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Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 

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FOR PUBLICATION

UNITED STATES COURT OF APPEALS

FOR THE NINTH CIRCUIT

SARAH E. DALE,

Plaintiff-Appellant,

v.

CAROLYN W. COLVIN,

Commissioner of Social Security,

Defendant-Appellee.

No. 14-35583

D.C. No.

3:13-cv-01187-HZ

OPINION

Appeal from the United States District Court

for the District of Oregon

Marco A. Hernandez, District Judge, Presiding

Submitted December 31, 2015*

San Francisco, California

Filed May 19, 2016

Before: Edward Leavy, Susan P. Graber,

and John B. Owens, Circuit Judges.

Opinion by Judge Graber;

Dissent by Judge Leavy

* The panel unanimously concludes that this case is suitable for decision

without oral argument. Fed. R. App. P. 34(a)(2).

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2 DALE V. COLVIN

SUMMARY**

Social Security

The panel reversed the district court’s judgment affirming

the Commissioner of Social Security’s denial of a claimant’s

application for supplemental securityincome under Title XVI

of the Social Security Act; held that the administrative law

judge (“ALJ”) erred in according “limited weight” to the

opinion of a nurse practitioner; and remanded for further

proceedings.

Nurse practitioners are considered “other sources.” 

20 C.F.R. § 404.1513(a) & (d)(1).

The panel held that an ALJ errs when he discounts an

other source’s entire testimony because of inconsistencywith

evidence in the record, where the ALJ had divided the

testimony into distinct parts and determined that only one part

of the testimony was inconsistent. The panel held that the

ALJ’s determination in this case – that the nurse

practitioner’s opinion regarding claimant’s “exertional and

postural” limitations was inconsistent with other evidence

in the record – was an insufficient reason to reject her

testimony regarding claimant’s manipulative and mental

limitations. The panel held that the error was not harmless

because the vocational expert opined that a person with the

mental limitations identified by the nurse practitioner could

not work. 

** This summary constitutes no part of the opinion of the court. It has

been prepared by court staff for the convenience of the reader.

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DALE V. COLVIN 3

The panel held that further administrative proceedings

were required to reconcile all the record evidence and to

consider additional issues, such as the onset date of

claimant’s disability, if any.

Judge Leavy dissented, and he would hold that the ALJ

gave specific, supported, and germane reasons for

discounting the nurse practitioner’s opinion, and the

Commissioner’s decision denying benefits should be

affirmed.

COUNSEL

Merrill Schneider, Schneider, Kerr & Gibney Law Offices,

Portland, Oregon, for Plaintiff-Appellant.

Lisa Goldoftas, Assistant Regional Counsel, David Morado,

Regional Chief Counsel, Social Security Administration,

Office of the General Counsel; Ronald K. Silver, Assistant

United States Attorney, and S. Amanda Marshall, United

States Attorney, Seattle, Washington, for DefendantAppellee.

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4 DALE V. COLVIN

OPINION

GRABER, Circuit Judge:

Claimant Sarah E. Dale appeals the district court’s

judgment affirming the Commissioner of Social Security’s

denial of her application for supplemental security income

under Title XVI of the Social Security Act. An

administrative law judge (“ALJ”) found that, despite having

severe impairments, Claimant is not disabled. The sole issue

on appeal is whether the ALJ erred in according “limited

weight” to the opinion of a nurse practitioner. We hold that

the ALJ did err and, therefore, reverse and remand for further

proceedings.

FACTUAL AND PROCEDURAL HISTORY

Claimant was born in 1985. She had a difficult

childhood, experiencing both sexual and physical abuse;

frequent moves; exposure to violence and drugs; and the

death of her mother when she was 12 years old. At age 17,

she earned a GED, which is the equivalent of a high school

diploma. She also completed a residential drug treatment

program to deal with methamphetamine use. Claimant has

two young children and a minimal work history.

In late 2009, Claimant filed an application for

supplemental security income, alleging that she had been

disabled since January 1, 2007. Claimant alleged that her

disability resulted from post-traumatic stress disorder

(“PTSD”), anxiety, panic disorder, degenerative disc disease,

high blood pressure, and dyslexia. The claim was denied

initially and on reconsideration.

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DALE V. COLVIN 5

At Claimant’s request, a hearing was held on her claim. 

