Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-4_22-cv-00163/USCOURTS-azd-4_22-cv-00163-0/pdf.json

Nature of Suit Code: 863
Nature of Suit: Social Security - DIWC/DIWW (405(g))
Cause of Action: 42:405 Review of HHS Decision (DIWC)

---

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Tyandrah Ashley,

Plaintiff,

v. 

Kilolo Kijakazi,

Acting Commissioner of Social Security,

Defendant.

No. CV-22-00163-TUC-EJM

ORDER

Currently pending before the Court is Plaintiff Tyandrah Ashley’s Opening Brief

(Doc. 18). Defendant filed her Answering Brief (“Response”) (Doc. 19), and Plaintiff 

replied (Doc. 23). Plaintiff brings this cause of action for review of the final decision of 

the Commissioner for Social Security pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3). 

Compl. (Doc. 1). Based upon the pleadings of the parties and the administrative record 

submitted to the Court, the Magistrate Judge denies Plaintiff’s Opening Brief (Doc. 18).

I. BACKGROUND

A. Procedural History

On July 4, 2020, Plaintiff protectively filed a Title II application for Social Security 

Disability Insurance Benefits (“DIB”), as well as a Title XVI application for Supplemental 

Security Income (“SSI”) alleging disability as of June 27, 2020, due to Bipolar I disorder, 

psychotic features, and anxious distress. See Administrative Record (“AR”) at 30–33, 86–

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 1 of 27
- 2 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

87, 89, 97–98, 100, 102, 108, 110, 112, 114, 116, 118–19, 130–31, 134, 340, 359, 361.

1

 

The Social Security Administration (“SSA”) denied these applications on July 30, 2020.

Id. at 30, 86–112, 142–49. On August 3, 2020, Plaintiff filed a request for reconsideration. 

Id. at 154–55. On August 13, 2020,

2 SSA denied Plaintiff’s application upon 

reconsideration. Id. at 30, 116–41, 156–63. On November 6, 2020, Plaintiff filed her

request for hearing. Id. at 30, 170–71. On April 6, 2021, a telephonic hearing was held 

before Administrative Law Judge (“ALJ”) Elizabeth Ebner. AR at 30, 47–67. On April 

16, 2021, the ALJ issued an unfavorable decision. Id. at 27–39. On June 15, 2021, Plaintiff 

requested review of the ALJ’s decision by the Appeals Council, and on November 4, 2021, 

review was denied. Id. at 1–6, 392–94. On April 5, 2022, Plaintiff filed this cause of 

action. Compl. (Doc. 1).

B. Factual History

Plaintiff was twenty-eight (28) years old at the time of the alleged onset of her

disability and twenty-nine (29) years old at the time of the administrative hearing. AR at 

30–32, 38, 47, 53–54, 68, 70, 72, 86–87, 89, 97–98, 100, 108, 110, 112, 114, 116, 118–19, 

130–31, 134, 210, 252, 291, 300, 340, 359, 361. Plaintiff is a high school graduate with a 

bachelor’s degree, as well as some work toward advanced degrees. Id. at 38, 68, 53–54, 

68, 70, 108, 110, 112, 114, 116, 335. Prior to her alleged disability, Plaintiff worked as a 

community helper, customer service representative in various technology industries, after 

school program developer, and management trainee. Id. at 50–51, 55–57, 58–59, 286–88, 

322–32, 335.

1. Plaintiff’s Testimony

a. Administrative Hearing

At the administrative hearing, Plaintiff confirmed that she had a bachelor’s degree 

1 Page numbers refer to the page numbers demarcated in the Administrative Record rather 

than the Court’s Case Management/Electronic Case Files (“CM/ECF”) page numbers.

2 August 13, 2020 is the date that SSA adjudicators signed off on the denial of Plaintiff’s 

claim, but the letters from the agency informing Plaintiff of the denial were dated September 3, 

2020.

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 2 of 27
- 3 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

and was taking an online course toward a master’s degree in finance. AR at 53–54. 

Plaintiff also confirmed that she had previously taken classes for a couple of months toward 

a Master of Business Administration degree. Id. at 54. Plaintiff described her most recent 

work to include kitchen staff at Eegee’s, deli clerk at Strauss,3and Red Lobster. Id. at 54–

56. Plaintiff worked at these jobs for a few days to approximately four (4) months. Id. 

Plaintiff testified that she worked for approximately three (3) call centers, and the duties in 

each position were broadly similar. Id. at 54. Plaintiff described these positions as sitting 

jobs that did not require any lifting. AR at 56. Plaintiff further testified that in 2015 she 

worked for AmeriCorps as an after school program developer. Id. at 57. Plaintiff explained 

that the AmeriCorps position involved standing, sitting, and lifting, but her primary 

responsibility was planning the lessons for an after school program and working directly 

with the children. Id. at 57–59. Following her time at AmeriCorps, Plaintiff went to work 

at America Eagle as a manager in training for approximately four (4) months. Id. at 57–

58. Plaintiff described the American Eagle position to include training the staff, processing 

incoming shipments, folding clothes, talking to customers, opening and closing the cash 

register, and putting up new displays and marketing. Id. at 58. Plaintiff indicated that she 

worked at AmeriCorps during her senior year of college. AR at 58. 

Plaintiff testified that she currently sees a therapist once every two weeks and her 

psychiatrist once every two (2) months. Id. at 59. Plaintiff estimated that she reduced her 

therapy from once a week to biweekly approximately one (1) year ago. Id. Plaintiff further 

testified that she had been seeing her psychiatrist every two (2) months since she began 

seeing him. Id. at 60. Plaintiff confirmed that she has seen improvement through 

treatment. Id. 

Plaintiff testified that she has gained personal satisfaction and understanding 

regarding her life, as well as greater stability and improved relationships, through 

treatment. AR at 60. Plaintiff described trying to find a job that fits as the main issue that 

3 The hearing transcript states “Strauss”; however, a review of the record indicates that 

Plaintiff was working at Sprouts grocery store.

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 3 of 27
- 4 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

she continues to struggle with in therapy. Id. Plaintiff acknowledged that different jobs 

had different reasons for not working out. Id. Plaintiff explained that Red Lobster would 

not allow her a break, at Sprouts she had reduced hours following her mental health break, 

and at Anderson Financial it was very stressful and she could not focus. Id. at 60–61. 

Plaintiff testified that some of her symptoms go in cycles. Id. at 61. Plaintiff described 

having difficulty sleeping, which becomes so severe, approximately once a year, that she 

cannot sleep even with medication and can cause suicidal ideation. AR at 61. Plaintiff 

further testified that her anxiety has reduced and fluctuates less as a result of her stable 

support system and ongoing medication compliance. Id. Plaintiff denied having any issues 

with medication compliance, and opined that the medications were the most important 

aspect of her treatment to maintain stability. Id. at 61–62. Plaintiff also indicated that her 

art program was still going well. Id. at 62. Plaintiff opined that she felt that a low stress 

job, isolated from people, would cause her to become depressed. Id. Plaintiff further 

opined that she requires interaction with others to maintain her stability in the workplace. 

AR at 62. Plaintiff doubted that she would be able to maintain a simple job for more than 

two (2) weeks, even with some interaction with people. Id. at 63. 

b. Administrative Forms

i. Work History Report

a. July 9, 2019

On July 9, 2019, Plaintiff completed a Work History Report.4 AR at 322–32. 

