Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_13-cv-01531/USCOURTS-azd-2_13-cv-01531-0/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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WO 

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Mary E. Koriel, 

Plaintiff, 

v. 

Carolyn W. Colvin, 

Defendant. 

No. CV-13-01531-PHX-BSB

ORDER 

 Mary E. Koriel (Plaintiff) seeks judicial review of the final decision of the 

Commissioner of Social Security (the Commissioner) denying her application for benefits 

under the Social Security Act (the Act). The parties have consented to proceed before a 

United States Magistrate Judge pursuant to 28 U.S.C. § 636(b), and have filed briefs in 

accordance with Local Rule of Civil Procedure 16.1. For the following reasons, the 

Court reverses the Commissioner’s decision and remands for benefits. 

I. Procedural Background 

 On August 26, 2009, Plaintiff applied for supplemental security income under 

Title XVI of the Act. (Tr. 231-39.)1

 Plaintiff alleged that she had been disabled since 

January 1, 2003. (Id.) Plaintiff later amended her disability onset date to August 14, 

2009. (Tr. 25.) After the Social Security Administration (SSA) denied Plaintiff’s initial 

application and her request for reconsideration, she requested a hearing before an 

 

1

 Citations to “Tr.” are to the certified administrative transcript of record. (Doc. 19.) 

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administrative law judge (ALJ). After conducting a hearing, the ALJ issued a decision 

finding Plaintiff not disabled under the Act. (Tr. 25-34.) This decision became the final 

decision of the Commissioner when the Social Security Administration Appeals Council 

denied Plaintiff’s request for review. (Tr. 1-6); see 20 C.F.R. § 404.981 (explaining the 

effect of a disposition by the Appeals Council). Plaintiff now seeks judicial review of 

this decision pursuant to 42 U.S.C. § 405(g). 

II. Medical Record 

 The record before the Court establishes the following history of diagnosis and 

treatment related to Plaintiff’s health. The record also includes a lay opinion and 

opinions from state agency physicians who examined Plaintiff or reviewed the records 

related to her health, but who did not provide treatment. 

A. Medical Treatment 

 1. Lauren Bonner, M.D. 

On June 9, 2004, Plaintiff sought treatment from Dr. Bonner for symptoms of 

psychological disturbance. (Tr. 390-91.) Plaintiff reported that she was attending a drug 

diversion program and was taking prescribed medications secondary to intrusive 

memories of a rape. (Id.) Dr. Bonner assessed major depressive disorder, posttraumatic 

stress disorder (PTSD), opiate dependence in full remission, and somatization disorder. 

(Id.) Dr. Bonner assessed a Global Assessment of Functioning (GAF) score of 50. (Id.) 

Later that same month, Dr. Bonner assessed a GAF score of 47-48. (Tr. 384.) 

 On February 18, 2004, Plaintiff reported that she was afraid to attend counseling 

related to the drug diversion treatment because she had difficulty discussing her feelings 

with strangers. (Tr. 381.) On February 27, 2004, Dr. Bonner noted that Plaintiff 

exhibited passive behavior and symptoms of anxiety, depression, helplessness, and low 

self-esteem. (Tr. 379.) Plaintiff reported that she was paranoid, depressed, and had 

trouble sleeping. (Tr. 377.) Dr. Bonner noted that Plaintiff’s compliance with 

medication was “poor” because she had taken more than the recommended dose of 

Klonipin. (Id.) 

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 On April 12, 2004, Dr. Bonner noted that Plaintiff’s condition was not improving 

with medication. (Tr. 375-76.) On April 29, 2004, Plaintiff was tearful, irritable, and 

dysphoric. (Tr. 369-70.) Plaintiff wanted to change anti-depressant medication to try to 

reduce her symptoms. (Id.) Dr. Bonner continued to treat Plaintiff throughout 2004 for 

depression and PTSD, and a possible eating disorder. (Tr. 354-68.) She noted that 

Plaintiff often presented in a dysphoric mood, sometimes missed appointments, refused 

counseling except for a women’s group, and self-adjusted her medication. (Id.) 

 2. NOVA 

 In July 2005, a nurse practitioner (NP) at NOVA examined Plaintiff and 

confirmed a history of anxiety, panic, anger, decreased concentration, and suicidal 

ideation. (Tr. 406-08.) Plaintiff reported auditory and visual hallucinations. (Id.) 

Plaintiff presented with an agitated labile affect, and was anxious and depressed. (Id.) 

She exhibited occasional loose associations, circumstantial speech, and a sense of 

diminished worth. (Id.) The NP opined that Plaintiff had bipolar disorder and possible 

negative effects from prescribed medications. (Tr. 409-10.) 

 On October 3, 2005, Plaintiff reported daily headaches, an inability to concentrate, 

tearfulness, and a flat, anxious, and agitated affect. (Tr. 401-02.) The NP diagnosed 

Plaintiff with bipolar disorder and schizoaffective disorder. (Id.) 

