Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_13-cv-00142/USCOURTS-azd-2_13-cv-00142-0/pdf.json

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

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WO 

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Cari Kravat-Jahner, 

Plaintiff, 

v. 

Carolyn W. Colvin, Acting Commissioner 

of Social Security, 

Defendant. 

No. CV-13-00142-PHX-BSB

ORDER 

 Cari Kravat-Jahner (Plaintiff) seeks judicial review of the final decision of the 

Commissioner of Social Security (the Commissioner), denying her application for 

disability insurance benefits under the Social Security Act (the Act). The parties have 

consented to proceed before a United States Magistrate Judge pursuant to 28 

U.S.C. § 636(b) and have filed briefs in accordance with Local Rule of Civil Procedure 

16.1. For the following reasons, the Court reverses and remands to the Commissioner for 

further proceedings. 

I. Procedural Background 

 In May 2010, Plaintiff applied for disability insurance benefits under Title II of the 

Act. 42 U.S.C. § 401-434. (Tr. 24.)1

 Plaintiff alleged that she had been disabled since 

May 2008. (Tr. 24.) After the Social Security Administration (SSA) denied Plaintiff’s 

initial application and her request for reconsideration, she requested a hearing before an 

 

1

 Citations to “Tr.” are to the certified administrative transcript of record. (Doc. 11.) 

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administrative law judge (ALJ). After conducting a hearing, the ALJ issued a decision 

finding Plaintiff not disabled under the Act. (Tr. 25-34.) This decision became the final 

decision of the Commissioner when the Social Security Administration Appeals Council 

denied Plaintiff’s request for review. (Tr. 1-6); see 20 C.F.R. § 404.981 (explaining the 

effect of a disposition by the Appeals Council.) Plaintiff now seeks judicial review of 

this decision pursuant to 42 U.S.C. § 405(g). 

II. Medical Records and Assessments of Plaintiff’s Mental Health 

 The record before the Court establishes the following history of diagnosis and 

treatment related to Plaintiff’s mental health. The record also includes opinions from a 

lay witness and state agency physicians who reviewed the records related to Plaintiff’s 

mental health. 

A. Jasbir Bisla, M.D., Treating Psychiatrist

 Psychiatrist Jasbir Bisla, M.D., treated Plaintiff first at the Terros Clinic and then 

in private practice. (Tr. 251-62, 266-69, 288-90, 293-94, 296-97.) He first saw Plaintiff 

in May 2008. (Tr. 285.) Dr. Bisla noted that Plaintiff was not taking her medication and 

that she had become angry and lost a job. (Tr. 285-86.) On examination, Dr. Bisla 

reported that Plaintiff had a dysphoric mood, and that she was alert and oriented, had a 

good appearance, good eye contact, normal motor activity, an appropriate affect, normal 

speech, logical thought process, good concentration, intact memory, good intelligence, 

good insight, and good judgment. (Tr. 285-286.) Dr. Bisla diagnosed mood and anxiety 

disorders (Tr. 286-287), assessed a Global Assessment of Functioning (GAF) score of 65 

(Tr. 285), and prescribed psychiatric medication.2

 (Tr. 286-287.) 

 

2

 “A GAF score is a rough estimate of an individual’s psychological, social, and occupational functioning used to reflect the individual's need for treatment.” Brewes v.

Comm’r of Soc. Sec. Admin., 682 F.3d 1157, 1160 n.2 (9th Cir. 2012) (quoting Vargas v. Lambert, 159 F.3d 1161, 1164 n.2 (9th Cir.1998)). Plaintiff notes that the latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders has abandoned the 

GAF rating system (Doc. 20-1 at 16), but that does not affect the Court’s decision in this 

case because the GAF system was used during the relevant period. 

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 Dr. Bisla examined Plaintiff in October 2008. (Tr. 250-254.) Plaintiff reported 

that she had been taking prescribed psychiatric medication, that her psychiatric 

medications were working well, and that her mood was stable, her anger was under good 

control, and her panic attacks had subsided ─ which she attributed to reuniting with her 

spouse. (Tr. 251.) She denied mood, panic, and obsessive compulsive symptoms. 

(Tr. 251-252.) Dr. Bisla noted that Plaintiff typically talked rapidly, got angry quickly, 

and had a labile mood. (Tr. 253.) 

 Dr. Bisla next examined Plaintiff in May 2009, noting he had not seen Plaintiff in 

six months. (Tr. 255-256.) Plaintiff that reported she had lost a job due to anger issues. 

She also reported that she had been taking psychiatric medication obtained elsewhere, 

and that she had better control of her emotions and better energy with medication. 

(Tr. 255.) On examination, Dr. Bilsa reported that Plaintiff had an anxious, dysphoric 

mood and rapid speech, but also good grooming, good eye contact, calm psychomotor 

activity, an appropriate affect, a logical and goal-directed thought processes, and normal 

attention span. (Id.) Dr. Bisla continued Plaintiff’s current treatment. (Tr. 256.) 

 Dr. Bisla examined Plaintiff again in September 2009. (Tr. 257-258.) Plaintiff 

reported that she was “doing well,” that her depression had not been bothering her, and 

that she had no problems other than irritability, which she attributed to her menstrual 

period. (Tr. 257.) Dr. Bisla reported that Plaintiff had an euthymic mood, good 

grooming, good eye contact, calm psychomotor activity, an appropriate affect, normal 

speech, logical and goal-directed thought processes, and normal attention span. 

(Tr. 257.) Dr. Bisla noted that Plaintiff’s mood was better although she experienced 

menstrual-related anger “a few days” monthly. (Tr. 258.) Dr. Bisla continued Plaintiff’s 

current treatment and added medication (Klonopin) for menstrual-related irritability. 

(Id.) 

 Dr. Bisla next examined Plaintiff in April 2010. (Tr. 259-260.) Plaintiff reported 

that medication was effective, but that she had difficulty affording Effexor. (Tr. 259.) 

Dr. Bilsa reported that on examination Plaintiff had an anxious mood, hyperactive 

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psychomotor activity, rapid speech, good grooming, good eye contact, an appropriate 

affect, a logical and goal-directed thought processes, and normal attention span. 

(Tr. 259). Dr. Bisla prescribed psychiatric medication, noting that Plaintiff’s compliance 

to treatment was poor due to her inability to afford Effexor. (Tr. 259-260.) 

 Dr. Bisla examined Plaintiff in May 2010. (Tr. 261-262.) Plaintiff reported 

increased anxiety and depression and an inability to maintain a job since discontinuing 

psychiatric medication due to her inability to afford it. Dr. Bisla recommended that 

Plaintiff seek treatment through an indigent care mental health agency, but Plaintiff 

resisted based on a reported past “bad experience at one agency.” (Tr. 262.) On 

examination, Plaintiff had a sad mood, easy distraction and poor concentration, a labile 

affect, and rapid speech. Plaintiff was also alert and oriented, demonstrated good eye 

contact, had a normal gait, had logical thought processes, could perform normal 

calculations, had an average fund of knowledge, and her insight, impulse control, and 

judgment were intact. (Tr. 261.) Dr. Bisla assessed a GAF score of 55, noting a previous 

GAF of 75. He concluded that Plaintiff was not doing well because she was not taking 

prescribed medications. (Doc. 261-62.) 