Plaintiff listed her prior work a Big Brother Big Sister community helper, customer service 

representative in technology sales, dictating for the hearing impaired, and customer service 

in fitness. Id. at 322. Plaintiff described the position at Big Brother Big Sister as fulltime—eight (8) hours per day, five (5) days per week. Id. at 323. Plaintiff reported earning 

$32,000.00 per year, without any further information regarding this position. Id. Plaintiff 

described the position of customer service representative at Cox Communications as full4 The Work History Report form appears undated; however, the Agency’s Exhibit List 

provides a date. AR Exhibit Index (Doc. 17-7) at 1 (refers to CM/ECF page number).

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 4 of 27
- 5 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

time—eight (8) hours per day, five (5) days per week. Id. at 324. Plaintiff reported earning 

$12.00 per hour, without any further information regarding this position. AR at 324. The 

next customer service job, Plaintiff described as full-time—eight (8) hours per day, five 

(5) days per week. Id. at 325. Plaintiff reported earning $11.00 per hour, without any 

further information regarding this position. Id. Plaintiff described her position at LA 

Fitness as full-time—eight (8) hours per day, five (5) days per week. Id. at 326. Plaintiff 

reported earning $10.00 per hour in this position, but did not provide any further details. 

Id. The position at Valley Premaculture Alliance, Plaintiff described as full-time—eight

(8) hours per day, five (5) days per week. AR at 327. Plaintiff reported earning $26,000.00

per year, without any further details. Id.

b. March 4, 2021

On March 4, 2021, Plaintiff completed a Work Background form.5 AR at 380. 

Plaintiff reported working at Eegee’s doing food preparation, cleaning, and dishes. Id.

ii. Function Report—Adult

On July 27, 2020, Plaintiff completed a Function Report—Adult.6 AR at 343–51. 

Plaintiff reported that she lived in an apartment with family. Id. at 343. Plaintiff outlined 

the limitations that her medical conditions cause as follows:

I am not able to hold a job for longer than a few months. It limits my ability 

to be independent and earn income[.]

Id. Plaintiff described her usual day to include waking up, performing personal hygiene 

tasks, then going for an approximately one (1) mile walk. Id. at 344. Plaintiff described 

the remainder of her day to include watching television, getting lunch or going grocery 

shopping, and relaxing, followed by taking a shower and bed. Id. Plaintiff denied caring 

for other people or pets. AR at 344. Plaintiff noted that prior to the onset of her bipolar 

disorder, she was able to go to sleep and stay asleep; however, these sleep issues have

5 The Work Background form appears undated; however, the Agency’s Exhibit List 

provides a date. AR Exhibit Index (Doc. 17-7) at 1 (refers to CM/ECF page number).

6 The Function Report form appears undated; however, the Agency’s Exhibit List provides 

a date. AR Exhibit Index (Doc. 17-7) at 1 (refers to CM/ECF page number).

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 5 of 27
- 6 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

resulted in hospitalization. Id. Plaintiff denied any trouble with personal care. Id. at 345. 

Plaintiff indicated that she buys her own lunches and eats out often. Id. Plaintiff 

reported that she prepares her own meals approximately two (2) to three (3) times per week, 

and it takes her between thirty (30) to forty-five (45) minutes to cook. Id. Plaintiff noted 

that her cooking habits were unchanged. AR at 345. Plaintiff indicated that she does 

laundry and dishes, as well as other cleaning including taking out the garbage and cleaning 

the bathtub. Id. at 346. Plaintiff estimated that it takes her approximately thirty (30) 

minutes to do each task, and she performs them two (2) to three (3) times per week. Id. 

Plaintiff reported that she goes outside approximately twice per day. Id. Plaintiff 

further reported that she is able to go out alone, and when she is out can walk, drive, and

ride a bicycle. Id. Plaintiff indicated that she shops in stores for home essentials and 

groceries. AR at 346. Plaintiff stated that she shops daily for approximately thirty (30) 

minutes. Id. Plaintiff noted that she is able to count change, handle a savings account, and 

use a checkbook or money orders, but has difficulty paying bills because she is unable to 

maintain employment. Id. at 347. Plaintiff denied that her ability to handle money had 

changed since the onset of her illness. Id.

Plaintiff listed her hobbies to include photography, cycling, going on walks, and 

watching television. Id. Plaintiff observed that she does not have the time or ability to do 

photography, and the heat prevents her from cycling. AR at 347. Plaintiff reported walking 

and watching television daily. Id. Plaintiff denied engaging in spending any time with 

others. Id. Plaintiff noted that prior to the COVID-19 pandemic, she enjoyed volunteering 

at a nonprofit bike shop. Id. Plaintiff also denied needing reminders to go places or anyone 

to accompany her, because she does not go anywhere due to COVID-19. Id. Plaintiff 

reiterated that she does not go out for any social activities. AR at 348.

Plaintiff reported that her illness affects her ability to complete tasks, concentrate, 

and follow instructions. Id. Plaintiff indicated that her “conditions do not allow [her] to 

complete tasks necessary to hold a job longer than a few months.” Id. Plaintiff is right 

handed. Id. Plaintiff reported that she can walk a mile prior to needing a rest, and noted 

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 6 of 27
- 7 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

that she can resume walking after twenty (20) minutes of rest. Id. Plaintiff further reported 

that she can pay attention for thirty (30) minutes and is able to finish what she starts. AR 

at 348. Plaintiff described being able to follow written and spoken instructions well. Id. 

Plaintiff also indicated that she is able to get along with authority figures. Id. at 349. 

Plaintiff reported that she is able to handle stress, but noted that it affects her ability to 

concentrate, socialize, and complete job tasks. Id.

Plaintiff indicated that she wears glasses and/or contact lenses. Id. Plaintiff 

described her mother as her caretaker. AR at 350. Plaintiff noted that her mother pays her 

bills and reminds her to take her medication. Id. Plaintiff observed that “[w]ithout [her] 

mother and family support, [she] would not be able to make the effort needed to seek 

employment that would accommodate [her] bipolar disability.” Id.

2. Plaintiff’s Medical Records

a. Treatment Records7

On June 2, 2019, Plaintiff was seen at the Crisis Response Center (“CRC”) after she 

had been discharged the previous week. AR at 680–95. Plaintiff remained at the CRC 

until June 4, 2019. See id. at 680–712. On June 14, 2019, Plaintiff returned to the CRC 

and was committed for inpatient mental health treatment at Sonora Behavioral Health from 

June 14, 2019, through June 26, 2019 via petition. Id. at 396–596, 713–22. During the 

course of her treatment, Plaintiff consented to voluntary treatment. Id. at 411. On June 26, 

2019, Plaintiff was discharged with a diagnosis of Bipolar I with psychosis. Id. at 403. 

Plaintiff’s medications on discharge included Lithobid and Risperdal. AR at 404.

On July 2, 2019, Plaintiff was seen by Ole J. Thienhaus, M.D. at Banner University 

Medical Center (“Banner UMC”) Integrated Whole Health Clinic (“WHC”). Id. at 643–

45. Plaintiff reported quitting her “job at a call center because ‘it was too stressful.’” Id.

at 643. “Shortly after, she was bothered by strange thoughts (no elaboration other than ‘it 

7 Although the Court has reviewed the entirety of Plaintiff’s medical records, its summary 

is generally limited to records regarding Plaintiff’s mental health treatment after her alleged onset 

date.