 3. John Koryakos, M.D. 

 In 2004, Plaintiff began treatment with Dr. Koryakos for physical and 

psychological issues. (Tr. 493-94.) On June 24, 2004, Dr. Koryakos noted that Plaintiff 

had chronic pelvic pain, depression, insomnia, headaches, chronic lower back and hip 

pain, and gastrointestinal upset. (Id.) Dr. Koryakos continued to treat Plaintiff for these 

issues, and also noted insomnia and a possible eating disorder. (Tr. 476-92.) 

 In September 2005, Dr. Koryakos saw Plaintiff for a medication refill. (Tr. 473.) 

Plaintiff reported pain and numbness in her fingers of both hands, and tenderness in her 

lumbar paraspinal muscles. (Tr. 473.) On October 26, 2005, Dr. Koryakos noted that 

Plaintiff continued to experience insomnia, headaches, and side effects from her 

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medications. (Tr. 474.) From November 2005 through January 2006, Dr. Koryakos 

found that Plaintiff also had ongoing pelvic pain, and gastroesophagel reflux disease 

(GERD) symptoms. (Tr. 471-72.) 

 In 2006, Dr. Koryakos continued treating Plaintiff for back and neck pain, body 

pain, joint pain, hip pain, and knee pain. (Tr. 469.) Plaintiff reported tingling and 

numbness in her left leg and the tips of her fingers. (Id.) An MRI of Plaintiff’s cervical 

spine on April 5, 2006 showed “mild left neural foraminal narrowing at C5-6 secondary 

to degenerative disc disease and mild facet arthropathy.” (Tr. 509-10.) Throughout 

2006, Dr. Koryakos treated Plaintiff for pelvic and body pain, numbness and tingling in 

her left arm, insomnia, anxiety, and pain in her shoulders. (Tr. 459-68.) 

 On April 16, 2008, Dr. Koryakos treated Plaintiff for increased low back pain after 

a fall. (Tr. 453.) On May 9, 2008, Plaintiff reported diffuse pain in all of her joints. 

(Tr. 452.) She had positive trigger points in her thoracic and lumbar spine, and fatigue. 

(Id.) Dr. Koryakos “suspect[ed]” fibromyalgia. (Id.) On June 24, 2008, Dr. Koryakos 

noted that Plaintiff had stomach upset and heart palpitations from Neurontin, and noted 

that Neurontin was not controlling Plaintiff’s pain. (Tr. 449.) Plaintiff continued to 

report chronic body and joint pain. (Id.) Dr. Koryakos assessed arthralgia, myalgias, and 

“F.M.” (fibromyalgia). (Id.) 

 Laboratory tests on October 9 and November 2008 showed that Plaintiff had low 

red blood cell counts, low hemoglobin, and low hematocrit. (Tr. 498-500.) On 

November 19, 2008, Dr. Koryakos noted that Plaintiff experienced pain in her arms and 

legs, headaches, bloating, positive trigger point tenderness, and bulimia. (Tr. 448.) 

 On March 6, 2009, Dr. Koryakos treated Plaintiff for a headache that had been 

present for two weeks and was not responding to Imitrex. (Tr. 447.) Dr. Koryakos 

treated Plaintiff for headaches and body pain on April 2, May 6, and May 18, 2009. 

(Tr. 444-46.) 

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 In 2008 and 2009, Dr. Koryakos treated Plaintiff for headaches, fibromyalgia, 

bloating, abdominal pain, low iron levels, dizziness, medication side effects, upper back 

pain, GERD, and fatigue. (Tr. 517-45.) 

 In 2009, Dr. Koryakos continued treating Plaintiff for body pain, GERD, 

dizziness, balance problems, and fibromyalgia. He also noted that Plaintiff had lost her 

insurance and was having difficulty affording medication. (Tr. 713-26.) 

 In 2010 and 2011, Dr. Koryakos continued treating Plaintiff for fibromyalgia pain, 

joint pain, pelvic pain, abdominal pain, and GERD. (Tr. 882-903.) 

 4. Michael Steingart, M.D. 

 On June 5, 2006, orthopedic surgeon Dr. Steingart examined Plaintiff and noted 

that she had whole body pain, laxity in her left shoulder, and positive Tinel’s and 

Phalen’s signs in her left wrist. (Tr. 789-90.) An MRI of Plaintiff’s cervical spine on 

July 17, 2006 showed a mild disc bulge and posterior spondylytic changes at C4-5, C5-6, 

and C6-7. (Tr. 792.) The MRI also showed mild multilevel degenerative disc disease 

and loss of normal cervical lordosis with reversal of curvature centered at C5. (Id.) 

Dr. Steingart continued treating Plaintiff for left shoulder and neck pain, noting that he 

suspected a glenolabral tear in the left shoulder. (Tr. 786-87.) He noted that Plaintiff had 

anxiety disorder which prevented “invasive testing.” (Tr. 786.) Dr. Steingart prescribed 

Valium for Plaintiff to allow him to perform diagnostic tests. (Id.) A July 21, 2006 EMG 

of Plaintiff’s upper extremities revealed mild right median neuropathy at the wrist. 

