Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_18-cv-02119/USCOURTS-casd-3_18-cv-02119-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:0405id Review of HHS Decision (SSID)

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UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF CALIFORNIA

DAVID S. SAHAGUN,

Plaintiff,

Case No. 18-cv-02119-BAS-RBM

ORDER:

(1)GRANTING PLAINTIFF’S 

MOTION FOR SUMMARY 

JUDGMENT (ECF No. 15);

(2)DENYING DEFENDANT’S 

MOTION FOR SUMMARY 

JUDGMENT (ECF No. 16);

AND

(3)REMANDING ACTION 

FOR FURTHER 

PROCEEDINGS

v.

ANDREW M. SAUL, Commissioner 

of Social Security,

Defendant.

Plaintiff David S. Sahagun seeks judicial review of a final decision by the 

Commissioner of Social Security1 denying his application for benefits under Title 

XVI of the Social Security Act (“the Act”). Presently before the Court are the 

 1 The Court substitutes Commissioner of Social Security Andrew M. Saul in place of the 

former official, Acting Commissioner of Social Security Nancy A. Berryhill. See Fed. R. Civ. P. 

25(d)(1).

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parties’ cross-motions for summary judgment. The Court finds these motions 

suitable for determination on the papers submitted and without oral argument. See

Fed. R. Civ. P. 78(b); Civ. L.R. 7.1(d)(1). For the following reasons, the Court 

GRANTS Plaintiff’s Motion for Summary Judgment, (ECF No. 15), and DENIES

the Commissioner’s Cross-Motion for Summary Judgment, (ECF No. 16). The 

Court will remand this matter to the Social Security Administration for further 

proceedings. 

I. ADMINISTRATIVE AND FACTUAL BACKGROUND

Plaintiff filed an application for supplemental security income in October 

2014, alleging the medical impairments of prostate cancer, depression, high 

cholesterol, and high blood pressure. (AR 157, 176.) Plaintiff alleged that his 

disability began in September 2014. (AR 157.) In a function report dated November 

8, 2014, Plaintiff reported fatigue, difficulty concentrating, and limited mobility.

(AR 193.) In February 2015, after reviewing medical records and ordering a 

psychological assessment that diagnosed Plaintiff with a major depressive disorder,

(AR 321), the Social Security Administration denied Plaintiff’s application. (AR 

70.) 

In March 2015, Plaintiff underwent a laparoscopic radical prostatectomy to 

treat prostate cancer. (AR 428.) Subsequent checkups did not indicate any serious 

complications from the surgery. (AR 435, 443.) In September 2015, Plaintiff 

requested reconsideration of his application. (AR 108.) Soon after requesting 

reconsideration, Plaintiff was diagnosed with degenerative disk disease and began 

physical therapy and pain management treatment. (AR 332.) In February 2016, the 

Administration upheld its initial decision, denying Plaintiff’s application for a 

second time. (AR 82.) Plaintiff immediately requested a hearing and review by an 

Administrative Law Judge (“ALJ”). (AR 115.)

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ALJ Donald Cole conducted a hearing in Plaintiff’s case on July 6, 2016.

(AR 20.) At the hearing, Plaintiff alleged that his daily activities were substantially 

limited by a combination of depression and back pain. (AR 43–49.) A vocational 

expert also testified at the hearing, stating that there were jobs available in a 

significant number in the economy for a hypothetical person of Plaintiff’s age, 

education, and work experience—who was also limited to light work with standard 

industry breaks and some additional physical, psychological, and social restrictions.

(AR 56.) The vocational expert further testified that if, in addition to the 

abovementioned limitations, the hypothetical person was off-task for more than an 

hour a day or would typically miss two days of work a month, there would be no 

work available for a person with those limitations. (AR 57.) 

At the time of the hearing, the Administration had ordered but had not yet 

received additional medical records from Plaintiff’s treating physicians. (AR 240, 

243.) These records included brief psychological evaluations by Plaintiff’s treating 

physicians, as well as information about Plaintiff’s prostatectomy and degenerative 

disk disease. (See id.; see also AR 26–29.) After receiving and reviewing these 

records, the ALJ issued a decision on January 10, 2017, finding Plaintiff was not 

disabled under the meaning of the Act. (AR 87.)

In March 2017, Plaintiff filed an appeal request. (AR 146.) Along with the 

request, Plaintiff submitted two mental impairment questionnaires, one signed by 

Nurse Practitioner Elizabeth Dewart and the other signed by Doctor Raul Gener. 

(AR 529–40.) Both N.P. Dewart and Dr. Gener had treated Plaintiff beginning in 

2016. (AR 529, 537.) The Appeals Council considered the new evidence—making 

the evidence part of the record—but ultimately denied review of Plaintiff’s case on 

April 13, 2017. (AR 15–19.)

