dr. Faer read 

the test and noted “[n]o acutely significant MRA abnormality detected. Specifically, no signs of 

intracranial aneurysm or stenosis seen.” Id. Later that night, Vasiliki Economou, M.D., 

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performed an EEG and found “[n]ormal electroencephalogram without evidence of any 

epileptiform abnormalities.” Id. at 805. Dr. Ghimire addressed the negative findings in his 

discharge notes, commenting that Parker’s severe headache was likely a “tension headache or 

possible migraine.” Id. at 748. On December 5, 2013, Dr. Khetrapal ordered an MRI of Parker’s 

brain and brain stem, which Dr. Faer read, finding “[n]o signs of intracranial hemorrhage, 

hematoma, hydrocephalus, acute infarct, large mass, mass effect, or fracture.” Id. at 793. On the 

same day, Shankar Prasad Ghimire, M.D., also ordered an MRI of Parker’s lumbar spine. Id. at 

791. Dr. Faer performed the MRI and noted “[n]o acutely significant MRI abnormality detected.” 

Id. at 791–92.

On December 6, 2013, Dr. Bhandari performed a colonoscopy on Parker. Id. at 763. He 

diagnosed her with “[c]olonic diverticulosis” and “internal hemorrhoids.” Id. Dr. Bhandari 

recommended “consideration for small bowel capsule endoscopy as an outpatient.” Id. 

Parker was discharged on December 6, 2013. In his discharge notes, Dr. Ghimire 

described the tests that had been performed while Parker was inpatient, and their results, and 

stated that Parker’s “[m]edication has been adjusted and [she] needs to follow up closely with 

[her] primary care doctor.” AR at 748. He further stated: 

[P]atient discharged home with following medications; clonidine 0.3mg one table 

p.o. three times a day, hydralazine 25 mg p.o three times a day, Protonix 40mg 

twice a day, sucralfate 1 gram twice a day, Colace 250 mg once a day, aspirin 162 

mg once a day, Zocor 20mg once a day, and continue Seroquel, Prozac as before 

and Xanax 1mg three times a day as needed, Percocet 5/325 mg one tablet every 

four hours as needed for moderate-to-severe pain and Dilaudid 2 mg p.o. every six 

hours as needed for severe pain and advised to follow up with primary care doctor 

and will be referred to pain specialist for further management of chronic pain 

including headache and all these plan[s] explained to the patient.

Id. at 748. 

iv. Dr. Khetrapal

Dr. Rabin Khetrapal, of Fremont Primary Care, treated Parker from November 27, 2013 to 

May 7, 2014. Id. at 1107, 1110. Progress notes have been provided for examinations on 

November 27, 2013, December 11, 2013, February 7, 2014, April 23, 2014 and May 7, 2014. Id. 

at 1101-1106. In addition, Dr. Khetrapal completed a Medical Opinion re: Ability to do WorkCase 3:18-cv-01845-JCS Document 27 Filed 09/18/19 Page 8 of 45
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Related Activities (Physical) form on May 7, 2014. Id. at 1107-1110. In that form, he states that 

Parker can lift or carry no more than 10 pounds occasionally and can stand and walk less than two 

hours in an eight-hour day due to pain. Id. at 1108. He opines that Parker must alternate 

between, sitting, standing and walking frequently to alleviate her discomfort, stating that she can 

sit no more than 10 minutes without changing position, stand no more than 5 minutes without 

changing position, and must walk around every ten minutes for at least 5 minutes. Id. He states 

that Parker must be able to shift at will and needs to lie down at unpredictable intervals. Id. He

states that she can never stoop, kneel or climb stairs or ladders and can rarely crouch or crawl. Id. 

at 1109. He states that Parker’s pain and other symptoms interferes with her attention and 

concentration constantly and that she would need to be absent more than three times a month due 

to her symptoms. Id. at 1109-1110.

v. Dr. Narra

Parker was referred for pain treatment to Kishore Narra, M.D., a physiatrist, by her 

primary care physician, Dr. Khetrapal. Id. at 1143. Dr. Narra treated Parker between December 

2013 and June 2014. Id. at 1143–71. Parker first saw Dr. Narra on December 10, 2013 for a pain 

evaluation. Id. at 1166. Dr. Narra diagnosed Parker with “chronic pain syndrome, lumbago, and 

polycystic kidney disease.” Id. at 1168. Dr. Narra recommended obtaining an x-ray of Parker’s 

spine. Id. On December 31, 2013, Robert Huberman, M.D., took x-rays of Parker’s 

thoracolumbar spine, finding “[s]pine alignment is unremarkable” and “minimal scoliosis.” Id. at 

1170. Parker saw Dr. Narra on the same day because she felt increased pain in her feet and hips. 

Id. at 1164. She reported that the Norco was not helping and that she could not walk because of 

the pain. Id. Dr. Narra diagnosed Parker with lumbago, chronic pain syndrome, and lesion of 

ulnar nerve, for which he prescribed methadone. Id. at 1165. On January 9, 2014, Parker saw Dr. 

Narra again because the night before she had “swelling in [her] whole body” and difficulty 

walking. Id. at 1161–63. Dr. Narra added diagnoses of “hypertension” and “hyperlipidemia” but 

kept the treatment the same. Id. When Parker saw Dr. Narra for a follow-up on February 28th,

2014, she said it “feels like someone is stabbing [me] in the legs.” Id. at 1158. Dr. Narra 

continued treatment with methadone. Id. at 1159. At an appointment on March 27, 2014, Dr. 

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Narra diagnosed chronic pain syndrome and paresthesia of the feet. Id. at 1156. He discontinued 

the methadone because Parker told him it was “making her sleepy all the time” and instead

prescribed Percocet. Id. at 1155–57. On April 23, 2014, Dr. Narra conducted a nerve conduction 

study and EMG, which showed “prolonged distal onset latency” of the left tibial motor nerve, but 

“all remaining nerves within normal limits.” Id. at 1149–54. On May 23, 2014, when Parker saw 

Dr. Narra for a one month follow-up, he prescribed 30 mg. MS Contin once daily for her chronic 

pain. Id. at 1147. At an appointment on July 18, 2014, Dr. Narra adjusted Parker’s MS Contin 

prescription to 15 mg. twice a day. Id. at 1143, 1145. 

vi. Dr. Rasheed 

Parker saw Sabiha Rasheed, M.D., at Tricity Rheumatology between March 11, 2014 and 

November 5, 2015. Id. at 1259–65. Parker first sought treatment from Dr. Rasheed for low back, 

hip, knee and foot pain on March 11, 2014. Id. at 1265. Dr. Rasheed noted that Parker had a 

history of back pain due to osteoarthritis. Id. Dr. Rasheed also diagnosed Parker with trochantric 

bursitis and recommended application of ice and Tylenol for pain. Id. In addition, treatment 

records from Dr. Rasheed reflect diagnoses of lumbosacral spondylosis and thoracic spondylosis 

without myelopathy. Id. at 1261, 1413-1414. 

Treatment notes from March 11, 2014 reflect that Dr. Rasheed ordered x-rays to evaluate 

Parker for osteoarthritis. Id. at 12654. On April 2, 2014, Dr. Robert Huberman at NorCal 

Imaging took x-rays of Parker’s hips, thoracic spine, knees, hands, wrists, and feet. Id. at 1267-

72. Dr. Huberman reported “mild midthoracic disc changes,” “mild scoliosis,” but “no other 

findings evident.” Id. at 1268. Each of the other x-rays showed “[n]o significant joint related 

abnormality” and normal “bone architecture findings.” Id. at 1267, 1269–72. Parker saw Dr. 

Rasheed again on April 2, 2014 for a follow-up. Id. at 1264. Dr. Rasheed diagnosed Parker with 

osteoarthritis of the thoracic and lumbar spine but noted “x-rays of the hands, knees, feet and hips: 

normal.” Id. She changed nothing in her treatment plan. Id. Dr. Rasheed saw Parker again on 

May 8, 2014, September 9, 2014, September 28, 2015, November 5, 2015, July 26, 2016 and 

October 25, 2016. Id. at 1259–62, 1412-1417. 

Treatment notes from July 26, 2016 reflect that Dr. Rasheed ordered an MRI of Parker’s 

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lumbar spine because Parker was experiencing “radicular pain in the lower extremities.” Id. at 

1415. She also ordered x-rays of Parker’s bilateral hips and noted, “consider steroid injection if 

[hip] pain persists.” Id. On October 25, 2016, an MRI of Parker’s lumber spine was performed. 

Id. at 1416. According to the report, the alignment of the lumbar spine was normal and there was 

no abnormal bone marrow edema, though the MRI showed polycystic kidney disease. Id. The 

report also revealed a “[s]mall posterior disc protrusion at L5-S1 with no significant neural 

impingement.” Id. In treatment notes from Parker’s October 25, 2016 visit to Dr. Rasheed, Dr. 

Rasheed observed that Parker was experiencing hip pain and lower back pain. Id. at 1417. She 

wrote that Parker had tenderness at the “trochanter of the right hip,” that her thoracic spine was 

“tender with paraspinal muscle spasm” and that the lumber spine was “tender at L5S1, SLRT +ve 

at 60 degrees, no sensory/motor deficit.” Id. 

On October 25, 2016, Dr. Rasheed completed a Residual Functional Capacity 

Questionnaire (“RFC Questionnaire”) and on October 26, 2016 she completed a form entitled

Medical Opinion re: Ability to do Work-Related Activities (Physical) (“Medical Opinion form”). 

AR 40-46. In the RFC Questionnaire, Dr. Rasheed lists the following diagnoses: 1) “osteoarthritis 

of lumbar and thoracic spine”; 2) “Myalgia – lower back sciatica”; and 3) “Hip bursitis.” AR 40. 

She found that Parker had the following physical limitations: lifting and carrying less than 10 

pounds; standing less than 2 hours in an 8 hour workday; walking less than 2 hours in an 8 hour 

workday; sitting less than 2 hours in an 8 hour workday; limited ability to push or pull as to both 

upper and lower extremities; and no climbing, balancing, stooping, kneeling, crouching or 

crawling. AR 40-41. In the Medical Opinion form, Dr. Rasheed wrote that Parker was “unable to 

walk at this time due to pain in midback, low back and hips.” Id. at 45.2

 

2 Plaintiff’s counsel alerted the ALJ at the October 27, 2016 hearing that Dr. Rasheed had 

completed these forms and the ALJ agreed to hold the record open for one day after the hearing to 

allow Parker’s counsel to submit them. See AR at 102-103, 109. According to the Commissioner, 

counsel did not submit the forms until after the ALJ issued his decision and therefore, these 

records were considered by the Appeals Council but not the ALJ. See Defendant’s Motion at 21. 

Although it is not clear from the Administrative Record when Parker’s counsel supplied these two 

records to the Social Security Administration, Parker does not dispute in her reply brief that they 

were submitted only to the Appeals Council and not the ALJ.