The ALJ received testimony from Claimant, a lay witness,

and a vocational expert. The ALJ also reviewed the medical

records. Applying the familiar five-step sequential

evaluation, 20 C.F.R. § 416.920, the ALJ denied benefits,

concluding:

• Step One: Claimant had not engaged in substantial

gainful activity since her application date.

• Step Two: Claimant had severe impairments,

specifically, mild degenerative disc disease of the lumbar

spine; minimal disc bulging in the cervical spine; anxiety; and

panic disorder.

• Step Three: Claimant’s impairments did not meet or

equal a listed impairment.

• Step Four: Claimant had no past relevant work.

• Step Five: Claimant’s residual functional capacity

(“RFC”) allowed her to perform light work, except that she

could occasionally climb ladders, ropes, and scaffolds and

could frequently climb ramps and stairs. Claimant could

frequently balance, stoop, kneel, crouch, and crawl. She

could reach overhead with her left arm, occasionally. But she

was limited to performing simple, routine tasks that involved

no more than occasional interaction with coworkers and the

public. The ALJ next found that there were jobs that existed

in significant numbers in the national economy that Claimant

could perform, including assembler, cleaner/polisher, and

night cleaner or housekeeper. Thus, Claimant was not

disabled.

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6 DALE V. COLVIN

The Appeals Council denied Claimant’s request for

review, making the ALJ’s decision the Commissioner’s final

decision. The district court affirmed the Commissioner’s

decision and dismissed the case with prejudice. This timely

appeal followed.

STANDARD OF REVIEW

We review the district court’s decision de novo. 

Valentine v. Comm’r Soc. Sec. Admin., 574 F.3d 685, 690

(9th Cir. 2009). We must affirm the Commissioner’s final

decision if it is supported by substantial evidence and is free

of legal error. 42 U.S.C. § 405(g).

DISCUSSION

The sole issue on appeal is whether, at Step Five, the ALJ

erred by improperly evaluating the opinion of Laurie Beeson,

a family nurse practitioner. Nurse practitioners are

considered “other sources.” 20 C.F.R. § 404.1513(a) &

(d)(1); Britton v. Colvin, 787 F.3d 1011, 1013 (9th Cir. 2015)

(per curiam). “The ALJ may discount testimony from these

‘other sources’ if the ALJ ‘gives reasons germane to each

witness for doing so.’” Molina v. Astrue, 674 F.3d 1104,

1111 (9th Cir. 2012) (quoting Turner v. Comm’r of Soc. Sec.,

613 F.3d 1217, 1224 (9th Cir. 2010)).

Beeson completed a medical questionnaire in 2012. 

Beeson provided opinions concerning both Claimant’s

physical limitations and her mental limitations. Beeson had

been treating Claimant for about three years. She opined that

Claimant’s medical conditions included chronic back pain,

generalized anxiety disorder, panic disorder (with

agoraphobia and panic attacks), PTSD, obesity, incontinence,

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DALE V. COLVIN 7

hypertension, left shoulder pain, and chronic leg pain. 

Claimant’s main problems consisted of panic disorder,

agoraphobia, and lower back pain with sciatica in the left leg.

With respect to Claimant’s physical functional capacity,

Beeson stated that Claimant could lift or carry less than ten

pounds frequently and occasionally, stand or walk fifteen

minutes at a time for a total of two hours per day, and sit two

hours at a time for a total of eight hours per day. Claimant

was limited in both upper and lower extremities; Claimant’s

ability to push and pull was limited, she could never climb,

balance, crouch, or crawl, and she could occasionally stoop,

bend, kneel, and engage in gross manipulation.

With respect to mental impairments, Beeson opined that

Claimant was moderately limited in concentration,

persistence, and pace. Because of her fear of leaving her

house, Claimant’s social functioning was markedly limited

due to agoraphobia. Claimant’s ability to handle the stress of

performing even simple, routine work was limited by what

Beeson considered a “severe anxiety disorder.” Claimant’s

attention and concentration would likely be impaired such

that she would be unable to perform even simple work tasks

for 20 percent of the workweek. Because of Claimant’s

mental impairments, Beeson expected her to miss 16 hours or

more per month from even a simple and routine sedentary

job. The vocational expert testified that a person with those

mental limitations would not be able to perform any jobs in

the economy.

The record also contained opinions from a non-examining

physician, a non-examining psychologist, and an examining

neurologist. The ALJ gave “great weight” to the

psychologist’s opinion but only “limited weight” to Beeson’s

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8 DALE V. COLVIN

opinion. The ALJ’s reason for discounting Beeson’s opinion

reads, in full:

Overall, the longitudinal record, includingMs.