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 7 of 27
- 8 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

had to do with the president and politics[’]), and became profoundly hopeless.” Id. 

On August 16, 2019, Plaintiff again saw Dr. Thienhaus. Id. at 641–42. Plaintiff 

discussed her work plans “after the managerial position she’d hoped for was filled.” Id. at 

642. On September 16, 2019, Plaintiff met briefly with Saren Seeley, MA, BHT at Banner 

University Medical Center (“Banner UMC”) Integrated Whole Health Clinic (“WHC”)

regarding her recently completed intake for EPICenter. AR at 639–40.

On January 20, 2020, Ms. Seeley called Plaintiff regarding her interest in returning 

to therapy. Id. at 638. On January 22, 2020, Plaintiff spoke with Ms. Seeley for an initial 

consultation. Id. at 636–37. On January 29, 2020, Plaintiff received telehealth services 

from Ms. Seeley for an individual therapy appointment. Id. at 634–35. Plaintiff reported 

that her job at Red Lobster was going well. Id. at 634.

On February 5, 2020, Plaintiff spoke with Ms. Seeley for an individual therapy 

appointment. Id. at 632–33. Plaintiff reported that she had been let go from Red Lobster 

because “they refused to provide her with any breaks during her 9.5 hour shifts.” AR at 

632. On February 12, 2020, Plaintiff returned to Ms. Seeley for a telephonic individual 

therapy appointment. Id. at 629–31. Plaintiff reported that she had been hired at Sprouts 

and discussed the events leading up to “her two ‘breakdowns’ after graduating from 

college.” Id. at 630. On February 20, 2020, Plaintiff spoke with Ms. Seeley (“WHC”) for 

an individual therapy appointment. Id. at 627–28. Plaintiff reported that she had started 

working at Sprouts and had been accepted in the University of Arizona as a business major. 

Id. at 627. On February 26, 2020, Plaintiff received telehealth services from Ms. Seeley

for an individual therapy appointment. AR at 625–26. Plaintiff reported enjoying her job 

and was contemplating which course of study she would pursue. Id. at 625. On February 

27, 2020, Plaintiff saw Dr. Thienhaus. Id. at 623–24. Treatment records indicate that 

Plaintiff had stopped all medications the previous Fall without a recurrence of symptoms. 

Id. at 623.

On March 11, 2020, Plaintiff again received telehealth services from Ms. Seeley for 

individual therapy. Id. at 620–22. Plaintiff reported that her week had been uneventful 

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 8 of 27
- 9 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

and she was scheduled to begin an MBA program online through Grand Canyon University 

the following week. AR at 620. On March 25, 2020, Plaintiff spoke with Ms. Seeley for 

a telephonic individual therapy appointment. Id. at 618–19. Plaintiff reported continuing 

to work at Sprouts and that she was generally doing well. Id. at 618.

On April 15, 2020, Plaintiff requested that Ms. Seeley put her therapy appointments 

on hold. Id. at 617. On April 27, 2020, Plaintiff was seen by Dr. Thienhaus. Id. at 615–

16. Dr. Thienhaus’s review of Plaintiff’s systems and mental status examination were

unremarkable. AR at 615–16. Treatment records indicate that Plaintiff did not exhibit a

re-emergence of her mood instability. Id. at 615. Dr. Thienhaus listed Plaintiff’s ongoing 

issues to include mood disorder of depressed type, schizophrenia spectrum disorder with a 

psychotic disorder type not yet determined, and severe manic bipolar 1 disorder with 

psychotic behavior. Id. at 615. Dr. Thienhaus assessed Plaintiff’s mood disorder to be in 

remission. Id. at 616.

On May 6, 2020, Ms. Seeley called Plaintiff following Plaintiff’s request to resume 

phone therapy. Id. at 614. Ms. Seeley left a message when Plaintiff failed to answer at the 

time of their scheduled appointment. AR at 614. On May 7, 2020, Plaintiff received 

telehealth services from Ms. Seeley. Id. at 677–79. Plaintiff discussed her previous 

hospitalization, as well as issues within her family of origin that contributed to her negative 

beliefs about herself. Id. at 677. Ms. Seeley’s observations regarding Plaintiff were 

generally unremarkable. Id. at 678. On May 8, 2020, Ms. Seeley received a call from 

Plaintiff and also spoke with her mother, after which Ms. Seeley and Dr. Thienhaus 

discussed restarting her antipsychotic medications. Id. at 673, 675. On May 11, 2020, Ms. 

Seeley received a voicemail from Plaintiff’s mother requesting a same-day appointment 

with a psychiatrist, because the weekend had been difficult. AR at 671. Ms. Seeley 

counseled Plaintiff’s mother regarding taking Plaintiff to the CRC versus waiting for a next 

day appointment with Dr. Thienhaus. Id. at 672. On May 12, 2020, Plaintiff received 

telehealth services from Dr. Thienhaus. Id. at 669–70, 792–93. Plaintiff reported having 

trouble sleeping, and her mother reported behavioral changes that she associated with 

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 9 of 27
- 10 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

prodromal symptoms before a psychotic break. Id. at 669, 792. Dr. Thienhaus stressed the 

importance of early intervention and restarting her medications that induced remission last 

time. Id. at 670, 793. His observations of Plaintiff were generally unremarkable. AR at 

669–70, 792–93. On May 13, 2020, Plaintiff received telehealth services from Ms. Seeley. 

Id. at 666–68. Plaintiff “reported that she is feeling ‘better’ after having re-started 

risperidone and lithium.” Id. at 666. Plaintiff indicated that she took a week off of work 

to adjust to the medications. Id. Ms. Seeley’s observations regarding Plaintiff were 

generally unremarkable. Id. at 667. On May 20, 2020, Plaintiff returned to Ms. Seeley for 

individual therapy. AR at 664–65. Treatment records reflect that Plaintiff was “continuing 

to take lithium and risperidone as prescribed.” Id. at 664. Plaintiff reported generally doing 

well. Id. at 664–65. On May 28, 2020, Ms. Seeley spoke with Plaintiff on the telephone 

following a no-show appointment the previous day. Id. at 662–663. Plaintiff reported that 

her return to work was “good” and that she did not have anything further to talk about at 

that time. Id. at 662.

On June 4, 2020, Plaintiff received telehealth services from Ms. Seeley. AR at 659–

61. Plaintiff reported generally doing well. Id. at 659. Plaintiff further reported having 

“finished one of her online courses and enjoying being back at work[.]” Id. Treatment 

records reflect that Plaintiff had difficulty finding balance during the stress of the 

pandemic, protests, and highly publicized examples of police brutality. Id. On June 11, 

2020, Plaintiff met with Ms. Seeley for a telehealth appointment. Id. at 655–57. Plaintiff 

reported that “things are going well” and that she did not have anything to talk about. AR

at 655. On June 18, 2020, Plaintiff received telehealth services from Ms. Seeley. Id. at 

652–54. Plaintiff was late due to a phone interview for a new job. Id. at 652. Plaintiff 

“reported that she had a ‘breakdown’ on Monday, which involved being emotionally 

distressed to the point where she was unable to eat or drink for a few hours.” Id. Plaintiff 

attributed the “breakdown” to stress living with several family members in a small 

apartment which did not give her sufficient space to be alone. Id. Ms. Seeley discussed 

revising/removing redundant diagnoses from Plaintiff’s chart leaving Bipolar Disorder 

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 10 of 27
- 11 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

with psychosis as the only diagnosis. AR at 653. On June 25, 2020, Plaintiff spoke with 

Ms. Seeley for an individual therapy appointment. Id. at 649–51. Plaintiff reported being 

stable and having another job interview. Id. at 649. Treatment records reflect that Plaintiff 

“experienced a re-emergence of a mood/psychosis episode mid-May[,] [and] . . . agreed to 

start taking psychiatric medication again (had stopped ⁓fall 2019) and symptoms resolved 

without the need for another hospitalization.” Id. at 650. On June 29, 2020, Plaintiff 

received individual therapy via videoconference from Shannon Carmona, LPC through the 

Banner Health Early Psychosis Intervention Center. Id. at 647–48, 789–90. Plaintiff 

reported looking for a new job because she was only working one (1) day per week, which 

provided insufficient income. AR at 647, 789. Plaintiff reported feeling better on her 

medications. Id.