(Tr. 795-96.) On December 21, 2006, Dr. Steingart treated Plaintiff for bilateral wrist 

and left shoulder pain. (Tr. 784.) 

 An arthrogram of Plaintiff’s left shoulder on March 29, 2007 was essentially 

normal. (Tr. 798-99.) An MRI that same day showed mild left acromioclavicular (AC) 

arthorsis. (Tr. 791.) On April 20, 2007, Dr. Steingart opined that Plaintiff needed 

physical therapy for her shoulder. (Tr. 780-81.) She had positive impingement signs and 

trouble lifting her left arm upwards. (Id.) 

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 5. Pattabi Kalyanam, M.D. 

 On referral from Dr. Koryakos, on June 5, 2007, Plaintiff saw neurologist 

Dr. Kalyanam at the Arizona Pain Center. (Tr. 419.) Plaintiff reported left neck pain, 

left arm pain, low back pain, and episodes of numbness and tingling. (Id.) On review of 

an MRI, Dr. Kalyanam found evidence of mild left neurforaminal narrowing of Plaintiff’s 

cervical spine, and mild facet arthropathy. (Tr. 421.) Dr. Kalyanam noted that Plaintiff 

had a diminished range of motion in her left arm due to pain, and diminished muscle 

strength and tone, and diminished deep tendon reflexes in her left arm and right leg. 

(Tr. 420.) Plaintiff had a “positive” facet joint examination bilaterally at L3, L4, L5, and 

S1. (Id.) “SI joint tenderness [was] positive bilaterally,” and trigger points were positive 

over both trapezium muscles and the upper and lower back. (Id.) Plaintiff’s hand grip 

was diminished on the left. (Id.) Plaintiff’s left arm was positive for allodynia. (Id.) 

Dr. Kalyanam opined that Plaintiff had cervical radiculopathy, left arm acromioclavicular 

arthritis, lumbar radiculopathy, and possible carpal tunnel syndrome in her left arm, and 

depression. (Tr. 420.) Dr. Kalyanam scheduled Plaintiff for cervical epidural steroid 

injections and bilateral trapezius muscle trigger point injections. (Id.) 

 6. New Arizona Family Clinic 

 From August 2008 through October 2009, Plaintiff obtained mental health 

treatment from providers at the New Arizona Family Clinic (Family Clinic) for suicidal 

ideation, anxiety, history of sexual abuse, depression, psychosis, substance abuse, and 

attention deficit hyperactivity disorder (ADHD). (Tr. 549-672.) Treatment providers 

frequently changed Plaintiff’s medications due to side effects or ineffectiveness. (Id.) 

Plaintiff reported constant suicidal ideation, decreased concentration, crying spells, and 

auditory hallucination. (Id.) She reported that she could only complete minimal 

activities of daily living. (Tr. 549-672.) On October 14, 2009 NP Nancy Mullins noted 

that Plaintiff appeared startled and was rocking back and forth in her chair. (Tr. 660.) 

Treatment notes indicate that Plaintiff continued to present with depression throughout 

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2009 and into 2010, at which point her health insurance was cancelled due to her inability 

to work. (Tr. 699-702.)

 Plaintiff continued to receive treatment for anxiety and depression at the Family 

Clinic from 2010 through May 26, 2011. (Tr. 805-11.) Treatment providers noted that 

Plaintiff was tearful, had suicidal ideation, was irritable, and had no joy in her activities. 

(Id.) 

 7. Hospitalization 

 From July 21, 2011 through August 4, 2011, Plaintiff was hospitalized for suicide 

ideation and mental health treatment. (Tr. 912-21.) At the time of admission, Plaintiff 

had symptoms of depression, poor hygiene, and was in moderate distress. (Id.) She had 

a GAF score of 45. (Tr. 920.) On discharge, Plaintiff described her mood as “good,” she 

was goal oriented, had “good concentrating ability,” denied anxiety, hallucinations, and 

delusions. (Id.) She had no suicidal ideations and had fair insight and judgment. (Id.) 

Dr. Sandra McDonald identified Plaintiff’s diagnoses as major depressive disorder, 

obsessive compulsive disorder (OCD), and borderline personality traits, and assessed a 

GAF score of 55-60. (Tr. 909.) 

B. Medical and Lay Opinion Evidence

 1. Dr. Koryakos 

On July 15, 2009, Dr. Koryakos completed a Medical Assessment of Ability to do 

Work-Related Physical Activities. (Tr. 515.) He opined that Plaintiff could sit, stand, 

and walk for two hours each in an eight-hour work day, and that she could lift less than 

ten pounds. (Id.) He identified Plaintiff’s diagnoses as chronic back and body pain, 

fibromyalgia, headaches, attention deficit disorder (ADD), anxiety, and depression. (Id.) 

On December 10, 2009, Dr. Koryakos completed another assessment of workrelated physical activities. (Tr. 696.) He opined that Plaintiff had limitations consistent 

with those he identified on July 15, 2009. (Compare Tr. 515-16 with Tr. 696-97.) 