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vii. Dr. Khalsa

In February of 2014, Parker was referred to Prabhjot Khalsa, M.D., at Fremont Neurology 

Medical Associates, by her primary care physician, Dr. Khetrapal. Id. at 999. Dr. Khalsa 

examined Parker on February 11, 2014 for “lower extremity pain and weakness.” Id. In his 

assessment, he listed “[p]ain in limb,” “[g]ait impairment “[p]aresthesias and numbness,”

“[w]eakness of muscles,” and “[f]amily history of cerebral aneurysm.” Id. at 1000. Dr. Khalsa 

ordered an MRI of Parker’s lumbosacral and cervical spine. Id. At a subsequent appointment on 

February 20, 2014, Dr. Khalsa summarized the results of the MRI as follows:

MRI of the cervical spine revealed C3-4, C4-5, C5-6, and C6-7 disc 

desiccation with mild canal stenosis and some right-sided neural 

foraminal stenosis at C5-6. MRI scan of the thoracic spine has 

revealed mild wedging along the superior end plate of T5, along with 

T6-7 left posterior lateral disc protrusion. Additionally, there was 

evidence of bilateral pleural effusions and extensive lesions identified 

within the right lung and/or within the hepatic parenchyma. MRI scan 

of the lumbar spine reveals L1-2 and L3-4, L5-S1 disc desiccation, 

L4-5 disc bulge, with moderate foraminal narrowing. Extensive 

bilateral renal cysts were demonstrated.

Id. at 1004. Dr. Khalsa recommended that Parker follow up with her primary care physician for 

“further evaluation and management of pleural effusions, lung/hepatic lesions, and bilateral renal 

cysts.” Id. At the February 20, 2014 appointment Dr. Khalsa also conducted electrodiagnostic 

studies to attempt to determine the “underlying neuropathology” of her “ongoing pain syndrome.” 

Id. at 1002–1003. He was unable to find “evidence of radiculopathy, plexopathy, or other 

peripheral neuropathic process” and recommended that Parker obtain a rheumatology evaluation. 

Id. at 1004.

Parker’s Mental Health Treatment

a. Treatment Providers

i. Dr. Kumar

Pradeep Kumar, M.D., a psychiatrist at Pathways to Wellness, treated Parker from 

November 2013 to April 2014. Id. at 1078-93. In his initial evaluation on November 20, 2013, he 

described Parker’s history as follows:

This 49-year-old Afro-American female who is treated for depression 

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and anxiety while at primary care for years. She was on Prozac 40 

mg a day for four years, Wellbutrin 150 mg for four years and Xanax 

0.25 mg three times a day. The patient felt current medication is not 

working because she has no motivation in her life. Her symptoms 

include chronic fatigue, depression, anhedonia, paranoid thought. 

People are watching her or they are doing something wrong and 

messing her life. She is also complaining about confusion, irritable 

mood, poor sleep, fatigue for few years. The patient denies auditory 

or visual hallucinations. Denies obsessive thoughts.

Id. at 1089. In the comments from Dr. Kumar’s mental status examination for the same visit, on 

November 20, 2013, Dr. Kumar writes that Parker was “very well dressed,” “cooperative,” that 

her speech was “normal rate and rhythm,” that she had “good eye contact” and no suicidal 

ideation, movement disorder or hallucination” and that her mood was “irritable and depressed,” 

her affect was “restrictive” and that she has “delusions,” namely, that she is “very paranoid about 

the people around her.” Id. at 1091. He rated Parker’s functional limitations as follows: mild 

restrictions of activities of daily living; moderate difficulties in maintaining social 

functioning/relationships; moderate difficulties in maintaining concentration, persistence of place; 

and moderate “episodes of decomposition and increased symptoms, each of extended duration.” 

Id. at 1092. In his supporting comments he wrote, “patient has significant irritable mood. She is 

fatigue[d] most of the time, unable to concentrate, unable to finish her job.” Id. He diagnosed 

Parker with Major Depressive Disorder, severe, and Generalized Anxiety Disorder. Id. Dr. 

Kumar increased Parker’s Prozac dose to 60 mg. a day, discontinued her Wellbutrin prescription, 

prescribed 100mg. of Seroquel at night, and increased her Xanax prescription from .25mg. three 

times a day to .50 mg. three times a day. Id. at 1092. 

When Parker returned for a follow-up on December 18, 2013, Dr. Kumar noted “[t]he 

patient states she is doing very well on current medications,” and that Parker “is sleeping well 

after many, many months.” Id. at 1086. The following month, on January 22, 2014, however, 

Parker still felt depressed and anxious, and reported that she was having difficulty concentrating. 

Id. at 1084–85. Dr. Kumar did not change Parker’s prescriptions of Xanax, Prozac, and Seroquel

at this appointment. Id. At Parker’s next visit, on February 19, 2014, Parker complained of “more 

anxiety. . . depression” and “poor concentration.” Id. at 1002. Dr. Kumar doubled her Seroquel 

dose “to decrease her depression and anxiety” but did not change her Xanax and Prozac 

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prescriptions. Id. at 1082. Parker returned for a follow-up visit on March 19, 2014, complaining 

that she was having significant concentration and focus problems. Id. at 1080. Dr. Kumar added 

“possible ADHD” to her diagnoses and prescribed Strattera. Id. at 1081. On April 21, 2014, 

Parker told Dr. Kumar that her concentration had improved but that she was “still feeling 

depressed.” Id. at 1072. He noted that Parker had “significant anhedonia,” had “no motivation,” 

and was “feeling fatigue[d].” Id. at 1078. 

ii. Dr. Hiawatha Harris

Hiawatha Harris, M.D., another psychiatrist at Pathways to Wellness, treated Parker in 

2015. Id. at 1245–57. Dr. Harris evaluated Parker on July 21, 2015 and diagnosed her with 

Bipolar Affective Disorder and General Anxiety Disorder. Id. at 1249. Dr. Harris noted that 

Parker was “trying to go back to school.” Id. at 1249. On August 13, 2015, Dr. Harris saw Parker 

again and confirmed the same diagnoses. Id. at 1247. Parker told Dr. Harris, “I’m not doing good 

today.” Id. Dr. Harris prescribed Abilify, Cymbalta, Hydroxyzine, Alprazolam and Venlafaxine. 

Id. at 1244. On September 15, 2015, Dr. Harris wrote that Parker had stopped taking her Abilify,

which caused “shakes.” Id. at 1245. Dr. Harris continued her other prescriptions. Id. at 1244. 

iii. ABODE providers

Celine Tardy, a mental health clinician at Alameda County Behavioral Health Care 

Services (ABODE), treated Parker weekly with psychotherapy sessions and case management

from October 2013 to June 2014. Id. at 1095–1141, 1312-1343. Each of her reports was signed 

off by Jane Love, LCSW, a clinical supervisor. Id. In addition, at a 6-Month Re-assessment 

Summary/ Treatment Plan completed in April 2014 and signed by Tardy and Love, Dr. Susan 

Harris, a psychiatrist at ABODE, is listed as “Consultant Psychiatrist – Medication Prescription as 

needed.” Id. at 1115. 

On an evaluation dated November 4, 2013, Tardy listed Parker’s diagnoses as PTSD and 

Major Depressive Disorder. Id. at 1313. She assigned Parker a GAF of 45. Id. Tardy described 

Parker as “alert and responsive to clinician,” “orient[ed] to time and location, and [with] good 

insight to her physical and mental condition.” Id. Under the heading “Symptoms 

Reported/Observed,” Tardy wrote:

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Ms. Parker reported that she currently “feels horrible.” She explained 

that she typically stays in bed during most days and also spends time 

with her family, stating that it “depends how I am feeling.” She 

shared that she has recently had a poor appetite and has lost 15 pounds 

in the last week and a half. She experiences difficulty in sleeping at 

night (falling asleep sometimes takes two hours for her) and 

experiences fatigue often. Other symptoms observed included a 

depressed mood, hopelessness and mention of past thoughts of not 

wanting to live anymore. Ms. Parker reported that much “chaos” 

around her can make her feel overwhelmed, and that she can usually 

only concentrate on one major task at once. . . .

Ms. Parker reported having intrusive thoughts of fear, and of 

something bad about to happen regularly. “I have been having panic 

attacks all of my life,” and that she is currently [having] them every 

other day. . . . She expressed that being alone makes her “terrified” 

that something will happen to her. She said that she can be fearful 

there is someone in the room with her or that someone is following 

her. Ms. Parker seemed to be aware this was a symptom and not 

reality.

Id. at 1315.

On December 18, 2013, Tardy completed another assessment of Parker. Id. at 1317-1328. 

Tardy again listed Parker’s diagnoses as PTSD and Major Depressive Disorder. Id. at 1317.

According to Tardy, Parker was currently experiencing “intrusive thoughts of fear, panic attack 

(with rapid heart rate, sweating, and strong fear that ‘something bad is about to happen’), paranoia, 

not wanting to be alone.” Id. She also noted that Parker had “poor appetite, difficulty sleeping, 

depressed mood, hopelessness, isolation, history of suicidal ideation without plan or attempts, 

symptoms lasting for more than 6 months.” Id. Tardy observed that Parker had “good insight on 

her mental condition and a strong desire to receive treatment.” Id. at 1322. She also noted under 

the heading “Participant’s Strengths and Resources” that Parker was “concerned for her physical 

appearance and makes efforts in keeping good hygiene for herself.” Id. Parker reported that some 

activities she had “enjoyed in the past” included going to church, id. at 1324, and Tardy wrote that 

Parker “attend[ed] a Christian church and [was] strongly active in her religious faith.” Id. at 1321. 

She also noted that Parker had also enjoyed “going to the gym” in the past and that she was 

“trying” to do cardio four times a week. Id. at 1324-1325.

 Each week, Tardy met with Parker for a one-hour session during which Parker reported

her mood and any other problems she faced with mental health. Id. at 1095-1141. On November 

26, 2013, Parker reported that Dr. Kumar had prescribed Seroquel three days before and that she 

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had “never been this happy in [her] life before.” Id. at 1342. Between February 5, 2014 and 

March 10, 2014, Parker reported feeling depressed and in physical pain, and Tardy noted “agitated 

mood” in her report. Id. at 1136-1141. On March 14, 2014, Parker forgot when and where her 

session with Tardy was to occur and said at a session on March 26, 2014, “[w]hen I get depressed 

like this, this is what happens.” Id. at 1134. Notes from an April 9, 2014 appointment reflect that 

Parker was “lethargic.” Id. at 1131. In notes from an April 18, 2014 appointment, Tardy observed 

that Parker was “in a lethargic mood as evidenced by slurred speech and difficulty staying 

focused.” Id. at 1130. On April 21, 2014, Tardy noted “client experienced PTSD symptoms,” 

including “intrusive thoughts of fear, panic attacks, paranoia, and not wanting to be alone.” Id. at 

1129. 

Tardy completed a “6 Month Re-Assessment Summary/Treatment Plan” on April 23,

2014. Id. at 1113–18. Tardy gave Parker a score of 47 on the Global Assessment of Functioning 

Scale (“GAF”)3. Id. at 1113. She again listed Parker’s diagnoses as Major Depressive Disorder 

Major Depressive Disorder and PTSD. Id. In connection with the diagnosis of Major Depressive 

Disorder, Tardy noted “[p]oor appetite, difficulty sleeping, depressed mood, hopelessness, 

isolation, history of suicidal ideation without plan or attempts, symptoms lasting for more than 6 

months.” Id. at 1114. In connection with Tardy’s diagnosis of PTSD, she wrote that Parker

[h]as experienced multiple traumas including physical abuse in childhood, 

domestic violence during marriage, and being raped in Oakland two years ago. 

