Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_18-cv-07005/USCOURTS-cand-3_18-cv-07005-1/pdf.json

Nature of Suit Code: 863
Nature of Suit: Social Security - DIWC/DIWW (405(g))
Cause of Action: 42:416 Denial of Social Security Benefits

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United States District Court

Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

JALALUDDIN ACHAKZAI,

Plaintiff,

v.

NANCY A BERRYHILL,

Defendant.

Case No. 18-cv-07005-JCS 

ORDER RE MOTIONS FOR

SUMMARY JUDGMENT

Re: Dkt. Nos. 15, 17

I. INTRODUCTION

Plaintiff Jalaluddin Achakzai brings this action appealing the final decision of Defendant 

Andrew Saul, Commissioner of Social Security (the “Commissioner”),1to deny Achakzai’s 

application for disability benefits. The parties have filed cross motions for summary judgment 

pursuant to Civil Local Rule 16-5. For the reasons discussed below, Achakzai’s motion is 

GRANTED, the Commissioner’s motion is DENIED, and the matter is REMANDED for further 

proceedings.

2

II. BACKGROUND 

Achakzai is an approximately fifty-eight-year-old former chef and military interpreter with 

a high school education. Administrative Record (“AR,” dkt. 14) at 80. He alleges disability due 

to hypertension, hyperlipidemia, insomnia, prediabetes, bilateral tinnitus, and post-traumatic stress 

disorder (PTSD). AR at 205. The alleged onset date of his disability is August 1, 2012. Id. 

1 Andrew Saul was confirmed as Commissioner while this action was pending, and is therefore 

substituted as the defendant as a matter of law. See 42 U.S.C. § 405(g); Fed. R. Civ. P. 25(d).

2 The parties have consented to the jurisdiction of the undersigned magistrate judge for all 

purposes pursuant to 28 U.S.C. § 636(c). 

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A. Medical Records 

Achakzai is only challenging the Administrative Law Judge’s (“ALJ’s”) severity 

determination regarding his post-traumatic stress disorder, major depressive disorder, and panic 

disorder. See Pl’s Mot. (dkt. 15). Accordingly, this summary of Achakzai’s medical records does 

not include records pertaining to his tinnitus, hypertension, or other physical medical problems 

except as they relate to his claim of PTSD. It is not intended to be a complete recitation of 

Achakzai’s medical history. 

Achakzai was born in Afghanistan. AR at 34. Immigration records indicate that he was 

born on January 1, 1962, but Achakzai estimates that he is older than his recorded age because of 

differences in record keeping between Afghanistan and the United States. Id. at 33. Achakzai 

immigrated to the United States when he was 28 years old. Id. at 322. Achakzai has eight 

children, the youngest four of whom live with him.3 Id. 

Achakzai’s past work includes being a restaurant owner, a chef, and a translator for the 

United States Military in Afghanistan. Id. at 212. He served as an interpreter in Afghanistan 

twice: once in 2004 and again in 2009. Id. During his first stint in Afghanistan, he accompanied 

the military on their missions, where he encountered battlefield dangers including “[a]mbushes, 

I.E.D., and gun fire.” Id. at 223. Achakzai reported that the Taliban retaliated against his family 

because of his association with the United States, killing four of his brothers. Id. at 40. Achakzai 

also witnessed car bombings, dismemberments, torture victims who had been skinned alive, and 

his nephew’s death. Id. at 360. According to his daughter, when he returned “he was a changed 

man.” Id. 

When he returned to the United States after his first tour in Afghanistan, he attempted to 

open a restaurant with his cousin as his partner. Id. at 360. Achakzai left the restaurant industry 

after his partner underhandedly persuaded him to transfer ownership of the restaurant. Id. at 223. 

He decided to return to Afghanistan as an interpreter a second time in 2009, motivated by that 

financial loss. Id. at 40, 360. In 2012, he was injured and hospitalized. Id. at 42. By the time he 

3 Another source reported that Achakzai has six children. AR at 341. However, “two of his 

children were missing for years.” Id. at 362. This may account for the discrepancy. 

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had recuperated, his team had left Afghanistan. Id. He returned to the United States with no job 

and no insurance benefits. Id. According to Achakzai, this is when his depression began. Id. at 

42–43; see also id. at 66 (alleging an onset date of August 1, 2012).

Achakzai sought treatment for his declining mental health three years later, when he told 

his primary care physician Dr. David Lee about his time in Afghanistan. Id. at 304. 

On a function report dated June 12, 2015, Achakzai described the symptoms that he 

claimed caused his disability:

I have anxiety and my doctor said it’s sign of PTSD from working 

with military overseas. I am not able to sleep even with the help of 

sleeping medicine from my doctor. I feel suffocated and stressed and 

worried all day/night. . . . I can’t do anything physical because of the 

pain and anxiety in my body. I spend time with my grandson and 

other times I am watching news on computer or TV. 

Id. at 224–25. Achakzai claimed the he was no longer “active” or “social,” that he preferred to be 

alone, and no longer enjoyed “anything.” Id. at 225–26. He linked his symptoms to his time in 

the military, reporting stress and anxiety since his return from his work as a translator. Id. at 227. 

He did not go out, and only went outside when his children made him go to a park about once per 

month. Id. While his son took him to the mosque for prayer on Fridays, he did not participate in 

the services. Id. at 228. His only hobby was watching the news, which made him worry about his 

family back in Afghanistan. Id. 

Achakzai also detailed physical limitations affecting lifting, squatting, bending, standing, 

walking, sitting, kneeling, talking, hearing, stair-climbing, seeing, memory, completing tasks, 

concentration, understanding, and using his hands. Id. at 229. He reported that he could walk for 

thirty minutes before needing to rest but did not continue walking when he stopped. Id. He 

indicated that he did not complete tasks, and that although he could follow spoken instruction 

“OK,” he could not follow written instructions “at all.” Id. He noted that, while he got along 

“good” with authority figures, he did not handle stress or changes in routine well. Id. at 230. He 

was “stressed constantly, worried and [got] anxiety attacks.” Id. at 230. 

Achakzai listed his medications and their side effects: he was taking 50mg of Trazodone, 

which caused nightmares and insomnia, and 10mg of Amlodipine Besylate and 50mg of 

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Hydrochlorothiazide, both of which caused dizziness. Id. at 231. He concluded his selfassessment by explaining: 

Working with military overseas in Afghanistan and the experiences I 

went through have really affected my life. I have witnessed a lot of 

my teams members lose their lives of body parts which I can’t never 

forget. I have anxiety and loss of sleep and the little sleep I get I have 

nightmares and I wake paniked [sic] and sad. 

Id. 

His son, Tawab Achakzai, completed a third-party function report for his father. Id. at 

233–42. Tawab wrote that his father “look[s] sad always and fragile and keeps to himself most of 

the time, watches to [sic] much news.” Id. at 233. According to Tawab, Achakzai spent all his 

time watching television news. Id. at 234. Tawab noted that, since his illness, his father was no 

longer active or social. Id. Tawab also explained that his father had trouble sleeping. Id. at 234. 

Even though Achakzai used to be a chef, Tawab reported that his father had “[n]o interest” in 

cooking or preparing meals and did not prepare his own meals. Id. at 235. Achakzai did not go 

out alone––Tawab “[took] him everywhere.” Id. at 236. According to Tawab, Achakzai spent all 

his time watching TV news, and his kids would “talk and spend time with him” because he was 

always at home. Id. at 237. Tawab took his father to Friday prayers, but he needed 

accompaniment and reminder to go. Id. Once there, he prayed but kept to himself, not engaging 

in conversation with the other worshipper at the mosque. Id. Since his father’s illness began, 

Tawab wrote, Achakzai was “[n]ot social at all and would rather keep to himself.” Id. at 238.

Tawab echoed his father’s assessment of his physical limitations. Id. at 238. He wrote, “I 

believe what he went through in Afghanistan and what he saw has affected in life traumatically.” 

Id. He linked his father’s blood pressure problems to his poor ability to handle stress. Id. at 239. 

Tawab noted “[h]e looks constantly worried and very dissappointed [sic] in himself.” Id. 

Achakzai sought treatment for his declining mental health on April 2, 2015, when he told 

his primary care physician Dr. David Lee about his time in Afghanistan. Id. at 304. Dr. Lee 

diagnosed Achakzai with insomnia and proscribed trazodone, noting, “Pt has component of PTSD. 

Was in Afghan army. Wakes up thinking about it.” Id. Achakzai previously asked Dr. Lee 

whether he could qualify for Social Security Disability Insurance based on his hypertension on 

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December 8, 2014. Id. at 300. Dr. Lee said, “I don’t think he qualifies.” Id. On August 3, 2015, 

when discussing Achakzai’s diagnosis of “[d]epression with anxiety,” Dr. Lee noted that Achakzai 

“[w]ants to start with medication and consider therapy in future.” Id. at 329. 

Psychologist Dr. Patricia Spivey saw Achakzai for a mental status disability report on 

August 18, 2015. Id. at 322. Achakzai was accompanied by his son. Id. He only spoke Pashto 

and used an interpreter to talk to Dr. Spivey; “he said that he has forgotten a lot of words in 

English recently.” Id. at 322–23. Achakzai told Dr. Spivey: 

[H]e had no history of psychiatric treatment until recently. He sought 

medications for depression and anxiety. He said that he has trouble 

sleeping. He is having memories of the war sounds and bombings, 

etc. He said that he had hallucinations, but when I asked him to 

describe those, he was describing paranoid ideas such as fearing that 

someone is wanting to kill him. He denied suicidal ideation. He is 

not on any form of therapy. He said that he has been taking the Paxil 

about one month; he is not feeling any effects of it and he does not 

think it has helped him. 

Id. at 323. She assessed Achakzai’s symptoms as “mild to moderate” and his prognosis as “[g]ood 

with continued treatment.” Id. 

Dr. Spivey offered her opinion as to Achakzai’s work-related abilities. Id. at 323–24. 

According to Dr. Spivey, Achakzai had mild to moderate impairments in his ability to maintain 

emotional stability and predictability and mild impairments in his ability to maintain adequate 

pace or persistence to complete one to two step simple repetitive tasks, maintain adequate pace or 

persistence to complete complex tasks, maintain adequate attention and concentration, adapt to 

changes in job routine, and ability to withstand the stress of a routine work day. Id. She further 

found that Achakzai had no impairments in his ability to follow simple and complex instructions, 

verbally communicate effectively with others, communicate effectively in writing, and interact 

appropriately with co-workers, supervisors, and the public on a daily basis. Id. Dr. Spivey gave 

Achakzai a GAF score of 65. Id. at 323. 

On November 3, Dr. Lee wrote that Achakzai was experiencing “[o]nly minimal 

improvement with paxil. Still waking up with panic attacks in the middle of the night.” Id. at 328. 

In a disability benefits interview dated November 17, 2015, Achakzai told interviewer C. 

Monterrosa that his condition had worsened since his original disability application. Id. at 245. 

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Dr. Lee completed a General Residual Functional Capacity Questionnaire on December 

15, 2015. Id. at 335–36. He diagnosed Achakzai with “PTSD, depression, anxiety” and opined 

that his prognosis was “Poor.” Id. at 335. According to Dr. Lee, Achakzai would be absent from 

work “[m]ore than four days per month” due to his symptoms. Id. Dr. Lee also indicted that 

Achakzai’s “experience of fatigue or other symptoms” would “[f]requently” be “severe enough to 

interfere with attention and concentration needed to perform even simple work tasks.” He noted 

that “emotional factors” contributed to Achakzai’s symptoms and limitations, and that Achakzai’s 

condition would have both good and bad days. Id. He found that Achakzai’s impairments were 

“reasonably consistent with the symptoms and functional limitations” and that Achakzai was not a 

malingerer. Id. 