On June 12, 2018, stating that it had committed a legal error, the Appeals 

Council set aside its previous decision and granted review of Plaintiff’s case to

consider additional information. (AR 152–55.) Plaintiff, who had recently retained 

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an attorney, submitted additional medical records from Paradise Valley Hospital, 

records from Operation Samahan Health Clinic, and evidence from Dr. Manuel 

Puig-Llano and Dr. Erick Alayo for the Appeals Council to consider. (AR 541–

640.)

The Appeals Council issued its final decision on July 23, 2018. (AR 4–7.) In 

its decision, the Appeals Council evaluated the ALJ’s decision and considered the 

additional evidence that Plaintiff submitted around July 12, 2018. (AR 4.) The 

Appeals Council found that the new evidence did not have a reasonable probability 

of changing the outcome of the decision. (Id.) It then adopted the ALJ’s findings 

and conclusions and held that Plaintiff was not disabled under the meaning of the 

Act. (AR 7.)

II. LEGAL STANDARD

Under 42 U.S.C. §§ 405(g) & 1383(c), an applicant for social security 

disability benefits may seek judicial review of a final decision of the Commissioner 

in federal district court. “As with other agency decisions, federal court review of 

social security determinations is limited.” Treichler v. Comm’r of Soc. Sec. Admin., 

775 F.3d 1090, 1098 (9th Cir. 2014). A federal court will uphold the 

Commissioner’s disability determination “unless it contains legal error or is not 

supported by substantial evidence.” Garrison v. Colvin, 759 F.3d 995, 1009 (9th 

Cir. 2014) (citing Stout v. Comm’r, Soc. Sec. Admin., 454 F.3d 1050, 1052 (9th Cir. 

2006)). When reviewing whether the Commissioner’s determination is supported 

by substantial evidence and free of error, the court must consider the record as a 

whole, “weighing both the evidence that supports and the evidence that detracts from 

the Commissioner’s conclusion.” Lingenfelter v. Astrue, 504 F.3d 1028, 1035 (9th

Cir. 2007) (quoting Reddick v. Chater, 157 F.3d 715, 720 (9th Cir 1998)). 

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III. STANDARD FOR DETERMINING DISABILITY

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 . . . 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). Under the Act’s 

implementing regulations, the Commissioner applies a five-step sequential 

evaluation process to determine whether an applicant for benefits qualifies as 

disabled. See 20 C.F.R. § 404.1520(a)(4). “The burden of proof is on the claimant 

at steps one through four, but shifts to the Commissioner at step five.” Bray v. 

Comm’r of Soc. Sec. Admin., 554 F.3d 1219, 1222 (9th Cir. 2009).

At step one, the Commissioner must determine whether the claimant is 

engaged in “substantial gainful activity.”2 20 C.F.R. § 404.1520(a)(4)(i). If so, the 

claimant is not disabled. If not, the Commissioner proceeds to step two. 

At step two, the Commissioner must determine whether the claimant has a 

severe medical impairment, or combination of impairments, that meets the duration 

requirement in the regulations. 20 C.F.R. § 404.1520(a)(4)(ii). If the claimant’s 

impairment or combination of impairments is not severe, or does not meet the 

duration requirement, the claimant is not disabled. If the impairment is severe, the 

analysis proceeds to step three.

At step three, the Commissioner must determine whether the severity of the 

claimant’s impairment or combination of impairments meets or medically equals the 

severity of an impairment listed in the Act’s implementing regulations. 20 C.F.R. § 

404.1520(a)(4)(iii). If so, the claimant is disabled. If not, the analysis proceeds to 

step four.

 2 “Substantial gainful activity” is work activity that (1) involves significant physical or 

mental duties and (2) is performed for pay or profit. 20 C.F.R. § 404.1510.

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At step four, the Commissioner must determine whether the claimant’s 

residual functional capacity (“RFC”)—that is, the most he can do despite his

physical and mental limitations—is sufficient for the claimant to perform his past 

relevant work. 20 C.F.R. § 404.1520(a)(4)(iv). The Commissioner assesses the RFC 

based on all relevant evidence in the record. Id. § 416.945(a)(1), (a)(3). If the 

claimant can perform his past relevant work, he is not disabled. If not, the analysis 

proceeds to the final step. 

At step five, the Commissioner bears the burden of proving that the claimant 

can perform other work that exists in significant numbers in the national economy, 

taking into account the claimant’s RFC, age, education, and work experience. 20 

C.F.R. § 404.1560(c)(1), (c)(2); see also id. § 404.1520(g)(1). The Commissioner

usually meets this burden through the testimony of a vocational expert, who assesses 

the employment potential of a hypothetical individual with all of the claimant’s 

physical and mental limitations that are supported by the record. Hill v. Astrue, 698 

F.3d 1153, 1162 (9th Cir. 2012). If the claimant is able to perform other available 

work, he is not disabled. If the claimant cannot make an adjustment to other work, 

he is disabled. 20 C.F.R. § 404.1520(a)(4)(v).