 Dr. Bisla examined again Plaintiff in September 2010. (Tr. 268-269.) Plaintiff 

reported experiencing anger and anxiety despite taking prescribed psychiatric medication 

regularly. (Tr. 268.) On examination she had an irritable mood, a labile affect, rapid 

speech, limited attention and concentration; she was also alert and oriented, demonstrated 

good eye contact, had a normal gait, had a logical thought processes, and her insight and 

judgment were intact. (Tr. 268.) Dr. Bisla assessed a GAF score of 55, noting a previous 

score of 75, and concluded that Plaintiff was experiencing “partial benefit” from 

medication. Dr. Bisla continued Plaintiff’s treatment. (Tr. 268.) 

 Dr. Bisla next saw Plaintiff in October 2010 to complete “forms for her attorney.” 

(Tr. 266-67.) Plaintiff reported experiencing anger and anxiety despite taking her 

prescribed medication regularly. (Tr. 266.) Dr. Bilsa examined Plaintiff and reported 

that she had an anxious, irritable mood, a labile affect, rapid speech, fidgetiness, easy 

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distraction, and limited concentration. (Id.) Plaintiff was also alert and oriented, 

demonstrated good eye contact, had a normal gait, logical thought processes, and her 

insight and judgment were intact. (Tr. 266.). Dr. Bisla assessed a GAF score of 55, 

noting a previous score of 75. (Id.) He concluded that Plaintiff was experiencing “partial 

benefit” from medication and continued treatment. (Id.) 

 On October 7, 2010, Dr. Bisla completed a “Medical Assessment of the Patient’s 

Ability to Perform Work Related Activity.” (Tr. 291-92.) Dr. Bisla found that Plaintiff 

had moderate limitations (“an impairment which affects but does not preclude ability to 

function”) in deterioration of personal habits and in her ability to perform simple tasks. 

(Tr. 291.) He also found that Plaintiff had moderately severe limitations (“an impairment 

which seriously affects ability to function”) in her abilities to: understand, carry out, and 

remember instructions; perform complex tasks; perform repetitive tasks; and perform 

varied tasks. (Id.) In addition, Dr. Bisla found that Plaintiff had severe limitations 

(“extreme impairment of ability to function” in her abilities to: relate to other people; 

attend to daily activities, such as going to meetings, working around the house, and 

socializing; respond appropriately to supervision; respond appropriately to coworkers; 

respond to customary work pressures; complete a normal workday/workweek without 

interruptions from psychologically based symptoms; and perform at a consistent pace 

without an unreasonable number/length of rest periods. (Tr. 291-92.) 

 Dr. Bisla next examined Plaintiff in July 2011. (Tr. 293-294.) Plaintiff reported 

decreased anger with compliance to treatment, but increased stress due to financial 

difficulty related to her spouse not working. (Tr. 293.) On examination she had an 

anxious, irritable mood, a labile affect, rapid speech, fidgetiness, easy distraction, limited 

concentration, but she was alert and oriented, demonstrated good eye contact, had a 

normal gait, had logical thought processes, and her insight and judgment were intact. 

(Id.) Dr. Bisla assessed a GAF score of 55, noting a previous GAF score of 75. (Id.) He 

concluded that Plaintiff was receiving “partial benefit” from medication and continued 

treatment, noting her compliance to treatment was “fair.” (Id.) 

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B. Mary Downs, Ph.D, Agency Reviewing Physician 

 On August 11, 2010, Mary Downs, Ph.D, a state agency psychologist, completed 

an assessment based on her review of the records. (Tr. 58-60.) Dr. Downs found that 

Plaintiff had affective and anxiety disorders that were “not severe.” (Tr. 60.) 

C. Adrianne Gallucci, Psy.D., Agency Reviewing Physician 

 On November 29, 2010, Adrianne Gallucci, Psy.D, a state agency psychologist, 

reviewed the record and completed an assessment. (Tr. 67-68.) Dr. Gallucci noted that 

medication kept Plaintiff’s mood stable and concluded that Plaintiff had affective and 

anxiety disorders that were not severe mental impairments. (Tr. 68.) 

D. Third-Party Statement 

 In a Third-Party Report, dated May 26, 2010, Plaintiff’s friend Matthew Garcia 

indicated that Plaintiff had difficulty with anxiety and “outbursts with others.” (Tr. 185-

187.) He also reported that Plaintiff cared for her personal needs without difficulty 

(Tr. 181), performed household chores without help or encouragement (Tr. 182), 

prepared simple meals (Tr. 182), attended “[a]ll needs” of her six-year-old son, including 

transporting him to and from school and playing with him (Tr. 180-181, 183-184), cared 

for a pet (Tr. 181), drove an automobile (Tr. 183), and went shopping. (Tr. 183-184.) He 

also indicated that Plaintiff did not need “special reminders” to care for her personal 

needs, to take medication, or to go places. (Tr. 182, 184.) He further stated that Plaintiff 

could go places alone (Tr. 183-184), manage her personal finances (Tr. 183), and pay 

attention for five hours. (Tr. 185.) He further noted that Plaintiff’s condition did not 

affect her abilities to remember, complete tasks, understand, or follow instructions. (Id.) 

E. Plaintiff’s Statement 

 In a Function Report, dated October 2, 2010, Plaintiff reported that she had 

anxiety, difficulty getting along with others, and a lack of motivation. (Tr. 220, 225-

226.) She also reported that she cared for her personal needs without difficulty (Tr. 221-

222), performed household chores without help or encouragement (Tr. 223), prepared 

simple meals (Tr. 222), cared for her son, including “everything a [six-year-]old needs[,]” 

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such as walking him to and from school, shopping for his school clothing and supplies, 

assisting him with homework, taking him to the park, and attending his school events. 

(Tr. 221, 223-224.) Plaintiff also stated that she cared for pets (Tr. 221, 224), crocheted 

(Tr. 224), drove an automobile “if [she absolutely had] to” (Tr. 223), and went shopping. 

(Tr. 223.) She also reported that she did not need special reminders to care for her 

personal needs, to take medication, or to go places (Tr. 222, 224), that that she could go 

places alone (Tr. 223-224), manage her personal finances (Tr. 224), and pay attention for 

a “normal length of time.” (Tr. 225.) She also reported that her condition did not affect 

her abilities to remember, complete tasks, concentrate, understand, or follow instructions. 

(Id.) 

III. Administrative Hearing Testimony

 Plaintiff, represented by counsel, appeared and testified at the August 9, 2011 

administrative hearing. (Tr. 42.) No other witness testified at the hearing. Plaintiff was 

in her mid-forties at the time of the administrative hearing. (Tr. 32.) She had a high 

school education plus “one year of college” (Tr. 160), and had past work experience as an 

after-school care manager/childcare leader. (Tr. 31, 152, 155, 160.) 

 Plaintiff testified that she could not maintain employment because she experienced 

depression and anxiety, for which she took medication. (Tr. 48-52.) She testified that 

she had “low energy,” sleep problems, stress, anxiety attacks, and that she sometimes got 

“real upset about things,” and “blurt[ed] out things she shouldn’t say.” (Tr. 50.) Plaintiff 

also testified that she resided with her spouse and her seven-year-old son (Tr. 45), had a 

valid driver’s license, and drove an automobile “when [she had] to.” (Tr. 51, 53.) She 

stated that she cared for her son, including taking him to and from school, the movies, a 

park, and a skate park. (Tr. 51, 53-54.) She also stated that she shopped (Tr. 51, 53), and 

occasionally dined out with a friend. (Tr. 52.) 

IV. The ALJ’s Decision 

 A claimant is considered disabled under the Social Security Act if she is unable 

“to engage in any substantial gainful activity by reason of any medically determinable 

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physical or mental impairment which can be expected to result in death or which has 

lasted or can be expected to last for a continuous period of not less than 12 months.” 42 

U.S.C. § 423(d)(1)(A); see also 42 U.S.C. § 1382c(a)(3)(A) (nearly identical standard for 

supplemental security income disability insurance benefits). To determine whether a 

claimant is disabled, the ALJ uses a five-step sequential evaluation process. See 20 

C.F.R. §§ 404.1520, 416.920. 