On July 22, 2020, Plaintiff received telehealth services from Ms. Carmona. Id. at 

726–27, 787–88. Plaintiff reported that she was “doing okay.” Id. at 726, 787. Plaintiff 

expressed the desire to be independent and noted that she was going to begin a new inbound 

sales job. Id. Plaintiff indicated that she “[e]njoys sales and talking to people.” AR at 

726, 787.

On August 4, 2020, Plaintiff spoke with Ms. Carmona for individual therapy. Id. at 

785–86. Plaintiff reported doing “pretty good” and noted that she had begun a new job. 

Id. at 785. Plaintiff expressed concern that if she does not feel challenged enough in the 

job, she will want to leave. Id. at 785. On August 11, 2020, Plaintiff received telehealth 

services from Ms. Carmona. Id. at 724–25, 783–81. Plaintiff reported that work had been 

productive, she was consistently taking her medications, and denied any positive 

symptoms. AR at 724, 783. On August 25, 2020, Plaintiff had an individual therapy 

telephone call with Ms. Carmona. Id. at 781–82. Plaintiff reported that she was feeling 

good and expressed a desire to increase exercise to help manage her depressive symptoms. 

Id. at 781.

On September 8, 2020, Plaintiff received telehealth services from Ms. Carmona. Id.

at 777–78. Plaintiff reported that things were going well and she had started a new 

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 11 of 27
- 12 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

administrative position for a mattress firm. Id. at 777. Plaintiff further reported that she 

was starting her MBA program in approximately two (2) weeks. AR at 777. Plaintiff also

discussed her mother’s health. Id. On September 22, 2020, Plaintiff spoke with Ms.

Carmona for individual therapy. Id. at 774–75. Plaintiff reported sadness following the 

death of her Godfather. Id. at 774. On the same date, Ms. Carmona staffed Plaintiff’s case 

with her treatment team. Id. at 776. Ms. Carmona noted that Plaintiff was compliant with 

her medications and denied any positive symptoms of psychosis or mood changes. AR at 

776. Plaintiff also reported that she had lost her job the previous week “due to a lack of 

communication.” Id. On September 25, 2020, Plaintiff received telehealth services from 

Dr. Thienhaus. Id. at 772–73. Treatment records indicate that Plaintiff had not had a 

recurrence of psychotic symptoms or mood instability. Id. at 772. Dr. Thienhaus’s 

examination of Plaintiff was generally unremarkable. Id. at 772–73. On September 30, 

2020, Plaintiff received telehealth services from Ms. Carmona. AR at 770–71. Plaintiff 

reported that she remained unemployed and feeling depressed. Id. at 770. Plaintiff 

indicated that she was still taking her medication. Id.

On October 6, 2020, Ms. Carmona received a call from Plaintiff regarding “her fears 

of not being able to hold down a job.” Id. at 769. Ms. Carmona discussed work programs 

in the community that are available to her. Id. On October 14, 2020, Plaintiff received 

telehealth services from Ms. Carmona. AR at 767–68. Plaintiff reported wanting help with 

maintaining employment. Id. at 767. On October 20, 2020, Ms. Carmona staffed 

Plaintiff’s case with her treatment team and indicated Plaintiff lost her job due to her 

mother’s health issues and not communicating her needs with her employer. Id. at 765–

66. On October 22, 2020, Plaintiff received telehealth services from Dr. Thienhaus. Id. at 

763–64. Treatment records indicate that Plaintiff was still unsuccessful maintaining 

employment, but had not suffered a recurrence of psychotic symptoms or excessive mood 

fluctuations. Id. at 763. Dr. Thienhaus’s examination of Plaintiff was generally 

unremarkable. AR at 763–64. On October 28, 2020, Plaintiff spoke with Ms. Carmona

for individualized therapy. Id. at 761–62. Plaintiff reported depression. Id. at 761. 

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 12 of 27
- 13 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

Plaintiff further indicated that she was trying to find a job and had submitted numerous 

applications without success. Id.

On November 11, 2020, Plaintiff received telehealth services from Ms. Carmona. 

Id. at 759–60. Plaintiff reported that she was doing fine and working with her mother until 

she can find a job. AR at 759. On November 13, 2020, Plaintiff spoke with Ms. Carmona

for an individual therapy session. Id. at 757–58. Plaintiff “reported anxiety associated 

with past trauma.” Id. at 757. On November 24, 2020, Plaintiff received telehealth services 

from Ms. Carmona. Id. at 755–56. Plaintiff reported that she was doing well, but not 

working. Id. at 755. Treatment records indicate that Plaintiff had not suffered a recurrence 

of psychotic symptoms or other mood instability. AR at 755.

On December 9, 2020, Ms. Carmona called Plaintiff for a scheduled telehealth 

appointment; however, Plaintiff had forgotten about the appointment and was unable to

meet. Id. at 754. On December 22, 2020, Plaintiff received telehealth services from Ms.

Carmona. Id. at 752–53. Plaintiff reported that she was doing well, but not currently 

looking for a job. Id. at 752. Plaintiff noted that her brother was living with them, which 

was an adjustment. Id. On the same date, Dr. Thienhaus completed a Mental Residual 

Functional Capacity Assessment regarding Plaintiff. AR at 729–31. Dr. Thienhaus 

reported Plaintiff’s diagnosis as schizoaffective disorder with symptoms including mood 

lability and intermittent psychotic episodes. Id. at 729. Dr. Thienhaus further reported that 

Plaintiff had no impairment of her ability to understand, remember, or apply information; 

mild impairment regarding her ability to concentrate, persist, or maintain pace; and 

moderate limitations on her ability to interact with others, as well as adapt or manage

herself. Id. Dr. Thienhaus opined regarding the percentage of a total work-month that he 

would expect Plaintiff’s symptoms to interfere with her ability to perform work-related 

functions as follows: her ability to remember locations and work-like procedures, 

understand and remember very short and simple instructions, carry out very short and 

simple instructions, make simple work-related decisions, and travel in unfamiliar places or 

use public transportation would be impacted less than ten percent (10%) of the time; 

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 13 of 27
- 14 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

Plaintiff’s ability to understand and remember detailed instructions, ask simple questions 

or request assistance, carry out detailed instructions, maintain attention and concentration 

for extended periods, perform activities within a schedule, maintain regular attendance, and 

be punctual within customary tolerance, and be aware of normal hazards and take 

appropriate precautions would be impacted between ten and fifteen percent (10%–15%) of 

the time; her ability to interact appropriately with the general public, accept instructions 

and respond appropriately to criticism from supervisors, maintain socially appropriate 

behavior and to adhere to basic standards of neatness and cleanliness, sustain an ordinary 

routine without special supervision, respond appropriately to changes in the work setting, 

and set realistic goals or make plans independently of others would be impacted between 

fifteen and twenty percent (15%–20%) of the time; Plaintiff’s ability to get along with 

coworkers or peers without distracting them or exhibiting behavioral extremes and work 

in coordination or in proximity to others without being distracted by them would be 

impacted between twenty-one and fifty percent (21%–50%) of the time; and her ability to 

complete a normal workday and workweek without interruptions from psychologically 

based symptoms and to perform at a consistent pace without an unreasonable number and 

length of rest periods would be impacted fifty-one percent (51%) or more of the time. Id.

at 730. Dr. Thienhaus noted that Plaintiff had been receiving care for at least two (2) years. 