Currently has intrusive thoughts of fear, panic attacks (with rapid heart rate, 

sweating, and strong fear that ‘something bad is about to happen’), paranoia, not 

wanting to be alone.

 

3 Physicians use the Global Assessment of Functioning (“GAF”) Scale to rate the patient’s overall 

level of functioning and ability to carry out activities of daily living. The GAF score is measured 

on a scale of 0–100, with a higher number associated with higher functioning. The Diagnostic and 

Statistical Manual of Mental Impairments states that a GAF score of 21-30 indicates that behavior 

is considerably influenced by hallucinations or delusions, 31-40 indicates major symptoms, 41-50 

indicates serious symptoms and functional limitations, 51-60 indicates moderate symptoms and 

functional limitations, and 61-70 or higher indicates mild, transient or no symptoms and 

limitations. A GAF score of 47 indicates “[s]erious symptoms OR any serious impairment in 

social, occupational, or school functioning.” Diagnostic and Statistical Manual of Mental 

Disorders 34 (Am. Psychiatric Ass’n 4th ed.)(2003). 

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Id. Tardy also noted that “[d]ue to client’s PTSD and Depression, she often experiences 

symptoms of panic attacks, difficulty sleeping, loss of appetite, feelings of worthlessness, loss of 

energy, and diminished ability to concentrate.” Id. at 1115. 

On May 5, 2014, Tardy completed a Mental Impairment Questionnaire. Id. at 1095–1100. 

Tardy found that Parker’s current GAF was 47 and that Parker’s ability to 1) carry out short, 

simple instructions, 2) make simple, work-related decisions, 3) maintain attention for two-hour 

segments, and 4) get along with co-workers or peers was “limited but satisfactory.” Id. at 1097. 

She found Parker’s ability to 1) understand and remember short, simple instructions, 2) maintain 

regular attendance and be punctual, and 3) sustain an ordinary routine without special supervision

to be “seriously limited, but not precluded.” Id. Tardy assessed Parker’s ability to 1) remember 

work-like procedures, 2) complete a normal workday and workweek without interruptions from 

psychologically based symptoms, and 3) deal with normal work stress as “unable to meet 

competitive standards.” Id. Tardy wrote “no useful ability to function” with respect to Parker’s 

ability to perform at a consistent pace without an unreasonable number and length of rest periods.” 

Id. As a result, Tardy concluded that Parker would have to take four or more days off per month 

because of her impairments. Id. at 1096. Tardy also opined that Parker’s psychiatric condition 

exacerbated her pain. Id. She noted that “Ms. Parker’s doctor has identified that she is 

experiencing Fibromyalgia, connected with her psychiatric condition.” Id. 

Tardy also assessed Parker’s “functional limitation” in the Mental Impairment 

Questionnaire. Id. at 1099. She concluded that Parker had “marked limitation” with respect to 

activities of daily living, maintaining social functioning and concentration, persistence, and pace. 

Id. Further, Tardy found that Parker would have at least four “repeated episodes of 

decompensation within [a] 12 month period, each of at least two weeks duration.” Id. Finally, 

Tardy noted that “Ms. Parker would currently have difficulty working at a regular job due to side 

effects from pain medications. These cause slurred speech and difficulty focus[ing], as well as 

decrease in memory functioning.” Id. 

The Medical Impairment Questionnaire completed by Tardy on May 5, 2014 was signed 

by Dr. Susan Harris, who was the “Consultant-Psychiatrist” assigned to Parker at ABODE, on 

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June 17, 2014. Id. at 1110. On the same date, Dr. Harris examined Parker, noting that Parker 

“appear[ed] to be doing a bit better in her depressive [symptoms] since her medication was 

changed by her psychiatrist last month. She is tapering off Prozac and is on 60mg/d Cymbalta.” 

Id. at 1111. Further, Dr. Harris noted that Parker is “treated for PTSD and MDD who is at risk for 

homelessness.” Id. 

b. Examining Physicians Who Did Not Treat Parker

The record contains reports by a number of physicians who were requested to examine 

Parker in connection with her application for disability benefits. These are summarized below. 

i. Dr. Rana, M.D. 

Farah Rana, M.D., a neurologist and internist, completed an internal medicine evaluation 

of Parker on April 12, 2016 at the request of the State agency. Id. at 1400. She examined Parker 

and reviewed “multiple notes” from “various primary care visits.” Id. Dr. Rana found that Parker 

could frequently lift and carry up to ten pounds and occasionally lift and carry 11-20 pounds. Id. 

at 1393. She found that Parker could sit, stand and walk five hours without interruption, and six 

hours total in an eight-hour work day. Id. at 1394. Dr. Rana found that Parker can “handle, 

manipulate, feel, and finger objects without any problem. She can stoop, bend, kneel, crouch, and 

climb on an occasional basis.” Id. at 1402. In describing Parker’s medical history, Dr. Rana noted 

“[s]he has a history of bipolar disorder. She has been on medications for years. She states that she 

has good days and bad days and she is not having a very good day today.” Id. at 1401. 

ii. Dr. Abraham, Ph.D. 

Deepa Abraham, a psychologist, completed an Adult Consultative Examination Report 

based on examination and psychological testing of Parker on May 20, 2014 and June 3, 2014 and a 

review of treatment records from Pathways to Wellness and ABODE. Id. at 1172-1186. Dr. 

Abraham found that “[a]ccording to the results obtained from clinical history and behavior 

observations, Ms. Parker meets the criteria of Mood Disorder Not Otherwise Specified” under 

DSM-IV. Id. at 1181. Dr. Abraham explained:

According to the DSM-IV, a diagnosis of Mood Disorder NOS is generally applied 

when a person does not exhibit symptoms consistent with a specific Mood Disorder 

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but tends to exhibit symptoms of both Depressive Disorder Not Otherwise 

Specified and Bipolar Disorder Not Otherwise Specified.

Id. Some of the symptoms Dr. Abraham’s used to support her diagnosis are: “lethargy, insomnia, 

apathy, poor concentration, and reduced appetite. Moreover, she maintains a socially isolative 

lifestyle without any friends.” Id. Dr. Abraham also noted that Parker “exhibits a manic 

presentation, which consists of hostility, heightened anxiety, and reckless behavior.” Id. Further, 

Dr. Abraham found that the “psychiatric hospitalization that occurred at John George Psychiatric 

Pavilion . . . most likely reflected a manic episode.” Id. Dr. Abraham also pointed to the fact that 

Parker’s son had been diagnosed with bipolar disorder in support of her opinion that “a genetic 

disposition underlies Ms. Parker’s mood disorder.” Id. at 1182. Dr. Abraham noted that her 

observations of Parker during the examination also substantiated her opinion that Parker meets the 

criteria of Mood Disorder Not Otherwise Specified. Id. She wrote that “[b]ehavior observations 

corroborate that Ms. Parker’s mood fluctuated between irritability, tearfulness, and euthymia.” Id. 

Dr. Abraham also diagnosed Parker with Polysubstance Dependence (DSMIV code: 

304.80) based on her “longstanding addiction to various substances.” Id. In support of this 

conclusion, Dr. Abraham notes that had Parker abused drugs and alcohol in her twenties and that 

although Parker denied using alcohol in the past two years, “she failed to provide collateral 

documents to support her claims.” She further noted that Parker “relies on heavy narcotic 

painkillers including [m]orphine; yet she still complains of chronic pain.” Id. Dr. Abraham 

concluded that Parker’s “clinical history suggests that she may be over-using prescription 

medicine and this may serve as a sustaining factor in her depressed mood.” Id. She also observed 

that Parker slurred her speech and appeared sleepy during the tests, leading her to conclude that 

morphine affects Parker’s ability to function normally. Id. 

Dr. Abraham concluded that there was insufficient evidence to support the PTSD 

diagnosis, noting that many of the symptoms Parker complained of, including insomnia, irritability 

and heightened anxiety, reflected her mood disorder; she further found that Parker’s “traumarelated symptoms” such as “nightmares” were “not prominent enough to cause dysfunction in all 

domains.” Id. In any event, Dr. Abraham opined, “the intensive therapeutic services that Ms. 

Parker received following the sexual assault most likely reduced the presence of symptoms 

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associated with Post Traumatic Stress Disorder.” Id. 

Dr. Abraham also diagnosed Parker with Histrionic Personality Disorder (DSM-IV code:

301.50) based on her behavior during the evaluation and her physical appearance, including the 

fact that Parker’s clothes were “emblazoned” with sequins, that she wore “excessive accessories,” 

and her hair was “two-toned,” which led Dr. Abraham to conclude Parker was seeking to “attract 

attention” to herself. Id. at 1182. She noted that “[i]n an attempt to control the session, she 

presented as manipulative and defiant, which compelled the examiner to split the evaluation into 

two sessions.” Id. Dr. Abraham commented on the fact that Parker “often prematurely quit and 

whined that she could not complete the task.” Id. at 1177. Further, she suggests that “[i]t is 

possible that Ms. Parker tends to over-dramatize her suffering and pain in order to seek attention 

and sympathy from others,” though she found that “[b]ehavioral observations do not indicate any 

evidence of malingering.” Id. at 1182, 1184. 

Dr. Abraham found that on Axis III of the DSM, Parker “meets the criteria for Pain 

Disorder Associated with a General Medical Condition.” Id. at 1183. This diagnosis was based 

on Parker’s polycystic liver and renal disease as well as chronic back pain. Id. Dr. Abraham 

confirmed that complications from these medical conditions “sustain her mood disorder and lead 

to a sense of hopelessness.” Id. Based on her physical and mental examination, Dr. Abraham 

concluded that Parker would “experience difficulty competing for jobs in an open labor market 

because of her limited mobility and accompanying chronic pain.” Id. at 1185. Dr. Abraham 

further opined: 

Her lack of strength prevents her from doing heavy labor including carrying heavy 

objects, bending, and standing for long periods of time. Moreover, heightened 

stressors may result in an increase in anxiety and compel her to turn to drugs in 

order to cope and suggests a proclivity for risky behavior. Furthermore, Ms. 

Parker’s depressive symptoms impacts [sic] her ability to carry out complex work 

assignments because of fatigue and low motivation. Moreover, if she relies on 

narcotic painkillers to ease her suffering, such as Morphine, she may not be able to 

sufficiently complete her assignments. These medications are central nervous 

system depressants and may exacerbate her symptoms of fatigue, irritability, and 

lack of focus and cause her to come across as disengaged and non-interactive. She 

would have difficulty maintaining attendance or arriving within appointed times. 

Further, completing a work-day without frequent rest breaks or interruptions from 

symptoms may pose a challenging environment. Hence, in the area of mental 

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abilities to attend, sustain effort comprehend or remember, she is rated as 

moderately impaired. 

Id. In addition, Dr. Abraham rated Parker as moderately impaired for “social interaction,” 

because she is isolated and has limited interactions with friends and family. Id. at 1186. 

Specifically, Dr. Abraham found that “Ms. Parker’s irritable and controlling disposition 

may interfere with her ability to maintain harmonious relations with others.” Id. Dr. 