 In June 2011, Dr. Koryakos completed another assessment of work-related 

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physical activities. (Tr. 326.) He opined that Plaintiff had limitations consistent with 

those he identified in 2009. (Compare Tr. 515-16 and Tr. 696-97 with Tr. 326-27.) 

 2. John Prieve, D.O. 

 On March 13, 2010, state agency physician Dr. Prieve examined Plaintiff for her 

application for benefits. (Tr. 728.) He noted that Plaintiff had a history of chronic pain, 

depression, and anxiety, and that she needed to change positions frequently. (Tr. 728.) 

He noted Plaintiff’s report that she dropped things due to wrist pain. (Id.) Dr. Prieve 

noted that Plaintiff had a flat affect. (Tr. 729.) He found diffuse tenderness in her spine, 

a decreased range of motion in the cervical spine, lumbar spine, and hips. (Tr. 730.) She 

had a positive response to sixteen of eighteen fibromyalgia trigger points, and positive 

Tinel’s and Phalen’s tests in her left wrist. (Tr. 731.) Dr. Prieve diagnosed fibromyalgia, 

left carpal tunnel syndrome, depression, and anxiety. (Id.) He opined that Plaintiff 

could stand or walk at least two hours, but less than six hours, in an eight-hour day (four 

hours intermittently). (Id.) He also found that Plaintiff could sit for at least two, but less 

than six hours a day (four to six intermittently), and lift up to ten pounds occasionally and 

frequently. (Tr. 731-32.) He opined that Plaintiff could occasionally climb, stoop, kneel, 

and crouch, handle, finger and feel with her left hand. (Id.) 

 3. Greg Peetoom, Ph.D. 

 On March 22, 2010, Dr. Peetoom examined Plaintiff as part of her application for 

benefits. (Tr. 734.) He noted Plaintiff’s history of depression, anxiety, difficulty 

concentrating, and ADHD. (Id.) He also noted that Plaintiff had panic attacks, had 

attempted suicide several times, and had been hospitalized for psychiatric treatment 

twice. (Id.) On examination, Plaintiff incorrectly identified the season, could not 

complete the serial seven’s test accurately, missed items during recall testing, and 

misunderstood test instructions. (Id.) She appeared drowsy and lethargic and needed 

instructions repeated. (Tr. 736.) 

 Dr. Peetoom noted that Plaintiff’s diagnoses included dysthymic disorder, 

generalized anxiety disorder, and ADHD with opioid dependency. (Id.) He opined that 

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Plaintiff had some limitations in her immediate memory, concentration, and attention. 

(Tr. 737.) He opined that Plaintiff could understand and remember simple work-related 

instructions and procedures, complete simple tasks, and interact appropriately with 

supervisors and co-workers. (Tr. 738.) He also opined that Plaintiff would have 

difficulty with more complex tasks and working consistently with the general public. 

(Id.) 

 4. Jean Goerss, M.D. 

 During the administrative proceedings, state agency physician Jean Goerss, M.D., 

reviewed the record and opined that Plaintiff retained abilities consistent with light work, 

including the ability to stand and walk for at least six hours in an eight-hour workday sit 

for about six hours in an eight-hour workday, and lift and carry twenty pounds 

occasionally and ten pounds frequently. (Tr. 763-70.) 

 5. Linda Jidou 

 For Plaintiff’s application for benefits, Plaintiff’s sister, Linda Jidou, submitted a 

Function Report describing Plaintiff’s limitations. (Tr. 328.) She stated that Plaintiff 

needed encouragement to get up and get dressed. (Id.) She described Plaintiff as being 

in constant pain, forgetful, and extremely fatigued. (Id.) Jidou indicated that Plaintiff 

preferred to be alone, had trouble sleeping, needed help with basic hygiene, and needed 

reminders to eat and shower. (Tr. 329-330.) She also noted that Plaintiff was sometimes 

too anxious to leave the house and was not motivated to perform household chores. 

(Tr. 331.) Jidou also noted that Plaintiff had difficulty lifting, standing, reaching, 

walking, sitting, remembering, completing tasks, following instructions, and getting 

along with others. (Tr. 333.) She indicated that Plaintiff was often depressed, tired, 

confused, anxious, and in a lot of pain. (Id.) 

III. Administrative Hearing Testimony 

 Plaintiff was in her early forties at the time of the administrative hearing and the 

ALJ’s decision in June 2012. (Tr. 44.) She had an eleventh grade education and past 

relevant work as a waitress. (Id.) Plaintiff testified that she had panic attacks and 

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sometimes had to pull over when she was driving to wait for the attacks to pass. (Tr. 50.) 

Plaintiff reported that near the end of her last job she was often absent due to depression 

and anxiety. (Tr. 51.) She stated that getting out of bed, getting dressed, and trying to 

talk to people about finding work caused too much anxiety. (Tr. 52.) Plaintiff also 

testified that she had pain from fibromyalgia, carpal tunnel syndrome, and other 

impairments. (Tr. 53.) She had radiating pain, migraines, and daily tension headaches. 