Id. at 731. Dr. Thienhaus reported that when Plaintiff is faced with changes in environment 

or demands that were not already a part of her life, she experienced an exacerbation of 

symptoms and deterioration in functioning. AR at 731. On December 29, 2020, Plaintiff 

received telehealth services from Dr. Thienhaus. Id. at 746–47. Plaintiff reported that she 

had not had any recurrence of psychotic symptoms or any major mood instability. Id. at 

746. Dr. Thienhaus’s examination of Plaintiff was generally unremarkable. Id. at 746–47.

On January 6, 2021, Plaintiff spoke with Ms. Carmona for an individualized therapy 

session. Id. at 744–45. Plaintiff reported that her brother had been staying with her and 

her mother for approximately one (1) month, which Plaintiff found disruptive. AR at 744. 

Plaintiff further reported that she had decided not to pursue her MBA as the classes were 

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 14 of 27
- 15 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

becoming increasingly difficult. Id. On January 20, 2021, Plaintiff received telehealth 

services from Ms. Carmona. Id. at 742–43. Plaintiff reported that things were going well. 

Id. at 742. Plaintiff expressed that she enjoys talking to people and likes to be on her feet, 

moving around. Id.

On February 12, 2021, Plaintiff spoke with Ms. Carmona for individual therapy. 

AR at 740–41. Plaintiff reported experiencing an auditory hallucination while waiting in 

line at the post office. Id. at 740. Plaintiff reported consistently taking her medications, 

and denied any other auditory hallucinations or intrusive thoughts. Id. On February 17, 

2021, Plaintiff received telehealth services from Ms. Carmona. Id. at 738–39. Plaintiff 

reported “feeling excited having found a new passion in design and photography.” Id. at 

738. On February 23, 2021, Plaintiff received telehealth services from Dr. Thienhaus. AR

at 736–37. Plaintiff reported a brief episode of auditory hallucination while working 

especially hard helping her mother, but was otherwise asymptomatic. Id. at 736. Dr. 

Thienhaus’s examination of Plaintiff was generally unremarkable. Id. at 736–37.

On March 3, 2021, Plaintiff spoke with Ms. Carmona for individualized therapy. 

Id. at 734–35. Plaintiff reported that things were “going well.” Id. at 734. Plaintiff 

discussed obtaining a Master of Fine Arts in Media Design. AR at 734. Plaintiff expressed 

that she wanted to find a job. Id. Plaintiff noted that she was not afraid of getting hired, 

but expressed concern that she would not be able to sustain it long term. Id.

b. Reviewing physicians

i. R. Nathan, M.D.

On July 29, 202, Dr. Nathan performed an initial review Plaintiff’s medical records. 

AR at 89–96, 100–107. Dr. Nathan considered Plaintiff’s impairments to include 

depressive, bipolar, and related disorders, and anxiety and obsessive-compulsive disorders. 

Id. at 90, 101. Dr. Nathan opined that if the bipolar diagnosis is correct, Plaintiff would 

likely continue to improve with continued medication and no drug or alcohol abuse; 

however, if Plaintiff is schizoaffective, as initially thought, she would likely become less 

functional. Id. at 91, 105.

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 15 of 27
- 16 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

ii. E. Campbell, Ph.D.

On August 13, 2020, on reconsideration, Dr. Campbell opined that “[Plaintiff] does 

not allege worsening of Y conditions[,] [and] [the] M[edical] E[vidence] [of] R[ecord] 

shows improvement and that she is working.” AR at 124, 136.

3. Vocational Expert Ruth Van Vleet’s Testimony

Ms. Van Vleet testified as a vocational expert at the administrative hearing. AR at 

30, 63–66. Ms. Van Vleet described Plaintiff’s past relevant work at Sprouts as a deli 

clerk. Id. at 64. Ms. Van Vleet reported this position as Dictionary of Occupational Titles 

(“DOT”) number 316.684-014, unskilled, and with a Specific Vocational Preparation 

(“SVP”) of 2. Id. Next, Ms. Van Vleet described Plaintiff’s past work in customer service 

at a call center as telephone solicitor or customer service representative, DOT number 

299.357-014, with an SVP of 3, semiskilled, and sedentary exertional level. Id. Ms. Van 

Vleet described Plaintiff’s past work as a customer order clerk, DOT number 249.362-026, 

with an SVP of 4, semiskilled, and sedentary exertional level. Id. Ms. Van Vleet described 

Plaintiff’s past work at Caption Call as somewhat close to a telecommunications operator,

DOT number 203.582-050, with an SVP of 4, semiskilled, and sedentary exertional level. 

AR at 64. Regarding Plaintiff’s past work at AmeriCorps, Ms. Van Vleet described a tutor

position, DOT number 099.227-034, an SVP of 7, skilled, and light exertional level. Id. 

Finally, Ms. Van Vleet described Plaintiff’s past work as a manager trainee, DOT number 

189.167-018, with an SVP of 6, skilled, and light exertional level. Id.

The ALJ asked Ms. Van Vleet to consider a hypothetical individual of Plaintiff’s 

age, education, and work history; who is limited to simple, routine tasks involving simple 

work related decisions and occasional changes in the work setting; and who can frequently 

interact with supervisors, coworkers, and the public. Id. at 64–65. Ms. Van Vleet opined 

that such an individual would be unable to perform Plaintiff’s past work. Id. at 65. Ms. 

Van Vleet further opined that such an individual would be employable as a housekeeper, 

cleaner, or janitor, DOT number 323.687-014, with an SVP of 2, unskilled, light exertional 

level, and of which there are up to 220,000 jobs in the national economy. AR at 65. Ms. 

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 16 of 27
- 17 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

Van Vleet also opined that such an individual would be employable as a paper pattern 

folder, DOT number 794.687-034, with an SVP of 1, unskilled, light exertional level, and 

up to 5,400 jobs in the national economy. Id. Finally, Ms. Van Vleet opined that such an 

individual would be employable as a dishwasher, DOT number 318.687-010, with an SVP 

of 2, unskilled, medium exertional level, and approximately 194,000 jobs in the national 

economy. Id. 

The ALJ then asked Ms. Van Vleet to modify the characteristics of the hypothetical 

individual to only occasional interaction with supervisors, coworkers, and the public. Id. 

Ms. Van Vleet opined that even with the further restriction, such an individual would be 

able to perform the janitor, paper pattern folder, and dishwasher jobs that she had 

previously described. Id. 

