Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_19-cv-00555/USCOURTS-casd-3_19-cv-00555-3/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:0402 Social Security Benefits

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UNITED STATES DISTRICT COURT 

SOUTHERN DISTRICT OF CALIFORNIA 

LAVON ANNETTE SEAWOOD, 

Plaintiff, 

v. 

NANCY A. BERRYHILL, Acting 

Commissioner of Social Security, 

Defendant. 

 Case No.: 19-CV-555-LAB(WVG) 

REPORT AND 

RECOMMENDATION ON CROSSMOTIONS FOR SUMMARY 

JUDGMENT 

[Doc. Nos. 17, 18.] 

 This is an action for judicial review of a decision by the Acting Commissioner of 

Social Security, Nancy A. Berryhill, denying Plaintiff Lavon Annette Seawood 

supplemental security income (“SSI”) benefits under Title XVI of the Social Security Act 

(the “Act”) and Social Security Disability Insurance under Title II of the Act. The parties 

have filed cross-motions for summary judgment, and the matter is before the undersigned 

Magistrate Judge for preparation of a Report and Recommendation. For the reasons stated 

below, the Court RECOMMENDS that Plaintiff’s motion for summary judgment be 

DENIED and Defendant’s cross-motion for summary judgment be GRANTED. 

/ / / 

/ / / 

/ / / 

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I. OVERVIEW OF SOCIAL SECURITY CLAIM PROCEEDINGS

Pursuant to the Social Security Act, the Social Security Administration (“SSA”) 

administers the SSI program. 42 U.S.C. § 901. The Act authorizes the SSA to create a 

system by which it determines who is entitled to benefits and by which unsuccessful 

claimants may obtain review of adverse determinations. Id. §§ 423 et seq. Defendant, as 

Acting Commissioner of the SSA, is responsible for the Act’s administration. Id. 

§ 902(a)(4), (b)(4). 

A. The SSA’s Sequential Five-Step Process 

The SSA employs a sequential five-step evaluation to determine whether a claimant 

is eligible for benefits. 20 C.F.R. §§ 416.920, 404.1520. To qualify for disability benefits 

under the Act, a claimant must show that (1) he or she suffers from a medicallydeterminable impairment1

 that can be expected to result in death or that has lasted or can 

be expected to last for a continuous period of twelve months or more and (2) the impairment 

renders the claimant incapable of performing the work that he or she previously performed 

or any other substantially gainful employment that exists in the national economy. See 42 

U.S.C. §§ 423(d)(1)(A), (2)(A); 1382(c)(3)(A). 

A claimant must meet both of these requirements to qualify as “disabled” under the 

Act, id. § 423(d)(1)(A), (2)(A), and bears the burden of proving that he or she “either was 

permanently disabled or subject to a condition which became so severe as to create a 

disability prior to the date upon which [his or] her disability insured status expired.” 

Johnson v. Shalala, 60 F.3d 1428, 1432 (9th Cir. 1995). An administrative law judge 

(“ALJ”) presides over the five-step process to determine disability. See Barnhart v. 

Thomas, 540 U.S. 20, 24-25 (2003) (summarizing the five-step process). If the 

Commissioner finds that a claimant is disabled or not disabled at any step in this process, 

                                                                

1

 A medically-determinable physical or mental impairment “is an impairment that results 

from anatomical, physiological, or psychological abnormalities, which can be shown by 

medically acceptable clinical and laboratory diagnostic techniques.” 42 U.S.C. § 423(d)(3). 

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the review process is terminated at that step. Corrao v. Shalala, 20 F.3d 943, 946 (9th Cir. 

1994). 

 Step one in the sequential evaluation considers a claimant’s “work activity, if any.” 

20 C.F.R. § 404.1520(a)(4)(i). An ALJ will deny a claimant disability benefits if the 

claimant is engaged in “substantial gainful activity.” Id. §§ 404.1520(b), 416.920(b). 

 If a claimant cannot provide proof of gainful work activity, the ALJ proceeds to step 

two to ascertain whether the claimant has a medically severe impairment or combination 

of impairments. The so-called “severity regulation” dictates the course of this analysis. Id. 

§§ 404.1520(c), 416.920(c); see also Bowen v. Yuckert, 482 U.S. 137, 140-41 (1987). 

An ALJ will deny a claimant’s disability claim if the ALJ does not find that a 

claimant suffers from a severe impairment or combination of impairments which 

significantly limits the claimant’s physical or mental ability to do “basic work activities.” 

20 C.F.R. § 404.1520(c). The ability to do “basic work activities” means “the abilities and 

aptitudes necessary to do most jobs.” Id. §§ 404.1521(b), 416.921(b). 

However, if the impairment is severe, the evaluation proceeds to step three. At step 

three, the ALJ determines whether the impairment is equivalent to one of several listed 

impairments that the SSA acknowledges are so severe as to preclude substantial gainful 

activity. Id. §§ 404.1520(d), 416.920(d). An ALJ conclusively presumes a claimant is 

disabled so long as the impairment meets or equals one of the listed impairments. Id. 

§ 404.1520(d). 

If the ALJ does not deem a claimant disabled—but before formally proceeding to 

step four—the ALJ must establish the claimant’s Residual Functional Capacity (“RFC”). 

Id. §§ 404.1520(e), 404.1545(a). An individual’s RFC is his or her ability to do physical 

and mental work activities on a sustained basis despite limitations from his or her 

impairments. Id. §§ 404.945(a)(1), 404.1545(a)(1). The RFC analysis considers “whether 

[the claimant’s] impairment(s), and any related symptoms, such as pain, may cause 

physical and mental limitations that affect what [the claimant] can do in a work setting.” 

Id. §§ 404.1545(a)(1), 416.945(a)(1). In establishing a claimant’s RFC, the ALJ must 

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assess relevant medical and other evidence, as well as consider all of the claimant’s 

impairments, including impairments categorized as non-severe. Id. § 404.1545(a)(3), (e). 

If an ALJ does not conclusively determine a claimant’s impairment or combination of 

impairments is disabling at step three, the evaluation advances to step four. 

At step four, the ALJ uses the claimant’s RFC to determine whether the claimant has 

the ability to perform the requirements of his or her past relevant work. Id. § 404.1520(f). 

So long as a claimant has the RFC to carry out his or her past relevant work, the claimant 

is not disabled. Id. § 404.1560(b)(3). Conversely, if the claimant either cannot perform or 

does not have any past relevant work, the analysis presses onward. 

 At the fifth and final step of the SSA’s evaluation, the ALJ must verify whether the 

claimant is able to do any other work in light of his or her RFC, age, education, and work 

experience. Id. § 404.1520(g). If the claimant is able to do other work, the claimant is not 

disabled. However, if the claimant is not able to do other work and meets the duration 

requirement, the claimant is disabled. Id. Although the claimant generally continues to have 

the burden of proving disability at step five, a limited burden of going forward with the 

evidence shifts to the SSA. At this stage, the SSA must present evidence demonstrating 

that other work that the claimant can perform—allowing for his RFC, age, education, and 

work experience—exists in significant numbers in the national economy. Id. §§ 404.1520, 

1560(c), 416.920, 404.1512(f). 