A. Five-Step Evaluation Process 

 In the first two steps, a claimant seeking disability benefits must initially 

demonstrate that she is not presently engaged in a substantial gainful activity, and that 

her impairment or combination of impairments is severe. 20 C.F.R. § 404.1520(a) (c). If 

a claimant meets steps one and two, she may be found disabled in two ways at steps three 

through five. At step three, she may prove that her impairment or combination of 

impairments meets or equals an impairment in the Listing of Impairments found in 

Appendix 1 to Subpart P of 20 C.F.R. pt. 404. 20 C.F.R. § 404.1520(a)(4)(iii). If so, the 

claimant is presumptively disabled. If not, the ALJ determines the claimant’s residual 

functional capacity (RFC). At step four, the ALJ determines whether a claimant’s RFC 

precludes her from performing her past work. 20 C.F.R. § 404.1520(a)(4)(iv). If the 

claimant establishes this prima facie case, the burden shifts to the government at step five 

to establish that the claimant can perform other jobs that exist in significant number in the 

national economy, considering the claimant’s RFC, age, work experience, and education. 

If the government does not meet this burden, then the claimant is considered disabled 

within the meaning of the Act. 

B. The ALJ’s Application of Five-Step Evaluation Process 

 Applying the five-step sequential evaluation process, the ALJ found that Plaintiff 

had not engaged in substantial gainful activity during the relevant period. (Tr. 26.) At 

step two, the ALJ found that Plaintiff had the following severe impairments: “depression, 

anxiety, bipolar disorder, and obsessive-compulsive disorder.” (Tr. 26.) At the third 

step, the ALJ found that the severity of Plaintiff’s impairments did not meet or medically 

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equal the criteria of an impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. 

(Id.) The ALJ next concluded that Plaintiff retained the RFC to “perform a full range of 

work at all exertional levels but with the following nonexertional limitations: the claimant 

is limited to simple, repetitive, unskilled work.” (Tr. 28.) The ALJ concluded that 

Plaintiff could not perform her past relevant work. (Tr. 32.) At step five, relying on the 

Medical-Vocational Guidelines, 20 CFR pt. 404, subpt. P, app. 2, § 204.00, the ALJ 

concluded that Plaintiff could perform other “jobs that exist in significant numbers in the 

national economy.” (Id) The ALJ concluded that Plaintiff was not disabled within the 

meaning of the Act. (Tr. 33.) 

V. Standard of Review 

 The district court has the “power to enter, upon the pleadings and transcript of 

record, a judgment affirming, modifying, or reversing the decision of the Commissioner, 

with or without remanding the cause for a rehearing.” 42 U.S.C. § 405(g). The district 

court reviews the Commissioner’s final decision under the substantial evidence standard 

and must affirm the Commissioner’s decision if it is supported by substantial evidence 

and it is free from legal error.3

 Smolen v. Chater, 80 F.3d 1273, 1279 (9th Cir. 1996); 

Ryan v. Comm’r of Soc. Sec. Admin., 528 F.3d 1194, 1198 (9th Cir. 2008). Even if the 

ALJ erred, however, “[a] decision of the ALJ will not be reversed for errors that are 

harmless.” Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir. 2005). 

 Substantial evidence means more than a mere scintilla, but less than a 

preponderance; it is “such relevant evidence as a reasonable mind might accept as 

adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 401 (1971) 

(citations omitted); see also Webb v Barnhart, 433 F.3d 683, 686 (9th Cir. 2005). In 

determining whether substantial evidence supports a decision, the court considers the 

 

3

 Plaintiff asserts that the “Commissioner proposes that judicial review is limited only to determining whether substantial evidence supports agency action.” (Doc. 28 at 3.) The Court rejects this assertion. Although the “Standard of Review” section of the Commissioner’s brief (Doc. 27 at 9) only discusses the substantial evidence component of judicial review, her brief addresses whether the ALJ erred and asserts that the “ALJ’s 

decision was supported by substantial evidence and is a correct application of the law and regulations.” (Doc. 27 at 27.) 

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record as a whole and “may not affirm simply by isolating a specific quantum of 

supporting evidence.” Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007) (internal 

quotation and citation omitted). The ALJ is responsible for resolving conflicts in 

testimony, determining credibility, and resolving ambiguities. See Andrews v. Shalala, 

53 F.3d 1035, 1039 (9th Cir. 1995). “When the evidence before the ALJ is subject to 

more than one rational interpretation, [the court] must defer to the ALJ’s conclusion.” 

Batson v. Comm’r of Soc. Sec. Admin., 359 F.3d 1190, 1198 (9th Cir. 2004) (citing 

Andrews, 53 F.3d at 1041). 

 The court “must judge the propriety of [administrative] action solely by the 

grounds invoked by the agency.” See SEC v. Chenery Corp., 332 U.S. 194, 196 (1947). 

If “those grounds are inadequate or improper, the court is powerless to affirm the 

administrative action by substituting what it considers to be a more adequate or proper 

basis.” Id.; see also Connett v. Barnhart, 340 F.3d 871, 874 (9th Cir. 2003) (stating that 

the court is “constrained to review the reasons the ALJ asserts” in support of his 

decision”). Although, when determining whether the ALJ’s disability determination is 

free from legal error the court cannot affirm the ALJ’s based on a ground upon which the 

ALJ did not rely, the court must still review the entire record to determine whether 

substantial evidence supports the ALJ’s decision. See Orn, 495 F.3d at 630. 

VI. Plaintiff’s Claims 

 Plaintiff asserts that the ALJ erred in his assessment of the medical source opinion 

evidence by rejecting Plaintiff’s symptom testimony without providing clear and 

convincing reasons, and by relying on the Medical-Vocational Guidelines, without the 

testimony of a vocational expert, to find Plaintiff not disabled. (Doc. 20-1 at 1-2.)4

 

Plaintiff asks the Court to remand this matter for a determination of disability benefits. In 

response, the Commissioner argues that the ALJ’s decision is free from legal error and is 

supported by substantial evidence in the record. (Doc. 27.) For the reasons discussed 

 

4

 Plaintiff’s opening brief is attachment 1 to her June 17, 2013 Notice of Errata. 

(Doc. 20, attachment 1.) For ease of reference, the Court uses the CM/ECF designation, and thus refers to Plaintiff’s opening brief as Doc. 20-1. 

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below, the Court reverses the Commissioner’s determination and remands for further 

proceedings. 

A. Weight Assigned to Medical Source Opinions 

 In weighing medical source evidence, the Ninth Circuit distinguishes between 

three types of physicians: (1) treating physicians, who treat the claimant; (2) examining 

physicians, who examine but do not treat the claimant; and (3) non-examining physicians, 

who neither treat nor examine the claimant. Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 

1995). Generally, more weight is given to a treating physician’s opinion. Id. The ALJ 

must provide clear and convincing reasons supported by substantial evidence for 

rejecting a treating or an examining physician’s uncontradicted opinion. Id.; Reddick v. 

Chater, 157 F.3d 715, 725 (9th Cir. 1998). An ALJ may reject the controverted opinion 

of a treating or an examining physician by providing specific and legitimate reasons that 

are supported by substantial evidence in the record. Bayliss v. Barnhart, 427 F.3d 1211, 

1216 (9th Cir. 2005); Reddick, 157 F.3d at 725. 

