Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-4_17-cv-06433/USCOURTS-cand-4_17-cv-06433-6/pdf.json

Nature of Suit Code: 865
Nature of Suit: Social Security - RSI (405(g))
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

KERRI JOHNSON,

Plaintiff,

v.

NANCY A. BERRYHILL,

Defendant.

Case No. 4:17-cv-06433-KAW 

ORDER GRANTING PLAINTIFF'S 

MOTION FOR SUMMARY 

JUDGMENT; ORDER DENYING 

DEFENDANT'S CROSS-MOTION FOR 

SUMMARY JUDGMENT

Re: Dkt. Nos. 23, 30

Plaintiff Kerri Johnson seeks judicial review, pursuant to 42 U.S.C. § 405(g), of the 

Commissioner’s final decision, and the remand of this case for payment of benefits, or, in the 

alternative, for further proceedings.

Pending before the Court is Plaintiff’s motion for summary judgment and Defendant’s 

cross-motion for summary judgment. Having considered the papers filed by the parties, and for 

the reasons set forth below, the Court GRANTS Plaintiff’s motion for summary judgment, and 

DENIES Defendant’s cross-motion for summary judgment. 

I. BACKGROUND

On November 3, 2014, Plaintiff protectively filed an application for social security 

disability benefits under Title II of the Social Security Act, with an alleged onset date of March 

28, 2014. Administrative Record (“AR”) 15. The claim was denied on April 1, 2015. AR 82-86. 

A request for reconsideration was filed on April 21, 2015. AR 113. That request was denied on 

August 4, 2015. AR 15; 114-118. On September 17, 2015, Plaintiff filed a written request for 

review of decision hearing. AR 119-33. A hearing was held before Administrative Law Judge 

(“ALJ”) Robert Milton Erickson on January 10, 2017. AR 15-29. At the hearing, Kweli Amusa, a 

medical expert, and Jose Chaparro, a vocational expert, testified. AR 15. 

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Plaintiff is fifty-six years old, and has a high school education. AR 27. Plaintiff has not 

been engaged in substantial gainful activity since March 2014, and resides with her teenage son. 

AR 20. At the hearing, Plaintiff testified that she had previously worked as a restaurant server.

AR 27, 60, 63.

On March 7, 2013, Plaintiff, recently diagnosed with pancreatitis, presented for a reevaluation and recommendations for abdominal pain with nausea and vomiting. AR 341. She 

reported that her pain interfered with her ability to sleep during the night and that the pain 

medications gave her minimal improvement. Id. She reported consuming alcohol four-to-five

nights per week to help with sleep. Id. On examination, she had epigastric tenderness with deep 

palpation. AR 342. Her chronic pancreatitis was likely to remain chronic, and Methadone, 

Gabapentin, Norco, and Tramadol medications were prescribed for pain. Id.

On May 16, 2013, Plaintiff presented to UCSF Medical Center for an appointment with 

Amy Smolinski, NP. AR 347. Plaintiff had been diagnosed with hepatitis C virus as a young adult,

but had never received treatment. AR 348. She had multiple emergency room visits due to her 

diagnosis of pancreatitis, which caused abdominal pain, nausea, and vomiting. Id. On exam, she 

was tearful and appeared to be in pain with changing positions. AR 348. She reported sleep 

disturbance, dysphoric mood, and agitation, and she was noted to be nervous and anxious during 

the appointment. Id. Nurse Smolinski assessed chronic neck and back pain; chronic pancreatitis; 

depression and anxiety; hypertension; hepatitis C virus for 30 years; hyperlipidemia; brain lesion 

at pineal gland; and skin and nail alterations. AR 349.

On August 30, 2013, Plaintiff presented to USCF for an evaluation of abdominal pain and 

saw Derrick Y. Siao, M.D. AR 355. She had constant mid-epigastric pain and rectal prolapse due 

to constipation side effects of pain medications. Id. Previous CT scans showed findings consistent 

with mild chronic pancreatitis and an upper endoscopy showed mild gastritis. AR 357. A referral 

was made for pain management and consideration for invasive options, such as celiac plexus block 

or possible sphincterotomy. AR 358. 

On September 20, 2013, Plaintiff reported to Nurse Smolinski that her pain had worsened 

in the last months, appeared to be in distress, and was tearful at times during the appointment. AR 

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358.