B. SSA Hearings and Appeals Process 

 In accordance with Defendant’s delegation, the Office of Disability Adjudication 

and Review administers a nationwide hearings and appeals program. SSA regulations 

provide for a four-step process for administrative review of a claimant’s application for 

disability payments. See id. §§ 416.1400, 404.900. Once the SSA makes an initial 

determination, three more levels of appeal exist: (1) reconsideration, (2) hearing by an ALJ, 

and (3) review by the Appeals Council. See id. §§ 416.1400, 404.900. If the claimant is not 

satisfied with the decision at any step of the process, the claimant has sixty days to seek 

administrative review. See id. §§ 404.933, 416.1433. If the claimant does not request 

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review, the decision becomes the SSA’s—and hence Defendant’s—binding and final 

decree. See id. §§ 404.905, 416.1405. 

 A network of SSA field offices and state disability determination services initially 

process applications for disability benefits. The processing begins when a claimant 

completes both an application and an adult disability report and submits those documents 

to one of the SSA’s field offices. If the SSA denies the claim, the claimant is entitled to a 

hearing before an ALJ in the SSA’s Office of Disability Adjudication and Review. Id. 

§§ 404.929, 416.1429. A hearing before an ALJ is informal and non-adversarial. Id. 

§ 404.900(b). 

 If the claimant receives an unfavorable decision by an ALJ, the claimant may request 

review by the Appeals Council. Id. §§ 404.967, 416.1467. The Appeals Council will grant, 

deny, dismiss, or remand a claimant’s request. Id. §§ 416.1479, 404.979. If a claimant 

disagrees with the Appeals Council’s decision or the Appeals Council declines to review 

the claim, the claimant may seek judicial review in a federal district court. See id.

§§ 404.981, 416.1481. If a district court remands the claim, the claim is sent to the Appeals 

Council, which may either make a decision or refer the matter to another ALJ. Id. 

§ 404.983. 

II. BACKGROUND

A. Procedural History 

Plaintiff is a 40-year-old woman who alleges to be too disabled to work. (AR 204-

07.) On December 22, 2014, Plaintiff protectively filed a Title II application for a period 

of disability and disability insurance benefits. (AR 204-07.) She also filed a Title XVI 

application for supplemental security income on December 22, 2014. (AR 209-16.) In both 

applications, Plaintiff alleged her disability began on October 1, 2005. (AR 204-16.) On 

September 9, 2015, the SSA denied these initial applications, (AR 131-38), and the SSA 

denied her applications for reconsideration on January 27, 2016, (AR 131-46). Plaintiff 

then requested a hearing before an ALJ, which occurred on February 22, 2018. (AR 33-

65.) The ALJ issued an unfavorable decision on April 10, 2018. (AR 12-26.) The Appeals 

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Council denied Plaintiff’s request for review of the unfavorable decision on February 14, 

2019. (AR 1.) On March 26, 2019, Plaintiff filed the Complaint in the instant case seeking 

review of the AJL’s decision. 

B. Medical Overview2

 At a prison intake screening in January 2013, Plaintiff reported a history of treatment 

for depression and anxiety, reported she was taking two anti-depressants medications, but 

she denied any current emotional distress of mental health concerns. (AR 386-88.) On 

examination, Plaintiff was cooperative and oriented with no indication of mental illness. 

(AR 387.) A prison psychologist found that Plaintiff was stable and had no noteworthy 

mental status issues. (AR 386, 388.) 

Later that month, Plaintiff met with Salvador Villalon, M.D., at the prison clinic, 

reporting a seven-year history of depression, treated by sertraline and trazodone. (AR 337.) 

On examination, Plaintiff was moderately anxious, with increased energy and decreased 

sleep. (AR 337.) Dr. Villalon observed that Plaintiff was alert and oriented, yet irritable, 

agitated, and anxious. (AR 338.) He assessed Plaintiff’s global assessment of functioning 

(GAF) at 51 to 70 (AR 339.)3

                                                                

2

 Plaintiff made no effort to summarize the medical evidence in the Record. However, 

Defendant provides an extensively detailed recitation of the medical evidence. The 

overview in this mirrors Defendant’s excellent summary, which has been checked against 

the Record for accuracy. This Court commends defense counsel for her painstakingly 

thorough work and for exerting the great effort required to complete this task. 

3

 A GAF score is a point-in-time snapshot assessment of an individual’s level of 

functioning, useful in planning treatment. Am. Psychiatric Ass’n, Diagnostic & Statistical 

Manual of Mental Disorders (DSM–IV) 32-34 (4th ed., 1994). GAF scores include a 

significant number of non-medical factors, such as financial and legal troubles, which do 

not constitute work-related functional limitations resulting from medical impairments. 

DSM-IV at 33. A GAF between 61 and 70 reflects “[s]ome mild symptoms (e.g., depressed 

mood and mild insomnia) OR some difficulty in social, occupational, or school functioning 

(e.g., occasional truancy or theft within the household), but generally functioning pretty 

well, has some meaningful interpersonal relationships.” DSM-IV at 34. A GAF between 

51 and 60 reflects “[m]oderate symptoms (e.g., depressed mood and mild insomnia) OR 

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Plaintiff returned to the clinic in April 2013, complaining of mood instability and 

insomnia. (AR 329.) On examination, Plaintiff was alert, oriented, cooperative, and 

anxious, with normal speech, logical thought processes, and no hallucinations, suicidal 

ideation, or homicidal ideation. (Id.) A clinician diagnosed anxiety and depressive disorder, 

and prescribed trazodone. (AR 330.) 

In July 2013, Plaintiff saw Saroj Gulani, M.D., at the prison clinic, reporting a 

history of depression and stress disorder, treated by sertraline and trazodone, with no side 

effects. (AR 321.) Plaintiff said she experienced some stress, but exercise helped. (Id.) Dr. 

Gulani observed that Plaintiff appeared well, with normal speech, language, and thought 

processes. (AR 322.) He diagnosed anxiety and depression, provided refills, and assessed 

GAF at 51 to 70. (AR 322-23.) 

From July through December 2013, Plaintiff visited the prison clinic for allergic 

reactions, headaches, and indigestion. (AR 298-319.) Clinicians observed that Plaintiff was 

alert, oriented, cooperative, and well-appearing, although occasionally agitated and 

anxious. (AR 298-99, 301-02, 305, 311, 313, 317.) GAF remained at 51 to 70. (AR 339, 

343.) Plaintiff met with a social worker in October 2013, concerned about what she could 

do to regain custody of her two children after her release from prison. (AR 383.) The social 

worker noted that Plaintiff was tearful and upset, yet insightful about her current situation. 

(Id.) 

In July 2014, seven months after her last visit to the prison clinic, Plaintiff went to 

County Behavioral Health, reported a history of abuse and neglect, and requested treatment 

for anxiety and depression. (AR 408-14, 463-69.) A counselor observed that Plaintiff was 

oriented, with slowed speech, impaired memory, circumstantial thought process, and 

irritable, agitated, and depressed mood. (AR 411.) The counselor diagnosed major 

depressive disorder and prolonged post-traumatic stress disorder (PTSD), and 

                                                                

moderate difficulty in social, occupational, or school functioning (e.g., few friends, 

conflicts with peers or coworkers).” DSM-IV at 34. 