IV. COMMISIONER’S FINDINGS

In Plaintiff’s case, the final agency decision on review is that of the Appeals 

Council. (AR 1.) However, because the Appeals Council adopted the findings and 

conclusions of the ALJ, (AR 4–5), the Court first examines the ALJ’s findings

directly. 

At step one, the ALJ found that Plaintiff had not engaged in substantial gainful 

activity since the date on which he filed his application for disability benefits. 

(AR 89.) At step two, the ALJ found that Plaintiff suffered from degenerative disk 

disease, depression, and anxiety—all severe impairments that more than minimally 

limited his ability to do basic work activities. (Id.) The ALJ found that Plaintiff had 

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recovered well from his prostatectomy and was not suffering from any lasting effects 

that would cause a severe impairment. (Id.) At step three, the ALJ found that 

Plaintiff’s combination of impairments did not match the severity of any of the listed 

impairments in 20 C.F.R. § 404.1520(a)(4)(iii). (AR 90.) At step four, the ALJ 

determined that Plaintiff had the RFC to perform light work, with standard industry 

breaks every two hours and some additional physical, psychological, and social 

restrictions. (AR 91.)

To reach his step four conclusions, the ALJ considered Plaintiff’s physical 

and psychological limitations. The ALJ supported his conclusions about Plaintiff’s 

physical limitations by relying on Plaintiff’s testimony and his 2015–2016 treatment 

records. (AR 92.) Plaintiff’s x-rays from November 2015 reveal mild chronic disk 

degeneration without acute findings (AR 332), and a CT scan in March 2016 showed

evidence of degenerative disc disease, (AR 397). Treatment notes from November 

2015 state that Plaintiff was experiencing “mild back pain.” (AR 334.) After several

physical therapy sessions, Plaintiff’s physical therapist reported overall 

improvement of his lower quadrant range of motion, good rehabilitation potential, 

and a positive response to treatment. (AR 519.) However, the records also indicate

that in late 2016 Plaintiff continued to report severe pain and difficulty with 

prolonged postures. (See, e.g., AR 454, 519.)

The ALJ made findings regarding Plaintiff’s psychological limitations based 

on an evaluation conducted by examining physician Beth Teegarden in January 

2015, and treatment notes by physicians Mohammed Ahmed and Ernest De Guzman 

from 2016. (AR 93.) Dr. Teegarden diagnosed Plaintiff with major depressive 

disorder and bereavement. (AR 321.) She found him to be moderately limited in 

his ability to follow detailed instructions, respond to work pressure, and respond to 

changes. (Id.) Dr. Teegarden also found Plaintiff to be mildly limited in his ability 

to comply with work rules such as attendance, comply with simple instructions, and 

interact with others. (Id.) Notably, Dr. Teegarden assessed Plaintiff well before he 

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was diagnosed with degenerative disk disease and two years before the ALJ’s 

decision. (See AR 87, 317.)

Plaintiff’s treating physicians also diagnosed Plaintiff with major depressive 

disorder. (AR 458, 467.) Dr. Ahmed’s evaluation in June 2016 indicated that 

Plaintiff’s thought process was within normal limits and that his coping skills were

good. (AR 467.) Dr. Ahmed noted that Plaintiff’s back pain was being controlled 

with medication. (Id.) Dr. De Guzman’s evaluation in August 2016 found that 

Plaintiff’s thought process was intact and his attention was good, but that Plaintiff

was frustrated by pain. (AR 451–52.) Neither Dr. De Guzman nor Dr. Ahmed 

opined about the extent of the limitations created by Plaintiff’s health issues. 

At his hearing before the ALJ, Plaintiff testified that he was unable to stand 

for more than one hour a day, (AR 43), that he rarely had social interactions, (AR 

49–50), and that he had difficulty focusing and remembering, (AR 48). The ALJ 

found that while Plaintiff’s medically determinable impairments could reasonably 

be expected to cause the symptoms he described, Plaintiff’s statements about the

limiting effects of his alleged symptoms were not entirely consistent with the 

medical record. (AR 92.) 

Relying on the medical record and accounting for Plaintiff’s testimony, the 

ALJ found that Plaintiff had an RFC for light work as defined by 20 C.F.R. §

416.967(b), 

except the claimant is limited to: occasional climbing of stairs and 

ramps and occasional balancing, stooping, kneeling, crouching, and 

crawling, but no climbing of ladders/ropes/scaffolding; limited to 

understanding, remembering, and carrying out simple, routine, 

repetitive tasks, with standard industry work breaks every two hours; 

no interaction with the general public and limited to occasional workrelated, non-personal, non-social interaction with co-workers and 

supervisors involving no more than a brief exchange of information or 

hand-off of product.

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(AR 91.) The ALJ concluded his decision by stating that “no treating source opined 

the claimant has symptoms or limitations inconsistent with the residual functional 

capacity assessment set forth above.” (AR 94.)