Abraham evaluated Parker for her ability to adapt and concluded that she was moderately 

impaired. Id. Her evaluation reads as follows: 

The occurrence of persistent depression suggests that Ms. Parker 

would have difficulty coping with daily or the usual stresses 

encountered in a competitive work environment. She would have 

difficulty adapting to changes in tasks or responsibilities because of 

her issues with chronic pain and depression. Specifically, her apathy 

in conjunction with lack of sleep due to insomnia may interfere with 

her ability to successfully hold a job. 

Id. Finally, Dr. Abraham concluded that in light of Parker’s various limitations, she “may be 

considered to have a chronic or persistent psychiatric disability.” Id. 

iii. Dr. Rivero, M.D. 

Maria Rivero, M.D., a physician who evaluated Parker for the purpose of “providing 

information to the disability office,” examined Parker on October 23, 2014. Id. at 1403. In 

addition, Dr. Rivero reviewed medical records from Alta Bates/Summit emergency department, 

primary care provider notes and echocardiogram labs, Dr. Narra’s records, Dr. Chawla’s notes, Dr. 

Kahlsa’s evaluation, and St. Rose Hospital records. Id. Dr. Rivero concluded that Parker:

can sit for up to 6 hours in an 8 hour work day with breaks every 30 minutes and 

stand or walk up to 2 hours in an 8 hour work day with breaks every 15 minutes to 

rest. She has an ulner [sic] neuropathy of the right arm and cannot lift, carry or 

lean on her R arm at or below the elbow. She cannot work over her head due to 

pain in her back and hips. She can carry 4 pounds or less occasionally with her L 

arm and 1 pound or less with her left arm. She doesn’t have normal grip strength 

with either hand and therefore should not be doing jobs that require normal grip 

strength. She appears to have normal fine motor function of both upper 

extremities. She cannot push or pull objects with her right side and is limited to 4 

pounds or less of pulling or pushing on the left side. She takes narcotics daily and 

therefore should not be operating dangerous machinery or working at heights. She 

is unable to squat or kneel.

Id. at 1410. 

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B. Legal Background for Determination of Disabilities 

Five Step Analysis 

Disability insurance benefits are available under the Social Security Act (the “Act”) when 

an eligible claimant is unable “to engage in any substantial gainful activity by reason of any 

medically determinable physical or mental impairment . . . which has lasted or can be expected to 

last for a continuous period of not less than 12 months.” 42 U.S.C. § 423(d)(1)(A); see also 42 

U.S.C. § 423(a)(1). The Commissioner has established a sequential, five-part evaluation process 

to determine whether a claimant is disabled under the Act. See Tackett v. Apfel, 180 F.3d 1094, 

1098 (9th Cir. 1999) (citing 20 C.F.R. § 404.1520). The claimant bears the burden of proof at 

steps one through four, but the burden shifts to the Commissioner at step five. Id. “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.” Id.

At step one, the Administrative Law Judge (“ALJ”) considers whether the claimant is 

presently engaged in “substantial gainful activity.” 20 C.F.R. § 404.1520(a)(4)(i). If she is, the 

ALJ must find that she is not disabled. Id. If she is not engaged in substantial gainful activity, the 

ALJ continues the analysis. See id.

At step two, the ALJ considers whether the claimant has “a severe medically determinable 

physical or mental impairment,” or combination of such impairments, which meets the 

regulations’ twelve-month duration requirement. 20 C.F.R. §§ 404.1509, 404.1520(a)(4)(ii). An 

impairment or combination of impairments is severe if it “significantly limits [the claimant’s] 

physical or mental ability to do basic work activities.” 20 C.F.R. § 404.1520(c). If the claimant 

does not have a severe impairment, disability benefits are denied. 20 C.F.R. § 404.1520(a)(4)(ii). 

If the ALJ determines that one or more impairments are severe, the ALJ proceeds to the next step. 

See id.

At step three, the ALJ compares the medical severity of the claimant’s impairments to a 

list of impairments that the Commissioner has determined are disabling (“Listings”). See 20 

C.F.R. § 404.1520(a)(4)(iii); see also 20 C.F.R. Pt. 404, Subpt. P, App. 1. If one or a combination 

of the claimant’s impairments meets or equals the severity of a listed impairment, she is disabled. 

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20 C.F.R. § 404.1520(a)(4)(iii). Otherwise, the analysis continues. See id.

At step four, the ALJ considers the claimant’s residual functional capacity (RFC) in light 

of her impairments and whether she can perform past relevant work. 20 C.F.R. § 

404.1520(a)(4)(iv) (citing 20 C.F.R. § 404.1560(b)). If she can perform past relevant work, she is 

not disabled. Id. If she cannot perform past relevant work, the ALJ proceeds to the final step. See 

id.

At step five, the burden shifts to the Commissioner to demonstrate that the claimant, in 

light of her impairments, age, education, and work experience, can perform other jobs in the 

national economy. Johnson v. Chater, 108 F.3d 178, 180 (8th Cir. 1997); see also 20 C.F.R. § 

404.1520(a)(4)(v). If the Commissioner meets this burden, the claimant is not disabled. See 20 

C.F.R. § 404.1520(f). Conversely, the claimant is disabled and entitled to benefits if there are not 

a significant number of jobs available in the national economy that she can perform. Id.

Supplemental Regulations for Determining Mental Disability 

The Social Security Administration has supplemented the five-step general disability 

evaluation process with regulations governing the evaluation of mental impairments at steps two 

and three of the five-step process. See generally 20 C.F.R. § 404.1520a. First, the Commissioner 

must determine whether the claimant has a medically determinable mental impairment. 20 C.F.R. 

§ 404.1520a(b)(1). Next, the Commissioner must assess the degree of functional limitation 

resulting from the claimant’s mental impairment with respect to four broad functional areas: (1) 

activities of daily living; (2) social functioning; (3) concentration, persistence, or pace; and (4) 

episodes of decompensation. 20 C.F.R. § 404.1520a(b)(2), (c). Finally, the Commissioner must 

determine the severity of the claimant’s mental impairment and whether that severity meets or 

equals the severity of a mental impairment listed in Appendix 1. 20 C.F.R. § 404.1520a(d). If the 

Commissioner determines that the severity of the claimant’s mental impairment meets or equals 

the severity of a listed mental impairment, the claimant is disabled. See 20 C.F.R. § 

404.1520(a)(4)(iii). Otherwise, the evaluation proceeds to step four of the general disability 

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inquiry.

4 See 20 C.F.R. § 404.1520a(d)(3).

This evaluation process is to be used at the second and third steps of the sequential 

evaluation discussed above. Social Security Ruling 96-8p, 1996 WL 374184, at *4 (“The 

adjudicator must remember that the limitations identified in the ‘paragraph B’ and ‘paragraph C’ 

criteria are not an RFC assessment but are used to rate the severity of mental impairment(s) at 

steps 2 and 3 of the sequential evaluation process.”). If the Commissioner determines that the 

claimant has one or more severe mental impairments that neither meet nor are equal to any listing, 

the Commissioner must assess the claimant’s residual functional capacity. 20 C.F.R. §§ 

404.1520a(d)(3). This is a “mental RFC assessment [that is] used at steps 4 and 5 of the 

sequential process [and] requires a more detailed assessment by itemizing various functions 

contained in the broad categories found in paragraphs B and C of the adult mental disorders 

listings in 12.00 of the Listing of Impairments. . . .” Social Security Ruling 96-8p, 1996 WL 

374184, at *4. 

C. Procedural History 

Parker applied for Title II benefits on March 3, 2014 and for Title XVI benefits on March 

6, 2014. AR at 307, 314. She alleged that she became unable to work because of her disabling 

conditions on December 31, 2008. Id. at 527. These include heart failure, nerve damage, kidney 

failure, liver failure, major depressive disorder, high blood pressure, PTSD, high cholesterol, 

 

4 Appendix 1 provides impairment-specific “Paragraph A” criteria for determining the 

presence of various listed mental impairments, but all listed mental impairments share certain 

“Paragraph B” severity criteria in common (and some have alternative “Paragraph C” severity 

criteria). See generally 20 C.F.R. § 404, Subpt. P, App. 1 at 12.00. Therefore, any medically 

determinable mental impairment—i.e., one that satisfies the Paragraph A criteria of one or more 

listed mental impairments—is sufficiently severe to render a claimant disabled if it satisfies the 

general Paragraph B criteria, which require that the claimant suffers at least two of the following: 

(1) marked restriction of activities of daily living; (2) marked difficulties in maintaining social 

functioning; (3) marked difficulties in maintaining concentration, persistence, or pace; or (4) 

repeated episodes of decompensation, each of extended duration. See id. A “marked” limitation is 

one that is “more than moderate but less than extreme” and “may arise when several activities or 

functions are impaired, or even when only one is impaired, as long as the degree of limitation is 

such as to interfere seriously with [a claimant’s] ability to function independently, appropriately, 

effectively, and on a sustained basis.” Id. at 12.00C.

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broken spine, and polycystic renal disease. Id. at 220. Parker’s requests under both titles were

denied on June 3, 2014. Id. at 201, 206. She filed a request for reconsideration on June 12, 2014. 

Id. at 212. That request was denied on September 12, 2014. Id. at 214. On October 3, 2014, 

Parker requested a hearing before an Administrative Law Judge (“ALJ”). Id. at 226. A hearing 

was held on March 30, 2016. Id. at 64. A second hearing was held on October 27, 2016 at the 

request of Parker’s counsel to address the report of Dr. Rana, who completed an internal medical 

evaluation on April 12, 2016 at the request of the state agency, as discussed above. Id. at 18, 99, 

102. ALJ E. Alis issued an unfavorable decision on January 12, 2017. Id. at 15–39. Parker

requested review by the Appeals Council, which was denied on January 24, 2018. Id. at 1. 

Following the rejection by the Appeals Council, Parker initiated this action for review under 42 

U.S.C § 405(g). 

1. The Hearings

The ALJ conducted the first hearing on March 30, 2016. AR at 64. The ALJ conducted a 

second hearing on October 27, 2016. Id. at 516. At both hearings, Parker and a vocational expert 

(“VE”) testified. The VE who testified at the second hearing, John Kilcher, offered the testimony 

upon which the ALJ relied in concluding that Parker was not disabled. 

Kilcher testified that Parker’s past work as a hair stylist was rated as skilled, SVP 6 and 

light level. Id. at 111. The ALJ then posed a series of hypotheticals. First, the ALJ asked the VE if 

an “individual of [Parker]’s same age, education and with that job of a hairstylist,” who is “limited 

to performing sedentary work as defined in the regulations” which means she can push, pull, “lift 

and/or carry ten pounds occasionally, less than ten pounds frequently” and who can sit or stand 

“two hours out of an eight-hour workday,” and is limited to “repetitive tasks, making simple, 

work-related decisions” in a “setting where there are few changes” in either the appearance of the 

work setting or the “processes used,” could “perform the past job” as described. Id. at 113. The 

VE responded that this hypothetical person could not be a hairstylist. Id. However, the VE said

that this person could be a sorter (DOT 739.684-010), “classified at the sedentary level and 

unskilled, SVP of two.” Id. at 113–114. In addition, he testified that the hypothetical person 

could be a weight tester (DOT 521.687-086) or assembler (DOT 739.684-094). Id. The VE noted 

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that the Dictionary of Occupational Titles (“DOT”) does not address concerns like level of 

interaction with coworkers or people in general. Id. Therefore, his opinions as to the 

hypotheticals were based on his experience. Id. The ALJ also asked if there were any transferable 

skills from being a hairstylist that could lend themselves to employment opportunities. See id. 