Dr. Lee checked boxes indicating that Achakzai would be “[s]eriously limited, but not 

precluded” from maintaining attention for a two hour segment, completing a normal workday and 

work week without interruptions from his symptoms, performing at a consistent pace without an 

unreasonable number and length of rest brakes, and being aware of and taking appropriate 

precautions against normal hazards. Id. at 336. He further found that Achakzai was “[u]nable to 

meet competitive standards” with regard to “[r]emember[ing] work-like procedures,”

“[s]ustain[ing] an ordinary routine without special supervision,” and “deal[ing] with work stress.” 

Id. Dr. Lee did not identify limitations in any of the other functional areas listed on the form. Id. 

State consultative physician Dr. James Kelly evaluated Achakzai’s record on September

12, 2015 in connection with his initial application. Id. at 72–73. Dr. Kelly wrote: “No mental 

medically determinable impairments established.” Id. at 72. Dr. Helen Patterson reviewed 

Achakzai’s record on January 15, 2016 as part of Achakzai’s request for reconsideration and 

found the same. Id. at 86–87. 

On January 19, 2016, Achakzai saw psychiatrist Dr. Amrit Saini for the first time, seeking 

help for what he described as “depression.” Id. at 360. Achakzai told Dr. Saini some of the things 

he saw when he was in Afghanistan during the war: 

He’s [sic] reports that during this time in Afghanistan he saw a lot of 

people dying . . . bombs blowing up cars, Dead bodies, Limbs 

separated from bodies, bodies of tortured people who were skinned 

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alive. . . . He saw his nephew dying in front of him in the war. He 

also reports [his] brothers died in Afghanistan during this time. . . . 

His daughter reports that the first time he came back from war he was 

a changed man. He became more irritable, sad and tearful. He now 

reports that he has nightmares bombs exploding and people dying. He 

also reports he has flashbacks . . . . He avoids going places, is socially 

isolated and reclusive. He cannot tolerate [loud s]ounds or even 

children crying. He cried profusely during the session and endorsed 

a sad mood he sleeps late wakes up early as [sic] spends all the time 

outside the house. 

Id. at 360. They also discussed Achakzai’s cousin embezzling from him, which led to a financial 

situation that forced him to go back to Afghanistan a second time. Id. Dr. Saini noted anhedonia, 

but no suicidal thoughts or passive death wish. Id. He diagnosed Achakzai with “Major 

depressive disorder, recurrent episode, moderate degree,” “Post-traumatic stress disorder,” and

“Panic disorder.” Id. at 361. 

On February 16, 2016, Achakzai told Dr. Saini that his sleep was “better,” and that his 

mood, nightmares, flashbacks, and crying spells had improved. Id. at 358. However, he was also 

experiencing “ongoing irritability . . . increased startle, avoidance.” Id. Dr. Saini also noted that 

Achakzai’s mother had died. Id. 

According to Achakzai’s son, Achakzai had “no difference” in his symptoms on March 15, 

2016. Id. at 356. Achakzai explained that, while he slept better when he was alone, being alone 

made him “really sad.” Id. His mood was “5/10” and, while his nightmares had decreased, he 

continued to experience “ongoing flashbacks,” “ongoing sad-anxious mood,” and anhedonia. Id. 

Dr. Saini thought that Achakzai “would benefit from titration4in dose of meds.” Id. 

On April 12, 2016, Achakzai’s mood was “5/10,” and he “noticed in the last two weeks 

that [he had] been feeling better.” Id. at 354. Achakzai tried not to stay alone because doing so 

contributed to his depression. Id. He reported an improved appetite and “[r]educed Anhedonia.” 

Id. Dr. Saini opined: 

Pt. appears to demonstrate improving response to prescribed 

medications. There has been reduction in the number, severity of 

nightmares. Pt. is also able to sleep after the nightmare unlike before 

4

“Titration is the ‘continual adjustment of a dose based on patient response. Dosages are adjusted 

until the desired clinical effect is achieved.’” Bruce v. Chaiken, No. 215CV0960TLNKJNP, 2018 

WL 4191871, at *29 (E.D. Cal. Aug. 31, 2018) (citing _https://medicaldictionary.thefreedictionary.com/titration+dose).

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when he was unable to sleep after the nightmare. . . . Pt. would benefit 

from longer trial with current meds. Better tolerance of side effects 

is expected as time goes on. 

Id. at 354–55. 

Achakzai’s son accompanied him to translate for Dr. Saini on June 4, 2016. Id. at 352. 

Dr. Saini wrote that Achakzai’s mood was “4-5/10,” although he was “less frequently tearful.” Id. 

He reported eating one meal per day “due to low motivation” as well as continued intermittent

anxiety and insomnia. Id. Dr. Saini also noted that Achakzai would get affected by news about 

Afghanistan and worried about his family. Id. 

Achakzai was “not doing bad” on August 22, 2016. Id. at 350. His nightmares had 

decreased and he was occasionally sleeping from five to six hours “with the help of Klonopin.” 

Id. His daughter told Dr. Saini that her parents spent their nights watching the news, listening to 

sermons, and praying. Id. According to Dr. Saini, Achakzai “spoke very little English and could 

understand some statements.” Id. 

On October 3, 2016, Achakzai reported having trouble sleeping. Id. at 348. His daughter 

told Dr. Saini: 

He has a fear that somebody is watching him at night and has fear that 

someone might come in and, might not kill him. . . . My father has 

lost many members of family in his native country. . . . If a small child 

screams in the day time he gets easily startled. . . He only eats one full 

meal in the day time at noon and breakfast is minimum. . . . He has 

stopped walking because his left knee is numb.

Id. (internal quotation marks omitted). According to her, Achakzai spent time reading and 

watching movies. Id. Dr. Saini increased Achakzai’s Zoloft to 200 mg per day, increased his 

Klonopin to .5 mg in the morning and 1 mg at night, and started him of 50 mg of Seroquel. Id. at 

349. 

Achakzai reported being “not bad” on November 7, 2016. Id. at 346. He was again 

accompanied by his daughter, who translated. Id. He was taking his medication and not 

experiencing any side effects. Id. He also “appear[ed] to demonstrate fair response to prescribed 

medications.” Id. 

On February 16, 2017, Achakzai was admitted to the hospital after almost collapsing. Id. 

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at 376. His son described it as “some type of anxiety attack where he just went motionless and 

couldn’t speak.” Id. at 53. Achakzai’s son testified that the attack was brought on by Achakzai’s 

fear of “losing a daughter” once that daughter married. Id.; see also id. at 342. 

According to the notes of Dr. Alfort Briones Santos:

[H]e went for a walk at 8:00 am and came home and took blood 

pressure medications. He was preparing breakfast and then suddenly 

felt weak and lightheaded. There was no loss of consciousness. . . . 

[H]is blood pressures have been fluctuating in-house from as low as 

107 systolic to as high as 165. . . . I suspect patient’s blood pressure 

is fluctuating too much in the outpatient setting and he came in 

clinically dry. 

Id. at 376. 

Achakzai returned to Dr. Saini on March 13, 2017 after his ER visit and hospital stay. Id. 

at 342. Achakzai’s daughter, again translating, explained that the tests done on Achakzai’s heart 

were normal. Id. She told Dr. Saini that her father felt guilty for upsetting the family’s plans for 

an engagement party. Id. Since then, Achakzai had traveled to Los Angeles to see his brother, 

who was undergoing treatment for cancer. Id. Achakzai was eating and sleeping “okay” and was 

“experiencing increasing anxiety and moments of sadness.” Id. In his notes, Dr. Saini wrote “Pt. 

appears to demonstrate lower than expected response to prescribed medications. . . . Pt. would 

benefit from adjusting psychiatric medications and possible therapy in Farsi.” Id. at 343. Dr. 

Saini discontinued Prazosin because it may have contributed the near-fainting episode. Id. He

continued Achakzai’s Zoloft, Klonopin, and Seroquel. Id. 

On March 5, 2017, Achakzai told Dr. Saini “[o]verall I have been doing good.” Id. at 344. 

His daughter served as a translator. Id. Achakzai reported feeling “good” and that his feelings of 

anxiety and suffocation were decreasing. Id. He was able to drive by himself. Id. However, his

appetite was “lower than expected” and he still got “upset easily.” Id. He told Dr. Saini that he 

was seeking treatment for his leg pain, although he was “walking regularly.” Id. Achakzai 

described his mind as “very sensitive.” Id. In the mental status exam, Dr. Saini noted that 

Achakzai “ha[d] limited insight due to cultural reservations into mental illness.” Id. Dr. Saini 

referred Achakzai for therapy in Farsi. Id. at 345. His sleep was improving, but his anxiety 

increased when he heard anything about Afghanistan. Id. He also prayed every day. Id. Every so 

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often, Dr. Saini noted, Achakzai would smile. Id. Dr. Saini increased Achakzai’s dose of 

Seroquel to “200 mg at night.” Id. According to his daughter, Achakzai was planning a trip to 

Germany to visit his brother.5 Id.

Dr. Saini wrote a letter on Achakzai’s behalf dated May 5, 2017. Id. at 362–63. In Dr. 

Saini’s opinion, Achakzai’s current symptoms were caused by his time in Afghanistan: “As per his 

report four of his brothers were allegedly murdered during the war. Also reportedly two of his 

children were missing for years. . . . Mr. Achakzai witnessed countless killings, witnessed the 

deaths of his team members and also endured lot of stress in his work.” Id. at 362. Dr. Saini 

opined that Achakzai’s trauma affected him interpersonally and psychosocially. Id. He also noted 

that Achakzai always brought one of his adult children to appointments. Id. In addition, Dr. Saini 

wrote:

He continues to experience full syndrome of major depression, high 

persistent anxiety state with frequent panic episodes and major 

symptoms of posttraumatic stress syndrome as social avoidance, 

depressed and labile mood, spontaneous irritability, recurrent 

insomnia associated with nightmares of traumatic events and 

flashback experiences. His daily biological and social functioning is 

significantly affected by his persisting symptoms such that quality of 

life is significantly affected negatively. Feelings of guilt and 

worthlessness continue to haunt him. Mr. Achakzai continues to 

experience increase in arousal and emotional reactivity with 

symptoms of anxiety and panic. 

At present his psychiatric symptoms are only partially controlled with 

non-sustained improvement and repeated worsening of all symptoms 

of mood, anxiety, insomnia and PTSD with stresses of daily life. 

With continuing psychiatric symptoms it would be very difficulty 

[sic] for him to have sustained attention, concentration and mental 

ability to allow him participate in useful work related activities. 

Id. 

Dr. Saini also completed a mental impairment report. Id. at 364–66. He described 

Achakzai’s response to treatment as “moderate . . . with frequent relapses.” Id. at 364. He 

checked boxes indicating that Achakzai was experiencing depressed mood, diminished interest in 

5 According to his motion, Achakzai did not go to Germany. Pl’s Mot. at 18 (“If the record is 

updated, it will emerge that the trip did not happen.”). Whether the trip occurred is not relevant to 

the outcome of the present motions. 

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almost all activities, appetite disturbance with change in weight, sleep disturbance, observable 

psychomotor retardation and agitation, decreased energy, feelings of guilt or worthlessness, 

difficulty concentrating or thinking, “passive” thoughts of death or suicide, distractibility, anxiety 

with restlessness and easy fatigue, irritability, “[p]anic attacks followed by a persistent concern or 

worry about additional panic attacks or their consequences”; “[i]nvoluntary, time consuming 

preoccupation with intrusive, unwanted thoughts”; qualitative deficits in nonverbal 

communication and social interaction; a pattern of detachment from social relationships; 

“[e]xposure to actual or threatened death, serious injury, or violence”; involuntary re-experiencing 

a traumatic event; avoidance of external reminders of the event; disturbance in mood and 

behavior; and increases in arousal and reactivity. Id. 