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recommended medication and therapy. (AR 411-12, 414.) The clinician’s notes also 

indicate that Plaintiff’s symptoms “interfere with meaningful relationships,” “interfere 

with normal requirements for work,” and “interfere with regular eating/sleeping pattern.” 

(AR 412.) 

Plaintiff went to Clinicas de Salud del Pueblo (Clinicas) later that month for a routine 

examination. (AR 444.) Plaintiff said she was compliant with her medications, which 

included Depakote (anti-seizure medication) and olanzapine (an antipsychotic). (Id.) She 

reported symptoms of depression, but denied difficulty with concentration, feelings of 

guilt, or suicidal ideation. (AR 445.) 

In August 2014, Plaintiff went to Pioneers Memorial emergency department, 

complaining of calf pain. (AR 430.) On examination, Plaintiff was alert, oriented, and 

cooperative, with a calm affect, coherent speech, and no barriers to learning. (Id.) Plaintiff 

stated that she was not currently taking any medications. (AR 434.) Plaintiff returned to 

Pioneers Memorial in September 2014, complaining of foot pain. (AR 415.) Clinicians 

again observed that Plaintiff was alert, oriented, and cooperative, with coherent, 

appropriate speech and appropriate behavior. (AR 415.) Plaintiff’s only medication was 

noted as Seroquel. (AR 422.) 

Plaintiff returned to Clinicas in November 2014 to follow up on her emergency room 

visit, reporting anxiety, depression, and difficulty with concentration. (AR 457, 459.) On 

examination, she was oriented, with appropriate mood and affect, and normal insight and 

judgment. (AR 461.) 

In January 2015, Plaintiff told a clinician at Clinicas that she was no longer taking 

any medication for bipolar because she was “just tired of taking pills.” (AR 449.) The 

clinician noted Plaintiff’s “very good insight” into issues related to weight gain, and 

encouraged Plaintiff to resume mental health treatment. (AR 449.) 

Plaintiff met with psychiatrist Alvaro Camacho, M.D., in February 2015, to initiate 

medication management. (AR 524-28.) Dr. Camacho prescribed Seroquel, Depakote, 

olanzapine, and assessed GAF at 55. (AR 525-26.) Plaintiff saw Dr. Camacho again in 

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March, April, and May 2015 for medication refills. (AR 512-23.) GAF remained at 55. 

(AR 518, 522.) 

On May 31, 2015, Plaintiff underwent an orthopedic consultative examination at the 

request of the Disability Determination Service (DDS), in response to her complaints of 

disabling back pain following a slip and fall injury in 2004. (AR 484-88.) Payam Mozaaza, 

M.D., observed that Plaintiff was “very pleasant” and noted no mental findings. (AR 484.) 

In June 2015, Plaintiff went to the Pioneers Memorial clinic, complaining of 

swelling in her legs. (AR 538.) On examination, Plaintiff was pleasant, well-appearing, and 

in no apparent distress. (AR 539, 547.) Mental status findings showed that Plaintiff was 

alert and oriented, with a calm affect and coherent speech. (AR 538-39, 542.) Plaintiff also 

met with Dr. Camacho that month for medication refills. (AR 508-11.) 

Plaintiff returned to Pioneers Memorial clinic in July 2015, complaining of flank 

pain. (AR 528-36.) Clinicians observed that Plaintiff was awake, alert, oriented, and 

cooperative, with a calm, appropriate affect and coherent speech. (AR 528, 536.) Plaintiff 

also saw Dr. Camacho that month for medication refills. (AR 504-07.) GAF was assessed 

at 45. (AR 506.) 

Plaintiff saw Dr. Camacho in August 2015 for medication refills. (AR 500-03.) Dr. 

Camacho made no findings on examination, and assessed GAF at 50. (AR 502.) Plaintiff 

returned to Clinicas later that month to address anemia and back pain. (AR 494-99, 555-

60.) On examination, Plaintiff was oriented, with appropriate mood and affect, and normal 

insight, judgment, and memory. (AR 497, 558.) A review of systems was negative for 

depression or other psychiatric issues. (AR 557.) 

On September 9, 2015, after reviewing the evidence of record, state agency 

physician N. Haroun, M.D., found no severe mental impairments. (AR 76, 88, 90.) Dr. 

Haroun noted that his exam showed mild depression and “no more than mild functional 

limitations.” (AR 90.) 

In January 2016, Plaintiff went to Clinicas for counseling and medication 

management. (AR 566-75.) Findings on mental status examination were “generally 

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normal,” with normal appearance and activity, cooperative attitude, and average eye 

contact. (AR 570.) Plaintiff had a euthymic mood and full affect, with rapid, pressured 

speech, tangential thought process, and normal perception. (AR 570-71.) Treatment notes 

indicate that Plaintiff had moderately impaired judgment (AR 571), but also indicate she 

had good insight and judgment, and was making good progress (AR 573). Dr. Camacho 

provided medication refills (AR 566) and assessed GAF at 50 (AR 572). Plaintiff went to 

Clinicas on two other occasions in January 2016 with no complaints and no noted 

symptoms of anxiety or depression. (AR 562-65, 576.) 

On January 27, 2016, after reviewing the evidence of record, including treatment 

records from Dr. Camacho and the consultative examination report, Tawnya Brode, Psy.D., 

found that Plaintiff had mild restrictions in activities of daily living and moderate 

difficulties in social functioning and concentration, persistence, or pace, due to affective 

and anxiety-related disorders. (AR 104-05, 115-17.) The doctor opined that Plaintiff was 

not significantly limited in understanding, remembering, and carrying out simple 

instructions; maintaining concentration and attention over extended periods for simple 

tasks; sustaining appropriate interaction in a limited public context; and responding 

appropriately to most changes in the work setting. (AR 109-10.) The doctor opined Plaintiff 

was moderately limited in interacting appropriately with the general public; accepting 

instructions and responding appropriately to criticism from supervisors; maintaining 

socially-appropriate behavior; adhering to basic standards of neatness and cleanliness; 

responding appropriately to changes in the workplace; carrying out detailed instructions; 

remembering, understanding, and carrying out detailed instructions; maintaining attention 

and concentration for extended periods; ability to work around others without being 

distracted by them; and completing a normal workday or workweek without interruptions 

from her psychologically-based symptoms. (Id.) 

Plaintiff saw Dr. Camacho for medication management in February 2016. (AR 585-

95.) Mental status findings were “unremarkable.” (AR 588.) Plaintiff had a euthymic 

mood, full affect, clear speech, logical thought process, average intelligence and insight, 

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and normal cognition, perception, and judgment. (AR 588, 590-91.) Dr. Camacho observed 

that Plaintiff had made “good progress” and was “very stable” on her medication regimen, 

and her anxiety was under control, with no manic or disruptive behaviors. (AR 590, 593.) 