Ms. Van Vleet testified that based upon her experience and contact with employers, 

such a hypothetical individual would typically sit less than five (5) minutes per hour. AR 

at 65. Ms. Van Vleet further testified that such an individual who was off-task five (5) 

percent of an eight (8) hour workday would be able to perform those jobs if that individual 

were able to stay in their workplace and change from task to task. Id. at 65–66. Ms. Van 

Vleet also opined that if such an individual was twenty (20) percent off task, they would 

not be able to maintain competitive employment. Id. at 66. Ms. Van Vleet opined that 

based on her experience with labor market research and placing individuals in jobs, it was 

unlikely that ten (10) to fifteen (15) percent of the time off task would be tolerated by an 

employer. Id. 

II. STANDARD OF REVIEW

The factual findings of the Commissioner shall be conclusive so long as they are 

based upon substantial evidence and there is no legal error. 42 U.S.C. §§ 405(g), 

1383(c)(3); Tommasetti v. Astrue, 533 F.3d 1035, 1038 (9th Cir. 2008). This Court may 

“set aside the Commissioner’s denial of disability insurance benefits when the ALJ’s 

findings are based on legal error or are not supported by substantial evidence in the record 

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 17 of 27
- 18 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

as a whole.” Tackett v. Apfel, 180 F.3d 1094, 1097 (9th Cir. 1999) (citations omitted); see 

also Treichler v. Comm’r of Soc. Sec. Admin., 775 F.3d 1090, 1098 (9th Cir. 2014).

Substantial evidence is “‘more than a mere scintilla[,] but not necessarily a 

preponderance.’” Tommasetti, 533 F.3d at 1038 (quoting Connett v. Barnhart, 340 F.3d 

871, 873 (9th Cir. 2003)); see also Garrison v. Colvin, 759 F.3d 995, 1009 (9th Cir. 2014). 

Further, substantial evidence is “such relevant evidence as a reasonable mind might accept 

as adequate to support a conclusion.” Parra v. Astrue, 481 F.3d 742, 746 (9th Cir. 2007). 

Where “the evidence can support either outcome, the court may not substitute its judgment 

for that of the ALJ.” Tackett, 180 F.3d at 1098 (citing Matney v. Sullivan, 981 F.2d 1016, 

1019 (9th Cir. 1992)); see also Massachi v. Astrue, 486 F.3d 1149, 1152 (9th Cir. 2007). 

Moreover, the court may not focus on an isolated piece of supporting evidence, rather it 

must consider the entirety of the record weighing both evidence that supports as well as 

that which detracts from the Secretary’s conclusion. Tackett, 180 F.3d at 1098 (citations 

omitted).

III. ANALYSIS

A. The Five-Step Evaluation

The Commissioner follows a five-step sequential evaluation process to assess 

whether a claimant is disabled. 20 C.F.R. § 404.1520(a)(4). This process is defined as 

follows: Step One asks is the claimant “doing substantial gainful activity[?]” 20 C.F.R. § 

404.1520(a)(4)(i). If yes, the claimant is not disabled. Step Two considers if the claimant 

has a “severe medically determinable physical or mental impairment[.]” 20 C.F.R. § 

404.1520(a)(4)(ii). If not, the claimant is not disabled. Step Three determines whether the 

claimant’s impairments or combination thereof meet or equal an impairment listed in 20 

C.F.R. Pt. 404, Subpt. P, App.1. 20 C.F.R. § 404.1520(a)(4)(iii). If not, the claimant is 

not disabled. Step Four considers the claimant’s residual functional capacity and past 

relevant work. 20 C.F.R. § 404.1520(a)(4)(iv). If claimant can still do past relevant work, 

then he or she is not disabled. Step Five assesses the claimant’s residual functional 

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 18 of 27
- 19 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

capacity, age, education, and work experience. 20 C.F.R. § 404.1520(a)(4)(v). If it is 

determined that the claimant can make an adjustment to other work, then he or she is not 

disabled. Id.

In the instant case, the ALJ found that Plaintiff had not engaged in substantial 

gainful activity since her alleged onset date of June 27, 2020. AR at 32. At step two of 

the sequential evaluation, the ALJ found that “[t]he claimant has the following severe 

impairments: bipolar I disorder with psychosis (20 CFR 404.1520(c) and 416.920(c)).” Id.

at 33. At step three, the ALJ further found that “[t]he claimant does not have an impairment 

or combination of impairments that meets or medically equals the severity of one of the 

listed impairments in 20 CFR Part 404, Subpart P, Appendix 1 (20 CFR 404.1520(d), 

404.1525, 404.1526, 416.920(d), 416.925 and 416.926).” Id. Prior to step four and “[a]fter 

careful consideration of the entire record,” the ALJ determined that “the claimant has the 

residual functional capacity to perform a full range of work at all exertional levels but with 

the following non-exertional limitations: simple, routine tasks involving simple work 

related decisions and occasional changes in the work setting[,] [and] [s]he can frequently 

interact with supervisors, coworkers, and the public.” Id. at 34. At step four, the ALJ 

found that “the claimant is unable to perform any past relevant work (20 CFR 404.1565

and 416.965).” Id. at 37. At step five, the ALJ found that after “[c]onsidering the 

claimant’s age, education, work experience, and residual functional capacity, there are jobs 

that exist in significant numbers in the national economy that the claimant can perform (20 

CFR 404.1569, 404.1569(a), 416.969, and 404.969(a)).” Id. at 38. Accordingly, the ALJ 

determined that Plaintiff was not disabled. AR at 39.

B. Plaintiff’s Symptom Testimony

Plaintiff asserts that “[t]he ALJ has failed to identify any clear and convincing 

reasons . . . supported by substantial evidence for disregarding symptom testimony[,] [and] 

. . . has failed to account for all factors of the other evidence apart from objective medical 

evidence.” Opening Br. (Doc. 18) at 17. Defendant argues that the ALJ “reasonably 

discounted Plaintiff’s subjective complaints” and “Plaintiff is effectively asking this Court 

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 19 of 27
- 20 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

to reweigh the evidence in a light more favorable to her.” Response (Doc. 19) at 3, 12. 

Defendant further argues that even if the ALJ erred, such error was harmless. Id. at 12. 

The Court agrees with agrees with Respondent and finds the ALJ provided clear and 

convincing reasons for discounting Plaintiff’s testimony.

1. Legal Standard

An ALJ must engage in a two-step analysis to evaluate a claimant’s subjective 

symptom testimony. Lingenfelter v. Astrue, 504 F.3d 1028, 1035–36 (9th Cir. 2007). First, 

“a claimant who alleges disability based on subjective symptoms ‘must produce objective 

medical evidence of an underlying impairment which could reasonably be expected to 

produce the pain or other symptoms alleged[.]’” Smolen v. Chater, 80 F.3d 1273, 1281–

82 (9th Cir. 1996) (quoting Bunnell v. Sullivan, 947 F.2d 341, 344 (9th Cir. 1991) (en banc) 

(internal quotations omitted)); see also Ghanim v. Colvin, 763 F.3d 1154, 1163 (9th Cir. 

2014). Further, “the claimant need not show that her impairment could reasonably be 

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

could reasonably have caused some degree of the symptom.” Smolen, 80 F.3d at 1282 

(citations omitted); see also Trevizo v. Berryhill, 871 F.3d 664, 678 (9th Cir. 2017). “Nor 

must a claimant produce ‘objective medical evidence of the pain or fatigue itself, or the 

severity thereof.’” Garrison v. Colvin, 759 F.3d 995, 1014 (9th Cir. 2014) (quoting 

Smolen, 80 F.3d at 1282). “[I]f the claimant meets this first test, and there is no evidence 

of malingering, ‘the ALJ can reject the claimant’s testimony about the severity of her 

symptoms only by offering specific, clear and convincing reasons for doing so.’” 