(Id.) Plaintiff testified that she had difficulty getting out of bed due to pain and 

depression, and that she preferred to be left alone. (Tr. 58.) She avoided grocery 

shopping because she felt like others were staring at her or talking about her. (Id.) This 

feeling had caused her to abruptly leave the store. (Tr. 59.) She also testified that she 

had carpal tunnel syndrome in her left hand, which caused a tendency to drop things. 

(Tr. 65.) 

 Plaintiff estimated that she could sit for about thirty minutes at a time, and stand or 

walk for ten minutes at a time. (Tr. 67.) She could lift a gallon of milk with her right 

hand. (Tr. 68.) Plaintiff was afraid to leave home because of her anxiety. (Tr. 69-71.) 

She napped throughout the day and was uncomfortable in any position. (Tr. 75-76.) She 

had trouble concentrating because her mind raced. (Tr. 72.) Plaintiff was afraid to return 

phone calls, did not socialize, and sometimes did not shower. (Tr. 73.) Plaintiff testified 

that she did not care if she lived or died. (Tr. 75.) 

 Vocational expert Ms. Tolly testified at the administrative hearing.2

 (Tr. 79.) She 

identified Plaintiff’s past relevant work as a waitress. (Id.) In response to a question 

from the ALJ, she testified that an individual with the limitations identified by 

Dr. Koryakos, who could sit or stand for two hours in an eight-hour work day, could not 

maintain competitive employment. (Tr. 80-81.) 

 The ALJ also asked the vocational expert to consider a person with limitations 

identified by Dr. Goerss, with a light exertional level, and with the ability to lift ten 

 

2

 The vocational expert’s first name does not appear in the transcript of the administrative hearing. (Tr. 41-103.) 

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pounds occasionally and frequently with the left hand, and ten pounds frequently and 

twenty pounds occasionally with the right hand, occasionally climb ramps and stairs, 

frequently balance, stoop, kneel, crouch and crawl, unlimited reaching and feeling, 

unlimited handling and fingering with the right hand and occasional handling and 

fingering with the left hand, who must avoid concentrated exposure to hazards, and was 

limited to simple, routine, repetitive task, a low stress position (occasional decision 

making and changes in the work setting), and occasional contact with the public. (Tr. 81-

82.) In response, the vocational expert testified that a person with those limitations could 

perform the positions of parking lot attendant, photocopy machine operator, and ticket 

seller. (Tr. 83.) 

 On further questioning, the vocational expert testified that a person with those 

limitations would not be able to perform the job of ticket seller because of the limitation 

to occasional public contact. Therefore, the vocational expert substituted the position of 

night guard for ticket seller, noting that this position was available in reduced numbers. 

(Tr. 85.) In response to questions from Plaintiff’s attorney, the vocational expert testified 

that the job of parking lot attendant would require “occasional to frequent” public 

contact. (Tr. 87-88.) The vocational expert testified that the occupations of night guard 

and apparel stock checker would be more appropriate; however, the job of apparel stock 

checker would require “occasional to frequent” handling with the non-dominant hand. 

(Tr. 88-89.) The vocational expert testified that the position of photocopying machine 

operator could involve frequent contact with the public depending on the type of 

business, and testified that the job would be available in reduced numbers for someone 

who was limited to occasional public contact.3

 (Tr. 91-92.) 

 The vocational expert testified that if an individual had to leave work several times 

a week due to panic attacks, that person would not be able to maintain sustained work. 

(Tr. 97-98.) She also testified that a person generally could not be absent more than one 

 

3

 When asked, “Okay, you did reduce the numbers,” the Tolly stated, “Yeah.” (Tr. 91.) 

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day each month and maintain employment. (Tr. 98-99.) She also testified that a person 

with moderate impairment in the ability to complete a normal work week without 

interruptions would be unable to maintain employment. (Tr. 99-100.) 

IV. The ALJ’s Decision

 A claimant is considered disabled under the Social Security Act if she is unable 

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

physical or mental impairment which can be expected to result in death or which has 

lasted or can be expected to last for a continuous period of not less than 12 months.” 

42 U.S.C. § 423(d)(1)(A); see also 42 U.S.C. § 1382c(a)(3)(A) (nearly identical standard 

for supplemental security income disability insurance benefits). To determine whether a 

claimant is disabled, the ALJ uses a five-step sequential evaluation process. See

20 C.F.R. §§ 404.1520, 416.920. 

A. Five-Step Evaluation Process 

 In the first two steps, a claimant seeking disability benefits must initially 

demonstrate (1) that she is not presently engaged in a substantial gainful activity, and 

(2) that her disability is severe. 20 C.F.R. § 404.1520(a)(4)(i) and (ii). If a claimant 

meets steps one and two, she may be found disabled in two ways at steps three through 

five. At step three, she may prove that her impairment or combination of impairments 

meets or equals an impairment in the Listing of Impairments found in Appendix 1 to 

Subpart P of 20 C.F.R. pt. 404. 20 C.F.R. § 404.1520(a)(4)(iii). If so, the claimant is 

presumptively disabled. If not, the ALJ determines the claimant’s residual functional 

capacity (RFC). 20 C.F.R. § 404.1520(e). At step four, the ALJ determines whether a 

claimant’s RFC precludes performance of her past work. 