 Opinions from non-examining medical sources are entitled to less weight than 

treating or examining physicians. Lester, 81 F.3d at 831. Although an ALJ generally 

gives more weight to an examining physician’s opinion than to a non-examining 

physician’s opinion, a non-examining physician’s opinion may nonetheless constitute 

substantial evidence if it is consistent with other independent evidence in the record. 

Thomas v. Barnhart, 278 F.3d 947, 957 (9th Cir. 2002). When evaluating medical 

opinion evidence, the ALJ may consider “the amount of relevant evidence that supports 

the opinion and the quality of the explanation provided; the consistency of the medical 

opinion with the record as a whole; [and] the specialty of the physician providing the 

opinion . . . .” Orn, 495 F.3d at 631. 

B. The ALJ’s Assessment of Medical Source Opinion 

 Plaintiff alleges that ALJ erred in discounting Dr. Bisla’s opinion regarding her 

mental functional ability. (Doc. at 20-1 at 11-21.) The ALJ discounted Dr. Bisla’s 

October 2010 assessment that Plaintiff was severely limited in her ability to complete a 

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normal workday on a consistent basis on the ground that Dr. Bisla’s report relied heavily 

on Plaintiff’s subjective reports of symptoms and limitations, which the ALJ found 

unreliable. (Tr. 30-31.) The ALJ also explained that Dr. Bisla had assessed GAF scores 

that were inconsistent with “severe” symptoms, that the evidence showed that Plaintiff’s 

symptoms “wax[ed] and wan[ed],” and that Dr. Bisla’s assessment was inconsistent with 

the “greater evidence of record, including his own treating records.” (Tr. 31.) 

 When there is a conflict between the opinions of a treating physician and an 

examining physician, or between the opinion of a treating physician and objective 

evidence in the record as a whole, the ALJ may disregard the opinion of the treating 

physician if he sets forth “‘specific and legitimate reasons supported by substantial 

evidence in the record for doing so.’” Tonapetyan v. Halter, 242 F.3d 1144, 1148 (9th 

Cir.2001) (quoting Lester, 81 F.3d at 830); see Batson, 359 F.3d at 1195 (stating that an 

ALJ “need not accept the opinion of any physician, including a treating physician, if that 

opinion is brief, conclusory, and inadequately supported by clinical findings”). Here, the 

treating physician’s assessment of severe limitations was in conflict with the assessments 

of reviewing physicians Dr. Gallucci and Dr. Downs (finding that Plaintiff’s mental 

impairments were not severe), and with the Function Reports completed by Plaintiff and 

Mr. Garcia (finding that that Plaintiff’s condition did not affect her abilities to remember, 

complete tasks, concentrate, understand, or follow instructions). Accordingly, the ALJ 

had to provide specific and legitimate reasons, supported by substantial evidence in the 

record, for discounting Dr. Bisla’s assessment. See Tonapetyan, 242 F.3d at 1148. 

 As discussed below, the ALJ gave legally sufficient reasons that are supported by 

substantial evidence in the record for giving “little weight” to Dr. Bisla’s October 2010 

assessment, including that: his opinion was inconsistent with his treatment notes; 

Dr. Bisla’s opinion was inconsistent with the GAF scores he assessed; and his opinion 

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was largely based on Plaintiff’s subjective complaints which the ALJ properly 

discredited.5

 

 1. Inconsistencies with the Treatment Notes 

 The ALJ found that Dr. Bisla’s treatment notes did not support his October 2010 

assessment of moderately-severe to severe limitations, and the ALJ discussed the 

treatment notes that he identified as inconsistent with that assessment.6

 (Tr. 28-30.) 

Specifically, the ALJ noted that Dr. Bisla’s treatment notes indicated that Plaintiff failed 

to follow-up on Dr. Bisla’s recommendations, which indicated that her symptoms might 

not have been as severe as Dr. Bisla assessed. (Tr. 29-30.) The ALJ also noted that 

Dr. Bisla’s treatment records indicated that when Plaintiff complied with treatment and 

took her medication she had better control of her emotions and had more energy. 

(Tr. 30.) “Impairments that can be controlled effectively with medication are not 

disabling for the purpose of determining eligibility for SSI benefits.” Warre v. Comm’r

of Soc. Sec. Admin., 439 F.3d 1001, 1006 (9th Cir. 2006). The ALJ cited several 

instances when Plaintiff reported “doing well” or showed improvement on the medication 

regimen for her mental impairments. (Tr. 30, 257, 259, 268, 293.) Evidence that an 

impairment can be controlled by treatment supports the ALJ’s finding that Plaintiff was 

not as severely impaired as Dr. Bisla found in his October 2010 assessment. See Odle v. 

Heckler, 707 F.2d 439, 440 (9th Cir. 1983) (affirming a denial of benefits and noting that 

the claimant’s impairments were responsive to medication). Evidence that medication 

effectively controlled Plaintiff’s symptoms is substantially supported by the record and is 

 

5

 Although the ALJ only had to provide specific and legitimate reasons for discounting Dr. Bisla’s opinion, his reasons for discounting Dr. Bisla’s assessment also satisfy the clear and convincing standard. See Orn, 495 F.3d at 632 (an ALJ must give “clear and convincing reasons” for rejecting a treating physician’s uncontradicted opinion). 

6

 The ALJ’s discussion of the treatment notes that he found inconsistent with 

Dr. Bisla’s assessment of severe mental limitations did not appear on the same page of his decision on which the ALJ discounted Dr. Bisla’s assessment. The ALJ’s discussion 

of the inconsistent treatment notes appeared earlier in the ALJ’s decision. (Tr. 30-31); see Lewis v. Apfel, 236 F.3d 503, 513 (9th Cir. 2001) (an ALJ must discuss and evaluate the evidence that supports his step three finding, but need not do so under a particular heading). 

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a legally sufficient reason for assigning less weight to Dr. Bisla’s October 2010 

assessment. 

 The ALJ further noted that, contrary to Dr. Bisla’s assessment that Plaintiff had 

“moderately-severe to severe limitations” in her abilities to concentrate, understand, and 

carry out and remember instructions, Dr. Bisla’s treatment notes indicated that Plaintiff’s 

“overall thought content [was] normal, [her] thought process [was] logical, [and her] 

insight and judgment [were] intact.” (Tr. 30.) The record contains substantial evidence 

in support of the ALJ’s determination. As the ALJ noted, Dr. Bisla’s treatment notes 

indicated that Plaintiff had normal thought content, a logical thought process, and that her 

judgment and insight were intact. (Tr. 30, 255, 257, 259, 261, 266, 268, 286, 293, 296.) 

Dr. Bisla’s treatment notes also indicated that Plaintiff was alert and oriented, 

demonstrated a euthymic mood, had an appropriate affect, had good 

grooming/appearance, maintained good eye contact, had normal and calm psychomotor 

activity/gait, had normal speech, good intelligence, an average fund of knowledge, and 

intact insight. (Tr. 255, 257, 259, 261, 266, 268, 285-286, 293, 296.) 

 The ALJ reasonably concluded that Dr. Bisla’s treatment notes were inconsistent 

with his assessment that Plaintiff was moderately-severe to severely limited in her mental 

functioning abilities. Thus, the ALJ properly discounted Dr. Bisla’s October 2010 

opinion on that basis. See 20 C.F.R. § 404.1527(d)(4) (stating that an ALJ must consider 

consistency of opinion with the record as a whole); Batson, 359 F.3d at 1195 (stating that 

an ALJ may discredit treating physician opinions that are conclusory, brief, and 

unsupported by the record as a whole). Although the treatment records may also support 

an interpretation more favorable to Plaintiff, the ALJ’s interpretation was rational and the 

court “must uphold the ALJ’s decision where the evidence is susceptible to more than 

one rational interpretation.” Magallanes, 881 F.2d at 750; see Batson, 359 F.3d at 1198 

(9th Cir. 2004). 