In Dr. Saini’s opinion, Achakzai had “Extreme” limitations in all four of the paragraph B 

areas: ability to understand, remember, and apply information; ability to interact with others; 

ability to concentrate, persist at tasks, or maintain pace over the course of an eight hour work day; 

and the ability to adapt or manage himself (“Ability to Regulate Emotions, Control behavior, and 

Manage One’s Well-being at Work”). Id. at 365. Dr. Saini estimated that Achakzai would miss 

“more than four days [of work] per month.” Id. at 366. He noted that Achakzai’s symptoms had 

been this severe for “more than one year.” Id. 

The record also includes several letters, certificates, and photographs from Achakzai’s time 

working as a linguist in Afghanistan. Id. at 368–73. 

B. Initial Denial of Application 

Achakzai filed his initial application for disability benefits on May 1, 2015. AR at 66. It 

was denied on September 14, 2015. Id. at 98. He requested reconsideration on November 13, 

2015. Id. at 95. That, too, was denied on January 28, 2016. Id. at 106. Achakzai filed a written 

request for a hearing on March 10, 2016. Id. at 111. 

C. The Administrative Hearing

ALJ Arthur Zeidman held an administrative hearing on June 8, 2017 in Oakland, 

California. AR at 28. Because Achakzai speaks Pashto, Mohammad Azizi served as a translator. 

Id. Through the translator, the ALJ explained the disability determination process and rationale to 

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Achakzai, who indicated that he understood. Id. at 31–32. Achakzai explained that his birthdate, 

recorded as January 1, 1962, is in dispute because of differences in the Afghani and United States 

calendars and record keeping. Id. at 33–34. He testified that he graduated from high school in 

Afghanistan. Id. at 36. The ALJ and Achakzai also discussed Achakzai’s service as a translator 

for the American military in Afghanistan. Id. at 37–39. In Afghanistan, Achakzai first worked 

with a company called Angility6 where he worked in “telecommunications.” Id. at 39. 

While working in Afghanistan, Achakzai reported that he found himself in danger and that 

his family suffered retaliation for his work with the United States military:

From the time was I been to the Army, 24 hours we are -- our life is 

in danger . . . . during that time is I went with the military Army of 

the United States and also all the Taliban and also against the 

Afghanistan government and against American they know about me 

and also is I lost four of my brothers and also two of them they did 

like a bomb explosion close to the place that they live in and I lost 

four of my brothers for that reason because of working with the 

military. 

Id. at 40. Achakzai reported that, after returning to the United States, he opened a restaurant 

called the Kabob Palace in Arizona. Id. He testified that his partner cheated him out of all his 

money, which led him to return to Afghanistan. Id. at 40–41. This time, he worked with Torres 

Advanced Enterprises. Id. at 41. 

When the ALJ asked Achakzai why he stopped working, Achakzai replied that he was 

injured and hospitalized in Afghanistan and that, by the time he was released, his team had 

returned to the United States and no other military contractors were hiring. Id. at 42. This was 

when his depression started. Id. Achakzai also testified that watching television increased his 

depression symptoms. Id. He testified that the did not receive any insurance or benefits from his 

former employers, but that he did enroll in Medicare. Id. at 42–43. He was hospitalized a second 

time, after which his symptoms of weakness, fatigue, and depression got worse. Id. at 43. He 

testified that medication was ineffective. Id. at 43. 

Achakzai elaborated on the trauma he witnessed in Afghanistan: 

6

In Achakzai’s motion, the name of the company is spelled “Engility.” Pl’s Mot. at 3. 

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During when I was in Afghanistan with the Army I see a lot of 

different things and a lot of bombing and killing and doing a lot of 

bad stuff I see and right now I see on the TV, I don’t want to see the 

TV but . . . every five minutes they come in news and then they show 

everything. There’s a lot of bombing a lot of explosion, people they 

kill, people they die, children, old, young, everybody. It was 

bothering me a lot and also I feeling suicidal and depression I have 

for that. 

Id. at 43–44. He discussed his cane, which he used to help him walk and sit. Id. at 44. He also 

noted his high blood pressure and high cholesterol. Id. 

When asked about managing his mental health, Achakzai reported that he took medication 

which relaxed him and helped him sleep, spent time with his family, and saw a psychiatrist. Id. at 

45. He detailed his daily activities: 

I don’t want to go outside and also I have grandchildren and also I’m 

so happy with my grandchildren to sit down and also talk and answer 

to whatever they ask me and I do communication with them and also 

sometimes they hold my hand and walk inside the house and things 

like that. 

Id. at 46. Even though Achakzai used to be a professional chef, he testified that he did not cook 

for his family but did direct his family while they cooked. Id. 

The ALJ then moved on to the collection of photographs and letters from Achakzai’s time 

with the army. Id. at 47. He asked why Achakzai’s ability to speak English had declined since his 

time as a translator. Id. at 47–48. Achakzai replied: “I’m taking a lot of medication . . . 

[S]ometimes I do translated English to Pashto-Pashto and then back to English and it takes a long 

time and then I get bothered me for that reason. For that I forget too much.” Id. at 48. 

Achakzai was then questioned by his attorney, who asked him to give more details about 

what he witnessed in Afghanistan. Id at 49. Achakzai explained that he had chronic nightmares

about some of the things he saw: 

Before I do nightmare and that time nightmare all the explosion and 

also dead body and also people, there’s another head, there’s another 

leg, or feet or hand doesn’t have it. I dream about it. 

And also that time I cry too much and screaming too much and my 

kids they come and they shake me and they say what’s going on, move 

yourself, move to the side and why you’re screaming, what’s 

happening. Then I tell them, then I didn’t go back to sleep because 

I’m scared to the same dream. 

And also I saw that was bothering me sometime and most of the time 

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is I dream about, nightmare, I saw there was Taliban. There was some 

people they take them out all the skin and just that the meat was with 

the bone they have it and also the skin is taken out. Those things I 

saw. Most of the time I dream about this. 

Id. at 49–50. While medication helped somewhat, he still experienced symptoms of PTSD and 

depression. Id. at 50. He also testified to other stressors in his life, such as his son being wounded 

in combat or his brother being diagnosed with cancer. Id. at 50–51. 

The ALJ then heard from Achakzai’s son, Tawab, who lives with him. Id. at 51–52. 

When Achakzai’s attorney asked for Tawab’s impression about his father’s condition, Tawab 

explained that Achakzai isolated himself at home and did not leave the house unless his children 

accompanied him. Id. at 52. It was difficult for the family to engage Achakzai in conversation. 

Id. Tawab reported that Achakzai would often watch the news and had trouble sleeping and 

socializing with others. Id. at 52. Tawab further testified that Achakzai could take care of his 

basic hygiene, but the family performed other hygiene functions like cutting Achakzai’s hair. Id. 

at 52–53. The family also cooked for Achakzai and encouraged him to eat. Id. at 53. Tawab also 

recounted an incident that took place around his sister’s engagement where Achakzai “had some 

type of anxiety attack where he just went motionless and couldn’t speak,” which led him to the 

emergency room. Id. Tawab testified that tests in the hospital reflected the effects of Achakzai’s 

illness on his ability to care for himself: he was low on potassium, low on magnesium, and 

dehydrated. Id. at 54. According to Tawab, Achakzai found some joy in his grandchildren, even 

though “he sometimes is hesitant to engage.” Id. at 55. 

The ALJ talked to Tawab about his memories of his father before Achakzai’s time in 

Afghanistan. Tawab explained, “I could see the change in him.” Id. at 56. Things got worse after 

Achakzai was hospitalized in Afghanistan. Id. at 57. The two also discussed what Achakzai was 

like prior to his time in Afghanistan. Id. at 57. Back then, Achakzai worked in the restaurant 

business and was well-liked and social. Id. Tawab remarked that the difference between his 

father than to his father now was a “complete 360.” Id. 

The ALJ then turned his attention to Sharon Spaventa, the Vocational Expert (“VE”). Id. 

at 58. Spaventa summarized Achakzai’s transferable skills, such as “knowledge of kitchen tools, 

equipment . . . cooking methods, with assembly and presentation.” Id. at 60. The VE opined that 

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Achakzai did not have any transferable skills from his time as an interpreter. Id. The ALJ offered 

the following hypothetical:

[A]ssume a hypothetical individual of the claimant’s age and 

education with the past jobs you described. Further assume that this 

individual is limited and these are nonexertional limitations only, 

understand, remember and carry out instructions, limited to perform 

simple routine tasks, using judgement limited to simple work-related 

decisions, respond appropriately to supervisors, co-workers and the 

public limited to occasionally. Dealing with changes in work setting 

is limited to simple work related to decisions. Can the hypothetical 

individual perform any of the past jobs you described as actually 

performed or generally performed in the national economy?

Id. at 60–61. The VE testified that such a person would not be able to perform any work, 

including his past jobs, because of such a person’s “[o]nly occasional ability to respond 

appropriately in the workplace to supervisors and co-workers.” Id. at 61. She further opined that 

such an individual could not “perform any other work” for the same reason. Id. She testified that 

her answer would be the same when the ALJ added “absent five days per month” to the 

hypothetical: “[n]o past work and no other work[.]” Id. 

After dismissing the VE, the ALJ again spoke to Mr. Achakzai. Id. at 62. He asked the 

translator to interpret the following: 

I had been considering when I was preparing for the hearing 

requesting a post hearing psychiatric examination. The reason for this 

is because there is conflicting and some inconclusive medical records 

of psychiatric and psychological evaluations. However, I do believe 

that the testimony today of Mr. Jalaluddin Achakzai and Mr. Tawab 

Achakzai are sufficient to resolve the questions that are raised by the 

inconsistencies in the psychological reports. So, I believe that I can 

resolve those differences. It appears that perhaps at the DDS level 

and with the other examination, that they didn’t have the benefit of a 

full understanding of Mr. Achakzai’s mental limitations. . . . As well 

as the behavioral expressions that are clear both in the records of the 

file as well as the testimony. 

Id. at 62. The ALJ ended the hearing by expressing his “hope that [Achakzai] can return in good 

health to be the loving grandfather and father that [he has] been for many years.” Id. at 64. 

D. Regulatory Framework for Determining Disability 

1. Five-Step Analysis

When a claimant alleges a disability and applies to receive Social Security benefits, the 

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ALJ evaluates the claim using a sequential five step process. 20 C.F.R. § 404.1520(a)(4). At Step 

One, the ALJ determines whether the applicant is engaged in “substantial gainful activity.” 20 

C.F.R. § 404.1520(a)(4)(I). Substantial gainful activity is “work activity that involves doing 

significant physical or mental activities . . . that the claimant does for pay or profit.” 20 C.F.R. 

§ 220.141(a)–(b). If the claimant is engaging in such activities, the claimant is not disabled; if not, 

the evaluation continues at Step Two. 

At Step Two, the ALJ considers whether the claimant has a severe and medically 

determinable impairment. Impairments are severe when “there is more than a minimal limitation 

in [the claimant’s] ability to do basic work activities.” 20 C.F.R. § 404.1520(c). If the claimant 

does not suffer from a severe impairment, he is not disabled; if he does have a severe impairment, 

the ALJ proceeds to Step Three. 

At Step Three, the ALJ turns to the Social Security Administration’s listing of severe 

impairments (the “Listing”). See 20 C.F.R. § 404, subpt. P, app. 1. If the claimant’s alleged 

impairment meets one of the entries in the Listing, the claimant is disabled. If not, the ALJ moves 

to Step Four. 

At Step Four, the ALJ assesses the claimant’s residual functional capacity, or RFC, to 

assess whether the claimant could perform his past relevant work. 20 C.F.R. § 404.1520(a)(1). 