On November 8, 2013, Plaintiff followed up for pain management with anesthesiologist 

George William Pasvankas, M.D. AR 360. She had recently been discharged from the hospital due 

to acute-on-chronic pancreatitis, at which time her medications were increased, but she reported 

minimal benefit to the pain medications. Id. CT Abdomen/Pelvis scans showed acute pancreatitis 

involving the pancreatic head with associated fluid in the pancreaticoduodenal groove and reactive 

inflammation of the adjacent duodenum and hepatic flexure. Id. Dr. Pasvankas noted that her 

pancreatitis was beyond the acute phase and it would be reasonable to convert 70% of her opioid 

medication to chronic form. AR 365. Her Methadone was increased to 10 mg and her Oxycodone 

was decreased to 120 mg. Id. On the same day, cervical epidural steroid injection was 

administered for neck pain. Id.

On January 27, 2014, Plaintiff presented to UCSF for abdominal pain. AR 373. She 

reported a constant, sharp epigastric discomfort, which radiated diffusely and was occasionally 

severe enough that she could not stand up straight. AR 374. Oxycodone helped her pain, but it 

made her constipated, which caused rectal prolapse. Id. She reported that she had stopped 

drinking, despite having a history of drinking 6-9 alcoholic beverages per week. Id. On 

examination, she had diffuse tenderness. AR 375. Assessment included history of hepatitis C 

without cirrhosis, neck and back pain on narcotics, constipation, depression, and epigastric 

abdominal pain. AR 376. Gabapentin was increased for pain. Id.

On May 7, 2014, Plaintiff reported severe epigastric abdominal pain, which had worsened 

in the previous weeks. AR 389. She reported that Methadone and Oxycodone were only helpful 

for 45 minutes and Lyrica made her feel unsteady. Id. She had recently fallen down the stairs and 

cut her left leg and wanted to stop Lyrica and restart the Gabapentin Id. She reported continued 

worry about her memory problems, and was tearful during her appointment. Id. Assessment 

included chronic pancreatitis with strong pain, anxiety and depression, chronic neck and back 

pain, knee pain with complete medial meniscus tear, bilateral epicondylitis, hepatitis C virus, and 

chronic constipation and rectal problems. AR 390.

On June 10, 2014, Plaintiff presented to UCSF for an appointment with Dr. Singh for 

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chronic pancreatitis. AR 393. She had constant, dull epigastric pain for more than two years. Id. 

She had failed a trial of neuropathic medications and pancreatic enzymes. AR 394. A recent celiac 

plexus block was administered for pain relief, but it did not improve her symptoms. Id. Her 

abdominal pain was constant, sharp, and radiated diffusely, which was occasionally so severe that 

she could not stand up straight. Id. On June 27, 2014, Plaintiff reported no improvement in pain 

control, despite increasing her dose of medications. AR 397. She appeared distressed, frustrated, 

and in pain at her appointment. Id.

On June 27, 2014 and July 30, 2014, Nurse Smolinski noted mild cognitive impairment 

and chronic pancreatitis with strong pain. AR 397-99. 

On August 29, 2014, Plaintiff was admitted to UCSF Medical Center due to acute-onchronic pancreatitis. AR 285. She reported cramping, mid-epigastric abdominal pain, nausea, and 

vomiting and she did not respond to her prescribed pain medications. AR 286. Plaintiff’s 

pancreatitis flare was much worse than the flares she had previously. Id. Diagnoses were acute-onchronic pancreatitis, elevated aminotransferases, hypertriglyceridemia, depression, and 

hypertension. AR 287. She was discharged on August 31, 2014. AR 286.

On October 1, 2014, Plaintiff followed up with Nurse Smolinski. AR 316. Plaintiff’s right 

abdominal pain had returned, which she characterized as “very strong,” daily, abdominal pain Id.

She used an extra 30 mg of morphine 4-8 times last month for severe pain. Id. Plaintiff was also 

taking Zofran every 1-2 days to help with nausea and vomiting. Id.

On November 25, 2014, Plaintiff was evaluated by Andrew Posselt, M.D. to determine

whether she was a candidate for a potential total pancreatectomy to treat her chronic pancreatitis. 

AR 412-15. Sphincterotomy and/or stent placement, as well as laparoscopic cholecystectomy and 

total pancreatectomy with transplantation were discussed for surgical intervention. AR 415. Dr. 

Posselt referred Plaintiff to another doctor for further evaluation. Id.

On February 6, 2015, Nurse Smolinski noted that Plaintiff had abdominal bloating and her 

abdomen was distended with a girth of 38 inches. AR 446. She had bilateral ankle swelling, which 

fully resolved within a few days. Id. Assessment was chronic abdominal pain, most likely related 

to chronic pancreatitis with a recent pancreatic duct stent removal. AR 447. Plaintiff was 

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prescribed MS Contin 60 mg, three times daily; Oxycodone 15 mg, every 2 hours; and Gabapentin 

300 mg for pain. Id.