Because Plaintiff had no past relevant work history, the ALJ proceeded to step 

five. (AR 95.) Based on the testimony of the vocational expert, the ALJ determined 

that a person of Plaintiff’s RFC, age, education, and work experience would be able 

to work as an assembler (DOT 729.687-010) or a solderer (DOT 813.684-022).

3

 

(AR 95–96.) Because there were jobs available that Plaintiff could perform, the ALJ 

determined that Plaintiff was not disabled between October 2014 and the date of the 

decision. (AR 96.)

On review, the Appeals Council “adopt[ed] the ALJ’s findings and 

conclusions regarding whether the claimant was disabled.” (AR 4–5.) The Appeals 

Council noted that the mental listings used by the Commissioner had been revised 

after the ALJ issued its decision. (AR 5.) Because of this change, the Appeals 

Council laid out its own mental impairment findings. (Id.) Based on its review, the 

Appeals Council found that Plaintiff had “mild limitations in [his] ability to 

understand, remember or apply information; moderate limitations in [his] ability to 

concentration [sic], persist, or maintain pace; and moderate limitations in [his]

ability to adapt or manage [him]self.” (Id.) The Appeals Council stated that its

mental impairment findings were consistent with the ALJ’s RFC assessment, which 

it upheld. (Id.)

During its review, the Appeals Council accepted a statement and additional 

evidence from Plaintiff. (AR 4.) The Appeals Council reviewed the evidence but 

did not find a reasonable probability that it would change the outcome of the 

 3 The ALJ’s decision incorrectly listed the DOT code for assembler as “211.462-010.” 

(AR 96.) However, the transcript shows that the vocational expert correctly stated the DOT code 

for assembler as “729.687-010,” (AR 56), and the Appeals Council addressed and corrected the 

ALJ’s error in its decision, (AR 4–5). 

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decision. (Id.) However, the Commissioner recognizes in his motion that the 

Appeals Council did not acknowledge the Dewart or Gener reports in its decision. 

(Def.’s Mot. 5:10–11.) As noted above, these reports were submitted prior to the 

Appeals Council’s first decision, which was later set aside. 

V. ANALYSIS

A. Failure to Review the Gener and Dewart Reports

In his Motion for Summary Judgment, Plaintiff argues that the Appeals 

Council committed a reversible error by improperly rejecting the reports by N.P.

Dewart and Dr. Gener. (Pl.’s Mot. 6:23–25.) To evaluate whether the Appeals 

Council erred, the Court must first analyze the requirements that apply when the

Appeals Council considers a request for review involving additional evidence. 

The Appeals Council should grant review of an ALJ decision if a claimant 

presents additional evidence that is “new, material, and relates to the period on or 

before the date of the hearing decision, and there is a reasonable probability that the 

additional evidence would change the outcome of the decision.” 20 C.F.R.

§ 404.970(a)(5). When the Appeals Council receives a request for review that 

contains new evidence, it may choose between two options. First, it may “view” the 

evidence and then send the claimant an official notice rejecting the evidence for a 

valid reason. Id. § 404.970(c).

4

 Alternatively, the Appeals Council may “consider”

the evidence as part of its decision-making process, incorporating the evidence into 

the official record regardless of whether or not it grants review. See Brewes v. 

Comm’r of Soc. Sec. Admin., 682 F.3d 1157, 1162 (9th Cir. 2012).

 4 20 C.F.R. § 404.970(c) permits the Appeals Council to reject additional evidence if the 

claimant did not have good cause for his delay in producing the new evidence, or if the documents 

do not relate to the period on or before the date of the ALJ’s hearing decision. In such cases, the 

Appeals Council must send a notice advising the claimant it did not accept the evidence and 

explaining how the evidence may be used to file a new claim. 

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In Taylor v. Commissioner of Social Security Administration, the Ninth 

Circuit considered a case where the Commissioner failed to address additional 

documents submitted directly to the Appeals Council. 659 F.3d 1228 (9th Cir. 

2011). The plaintiff submitted additional medical opinions with a request for 

review, but the Appeals Council rejected his appeal as untimely. Id. at 1231. The 

Appeals Council later set aside its first decision, and considered the plaintiff’s appeal 

anew, but ultimately denied review. Id. In doing so, the Appeals Council failed to 

offer a reason for rejecting an additional medical opinion that plaintiff had submitted 

with his first appeal request. Id. at 1232.

The Ninth Circuit noted that the Appeals Council was not required to make 

any “particular evidentiary finding” when faced with “new evidence.” Id. at 1232 

(interpreting Gomez v. Chater, 74 F.3d 967, 972 (9th Cir. 1996)). However, the 

Ninth Circuit still remanded the case, holding that where the Appeals Council fails 

to address material additional evidence at all it commits reversible error. See id. at 

1233. Taylor’s holding indicates that the Appeals Council is not required to give 

specific reasons for rejecting additional evidence, but it has a duty, at minimum, to 

view and acknowledge existence of the additional evidence. See id.