The RFC is a determination of “the most [the claimant] can do despite [the claimant’s] 

limitations.” 20 C.F.R. § 404.1520(a)(1). The ALJ considers past relevant work to be “work that 

[the claimant] has done within the past fifteen years, that was substantial gainful activity, and that 

lasted long enough for [the claimant] to learn how do to it.” 20 C.F.R. § 404.11560(b)(1). If the 

claimant is able to perform past relevant work, he is not disabled; if he is not able to perform such 

past relevant work, the ALJ continues to Step Five. In the case of claimants who are fifty-five or 

older, are restricted to sedentary work, have no transferable skills, and have not completed any 

relevant vocational education, the Commissioner will usually not offer any evidence of work 

meeting the claimant’s RFC and the ALJ will decide disability based on the claimant’s ability to 

perform past work. 20 C.F.R. § 404, subpt. P, app. 2 § 201.00(d). 

At the fifth and final step, the burden shifts from the claimant to prove disability to the 

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Commissioner to “identify specific jobs existing in substantial numbers in the national economy 

that the claimant can perform despite her identified limitations.” Meanel v. Apfel, 172 F.3d 1111, 

1114 (9th Cir. 1999) (citing Johnson v. Shalala, 60 F.3d 1428, 1432 (9th Cir. 1995)). If the 

Commissioner is able to identify such work, then the claimant is not disabled; if not, the claimant 

is disabled and entitled to benefits. 20 C.F.R. § 404.1520(g)(1). 

2. Supplemental Regulations for Determining Mental Disability

The Social Security Administration has supplemented the five-step general disability 

evaluation process with regulations governing the evaluation of mental impairments at steps two 

and three of the five-step process. See generally 20 C.F.R. § 404.1520a; see also Clayton v. 

Astrue, No. CIV 09-2282-EFB, 2011 WL 997144, at *3 (E.D. Cal. Mar. 17, 2011) (citing Maier v. 

Comm’r of Soc. Sec. Admin., 154 F.3d 913 (9th Cir. 1998)). First, the Commissioner must 

determine whether the claimant has a medically determinable mental impairment. 20 C.F.R. 

§ 404.1520a(b)(1). Next, the Commissioner must assess the degree of functional limitation 

resulting from the claimant’s mental impairment with respect to four broad functional areas: (1) 

understanding, remembering, or applying information; (2) interacting with others; 

(3) concentration, persistence, or maintaining pace; and (4) adapting and managing oneself. 20 

C.F.R. § 404.1520a(b)(2), (c). Finally, the Commissioner must determine the severity of the 

claimant’s mental impairment and whether that severity meets or equals the severity of a mental 

impairment listed in Appendix 1. 20 C.F.R. § 404.1520a(d). If the Commissioner determines that 

the severity of the claimant’s mental impairment meets or equals the severity of a listed mental 

impairment, the claimant is disabled. See 20 C.F.R. § 404.1520(a)(4)(iii). Otherwise, the 

evaluation proceeds to Step Four of the general disability inquiry. See 20 C.F.R. § 

404.1520a(d)(3).

Appendix 1 provides impairment-specific “Paragraph A” criteria for determining the 

presence of various listed mental impairments, but all listed mental impairments share certain 

“Paragraph B” severity criteria in common (and some have alternative “Paragraph C” severity 

criteria). See generally 20 C.F.R. § 404, Subpt. P, App. 1 at 12.00. Therefore, any medically 

determinable mental impairment—i.e., one that satisfies the Paragraph A criteria of one or more 

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listed mental impairments—is sufficiently severe to render a claimant disabled if it satisfies the 

general Paragraph B criteria, which require that the claimant suffers at least two of the following: 

(1) understanding, remembering, or applying information; (2) interacting with others; 

(3) concentration, persistence, or maintaining pace; and (4) adapting and managing oneself. See 

id. A “marked” limitation is one that is “more than moderate but less than extreme” and “may 

arise when several activities or functions are impaired, or even when only one is impaired, as long 

as the degree of limitation is such as to interfere seriously with [a claimant’s] ability to function 

independently, appropriately, effectively, and on a sustained basis.” Id. at 12.00C.

This evaluation process is to be used at the second and third steps of the sequential 

evaluation discussed above. Social Security Ruling 96-8p, 1996 WL 374184, at *4 (“The 

adjudicator must remember that the limitations identified in the ‘paragraph B’ and ‘paragraph C’ 

criteria are not an RFC assessment but are used to rate the severity of mental impairment(s) at 

steps 2 and 3 of the sequential evaluation process.”). If the Commissioner determines that the 

claimant has one or more severe mental impairments that neither meet nor are equal to any listing, 

the Commissioner must assess the claimant’s residual functional capacity. 20 C.F.R. §§ 

404.1520a(d)(3). This is a “mental RFC assessment [that is] used at steps 4 and 5 of the 

sequential process [and] requires a more detailed assessment by itemizing various functions 

contained in the broad categories found in paragraphs B and C of the adult mental disorders 

listings in 12.00 of the Listing of Impairments . . . . ” Social Security Ruling 96-8p, 1996 WL 

374184, at *4.

E. The ALJ’s Opinion 

After the hearing, the ALJ concluded that Achakzai was not disabled. AR at 9. The ALJ 

found that Achakzai “had the following medically determinable impairments: anxiety, affective 

mood, posttraumatic stress disorder, tinnitus, hypertension, and insomnia.” Id. (citing 20 C.F.R.

§ 404.1521 et seq.). However, at Step Two of the disability analysis, the ALJ found that Achakzai 

“did not have a severe impairment or combination of impairments.” Id. at 11. The ALJ opined 

that Achakzai could perform jobs that required:

1. Physical functions such as walking, standing, sitting, lifting, 

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pushing, pulling, reaching, carrying or handling; 

2. Capacities for seeing, hearing, and speaking; 

3. Understanding, carrying out, and remembering simple 

instructions;

4. Responding appropriately to supervision, co-workers, and 

unusual work situations; and

5. Dealing with changes in a routine work setting (SSR-85-28).

Id. at 12. He further concluded that Achakzai “can read, write, speak, and understand English.” 

Id. (citing id. at 204, 206)

The ALJ explained that he “has read and considered the statements in the claimant’s 

function report dated June 12, 2015, and finds them inconsistent with the severity of the claimant’s 

alleged limitations.” Id. at 13 (citing id. at 224–32). Specifically, the ALJ noted that Achakzai 

was able to spend time with his grandson and his children, use a computer, watch television, spend 

time in his backyard (even if his children had to “force” him), and attend Friday prayers at his 

mosque. Id. The ALJ noted that Achakzai “described no problems performing personal care. He 

stated he was capable of taking out the trash and watering plants. . . . [H]e acknowledged being 

capable of walking for 30 minutes before needing to rest, ‘ok’ at following spoken instructions, 

and ‘good’ at getting along with authority figures.” Id. “Despite his alleged impairments,” the 

ALJ continued, “the claimant has engaged in somewhat normal activity levels. . . . Moreover, 

some of the physical and mental abilities required to perform these activities are the same as those 

necessary for obtaining and maintaining employment.” Id. The ALJ noted that Achakzai’s 

testimony at the hearing was consistent with his Function Report: he was married, had a driver’s 

license, and was “capable of cooking and preparing meals for his family when he is in a good 

mood.” Id. 

The ALJ summarized the testimony from Achakzai’s son, Tawab and found “the son’s 

testimony only partially consistent with the entire evidence of record and then only to the extent 

that claimant can do the work described therein.” Id. at 13 (citing id. at 51–58, id. at 233–41). 

The ALJ noted that, while Tawab described his father’s panic attack, hospitalization, and 

difficulties eating and drinking, he also noted that Achakzai picked up his seventeen-year-old son 

from school. Id. Overall, the ALJ found Tawab’s lay testimony was “not supported by the 

clinical or diagnostic medical evidence.” Id. at 14. 

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While the ALJ acknowledged Achakzai’s service in Afghanistan, id. (citing id. at 367–78), 

he noted that Achakzai’s “date last insured (DLI) was June 30, 2017. Thus, if onset of disability 

cannot be established on or before the DLI, the claim for a period of disability and disability 

insurance under Title II must be denied. Since this claim is for Title II benefits only, the period of 

adjudication ends with the DLI.” Id. He also noted that Achakzai “had no treatment notes 

available in the record from the alleged onset date of August 1, 2012 until May 15, 2014.” Id. 

(citing id. at 289–321, 325–78). 

After summarizing the record, the ALJ explained that he gave “little weight to the 

disability statements written by Amrit Saini on May 5, 2017 and May 7, 2017.” Id. (citing id. at

362–66). He opined that “[t]he findings of Dr. Saini are not consistent with the entire evidence of 

the record.” Id. at 17. The ALJ interpreted the lack of treatment records between August 1, 2012 

and May 15, 2014 as “suggestive that the claimant’s mental health impairments during that period 

were not as severe as alleged.” Id. He also noted that Achakzai’s condition improved over time, 

particularly with medication. Id. The ALJ looked to Dr. Saini’s treatment notes in March 2017:

[T]he claimant was capable of continuing to walk regularly, which 

the undersigned notes is suggestive the claimant was not isolating at 

home. He was noted as been capable of driving around in the city and 

driving to the appointment. . . . He was also reported as being capable 

of recently traveling to Los Angeles to meet and see his brother who 

apparently had been diagnosed with cancer, and was under treatment. 

He was reported as sleeping and eating were “okay.” Again, the 

undersigned notes this is suggestive the claimant’s impairments were 

not as severe as alleged. He had a valid driver’s license. He also 

testified not seeing a doctor and spending time with his family, which 

he likes being around his grandchildren [sic]. He admitted being 

capable of cooking and preparing meals for this family when he is in 

a good mood. Thus, the undersigned has given Dr. Saini’s opinions 

little weight . . . . 

Id. 

The ALJ also gave “little weight” to Dr. Lee’s opinion in his December 15, 2015 disability 

statement, because his findings “are not consistent with the entire evidence of record” and because 

a lack of treatment notes after November 2015 “is suggestive Dr. Lee was not aware of the 

claimant’s improvement with treatment.” Id. at 17–18. 

The ALJ gave “significant weight” to the opinion of Dr. Spivey, who examined Achakzai 

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on August 18, 2015. Id. Dr. Spivey’s opinion that Achakzai’s limitations were not severe “is 

supported by Dr. Spivey’s benign clinical objective findings.” Id. He also gave “significant 

weight” to the opinions of the consultative psychologists. Id. (citing id. at 66–79, 81–94). 

With regard to Achakzai’s physical limitations, the ALJ gave “significant weight to the 

disability statements written by the same Dr. Lee as noted above on December 8, 2014. Dr. Lee 

was documented as saying ‘I don’t think he qualifies for disability’ in regard to the claimant’s 

asking if he could get disability for his hypertension.” Id. (internal citations omitted) (citing id. at 

300). According to the ALJ, Dr. Lee’s findings in 2014 “are consistent with the entire evidence of 

record in regards the claimant’s physical impairments.” Id. at 19. The ALJ repeated the evidence 

he had summarized previously, again noting that Achakzai did not have treatment records for the 

time between August 1, 2012 and May 15, 2014, which led him to assume that Achakzai’s 

“physical impairments were not as severe as alleged,” and that Achakzai’s “longitudinal treatment 

for his physical impairments was routine and conservative and not as severe as alleged.” Id. 

The ALJ gave “little weight” to the findings of the consultative physicians who reviewed 

Achakzai’s record on initial review and reconsideration. Id. (citing 66–79, 81–94). He explained 

“[t]hese State agency consultants did not have the benefit of considering the additional evidence 

that was available only after the reconsideration determination including subsequent medical 

evidence and hearing testimony.” Id. 

Finally, the ALJ assessed Achakzai’s limitations under the paragraph B criteria. Id. at 20 

(citing 20 C.F.R., Part 404, Subpart P, Appendix 1). The ALJ found that Achakzai had mild 

limitations in all four functional areas: understanding, remembering, or applying information; 

interacting with others; concentrating, persisting, or maintaining pace; and adapting and managing 

oneself. Id. The ALJ noted again that there were no treatment notes before November of 2015, 

suggesting to the ALJ that Achakzai’s condition was not severe. Id. He noted Achakzai’s 

“minimal improvement with Paxil” and improvement while working with Dr. Saini, and reiterated 

the activities that, to his mind, undermined Achakzai’s claim of severe symptoms. Id. at 20–21. 