 

 

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 2. Plaintiff’s GAF Scores 

 The ALJ also discounted Dr. Bisla’s October 2010 assessment as incompatible 

with the GAF score of 55 that Dr. Bisla assessed during the same time period he 

completed the October 2010 assessment. (Tr. 31.) The ALJ also noted that Dr. Bisla 

assessed GAF scores ranging from 55 to 75 during the course of treatment. (Tr. 30.) 

Plaintiff argues that the GAF scores do not provide a legally sufficient basis for 

discounting Dr. Bisla’s assessment of Plaintiff’s ability to work because a GAF score is a 

subjective rating of a claimant’s overall level of functioning in a treatment setting and 

does not correlate directly to a claimant’s ability to work. (Doc. 20-1 at 16.) “The Ninth 

Circuit has countenanced an ALJ’s reliance on GAF scores as evidence that contradicts a 

physician’s opinion of severe limitation.” Nelson v. Colvin, 2013 WL 4010860, at *7 

(D. Ariz. Aug. 6, 2013) (citing Melton v. Comm’r of Soc. Sec. Admin., 442 Fed. App’x 

339, 341 (9th Cir. 2011)); see also Mann v. Astrue, 2009 WL 224635, at *2 (C.D. Cal. 

Jul. 24, 2009) (citing Olds v. Astrue, 2008 WL 339757, at *4 (D. Kan. Feb. 5, 2008)) (a 

GAF score is evidence to be considered with the rest of the record)). 

 Here, the ALJ found that Plaintiff’s GAF scores, including the score of 55 

assessed in October 2010, suggested no significant functional impairments that would 

preclude substantial gainful activity. (Tr. 30-31.) The ALJ properly considered 

Plaintiff’s GAF scores in weighing the medical opinion evidence. See Burkin v. Astrue, 

2012 WL 21916984, at *6 (D. Ariz. Jun. 14, 2012) (stating that “the fact that [the 

claimant] routinely had GAF scores that reflected no more than moderate symptoms or 

limitations was a legitimate reason for the ALJ to consider when determining whether 

[the claimant] was unable to work”). Plaintiff’s GAF scores ranging from 55 to 75 could 

reasonably be perceived as inconsistent with Dr. Bisla’s opinion that Plaintiff was 

moderately-severe to severe limitations in her mental functioning and that she was 

severely limited in her ability to work. (Tr. 30, 291-92.) Her GAF scores of 55 to 75 

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indicate only mild to moderate symptoms.7 Additionally, there is no evidence that the 

ALJ treated the GAF scores as dispositive of the issue of disability or otherwise accorded 

them improper weight; rather, they were one piece of evidence upon which the ALJ 

relied in making the disability determination. (Tr. 31.) Thus, the ALJ did not err in this 

regard. See Pelletier v. Astrue, 2012 WL 135992, at *5 (D. Ariz. Jan. 18, 2012) (ALJ 

properly gave little weight to physician’s opinion after finding it inconsistent with the 

claimant’s GAF scores and overall record of mental health treatment). 

 3. Medical Opinion Based on Subjective Complaints

 The ALJ also discounted Dr. Bisla’s assessment because it appeared to be based 

mainly on Plaintiff’s subjective complaints. (Tr. 31.) Because the ALJ properly 

discredited Plaintiff’s subjective complaints as discussed in Section VI(D)(2) below, the 

ALJ did not err in this regard. See Bray v. Comm’r of Soc. Sec. Admin., 554 F.3d 1219, 

1228 (9th Cir. 2009) (ALJ properly discounts a physician’s opinion that is based solely 

upon claimant’s self-reporting if ALJ concludes that claimant’s self- reporting is not 

credible); see also Thomas v. Barnhart, 278 F.3d 947, 957 (9th Cir. 2002) (rejecting 

physician’s opinion in part because it was based on claimant’s subjective complaints, not 

on new objective findings); Tonapetyan, 242 F.3d at 1149 (medical opinion premised on 

subjective complaints may be disregarded when record supports ALJ in discounting 

claimant’s credibility). 

 

7

 A GAF score between 51 and 60 indicates moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). Michaels v. Colvin, 2014 WL 37744, at *1(C.D. Cal. Jan. 6, 2004) (citing Diagnostic and Statistical Manual of Mental Disorders (4th ed. 2000) (DSM-IV)). 

A GAF “score of 61–70 reflects mild symptoms or some difficulty in social, occupational, or school functioning, but generally functioning pretty well.” Nelson, 2013 

WL 4010860, at *7 (citing DSM-IV). 

A GAF between 71 and 80 indicates that if symptoms are present, they are transient and expectable reactions to psychological stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork). Bizonia v. Astrue, 2011WL 

1656075, at *2 n.3 (C.D. Cal. May 3, 2011) (citing DSM-IV). 

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 4. Varying Degree of Symptoms

 The ALJ also stated that he discounted Dr. Bisla’s October 2010 assessment 

because Plaintiff’s “moods ‘wax[ed] and wan[ed]’ based on social and economic 

stressors.” (Tr. 31.) Plaintiff asserts that the ALJ erred in relying on variation in 

Plaintiff’s symptoms to reject Dr. Bisla’s assessment because occasional symptom-free 

periods are not inconsistent with disability. (Doc. 20-1 at 17.) The Commissioner 

appears to argue that the ALJ did not err in this regard. However, the Court cannot 

discern the basis for that argument from the Commissioner’s analysis, which consists of a 

general discussion of mood disorder. (Doc. 27 at 16-17.) Nonetheless, even if the ALJ 

erred in this regard, the error was harmless because, as discussed in Section VI(B)(1)-(3), 

the ALJ gave other legally sufficient reasons for discounting Dr. Bisla’s assessment. 

C. The ALJ’s Reliance on Reviewing Physicians’ Opinions

 Plaintiff also argues that the ALJ erred in relying on the opinions of reviewing 

state agency physicians Dr. Gallucci and Dr. Downs as substantial evidence in support of 

his RFC and disability determinations. (Doc. 20-1 at 18.) Dr. Gallucci and Dr. Downs 

found that Plaintiff’s affective and anxiety disorders were not “severe.” (Tr. 60, 68.) The 

ALJ accorded “greater weight” to the opinions of Dr. Gallucci and Dr. Downs because 

those opinions were “not inconsistent with the greater objective record, particularly 

regarding the finding that the claimant has no significant limitations precluding all work, 

even taking into account the problems with her moods, anxiety, and bipolar disorder.” 

(Tr. 31.) The opinions of non-examining physicians may serve as substantial evidence 

when they are consistent with independent clinical findings or other record evidence. See 

Thomas, 278 F.3d at 957;Social Security Ruling (SSR) 96-6p, 1996 WL 374180, at *2-3 

(1996) (findings made by state agency physicians must be treated as expert opinion 

evidence). 

 Here, the opinions of Dr. Gallucci and Dr. Downs were consistent with the record 

evidence and constituted substantial evidence upon which the ALJ could rely in support 

of his disability determination. See Thomas, 278 at 957 (“The opinions of non-treating or 

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non-examining physicians may also serve as substantial evidence when the opinions are 

consistent with independent clinical findings or other evidence in the record.”). 