On February 12, 2015, Plaintiff underwent an internal medicine consultative evaluation 

with Rose Lewis, M.D. AR 433-38. Plaintiff reported that in January 2013 she developed 

pancreatitis, which was not alcohol induced. AR 435. She reported a great deal of abdominal pain 

as well as bloating, but no nausea or vomiting. Id. There was no etiology as to the reason for the 

pancreatitis, which was recurrent. Id. She reported going to a pain management clinic for back and 

neck pain, and her treatment had included steroid injections. Id. Plaintiff had a lumbar 

laminectomy in 2006 for degenerative disc disease, and was involved in a motor vehicle accident 

in 2009, which caused subsequent pain in her neck and lower back. Id. Plaintiff reported that she 

could stand, walk, and climb a flight of stairs without difficulty. Id. The claimant reported wearing 

an elastic support on her right knee and noted that her knee frequently swelled. Id. She gave a 

history of a torn medial meniscus, but said surgery had been delayed because of her pancreatitis. 

Id. Plaintiff reported being able to take care of her own personal needs, including all household 

chores, such as vacuuming, mopping, sweeping, dusting, laundry and dishes. Plaintiff reported

sleeping mostly during the day. Id. Plaintiff denied drinking alcohol or having a history of heavy 

alcohol consumption, but admitted that she smokes a half pack of cigarettes a day and has done so 

for the past 35 years. AR 436. Dr. Lewis observed Plaintiff sitting comfortably, and saw that she 

was able to get on and off the examination table without difficulty. Id. She was also able to put on 

and take off her shoes without problems. Id. The physical examination demonstrated a very 

bloated abdomen with medial hepatomegaly. Id. She was able to do tandem as well as toe and heel 

walking without difficulty. AR 437. Motor strength and sensation was intact in the bilateral upper 

and lower extremities. Id. Range of motion of the lumbar and cervical spine, as well as the right 

knee, were normal. Id. Dr. Lewis opined that Plaintiff was capable of performing medium work 

with frequent climbing, and could stand and walk up to six hours, and could sit without limitation. 

AR 438. 

On February 20, 2015, Dr. Kobashi noted that recent FibroSure testing (1/30/2015) score 

was consistent with cirrhosis of the liver. AR 448. Plaintiff continued to have abdominal swelling, 

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which had worsened in the previous two weeks. Id. On examination, she had a moderately 

distended abdomen Id. Dr. Kobashi’s diagnosed Plaintiff with chronic abdominal pain, and 

chronic hepatitis C virus. Id. Her abdominal pain was chronic and worsening. Id. Her bloating and 

abdominal pain could have been related to hepatic congestion, which could be due to hepatitis C 

cirrhosis of the liver. Id.

On April 10, 2015, Nurse Smolinski noted that Plaintiff reported baseline flares of pain

with even simple chores. AR 449. Specifically, Plaintiff reported that her pain had worsened, and 

she was now experiencing swelling in her lower extremities due to her activities of daily living, 

such as laundry and chores, as well as using stairs. Id. Her strong abdominal pain and back pain

continued. Id. On examination, her abdominal girth was 37.5 inches. AR 450. Assessment 

included chronic abdominal pain, which was most likely related to pancreatitis. Id.

On August 23, 2015, Plaintiff presented for an appointment with transplant hepatologist 

Monika Sarkar, M.D. for decompensated cirrhosis and portal hypertension management options. 

AR 815, 826. Plaintiff had newly decompensated hepatitis C virus cirrhosis, genotype 1b, and 

underwent 12 weeks of Harvoni treatment from May 22, 2015 to August 13, 2015, and her viral 

load was negative on August 14, 2015. AR 815. Plaintiff was weaned off of diuretics for her 

abdominal swelling, and her hyponatremia had resolved. Id. The Fibroscan showed cirrhosis with 

portal hypertension. AR 826. She was not a candidate for liver transplantation due to continued 

alcohol use. AR 827. Possible cholecystectomy surgery was deferred, because the surgery was too 

risky due to decompensated cirrhosis with portal hypertension. AR 826. Dr. Sarkar’s impression 

was that Plaintiff had chronic hepatitis C cirrhosis, chronic pancreatitis, and alcohol use. AR 826-

27. 