“In sum,” he concluded, “the claimant’s physical and mental impairments, considered singly and 

in combination, do not significantly limit the claimant’s ability to perform basic work activities. 

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Thus, the claimant does not have a severe impairment or combination of impairments.” Id. at 21. 

F. The Parties’ Arguments 

Achakzai claims that the ALJ erred by not finding Achakzai’s mental impairments were 

severe at Step Two, erred in how he weighed the opinions of Achakzai’s treating and examining 

medical providers, and that he erred by giving great weight to the opinions of non-examining state 

physicians. For those reasons, Achakzai asks the Court to remand this matter for an award of 

benefits. 

1. Severity Determination 

Achakzai first argues that the ALJ’s determination at Step Two that his PTSD, MDD, and 

Panic Disorder were not severe impairments is not “clearly established by medical evidence.” 

Pl.’s Mot. at 12 (quoting Webb v. Barnhart, 433 F.3d 683, 687 (9th Cir. 2005)). He claims the 

ALJ’s reasoning that Achakzai spent time with family unconvincing because he “lives with his 

children and grandchildren so by definition he spends time in their company.” Id. Achakzai also 

argues that his television watching is a “dysfunctional behavior” symptomatic of his depression, 

not an interest or activity, because it triggers his PTSD. Id. at 13. Achakzai argues that the ALJ 

claimed that he could cook and drive, but points to places in the record indicating that he did not 

do those things because of his disabling conditions. Id. He also explains that he only goes to 

religious services when his son accompanies him. Id. 

Achakzai also takes issue with the ALJ’s “suggest[ion] that Mr. Achakzai’s psychiatric 

condition is not severe because he did not have psychiatric treatment between 2012 and 2014,” a 

conclusion Achakzai claims the ALJ reached without asking why he did not seek treatment. Id. at 

14. Achakzai cites a study from the National Institutes of Health that describes reasons why 

people suffering from mental illness either delay or do not receive treatment. Id. He explains that 

improvement, one of the ALJ’s reasons to find his PTSD nonsevere, “does not mean that the 

problem has gone away, or that Mr. Achakzai’s ability to work is restored.” Id. at 15. 

The Commissioner claims that the ALJ drew reasonable inferences from Achakzai’s delay 

in seeking treatment and the conservative treatment he eventually received. Def.’s Mot. (dkt. 16) 

at 7–8. He notes that Achakzai did not mention his psychological symptoms even as he sought 

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treatment for other medical conditions, such as hypertension, high cholesterol, and tinnitus. Id. at 

7 (citing AR at 287–88, 299, 300). Because Achakzai did not discuss any mental health concerns 

with his primary care physician until well into their treatment relationship, the ALJ’s inference 

that those concerns were not severe is a reasonable one, according to the Commissioner. Id. at 7. 

In addition, the Commissioner contends that the ALJ was not unreasonable in inferring that, 

because Achakzai’s condition improved with relatively conservative treatment, his condition was 

not severe. Id. at 8. Such reasonable inferences, the Commissioner argues, may not be supplanted 

by the district court. Id. (citing Bayliss v. Barnhart, 427 F.3d 1211, 1214 n.1 (9th Cir. 2005)). 

In his Reply, Achakzai reiterates his argument that the evidence the ALJ cited to support 

his nonseverity decision was inadequate because it was based on the opinions of a non-treating or 

non-examining physicians evaluating an incomplete record and because the ALJ “cherry-picked 

and blatantly misconstrued partial quotes from the record of Mr. Achakzai’s symptoms and daily 

activities.” Reply (dkt. 17) at 2. He also notes that the VE’s response to the ALJ’s hypothetical 

establishes that someone with Achakzai’s impairments could not engage in prior work or any 

gainful employment which, in Achakzai’s opinion, “ends the entire discussion.” Achakzai argues 

that the ALJ erred by listing conservative treatment among the reasons he did not find Achakzai’s 

PTSD a severe impairment because the standard to qualify for the alternative to what the ALJ 

considered conservative treatment, which Achakzai posits is inpatient psychiatric treatment, is 

higher than the standard for a severe impairment. Id. at 5. “Thus, the fact that Mr. Achakzai has 

not had an inpatient psychiatric hospitalization is not a legitimate reason to not evaluate 

posttraumatic stress disorder as a severe mental impairment.” Id. 

Achakzai points to Diedrich v. Berryhill, 874 F.3d 634, 642 (9th Cir. 2017) and argues 

that, when it comes to mental health impairments like PTSD which are characterized by ebbs and 

flows of symptoms, it is improper for an ALJ to infer that symptoms are mild because the record 

indicates a claimant experienced a period of improvement. Id. He asserts that to do so is legal 

error. Id. at 7 (citing Gallant v. Heckler, 753 F.2d 1450, 1456 (9th Cir. 1984)). Finally, he notes 

that participating in some daily activities is not a clear and convincing reason to find an illness not 

severe. Id. (citing Diedrich, 874 F.3d at 642 (9th Cir. 2017); Cooper v. Bowen, 815 F.2d 557, 561 

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(9th Cir. 1987)). Achakzai explains why each of the activities the ALJ mentioned is not indicative 

of nonsevere symptoms. Id. at 8. Overall, he argues:

[P]erforming these activities is not inconsistent with nightmares of 

people being skinned alive, or unremitting guilt that because he 

participated on the side of the U.S. Army his brothers were murdered 

by the Taliban, anxiety about family members still in Afghanistan, 

that he startles with loud noise, is triggered by news of Afghanistan 

or encounters with Afghani persons at mosque or elsewhere, and that 

he must be pushed to engage in conversation. 

Id. at 8–9. 

Achakzai also argues that the ALJ did not give clear and convincing reasons to find 

Achakzai’s testimony and his son’s testimony not credible. Id. at 16 (citing Molina v. Astrue, 674 

F.3d 1104, 1112 (9th Cir. 2012); Reddick v. Chater, 157 F.3d 715, 722 (9th Cir. 1998)). The 

Commissioner responds by charging that “Plaintiff does not engage with any of the ALJ’s 

analysis, including the ALJ’s findings that the testimony was inconsistent with the objective 

medical evidence; the treatment record of routine, conservative, and successful treatment; the lack 

of treatment between the alleged onset date and May 2014; and Plaintiff’s activities.” Id. at 13 

(citing AR at 13–14). He argues that the reasons the ALJ gave for disregarding the opinions of 

Achakzai’s treating and examining physicians equally apply to his reasons for disregarding the 

testimony of Achakzai and his son. Achakzai counters by pointing to the ALJ’s “boilerplate” 

language and arguing that the ALJ committed “legal error” because he did not explain which 

statements he found not credible. Reply at 10–11 (citing Brown-Hunter v. Colvin, 806 F. 3d 487, 

493 (9th Cir. 2015)). 

2. Weighing Treating Physicians’ Opinions 

Achakzai argues that the ALJ did not give specific and legitimate reasons, supported by the 

evidence, to reject the opinion of Dr. Saini, Achakzai’s treating psychiatrist. Pl.’s Mot. at 17 

(citing Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995)). He claims that “[m]ost of these 

‘reasons’ are a re-hash of statements made in connection with the ALJ’s discussion of why there 

was no severe impairment.” Id. Achakzai reasserts that the lack of treatment notes is not an 

indication of severity and that improvement does not indicate ability to work. Id. at 17–18. He 

questions whether the ALJ’s second reason––minimal improvement with the medication Paxil––is 

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truly inconsistent with Dr. Saini’s findings of severe symptoms. Id. at 17. Finally, Achakzai 

clarifies that while he ultimately did not go to visit his brother in Germany, the planned visit was 

not inconsistent with Dr. Saini’s severity determination because “Mr. Achakzai’s brother had 

cancer, and Mr. Achakzai might travel to Germany despite it being difficult for Mr. Achakzai.

Further, Mr. Achakzai might experience nightmares and startle reactions to noise when he was in 

Germany, just as in America.” Id. at 18. Achakzai further argues that the ALJ erred by assigning 

little weight to treating physician Dr. Lee’s opinion because, contrary to the ALJ’s finding, Dr. 

Lee’s opinion was consistent with the rest of the record. Id. 

In response, the Commissioner asserts that the ALJ gave legally valid reasons, supported 

by substantial evidence, for rejecting Dr. Saini and Dr. Lee’s opinions. He claims that not only 

did Achakzai not provide mental health records until April 2015, but that “[t]he absence of any 

evidence of mental health complaints—particularly when Plaintiff sought treatment for other 

conditions . . . supported the ALJ’s reasonable inference that Plaintiff’s symptoms were not 

serious enough to motivate him to seek treatment.” Def.’s Mot. at 7 (citing AR at 17; Macri v. 

Chater, 93 F.3d 540, 544 (9th Cir. 1996)). He further argues that the record supports the ALJ’s 

interpretation that “improvement with conservative treatment under Dr. Saini’s care . . . 

contradicted Dr. Saini’s opinion asserting sustained, debilitating symptoms and extreme 

limitations.” Id. at 8 (citing AR at 362–66). He dismisses Achakzai’s argument as “an alternative 

reading of the evidence to support his disability claim, which is not a basis for reversing the ALJ.” 

Id. (citing Bayliss, 427 F.3d at 1214 n.1). The Commissioner also argues that the ALJ drew a 

valid inference––that Dr. Saini’s assessment of Achakzai’s limitations in interpersonal and 

psychosocial functioning, coping with stress or daily life, interacting with other people, and 

managing his well-being are not supported by the record––from Achakzai’s reported activities. Id. 

at 8–9 (citing Morgan v. Comm’r, 169 F.3d 595, 601-02 (9th Cir. 1999)). In reply, Achakzai notes 

that the form Dr. Saini completed defined “extreme” in the social security context: that the 

claimant is not able to function in a given area “independently, appropriately, effectively and on a 

sustained basis.” Reply at 9–10. 

The Commissioner further argues that Dr. Lee’s opinion is inconsistent with the record in 

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the same ways that Dr. Saini’s is: “Plaintiff’s lack of treatment, conservative treatment, 

improvement with medication, and activities of daily living.” Def.’s Mot. at 10. He also notes 

that, because of the timing of Dr. Lee’s opinion, he could not have considered Plaintiff’s later 

improvement under Dr. Saini’s care.” Id. (citing AR at 18). Achakzai describes the 

Commissioner’s argument as being “cherry-picked,” and argues that a full review of the record 

supports Dr. Lee’s assessment. Reply at 9. 

3. Weighing Consultative Physicians’ Opinions 

Finally, Achakzai argues that the ALJ erred by relying on the opinions of consultative 

examining physician Dr. Spivey and non-examining reviewing physicians Dr. Kelly and Dr. 

Patterson. Pl.’s Mot. at 19–20; see also AR at 72–73 (opinion of Dr. Kelly); 86–87 (opinion of 

Dr. Patterson). He argues that the ALJ mischaracterized Dr. Spivey’s opinion, which indicated 

that “she found ‘mild to moderate’ symptoms of anxiety and made a provisional diagnosis of 

Anxiety Disorder,” because the “finding of mild to moderate symptoms does not equate to no 

symptoms or to no impairment.” Id. at 19 (citing AR at 323). In addition, Achakzai notes that Dr. 

Spivey only saw him once, which means her opinion should be given less weight than the opinion 

of other physicians with longitudinal treatment relationships under Lester, 81 F.3d at 830. Pl.’s 

Mot. at 20. The Commissioner replies that the ALJ’s characterization of Dr. Spivey’s opinion was 

accurate given the entirety of her exam results, which were “generally unremarkable” and found a 

GAF of 65. Def.’s Mot. at 11 (citing AR at 18, 323). 