 Their opinions were consistent with Dr. Bisla’s treatment notes. (See Section 

VI(B)(1).) Additionally, Dr. Gallucci’s and Dr. Downs’s assessments were supported by 

Plaintiff’s own reports that she did not need reminders to care for her personal needs, to 

take medication, or to go places (Tr. 190, 192, 222, 224), that she could go out alone 

(Tr. 191-192, 223-224), manage personal finances (Tr. 191, 224), and pay attention for 

three hours or a “normal length of time” (Tr. 193, 225), and that her condition did not 

affect her abilities to remember, complete tasks, concentrate, understand, or follow 

instructions. (Tr. 193, 225.) Mr. Garcia similarly indicated that Plaintiff did not need 

any reminders to care for her personal needs, to take medication, or to go places 

(Tr. 182, 184), that she could go out alone (Tr. 183-184), manage personal finances 

(Tr. 183), and pay attention five hours (Tr. 185), and that her condition did not affect her 

abilities to remember, complete tasks, understand, or follow instructions. (Tr.185.) 

 Therefore, the opinions from reviewing state agency physicians were consistent 

with the medical evidence and with evidence of Plaintiff’s activities during the relevant 

time period. (Tr. 30.) The ALJ reasonably gave “greater weight” to those opinions. See 

20 C.F.R. § 404.1527(f)(2)(i) (“State agency medical . . . consultants . . . are highly 

qualified physicians . . . who are also experts in Social Security disability evaluation”); 

Thomas, 278 F.3d at 957 (reviewing source opinions may serve as substantial evidence 

when they are consistent with independent clinical findings or other evidence in the 

record). 

 The Court rejects as meritless Plaintiff’s contention that the opinions of 

Dr. Downs and Dr, Gallucci did not constitute substantial evidence because they failed to 

explain how the evidence supported their conclusions. (Doc. 20-1 at 19.) Dr. Downs and 

Dr. Gallucci both noted Plaintiff’s improvement, including a stable mood, with 

compliance to psychiatric medication. (Tr. 60, 68.) Plaintiff’s argument that the 

opinions of Dr. Downs and Dr. Gallucci do not constitute substantial evidence because 

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their opinions were based on a limited portion of the record also lacks merit. The ALJ 

properly considered these opinions even though Dr. Downs’s opinion was rendered at an 

early step in the administrative process before Dr. Bisla issued his 2010 assessment of 

Plaintiff. The ALJ was required to review the evidence in determining Plaintiff’s RFC 

and whether she was disabled under the Act. See 20 C.F.R. §§ 404.1527(e)(2), 

404.1546(c). 

 Plaintiff also argues that Dr. Gallucci’s and Dr. Downs’s opinions that Plaintiff did 

not have any severe impairment do not support the ALJ’s RFC and disability 

determinations because the ALJ found that Plaintiff had the following severe 

impairments: “depression, anxiety, bipolar disorder, and obsessive-compulsive disorder.” 

(Doc. 20-1 at 19 (citing Tr. 26).) The ALJ gave “greater weight” to the reviewing 

doctors’ opinions because he found them more consistent with the record evidence than 

the opinion of Dr. Bisla. (Tr. 31.) Although the ALJ found Plaintiff more impaired than 

the reviewing doctors, Plaintiff has not cited any authority indicating that an ALJ cannot 

moderate “the full adverse force of a medical opinion” in a manner that is more favorable 

to a claimant. See Chapo v. Astrue, 682 F.3d 1285, 1288 (10th Cir. 2012) (stating that an 

ALJ does not commit reversible error by tempering extremes of medical opinion that are 

adverse to claimant’s application for disability benefits). 

D. Plaintiff’s Subjective Complaints 

 1. The Two-Step Analysis 

 An ALJ engages in a two-step analysis to determine whether a claimant’s 

testimony regarding subjective pain or symptoms is credible. Lingenfelter v. Astrue, 504 

F.3d 1028, 1035-36 (9th Cir. 2007). “First, the ALJ must 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.’” Id. at 1036 

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

is not required to show objective medical evidence of the pain itself or of a causal 

relationship between the impairment and the symptom. Smolen, 80 F.3d at 1282. 

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Instead, the claimant must only show that an objectively verifiable impairment “could 

reasonably be expected” to produce his pain. Lingenfelter, 504 F.3d at 1036 (quoting 

Smolen, 80 F.3d at 1282); see also Carmickle v. Comm’r of Soc. Sec., 533 F.3d at 1160-

61 (9th Cir. 2008) (“requiring that the medical impairment could reasonably be expected 

to produce pain or another symptom . . . requires only that the causal relationship be a 

reasonable inference, not a medically proven phenomenon”). If a claimant produces 

medical evidence of an underlying impairment that is reasonably expected to produce 

some degree of the symptoms alleged, and there is no affirmative evidence of 

malingering, an ALJ must provide “clear and convincing reasons” for an adverse 

credibility determination. See Smolen, 80 F.3d at 1281; Gregor v. Barnhart, 464 F.3d 

968, 972 (9th Cir. 2006). 

 In evaluating a claimant’s credibility, the ALJ may consider the objective medical 

evidence, the claimant’s daily activities, the location, duration, frequency, and intensity 

of the claimant’s pain or other symptoms, precipitating and aggravating factors, 

medication taken, and treatments for relief of pain or other symptoms. See 20 

C.F.R. § 404.1529(c); Bunnell, 947 F.2d at 346. An ALJ may also consider such factors 

as a claimant’s inconsistent statements concerning his symptoms and other statements 

that appear less than candid, the claimant’s reputation for lying, unexplained or 

inadequately explained failure to seek treatment or follow a prescribed course of 

treatment, medical evidence tending to discount the severity of the claimant’s subjective 

claims, and vague testimony as to the alleged disability and symptoms. See Tommasetti 

v. Astrue, 533 F.3d 1035, 1040 (9th Cir. 2008); Smolen, 80 F.3d 1273, 1284 (9th Cir. 

1996). If substantial evidence supports the ALJ’s credibility determination, that 

determination must be upheld, even if some of the reasons cited by the ALJ are not 

correct. Carmickle, 533 F.3d at 1162. 

 Relying on the Ninth Circuit decision in Bunnell, the Commissioner appears to 

argue that an ALJ need not provide “clear and convincing” reasons for discrediting a 

claimant’s testimony regarding subjective symptoms, and instead must make findings 

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that are “‘supported by the record’ and ‘sufficiently specific to allow a reviewing court to 

conclude the adjudicator rejected the claimant’s testimony on permissible grounds.’” 

(Doc. 27 at 18-19 (citing Bunnell, 947 F.2d at 345-46).) In Bunnell, the court did not 

apply the “clear and convincing” standard, and the Commissioner argues that because no 

subsequent en banc court has overturned Bunnell, its standard remains the law of the 

Ninth Circuit. (Doc. 18 at 8-9.) Although the Ninth Circuit has not overturned Bunnell, 

subsequent cases have elaborated on its holding and have accepted the clear and 

convincing standard. See Taylor v. Comm’r of Soc. Sec. Admin., 659 F.3d 1228, 1234 

(9th Cir. 2011); Vasquez v. Astrue, 572 F.3d 586, 591 (9th Cir. 2009); Lingenfelter, 504 

F.3d at 1036; Reddick, 157 F.3d at 722; Swenson v. Sullivan, 876 F.2d 683, 687 (9th Cir. 

1989). Accordingly, the Court will determine whether the ALJ provided clear and 

convincing reasons for discounting Plaintiff’s credibility. 