Dr. Camacho provided medication refills (AR 587) and assessed GAF at 55 (AR 587, 592). 

Plaintiff went to Clinicas in March 2016, complaining of back and knee pain. (AR 

598.) On examination, Plaintiff was oriented, with appropriate mood and affect and normal 

memory. (AR 600.) She returned to Clinicas in April and May 2016, complaining of back 

pain. (AR 603-10.) On examination, Plaintiff was oriented, with appropriate mood and 

affect and no abnormalities in mental status. (AR 610.) 

In July 2016, Plaintiff told Dr. Camacho that she was doing okay but she had run out 

of medication and missed an appointment due to ongoing issues with child support. (AR 

622.) Findings on mental status examination were “generally normal,” with normal 

appearance, cooperative attitude, and average eye contact. (AR 622.) Plaintiff had a 

depressed mood, with full affect, clear speech, logical thought process, and normal to good 

perception, insight, and judgment. (AR 622-23, 625.) Plaintiff was making “good 

progress.” (AR 625.) Dr. Camacho provided medication refills (AR 618-19) and assessed 

GAF at 55 (AR 620, 624). Plaintiff also went to Clinicas that month and the next, reporting 

back pain. (AR 612-17, 630.) On examination, Plaintiff was oriented, with appropriate 

mood and affect and normal memory. (AR 615, 632.) 

Plaintiff saw Dr. Camacho two months later, in September 2016, complaining of 

stress, anger, and depression due to ongoing issues with her ex-husband. (AR 635-44.) She 

denied any psychosis or impulsive behavior. (AR 639.) General observations on mental 

status examination were within normal limits, other than Plaintiff’s anxious attitude. (Id.) 

Plaintiff had a depressed, anxious mood with full affect, clear speech, normal perception, 

and racing thought process. (AR 639.) Her insight was normal, but her judgment was 

mildly impaired. (Id.) Treatment notes also indicate that Plaintiff’s insight and judgment 

were “good,” and she was making good progress. (AR 642.) Dr. Camacho continued 

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Plaintiff’s medications and adjusted her dosage of Depakote secondary to mood lability. 

(AR 636, 643.) 

During October 2016, Plaintiff twice met with Allyson Kellum, L.C.S.W., at 

Clinicas. The first meeting was for counseling intake upon referral from Dr. Camacho. (AR 

645-54.) Plaintiff told Ms. Kellum that she had a high school education and vocational 

training, but she did not want to work, was not looking for work, and did not want any 

assistance finding employment or furthering her education. (AR 647.) She just wanted to 

resolve custody issues and be more stable on medications. (AR 648.) Plaintiff said she was 

living with her mother and two children, and she had an excellent relationship with her 

children and fair relationship with her mother. (AR 646.) She claimed to enjoy cooking, 

listening to music, tending to her children, and said her mother and children were her 

primary social supports. (Id.) On examination, Plaintiff was neatly dressed and well 

groomed, with normal speech, intact thought process, and good eye contact. (AR 648.) She 

complained of severe depression and anxiety, reporting stressors related to her children’s 

father and difficulty complying with psychotropic medications. (Id.) The clinician thought 

Plaintiff would benefit from counseling services. (Id.) Plaintiff saw Ms. Kellum for a 

counseling session later that month. (AR 655-62.) Treatment notes do not include mental 

status findings or a summary of topics discussed. GAF was 55. (AR 657.) 

Plaintiff returned to Clinicas in October 2016, complaining of back pain. (AR 663-

67.) On examination, Plaintiff was oriented, with appropriate mood and affect and normal 

memory. (AR 665.) 

In December 2016, Plaintiff told Dr. Camacho that she had run out of medication 

and experienced an episode of anger and impulsivity. (AR 675.) She said she had applied 

for SSI and was unable to keep a job “due to her disruptive impulsive violent [behavior] 

toward others.” (Id.) Mental status observations were generally within normal limits, other 

than an anxious attitude. (Id.) On examination, Plaintiff had an angry, irritable mood, with 

labile affect, pressured speech, and racing thought process. (Id.) Insight and judgment were 

normal. (AR 676.) Dr. Camacho attributed Plaintiff’s depression and anxiety to her 

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noncompliance with medication (AR 675), yet elsewhere he noted that Plaintiff took 

medications as prescribed (AR 677). Dr. Camacho provided medication refills, instructed 

Plaintiff to resume medications, and assessed GAF at 55. (AR 673, 677-79.) 

Plaintiff saw Dr. Camacho again in January 2017, reporting difficulty interacting 

with others and sustaining a job, but denying any violent or disruptive behavior. (AR 685.) 

Plaintiff reported compliance with medications. (Id.) Observations on mental status 

examination were “generally normal.” (Id.) Plaintiff had a euthymic mood and full affect, 

with rapid speech, racing thought process, normal perception, and moderately impaired 

judgment. (AR 685-86.) The doctor noted an episode of hypomania (AR 687), provided 

medication refills (AR 682), and assigned GAF of 55 (AR 683, 687). He noted that Plaintiff 

had good insight and judgment and had made good progress. (AR 688.) 

Plaintiff saw Dr. Camacho a month later, in February 2017, for medication refills. 

(AR 691-700.) She reported depression, stress, and diminished concentration due to 

ongoing court proceedings regarding child custody and alleged child abuse, but she denied 

any violent impulses or thoughts of hurting herself or others. (AR 695.) On examination, 

Plaintiff was depressed and anxious, with clear speech, logical thought process, and normal 

perception, insight, and judgment. (AR 695-96.) Dr. Camacho refilled medications, 

increasing Plaintiff’s dosage of Seroquel (AR 697-99), and noted that Plaintiff had good 

insight, judgment, and was making good progress. (AR 698.) GAF was 55. (AR 693, 697.) 

Four months later, in June 2017, Plaintiff saw Dr. Camacho for refills, again 

reporting anxiety and depression due to the ongoing custody case, but denying any 

violence, disruptive behavior, or thoughts of injuring herself or others. (AR 701-06.) On 

examination, Plaintiff had a depressed, anxious mood with full affect, clear speech, logical 

thought process, and normal perception, cognition, insight, and judgment. (AR 701-02.) 

Dr. Camacho diagnosed dipolar disorder in partial remission. (AR 702.) He adjusted 

Plaintiff’s Seroquel dosage due to increased anxiety specifically associated with custody 

proceedings. (AR 705.) GAF was 50. (AR 702.) 

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Plaintiff went to Clinicas in July 2017 complaining of back pain. (AR 709-14.) 

Psychiatric findings on examination were normal, showing normal memory and 

appropriate mood and affect. (AR 712.) 

Plaintiff met with Dr. Camacho in August 2017, reporting mild to moderate stress, 

specifically due to custody issues. (AR 715-24.) GAF remained at 50. (AR 717.) Plaintiff 

said she was not sure why she lost custody, but suspected it was related to her imprisonment 

on money laundering charges. (AR 719.) Plaintiff reported noncompliance with 

medication, stating that she was having “occasional anger and getting in fights” since she 

was not taking her medications. (Id.) General observations on mental status examination 

were “generally normal.” (Id.) Plaintiff showed an angry mood, full affect, rapid speech, 

racing thoughts, and normal perception and insight and mildly impaired judgment. (AR 

719-20.) Dr. Camacho provided refills and referred Plaintiff to psychotherapy. (AR 721-

23.) 