Lingenfelter, 504 F.3d at 1036 (quoting Smolen, 80 F.3d at 1281); see also Burrell v. 

Colvin, 775 F.3d 1133, 1137 (9th Cir. 2014) (rejecting the contention that the “clear and 

convincing” requirement had been excised by prior Ninth Circuit case law). “This is not 

an easy requirement to meet: ‘The clear and convincing standard is the most demanding 

required in Social Security cases.’” Garrison, 759 F.3d at 1015 (quoting Moore v. Comm’r 

of Soc. Sec. Admin., 278 F.3d 920, 924 (9th Cir. 2002)).

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 20 of 27
- 21 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

SSR 16-3p8states, in relevant part:

We will not evaluate an individual’s symptoms based solely on objective 

medical evidence unless that objective medical evidence supports a finding 

that the individual is disabled. We will evaluate an individual’s symptoms 

based on the evidence in an individual’s record as described below; however, 

not all of the types of evidence described below will be available or relevant 

in every case.

* * *

In evaluating an individual’s symptoms, it is not sufficient for our 

adjudicators to make a single, conclusory statement that “the individual’s 

statements about his or her symptoms have been considered” or that “the 

statements about the individual’s symptoms are (or are not) supported or 

consistent.” It is also not enough for our adjudicators simply to recite the 

factors described in the regulations for evaluating symptoms. The 

determination or decision must contain specific reasons for the weight given 

to the individual’s symptoms, be consistent with and supported by the 

evidence, and be clearly articulated so the individual and any subsequent 

reviewer can assess how the adjudicator evaluated the individual’s 

symptoms.

SSR 16-3p, available at 2017 WL 5180304, at *5, 10 (October 25, 2017). “[T]he ALJ is 

not ‘required to believe every allegation of disabling pain, or else disability benefits would 

be available for the asking, a result plainly contrary to 42 U.S.C. § 423(d)(5)(A).’” Molina 

v. Astrue, 674 F.3d 1104, 1112 (9th Cir. 2012), superseded by regulation on other grounds

(quoting Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989)). Plaintiff “bears the burden of 

proving that an impairment is disabling.” Miller v. Heckler, 779 F.2d 845, 849 (9th Cir. 

1985) (citations omitted).

2. Analysis

The ALJ acknowledged the two-step process for assessing Plaintiff’s symptom 

testimony. AR at 34–35. Next, the ALJ described Plaintiff’s responses on the 

administrative forms and recounted her hearing testimony. Id. at 35. The ALJ then

8 Social Security Rulings are “binding on all components of the Social Security 

Administration.” 20 C.F.R. §§ 402.35(b)(1) and (2); Heckler v. Edwards, 465 U.S. 873 n.3, 104 

S. Ct. 1532, 79 L. Ed. 2d 878 (1984).3

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 21 of 27
- 22 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

concluded “[a]fter careful consideration of the evidence, the undersigned finds that the 

claimant’s medically determinable impairments could reasonably be expected to cause the 

alleged symptoms; however, the claimant’s statements concerning the intensity, 

persistence and limiting effects of these symptoms are not entirely consistent with the 

medical evidence and other evidence in the record for the reasons explained in this 

decision.” Id. at 35. The ALJ went on to review Plaintiff’s medical records and other 

evidence in the file. See id. at 35–36. 

a. Improvement with medication

Plaintiff asserts that her 2019 mental breakdown “is clearly evidence of severe 

mental illness.” Pl.’s Opening Br. (Doc. 18) at 12 (citations omitted). Plaintiff 

acknowledges that “her condition improved with medication[,] [but] . . . contend[s] [] that 

she is not yet at a point where she can return to the workforce on a regular and continuing 

basis.” Pl.’s Reply (Doc. 23) at 1–2. The ALJ observed that “[c]onsistent with the 

claimant’s testimony regarding symptom stability with medication and therapy, behavioral 

health records show no signs of major mood instability and no recurrence of psychotic 

symptoms[.]” AR at 35 (citations omitted). 

Plaintiff alleges an onset date of June 27, 2020. See, e.g., AR at 30. At the time of 

her alleged onset, Plaintiff was receiving regular behavioral health treatment. See Factual 

Bkgd., Section I.B.2., supra. On May 12, 2020, Dr. Thienhaus stressed the importance of 

early intervention and restarting her medications that induced remission last time, and his 

observations of Plaintiff were generally unremarkable. AR at 669–70, 792–93. 

Subsequently, Plaintiff “reported [to her therapist] that she [wa]s feeling ‘better’ after 

having re-started risperidone and lithium.” Id. at 666. Treatment records further reflect 

that Plaintiff “experienced a re-emergence of a mood/psychosis episode mid-May[,] [and]

. . . agreed to start taking psychiatric medication again (had stopped ⁓fall 2019) and 

symptoms resolved without need for another hospitalization.” Id. at 650. Throughout the 

remainder of 2020, Plaintiff consistently reported doing “good,” “well,” or other positive 

descriptor to treatment providers. See AR at 647, 655, 659, 662, 664–65, 726, 752, 755, 

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 22 of 27
- 23 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

759, 777, 781, 785, 787, 789. In February 2021, Plaintiff reported experiencing an auditory 

hallucination or intrusive thought while waiting in line at the post office, and once while 

working especially hard helping her mother. Id. at 736, 740. Other than these two 

episodes, once on medication Plaintiff remained asymptomatic. See id. at 736, 740, 746, 

755, 763, 772, 776.

“Impairments that can be controlled effectively with medication are not 

disabling[.]” Warre v. Comm’r of Soc. Sec. Admin., 439 F.3d 1001, 1006 (9th Cir. 2006). 

The ALJ reasonably found that Plaintiff’s symptoms were controlled with medication.

b. Work and school

The ALJ observed that Plaintiff’s “[b]ehavioral health records from June 2020 note 

the claimant was making good progress with her goals, getting along well with co-workers, 

and going on job interviews for a new position with more hours[.]” AR at 35 (citations 

omitted). The ALJ further noted that “[b]y July 2020, the claimant obtained a new job in 

sales, working from home[,] . . . [and] reported that she enjoyed talking to people and 

described her work as productive.” Id. at 35–36. The ALJ also considered Plaintiff’s

applications to, and participation in, various graduate programs, as well as her reports of 

working with employment services to find a new position. Id. The ALJ determined “[s]uch 

evidence suggests that the claimant can adapt and manage to occasional changes in a work 

setting, simple work-related decision making, and frequent interactions with co-workers, 

supervisors, and the public.” Id. at 36.

Plaintiff “does not dispute that she is grossly capable of such activities for a time; 

however, she contends that she is not capable of maintaining such activities on a regular 

and continuing basis.” Pl.’s Opening Br. (Doc. 18) at 17. Plaintiff further contends that 

her “history of short-lived work activity, marked by a pattern of finding reasons for leaving 

or giving her employer reasons to terminate her overlaying bipolar disorder that reduces 

her ability to maintain attention and concentration on a regular and continuing basis, is not 

a clear and convincing reason to disregard her consistent symptom testimony.” Id.