 2. Plaintiff’s Pain and Symptom Testimony 

 Although the ALJ stated that Plaintiff’s “medically determinable impairments 

could reasonably be expected to cause the alleged symptoms alleged,” he found that 

Plaintiff’s “statements concerning the intensity, persistence and limiting effects of these 

symptoms are not credible to the extent that they are inconsistent with the above residual 

functional capacity assessment.” (Tr. 29.) Plaintiff argues that the ALJ did not give clear 

and convincing reasons for discrediting her symptom testimony.8

 

 Because there was no record evidence of malingering, the ALJ was required to 

provide clear and convincing reasons for concluding that Plaintiff’s description of her 

functional limitations was not wholly credible. The ALJ first stated that he discounted 

Plaintiff’s symptom testimony because the objective medical record did not support the 

 8

 Plaintiff first argues that the ALJ’s conclusion that Plaintiff’s testimony was not 

credible to the extent that it was inconsistent with the ALJ’s RFC assessment is improper 

circular reasoning. (Doc. 20-1 at 22-23). Even if the ALJ erred in relying on circular 

reasoning to discredit Plaintiff’s credibility, any error was harmless because, as discussed 

in Section VI(D)(2), he provided other clear and convincing reasons for discrediting 

Plaintiff’s symptom testimony. 

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level of symptoms alleged. (Tr. 30-31.) Contrary to Plaintiff’s assertion, the ALJ cited 

evidence in the medical record that supported his conclusion. The ALJ noted that 

Dr. Bisla’s treatment notes indicated that his examinations of Plaintiff revealed logical 

thought processes, intact insight, intact judgment, and GAF scores between 55 and 75. 

(Tr. 30-31.) Although an ALJ may not reject a claimant’s subjective complaints based 

solely on lack of objective medical evidence to fully corroborate the alleged severity of 

symptoms, see Rollins v. Massanari, 261 F.3d 853, 856-57 (9th Cir. 2001); Fair, 885 

F.2d at 602, the lack of objective medical evidence supporting the claimant’s claims may 

support the ALJ’s finding that the claimant is not credible. See Batson, 359 F.3d at 1197. 

 The ALJ further explained that he discounted Plaintiff’s subjective complaints 

because her reported limitations were inconsistent with her daily activities. (Tr. 29.) The 

ALJ noted (Tr. 27-29), and substantial evidence in the record indicates, that Plaintiff 

cared for her personal needs without difficulty (Tr. 181, 189, 221-222), performed 

household chores without help or encouragement (Tr. 182, 190, 223), prepared simple 

meals (Tr. 182, 190, 222), had a valid driver’s license and drove an automobile (Tr. 51, 

53, 183, 191, 223), cared for pets, (Tr. 181, 189, 221, 224), crocheted (Tr. 224), watered 

her lawn (Tr. 190), went shopping (Tr. 51, 53, 183-184, 191-192, 223), and occasionally 

dined out with a friend (Tr. 52.) 

 The ALJ found it significant that Plaintiff cared for her young son including 

bathing and dressing him, transporting him to and from school, assisting him with 

homework, shopping for his school clothing and supplies, attending his school events, 

taking him to movies, taking him to the park, and playing with him. (Tr. 51, 53-54, 180-

181, 183-184, 188-189, 191-192, 221, 223-225.) The ALJ found that Plaintiff’s daily 

activities suggested that she had “greater mental capacities than she stated in the 

testimony and written statements.” (Tr. 29.) Plaintiff argues that the ALJ did not provide 

any evidence in support of his statement that she spent a “substantial part of the day” 

engaged in daily activities that were inconsistent with disability. (Doc. 20-1 at 24.) The 

ALJ cited to the evidence in the record regarding Plaintiff’s daily activities, and based on 

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his review of the record, concluded that Plaintiff spent a substantial part of the day doing 

those activities. The ALJ is responsible for resolving conflicts in testimony, determining 

credibility, and resolving ambiguities. See Andrews, 53 F.3d at 1039. Although the 

evidence of Plaintiff’s daily activities may also support an interpretation more favorable 

to her, the ALJ’s interpretation was rational, and the court “must uphold the ALJ’s 

decision where the evidence is susceptible to more than one rational interpretation.” 

Magallanes, 881 F.2d at 750; see Batson, 359 F.3d at 1198. 

 The Ninth Circuit has found that a claimant’s activities, including childcare, were 

legally sufficient reasons for discounting a claimant’s subjective complaints. See Conley 

v. Astrue, 471 Fed. App’x 758, 759 (9th Cir. 2012) (unpublished) (finding that claimant’s 

activities that included child care constituted legally sufficient reason for discounting 

subjective complaints); Burch, 400 F.3d at 681 (claimant’s ability to interact with family 

members and daily activities that included household chores, handling finances, and 

caring for young children undermined claims of disability); Rollins, 261 F.3d at 857 

(finding that disability claimant’s symptom allegations were undermined by activities that 

included attending to the needs of two young children). Accordingly, the ALJ properly 

considered Plaintiff’s daily activities in his credibility analysis. 

 The ALJ next found that Plaintiff’s credibility was diminished by evidence that 

she was “not entirely compliant” with treatment and that she did not “follow-up on 

recommendations” made by her treating physician. (Tr. 29.) Noncompliance with 

treatment may form the basis for an adverse credibility finding. See Fair v. Bowen, 885 

F.2d 597, 603 (9th Cir. 1989) (stating that “an unexplained, or inadequately explained, 

failure to . . . follow a prescribed course of treatment . . . can cast doubt on the sincerity 

of the claimant’s pain testimony); Burch, 400 F.3d at 681 (lack of consistent treatment 

may be considered in assessing credibility as to severity of pain); Bunnell, 947 F.2d at 

346 (en banc) (noncompliance with prescribed course of treatment is a relevant factor in 

assessing credibility). 

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 Here, the ALJ noted that Plaintiff was not fully compliant with taking her 

medication and also noted that Plaintiff reportedly could not afford her medication. 

(Tr. 29 (citing hearing exhibit 1F at 12).) The ALJ stated that, although he did not “fault 

the claimant for her lack of insurance or funds, the evidence show[ed] that claimant was 

unwilling to seek out other alternative modes of treatment, such as free clinics.” (Tr. 29.) 

The record indicates that Plaintiff sometimes did not take her medication due to limited 

funds. (Tr. 259, 261-62, 293.) The record also reflects that Dr. Bisla recommended that 

Plaintiff seek treatment at free mental health clinics. (Tr. 261-62.) Plaintiff, however, 

was unwilling to go to “AHCCCS related psychiatric services agencies” because she had 

had a bad experience with a free clinic. (Tr. 262.) The record does not contain any 

information about this alleged bad experience. Here, there is no evidence that Plaintiff 

sought no-cost or low-cost treatment, or that she was denied treatment by any medical 

facility for financial reasons. See Keokham v. Astrue, 2008 WL 4196972, at *7 (E.D. 

Cal. 2008) (affirming ALJ’s adverse credibility determination based on claimant’s noncompliance with treatment; although claimant could not always afford medication, there 

was no evidence that she sought free or low cost medical assistance) (citing Social 

Security Ruling 82-59 (noting that clinics, charitable and public assistance agencies must 

be explored)). 

 Plaintiff also argues that the ALJ erred in relying on her noncompliance with 

treatment to discredit her symptom testimony because noncompliance with treatment is a 

reflection of Plaintiff’s mental impairments. (Doc. 20-1 at 26.) Although the 

Commissioner does not dispute that such can be the case, she argues that the record in 

this case does not support that conclusion. (Doc. 27 at 22-23.) The Court agrees that the 

record supports the ALJ’s determination that Plaintiff was sometimes noncompliant with 

her medication and indicates that Plaintiff was able to follow her course of treatment 

despite her impairments. Plaintiff and Mr. Garcia reported that Plaintiff had no difficulty 

following instructions (Tr. 185, 193, 225), and that she did not need reminders to take her 

medications. (Tr. 182, 190, 222.) Plaintiff’s noncompliance with her medication and 

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with Dr. Bisla’s recommendation that she seek treatment at free clinics because she 

lacked resources to pay for medication is substantially supported by the record and a clear 

and convincing reason for discrediting Plaintiff’s symptom testimony. See Burch, 400 

F.3d at 681. 