The VE said that all possible jobs would require interaction with the public, so there were likely 

not any transferable skills due to the restrictions described above. See id. at 115.

Parker’s counsel then asked the VE whether a person in the above hypothetical who also 

could not reach, handle, finger or feel would be able to perform the jobs he listed in response to 

the ALJ’s hypotheticals. Id. The VE said there would not be any jobs for a person with these 

additional restrictions. Id. Parker’s counsel also asked if a person with the same restrictions but 

who would be off task twenty percent of the time would be able to perform the jobs the VE listed. 

Id. The VE again answered no. Id. Finally, Parker’s counsel asked if this hypothetical person 

would be able to perform these jobs if she also was required to miss two or more days per month 

for sick leave. Id. at 116. The VE responded that the jobs would not be available to such an 

individual with this additional restriction. Id. 

The ALJ then posed a second hypothetical:

[T]his individual is limited to performing light work as defined in our regulations, 

meaning she can lift and/or carry 20 pounds occasionally, 10 pounds frequently, 

can stand, walk or sit each six hours out of an eight-hour workday. She can push 

and/or pull as much as she can lift and/or carry. She would need to have a sit/stand 

up option where she could change positions briefly for up to two minutes after 

being in any one position for 30 minutes . . . And this individual can only 

occasionally stoop, kneel, crouch, climb ladders, ropes or scaffolds, occasionally 

climb ramps and stairs.

Id. at 117. The ALJ asked if a person fitting the above description would be able to perform the 

past job of a hairstylist. Id. The VE said that this individual could not, but the hypothetical person 

could be a garment sorter (DOT 222.687-014), stock checker (DOT 299.667-014), or garment 

folder (DOT 789.687-066), all categorized as light, unskilled, level 2 SVP. Id. at 117–118. 

Parker’s counsel then qualified this hypothetical, adding a limitation of not being able to 

reach with both arms, and asked if this person could do any of the jobs listed above. Id. at 119. 

The VE responded no. Id. Parker’s counsel also asked if a person in the ALJ’s second 

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hypothetical who also had to be able to lay down at unpredictable times could perform the jobs the 

VE had listed and the VE said no. Id. 

Finally, the ALJ asked the VE to clarify how he interpreted “reaching” when he responded 

to counsel’s added limitation above. Id. The VE said he interpreted it as reaching in any 

direction. See id. The ALJ then asked what the VE’s testimony would be if the hypothetical

person was “only restricted to no overhead reaching bilaterally.” Id. at 120. The VE responded 

that a limitation only on overhead reaching would not disqualify someone from working the jobs 

he had listed because none of them requires overhead reaching. Id. 

2. The ALJ’s Decision 

Employing the five-step evaluation process described above, the ALJ found that Parker 

had “not been under a disability within the meaning of the Social Security Act from December 

31, 2008, through the date of this decision.” Id. at 19. 

At step one, the ALJ found that the record did not support a finding that Parker engaged in 

substantial gainful activity since the alleged onset date of December 31, 2008. Id. at 21. The ALJ 

also found that Parker “met the insured status requirements of the Social Security Act” on 

December 31, 2009. Id. 

At step two, the ALJ found that Parker had the following severe impairments: (1) 

polycystic kidney, liver and ovarian disease, (2) osteoarthritis of the lumbar spine, (3) a mood 

disorder not otherwise specified (NOS), (4) an anxiety disorder “versus a posttraumatic stress 

disorder,” and (5) a polysubstance addiction disorder. Id. The ALJ further found that Parker’s

“impairments significantly limit her ability to perform basic work activities,” under 20 C.F.R.

§404.1521 and §416.921, and therefore are deemed to be “severe.” Id. The ALJ specifically 

excluded two other conditions noted in the record, stable osteoarthritis of the thoracic spine and 

hypertension, which he did not consider to be severe because they “do not contribute to the 

claimant’s functional limitations.” Id. 

At step three, the ALJ determined that Parker’s impairments did not meet or medically 

equal the severity of one of the listed impairments (together or in combination). Id. Specifically, 

the ALJ focused on Parker’s gastrointestinal issues, spinal conditions and mental impairments. Id. 

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First, the ALJ found that Parker’s symptoms do not meet the criteria in listing 5.00, “disorders of 

the digestive system.” Id. at 21. The ALJ also did not find evidence of a spinal condition which 

would result in “the need for changes in position or posture more than once every two hours” or 

the “inability to ambulate effectively.”5 Id. With respect to Parker’s mental impairments, the ALJ 

found that Listings 12.046, 12.067 and 12.098 were not met. Id. at 22. In order to make this 

determination, the ALJ evaluated whether or not the “Paragraph B” and “Paragraph C” criteria 

were satisfied; he did not address Paragraph A requirements. Id. He concluded that neither 

Paragraph B nor Paragraph C was satisfied. Id. To satisfy Paragraph B, the mental impairment in 

question must result in two or more 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 extended duration.

Id. With respect to the first category, “activities of daily living,” the ALJ found that Parker has 

only mild restriction. Id. In support of the conclusion, the ALJ pointed to Parker’s involvement in 

her church, ability to attend medical appointments consistently, concern for her physical 

appearance, and ability to work well with others and “use resources in the community well.” Id. 

With respect to “concentration,” the ALJ found that Parker has moderate difficulties, especially 

because of symptoms from chronic depression and possibly from side effects of pain medication. 

 

5 The ALJ did not identify a specific listing related to spinal conditions but it appears that he was 

considering listing 1.04, which relates to disorders of the spine. 

6 Listing 12.04 pertains to affective disorders, with “paragraph A” criteria requiring “[m]edically 

documented persistence” of: (1) “[d]epressive syndrome”; (2) “[m]anic syndrome”; or (3) 

“[b]ipolar syndrome.” 20 C.F.R. Pt. 404, Subpt. P, App. 1, 12.04. 

7 Listing 12.06 pertains to anxiety-related disorders, with the “paragraph A” criteria requiring that 

the claimant have “[m]edically documented findings of at least one of the following”: “(1) 

[g]eneralized persistent anxiety accompanied” by certain listed symptoms; (2) “[a] persistent 

irrational fear of a specific object, activity, or situation which results in a compelling desire to 

avoid the dreaded object, activity, or situation”; or (3) “[r]ecurrent severe panic attacks manifested 

by a sudden unpredictable onset of intense apprehension, fear, terror, and sense of impending 

doom occurring on the average of at least once a week.” 20 C.F.R. Pt. 404, Subpt. P, App. 1, 

12.06.

8 Listing 12.09 pertains to “[b]ehavioral changes or physical changes associated with the regular 

use of substances that affect the central nervous system.” 20 C.F.R. Pt. 404, Subpt. P, App. 1, 

12.06. 

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Id. The ALJ found that Parker has experienced no episodes of decompensation or “a residual 

disease process that has resulted in such marginal adjustment that even a minimal increase in 

mental demands or change in the environment would be predicated to cause the individual to 

decompensate.” Id. Therefore, the ALJ concluded that Parker did not satisfy the criteria of 

Paragraph C. Id. For these reasons, the ALJ concluded that Parker did not meet or equal a Listing 

at Step Three. Id. at 21. In support of his finding that Parker does not meet Listing 12.04, 12.06 

or 12.09, the ALJ pointed to Dr. Abraham’s opinion that Parker “likely overused her prescription 

narcotic pain medications, with resulting slurring of her words and appearance of lethargy” and 

that Parker has a “histrionic aspect, with over-dramatization of her symptoms.” Id. at 24. 

At step four, the ALJ found that Parker: 

[H]as the residual functional capacity to perform light work as defined in 20 CFR 

404.1567(b) and 416.967(b) (lift and carry 10 pounds frequently and 20 pounds 

occasionally; sit, stand, or walk for six hours each in an eight-hour workday, and 

push/pull to the same weight limits) except she occasionally could stoop, kneel, 

crouch, and climb (ladders, ropes, scaffolds, ramps, and stairs). She would need 

the option to change positions between sitting and standing briefly for up to two 

minutes after being in any one position for 30 minutes. She is limited to simple 

repetitive tasks with simple, work-related decisions, in a stable work environment, 

meaning few changes, if any, in the day-to-day work setting and in the tools and/or 

work processes used to accomplish tasks. She could have the occasional 

interaction with supervisors, co-workers, and the public but only superficial 

contacts such as pleasantries and greetings. She could not perform tandem tasks or 

work in a team or group. 

Id. at 23. The ALJ explained that in reaching the RFC finding, he “considered all 

symptoms and the extent to which these symptoms reasonably can be accepted as 

consistent with the objective medical evidence and other evidence.” Id. In assessing 

Parker’s credibility, the ALJ concluded that Parker’s “medically determinable impairments 

reasonably could be expected to cause the alleged symptoms.” Id. at 24. However, the 

ALJ found that her “statements concerning the intensity, persistence and limiting effects of 

these symptoms are not entirely consistent with medical evidence and other evidence in the 

record. . . . ” Id. 

The ALJ gave “significant weight” to the opinions of the State agency consultants who 

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reviewed Parker’s medical records because they “are consistent with the records they reviewed” 

and “provided adequate explanation for the discrepancies.” Id. at 24. The ALJ acknowledged the 

note of Dr. Chawla that there is no known treatment to “prevent or delay” Parker’s chronic kidney 

disease, but found that “to date, there has been no apparent worsening, acute treatment, or referral 

for dialysis.” Id. at 25. 

With regard to Parker’s physical limitations, the ALJ “modified” the opinions of State 

agency reviewers based on the opinions of Dr. Rana, who examined Parker at the request of the 

state agency, as discussed above. Id. at 26. The ALJ found that Dr. Rana’s “evaluation, when 

combined with the benign imaging findings indicates that overall . . . the claimant is capable of a 

range of light exertional work.” Id. The ALJ also relied to a lesser extent on the opinions of Dr. 

Rivero, explaining that “Dr. Rana’s limitations to occasional postural activity are uncontradicted 

by Dr. Rivero, so they are adopted.” Id. However, the ALJ rejected Dr. Rivero’s finding that 

Parker could “not lift more than four pounds.” Id. at 27. The ALJ concluded that this finding was 

not supported by objective testing and is rejected in favor of the 

conclusions by the State agency and Dr. Rana . . . because these 

opinions are more consistent with the longitudinal medical record and 

objective evidence ...

Id. The ALJ supports his decision to give Dr. Rana and the State agency consultants’ opinions 

more weight than Dr. Rivero’s on the basis that Dr. Rivero “appeared to rely more heavily on the 

claimant’s subjective statements.” Id. 

With regard to Parker’s mental impairments, the ALJ discounted the GAF score of 45 

assigned by Tardy on December 18, 2013, pointing to other comments in Tardy’s notes about 

Parker’s daily activities and abilities that he concluded showed the GAF score “significantly 

understates the claimants functional capacity.” Id. For example, the ALJ noted that Parker

was active in her church, she had good insight into her mental condition, she 

attended appointments consistently, stayed in contact with her clinician, she could 

access all health care and make appointments independently...

Id. The ALJ also relied on treatment notes from November 2013 and September 2014 to suggest 

that Parker’s mood had improved over time. Id. The ALJ cited Parker’s report on November 26, 

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2013 that she had “never been this happy in [her] life” and noted that “[b]y September 2014, she 

was described as ‘calm and in euthymic mood,’ [and reported] decreased stress, positive 

experiences, and making new friends.” Id. 