Indeed, the ALJ considered that “[w]hile [Plaintiff] testified that she has trouble 

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 23 of 27
- 24 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

keeping a job, the record does not show that her job losses were related to her bipolar 

disorder.” AR at 36. This conclusion is supported by the record. “Even where th[e] 

activities suggest some difficulty functioning, they may be grounds for discrediting the 

claimant’s testimony to the extent that they contradict claims of a totally debilitating 

impairment.” Molina v. Astrue, 674 F.3d 1104, 1113 (9th Cir. 2012) (citations omitted), 

superseded by regulation on other grounds. The ALJ reasonably found that Plaintiff’s 

reports of debilitating mental health symptoms unsupported by the record. Where “the 

evidence can support either outcome, the court may not substitute its judgment for that of 

the ALJ.” Tackett v. Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999) (citing Matney v. Sullivan, 

981 F.2d 1016, 1019 (9th Cir. 1992)); see also Massachi v. Astrue, 486 F.3d 1149, 1152 

(9th Cir. 2007).

c. Stress Management

The ALJ also considered Plaintiff’s ability to manage stressors. AR at 36. The ALJ 

noted that “[d]uring June 2020, [Plaintiff] reported increased stress from her crowded 

living situation [and] her job that did not provide enough work hours[.]” Id. (citations 

omitted). The ALJ observed that “[d]espite this stress, [Plaintiff’s] symptoms remained 

stable with medication, without any negative side effects.” Id.

The ALJ reasonably concluded that Plaintiff’s ability to manage stressors was 

inconsistent with her reports of totally disabling mental health symptoms. Where “the 

evidence can support either outcome, the court may not substitute its judgment for that of 

the ALJ.” Tackett v. Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999) (citing Matney v. Sullivan, 

981 F.2d 1016, 1019 (9th Cir. 1992)); see also Massachi v. Astrue, 486 F.3d 1149, 1152 

(9th Cir. 2007).

C. Medical Opinion Evidence

Plaintiff asserts that “[t]he ALJ’s analysis of opinion evidence of record fails to 

adequately address the factors of supportability and consistency in a manner that is 

supported by substantial evidence.” Pl.’s Opening Br. (Doc. 18) at 20. The Court finds 

that the ALJ properly considered the medical opinion evidence.

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 24 of 27
- 25 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

1. Legal Standard

Section 404.1520c, 20 C.F.R., governs the analysis of medical opinions for 

disability claims filed on or after March 27, 2017. “Under the revised regulations, ‘there 

is not an inherent persuasiveness to evidence from [government consultants] over [a 

claimant’s] own medical source(s), and vice versa.’”9 Woods v. Kijakazi, 32 F.4th 785, 

791 (9th Cir. 2022) (alterations in original) (quoting Revisions to Rules Regarding the 

Evaluation of Medical Evidence, 82 Fed. Reg. at 5844)). Rather, medical opinions are 

evaluated pursuant to the factors set forth in Section 404.1520c(c)(1)–(5), with the most 

important factors being supportability and consistency:

(1) Supportability. The more relevant the objective medical 

evidence and supporting explanations presented by a medical 

source are to support his or her medical opinion(s) or prior 

administrative medical finding(s), the more persuasive the 

medical opinions or prior administrative medical findings(s) 

will be.

(2) Consistency. The more consistent a medical opinion(s) 

or prior administrative medical fining(s) is with the evidence 

from other medical sources and nonmedical sources in the 

claim, the more persuasive the medical opinion(s) or prior 

administrative medical finding(s) will be.

20 C.F.R. § 404.1520c(c); see also 20 C.F.R. § 404.1520c(b)(2). The regulations

specifically require the ALJ to explain how he or she considered supportability and 

consistency in evaluating medical opinions and making the disability determination. 20 

C.F.R. § 404.1520c(b)(2). Additionally, the ALJ may, but is not required to, consider other 

factors such as the medical source’s relationship with the claimant, the medical source’s 

area of specialization, or “evidence showing a medical source has familiarity with the other 

evidence in the claim or an understanding of our disability program’s policies and 

evidentiary requirements.” 20 C.F.R. 404.1520c(c)(3)–(5).

9 The Ninth Circuit Court of Appeals has held that its previous “requirement that ALJs 

provide ‘specific and legitimate reasons’ for rejecting a treating or examining doctor’s opinion . . 

. is . . . incompatible with the revised regulations. Woods v. Kijakazi, 32 F.4th 785, 792 (9th Cir. 

2022).

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 25 of 27
- 26 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

2. Analysis

The ALJ summarized Dr. Thienhaus’s Mental Residual Functional Capacity 

(“MRFC”) Assessment regarding Plaintiff and contrasted it with inconsistencies with his 

own treatment notes, as well as Plaintiff’s hearing testimony. AR at 36–37. As an initial 

matter, the ALJ observed that Dr. Thienhaus’s MRFC Assessment was on a checkbox 

form. The Ninth Circuit has held “that the ALJ may ‘permissibly reject[] . . . check-off 

reports that [do] not contain any explanation of the bases of their conclusions.’” Molina v. 

Astrue, 674 F.3d 1104, 1111 (9th Cir. 2012) (alterations in original) (quoting Crane v. 

Shalala, 76 F.3d 251, 253 (9th Cir. 1996)), superseded by regulation on other grounds. 

Plaintiff focuses on Dr. Thienhaus description of “intermittent” psychotic episodes in the 

MRFC to demonstrate that his opinion was not inconsistent; however, this does not account 

for Dr. Thienhaus’s repeated unremarkable mental status examinations of Plaintiff. 

Plaintiff further objects to the ALJ’s observation that Plaintiff “has sustained the 

concentration, persistence, and pace to complete coursework online.” Compare AR at 37, 

with Pl.’s Opening Br. (Doc. 18) at 20. Plaintiff’s inability to pass her graduate level 

accounting class does not negate the ALJ’s finding. 

Plaintiff further objects to the ALJ’s consideration of the State-agency medical 

consultant’s opinions, asserting that “none of the[] background assumptions and 

considerations [are] supported by substantial evidence.” Pl.’s Opening Br. (Doc. 18) at 20. 

Contrary to Plaintiff’s argument, however, the Court finds that the ALJ properly 

summarized and considered the State-agency physician testimony.

Substantial evidence “means—and means only—such relevant evidence as a 

reasonable mind might accept as adequate to support a conclusion.” Biestek v. Berryhill, 

139 S. Ct. 1148, 1154 (2019) (quotations and citations omitted). The Court finds that the 

ALJ properly analyzed the medical opinion evidence of record, and the ALJ’s findings are

supported by the record.

. . .

. . .

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 26 of 27
- 27 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

IV. CONCLUSION

Based on the foregoing, the Court finds the ALJ properly assessed the medical 

opinion evidence of record and Plaintiff’s symptom testimony. Plaintiff “bears the burden 

of proving that an impairment is disabling.” Miller v. Heckler, 779 F.2d 845, 849 (9th Cir. 

1985) (citations omitted). Plaintiff has not met her burden in this case.

Accordingly, IT IS HEREBY ORDERED that Plaintiff’s Opening Brief (Doc. 18) 

is DENIED, and the Commissioner’s decision is AFFIRMED.

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

accordingly.

Dated this 26th day of September, 2023.

Case 4:22-cv-00163-EJM Document 24 Filed 09/27/23 Page 27 of 27