20 C.F.R. § 404.1520(a)(4)(iv). If the claimant establishes this prima facie case, the 

burden shifts to the government at step five to establish that the claimant can perform 

other jobs that exist in significant number in the national economy, considering the 

claimant’s RFC, age, work experience, and education. 20 C.F.R. § 404.1520(a)(4)(v). If 

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the government does not meet this burden, then the claimant is considered disabled 

within the meaning of the Act. 

B. The ALJ’s Application of Five-Step Evaluation Process 

 Applying the five-step sequential evaluation process, the ALJ found that Plaintiff 

had not engaged in substantial gainful activity since November 30, 2008, the alleged 

disability onset date. (Tr. 27.) At step two, the ALJ found that Plaintiff had the 

following severe impairments: “carpal tunnel syndrome, depression and anxiety (20 

C.F.R. 416.920(c)).” (Id.) At the third step, the ALJ found that the severity of those 

impairments did not meet or medically equal the criteria of an impairment listed in 20 

C.F.R. Part 404, Subpart P, Appendix 1. (Id.) 

 The ALJ next concluded that Plaintiff retained the RFC “to perform light work as 

defined in 20 C.F.R.§ 416.967(b) with lifting and carrying [limited] to 10 pounds 

frequently and 20 pounds occasionally, [and] sitting standing, and walking [limited] to 6 

hours per 8-hour day.” (Tr. 29.) The ALJ further found that Plaintiff should not climb 

ladders, ropes, or scaffolds, and that she could occasionally climb ramps or stairs. (Id.)

The ALJ found that Plaintiff should not stoop or crawl. (Id.) He found that Plaintiff had 

“limited” overhead reaching, handling, and fingering with her right upper extremity, and 

that she could frequently finger and reach with her left upper extremity. (Id.) The ALJ 

further found that Plaintiff should avoid exposure to hazardous machinery and heights. 

(Id.) Finally, he found that Plaintiff was limited to “simple, repetitive tasks in a lowstress work environment with no more than occasional changes in the workplace setting 

and occasional contact with members of the general public.” (Id.) 

 At step four, the ALJ found that Plaintiff could not perform her past relevant work. 

(Tr. 33.) The ALJ concluded that Plaintiff could perform other work that existed in 

significant numbers in the national economy including parking lot attendant, photocopier, 

and ticket salesperson. (Tr. 34.) Accordingly, the ALJ found that Plaintiff was not 

disabled under the Act. 

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V. Standard of Review 

The district court has the “power to enter, upon the pleadings and transcript of 

record, a judgment affirming, modifying, or reversing the decision of the Commissioner, 

with or without remanding the cause for a rehearing.” 42 U.S.C. § 405(g). The district 

court reviews the Commissioner’s final decision under the substantial evidence standard 

and must affirm the Commissioner’s decision if it is supported by substantial evidence 

and it is free from legal error. Ryan v. Comm’r of Soc. Sec. Admin., 528 F.3d 1194, 1198 

(9th Cir. 2008); Smolen v. Chater, 80 F.3d 1273, 1279 (9th Cir. 1996). Even if the ALJ 

erred, however, “[a] decision of the ALJ will not be reversed for errors that are 

harmless.” Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir. 2005). 

 Substantial evidence means 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.” Richardson v. Perales, 402 U.S. 389, 401 (1971) 

(citations omitted); see also Webb v. Barnhart, 433 F.3d 683, 686 (9th Cir. 2005). In 

determining whether substantial evidence supports a decision, the court considers the 

record as a whole and “may not affirm simply by isolating a specific quantum of 

supporting evidence.” Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007) (internal 

quotation and citation omitted). 

 The ALJ is responsible for resolving conflicts in testimony, determining 

credibility, and resolving ambiguities. See Andrews v. Shalala, 53 F.3d 1035, 1039 (9th 

Cir. 1995). “When the evidence before the ALJ is subject to more than one rational 

interpretation, [the court] must defer to the ALJ’s conclusion.” Batson v. Comm’r of Soc.

Sec. Admin., 359 F.3d 1190, 1198 (9th Cir. 2004) (citing Andrews, 53 F.3d at 1041). 

VI. Plaintiff’s Claims 

Plaintiff argues that the ALJ erred by rejecting Dr. Koryakos’s opinions, her 

symptom testimony, and the lay witness statement. (Doc. 25 at 14-23.) Plaintiff also 

argues that the ALJ’s step-five determination is not supported by substantial evidence. 

(Id. at 25.) 

 

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A. Weighing Medical Source Opinions

 In weighing medical source evidence, the Ninth Circuit distinguishes between 

three types of physicians: (1) treating physicians, who treat the claimant; (2) examining 

physicians, who examine but do not treat the claimant; and (3) non-examining physicians, 

who neither treat nor examine the claimant. Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 

1995). Generally, more weight is given to a treating physician’s opinion. Id. The ALJ 

must provide clear and convincing reasons supported by substantial evidence for 

rejecting a treating or an examining physician’s uncontradicted opinion. Id.; Reddick v.