The Commissioner further argues that the ALJ did not rely on the opinions of 

nonexamining physicians alone because “the ALJ found them consistent with other evidence 

including Plaintiff’s treatment history and activities.” Id. at 12 (citing AR at 18, 72–73, 86–87; 20 

C.F.R. § 404.1527(e)(2)(i); Thomas v. Barnhart, 278 F.3d 947, 957 (9th Cir. 2002) (“The opinions 

of nontreating or non-examining physicians may also serve as substantial evidence when . . . 

consistent with independent clinical findings or other evidence.”)). The Commissioner further 

notes that there is no legal requirement for state agency physicians to review the entire 

longitudinal record. Id. at 12. In response, Achakzai notes that Dr. Kelley “specifically pointed to 

the lack of a psychiatric diagnosis and to the lack of medical evidence pertaining to psychiatric 

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issues in formulating his opinion,” and argues that “it is quite possible that Dr. Kelly’s opinion 

would be different if he had the evidence he felt was lacking.” Reply at 3 (citing AR at 73). 

Achakzai extends his reasoning to Dr. Patterson, who, according to Achakzai, “found since he was 

reviewing the case not long after Dr. Spivey’s CE, that it was not possible for Mr. Achakzai’s 

condition to have worsened, so he simply adopted Dr. Kelly’s opinion.” Id. 

4. Remand 

Achakzai argues that the proper remedy for the ALJ’s errors is for the Court to remand for 

an award of benefits under the Ninth Circuit’s “credit-as-true” rule because “if the ALJ were to 

credit the evidence of record as true, the ALJ would necesssarily [sic] find disability at either at 

Step III or V.” Pl.’s Mot. at 21. Achakzai argues that, had the ALJ continued his disability 

analysis and properly credited the medical evidence and testimony in the record, he would have 

found that Achakzai met the criteria for Listing 12.15 for trauma and stressor-related disorders at 

Step Three. Id. According to Achakzai, the record indicates that he suffers from all five of the 

paragraph A criteria: exposure to actual or threatened death, serious injury, or violence; 

subsequent involuntary re-experiencing of the traumatic event; avoidance of external reminders of 

the event; disturbance in mood and behavior; and increases in arousal and reactivity, specifically 

sleep disturbance. Id. at 22. In addition, Achakzai argues, Dr. Lee’s physician source statement 

indicated that Achakzai has extreme limitations in all four paragraph B criteria, findings supported 

by Dr. Saini’s check-box answers and the accompanying letter. Id. at 22–23. Achakzai also 

points to the VE’s conclusion that someone with the hypothetical restrictions presented by the ALJ 

could not work, arguing that those restrictions are supported by the record and compel a 

conclusion that Achakzai is disabled based on the Step 5 analysis of whether there are jobs 

available that he could perform. Id. at 24.

Finally, Achakzai contends that remanding for further proceedings would constitute an 

undue burden: 

If this case is remanded for hearing, Mr. Achakzai will have to endure 

the wait (approximately one year) before a hearing is scheduled. Mr. 

Achakzai will have to go through the stress of appearing before ALJ 

Zeidman to describe his symptoms after ALJ Zeidman made clear that 

he does not believe what Mr. Achakzai describes. Then, Mr. Achakzai 

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will have to wait (approximately six months) after hearing before a 

decision is issued. In my experience of cases before ALJ Zeidman, it 

is unlikely that he will view things differently on remand, and Mr. 

Achakzai’s case will be appealed once again.

Id. at 24. 

The Commissioner contends that the credit as true rule does not apply because the ALJ 

stopped the analysis at Step Two, which requires the Court to remand for further proceedings “to 

complete the sequential analysis.” Def’s Mot. at 14 (citing Benecke v. Barnhart, 379 F.3d 587, 

593 (9th Cir. 2004) (“Remand for further administrative proceedings is appropriate if 

enhancement of the record would be useful.”); Marsh v. Colvin, 792 F.3d 1170, 1173 (9th Cir. 

2015) (“[T]he decision on disability rests with the ALJ and the Commissioner of the Social 

Security Administration in the first instance, not with a district court.”)). He also argues that 

remand for further proceedings is warranted because there are conflicts within the medical record. 

Id. (citing Dominguez v. Colvin, 808 F.3d 403, 409 (9th Cir. 2016); Treichler v. Comm’r of SSA, 

775 F.3d 1090, 1105–06 (9th Cir. 2014)). The Commissioner asserts there is doubt about 

Achakzai’s claim, such as the possibility that “Plaintiff left work for reasons other than his alleged 

impairments—his restaurant failed.” Id. According to the Commissioner, this, too, would require 

the Court to remand for further proceedings if the Court determines that the ALJ erred. Id. (citing 

Garrison v. Colvin, 759 F.3d 995, 1021 (9th Cir. 2014)). 

III. ANALYSIS 

A. Legal Standard 

District courts have jurisdiction to review the final decisions of the Commissioner and may 

affirm, modify, or reverse the Commissioner’s decisions with or without remanding for further 

hearings. 42 U.S.C. § 405(g); see also 42 U.S.C. § 1383(c)(3). 

When reviewing the Commissioner’s decision, the Court takes as conclusive any findings 

of the Commissioner that are free of legal error and supported by “substantial evidence.” 

Substantial evidence is “such evidence as a reasonable mind might accept as adequate to support a 

conclusion” and that is based on the entire record. Richardson v. Perales, 402 U.S. 389, 401. 

(1971). “‘Substantial evidence’ means more than a mere scintilla,” id., but “less than 

preponderance.” Desrosiers v. Sec’y of Health & Human Servs., 846 F.2d 573, 576 (9th Cir. 

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1988) (citation omitted). Even if the Commissioner’s findings are supported by substantial 

evidence, the decision should be set aside if proper legal standards were not applied when 

weighing the evidence. Benitez v. Califano, 573 F.2d 653, 655. (9th Cir. 1978) (quoting Flake v. 

Gardner, 399 F.2d 532, 540 (9th Cir. 1978)). In reviewing the record, the Court must consider 

both the evidence that supports and the evidence that detracts from the Commissioner’s 

conclusion. Smolen v. Chater, 80 F.3d 1273, 1279 (9th Cir. 1996) (citing Jones v. Heckler, 760 

F.2d 993, 995 (9th Cir. 1985)). 

The legal standard to reject a claimant’s subjective symptom testimony is “specific, clear 

and convincing reasons.” Garrison, 759 F.3d at 1014–15. The legal standard for giving less than 

“great weight” to the opinion of a treating physician when that opinion is contradicted by the 

report of another examining physician is “specific and legitimate reasons.” Murray v. Heckler, 

722 F.2d 499, 502 (9th Cir. 1983)). The legal standard to support a severity determination at Step 

Two of the disability analysis is “substantial evidence.” Webb, 433 F.3d at 687. If the ALJ failed 

to meet these standards in his opinion, the court may find legal and reversible error. See Benitez, 

573 F.2d at 655. The Court may then remand for further proceedings or for a calculation of 

benefits. See Garrison, 759 F.3d at 1019–21. 

B. The ALJ Erred in Finding Achakzai’s Testimony Only Partially Credible 

Many of Achakzai’s arguments stem from his contention that the ALJ erroneously found 

his testimony not credible. “The ALJ is responsible for determining credibility and resolving 

conflicts in medical testimony.” Magallanes v. Bowen, 881 F.2d 747, 750 (9th Cir. 1989) (citing 

Allen v. Heckler, 749 F.2d 577, 579 (9th Cir. 1984)). To make such a determination, the ALJ must 

first determine “whether the claimant has presented objective medical evidence of an underlying 

impairment ‘which could reasonably be expected to produce the pain or other symptoms alleged.’” 

Treichler, 775 F.3d at 1102 (quoting Lingenfelter v. Astrue, 504 F.3d 1028, 1036 (9th Cir. 2007)). 

Then, when there is no evidence of malingering, “the ALJ can reject the claimant’s testimony 

about the severity of [his] symptoms only by offering specific, clear and convincing reasons for 

doing so.” Smolen, 80 F.3d at 128. These reasons must be “sufficiently specific to permit the 

court to conclude that the ALJ did not arbitrarily discredit claimant’s testimony.” Thomas v. 

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Barnhart, 278 F.3d 947, 958 (9th Cir. 2002). “General findings are insufficient.” Reddick v. 

Chater, 157 F.3d 715, 722 (9th Cir. 1998) (internal quotation marks omitted). 

Here, there was no affirmative evidence of malingering, and the ALJ recognized that 

Achakzai’s “medically determinable impairments could have been reasonably expected to produce 

the alleged symptoms.” AR at 14. Therefore, the ALJ erred by failing to provide specific, clear, 

and convincing reasons, supported by substantial evidence in the record, to reject Achakzai’s 

testimony. Smolen, 80 F.3d at 128. 

At the hearing, Achakzai testified that his depression, anxiety, and PTSD symptoms were 

severe and persistent to the extent that they prevented him from working. AR at 42–51 (testifying 

that his symptoms were what made him stop working and that his symptoms affected his daily 

life). In his self-administered function report, Achakzai explained that his symptoms impacted his 

ability to concentrate, be motivated, and interact with others. AR at 224–32. The ALJ rejected the

testimony from both the hearing and the report as not credible because it was not consistent with 

the objective medical evidence in the record and because, with respect to Achakzai’s daily 

activities, his “ability to participate in such activities undermined the claimant’s assertion of 

disabling functional limitations.” Id. at 13. Neither of these reasons are clear and convincing. 

1. The ALJ Did Not Provide Specific Reasons to Support His Contention that 

Achakzai’s Testimony Conflicted with the Objective Medical Evidence 

The ALJ’s first reason to discredit Achakzai’s testimony was that it was “not consistent 

with the objective medical evidence.” AR at 13. However, he did not elaborate as to which 

testimony was inconsistent with the medical record. See id. at 13–14 (listing activities and 

asserting, without explanation, that Achakzai’s testimony conflicted with the objective medical 

evidence). This finding is too general and does not “permit the court to conclude that the ALJ did 

not arbitrarily discredit claimant’s testimony.” Thomas, 278 F.3d at 958. The Ninth Circuit has 

ruled that “[a]n ALJ’s ‘vague allegation’ that a claimant's testimony is ‘not consistent with the 

objective medical evidence,’ without any ‘specific findings in support’ of that conclusion is 

insufficient.” Treichler, 775 F.3d at 1103 (quoting Vasquez v. Astrue, 572 F.3d 586, 592 (9th Cir. 

2009)). When, as here, the ALJ offers only an assertion that the claimant’s testimony is 

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inconsistent with the medical record, he has erred. Id. This reason is not specific, let alone clear 

and convincing. 

2. Substantial Evidence Does Not Support the ALJ’s Use of Achakzai’s 

Reported Activities to Undermine His Credibility 

The Ninth Circuit recognizes two situations in which an ALJ may use a claimant’s 

reported daily activities as evidence to discredit his testimony. Orn v. Astrue, 495 F.3d 625, 639 

(9th Cir. 2017). The first is to prove that “a claimant is able to spend a substantial part of his day 

engaged in pursuits involving the performance of physical functions that are transferable to a work 

setting.” Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989) (emphasis omitted). To invoke a 

claimant’s activities for this purpose “[t]he ALJ must make ‘specific findings relating to [the 

daily] activities’ and their transferability to conclude that a claimant's daily activities warrant an 

adverse credibility determination.” Orn, 495 F.3d at 639 (quoting Burch v. Barnhart, 400 F.3d 

676, 681 (9th Cir. 2005)). The second permissible use is to show that the claimant’s statements 

contradict the record itself. Fair, 885 F.2d at 603. Here, the ALJ has not provided substantial 

evidence to support either of these uses. 