Beeson’s treatment notes[, does] not

objectively support the degree of exertional

and postural limitation that she proposes. 

Nevertheless, the residual functional capacity

found in this decision includes manipulative

and mental limitations that are generally

consistent with Ms. Beeson’s assessment.

That is, the ALJ found a single inconsistency: 

Beeson’s evaluation of Claimant’s exertional

and postural limitations was not supported by

her own treatment notes. By contrast, the ALJ

gave no reason—germane or otherwise—to

discount Beeson’s assessment of Claimant’s

manipulative and mental limitations, which

differed from the assessment given by the

psychologist to whose opinion the ALJ

deferred. And, of course, we are limited to

considering the reasons the agency gave for

its decision. Bray v. Comm’r of Soc. Sec.

Admin., 554 F.3d 1219, 1225–26 (9th Cir.

2009).

Typically, of course, the reason for discounting an “other”

source applies to the entire testimony of the witness. For

example, in Turner, the source did not give an opinion about

the claimant’s condition until two years after the date last

insured—making the opinion only marginally relevant—and

the source’s entire testimony differed from the opinion of all

the doctors. 613 F.3d at 1224. In Molina, the source’s

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DALE V. COLVIN 9

opinion on the sole issue in dispute conflicted with her own

earlier assessment of the claimant and with the opinion of the

relevant medical specialist. 674 F.3d at 1111–12. Other

examples readily come to mind. For example, an ALJ may

discount a witness’ testimony because of bias. See Valentine,

574 F.3d at 694 (explaining that claims of bias “in the

abstract” are inadequate, but evidence that a witness

exaggerated a claimant’s symptoms for the witness’ benefit

could support a finding of bias). Reasons such as these apply

to a witness’ entire testimony. Often, too, as in Molina, the

other source gives an opinion about only one thing, so that a

germane reason necessarily applies to the source’s whole

opinion.

Here, however, the situation is different. The ALJ

himself divided Beeson’s testimony into two parts: 

(1) “exertional and postural” limitations and

(2) “manipulative and mental” limitations.1 As to the former,

the ALJ permissibly discounted Beeson’s testimony on the

ground that her treatment notes did not objectively support

the degree of limitation proposed. As to the latter, the ALJ

stated his intention to devise an RFC finding that was

“generally consistent with Ms. Beeson’s assessment”—that

is, to credit, or at least not contradict, Beeson’s opinion of

1 The dissent contends that the ALJ’s division of Beeson’s testimony

“originated in the format supplied by Dale’s attorney.” Dissent at 15. 

Whether the attorney or the ALJ was first to separate physical and mental

limitations is immaterial. What matters is that the ALJ independently

adopted the two-part structure and clearly stated that, although he rejected

Beeson’s assessment of the exertional and postural limitations, the

manipulative and mental limitations assessment was “generally

consistent” with the RFC. As explained above, however, the RFC was not

consistent with either part of Beeson’s testimony. 

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10 DALE V. COLVIN

Claimant’s “manipulative and mental” limitations.2 But in

fact the RFC differs markedly from Beeson’s view. For

example, the ALJ found that Claimant could only

occasionally reach overhead, whereas Beeson found that she

could frequently reach overhead. Beeson limited Claimant to

only occasional handling with both upper extremities, but the

RFC did not include limitations as to her handling

capabilities. Lastly, the RFC failed to incorporate mental

limitations consistent with Beeson’s opinion, such as her

findings that Claimant would be unable to perform simple

work tasks for 20 percent of the workweek and would be

expected to miss at least two days of work per month due to

her anxiety and PTSD.

We have not addressed in our past cases the question

whether an ALJ may discount the entire medical opinion of

an other source when the ALJ has divided the opinion into

distinct parts and only one of those parts is inconsistent with

objective evidence in the record. But we have upheld an

ALJ’s decision to reject only the part of a lay witness’

testimony that was inconsistent with objective evidence in the

record. See, e.g., Bayliss v. Barnhart, 427 F.3d 1211, 1218

(9th Cir. 2005). We now hold that an ALJ errs when he

discounts an other source’s entire testimony because of

inconsistency with evidence in the record, when the ALJ has

divided the testimony into distinct parts and determined that

2 Beeson’streatment notes with respect to Claimant’s manipulative and

mental impairments, unlike her treatment notes with respect to exertional

and postural limitations, appear to be consistent with her assessment.