Chater, 157 F.3d 715, 725 (9th Cir. 1998). An ALJ may reject the controverted opinion 

of a treating or an examining physician by providing specific and legitimate reasons that 

are supported by substantial evidence in the record. Bayliss v. Barnhart, 427 F.3d 1211, 

1216 (9th Cir. 2005); Reddick, 157 F.3d at 725. 

 Opinions from non-examining medical sources are entitled to less weight than 

opinions from treating or examining physicians. Lester, 81 F.3d at 831. Although an 

ALJ generally gives more weight to an examining physician’s opinion than to a nonexamining physician’s opinion, a non-examining physician’s opinion may nonetheless 

constitute substantial evidence if it is consistent with other independent evidence in the 

record. Thomas v. Barnhart, 278 F.3d 947, 957 (9th Cir. 2002). When evaluating 

medical opinion evidence, the ALJ may consider “the amount of relevant evidence that 

supports the opinion and the quality of the explanation provided; the consistency of the 

medical opinion with the record as a whole; [and] the specialty of the physician providing 

the opinion . . . .” Orn v. Astrue, 495 F.3d 625, 631 (9th Cir. 2007). 

B. Weight Assigned Dr. Koryakos’s Opinions 

Dr. Koryakos completed three assessments of Plaintiff’s ability to perform workrelated physical activities. (Tr. 515-16, 696-97, 326-37.) Dr. Koryakos consistently 

found that Plaintiff was limited to sitting, standing, and walking for two hours in an 

eight-hour day. (Id.) The ALJ rejected Dr. Koryakos’s opinions. (Tr. 32.) He explained 

that Dr. Koryakos’s opinions that Plaintiff was unable to perform any work were 

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inconsistent “with the greater objective record.” (Id.) The ALJ also stated that 

Dr. Koryakos “did not offer any specific laboratory or clinical findings to support his 

assessed limitations.” (Id.) As an example, the ALJ cited a May 18, 2011 treatment note 

that included “grossly normal neurological findings.” (Id. (citing Admin. Hrg. Ex. 33F at 

3).) 

As Plaintiff argues, the ALJ erred in rejecting Dr. Koryakos’s opinions as 

inconsistent with the medical record and as unsupported by clinical findings. Plaintiff 

argues that it was error for the ALJ to reject Dr. Koryakos’s opinions based on 

inconsistency with the objective record and as unsupported by laboratory findings 

because fibromyalgia does not produce positive laboratory tests or similar objective 

evidence.4

 (Doc. 25 at 17.) The Commissioner does not address this argument in her 

response. (Doc. 26 at 16-20.) The Ninth Circuit has recognized that fibromyalgia eludes 

objective measurement. See Benecke v. Barnhart, 379 F.3d 587, 590 (9th Cir. 2004) 

(“Fibromyalgia’s cause is unknown, there is no cure, and it is poorly-understood within 

much of the medical community. The disease is diagnosed entirely on the basis of 

patients’ reports of pain and other symptoms.”); see also Jordan v. Northrop Grumman 

Corp., 370 F.3d 869, 872 (9th Cir. 2004) (fibromyalgia’s “symptoms are entirely 

subjective. There are no laboratory tests for [its] presence or severity”), overruled in 

non-relevant part by Abatie v. Alta Health & Life Ins. Co., 258 F.3d 955, 969 (9th Cir. 

2006) (en banc); Lang v. Long–Term Disability Plan of Sponsor Applied Remote Tech., 

Inc., 125 F.3d 794, 796 (9th Cir. 1997) (same).

 As the Ninth Circuit has explained, “[t]he American College of Rheumatology 

[has] issued a set of agreed-upon diagnostic criteria in 1990, but to date there are no 

laboratory tests to confirm the diagnosis.” Benecke, 379 F.3d at 590. The accepted 

 4

 Although the ALJ did not find Plaintiff’s fibromyalgia severe, he was required to consider it when determining whether she was disabled. See Smolen v. Chater, 80 

F.3d 1273, 1290 (9th Cir. 1996) (recognizing that, if one severe impairment exists, all medically determinable impairments must be considered in the remaining steps of the sequential analysis). 

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diagnostic test for fibromyalgia is that an individual must have pain in eleven of eighteen 

tender points. See Jordan, 370 F.3d at 877; see also Rollins v. Massanari, 261 F.3d 853, 

855 (9th Cir. 2001) (claimant had eleven of eighteen tender points). Here, Plaintiff had 

sixteen of eighteen tender points and had chronic pain. (Tr. 731, 521, 523, 525, 531, 535, 

716, 718, 725, 884-86, 888-89, 891-95, 897-99.) 

 Additionally, there are “clinical findings” to support the assessed limitations. 