First, the ALJ did not explain which of the activities he cited would be transferable to a

work setting. The Ninth Circuit has “repeatedly warned that ALJs must be especially cautious in 

concluding that daily activities are inconsistent with testimony about pain,[7]because impairments 

that would unquestionably preclude work and all the pressures of a workplace environment will 

often be consistent with doing more than merely resting in bed all day.” Garrison, 759 F.3d at 

1016; see also Vertigan v. Halter, 260 F.3d 1044, 1049–50 (9th Cir. 2001) (“The mere fact that a 

plaintiff has carried on certain daily activities . . . does not in any way detract from [his] credibility 

as to [his] overall disability. One does not need to be ‘utterly incapacitated’ in order to be 

disabled.”). The mere fact that Achakzai engaged in some activities does not itself contradict his 

testimony that his symptoms were persistent and severe. While the ALJ did add that “some of the 

7 Although the Garrison court addressed this principle in the context of the physical pain 

symptoms at issue in that case, this Court finds the same reasoning applicable to the symptoms 

that Achakzai asserts here.

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physical and mental abilities required in order to perform these activities are the same as those 

necessary for obtaining and maintaining employment,” AR at 13, he did not “make ‘specific 

findings relating to [the daily] activities’” or establish that Achakzai spent a substantial amount of 

his day engaged in these activities. Cf. Orn, 495 F.3d at 639 (quoting Burch, 400 F.3d at 681). 

Accordingly, the ALJ’s assertion that Achakzai’s general activity level was inconsistent with his 

symptom testimony is not a legitimate reason, supported by substantial evidence, to find 

Achakzai’s testimony less than fully credible. 

Nor do any of the activities the ALJ mentioned factually contradict Achakzai’s testimony 

at the hearing or in his functional report. For example, the ALJ mischaracterized Achakzai’s 

activities with regard to cooking. The ALJ wrote that Achakzai “admitted being capable of 

cooking and preparing meals for his family when he is in a good mood.”’ AR at 13. However, 

Achakzai testified not that he cooked meals but that he directed his family as to “what they should 

be cooking and how they should be cooking when [he] was in the good mood.” Id. at 46. This 

hearing testimony is consistent with his statement in the function report that he does not cook his 

own meals, id. at 226, and consistent with the rest of the record. See id. at 235 (third-party report 

from son Tawab Achakzai that Achakzai does not prepare his own meals); id. at 323 (Achakzai 

reporting to Dr. Spivey that he could not cook for himself). 

In addition, the ALJ concluded that Achakzai’s ability to take out the trash, work on plants 

in the yard, and generally go outside was inconsistent with the claimed severity of his depression 

and PTSD symptoms. Id. While Achakzai did testify that he did not “want to go outside,” id. at 

46, this testimony is not inconsistent with the rest of the record. His son Tawab explained that 

Achakzai went outside “[r]arely” and that he had to “bug him to go out.” Id. at 236. 

The ALJ noted that Achakzai acknowledged having only mild impairments in certain 

respects—for example, that he was “‘ok’ at following spoken instructions”—but did not explain 

why those abilities would contradict his testimony regarding more severe symptoms. See id. at 13. 

* * *

The ALJ did not make sufficiently specific findings for the Court to conclude that 

Achakzai’s daily activities could be transferred to a work setting. Further, substantial evidence in 

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the record does not support the ALJ’s assertion that Achakzai’s testimony was inconsistent with 

the objective medical record or that his reported daily activities undermined his testimony or his 

credibility. Therefore, the ALJ erred by not providing clear and convincing reasons, supported by 

substantial evidence, to reject Achakzai’s symptom testimony. 

C. The ALJ’s Reason to Reject Tawab Achakzai’s Testimony Is Not Germane 

The ALJ further erred when he failed to provide sufficient reasons for rejecting Tawab 

Achakzai’s testimony as not credible. “[T]he ALJ may expressly disregard lay testimony if the 

ALJ ‘gives reasons germane to each witness for doing so.’” Turner v. Comm’r of Soc. Sec., 613 

F.3d 1217, 1224 (9th Cir. 2010) (quoting Lewis v. Apfel, 236 F.3d 503, 511 (9th Cir. 2001)). The 

ALJ’s reason for discounting Tawab Achakzai’s testimony was that “his statements are not 

supported by the clinical or diagnostic medical evidence.” AR at 14. The Ninth Circuit has held 

that an ALJ errs when she does not “identify which testimony she found not credible and why.” 

Brown-Hunter, 806 F.3d at 489. An ALJ must “tie the reasoning of their credibility 

determinations to the particular witnesses whose testimony they reject.” Valentine v. Comm’r Soc. 

Sec. Admin., 574 F.3d 685, 694 (9th Cir. 2009); see also Stephens v. Colvin, No. 13-CV-05156-

RS, 2014 WL 6982680, at *7 (N.D. Cal. Dec. 9, 2014) (“Valentine is thus better understood as 

allowing ALJs to reject lay witness testimony only with express reference to reasons already put 

forth to reject similar testimony”). The ALJ did not provide a germane reason tied to Tawab’s 

testimony, but rather offered a vague and general conclusion that did not point to any specific 

inconsistencies between Tawab Achakzai’s testimony and the record. See Diedrich, 874 F.3d at 

640 (“A lack of support from medical records is not a germane reason to give little weight’ to [a 

layperson’s] observations.”). Therefore, he erred. 

D. The ALJ’s Nonseverity Finding Is Not Supported by Substantial Evidence 

Achakzai further argues that the ALJ erred when he found that Achakzai’s mental 

impairments due to major depressive disorder, anxiety, and PTSD were not severe at Step Two. 

Because a lack of severity is not clearly established by the medical record, the Court agrees. 

An impairment is considered severe when it significantly limits a person’s “physical or 

mental ability to do basic work activities.” 20 C.F.R. § 404.1520(c). At Step Two of the disability 

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determination, “[a]n impairment or combination of impairments may be found ‘not severe only if 

the evidence establishes a slight abnormality that has no more than a minimal effect on an 

individual’s ability to work.’” Webb, 433 F.3d at 686 (quoting Smolen, 80 F.3d at 1290 (internal 

quotation marks omitted)). The severity determination at Step Two is “a de minimis screening 

device [used] to dispose of groundless claims.” Smolen, 80 F.3d at 1290. “[A]n ALJ may find 

that a claimant lacks a medically severe impairment or combination of impairments only when his 

conclusion is ‘clearly established by medical evidence.’” Webb, 433 F.3d at 687 (citing SSR 85-

28). In evaluating an ALJ’s severity determination, the district court “must determine whether the 

ALJ had substantial evidence to find that the medical evidence clearly established that [the 

claimant] did not have a medically severe impairment or combination of impairments.” Webb, 

433 F.3d at 687. 

Here, the ALJ ignored the larger record of medical evidence which, as a whole, does not 

clearly establish that Achakzai’s impairments were not severe. Accordingly, the ALJ’s severity 

determination is not supported by substantial evidence and constitutes legal error. 

1. The ALJ Did Not Consider Evidence That Achakzai’s Impairments Were 

Severe and Kept Him from Working 

First, the ALJ did not acknowledge that Achakzai’s doctor and psychiatrist had diagnosed 

him with PTSD, depression, and anxiety. See AR at 304 (Dr. Lee adding “Pt has a component of 

PTSD” to his diagnosis of insomnia); id. at 329 (Dr. Lee diagnosing Achakzai with depression and 

anxiety); id. at 361 (Dr. Saini diagnosing Achakzai with “Major depressive disorder, recurrent 

episode, moderate degree,” “Post-traumatic stress disorder,” and “Panic disorder”). Courts in this 

circuit have held that, when a claimant alleges a mental illness, the diagnosis of a medical 

professional is enough to pass the Step Two severity inquiry. See Orellana v. Astrue, 547 F. Supp. 

2d 1169, 1173 (E.D. Wash. 2008) (“[F]or purposes of a step two finding, where there is no 

inconsistency between a claimant’s complaints and the diagnoses of record from examining and 

treating doctors, a claim cannot be found ‘groundless’ under the de minimis standard of step two.” 

(citing Webb, 433 F.3d at 688)). 

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2. Substantial Evidence Does Not Support the ALJ’s Conclusion Regarding 

Achakzai’s Activities 

In finding that Achakzai did not have a severe impairment, the ALJ opined that the record 

did not support the degree of severity Achakzai alleged because of Achakzai’s daily activities, 

including “spending time with his grandson, using a computer, and watching television.” AR at 

13. He also visited the mosque to pray. Id. However, the record indicates that Achakzai 

performed these activities in a manner consistent with his claimed limitations: he went to the 

mosque on Fridays, but only because his son accompanied him, and he did not interact with other 

worshippers. Id. at 52. When he watched television, he had an emotional reaction when his native 

country was mentioned. Id. at 43. He spent time with his family because his children made the

effort to be around him in the home they share; they had to “pry” him out of the house to engage 

in family activities. Id. at 55.8 Accordingly, the assertion that Achakzai’s impairments were not 

severe because of his reported activities is not clearly established medical evidence on which the 

ALJ may base his severity determination. 

3. Conservative Treatment is Not Supported by the Record 

Finally, the ALJ claimed that Achakzai’s “routine and conservative treatment” indicated 

that his symptoms were not severe. AR at 14. This finding is not supported by the record. Courts 

in this circuit have found that, when a claimant is taking “several psychiatric medications at 

significant doses,” the record did not support an ALJ’s characterization of treatment as 

conservative. See Callahan v. Berryhill, No. EDCV 17-1247-KS, 2018 WL 2446649, at *4 (C.D. 

Cal. May 29, 2018) (citing cases). Here, Achakzai was taking three medications for his 

depression, PTSD, and panic disorders: 100 mg of Zoloft, .5 mg of Klonopin, and 40 mg of Paxil.9 

8 The ALJ’s conclusion that Achakzai has no severe impairments is also not consistent with the 

hypothetical limitations that the ALJ presented to the VE, to which the VE responded that no work 

would be available. The ALJ posed no hypothetical of lesser restrictions that would allow work. 

Although the ALJ apparently reconsidered Achakzai’s limitations at some point between the 

hearing and issuing his decision, it is not at all clear how his view of Achakzai’s symptoms shifted 

dramatically from restrictions that would preclude all work to not even meeting the de minimis 

standard of a “severe impairment” at Step Two.

9 Achakzai also takes Prazosin for his hypertension. AR at 361. Studies have shown a link 

between hypertension and anxiety. See Wenpeng Cai, et. al., Association between anxiety and 

hypertension: a systematic review and meta-analysis of epidemiological studies, 11 

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AR at 361. Further, Achakzai was hospitalized after a near-fainting incident brought on by 

hypertension, which his son and daughter described as being related to his anxiety. See id. at 53, 

342. Therefore, the ALJ’s assertion that Achakzai’s treatment was conservative is not supported 

by the medical evidence and does not support the ALJ’s severity determination. 

E. The ALJ Erred in Weighing the Opinion Evidence

Finally, Achakzai argues that the ALJ erred when he disregarded the opinions of 

Achakzai’s treating physicians Dr. Saini and Dr. Lee because he did not provide specific and 

legitimate reasons, supported by substantial evidence, for doing so. The Court agrees. 

“Cases in this circuit distinguish among the opinions of three types of physicians: (1) those 

who treat the claimant (treating physicians); (2) those who examine but do not treat the claimant 

(examining physicians); and (3) those who neither examine nor treat the claimant (nonexamining 

physicians).” Lester, 81 F.3d at 830. The Ninth Circuit “afford[s] greater weight to a treating 

physician’s opinion because ‘he is employed to cure and has a greater opportunity to know and 

observe the patient as an individual.’” Magallanes, 881 F.2d at 751 (quoting Sprague v. Bowen, 

812 F.2d 1226, 1230 (9th Cir. 1987)). When, as here, the treating physician’s opinion is 

contradicted by other opinions in the record, the ALJ must provide specific and legitimate reasons 

supported by substantial evidence before discounting that opinion. Murray, 722 F.2d at 502 (9th 

Cir. 1983). The reasons the ALJ provided were specific, but they were not legitimate or supported 

by substantial evidence. Accordingly, the ALJ erred. 