In comparison, ALJs may only reject the opinion of an uncontradicted treating 

medical source for “clear and convincing reasons” and may only reject contradicted 

treating sources for “specific and legitimate reasons.” Bayliss v. Barnhart, 427 F.3d 

1211, 1216 (9th Cir. 2005). These reasons must be supported by “substantial 

evidence.” Id. Plaintiff asks the Court to apply this same standard to the Appeals 

Council’s review of additional information. (Pl.’s Mot. 6: 23–25.) In light of Taylor,

however, it is unclear whether this standard applies to additional information on 

review before the Appeals Council. See 659 F.3d at 1232–33; see also Palomares 

v. Astrue, 887 F. Supp. 2d 906, 914–16 (N.D. Cal. 2012); Warner v. Astrue, 859 F. 

Supp. 2d 1107, 1113 (C.D. Cal. 2012) (reviewing Ninth Circuit precedent on the 

issue of whether the same review standards apply to Appeals Council review of 

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additional documents and finding the precedent inconclusive). 

Regardless, as Plaintiff notes in his brief, the Appeals Council neglected to 

make a valid written response to the Gener and Dewart reports. (Pl.’s Mot. 18:4.) 

Plaintiff submitted the reports before the Appeals Council made its 2017 decision

denying review. (AR 16, 18.) In its 2017 decision, the Appeals Council considered 

the reports but dismissed them as immaterial to the outcome of the claim. (AR 16.) 

However, when the Appeals Council set aside its 2017 decision based on legal error,

it also set aside its response to the Gener and Dewart reports, thus reviving its

obligation to respond to them in a subsequent action. See Taylor, 659 F.3d at 1232–

33 (illustrating that when the Appeals Council sets aside its decision denying review, 

it has an obligation to acknowledge documents submitted prior to the first decision).

In its 2018 decision, the Appeals Council referenced and dismissed 100 pages 

of new evidence but, as in Taylor, the Appeals Council did not acknowledge the 

previously-submitted Gener and Dewart reports. (AR 4.) There is also no record of 

a rejection notice sent to Plaintiff by the Appeals Council under 20 C.F.R. § 

404.970(c). Regardless of whether the Appeals Council had a duty to give elaborate 

reasons or make a simple conclusory rejection, it did not meet even the minimal 

burden of acknowledging the existence of the additional evidence. By failing to 

address the reports either through written rejection or a valid decision, the Appeals 

Council committed a legal error. See Taylor, 659 F.3d at 1233 (holding that the 

Appeals Council’s failure to acknowledge new evidence through a valid rejection or 

a decision was a legal error requiring remand); accord Hernandez v. Berryhill, No. 

1:17-cv-00483-SKO, 2018 WL 2021021, at *6 (E.D. Cal. May 1, 2018); Ruth v. 

Berryhill, No. 1:16-CV-0872-PK, 2017 WL 4855400, at *10 (D. Or. Oct. 26, 2017).

B. Harmless Error Analysis 

The Appeals Council’s failure to address the Dewart and Gener reports is a 

legal error, but that does not necessarily mean that the Court must reverse the 

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Commissioner’s decision. The Ninth Circuit has recognized that the doctrine of 

“harmless error applies in the Social Security context.” Stout, 454 F.3d at 1054. 

Reversal is not called for if a mistake is nonprejudicial, is irrelevant to the 

determination, or occurs during an unnecessary procedural step. Id. at 1055. The 

standard for harmless error remains deferential to the Commissioner, and a district 

court should uphold the decision if the error is “inconsequential to the ultimate 

nondisability determination.” See Molina v. Astrue, 674 F.3d 1104, 1115 (9th Cir. 

2012); Robbins v. Soc. Sec. Admin., 466 F.3d 880, 885 (9th Cir. 2006). 

If excluding the Gener and Dewart reports was “inconsequential to the 

ultimate nondisability determination,” then the Court is not required to reverse. See 

Molina, 674 F.3d at 1115. The Court therefore considers the record as a whole, 

including the weight and contradictory nature of the additional evidence, to 

determine whether the Appeals Council’s error was outcome-affecting. See Ramirez 

v. Shalala, 8 F.3d 1449, 1452 (9th Cir. 1993). In doing so, the Court keeps in mind 

that “[a]s a general rule, where the ‘critical portions’ of a treating physician’s 

discredited opinion were presented for the first time to the Appeals Council, ‘[t]he 

appropriate remedy . . . is to remand th[e] case to the ALJ’ to consider the additional 

evidence.” Gardner v. Berryhill, 856 F.3d 652, 657–58 (9th Cir. 2017) (quoting

Harman v. Apfel, 211 F.3d 1172, 1180 (9th Cir. 2000)).