At a “well-woman” examination later that month, a review of systems and 

examination were negative for psychiatric issues. (AR 729-30.) Appointments at Clinicas 

in October and November 2016 showed normal mental status. (AR 736-37, 743-44.) 

Plaintiff met with Dr. Camacho in November 2017, reporting that she had been 

doing “okay” and her symptoms were under control despite her unresolved custody issues. 

(AR 748, 752.) Plaintiff acknowledged that medication controlled her depression, 

irritability, and mood lability when taken, but she had mood fluctuations when she did not 

take medication as prescribed. (AR 752.) Plaintiff said she was spending time at home with 

her boyfriend and cleaning the house. (Id.) On mental status examination, Plaintiff had a 

euthymic mood, full affect, rapid speech, racing thoughts, normal perception and insight, 

and mild impairment in judgment. (AR 753.) Dr. Camacho provided refills, noting 

Plaintiff’s good judgment, insight into her symptoms, and progress. (AR 755-56.) GAF 

was 50. (AR 750, 754.) 

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Plaintiff went to Clinicas in December 2017 and January 2018 for issues unrelated 

to mental health. (AR 758-55.) On both occasions, psychiatric findings on examination 

were normal. (AR 764, 772.) 

Dr. Camacho completed a mental function medical source statement (MSS) on 

February 5, 2018. (AR 781-85.) Dr. Camacho checked boxes indicating maximum 

limitations in 33 of the 34 areas evaluated, opining extreme limitations in Plaintiff’s ability 

to interact with others; concentrate, persist, or maintain pace; and adapt or manage one’s 

self. (Id.) The single exception to extreme findings was in the area of ability to understand, 

remember, or apply information. (AR 785.) In that domain, Dr. Camacho indicated marked, 

rather than extreme, limitations. (Id.) Dr. Camacho identified a diagnosis of bipolar 

disorder, with fair prognosis. (AR 781.) He listed Plaintiff’s medications as Seroquel, 

olanzapine, and Neurontin, and stated that medications caused fatigue, dizziness, and 

occasional sedation. (AR 781.) He checked boxes to indicate that Plaintiff’s symptoms 

made her unable to work as of March 2014, and she would be unable to perform tasks for 

20 percent of more of the workday in all areas evaluated. (AR 781-83.) He checked boxes 

to indicate that she would be off task more than 30 percent of the workday, she would miss 

more than six days a month, and she would be unable to complete an eight-hour workday 

more than six days a month due to her impairments. (AR 783.) He opined that Plaintiff had 

average intelligence, but she had problems making decisions due to mood lability and poor 

anger control, and her anger, impulsive behavior, and problems interacting with others 

would preclude her from competitive work. (AR 784.) He said he based his opinion on 

Plaintiff’s medical history, file, and office treatment notes. (Id.) 

C. Consultative Examining Expert Evidence 

Psychiatrist Ernest Bagner III, M.D., examined Plaintiff on July 25, 2015, at the 

request of DDS and performed a complete psychiatric evaluation. (AR 489-93.) Plaintiff 

reported a history of sleep disorder, anxiety, depression, crying, nightmares, and 

flashbacks, and endorsed difficulty with concentration and memory. (AR 489.) She 

reported outpatient treatment in 2010 and 2011, but denied any psychiatric hospitalization. 

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(AR 489-90.) She reported her current medications as Seroquel, Depakote (divalproex), 

and olanzapine. (AR 490.) On examination, Plaintiff was tearful yet alert, oriented, 

cooperative, and had good eye contact. (AR 491.) Her speech was soft, slow, and 

emotional, and her mood was depressed, with appropriate affect. (AR 491.) She denied 

hallucinations and showed no evidence of delusions or thought disorder. (AR 491.) 

Memory, concentration, fund of information, and insight were normal. (AR 491-92.) Dr. 

Bagner diagnosed bipolar disorder and possible PTSD. (AR 492.) He opined that Plaintiff 

would be able to follow simple oral and written instructions and comply with job rules 

without limitation, but she was mildly limited in her ability to follow detailed instructions, 

interact appropriately with the public coworkers and supervisors, respond to changes in a 

work setting, and complete daily activities, and moderately limited in her ability to respond 

to work pressure was moderately limited due to sadness and low motivation. (AR 492-93.) 

Dr. Bagner assigned a GAF of 65. (AR 492.)

D. Plaintiff’s Testimony 

 Plaintiff testified at the hearing before the ALJ that she suffers from nerve damage 

in her back and leg. (AR 43.) She reported that she experiences shooting pain in her back, 

numbness, tingling, swelling in her feet; and that her knee “goes out” when standing or 

walking. (AR 40.) Most recently, Plaintiff began suffering from asthma. (AR 38.) 

Plaintiff’s pain medications cause lightheadedness, weakness, and fatigue. (AR 54-55.) 

 Plaintiff’s primary complaint is her mental impairments. She testified that she suffers 

from depression, anxiety, and irritated and aggressive behavior. (AR 40, 51.) Her irritation 

is triggered when she is around strangers or in a room with other people. (AR 51-52.) 

Additionally, Plaintiff suffers from auditory hallucinations that tell her to “try to do 

something about all of this.” (AR 55.) 

E. ALJ’s Findings 

 At step one of the sequential evaluation process described above, the ALJ found 

Plaintiff had not engaged in substantial gainful activity since October 1, 2005, the alleged 

onset date. (AR 17.) At step two, the ALJ found Plaintiff met the insured status 

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requirements of the Social Security Act through June 30, 2008, and there was no objective 

evidence in the record to show severe impairments prior to the date last insured. (Id.) Thus, 

Plaintiff’s Title II claim for disability benefits failed at step two. (Id.) Regarding Plaintiff’s 

Title XVI claim for supplemental social security benefits, the ALJ found Plaintiff had 

severe impairments of lumbago/back pain, mood disorder with bipolar and depressive 

traits, and anxiety. (AR 17-18.) At step three, the ALJ found Plaintiff did not have an 

impairment or combination of impairments that met or medically equaled the severity of 

one of the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1. (AR 18.) 

 In the ALJ’s RFC assessment between steps three and four, he found Plaintiff could 

perform the full range of medium work as defined in 20 C.F.R. §§ 404.1567(c), 416.967(c). 

(AR 19.) Specifically, Plaintiff is limited to frequently balance, stoop, kneel, crouch, crawl, 

and climb ramps and stairs, and occasionally climb ladders and scaffolds but never ropes. 

(Id.) Plaintiff is limited to simple, routine tasks that do not involve work with quotas or 

performed at assembly line pace. (Id.) Plaintiff is limited to occasional contact with 

supervisors and co-workers, and no contact with the general public. (Id.) 

 At step four, the ALJ found Plaintiff can perform jobs that exist in significant 

numbers in the national economy. (AR 25.) 