As Plaintiff’s treating medical provider, Nurse Smolinski completed a medical source 

statement on February 19, 2016, which was co-signed by Dr. Kobashi. AR 512-514. She had 

treated Plaintiff since May 2013, seeing her every one-to-three months. AR 512. Plaintiff’s 

diagnoses were chronic pancreatitis, chronic back pain, pelvic pain, hip pain, and knee pain. Id.

Nurse Smolinski noted that Plaintiff was also being seen by a pain specialist, orthopedist, liver 

specialist, and gastroenterologist. Id. Symptoms included daily abdomen, back, neck, pelvis, and 

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joint pain, fatigue, as well as nausea and vomiting. Id. Nurse Smolinski opined that Plaintiff could 

sit for a total of 4 hours out of an 8 hour work day. Id. She could stand and walk for a total of 2 

hours out of an 8 hour work day. AR 513. She could rarely lift 21-50 pounds, occasionally lift 11-

20 pounds, and frequently lift 10 pounds or less. Id. Plaintiff could occasionally bend, squat, and 

reach above shoulder level. Id. She could use her hands continuously. Id. Pain would affect her 

concentration, persistence, and pace to such an extent that it would seriously interfere with her 

ability to perform simple, routine work on a regular basis. AR 514.

On April 13, 2016, Plaintiff presented for a visit with Nurse Smolinski. AR 546. Plaintiff 

described her pancreatic pain as the same or worse. AR 546. She had continued to have swelling 

in her abdomen. Id. Plaintiff reported walking her dog in the park twice daily, which required 

walking down four flights of stairs and then walking to the park four blocks away. Id.

On August 22, 2016, Plaintiff presented for a visit with Nurse Smolinski, and reported 

having hallucinations. AR 563. Plaintiff had recent falls, and, on one occasion, thought she had 

consumed lemonade, but she had actually drank Mr. Clean cleaning liquid. Plaintiff’s severe 

abdominal pain continued and she reported two episodes of severe abdominal pain in the last 

weeks, which were worse than usual. Id. Nurse Smolinski noted diagnoses of delirium, chronic 

hepatitis C cirrhosis with portal hypertension, chronic abdominal pain, and anxiety. AR 564. 

On August 31, 2016, Nurse Smolinski noted that Plaintiff’s continued delirium could be 

related to cirrhosis, high opioid dose or her family history of early dementia. AR 567. She had 

mild elevated ammonia and mild volume loss on brain MRI. Id. She had started Lactulose, which 

was used to reduce ammonia in the blood stream due to cirrhosis. Id.

On September 7, 2016, Plaintiff presented to an appointment with neurologist Kevin 

Kennan, M.D. due to her delirium and hallucinations. AR 568. Plaintiff reported experiencing 

auditory hallucinations for the past three months, which caused her to interact with people who 

were not there, such as deceased family members and friends, and she often fell asleep in random 

places. AR 568-69. Also, she reported episodes in which she had believed she was at a campfire 

with family when was cooking in her own kitchen, and she consumed cleaning liquid on accident 

on one occasion. AR 569. On neurological examination, her auditory hallucinations and 

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fluctuations in alertness were consistent with delirium rather than neurodegenerative disorder. AR 

574. Hepatic encephalopathy was a possible diagnosis, given her elevated ammonia and anticholinergic side effects from Hydroxyzine medication. Id. Dr. Keenan wrote an Attestation and 

noted that Plaintiff’s elevated ammonia levels and her “clinical picture” were consistent with 

hepatic encephalopathy, and her auditory hallucinations were likely a manifestation of same. AR 

575. The neurologist recommended she decrease the large amount of narcotic medications she 

was taking. Id.

On September 21, 2016, Dr. Sarkar reported new altered mental status due to 

hallucinations. AR 593. She continued to have chronic abdominal pain and bloating. Id. Since her 

last visit, Plaintiff developed hallucinations and altered mental state, which, combined with her 

sleep cycle reversal, was consistent with hepatic encephalopathy. Id. 

On December 12, 2016, Nurse Smolinski completed a second medical source statement. 