Finally, the ALJ considered the opinion of Dr. Abraham, the State agency psychologist 

who evaluated Parker’s mental condition. Id. at 28. The ALJ noted that Dr. Abraham described 

Parker as “moderately limited in her ability to attend, sustain effort, comprehend or remember; 

maintain social interactions; and adapt to the usual stress in a work environment.” Id. The ALJ 

found that this was consistent with observations from Parker’s social worker at ABODE. Id. 

Further, the ALJ posited that “her occasional slurred speech and slow affect appear related to her 

use or overuse of pain medications and not to an underlying psychological disorder.” Id. The ALJ 

concluded that “taking into consideration her good presentation at most appointments but some 

concerns about interpersonal relationships, she is limited to simple unskilled work . . . . ” Id. at 

28. 

At step five, the ALJ found that, “[c]onsidering [Parker’s] age, education, work 

experience, and residual functional capacity, there are jobs that exist in significant numbers in the 

national economy that [Parker] can perform.” Id. at 29. This decision was based on the vocational 

expert’s testimony. Id. at 30. The VE testified that appropriate work for a hypothetical person 

with Parker’s limitations existed in significant numbers, including “garment sorter,” “stock 

checker,” and “garment folder.” Id. 

D. Plaintiff’s Contentions 

In her Motion for Summary Judgment, Parker contends the ALJ erred in giving little 

weight to the opinions of treating sources without providing “specific and legitimate reasons 

supported by substantial evidence.” Pl.’s Mot. at ECF p.6. Further, Parker contends the ALJ erred 

in finding that she does not meet or equal a Listing. Id. at ECF p. 9. Finally, Parker argues that 

the ALJ erred in determining her RFC. Id. at ECF p. 10. 

With respect to Parker’s first contention, she argues that the ALJ improperly rejected – and 

did not even address – the opinions of Drs. Rasheed and Khetrapal, both treating physicians, about 

the limitations associated with Parker’s chronic pain, which they opined would limit Parker to less 

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than sedentary work. Id. at ECF p. 7. Plaintiff further points out that Dr. Khetrepal’s opinion was 

based on the MRI findings of Dr. Khalsa but that the ALJ also failed to address those findings; nor 

did he address the references to lumbosacral spondylosis and thoracic spondylosis in treatment 

notes from TriCity Rheumatology, or Dr. Rasheed’s opinions about Parker’s limitations in the 

October 25, 2016 RFC Questionnaire. Id.

Parker further asserts that the ALJ failed to offer specific and legitimate reasons for giving 

reduced weight to the opinions of her treatment providers at ABODE Services, Ms. Tardy and Dr. 

Harris, about her limitations. Id. at ECF p. 8. In particular, the ALJ failed to explain why 

evidence that Parker experienced “some improvement at times” justified “brush[ing] off” their 

opinions. Id. at 8 (internal citations omitted). Further, to the extent the ALJ relied on the opinions 

of Dr. Abraham to support his conclusion, Parker claims that the ALJ mischaracterized Dr. 

Abraham’s opinions, ignoring her opinion that “Ms. Parker may be considered to have a chronic 

or persistent psychiatric disability,” which supports the conclusions of the ABODE clinicians. Id.

at ECF pp. 8–9 (internal citations omitted). 

Parker also argues that the ALJ erred in finding that she does not meet or equal Listings

12.04, 12.06, and 12.09. Id. She contends that if he had given the opinions of the treating source 

physician from ABODE appropriate weight, she would meet all three of the above listings. Id. 

While the treating physician from ABODE noted that Parker would have “marked” limitations in 

each of the categories, the ALJ found that she was “only mildly limited.” Id. Parker notes that 

this finding is even less restrictive than Dr. Abraham’s conclusion. Id. 

Finally, Parker contends that the ALJ erred in determining her RFC. Id. at ECF p. 10. 

Specifically, she argues that the ALJ’s conclusion was not supported by substantial evidence 

because he did not give appropriate weight to the opinions of Dr. Khetrapal, Dr. Rasheed, Ms. 

Tardy and Dr. Harris. Id. at ECF p. 11. She further argues that if these opinions were given 

appropriate weight, the ALJ would have found that Parker cannot perform any of the jobs listed by 

the Vocational Expert during the hearing. Id. 

Parker argues that the proper remedy in this case is to reverse the decision of the 

Commissioner and remand with instructions to award benefits because the ALJ did not “provide 

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legally sufficient reasons for rejecting the medical evidence.” Id. at ECF p. 12. 

III. ANALYSIS

A. Legal Standard Under 42 U.S.C §§ 405(g) and 1383(c)(3) 

District courts have jurisdiction to review the final decisions of the Commissioner and 

have the power to affirm, modify, or reverse the Commissioner’s decisions, with or without 

remanding for further hearings. 42 U.S.C. § 405(g); see also 42 U.S.C. § 1383(c)(3). When 

reviewing the Commissioner’s decision to deny benefits, the Court “may set aside a denial of 

benefits only if it is not supported by substantial evidence or if it is based on legal error.” Thomas 

v. Barnhart, 278 F.3d 947, 954 (9th Cir. 2002) (quoting Jamerson v. Chater, 112 F.3d 1064, 1066 

(9th Cir. 1997)) (quotation marks omitted). Substantial evidence must be based on the record as a 

whole and is “such relevant evidence as a reasonable mind might accept as adequate to support a 

conclusion.” Richardson v. Perales, 402 U.S. 389, 401 (1971). Substantial evidence “must be 

‘more than a mere scintilla,’ but may be less than a preponderance.” Molina v. Astrue, 674 F.3d 

1104, 1110–11 (9th Cir. 2012) (quoting Desrosiers v. Sec’y of Health and Human Servs., 846 F.2d 

573, 576 (9th Cir. 1988)). Even if the Commissioner’s findings are supported by substantial 

evidence, “the decision should be set aside if the proper legal standards were not applied in 

weighing the evidence and making the decision.” Benitez v. Califano, 573 F.2d 653, 655 (9th Cir. 

1978).

If the Court finds defects in the administrative proceeding or the ALJ’s conclusions that 

warrant reversal of the Commissioner’s decision, the Court may remand for further proceedings or 

for award of benefits. See Garrison v. Colvin, 759 F.3d 995, 1019−21 (9th Cir. 2014).

B. Legal Standard for the Evaluation of Medical Opinions

The Ninth Circuit differentiates among the opinions of three different types of physicians. 

Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995). The categories are as follows: “(1) those who 

treat the claimant (treating physicians); (2) those who examine but do not treat the claimant 

(examining physicians); and (3) those who neither examine nor treat the claimant (non-examining 

physicians).” Id. “[T]he opinion of a treating physician is . . . entitled to greater weight than that 

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of an examining physician, [and] the opinion of an examining physician is entitled to greater 

weight than that of a non-examining physician.” Garrison, 759 F.3d at 1012.

“If a treating or examining doctor’s opinion is contradicted by another doctor’s opinion, an 

ALJ may only reject it by providing specific and legitimate reasons that are supported by 

substantial evidence.” Bayliss v. Barnhart, 427 F.3d 1211, 1216 (9th Cir. 2005) (citing Lester v. 

Chater, 81 F.3d at 830-831). An ALJ can satisfy the “substantial evidence” requirement by 

“setting out a detailed and thorough summary of the facts and conflicting clinical evidence, stating 

his interpretation thereof, and making findings.” Reddick v. Chater, 157 F.3d 715, 725 (9th Cir. 

1998). “The ALJ must do more than state conclusions. He must set forth his own interpretations 

and explain why they, rather than the doctors’, are correct.” Id. (citation omitted). “Because a 

court must give ‘specific and legitimate reasons’ for rejecting a treating doctor’s opinions, it 

follows even more strongly that an ALJ cannot in its decision totally ignore a treating doctor and 

his or her notes, without even mentioning them.” Marsh v. Colvin, 792 F.3d 1170, 1172–73 (9th 

Cir. 2015). While harmless error analysis applies in the social security context, a failure to give 

adequate reasons for discounting the opinions of treating or examining physicians is only harmless 

if the reviewing court “‘can confidently conclude that no reasonable ALJ, when fully crediting the 

testimony, could have reached a different disability determination.’” Id. (quoting Stout v. 

Comm’r, Soc. Sec. Admin., 454 F.3d 1050, 1056 (9th Cir. 2006)). 

Finally, “[i]f a treating provider’s opinions are based ‘to a large extent’ on an applicant’s 

self-reports and not on clinical evidence, and the ALJ finds the applicant not credible, the ALJ 

may discount the treating provider’s opinion.” Ghanim v. Colvin, 763 F.3d 1154, 1162 (9th Cir. 

2014) (citing Tommasetti v. Astrue, 533 F.3d 1035, 1041 (9th Cir. 2008)). “However, when an 

opinion is not more heavily based on a patient’s self-reports than on clinical observations, there is 

no evidentiary basis for rejecting the opinion.” Id. (citing Ryan v. Comm'r of Soc. Sec., 528 F.3d 

1194, 1199-1200 (9th Cir. 2008)). 

C. Legal Standard for Weighing the Opinions of “Other Sources”

“In addition to considering the medical opinions of doctors, an ALJ must consider the 

opinions of medical providers who are not within the definition of ‘acceptable medical sources.’” 

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Revels v. Berryhill, 874 F.3d 648, 655 (9th Cir. 2017) (citing 20 C.F.R. § 404.1527(b), (f); SSR 

06-3p). If the medical provider who offers the opinion is not herself an acceptable medical source 

but is “working closely with, and under the supervision of [an acceptable medical source], her 

opinion is to be considered that of an ‘acceptable medical source.’” Turner v. Comm’r of Soc. Sec., 

613 F.3d at 1223–24 (citing Gomez v. Chater, 74 F.3d 967, 971 (9th Cir. 1996)). Otherwise, these 

medical sources are considered “other sources.” While only “acceptable medical sources” can 

diagnose and establish that a medical impairment exists, evidence from “other sources” can be 

used to determine the severity of that impairment and how it affects the claimant’s ability to work.

Catt v. Colvin, No. 3:12-CV-02087-HZ, 2014 WL 98720, at *6 (D. Or. Jan. 8, 2014)(citing 20 

C.F.R. § 404.1513(a), (d)). To disregard the opinion of an “other source” the ALJ is required to

provide a reason that is “arguably germane” to that witness. Id. (citing Lewis v. Apfel, 236 F.3d 

503, 512 (9th Cir. 2001); Turner v. Comm'r of Soc. Sec., 613 F.3d 1217, 1223–24 (9th Cir. 2010)). 

The same factors used to evaluate the opinions of medical providers who are acceptable 

medical sources are used to evaluate the opinions of those who are not. 20 C.F.R. § 404.1527(f); 

SSR 06-3p. Those factors include the length of the treatment relationship and the frequency of 

examination, the nature and extent of the treatment relationship, supportability, consistency with 

the record, and specialization of the doctor. Id. § 404.1527(c)(2)–(6). Under certain circumstances, 

the opinion of a treating source who is not an acceptable medical source may be given greater 

weight than the opinion of a treating source who is—for example, when the provider “has seen the 

individual more often than the treating source, has provided better supporting evidence and a 

better explanation for the opinion, and the opinion is more consistent with the evidence as a 

whole.” 20 C.F.R. § 404.1527(f)(1).