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DALE V. COLVIN 11

only one part of the testimony is inconsistent.3 Thus, the

ALJ’s determination in this case that Beeson’s opinion

regarding Claimant’s “exertional and postural” limitations

was inconsistent with other evidence in the record was an

insufficient reason to reject her testimony regarding

Claimant’s manipulative and mental limitations.4

That error was not harmless, Molina, 674 F.3d at 1115,

because the vocational expert opined that a person with the

mental limitations identified by Beeson could not work. But

further proceedings are required to reconcile all the record

evidence and to consider additional issues, such as the onset

3 We need not decide whether an ALJ who has not divided an other

source’s testimony into distinct parts may discount that witness’ entire

opinion when only some of the opinion is inconsistent with evidence in

the record. We note, however, that at least one district court within our

circuit has concluded that the ALJ may not dismiss an other source’s

entire opinion in such circumstances. See McCann v. Colvin, 111 F. Supp.

3d 1166, 1174 (W.D. Wash. 2015) (citing Bayliss and holding that, when

an ALJ discounts the opinion of an other source because it is “inconsistent

with the objective evidence in the record, he must discount only those

portions ofthe opinion that are actually inconsistent, not those parts which

are uncontradicted”).

4 The dissent asserts that the ALJ permissibly rejected Beeson’s opinion

regarding the manipulative and mental limitations because the opinionwas

manipulated by Dale’s lawyer or was “pure conjecture and relie[d] only

on Dale’s self-reported symptoms.” Dissent at 15. But the ALJ did not

state any such reasoning in his decision—much to the contrary, he

suggested that he was accepting Beeson’s recommendations regarding the

manipulative and mental limitations. Therefore, we may not consider on

appeal the reliability of Beeson’s opinion regarding the manipulative and

mental limitations. See Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007)

(“We review only the reasons provided by the ALJ in the disability

determination and may not affirm the ALJ on a ground upon which he did

not rely.”). 

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12 DALE V. COLVIN

date of Claimant’s disability, if any. Accordingly, we reverse

and remand for further administrative proceedings.

REVERSED and REMANDED.

LEAVY, Circuit Judge, dissenting.

The ALJ, applying the standard legal framework,

determined that Dale was not “disabled” as defined in the

Social Security Act. The Act defines “disability” as the

“inability 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)

(emphasis added); see also 42 U.S.C. § 1382c(a)(3)(A). A

“physical or mental impairment” is one that “results from

anatomical, physiological, or psychological abnormalities

which are demonstrable by medically acceptable clinical and

laboratory diagnostic techniques.” 42 U.S.C. §§ 423(d)(3),

1382c(a)(3)(D) (emphasis added). See Ukolov v. Barnhart,

420 F.3d 1002, 1004–05 (9th Cir. 2005) (quoting same).

Nurse practitioner Laurie Beeson was one of several

employees of the Multnomah CountyHealth Department who

treated Dale’s impairments. The ALJstated in his findings of

fact:

Treatment notes from Multnomah County

Health Department show the claimant

carrying diagnoses for various mental

impairments, including panic disorder,

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DALE V. COLVIN 13

generalized anxiety, depressive disorder, and

posttraumatic stress disorder. (Exhibit 2F). 

These assessments were made by nonphysician treatment providers and do not

include any objective testing.”1(emphasis

added).

In evaluating the severity of mental impairments, the ALJ

is required to “specify the symptoms, signs, and laboratory

findings that substantiate the presence of the impairment(s)

and document [the findings].” 20 C.F.R. §§ 404.1520a(b)(1),

416.920a(b)(1) (emphasis added). The ALJ noted that Dale

received mental health treatment from Western Psychological

& Counseling Services with a diagnosis summary by a

psychologist who listed the diagnoses of generalized anxiety

disorder and panic disorder with agoraphobia.

As a general matter, a nurse practitioner is an “other

source” for the purposes of medical testimony, see 20 C.F.R.

§ 404.1513(a) & (d), and, as such, the ALJ is entitled to give

less weight to an “other source” medical opinion by providing

“reasons germane to each witness for doing so.” Turner v.