AR 522-24. Nurse Smolinski continued to see Plaintiff every one-to-three months. AR 522. Since 

her last assessment, Plaintiff had been diagnosed with cirrhosis of the liver. Id. Plaintiff continued

to have problems with concentration and poor memory related to hepatic encephalopathy for the 

previous 4-6 months. AR 524. She continued to have severe, chronic abdominal pain and she had 

frequent falls in the last 4-6 months, which had worsened. Id. Nurse Smolinski opined that 

Plaintiff Johnson could sit for a total of 8 hours out of an 8 hour work day. AR 522. She could 

stand and walk for a total of 3 hours out of an 8 hour work day. AR 523. She could rarely lift 11-

20 pounds and occasionally lift 10 pounds or less. Id. She could never bend, rarely squat, and 

frequently reach above shoulder level. Id. She could occasionally perform simple grasping, fine 

manipulation; occasionally use keyboard; and rarely perform forceful grasping and pushing and 

pulling. Id. She had weakness in her hands due to encephalopathy. AR 524. Nurse Smolinski 

opined that pain would affect Plaintiff’s concentration, persistence, and pace to such an extent that 

it would seriously interfere with her ability to perform simple, routine work on a regular basis. Id.

Nurse Smolinski further incorporated her progress notes from the December 12, 2016 clinic visit, 

which provided that Plaintiff reported more swelling in her legs recently, and that her neck and 

back pain flares have limited her mobility by making it more difficult to climb stairs and complete 

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household tasks, such as laundry. AR 525. Plaintiff reported that steroid injections help with the 

pain, but that she is only able to get them every three months, and the relief only lasts for 

approximately six weeks. Id.

An unfavorable decision was issued on May 17, 2017. AR 15-29. A request for review of 

the hearing decision was filed with the Appeals Council on May 23, 2017. AR 170-71. On 

October 4, 2017, the Appeals Council denied Plaintiff's request for review. AR 1-6. On 

November 3, 2017, Plaintiff commenced this action for judicial review pursuant to 42 U.S.C. 

§405(g). (Compl., Dkt. No. 1.)

On April 25, 2018, Plaintiff filed a motion for summary judgment. (Pl.'s Mot., Dkt. No. 

23.) On June 29, 2018, Defendant filed an opposition and cross-motion for summary judgment. 

(Def.'s Opp'n, Dkt. No. 30.) No reply was filed, so the motion is fully briefed.

II. LEGAL STANDARD

A court may reverse the Commissioner’s denial of disability benefits only when the 

Commissioner's findings are 1) based on legal error or 2) are not supported by substantial 

evidence in the record as a whole. 42 U.S.C. § 405(g); Tackett v. Apfel, 180 F.3d 1094, 1097 

(9th Cir. 1999). Substantial evidence is “more than a mere scintilla but less than a 

preponderance”; it is “such relevant evidence as a reasonable mind might accept as adequate to 

support a conclusion.” Id. at 1098; Smolen v. Chater, 80 F.3d 1273, 1279 (9th Cir. 1996). In 

determining whether the Commissioner's findings are supported by substantial evidence, the 

Court must consider the evidence as a whole, weighing both the evidence that supports and the 

evidence that detracts from the Commissioner's conclusion. Id. “Where evidence is susceptible 

to more than one rational interpretation, the ALJ's decision should be upheld.” Ryan v. Comm'r 

of Soc. Sec., 528 F.3d 1194, 1198 (9th Cir. 2008).

Under Social Security Administration (“SSA”) regulations, disability claims are evaluated 

according to a five-step sequential evaluation. Reddick v. Chater, 157 F.3d 715, 721 (9th Cir. 

1998). At step one, the Commissioner determines whether a claimant is currently engaged in 

substantial gainful activity. Id. If so, the claimant is not disabled. 20 C.F.R. § 404.1520(b). At 

step two, the Commissioner determines whether the claimant has a “medically severe impairment 

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or combination of impairments,” as defined in 20 C.F.R. § 404.1520(c). Reddick, 157 F.3d 715 at 

721. If the answer is no, the claimant is not disabled. Id. If the answer is yes, the Commissioner 

proceeds to step three, and determines whether the impairment meets or equals a listed impairment 

under 20 C.F.R. § 404, Subpart P, Appendix 1. 20 C.F.R. § 404.1520(d). If this requirement is 

met, the claimant is disabled. Reddick, 157 F.3d 715 at 721. 

If a claimant does not have a condition which meets or equals a listed impairment, the 

fourth step in the sequential evaluation process is to determine the claimant's residual functional 

capacity (“RFC”) or what work, if any, the claimant is capable of performing on a sustained basis, 

despite the claimant’s impairment or impairments. 20 C.F.R. § 404.1520(e). If the claimant can 

perform such work, he is not disabled. 20 C.F.R. § 404.1520(f). RFC is the application of a legal 

standard to the medical facts concerning the claimant's physical capacity. 20 C.F.R. § 404.1545(a). 