1. Weight of the Evidence

Under the Ninth Circuit’s “treating physician rule,” the opinion of a treating 

physician receives the “greatest weight.” Tonapetyan v. Halter, 242 F.3d 1144, 

1148 (9th Cir. 2001). The Commissioner should also assign weight to opinions

based on the “length, nature, and extent of the treatment relationship; frequency of 

examination; supportability; and consistency with the overall record.” Fleenor v. 

Berryhill, 752 F. App’x 451, 452 (9th Cir. 2018); see also 20 C.F.R. § 

404.1527(c)(2)–(6); Trevizo v. Berryhill, 871 F.3d 664, 676 (9th Cir. 2017) (holding 

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that the ALJ committed a reversible error by discounting a medical opinion without 

weighing these factors); Garrison, 759 F.3d at 1013 (holding that medical opinions

that were presented in a check-box form were still entitled to weight because they 

were “based on significant experience” and “supported by numerous records”). 

The Commissioner may only disregard an uncontradicted treating physician’s 

testimony for “clear and convincing reasons . . . supported by substantial evidence.”

Bayliss, 427 F.3d at 1216. If the opinion is contradicted by another doctor, the 

Commissioner must still provide “specific and legitimate reasons . . . supported by 

substantial evidence” before rejecting the opinion. Id. There are many legitimate

reasons for disregarding a treating physician’s testimony, including that the opinion 

is clearly biased, conclusory, or unsupported by clinical findings. Matney v. 

Sullivan, 981 F.2d 1016, 1019 (9th Cir. 1992).

2. N.P. Dewart Report 

Excluding N.P Dewart’s report was not a harmless error. The Dewart report 

is material, it expresses the opinion of a valid medical source, and it contradicts the 

Commissioner’s RFC findings. 

First, N.P Dewart’s report is material. N.P. Dewart had a history of treating 

Plaintiff and was operating within her specialty as a psychiatric nurse practitioner,

which gave her great familiarity with Plaintiff’s condition. (AR 529.) Her report is

not conclusory; it provides details and references information about Plaintiff’s 

ongoing treatment. (AR 529–533.) The report also relates to the time period 

relevant to the disability determination. (Id.) Furthermore, her report is backed up 

by reference to medical findings made by Dr. De Guzman, which are part of the 

administrative record. (AR 529–33; see also, e.g., AR 451, 457, 547–48, 598, 618–

19, 627–28, 633–34.)

Second, N.P Dewart is a valid medical source, either as an “acceptable” or an 

“other” medical source. A report from a nurse practitioner acting alone does not 

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receive the same weight given to a report by a treating physician. Dale v. Colvin, 

823 F.3d 941, 943 (9th Cir. 2016) (noting nurse practitioners are “other” sources 

under 20 C.F.R. § 404.1513(a) and the ALJ may discount their opinions by giving 

germane reasons for doing so). However, N.P. Dewart’s report indicates that she 

worked with one of Plaintiff’s primary treating physicians, Dr. De Guzman (AR 

529), and that she reviewed Dr. De Guzman’s documentation and charts prior to 

filling out the report, (AR 531). The Ninth Circuit allows nurse practitioners 

operating under the close supervision of a treating physician to be treated as agents 

of the physician and therefore as acceptable medical sources. See Britton v. Colvin, 

787 F.3d 1011, 1013 (9th Cir. 2015) (citing Gomez, 74 F.3d at 971).

5

N.P. Dewart appears to be an “acceptable” medical source, but even if she 

was an “other” source, the Commissioner would still be required to provide germane 

reasons for discounting her report. See Popa v. Berryhill, 872 F.3d 901, 906–07 (9th 

Cir. 2017) (suggesting that a nurse’s medical opinions should not receive “reduced

weight” when she had provided primary treatment for 18 months and holding that 

the ALJ could not reject the opinion of an “other source” simply because it was a

check-box form). 

Finally, N.P. Dewart’s report contradicts the ALJ’s findings. The 

Commissioner suggests that even if the Dewart report had been considered and 

properly weighed by the Appeals Council, it would not have affected the disability 

determination because N.P. Dewart’s opinions were accommodated in the ALJ’s 

 5 In 2012, the Ninth Circuit acknowledged that in finding nurse practitioners were valid 

sources, it “relied in part on language in” a now-repealed section of 20 C.F.R. § 416.913(a)(6), 

which states that “[a] report of an interdisciplinary team that contains the evaluation and signature 

of an acceptable medical source is also considered acceptable medical evidence.” Molina, 674 

F.3d at 1111 n.3. However, the Ninth Circuit has also found that nurse practitioners are a valid 

medical source based on agency theory. Gomez, 74 F.3d at 971. In recent years, the Ninth Circuit 

has repeatedly declined to address the validity of Gomez. Britton, 787 F.3d at 1013 n.4; Colburn 

v. Berryhill, 694 F. App’x 582, 583 (9th Cir. 2017). Therefore, the Court continues to rely on 

Gomez as valid precedent. 