D. Legal Standard Governing Consideration of Evidence of Variations in the 

Claimant’s Symptoms

It is “error for an ALJ to pick out a few isolated instances of improvement over a period of 

months or years and to treat them as a basis for concluding a claimant is capable of working.” 

Garrison, 759 F.3d at 1017. Further, Social Security Ruling 96-7p states: 

Symptoms may vary in their intensity, persistence, and functional effects, or may 

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worsen or improve with time, and this may explain why the individual does not 

always allege the same intensity, persistence, or functional effects of his or her 

symptoms. Therefore, the adjudicator will need to review the case record to 

determine whether there are any explanations for any variations in the individual’s 

statements about symptoms and their effects.

Id.; see also Holohan v. Massanari, 246 F.3d 1195, 1205 (9th Cir. 2001) (holding that notes of 

treating doctor must be “read in context of the overall diagnostic picture he draws” and opining, 

“[t]hat a person who suffers from severe panic attacks, anxiety, and depression makes some 

improvement does not mean that the person’s impairments no longer seriously affect her ability to 

function in a workplace.”).

E. The ALJ Erred in Evaluating Evidence of Parker’s Physical Impairments

Parker asserts that the ALJ’s decision should be reversed because the ALJ did not offer 

specific and legitimate reasons supported by substantial evidence for rejecting opinions of two 

treating doctors, Dr. Khetrapal and Dr. Rasheed, or even address these opinions. The Court 

agrees.

First, there is no question that the ALJ was required to provide specific and legitimate 

reasons for rejecting the opinions of Dr. Khetrapal, who was Parker’s primary care physician from 

November 2013 to May 2014. He not only examined Parker on numerous occasions himself but 

also referred her to Dr. Khalsa, at Fremont Neurology Medical Associates, who reported to Dr. 

Khetrapal the results of a neurological and electrodiagnostic evaluation and an MRI that revealed 

multi-level desiccation, mild canal stenosis and right-sided neural foraminal stenosis, as well as 

“[e]xtensive bilateral renal cysts.” AR at 1003-1004. The ALJ did not discuss Dr. Khetrapal’s 

opinions at all in his decision, even though Dr. Khetrapal found Parker’s limitations to be more 

severe than the RFC the ALJ adopted. In particular, as discussed above, Dr. Khetrapal found that 

Parker’s could lift or carry no more than 10 pounds occasionally and could stand and walk less 

than two hours in an eight-hour day due to pain. Id. at 1108. He also found that Parker would 

need to alternate between, sitting, standing and walking frequently to alleviate her discomfort, 

opining that she could sit no more than 10 minutes without changing position, stand no more than 

5 minutes without changing position, and needed to walk around every ten minutes for at least 5 

minutes. Id. Finally, he found that Parker would need to be absent more than three times a month 

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due to her symptoms. Id. at 1109-1110.

The Commissioner argues that it was sufficient for the ALJ to cite to the opinions of the 

state agency doctors who reviewed the record because those doctors expressly rejected Dr. 

Khetrapal’s opinions, finding that they were not consistent with objective findings. See AR at 

175, 193. However, the Commissioner cites no authority suggesting that an ALJ is excused from 

providing specific and legitimate reasons for rejecting a treating physician’s opinions simply 

because, buried in the record, there are notes by state agency reviewers setting forth reasons for 

rejecting a treating physician’s opinion. Moreover, as these doctors did not examine or treat 

Parker, their opinions are entitled to less weight than the opinions of Dr. Khetrapal. The 

conclusory statements of these reviewers that Dr. Khetrapal’s opinions are not consistent with 

objective medical findings are not specific and legitimate and would not be sufficient to support 

the ALJ’s legal obligation to provide specific and legitimate reasons for his conclusions even if he 

had included them in his own written opinion. Accordingly, the Court concludes that the ALJ 

erred in failing to offer specific and legitimate reasons for rejecting the opinions of Dr. Khetrapal 

with respect to Parker’s physical limitations.

With respect to the ALJ’s failure to address references to Dr. Rasheed’s diagnoses of

lumbosacral spondylosis and thoracic spondylosis without myelopathy, Parker has not explained 

why these diagnoses would render the conclusions the ALJ did reach about Dr. Rasheed’s 

opinions (which Parker does not challenge) invalid. The ALJ’s failure to address the opinions 

contained in the RFC Questionnaire and Medical Opinion form that Dr. Rasheed completed in 

October 2016 is more problematic. In the wake of the Ninth Circuit’s decision in Taylor v. 

Comm’'r of Soc. Sec., 659 F.3d 1228, 1231 (9th Cir.2011), courts in the Ninth Circuit have found 

that where new evidence is submitted to the Appeals Council that was not considered by the ALJ, 

“the Appeals Council is not required to give specific and legitimate reasons for its rejection of a 

treating physician’s evidence when it does not review the ALJ's decision.” Palomares v. Astrue, 

887 F. Supp. 2d 906, 916 (N.D. Cal. 2012). Nonetheless, the Appeals Council is still obligated to 

consider whether, in light of the new evidence, there is substantial evidence to support the ALJ’s 

decision and the Commissioner’s decision must still be reversed if that requirement is not met. Id. 

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As discussed above, in the forms that Dr. Rasheed completed in October 2016, she found 

that found that Parker had the following physical limitations: lifting and carrying less than 10 

pounds; standing less than 2 hours in an 8 hour workday; walking less than 2 hours in an 8 hour 

workday; sitting less than 2 hours in an 8 hour workday; limited ability to push or pull as to both 

upper and lower extremities; and no climbing, balancing, stooping, kneeling, crouching or 

crawling. AR 40-41. In other words, Dr. Rasheed, who had continued to treat Parker in 2015 and 

2016, found that Parker was significantly more limited in her abilities than Dr. Rana, who 

examined Parker only once, in 2016, and upon whom the ALJ relied heavily. Dr. Rasheed’s 

findings are also closer to (and in some cases identical to) the limitations found by Dr. Khetrapal 

in 2014.

In sum, the Court finds that the ALJ erred by failing to provide specific and legitimate 

reasons supported by substantial evidence for rejecting the opinions of Dr. Khetrapal and the 

Commissioner’s decision with respect to Parker’s physical limitations also is not supported by 

substantial evidence in light of the opinions of Dr. Rasheed that were submitted to the Appeals 

Council before the ALJ’s decision became final.

F. The ALJ Erred in Evaluating Evidence of Parker’s Mental Impairments

Parker contends the ALJ improperly weighed the opinions in the Mental Impairment 

Questionnaire completed by Tardy and signed by Dr. Harris. The ALJ rejected the opinion in the 

questionnaire that Parker likely would be absent from work more than four days per month due to 

her symptoms, which included dizziness, fatigue, and slurred speech attributed to side effects from 

medications. Id. at 24. The ALJ also rejected other limitations noted in the questionnaire, 

“including lack of ability to remember work procedures, complete a normal workday, and perform 

at a consistent pace.” Id. The ALJ offered the following reasons for rejecting these opinions: 1) 

“there were treatment notes indicating that the claimant improved with treatment, with normal 

concentration and attention”, id. at 27; 2) Dr. Abraham found that Parker had a “histrionic aspect, 

with over-dramatization of her symptoms,” and that Parker overused her pain medication and 

would be able to “sustain simple and complex tasks for a 40-hour work week and interact 

adequately with others” if she did not overuse her pain medications, id. at 24; and 3) the activities 

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and abilities described in the questionnaire indicated that Parker’s limitations were not as severe as 

was stated in the questionnaire. Id. at 27. 

As a preliminary matter, to the extent the Commissioner suggests in his summary 

judgment motion that Tardy’s opinion could be rejected under the standards that govern 

the evaluation of opinions of “other sources” because she is a social worker rather than a 

medical doctor, the Court rejects that argument. First, the ALJ made no such finding, 

apparently treating Tardy’s evaluation as the opinion of an acceptable medical source. 

Second, substantial evidence in the records supports the conclusion that Tardy was entitled 

to be treated as an acceptable medical source, at least as to the opinions expressed in the 

assessment she completed on May 5, 2014, because she worked closely with and was

under the supervision of Dr. Harris. As noted above, Dr. Harris was listed as the 

“consultant psychiatrist” at ABODE and prescribed Parker’s medications. Even more 

significant is the fact that Dr. Harris waited to sign Tardy’s Mental Impairment 

Questionnaire until she examined Parker, on June 17, 2014, indicating that Dr. Harris

adopted the opinions expressed by Tardy in the questionnaire. Therefore, the Court 

concludes that the ALJ was required to give specific, legitimate reasons for rejecting the 

opinions expressed in the questionnaire with respect to Parker’s limitations. The Court 

concludes that the ALJ’s reasons for rejecting the opinions in the questionnaire completed 

by Tardy and signed by Dr. Harris are not specific and legitimate and are not supported by 

substantial evidence.

First, the ALJ’s reliance on isolated treatment notes to conclude that Parker 

“improved with treatment” does not constitute a “specific, legitimate reason” supported by 

substantial evidence in the record for rejecting Tardy and Dr. Harris’s opinions with 

respect to Parker’s limitations. See Garrison, 759 F.3d at 1012. Although Tardy noted 

some instances of improvement in her treatment notes, “such observations must be ‘read in 

context of the overall diagnostic picture’ the provider draws.” Ghanim v. Colvin, 763 F.3d 

1154, 1162 (9th Cir. 2014) (quoting Holohan v. Massanari, 246 F.3d 1195, 1205 (9th Cir. 

2001)). “The fact that a person suffering from depression makes some improvement ‘does 

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not mean that the person’s impairment [ ] no longer seriously affect[s] [his] ability to 

function in a workplace.’”Id. (quoting Holohan, 246 F.3d at 1205). Here, the ALJ cherrypicked notes reflecting Parker’s “good days” while ignoring the bad days, citing a note on 

November 26, 2013 when Parker told Tardy that she had “never been this happy in [her]

life” and another note from a session almost a year later, in September 2014 2014 when 

she was described as in a “calm in euthymic mood” to show that Parker was improving. 

See AR at 24, 27.

Yet treatment notes by both Tardy and Dr. Kumar during the intervening months do not 

support the ALJ’s reading of the record, instead showing that Parker’s symptoms fluctuated, with 

both practitioners observing on numerous occasions that Parker’s mood was depressed and 

anxious. See, e.g., AR at 1084-1085 (notes from January 22, 2014 by Dr. Kumar reporting that 

Parker felt depressed and anxious and was having difficulty concentrating); id. at 1002 (notes 

from February 19, 2014 by Dr. Kumar that Parker complained of “more anxiety. . . depression” 

and “poor concentration.”); id. at 1129 (notes from April 21, 2014 by Tardy observing that 

“client experienced PTSD symptoms,” including “intrusive thoughts of fear, panic attacks, 

paranoia, and not wanting to be alone.). Id. at 1129. This fluctuation in symptoms is consistent 

with Dr. Abraham’s finding of “mood instability” and her diagnosis of Mood Disorder Not 

Otherwise Specified, which the ALJ apparently adopted. It is also consistent with the diagnosis of 

Dr. Hiawatha Harris that Parker suffers from Bipolar Affective Disorder, see id. at 1249, and Dr. 