If the claimant meets the burden of establishing an inability to perform prior work, the 

Commissioner must show, at step five, that the claimant can perform other substantial gainful 

work that exists in the national economy. Reddick, 157 F.3d 715 at 721. The claimant bears the 

burden of proof in steps one through four. Bustamante v. Massanari, 262 F.3d 949, 953-954 (9th 

Cir. 2001). The burden shifts to the Commissioner in step five. Id. at 954. 

III. THE ALJ’S DECISION

As an initial matter, the ALJ found that Plaintiff met the insured status requirements of the 

Social Security Act as of December 31, 2018. AR 17. 

The ALJ found at step one that Plaintiff had not engaged in substantial gainful activity 

since March 28, 2014, the alleged onset date. AR 17. 

At step two, the ALJ found that Plaintiff had the following severe impairments: 

pancreatitis, degenerative disc disease of the lumbar and cervical spine, degenerative joint disease 

of the right knee, hepatitis C, gallstones, depression, anxiety, alcohol, and opioid abuse. AR 17. 

At step three, the ALJ concluded that Plaintiff did not have an impairment or combination 

of impairments that met or medically equaled a listed impairment in 20 C.F.R. § 404, Subpart P, 

Appendix 1. AR 18. 

Before considering step four, the ALJ determined that Plaintiff has the residual functional 

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capacity to perform medium work, as defined in 20 C.F.R. § 404.1567(c), with the following 

modifications: she can stand or walk for six hours in an eight-hour workday; there are no 

restrictions in sitting; she “can perform no more than frequent climbing of any kind;” she is 

capable of constant, simple repetitive tasks, but only occasional detailed tasks; and she has no 

restrictions in interacting with the public, coworkers or supervisors. AR 19. 

At step four, the ALJ concluded that Plaintiff was unable to perform any past relevant 

work. AR 27. Lastly, at step five, the ALJ concluded that there were jobs that exist in significant 

numbers in the national economy that Plaintiff could perform, such that she was not disabled for 

the purposes of the Social Security Act. AR 28.

IV. DISCUSSION

In her motion for summary judgment, Plaintiff argues that the ALJ erred in denying her 

application for social security benefits and that the case should be remanded for payment of 

benefits or, alternatively, for further proceedings, for three reasons: 1) the ALJ erred at Step Two 

by failing to include Cirrhosis of the Liver and Hepatic Encephalopathy among Plaintiff’s severe 

impairments; 2) the ALJ erred by assigning more weight to the opinion of the non-examining state 

consultants and examining consultants than that of the plaintiff’s treating nurse practitioner, Amy 

Smolinski, NP; and 3) the ALJ erred in discrediting and ignoring the evidence in the treatment 

notes and selectively relying on records indicating improvement and relatively intact daily 

activities. (Pl.’s Mot. at 4.)

A. The ALJ may have erred by failing to include Cirrhosis of the Liver and 

Hepatic Encephalopathy among Plaintiff’s severe impairments.

The ALJ found that the medical evidence established that Plaintiff had limitations in her 

capacity to perform basic work activities due to her severe physical and mental impairments, 

which included pancreatitis, degenerative disc disease of the lumbar and cervical spine,

degenerative joint disease of the right knee, hepatitis C, gallstones, depression, anxiety, as well as 

alcohol and opioid abuse. AR 17.

Plaintiff contends that the ALJ erred by failing to include Cirrhosis of the Liver and 

Hepatic Encephalopathy as severe impairments. (Pl.’s Mot. at 15.) Defendant argues that “the

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relevant question is not whether the ALJ should have found Plaintiff’s cirrhosis and hepatic 

encephalopathy to be severe, but instead whether the RFC determination was supported by 

substantial evidence.” (Def.’s Opp’n at 2.)

Ignoring medical evidence of other impairments without providing any reason for doing so 

is legal error. Smolen v. Chater, 80 F.3d 1273, 1282 (9th Cir. 1996) (citing Cotton v. Bowen, 799 

F.2d 1403, 1408-09 (9th Cir. 1986)(legal error where ALJ's findings completely ignore medical 

evidence without giving specific, legitimate reasons for doing so)). While the ALJ is supposed to 

consider all of the claimant’s impairments, including severe and non-severe impairments, any 

omission at step two is harmless if the limitations posed by the impairment are considered at step 

four, which requires a residual functional capacity (“RFC”) assessment that includes all of the 

claimants impairments. Lewis v. Astrue, 498 F.3d 909, 911 (9th Cir. 2007)

Defendant contends that the ALJ considered Dr. Amusa’s testimony at the hearing, which 

specifically addressed cirrhosis and encephalopathy. (Def.’s Opp’n at 2)(citing AR 55-58.) While 

the ALJ noted that it was Dr. Amusa’s opinion that Plaintiff has mild cirrhosis in connection with 

Hepatitis C, the ALJ gave her opinion little weight. AR 24. Also, despite generally citing to 

Exhibit 12F, where cirrhosis was noted in the treatment records, the ALJ does not mention 

cirrhosis outside of his acknowledgement of Dr. Amusa’s opinion. See AR 23-24, 804, 809. 