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RFC findings. (Def.’s Mot. 8:1–3.) The Court disagrees. N.P. Dewart indicated 

that Plaintiff’s depression and grief exacerbate ongoing chronic pain. (AR 531.) 

She estimated that Plaintiff’s health conditions resulted in “marked limitations in his 

ability to complete a workday without interruptions from psychological symptoms” 

and to “[p]erform at a consistent pace without rest periods of unreasonable length or 

frequency.” (AR 532.) A marked limitation would interfere with Plaintiff’s ability 

to perform basic work activities more than two thirds of an eight hour workday. (Id.)

This opinion contradicts the ALJ’s RFC finding that Plaintiff could work a 

consistent schedule with only standard industry breaks every two hours. (AR 91.) 

In fact, during the hearing before ALJ Cole, a vocational expert testified that a 

person with Plaintiff’s characteristics who was off-task for more than one hour a day 

would not be employable. (AR 57.) The Dewart report also contradicts the Appeals 

Council’s mental capacity findings, which assessed that Plaintiff had only “moderate 

limitations in the ability to concentration [sic], persist, or maintain pace.” (AR 5.)

In sum, N.P. Dewart’s report is material and is the opinion of a valid medical 

source. The Commissioner would, at the least, have been required to provide 

germane reasons for rejecting the report. Because N.P. Dewart’s report contradicts 

the ALJ’s and the Appeals Council’s findings, the Appeals Council’s oversight in 

failing to acknowledge the report is a harmful error. 

 

3. Dr. Gener Report 

The exclusion of Dr. Gener’s report is also not a harmless error. Dr. Gener is 

a treating medical source who had several prior encounters with Plaintiff. (AR 537.) 

Despite opining that he lacked knowledge as to several factors on the check-box 

evaluation form, Dr. Gener reported treating Plaintiff on a monthly basis, and his 

report references information about Plaintiff’s ongoing treatment within the time 

period under consideration. (Id.; see also, e.g., AR 455–56, 611–12, 615–16, 622–

23, 631.) Because Dr. Gener is a treating physician and his report is not conclusory,

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his report would have been entitled to significant weight. See Garrison, 759 F.3d at

1013. The Commissioner could not reject Dr. Gener’s opinion without providing

specific and legitimate reasons supported by substantial evidence. See Bayliss, 427 

F.3d at 1216. 

Dr. Gener’s report contradicts the ALJ and the Appeals Council’s findings. 

Dr. Gener reported that Plaintiff suffered from recurring panic attacks and that he 

had “moderate to marked” limitations in his ability to “maintain attention and 

concentrate for extended periods.” (AR 538–39). A moderate to marked limitation 

would interfere with Plaintiff’s ability to perform activities one third to two thirds 

of an eight-hour workday. Dr. Gener’s medical opinion suggests that Plaintiff would 

likely not be employable in a role with only standard industry work breaks every 

two hours.

Thus, Dr. Gener’s report is material, relates to the period at issue, and is

entitled to significant weight. It could not be rejected absent a specific and legitimate 

reason supported by substantial evidence. Because Dr. Gener’s report contradicts 

the ALJ’s RFC findings, the Appeals Council’s failure to acknowledge the report 

was a harmful error.

C. Remedy

Having concluded the Commissioner committed harmful legal error, the 

Court must determine the appropriate remedy. “[T]he proper course, except in rare 

circumstances, is to remand to the agency for additional investigation or 

explanation.” Benecke v. Barnhart, 379 F.3d 587, 595 (9th Cir. 2004). This 

“ordinary remand rule” respects the Commissioner’s role in developing the factual 

record, and helps guard against the displacement of administrative judgment by 

judicial decree. See Treichler, 775 F.3d at 1099–100. That the ALJ did not have an 

opportunity to consider material evidence because it was presented for the first time 

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to the Appeals Council is yet another reason to conclude that further proceedings is 

an appropriate remedy. See Gardner, 856 F.3d at 657–58.

Plaintiff initially argues that the appropriate remedy is to remand under the 

traditional “credit as true” rule for the immediate award of benefits. (Pl.’s Notice of 

Mot. 2:1–2.) However, Plaintiff also recognizes that the record is not entirely

developed, and that it is not “fully clear whether crediting [the] opinion[s] would 

warrant a finding of disability.” (Pl.’s Mot. 9: 2–5.) Plaintiff argues in the 

alternative that if the Court remands for further proceedings, it should order the 

Commissioner to credit as true the Dewart and Gener reports. (Id.)