 The ALJ also discounted Plaintiff’s complaints of disabling symptoms because 

Dr. Bisla’s treatment notes reflected that when Plaintiff took her medication as prescribed 

she had better control of her emotions and more energy. (Tr. 30.) The treatment notes 

indicate that Plaintiff’s medications were helpful in controlling her symptoms and giving 

her more energy without side effects. (Tr. 30, 255, 257, 259, 285.) Although the 

treatment notes also indicate that Plaintiff was not entirely symptom free when she 

followed the prescribed course of treatment, substantial evidence supports the ALJ’s 

conclusion that medication helped control Plaintiff’s symptoms. See Batson, 359 F.3d at 

1198 (citing Andrews, 53 F.3d at 1041). “Impairments that can be controlled effectively 

with medication are not disabling for the purpose of determining eligibility” for disability 

benefits under the Act. Warre, 439 F.3d at 1006 (citing Brown v. Barnhart, 390 F.3d 

535, 540 (8th Cir. 2004)); see Odle v. Heckler, 707 F.2d 439, 440 (9th Cir.1983) 

(affirming a denial of benefits and noting that the claimant’s impairments were 

responsive to medication). Evidence that medication effectively controlled Plaintiff’s 

symptoms is substantially supported by the record and a legally sufficient reason for 

discounting Plaintiff’s credibility. 

 In conclusion, the ALJ’s credibility determination is free from legal error and 

supported by substantial evidence in the record. The ALJ’s credibility determination is 

affirmed. 

E. Reliance of the Medical and Vocational Guidelines 

 Finally, Plaintiff argues that that the ALJ erred at step five of the sequential 

evaluation by relying on the Medical-Vocational Guidelines (the Grids) without 

consulting a vocational expert to determine whether she was disabled under the Act 

because the Grids do not account for Plaintiff’s significant non-exertional limitations 

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resulting from her mental impairments. (Doc. 20-1 at 27.) The Commissioner responds 

that Plaintiff’s mental impairments were not so severe that they created significant nonexertional limitations, therefore, the use of the Grids was appropriate. (Doc. 27 at 24-25.) 

 At step five, the ALJ considers whether claimant can perform work that exists in 

the national economy considering the claimant’s RFC, age, education, and work 

experience. The Commissioner can make a step-five determination by either using “the 

testimony of a vocational expert or by reference to the Medical Vocational Guidelines.” 

Thomas, 278 F.3d at 955. The Grids “consist of a matrix of [the four factors including 

claimant’s RFC, age, work experience, and education] and set forth rules that identify 

whether jobs requiring a specific combination of these factors exist in significant 

numbers in the national economy.” Heckler v. Campbell, 461 U.S. 458, 461–462 (1983). 

“The [Social Security Administration’s] need for efficiency justifies use of the grids at 

step five where they completely and accurately represent a claimant’s limitations.” 

Tackett, 180 F.3d at 1101 (internal citation omitted). 

 The Grids should not be used if they “fail accurately to describe a claimant’s 

particular limitations.” Jones v. Heckler, 760 F.2d 993, 998 (9th Cir. 1985). An alleged 

non-exertional limitation, however, “does not automatically preclude application of the 

grids. The ALJ should first determine if a claimant’s non-exertional limitations 

significantly limit the range of work permitted by his exertional limitations.” Tackett, 

180 F.3d at 1102. “A vocational expert is required only when there are significant and 

‘sufficiently severe’ nonexertional limitations not accounted for in the grid.” Hoopai v. 

Astrue, 499 F.3d 1071, 1075-76 (9th Cir. 2007) (stating that when a claimant has 

“significant non-exertional limitations,” the ALJ cannot rely solely on the grids); see also 

Burkhart, 856 F.2d at 1340 (“the grids are inapplicable [w]hen a claimant’s nonexertional limitations are sufficiently severe so as to significantly limit the range of work 

permitted by the claimant’s exertional limitations”) (internal quotations omitted). Nonexertional limitations that may make reliance the Grids inappropriate include poor vision, 

see Tackett, 180 F.3d at 1101-02, pain, see Perminter v. Heckler, 765 F.2d 870, 872 (9th 

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Cir. 1985), and “‘mental, sensory, postural, manipulative, or environmental (e.g., 

inability to tolerate dust or fumes) limitations.’” Burkhart, 856 F.2d at 1340-41 (quoting 

Desrosiers v. Sec’y of Health and Human Servs, 846 F.2d 573, 579 (9th Cir. 1988)). 

 Here, the ALJ found that Plaintiff had the RFC to perform “simple, repetitive, 

unskilled work” at “all exertional levels.”9

 (Tr. 29.) At step four, the ALJ found that 

Plaintiff was unable to perform her past “semi-skilled” work as an “after-school care 

manager/child care leader.” (Tr. 31.) However, at step five of the evaluation process the 

ALJ did not adequately explain how Plaintiff nonetheless could perform other work in 

the national economy. The ALJ erred by applying the Grids without sufficiently 

explaining their application despite record evidence suggesting that the Grids may not 

encompass Plaintiff’s non-exertional limitations, including her “limited concentration,” 

that the ALJ noted in his decision (Tr. 30), and her limitations in her ability to “respond 

appropriately to supervision, co-workers, and a usual work situation,” that the 

Commissioner noted in her memorandum in support of the Commissioner’s decision. 

(Doc. 27 at 25.) Because Plaintiff had non-exertional limitations that are not adequately 

accounted for in the Grids, the ALJ was required to obtain the testimony of a vocational 

expert. See Perkins v. Colvin, 2013 WL 3930407, at *10 (D. Ariz. Jul 30, 2013) (finding 

that ALJ erred by applying the Grids at step five when there was evidence that claimant 

had non-exertional limitations related to his cognitive impairments and remanding to the 

Commissioner for further proceedings); Pagan-Velez v. Astrue, 2010 WL 3789486, at 

*10 (D. Ariz. Sept. 22, 2010) (ALJ erred by applying Grids when he found that claimant 

had numerous impairments that prevented her from performing her past work, but did not 

explain show she could perform other work in the national economy despite those 

impairments and remanding to the Commissioner for further proceedings). 

 

9

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to “unskilled” work was not a substitute for a mental functional capacity determination. (Doc. 20-1 at 29 n.16.) Plaintiff, however, does not raise this issue as a ground for reversing the ALJ’s disability determination and states that the issue is “not essential to 

this appeal.” (Id.) Accordingly, the Court will not further consider this issue. 

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VII. Conclusion 

 Based on the foregoing, the ALJ erred at step five of the sequential evaluation 

process by failing to consider the testimony of a vocational expert. The Court reverses 

the Commissioner’s decision and remands to the ALJ pursuant to sentence four of 42 

U.S.C. § 405(g). On remand, the ALJ is directed to conduct further proceedings, 

including obtaining evidence from a vocational expert at step five of the sequential 

evaluation process. 

 Accordingly, 

IT IS ORDERED that the Commissioner’s determination is REVERSED and 

this matter is REMANDED to the Commissioner for further proceedings consistent with 

this Order. The Clerk of Court shall enter judgment accordingly and terminate this 

matter. 

 Dated this 6th day of March, 2014. 

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