Instead, the ALJ appears to be using hepatitis C and cirrhosis interchangeably, and vaguely refers 

to Plaintiff as having “liver disease.” AR 21, 23. Even though Dr. Amusa’s opinion was afforded 

little weight, she testified that Plaintiff’s mild cirrhosis resulted in swelling in Plaintiff’s lower 

extremities, which was currently being treated with diuretics. AR 55. At the time of the hearing, 

Plaintiff continued to experience swelling despite her viral load from hepatitis C being otherwise 

undetectable. See AR 27, 55, 69. She specifically testified that she experienced “incredibly 

painful” flareups in her legs every three months. AR 69.

In supporting the residual functional capacity (“RFC”) assessment, the ALJ concluded that 

Plaintiff had “intact gait” and “normal sensation and strength in the upper and lower extremities.” 

AR 27. The ALJ acknowledged that Plaintiff was taking diuretics at the time of the hearing, on 

January 10, 2017, despite having also concluded that the swelling in her left leg had resolved in 

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2015. AR 20, 23. As a result, the ALJ did not address what effect, if any, Plaintiff’s remaining 

swelling in her lower extremities due to cirrhosis, even if managed with diuretics, had on her 

residual functional capacity.

The ALJ similarly fails to mention hepatic encephalopathy, which was noted in Nurse 

Smolinkski’s notes, as well as in the notes of Drs. Keegan and Sarkar. AR 526, 575, 593. While 

this was also briefly addressed in Dr. Amusa’s testimony, the ALJ did not address what effect, if 

any, this condition had on Plaintiff’s RFC.

Accordingly, the ALJ’s failure to address these two impairments requires that the case be 

remanded for further proceedings, and the Commissioner must consider Plaintiff’s cirrhosis 

diagnosis, and the resulting symptoms, as well as hepatic encephalopathy in determining whether 

they qualify as severe impairments at step two, and to what extent the attendant symptoms affect 

her RFC.

B. The ALJ erred by assigning more weight to the opinion of non-examining sources 

and an examining consultant than to Plaintiff’s treating nurse practitioner.

The opinions of treating medical sources may be rejected only for clear and convincing 

reasons if not contradicted by another doctor. Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995). 

Where the record contains conflicting medical evidence, the ALJ must make a credibility 

determination and resolve the conflict. Chaudhry v. Astrue, 688 F.3d 661, 671 (9th Cir. 2012) 

(quoting Benton v. Barnhart, 331 F.3d 1030, 1040 (9th Cir. 2003)). “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). “The ALJ need not accept the opinion of any 

physician, including a treating physician, if that opinion is brief, conclusory, and inadequately 

supported by clinical findings.” Bray v. Comm'r of Soc. Sec. Admin., 554 F.3d 1219, 1228 (9th 

Cir. 2009) (citations omitted).

A nurse practitioner, however, is an “other” medical source, which requires the ALJ to 

provide germane reasons to discount the medical opinion of a treating nurse practitioner. Popa v. 

Berryhill, 872 F.3d 901, 906 (9th Cir. 2017) (citing Molina v. Astrue, 674 F.3d 1104, 1111 (9th 

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Cir. 2012)).

Here, Plaintiff argues that the ALJ did not provide clear and convincing reasons for 

preferring the opinion of the examining state consultants and non-examining state consultants over 

the opinions of Plaintiff’s treating nurse practitioner Amy Smolinski. (Pl.’s Mot. at 21.) In 

opposition, Defendant contends that the ALJ properly rejected Nurse Smolinski’s medical 

opinions. (Def.’s Opp’n at 4.) The Court disagrees.

In the hearing decision, the ALJ explains that he assigned little weight to the medical 

source statement of Nurse Smolinski and Dr. Kobashi because it was “inconsistent with the 

claimant's admitted ability to walk well,” and her activities of daily living. AR 25. The statement 

was also discounted because it did not describe how Plaintiff’s alcohol consumption contributed to 

the described limitations. Id. The ALJ then assigned no weight to Nurse Smolinski’s December 

2016 medical source statement because the restrictions noted were more severe, and “she did not 

explain the change in her opinion that was proffered 10 months prior.” Id. Here, the ALJ erred for 

three reasons. First, the ALJ did not acknowledge that Nurse Smolinski was Plaintiff’s primary 

care provider, who saw her every one-to-three months, and provided four years of progress notes. 