1. The ALJ’s Interpretation of the Lack of Treatment Notes is Unsupported

The inference that Achakzai delayed seeking psychiatric treatment because his symptoms 

are not severe is not supported by the record; consequently, the ALJ erred by citing it as a reason 

to give little weight to Dr. Saini’s testimony. The record indicates that culture and language 

prevented Achakzai from seeking psychiatric help sooner: Dr. Saini wrote that Achakzai had 

NEUROPSYCHIATR. DIS. & TREAT. 1121 (2015) (reviewing studies and concluding that “there is an 

association between anxiety and increased risk of hypertension.”). This medication can arguably 

be included in the “several medications” that Achakzai takes to manage his psychiatric conditions. 

Whether Achakzai’s hypertension medication is included in this analysis is not relevant to the 

outcome of the present motions, however, because Achakzai’s Zoloft, Klonopin, and Paxil are 

sufficient to show more than conservative treatment. 

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“limited insight due to cultural reservations into mental illness.” AR at 344. Dr. Saini also felt 

that Achakzai would benefit from “culture sensitive psychotherapy” and referred him to a Farsispeaking therapist. Id. at 345–46. In addition, Achakzai sought help from his physician, Dr. Lee, 

who prescribed medication for his insomnia and depression, which suggests that Achakzai was 

concerned enough about his condition discuss it with his medical doctor even as he wrestled with 

cultural stigma around psychiatric treatment. See id. at 304 (“Pt has component of PTSD. Was in 

Afghan army. Wakes up thinking about it.”). Finally, Achakzai testified at the administrative 

hearing that he did not have insurance or access to medical care after he returned from 

Afghanistan in 2012, which was when he alleges his disability began. Id. at 42–43. The ALJ did 

not consider any of the above evidence in evaluating that Achakzai’s delay in treatment, nor did he 

ask Achakzai why there were no medical records before May of 2014 or why he did not seek 

treatment until then. Accordingly, this reason is not legitimate. 

2. Periods of Improvement Are Not a Legitimate Reason 

The ALJ’s second reason, that Achakzai’s improvement with medication undermines Dr. 

Saini’s testimony, is not a legitimate reason supported by the record. Periods of improvement do 

not negate a finding of disability. The Ninth Circuit has held that, when evaluating nonexertional 

impairments based on mental illness, the ALJ “must interpret reports of improvement . . . with an 

understanding of the patient’s overall well-being and the nature of her symptoms.” Attmore v. 

Colvin, 827 F.3d 872, 877 (9th Cir. 2016) (quoting Garrison, 759 F.3d at 1017). The ALJ did not 

situate the instances of improvement within the larger context of Achakzai’s condition as 

described in the record. For example, Achakzai suffered an “anxiety attack” in February of 2017, 

which left him hospitalized for three days. AR at 53.10 This incident occurred during a period of 

relative improvement. See id. at 344 (reporting to Dr. Saini “[o]verall I have been doing good” 

and “reasonable response to prescribed medication” on January 30, 201711). 

10 Dr. Santos noted that the cause of Achakzai’s episode was “unclear,” AR at 378, but indicated 

that Achakzai’s blood pressure fluctuation was “of note,” id. at 376. Hypertension (or high blood 

pressure) is linked to anxiety. See Cai, et. al., supra note 11. 

11 This treatment note is dated “03/05/2017,” but an addendum reads “Please consider this 

progress note as of service on 1/30/2017.” AR at 344–45.

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In addition, Achakzai’s limited improvement is consistent with the record as a whole and 

supports Dr. Saini’s overall opinion and the opinion of Dr. Lee, Achakzai’s treating physician. 

Dr. Lee indicated that Achakzai would have periods of improvement and periods of intensifying 

symptoms. Id. at 335 (Dr. Lee answering “yes” when asked if Achakzai’s impairments were 

“likely to produce ‘good days’ and ‘bad days’”). Dr. Saini also characterized Achakzai’s 

improvement as “non-sustained,” id. at 363, and his treatment response as subject to “frequent 

relapses.” Id. at 364. The event in February is an example of those opinions being supported by 

the record, as well as an illustration of the Ninth Circuit’s observation in Holohan v. Massanari: 

“That a person who suffers from severe panic attacks, anxiety, and depression makes some 

improvement does not mean that the person’s impairments no longer seriously affect” him. 246 

F.3d 1195, 1205 (9th Cir. 2001). 

Because the record supports Dr. Saini’s assertion that Achakzai’s improvement is periodic 

and “non-sustained,” AR at 365, the ALJ’s finding that Achakzai’s improvement negated Dr. 

Saini’s opinion is not supported by substantial evidence. 

3. The ALJ Did Not Provide Valid and Specific Reasons for Rejecting Dr. Lee’s 

Functional Capacity Opinion 

The ALJ dismissed the Functional Capacity Questionnaire of Dr. Lee, AR at 336–37, 

because it was “not consistent with the entire evidence of record” and “there were no treatment 

notes in the record past November 2015 from Dr. Lee, which the [ALJ considered] suggestive Dr. 

Lee was not aware of the claimant’s improvement with treatment.” Id. at 18. As discussed above, 

the record does not support a finding that Achakzai had substantially improved after November of 

2015 and the inference the ALJ drew from the lack of treatment notes is not legitimate. 

The ALJ’s second reason––that Dr. Lee’s opinion as to Achakzai’s mental impairments12

were not consistent with the record––is also not supported by substantial evidence. Dr. Lee’s 

questionnaire opinion is consistent with Dr. Saini’s assessment on May 7, 2015, which was 

12 The ALJ gave “significant weight” to Dr. Lee’s treatment notes and opinions as to Achakzai’s 

physical impairments. AR at 19. As discussed above, Achakzai does not contest the ALJ’s 

findings as to his physical limitations. 

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conducted after November of 2015. Compare id. at 335 (Dr. Lee finding that Achakzai would be 

absent from work more than four days per month) with id. at 366 (finding the same); id. at 336 

(Dr. Lee finding Achakzai “Unable to meet competitive standards” with regard to dealing with 

normal work stress and sustaining an ordinary routine without supervision) with id. at 365 (Dr. 

Saini finding extreme limitations in concentrating, persisting at tasks, and maintaining pace and 

ability to regulate emotions, control behavior, and manage well-being at work). 

Because neither of the ALJ’s reasons for discounting Dr. Lee’s or Dr. Saini’s opinions are 

supported by substantial evidence, the ALJ did not provide clear and convincing reasons for 

rejecting that opinion and therefore erred.

F. Remedy

The proper remedy for the ALJ’s legal errors is to remand the case for further 

administrative proceedings. “When the ALJ denies benefits and the court finds error, the court 

ordinarily must remand to the agency for further proceedings before directing an award of 

benefits.” Leon v. Berryhill, 880 F.3d 1041, 1045 (9th Cir. 2017) (citing Treichler, 775 F.3d at

1099). This is because “an ALJ’s failure to provide sufficiently specific reasons for rejecting the 

testimony of a claimant or other witness does not, without more, require the reviewing court to 

credit the testimony as true.” Treichler, 775 F.3d at 1106. In appropriate circumstances, however, 

the court may order an immediate award of benefits under the Ninth Circuit’s “credit-as-true” rule. 

Leon, 880 F.3d at 1045 (citing Garrison, 759 F.3d at 1019).

The district court may remand to the ALJ to calculate and award benefits when: (1) “the 

ALJ failed to provide legally sufficient reasons for rejecting evidence, whether claimant testimony 

or medical opinion”; (2) “there are [no] outstanding issues that must be resolved before a disability 

determination can be made” and “further administrative proceedings would [not] be useful”; and 

(3) “on the record taken as a whole, there is no doubt as to disability.” Leon, 880 F.3d at 1045

(citations and internal quotation marks omitted); see also Garrison, 759 F.3d at 1021 (holding that 

a district court abused its discretion in declining to apply the “credit as true” rule to an appropriate 

case). The “credit-as-true” rule does not apply “when the record as a whole creates serious doubt 

as to whether the claimant is, in fact, disabled within the meaning of the Social Security Act,” 

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Garrison, 759 F.3d at 1021, when “there is a need to resolve conflicts and ambiguities,” Treichler, 

775 F.3d at 1101, or when there is ambiguity about when the claimant’s disability began that is not 

solved by the record credited as true. See Dominquez v. Colvin, 808 F.3d 403, 409 (9th Cir. 2015). 

Here, there are ambiguities in the record that further proceedings would be useful to reconcile. 

One such ambiguity is the precise date when Achakzai’s disability began, particularly in light of 

the lack of treatment records from the first years of the alleged period of disability. The credit-astrue rule therefore does not apply, and the Court remands for further administrative proceedings. 

To the extent such evidence exists, Achakzai should submit additional evidence 

documenting the onset of his alleged disability. While the record strongly suggests that Achakzai 

was disabled for at least some portion of the period at issue, there is insufficient evidence at this 

time for the Court to conclude that Achakzai’s disability began on August 1, 2012 as alleged. At 

the administrative hearing, Achakzai spoke generally about his disability beginning sometime time 

in 2012. Id. at 41–43. He further testified that he stopped working not only because of the 

severity of his symptoms but also because his company left Afghanistan and no other companies 

were hiring translators. Id. at 42. In addition, Achakzai has not submitted medical records that 

reflect his condition prior to May 15, 2014; there is not any evidence in the record about the 

severity of his condition from the alleged onset date through mid-May almost two years later. The 

treatment notes in the record refer only to the year of Achakzai’s return, not the precise date, and 

do not indicate when Achakzai’s disabling symptoms began. See id. at 322 (Dr. Spivey nothing 

that Achakzai “has not worked since 2012,” but not precisely when or why); 360 (Dr. Saini 

documenting Achakzai’s return as occurring in 2012). While this lack of records does not 

preclude Achakzai from showing a severe impairment during portions of the period at issue, it 

complicates the task of determining the onset date of the alleged disability. Given the lack of 

evidence establishing the onset date of Achakzai’s disabling condition, further administrative 

proceedings are required and the credit-as-true rule does not apply.

The record might also benefit from additional psychological evaluation of Achakzai to 

assess his condition. At the hearing, the ALJ told Achakzai, “I had been considering when I was 

preparing for the hearing requesting a post hearing psychiatric examination. The reason for this is 

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because there is conflicting and some inconclusive medical records of psychiatric and 

psychological evaluations.” AR at 62. In context, the ALJ appears to have believed at the time 

that Achakzai was disabled. Assuming, however, that the ALJ believed—consistent with his later 

decision—that an examination was unnecessary because Achakzai clearly had no severe 

impairment, his consideration of ordering another evaluation suggests that further evidence might 

be necessary to determine the nature of Achakzai’s impairments. Such an examination could help 

resolve the conflicts in the record, such as the precise degrees of impairment identified by Dr. 

Spivey, Dr. Lee, and Dr. Saini and provide a contemporaneous account of Achakzai’s symptoms. 

If, on remand, the Commissioner does not find the existing evidence sufficient to establish 

disability, the Commissioner should consider ordering a further psychological evaluation as 

contemplated at the administrative hearing. 

IV. CONCLUSION 

For the reasons discussed above, Achakzai’s motion is GRANTED, the Commissioner’s 

motion is DENIED, and the matter is REMANDED to the Commissioner for further proceedings

consistent with this order. The Clerk is instructed to enter a judgment accordingly and to close the 

file.

IT IS SO ORDERED.

Dated: March 25, 2020

______________________________________

JOSEPH C. SPERO

Chief Magistrate Judge

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