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

(internal quotations omitted). The “reasons germane to the

witness” standard originated in Dodrill v. Shalala, 12 F.3d

915, 919 (9th Cir. 1993), and is applied to review “other

source” as well as lay evidence. See, e.g., Britton v. Colvin,

787 F.3d 1011, 1013 (9th Cir. 2015) (nurse practitioner);

Bayliss 427 F.3d at 1218 (lay witness). The ALJ stated that

1 Beeson’s treatment notes dated in April 2011 stated that Beeson had

last seen Dale two months earlier. Dale told Beeson that she made the

current appointment because “she is applying for disability and [was]

advised by her lawyer she is not coming in frequent [sic] enough.” 

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Beeson “normally would not be an acceptable source to

proffer a medical opinion.” The ALJ nevertheless considered

Beeson’s opinion because the ALJ stated “[Beeson] has a

treating relationship with the claimant.”

Beeson’s opinion consisted of a check-the-box

questionnaire created and supplied by Dale’s attorney. The

5-page questionnaire assessed Dale’s residual functional

capacity and covered physical limitations followed by mental

limitations. Beeson checked the various boxes for most of

her answers and gave several brief explanations for other

answers. Beeson checked a box indicating that Dale’s

attention and concentration would be impaired to such a

degree that she could not be expected to perform even simple

work tasks for 20 percent of the work week. Beeson also

checked a box indicating that she expected Dale to miss 16

hours or more per month from even a simple and routine

sedentary job because of Dale’s anxiety and posttraumatic

stress disorder. Beeson cited no supportingmedical evidence. 

When asked to state “findings that support your opinion” as

to Dale’s anxiety disorders, Beeson left the answer blank,

which was consistent with the ALJ’s finding that the

Multnomah County Health Department did not perform

objective testing of Dale’s mental impairments.

Dale contends “The ALJ’s failure to expressly reject or

account for Nurse Beeson’s findings that Ms. Dale could only

perform occasional handling, would be off task for 20 percent

of the time, and would miss more than two days of work per

month (‘manipulative and mental limitations’) is the

dispositive issue and constitutes reversible error.” (emphasis

added).

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DALE V. COLVIN 15

The ALJ committed no legal error by discounting

Beeson’s opinion because the ALJ determined that Beeson’s

treatment notes did not support her proposed degree of

exertional and postural limitations, and the mental

assessments from non-physician treatment providers

(includingBeeson’s opinion as to Dale’s mental impairments)

were unsupported by clinical evidence. See Molina v. Astrue,

674 F.3d 1104, 1111–12 (9th Cir. 2012) (ALJ permissibly

discounted the nurse practitioner’s check-off report that failed

to provide supporting reasoning or clinical findings); Bayliss

v. Barnhart, 427 F.3d 1211, 1217 (9th Cir. 2005) (ALJ

properly rejected a doctor’s opinion as to the claimant’s

mental impairment because the opinion was not supported by

clinical evidence); Tonapetyan v. Halter, 242 F.3d 1144,

1149 (9th Cir. 2001) (ALJ need not accept a medical opinion

if it is inadequately supported by clinical findings). 

Accordingly, the ALJ properly accounted for and discounted

Beeson’s entire opinion.

The “majority holds that the ALJ erred in discounting

Beeson’s entire opinion when the ALJ “has divided the

opinion into distinct parts and only one of those parts is

inconsistent with other objective evidence in the record.” I

disagree. The division of Beeson’s opinion in this case

originated in the format supplied by Dale’s attorney, which

tracks the categories set forth in the regulations for residual

functional capacity. Beeson’s opinion as to Dale’s extertional

and postural limitations was inconsistent with her own

treatment notes. Beeson’s opinion as to Dale’s manipulative

and mental limitations, specifically regarding the

“dispositive” issue of Dale’s work absenteeism, is pure

conjecture and relies only on Dale’s self-reported symptoms. 

See Bayliss 427 F.3d at 1217 (the ALJ properly rejected an

opinion rendered on the basis of subjective complaints);

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16 DALE V. COLVIN

Ukolov, 420 F.3d at 1005 (discussing the requirement of

objective medical evidence to a determination of an

impairment).

Because the ALJ gave specific, supported, and germane

reasons for discounting Beeson’s opinion, the

Commissioner’s decision denying benefits should be

affirmed. Even assuming possible merit in the majority’s

requirement when an ALJ divides “other source” testimony

into “distinct parts,” that situation is not present in this case. 

Here, the ALJ correctly determined that the mental

impairment assessments from a non-physician treatment

provider were unsupported by objective medical evidence.

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