See AR 512. Second, while Plaintiff was counseled not to consume any alcohol, by the time of the 

source statements and the hearing, Plaintiff was, on average, consuming one alcoholic beverage 

per week. AR 49, 526. While alcohol should not be consumed by those with liver problems, the 

fact that the source statements did not address her de minimus alcohol consumption appears, at 

first blush, to be trivial. 

Third, Nurse Smolinski explained in the December 12, 2016 medical source statement, and 

the incorporated treatment notes from the same date, show that Plaintiff’s condition had worsened. 

For example, Nurse Smolinski noted that Plaintiff continued to experience severe, chronic 

abdominal pain and that she had begun experiencing frequent falls since the prior source 

statement. AR 524. Furthermore, Plaintiff was now experiencing weakness in her hands due to 

encephalopathy, which adversely affected her fine motor skills. AR 524. Nurse Smolinski’s 

incorporated progress notes provided that Plaintiff reported more swelling in her legs recently, and 

that her neck and back pain flares have limited her mobility by making it more difficult to climb 

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stairs and complete household tasks, such as laundry. AR 525. Thus, the ALJ’s statement that 

Nurse Smolinski did not explain her rationale for the additional restrictions is inaccurate, and, 

therefore, is not a germane reason to discount her opinion.

On February 12, 2015, Dr. Lewis performed a consultative, internal medicine examination, 

which was afforded great weight because it was “well supported by the objective medical evidence 

that demonstrates mild pancreatitis, her undetectable hepatitis C viral load after treatment, the 

resolved lower extremity edema, her normal gait, intact strength in the upper and lower 

extremities, the fact that her pain is well controlled with medication and the extent of the 

claimant's activities of daily living.” AR 25. Based on the entire administrative record, however, 

Plaintiff’s condition appears to have worsened since Dr. Lewis’s consultative evaluation. See 

generally Background, supra, Part I. The ALJ does not acknowledge this fact. Rather, he notes 

that Plaintiff’s activities of daily living suggest that she is more capable than opined by her 

treating medical provider. AR 25.

Thus, the Court finds that the ALJ’s failure to properly consider Nurse Smolinski’s opinion 

regarding Plaintiff’s condition and RFC is not harmless, since a reasonable ALJ, when fully 

crediting her opinion, could have reached a different disability determination. See Zimmerman v. 

Colvin, 628 Fed. Appx. 556, 557 (9th Cir. 2016). Accordingly, the case must be remanded at step 

three for further proceedings. 

C. The ALJ erred in discrediting and ignoring the evidence in the treatment notes 

and selectively relying on records indicating improvement and relatively intact 

daily activities.

Plaintiff argues that the ALJ erred in discrediting and ignoring the medical evidence that 

showed that her condition worsened. (Pl.’s Mot. at 23.) Instead, the ALJ discounted Plaintiff’s 

subjective complaints, finding them not credible based on her activities of daily living. (Pl.’s Mot. 

at 26.) Defendant contends the ALJ properly evaluated the medical evidence and made the 

determination that Plaintiff’s alleged limitations were not credible. (Def.’s Opp’n at 6-7.)

As discussed above, the ALJ did not properly consider the medical evidence provided after 

Dr. Lewis’s consultative evaluation, which tended to show that Plaintiff’s condition had worsened, 

including the medical source statements from Nurse Smolinski. See discussion, supra, Part IV.B.

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Accordingly, the Court need not address this argument further, as the case is subject to 

remand for further proceedings on other grounds. Notwithstanding, the ALJ’s contention that 

Plaintiff’s ability to attend her son’s baseball games is somehow inconsistent with her alleged 

limitations is unavailing, as the medical record provides that she is capable of sitting for extended 

periods of time. 

V. CONCLUSION

For the reasons set forth above, Plaintiff’s motion for summary judgment is GRANTED, 

Defendant’s cross-motion for summary judgment is DENIED, and this action is REMANDED to 

the Commissioner pursuant to sentence four of 42 U.S.C. § 405(g), for further proceedings, 

consistent with this order. Specifically, the remand shall include a new internal medicine 

consultative evaluation, and a new administrative hearing.

The Clerk of the Court shall close this case.

IT IS SO ORDERED.

Dated: March 28, 2019

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KANDIS A. WESTMORE

United States Magistrate Judge

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