The traditional credit as true test has three requirements. Garrison, 759 F.3d 

at 1019–21. First, the court must determine that the Commissioner committed legal 

error. Dominguez v. Colvin, 808 F.3d 403, 407 (9th Cir. 2016). Second, if the court 

finds such error, it must determine whether “the record has been fully developed and 

further administrative proceedings would serve no useful purpose.” Garrison, 759 

F.3d at 1020. If the court determines that the record has been fully developed and 

there are no outstanding issues left to be resolved, the court must finally consider 

whether the Commissioner “would be required to find the claimant disabled on 

remand” if the “improperly discredited evidence were credited as true.” Dominguez, 

808 F.3d at 407 (quoting Garrison, 759 F.3d at 1020). If all three steps are met, the 

district court may, but is not required to, remand for an award of benefits. Id. The 

court may choose to remand for further proceedings when the record as a whole 

creates “serious doubt” as to whether the claimant is disabled. Id. at 1021.

Under the version of the credit as true rule requested by Plaintiff in the 

alternative, the Court would remand for further proceedings but would instruct the 

ALJ to “credit as true” the improperly rejected testimony. (Pl.’s Mot. 9:3–7.) This 

instruction is punitive and is generally reserved for circumstances where 

administrative errors have unnecessarily delayed a decision for a plaintiff of 

advanced age. See Vasquez v. Astrue, 572 F.3d 586, 593–94 (9th Cir. 2009); 

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Hammock v. Bowen, 879 F.2d 498, 503–04 (9th Cir. 1989). This instruction may be 

given even if the record is not fully developed and it is not clear that the plaintiff is 

disabled. Hammock, 879 F.2d at 504.

In Plaintiff’s case, there is clear legal error, but the record has not been fully 

developed, and it is not clear from the existing record that the ALJ would be required 

to find Plaintiff disabled on remand if the improperly unacknowledged medical 

opinions were credited as true. See Dominguez, 808 F.3d at 407. 

First, because neither the Appeals Council nor the ALJ properly addressed the 

Gener and Dewart reports, further administrative proceedings would allow the 

Administration to consider the reports in light of the existing record, and to further 

develop the record if necessary. The Ninth Circuit has held that in cases with 

outstanding issues, additional evidence “‘may well prove enlightening’ in light of 

the passage of time[.]” Treichler, 775 F.3d at 1101 (quoting INS v. Ventura, 537 

U.S. 12, 18 (2002)). On remand, the Administration may choose to have Plaintiff 

undergo a new psychological exam, since the passage of time and the development 

in Plaintiff’s degenerative disk disease may render the January 2015 exam by Dr. 

Teegarden relatively unhelpful.

Second, “[i]n cases where the testimony of the vocational expert has failed to 

address a claimant’s limitations as established by improperly discredited evidence,” 

courts “consistently have remanded for further proceedings rather than payment of 

benefits.” See Harman, 211 F.3d at 1180; see also, e.g., Graham v. Colvin, No. 

C14-5311BHS, 2015 WL 509824, at *7 (W.D. Wash. Feb. 6, 2015) (remanding for 

further proceedings where there was a “lack of vocational expert testimony based on 

the limitations” contained in improperly discredited evidence). Here, the vocational 

expert was asked about a hypothetical person who had all the limitations of 

Plaintiff’s RFC, and the additional limitation of being off-task for at least one extra 

hour a day. (AR 57.) While this hypothetical could be consistent with the 

unacknowledged medical opinions, the ALJ may find it helpful to request the 

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testimony of a new vocational expert who can consider Plaintiff’s limitations more 

accurately. See Harman, 211 F.3d at 1180. In fact, as mentioned, Plaintiff himself 

acknowledges that there is an “absence of vocational evidence” and that “further 

administrative proceedings” are necessary. (Pl.’s Mot. 9:3–4.)

Accordingly, the Court declines to remand for benefits based on the traditional 

credit as true rule. It also declines to remand with an order that the Commissioner 

credit as true the Dewart and Gener reports. The Ninth Circuit has previously held 

that such instructions can be appropriate where the plaintiff is of “advanced age” 

and has already suffered “severe delays” in his application. See Vasquez v. Astrue, 

572 F.3d at 593–94. Although Plaintiff has reached an advanced age (he is 56 years 

old),

6 the record does not contain enough evidence of severe delays caused by the 

Administration to merit a “credit as true” order.

In sum, in exercising its discretion under 42 U.S.C. § 1383(c), the Court 

declines to depart from the ordinary remand rule in this case.

VI. CONCLUSION

In light of the foregoing, the Court GRANTS Plaintiff’s Motion for Summary 

Judgment (ECF No. 15) and DENIES the Commissioner’s Cross-Motion for 

Summary Judgment (ECF No. 16). The Court REMANDS this action for further 

proceedings consistent with this order. See 42 U.S.C. § 405(g). 

IT IS SO ORDERED.

DATED: June 28, 2019

 6 Pursuant to 20 C.F.R. § 404.1563(e), the Administration categorizes claimants over the 

age of 55 as “persons of advanced age.”

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