III. STANDARD OF REVIEW

 A district court will not disturb the Commissioner’s decision unless it is based on 

legal error or not supported by substantial evidence. Smolen v. Chater, 80 F.3d 1273, 1279 

(9th Cir. 1996). Substantial evidence means more than a scintilla, but less than a 

preponderance. Id. Substantial evidence is evidence that a reasonable mind would consider 

adequate to support a conclusion. Id. The ALJ is responsible for determining credibility, 

resolving conflicts in medical testimony, and resolving ambiguities. Andrews v. Shalala, 

53 F.3d 1035, 1039 (9th Cir. 1995). If the evidence is subject to more than one rational 

interpretation, the ALJ’s conclusion must be upheld. Burch v. Barnhart, 400 F.3d 676, 679 

(9th Cir. 2005). 

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IV. DISCUSSION

Plaintiff challenges the ALJ’s unfavorable decision on the grounds that the ALJ did 

not provide legally sufficient reasons for giving the opinion of Plaintiff’s treating 

physician, Dr. Camacho, little weight. First, Plaintiff contends that contrary to the ALJ’s 

findings, Dr. Camacho’s opinion was not inconsistent with his own treatment notes and 

examination findings. Second, Plaintiff contends that Dr. Bagner’s consultative 

examination was deficient and the ALJ evaluated it erroneously. The Court addresses each 

assignment of error in turn. 

A. The ALJ Properly Found Dr. Camacho’s Opinion Was Inconsistent with His 

Own Treatment Notes and Examination Findings. 

Plaintiff contends the ALJ erroneously discounted Dr. Camacho’s opinions. She 

argues that Dr. Camacho’s opinion was consistent with his own treatment notes and 

examination findings for two reasons. First, because the ALJ failed to “set forth his own 

interpretations” and instead simply cited to the entirety of the treatment notes. Second, 

because the ALJ inaccurately characterized Dr. Camacho’s notes by claiming that they 

show clear speech, logical thought process, and normal perceptions. Defendant contends 

the ALJ articulated appropriate reasons for discounting Dr. Camacho’s opinion. The Court 

agrees with Defendant for the reasons set forth below. 

1. The ALJ Set Forth His Own Interpretations With Support Through 

Citations to the Record.

If the ALJ chooses to disregard a treating physician’s medical opinion, “he must set 

forth specific, legitimate reasons for doing so, and this decision must itself be based on 

substantial evidence.” Embrey v. Bowen, 849 F.2d 418, 421 (9th Cir. 1988) (citations 

omitted). However, the ALJ is not required, nor should he, pick a single medical opinion 

and adopt it wholesale. Andrews v. Shalala, 53 F.3d 1035, 1041 (9th Cir. 1995). The ALJ 

is to resolve conflicts in the record and assess the claimant’s functionability based on the 

record as a whole. Tommasetti v. Astrue, 533 F.3d 1035, 1041-42 (9th Cir. 2008). If the 

ALJ chooses to assert that the findings of treating physicians are “unsupported by sufficient 

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objective findings,” he “must set forth his own interpretations and explain why they, rather 

than the doctors’, are correct.” Embrey, 849 F.2d at 421-22. 

Here, Plaintiff cites the rule set forth in Embrey and asserts that the ALJ has failed 

to cite to specific treatment notes, thus “forc[ing] parties to guess as to what treatment notes 

he referred to.” (Doc. No. 17 at 7.) However, the ALJ cited to the treatment notes, and the 

corresponding dates that demonstrate Dr. Camacho’s findings are inconsistent. 

Specifically, the ALJ articulated the following in his written decision. He noted that in 

April 2013, Plaintiff was seen by federal prison medical staff complaining of mood 

instability, and a mental health clinician “performed a mental status exam and found 

appropriate expression, normal rate of speech, and logical thought process.” (AR 22 

(emphasis in original).)4

 In July 2016, Dr. Camacho evaluated Plaintiff “and found full 

affect, tangential thought process, perception within normal limits, and euthymic mood.” 

(Id.) In July 2016, Dr. Camacho found Plaintiff’s “mood was depressed but in full affect, 

clear speech, logical thought process, and perception within normal limits.” (Id. (emphasis 

in original)) In February 2017, Dr. Camacho assessed Plaintiff “with bipolar disorder in 

partial remission.” (Id.) In June 2017, Dr. Camacho “found logical thought process, clear 

speech, full affect, and cognition and perception within normal limits.” (Id. (same).) In 

November 2017, Dr. Camacho assessed Plaintiff “with bipolar disorder in partial

remission.” (Id. (same)) The foregoing references show that the ALJ made specific 

citations to Dr. Camacho’s treatment notes and did not, as Plaintiff contends, “force the 

parties to guess.” Therefore, this Court finds that the ALJ set forth specific, legitimate 

reasons for disregarding the treating physician’s medical opinion. 

                                                                

4

 Although the ALJ did not cite a report by a federal prison staff psychiatrist, that doctor 

evaluated Plaintiff in 2013 and deemed her “stable” and found her “psychological stability 

for custody is judged to be FAVORABLE.” (AR 386-88 (emphasis in original).) 

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Plaintiff also contends that the ALJ did not explain why his interpretations, rather 

than Dr. Camacho’s, are correct. However, the following is just one example of the ALJ’s 

detailed interpretations of the evidence of record and testimony at hearing: 

The claimant is separated from her children as the father has custody and the 

record shows that her mental stress and anxiety is linked to an ongoing child 

custody dispute with the children’s father. Thus, the record shows the 

claimant’s mental health symptoms are primarily situational and not the result 

of psychological limitations that prevent her from working. The record shows 

the claimant is not socially isolated as she alleged at hearing. The claimant 

has a boyfriend who lives in Los Angeles . . . [she] reported she traveled to 

Los Angeles four times [in 2017] and six times in 2016. Thus, she has the 

ability to travel and socialize notwithstanding her assertions at hearing. . . . 

The claimant reported she prepares simple meals . . . and performs household 

chores such as laundry and cleaning her room. The claimant reports she is able 

to pay bills, handle a savings account, and use a checkbook. Finally, the 

claimant showed the ability to persist and follow through on quitting smoking. 

(AR 21 (internal citations omitted).) The ALJ’s explanation demonstrates that he carefully 

considered the entire record, including testimony at the hearing, before making his 

determination. Therefore, the Court concludes that ALJ set forth his own interpretations 

and explained why his, rather than the treating physician’s, interpretations are correct. 

Thus, the Court finds that the ALJ set forth his own interpretations and evidenced 

them by citations to the record. 

2. The ALJ Accurately Characterized Dr. Camacho’s Treatment Notes. 

Plaintiff contends that the ALJ inaccurately characterized Dr. Camacho’s treatment 

notes when the ALJ noted that the notes showed clear speech, logical thought process, and 

normal perceptions. Plaintiff states that “the treatment notes paint a very different picture,” 

because “[o]ut of nine treatment notes that the ALJ stated had clear speech, logical thought 

process and normal perceptions only two of them – February 11, 2016 and July 19, 2016, 

revealed clear speech; logical thought process; and within normal judgment.” (Doc. No. 17 

at 8.) Thus, Plaintiff claims this is an “inaccurate characterization of the evidence” that 

warrants remand. (Id. citing Regennitter v. Comm’r, 166 F.3d 1294, 1297 (9th Cir. 1999).) 