Plaintiff had fibromyalgia, carpal tunnel, headaches, depression and anxiety. Treatment 

records reflect positive response to multiple fibromyalgia trigger points (Tr. 448-49, 452), 

lumbar paraspinal muscle tenderness (Tr. 454), elevated liver function tests (Tr. 476), low 

red blood cell, hemoglobin, and hematocrit tests (Tr. 498), neural foraminal narrowing 

and facet arthropathy on the cervical spine MRI (Tr. 509-10), decreased range of motion 

in the neck, back, and hips (Tr. 730), positive Tinel’s and Phalen’s signs in the left wrist 

(Tr. 731), a positive impingement sign in the left shoulder (Tr. 780), abnormalities in 

memory and concentration during psychiatric testing (Tr. 736), an MRI showing AC 

arthrosis in the left shoulder (Tr. 791), evidence of bulging discs and degenerative 

changes on an MRI of the cervical spine (Tr. 792), and median neuropathy of the wrist on 

an EMG test. (Tr. 795-96.) 

 Therefore, the ALJ erred in rejecting Dr. Koryakos’s opinions. That error was not 

harmless because the vocational expert testified that an individual with the limitations 

that Dr. Koryakos assessed would be unable to sustain employment. (Tr. 80-81.) 

Accordingly, the Court reveres the Commissioner’s disability determination.5

VII. Whether to Remand for Benefits or Further Proceedings 

 Having found that the ALJ erred in assigning little weight to Dr. Koryakos’s 

opinions, the Court reverses the Commissioner’s decision. The Court has the discretion 

to remand the case for further development of the record or for an award benefits. See 

Reddick, 157 F.3d at 728. The decision to remand for benefits is controlled by the Ninth 

 

5

 Having concluded that the ALJ committed reversible error by rejecting Dr. Koryakos’s opinions, the Court does not need to reach Plaintiff’s other claims of 

error. (Doc. 25.) 

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Circuit’s “three-part credit-as-true standard.” Garrison v. Colvin, 759 F.3d 995, 1020 

(9th Cir. 2014). Under that standard, evidence should be credited as true and an action 

remanded for an immediate award of benefits when each of the following factors are 

present: “(1) the record has been fully developed and further administrative proceedings 

would serve no useful purpose; (2) the ALJ has failed to provide legally sufficient 

reasons for rejecting evidence, whether claimant’s testimony or medical opinion; and 

(3) if the improperly discredited evidence were credited as true, the ALJ would be 

required to find the claimant disabled on remand.” Id. (citing Ryan v. Comm’r Soc. Sec., 

528 F.3d 1194, 1202 (9th Cir. 2008)); see also Benecke, 379 F.3d at 595. 

 Plaintiff has satisfied all three criteria of the credit-as-true rule. On the first factor, 

there is no need to further develop the record. See Garrison, 759 F.3d at 1021 (citing 

Benecke, 379 F.3d at 595) (“Allowing the Commissioner to decide the issue again would 

create an unfair ‘heads we win; tails, let’s play again’ system of disability benefits 

adjudication.”)). On the second factor, the ALJ failed to provide legally sufficient 

reasons for rejecting the opinions of treating physician Dr. Koryakos. On the third factor, 

if the discredited evidence were credited as true, the ALJ would be required to find 

Plaintiff disabled on remand because the vocational expert testified that a person with the 

sitting, standing, and walking and limitations that Dr. Koryakos identified would be 

incapable of sustained full-time work. (Tr. 80-81.) Therefore, based on this evidence, 

Plaintiff is disabled. See Garrison, 759 F.3d at 1022 n.28 (stating that when the 

vocational expert testified that a person with the plaintiff’s RFC would be unable to 

work, “we can conclude that [the plaintiff] is disabled without remanding for further 

proceedings to determine anew her RFC.”). 

 Having concluded that Plaintiff meets the three criteria of the credit-as-true rule, 

the Court considers “the relevant testimony [and opinion evidence] to be established as 

true and remand[s] for an award of benefits[,]” Benecke, 379 F.3d at 593 (citations 

omitted), unless “the record as a whole creates serious doubt as to whether the claimant 

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is, in fact, disabled with the meaning of the Social Security Act.” Garrison, 759 F.3d at 

1021) (citations omitted). 

 Considering the record as a whole, there is no reason for serious doubt as to 

whether Plaintiff is disabled. See Garrison, 759 F.3d at 1021 (stating that that when the 

court conclude “that a claimant is otherwise entitled to an immediate award of benefits 

under the credit-as-true analysis, [the court has] flexibility to remand for further 

proceedings when the record as a whole creates serious doubt as to whether the claimant 

is, in fact, disabled within the meaning of the Social Security Act.”). The ALJ failed to 

set forth specific and legitimate reasons supported by substantial evidence for rejecting 

Dr. Koryakos’s opinions. When a hypothetical question was posed to the vocational 

expert incorporating limitations that Dr. Koryakos identified, the vocational expert 

testified that such limitations would preclude Plaintiff from working. (Tr. 80-81.) On the 

record before the Court, Dr. Koryakos’s opinions should be credited as true and the case 

remanded for an award of benefits. 

 Accordingly, 

IT IS ORDERED that the Commissioner’s decision denying benefits is reversed 

and this matter is remanded for an award of benefits. 

IT IS FURTHER ORDERED that the Clerk of Court shall enter judgment 

accordingly and terminate this case. 

 Dated this 19th day of February, 2015. 

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