Rana’s comment that Parker has a history of bipolar disorder. Id. at 1401. Despite apparently 

accepting Dr. Abraham’s diagnosis, the ALJ did not address any of this evidence or acknowledge 

mood instability as a limitation that is relevant to Parker’s ability to work. Therefore, the Court 

concludes that the ALJ’s reading of the record with respect of Parker’s mental limitations was not 

supported by substantial evidence and that the selective citation to days on which Parker was 

doing better was not a specific and legitimate reason for rejecting the limitations in the 

questionnaire completed by Tardy and Dr. Harris.

The ALJ’s reliance upon the opinions of Dr. Abraham also does not constitute a 

specific and legitimate reason supported by substantial evidence for rejecting Tardy and 

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Dr. Harris’s opinions with respect to Parker’s mental limitations. Again, the ALJ reads Dr. 

Abraham’s report selectively, ignoring significant aspects of her opinions that do not fit the 

ALJ’s conclusions. Thus, he quotes Dr. Abraham’s opinion that Parker “tends to 

overdramatize her suffering and pain in order to seek attention and sympathy from others,”

implying that Dr. Abraham found that Parker is malingering with respect to the severity of 

her symptoms, while ignoring Dr. Abraham’s express finding that there was not “any 

evidence of malingering.” Id. at 1184. The ALJ also ignores the conclusion that Dr. 

Abraham reached with respect to Parker’s “histrionic” behavior, namely, that Parker meets 

the criteria of Histrionic Personality Disorder. See id. at 1182. Based in large part on this 

diagnosis, Dr. Abraham concluded that Parker has a “chronic or persistent psychiatric 

disability.” Id. at 1186. Among other things, Dr. Abraham found that Parker’s “irritable 

and controlling disposition may interfere with her ability to maintain harmonious relations 

with others,” that her “sense of entitlement” and “defian[ce]” would lead her to “clash with 

positions of authority,” that she was “not able to persist with the course of the assessment 

without it being split into two sessions” despite a “great deal of effort to comply with the 

requirements of completing tasks. Id. Therefore, the ALJ’s reliance on Dr. Abraham’s 

opinion about Parker’s “histrionic” aspect does not constitute a specific and legitimate

reason for rejecting the mental limitations found by Tardy and Dr. Harris.

In evaluating Parker’s mental limitations and rejecting the limitations of Tardy and 

Dr. Harris, the ALJ also relied on Dr. Abraham’s opinion that Parker likely “overused” her 

pain medication, concluding that without this overuse Parker “should be able to sustain 

simple and complex tasks for a 40-hour work week and interact adequately with others.” 

See id. at 24. But while Dr. Abraham opined that Parker “may be overusing her pain 

medication,” she offered no opinion as to Parker’s ability to work if she did not overuse 

her pain medication. Instead, the ALJ relied on the opinion of one of the state agency 

doctors, Dr. Karen Ying, who reviewed the record but did not examine or treat Parker. Dr. 

Ying stated that “without over use of pain killers or with adjusted dosaging regime 

(changing amt or the medication to reduce sedation), she should be able to sustain simple 

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and complex tasks for a 40 hour work wk. She should be able to interact adequately with 

others in a work setting. She should be able to travel and make decisions in a work 

setting.” AR at 170. As Dr. Ying did not examine or treat Parker and none of the doctors 

who did offered such an opinion (or even suggested that Parker’s pain medication could 

be changed in a way that would both control her pain and eliminate or reduce the side 

effects associated of her pain medication), this opinion does not provide substantial 

evidence for the ALJ’s finding. See Lester v. Chater, 81 F.3d 821, 831 (9th Cir. 1995), as 

amended (Apr. 9, 1996) (“The opinion of a nonexamining physician cannot by itself 

constitute substantial evidence that justifies the rejection of the opinion of either an 

examining physician or a treating physician.”).

Furthermore, “[t]he side effects of necessary medications are recognized as 

nonexertional limitations.” Nelson v. Comm’r of Soc. Sec., No. C 07-1810 PVT, 2010 WL 

4973623, at *2 (N.D. Cal. Dec. 1, 2010) (citing Allgrove v. Astrue, 2009 WL 1814435, *6 

(N.D.Cal.2009), citing Tackett v. Apfel, 180 F.3d 1094, 1102 (9th Cir. 1999)). “Like pain, 

the side effects of medications can have a significant impact on an individual’s ability to 

work and should figure in the disability determination process.” Id. (internal quotations 

and citations omitted). The record in this case is replete with observations and opinions 

from treatment providers that Parker’s pain medication caused considerable mental 

impairment. See, e.g., AR at 1185 (Dr. Abraham, stating “if she relies on narcotic 

painkillers to ease her suffering, such as Morphine, she may not be able to sufficiently 

complete her assignments. These medications are central nervous system depressants and 

may exacerbate her symptoms of fatigue, irritability, and lack of focus and cause her to 

come across as disengaged and non-interactive”); 1130 (Tardy notes from an April 18, 

2014 appointment observing that Parker was “in a lethargic mood as evidenced by slurred 

speech and difficulty staying focused”); 1099 (Mental Impairment Questionnaire signed by 

Tardy and Dr. Harris stating that “Ms. Parker would currently have difficulty working at a 

regular job due to side effects from pain medications. These cause slurred speech and 

difficulty focus[ing], as well as decrease in memory functioning”), 1347 (Tardy notes from 

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October 12, 2014 appointment observing that Parker “appeared intoxicated, or 

experiencing side effects of medication, due to showing difficulty in staying alert and 

showing slurred speech”). The ALJ acknowledged the symptoms associated with Parker’s 

pain medications, see AR at 27 (citing October 12, 2014 notes by Tardy), but did not take 

them into account in determining Parker’s functional limitations, concluding that these side 

effects could be avoided. This finding was not supported by substantial evidence, as 

discussed above.

Finally, the ALJ found that the GAF of 45 assigned by Tardy on December 18, 2013, see 

id. at 1318, did not accurately reflect Parker’s ability to function because Tardy noted elsewhere 

in the assessment that Parker was able to schedule her own doctor appointments, take care of her 

hygiene and grooming and go to church; the ALJ also noted that Parker was “encouraged to” take 

college classes and participate in therapy. See id. at 27. The Court finds that these are not 

specific and legitimate reasons for rejecting the opinions of Tardy and Dr. Harris in the RFC 

Questionnaire signed by Dr. Harris on June 17, 2014. First, the comments in Tardy’s assessment 

about the activities the ALJ cites shed little light on Parker’s functional limitations. For example, 

Tardy notes only that it “would be good for Parker’s mental health” if she took college classes –

not that Parker actually enrolled in classes or that she was likely to be able to attend them. See id.

at 1326. Likewise, there are no details in the assessment about how often Parker attended church 

or how long she remained there and it is unclear how her attending church shows that her 

functional abilities are greater than stated in the assessment. Nor does the ALJ explain why a

recommendation that Parker participate in therapy supports the conclusion that Tardy and Dr. 

Harris have exaggerated Parker’s functional limitations rather than supporting the opposite 

conclusion. 

The ALJ also fails to address the notes in the assessment that do support Tardy and Dr. 

Harris’s opinions about Parker’s functional limitations, including a comment that Parker “often 

experiences symptoms of panic attacks, difficulty sleeping, loss of appetite, feelings of 

worthlessness, loss of energy, and diminished ability to concentrate.” Id. at 1326. Tardy further 

notes that Parker “isolates herself when overwhelmed and finds difficulty in completing projects 

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or activities she wants to pursue . . . .” Id. In addition, Tardy states that Parker “often finds 

herself depending on others to assist her” and has “difficulty with employment and maintaining 

housing” due to her symptoms. Id. The ALJ does not address these notes, again citing selectively 

from the treatment records to support his conclusion. 

For these reasons, the Court finds that the ALJ failed to provide specific and legitimate 

reasons supported by substantial evidence for rejecting the opinions of Tardy and Dr. Harris with 

respect to Parker’s mental limitations, which are more severe than is reflected in the ALJ’s RFC.

G. Remedy 

Once a district court has determined that an ALJ has erred, the court must decide whether 

to remand for further proceedings or to remand for immediate award of benefits. Harman v. Apfel, 

211 F.3d 1172, 1177–78 (9th Cir. 2000). As a general rule, reversal of the Commissioner’s 

decision results in remand for further proceedings, but a court may remand for award of benefits in 

“‘rare circumstances,’ . . . ‘where no useful purpose would be served by further administrative 

proceedings and the record has been thoroughly developed.’” Treichler v. Comm'r of Soc. Sec. 

Admin., 775 F.3d 1090, 1100 (9th Cir. 2014) (quoting Moisa v. Barnhart, 367 F.3d 882, 886 (9th 

Cir. 2004) and Hill v. Astrue, 698 F.3d 1153, 1162 (9th Cir. 2012) (internal quotation marks 

omitted)). A court may remand for award of benefits under the credit-as true rule if all of the 

following requirements are satisfied: “(1) the ALJ has failed to provide legally sufficient reasons 

for rejecting such evidence, (2) there are no outstanding issues that must be resolved before a 

determination of disability can be made, and (3) it is clear from the record that the ALJ would be 

required to find the claimant disabled were such evidence credited.” Harman, 211 F.3d at 1178. 

In Treichler, the Ninth Circuit explained that in determining whether the second requirement is 

satisfied, courts should consider whether further proceedings would be useful to develop the 

record or resolve conflicts or ambiguities in the evidence. 775 F.3d at 1101.

The Court finds that all three requirements of the credit-as-true rule are satisfied in this 

case. First, the ALJ failed to provide legally sufficient reasons supported by substantial evidence

for rejecting opinions of treating physicians Drs. Rasheed and Khetrapal about the limitations 

associated with Parker’s physical impairments. These treating physicians agreed that Parker was 

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limited to less than sedentary work due to her chronic pain, and Dr. Khetrapal opined that Parker 

would miss more than three days of work every month. The ALJ also did not offer sufficient 

reasons supported by substantial evidence for rejecting the opinion of Dr. Harris and Clinical 

Social Worker Tardy about the limitations associated with Parker’s mental impairments, including 

their opinions about the side-effects of Parker’s pain medications, that Parker would miss four or 

more days a month of work and would be off task twenty percent of the time. The Court finds that 

there are no outstanding issues that need to be resolved on remand and that further proceedings are 

not required to resolve ambiguities in the evidence. Further, the VE’s testimony at the hearing 

establishes that with the limitations found by these treatment providers, if credited as true, Parker

cannot perform any of the jobs identified by the ALJ and therefore, that she should be found

disabled at Steps Four and Five.

9

 The Court therefore concludes that it is appropriate to remand 

for award of benefits under the credit-as-true rule.

IV. CONCLUSION

For the reasons stated above, the Court GRANTS Plaintiff’s motion for summary 

judgment, DENIES Defendant’s motion for summary judgment and remands to the Social 

Security Administration for award of benefits.

IT IS SO ORDERED.

Dated: September 18, 2019

______________________________________

JOSEPH C. SPERO

Chief Magistrate Judge

 

9 Because the Court find that a finding of disability is required based on Parker’s RFC, it does not 

address whether Parker has also established that she is disabled at Step Three because her 

impairments meet or equal a Listing.

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