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 The Court finds that the ALJ did not mischaracterize the evidence. Plaintiff cites 

only nine of Dr. Camacho’s treatment notes in her Motion for Summary Judgment and 

claims they evidence a finding of disability. However, Plaintiff did not address the 

remainder of Dr. Camacho’s notes, nor the additional office visits or counseling sessions 

with other providers that support a finding of non-disability. Instead, Plaintiff relies on the 

technicality that clear speech, logical thought process, and normal perceptions are not 

present in every one of the nine treatment notes cited. However, the ALJ need not find all 

three symptoms present at once to find that Dr. Camacho’s opinion was inconsistent. 

Rather, the ALJ is required to assess a claimant’s functional ability based on the record as 

a whole. Tommasetti, 533 F.3d at 1041-42. Here, the record as a whole contains substantial 

evidence that Dr. Camacho found clear speech, (see, e.g., AR 588, 590, 622, 639, 695, 

701); logical thought process, (see, e.g., AR 588, 591, 622, 701); and perceptions within 

normal limits, (see, e.g., AR 570, 588, 622, 639, 675, 685, 701, 720, 753.) Further, in seven 

of the notes where Dr. Camacho observed irregular mood, speech, or thought processes, he 

partially attributed the stress to issues with Plaintiff’s ex-husband, her child custody battle, 

or noncompliance with medication. (AR 622, 635-44, 675, 695, 701-06, 715-24, 748, 752.) 

The ALJ accordingly opined these mental health symptoms are primarily situational and 

not the result of psychological limitations that prevent Plaintiff from working. (AR 21.) 

3. Conclusion 

The ALJ did not err in giving Dr. Camacho’s opinion little weight. The ALJ set forth 

specific, legitimate reasons for rejecting Dr. Camacho’s finding of disability by detailing 

inconsistencies between Dr. Camacho’s treatment notes and other evidence of record. 

Further, the ALJ did not inaccurately characterize Dr. Camacho’s treatment notes because 

he assessed the record as a whole and provided specific findings of clear speech, logical 

thought processes, and normal perceptions. Thus, the ALJ’s decision was not based on 

legal error and was supported by substantial evidence. 

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B. Dr. Bagner’s Consultative Examination Findings Are Supported by the Record 

and Were Properly Evaluated. 

Plaintiff contends that Dr. Ernest Bagner’s consultative examination opinion was 

inadequate. Plaintiff argues, first, that the ALJ utilized Dr. Bagner’s “snap shot evaluation” 

rather than considering the record as a whole. Second, Plaintiff contends Dr. Bagner’s 

examination was insufficient because he did not review Plaintiff’s medical records. Third, 

Plaintiff argues the ALJ only considered one of the six factors set forth in 20 C.F.R. 

§ 416.27(c). Defendant contends the ALJ gave appropriate weight to Dr. Bagner’s opinion. 

The Court agrees with Defendant for the reasons set forth below. 

1. The ALJ Considered the Record as a Whole and Did Not Rely on a “Snap 

Shot Examination.” 

 Plaintiff claims the ALJ improperly relied on Dr. Bagner’s “snap shot examination,” 

rather than reviewing the record as a whole. (Doc. No. 17 at 8.) Defendant claims the ALJ 

did not base his decision wholly on Dr. Bagner’s assessment, but he rather based it on the 

entirety of the evidence, including Dr. Camacho’s treatment records and Plaintiff’s 

symptom testimony. 

 It is an “accepted principle” that a treating physician’s opinion is not binding if it is 

contradicted by substantial evidence, and “the report of a consultative physician may 

constitute such evidence.” Mongeur v. Heckler, 722 F.2d 1033, 1039 (2d Cir. 1983). A 

consultative doctor’s opinion constitutes substantial evidence if it rests on his own 

independent examination of a patient. Tonapetyan v. Halter, 242 F.3d 1144, 1149 (9th Cir. 

2001). The Ninth Circuit has upheld findings of non-disability when the ALJ “rest[ed] 

primarily” on the testimony of a consultative doctor who performed a single neurological 

examination. See, e.g., Allen v. Heckler, 749 F.2d 577, 578 (9th Cir. 1984). While, the 

consultative physician’s opinion may be one piece of substantial evidence, the ALJ must 

still review the entire record in reaching his or her final opinion. Tommasetti, 533 F.3d at 

1041-42. 

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 Here, the ALJ gave sufficient reasons for giving Dr. Bagner’s opinion substantial 

weight. Specifically, the ALJ stated that Dr. Bagner was “an accepted medical source who 

examined the claimant directly [and] his conclusions are consistent with the bulk of the 

evidence in the record.” (AR 23.) The fact that Dr. Bagner conducted a single 

examination—what Plaintiff labels as a “snap shot”—does not discredit his opinion. 

Further, the ALJ considered multiple treaters’ opinions and testimony at the hearing in 

reaching his decision. For example, the decision discusses the treatment records of mental 

health clinician Charito Reyes at the Bureau of Prisons Health Services, (AR 22); unnamed 

clinicians at Clinicas de Salud del Pueblo, (id.); Dr. Camacho at Clinicas de Salud del 

Pueblo, (AR 23, 24); consultative expert Dr. Bagner, (AR 23); DDS psychological 

consultant Dr. Tawnya Brode, (AR 24); and Plaintiff’s hearing testimony, (AR 19-21). The 

ALJ then provided a thorough explanation of his findings. Thus, the Court finds there is 

substantial evidence that the ALJ considered the record as a whole and appropriately gave 

Dr. Bagner’s opinion substantial weight. 

2. The ALJ Considered Dr. Bagner’s Entire Examination, Which is Not 

Discredited by the Fact that He Did Not Review Plaintiff’s Medical 

Records. 

 Plaintiff claims that the ALJ “utilized only two areas of Dr. Bagner’s mental status 

examination–thought process and thought content as a reason to give Dr. Camacho’s 

opinion little weight without looking at [Plaintiff’s] mood and speech . . . .” (Doc. No. 17 

at 9.) Further, Plaintiff argues that Dr. Bagner’s opinion was not based on a complete 

medical assumption because he did not review Dr. Camacho’s records. Defendant responds 

that “[t]he same could be said for Dr. Camacho’s opinion, as there is no indication in the 

record that Dr. Camacho reviewed Plaintiff’s complete medical record and thus, by 

Plaintiff’s own argument, Dr. Camacho would be unable to express an opinion with any 

degree of medical certainty.” (Doc. No. 18 at 23.) The Court finds the ALJ utilized more 

than two areas of Dr. Bagner’s mental status examination, and Dr. Bagner was not required 

to review Plaintiff’s medical records before he reached his opinion. 

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 First, Plaintiff’s claim that the ALJ only utilized two areas of Dr. Bagner’s mental 

status examination is not supported by the record. The ALJ discussed Dr. Bagner’s findings 

regarding Plaintiff’s ability to follow oral and written instruction, ability to interact 

appropriately with the public and coworkers, and ability to comply with job rules. (AR 23.) 

Thereafter, the ALJ reconsidered Dr. Bagner’s opinion in light of Plaintiff’s testimony at 

the hearing. (Id.) The ALJ then contrasted Dr. Bagner’s opinion regarding thought 

processes and thought content with Dr. Camacho’s. (AR 23.) These discussions, in total, 

show the ALJ considered the entirety of Dr. Bagner’s opinion while also considering other 

evidence of record. 

 Second, Plaintiff cites no case law requiring a consultative doctor to review a 

claimant’s medical records before opining. Conversely, the ALJ may give substantial 

weight to the opinion of a consultative doctor who obtained a medical history by 

interviewing the patient. See Allen, 749 F.2d at 578. In Allen, the ALJ relied heavily on the 

opinion of a consultative physician (who supported a finding of non-disability), as opposed 

to the conflicting testimony of the plaintiff’s treating physician (who supported a finding 

of disability). Id. The Court noted that the consultative doctor performed a full neurological 

examination and obtained a medical history through an interview. Id. The court found that 

the consultative doctor’s opinion constituted substantial evidence. Id. at 580. 

 Here, Dr. Bagner conducted a complete psychiatric evaluation. He noted that 

Plaintiff was a “fair and reliable historian” and obtained a history through interview. (AR 

489.) Plaintiff gave him a history of her present illness, past psychiatric history, family 

psychiatric history, medical and surgical history, and family, social, and environmental 

history. (AR 489-90.) Dr. Bagner’s notes from this interview are included in his report 

prior to his mental status examination findings. (Id.) Dr. Bagner did not need to review 

Plaintiff’s medical records to express an opinion with medical certainty; obtaining a 

medical history through interview was sufficient. 

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 Thus, the Court finds there is substantial evidence that the ALJ utilized the entirety 

of Dr. Bagner’s mental status exam, and his opinion is not discredited by the fact that he 

did not review Dr. Camacho’s treatment notes or opinion. 

3. The ALJ Applied More Factors Than Just Supportability. 

A treating physician’s opinion is given “controlling weight” so long as it is not 

inconsistent with the other substantial evidence of record. Trevizo, 871 F.3d at 675. When 

the opinion is not controlling, it is weighted according to the factors set forth in 20 C.F.R. 

§ 416.927(c)(1)-(6), such as the length of the treatment relationship and frequency of 

examination, the nature and extent of the treatment relationship, supportability, consistency 

with the record, specialization of the physician, and other factors. Id. 

Plaintiff claims the ALJ only applied one of the six factors set forth in section 

416.927—supportability—in determining the extent to which Dr. Camacho’s opinion 

should be credited. Defendant claims the law does not require the ALJ to discuss each 

regulatory factor and explain how it supports the decision. Rather, Defendant contends the 

law requires the ALJ only to consider the factors and provide specific and legitimate 

reasons for rejecting a treating physician’s opinion, which the ALJ did. (Doc. No. 18 at 24 

(citing Trevizo v. Berryhill, 871 F.3d 664, 676 (9th Cir. 2017)).) The Court agrees with 

Defendant. 

Here, the language of the ALJ’s discussion supports a finding that he considered the 

six factors in reaching his decision. Plaintiff admits that the ALJ considered the 

supportability of Dr. Camacho’s opinion. There is substantial evidence the ALJ considered 

the frequency of examination and the nature and extent of the treatment relationship. The 

ALJ articulated the dates of Dr. Camacho’s treatment notes in his decision, which began 

in 2016. (AR 22.) Thereafter, he notes the frequency in which Plaintiff visited Dr. 

Camacho, and his status as Plaintiff’s treating physician. (Id.) There is substantial evidence 

the ALJ considered consistency with the record. In his written decision, the ALJ compared 

Dr. Camacho’s finding with Dr. Bagner’s observation that “low motivation may be a 

material issue,” testimony at the hearing that Plaintiff travels to Los Angeles to visit her 

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boyfriend, and Dr. Camacho’s own treatment notes that state that her ongoing mental stress 

and anxiety is linked to an ongoing child custody dispute. (Id.) The ALJ specifically stated 

that “Dr. Camacho’s conclusions are not consistent with the findings of psychological CE 

Ernest Bagner.” (AR 24.) Further, in Plaintiff’s own brief, she states that the ALJ 

discounted Dr. Camacho’s opinion because it was inconsistent with his own treatment 

records and inconsistent with Dr. Bagner’s findings. Moreover, there is substantial 

evidence the ALJ considered Dr. Camacho’s specialization. The ALJ noted that Plaintiff 

presented to Clinicas de Salud del Pueblo specifically seeking mental health treatment, not 

primary care. (AR 23.) The ALJ later notes that Dr. Bagner is a psychological5

 consulting 

examiner, implicitly contrasting this with Dr. Camacho’s status as a treating psychiatrist. 

Finally, the ALJ need not address each factor in turn in his written decision. Rather, 

the ALJ is required to consider each factor in reaching his decision and may only reject it 

for clear and convincing reasons supported by substantial evidence. Trevizo, 871 F.3d at 

675. This Court concludes there is substantial evidence that the ALJ considered more 

factors than only “supportability” in reaching his decision. 

4. Conclusion 

The ALJ did not err in giving Dr. Bagner’s opinion substantial weight. The Ninth 

Circuit has held that a consultative doctor’s examination may be considered substantial 

evidence even when a history is obtained through interview. Further, it is clear from the 

written decision the ALJ considered more than just the supportability of Dr. Camacho’s 

opinion. Thus, the ALJ’s decision was not based on legal error and was supported by 

substantial evidence. 

C. Plaintiff is Not Entitled to Summary Judgment. 

Based on the foregoing, the Court recommends that Defendant’s MSJ be 

GRANTED. This Court necessarily recommends that Plaintiff’s MSJ be DENIED. 

                                                                

5

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be noted that Dr. Bagner is a psychiatrist, not a psychologist. 

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V. CONCLUSION

This Court RECOMMENDS that Plaintiff’s MSJ be DENIED and that Defendant’s 

Cross-MSJ be GRANTED. 

 This Report and Recommendation is submitted to the United States District Judge 

assigned to this case, pursuant to the provisions of 28 U.S.C. § 636(b)(1) and Federal Rule 

of Civil Procedure 72(b). 

 IT IS ORDERED that no later than May 1, 2020, any party to this action may file 

written objections with the Court and serve a copy on all parties. The document shall be 

captioned “Objections to Report and Recommendation.” 

 IT IS FURTHER ORDERED that any reply to the objections shall be filed with the 

Court and served on all parties no later than May 22, 2020. The parties are advised that 

failure to file objections within the specified time may waive the right to raise those 

objections on appeal of the Court’s order. Martinez v. Ylst, 951 F.2d 1153 (9th Cir. 1991). 

IT IS SO ORDERED. 

DATED: April 2, 2020 

Hon. William V. Gallo 

United States Magistrate Judge 

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