Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_06-cv-02108/USCOURTS-azd-2_06-cv-02108-0/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 (DIWC)

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WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Yolanda Gonzales, 

Plaintiff,

vs.

Michael J. Astrue, Commissioner of

Social Security Administration, 

Defendant.

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No. CV-06-2108-PHX-DGC

ORDER

Plaintiff has filed a motion for summary judgment. Dkt. #16. Defendant has filed a

response and cross-motion for summary judgment. Dkt. ##24, 25. The Court will grant

Plaintiff’s motion and deny Defendant’s cross-motion.

I. Background.

Plaintiff applied for disability insurance benefits on February 27, 2003, claiming

disability as of October 17, 2001. Dkt. #10, Tr. 83-85. The application was denied initially

and on reconsideration. Tr. 53-54. A hearing was held before an Administrative Law Judge

(“ALJ”) on April 26, 2004. Tr. 381-413. The ALJ issued a decision on June 4, 2004, finding

that Plaintiff was not disabled within the meaning of the Social Security Act. Tr. 309-16.

The Appeals Council granted Plaintiff’s request for review and remanded the case for

further proceedings. Tr. 330-34. Another hearing was held and the ALJ issued a new

decision on March 23, 2005, again finding Plaintiff not disabled. Tr. 16-26, 361-80.

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This decision became Defendant’s final decision when the Appeals Council denied review.

Tr. 7-9. Plaintiff then commenced this action for judicial review. Dkt. #1.

II. Standard of Review.

Defendant’s decision to deny benefits will be vacated “only if it is not supported by

substantial evidence or is based on legal error.” Robbins v. Soc. Sec. Admin., 466 F.3d 880,

882 (9th Cir. 2006). Substantial evidence is more than a mere scintilla, but less than a

preponderance. Id. In determining whether the decision is supported by substantial

evidence, the Court must consider the record as a whole, weighing both the evidence that

supports the decision and the evidence that detracts from it. Reddick v. Charter, 157 F.3d

715, 720 (9th Cir. 1998).

III. Analysis.

On remand, the ALJ found that Plaintiff had two severe impairments, major

depressive disorder and personality disorder. Tr. 17, 25 ¶ 3. The ALJ also found that

Plaintiff had several non-severe impairments: asthma, migraine headaches, shoulder bursitis,

and fibromyalgia. Tr. 17, 25 ¶ 4. The ALJ determined that Plaintiff’s impairments did not

meet or equal a listed impairment. Tr. 17, 25 ¶ 3. The ALJ further determined that

Plaintiff’s testimony regarding the severity of her impairments was not fully credible. Tr.

23, 25 ¶ 5. The ALJ concluded that while Plaintiff was not able to perform her past work as

a court clerk, she was able to perform simple, repetitive work in an environment with limited

social contact. Tr. 24, 25 ¶¶ 6-7.

Plaintiff contends that the ALJ erred in concluding that Plaintiff’s asthma, migraine

headaches, and shoulder bursitis were not severe. Plaintiff further contends that the ALJ

erred by giving improper weight to various medical opinions, by discrediting Plaintiff’s

testimony and ignoring a statement of her sister regarding the severity of her impairments,

and by concluding that Plaintiff had the residual functional capacity to perform simple,

repetitive work in an environment with limited social contact. Dtk. #21. Defendant argues

that the ALJ did not err and that her decision is supported by substantial evidence. Dkt. #27.

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A. The Severity Determination.

The Appeals Council’s remand order directed the ALJ to provide rationale for her

finding that Plaintiff’s asthma, migraine headaches, and shoulder bursitis were not severe.

Tr. 331-32; see Tr. 310, 315 ¶ 4. Plaintiff argues that the ALJ failed to provide the required

rationale, and that this failure constitutes reversible error. Dkt. #21 at 3-8. The Court agrees.

 Dr. Michael Ridge has been Plaintiff’s family physician since 1980, and he treated

Plaintiff for her alleged impairments from at least October 2001 through December 2004.

Tr. 134-41, 199-262, 288-305, 343-53, 376. He opined that there was a direct correlation

between the severity of Plaintiff’s physical and mental impairments and that the combined

effect of the impairments rendered Plaintiff disabled. Tr. 200; see Tr. 139-41, 237, 248-49,

253, 289, 351. In finding that Plaintiff’s asthma, migraine headaches, and shoulder bursitis

were not severe, however, the ALJ considered the effect of each impairment individually.

See Tr. 21. This constitutes legal error. “[T]he ALJ must consider the combined effect of

all of [Plaintiff’s impairments] on her ability to function, without regard to whether each

alone was sufficiently severe.” Smolen v. Chater, 80 F.3d 1273, 1290 (9th Cir. 1996) (citing

42 U.S.C. § 423(d)(2)(B)); see Hammock v. Bowen, 879 F.2d 498, 500 (9th Cir. 1989)

(reversing the denial of benefits where “[t]he Secretary did not consider the combined effect

of all of [the claimant’s] impairments”); 20 C.F.R. § 404.1520(c); SSR 85-28, 1985 WL

56856, at *3 (1985).

Moreover, substantial evidence does not support the ALJ’s finding that Plaintiff’s

headaches and asthma were not severe. “An 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 v. Barnhart, 433 F.3d 683,

686 (9th Cir. 2005) (quoting Smolen, 80 F.3d at 1290; emphasis in original); see Yuckert v.

Bowen, 841 F.2d 303, 306 (9th Cir. 1988); SSR 85-28, at *3. In short, the severity

determination is merely “‘a de minimis screening device used to dispose of groundless

claims[.]’” Webb, 433 F.3d at 687 (quoting Smolen, 80 F.3d at 1290); see SSR 85-28, at *2

(“[T]he severity regulation is to do no ‘more than allow the Secretary to deny benefits

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summarily to those applicants with impairments of a minimal nature which could never

prevent a person from working.’”) (citation omitted).

The ALJ found that Plaintiff’s headaches were not severe because “she received little

in the way of ongoing treatment” and there was “a lack of specific restrictions placed on her

by [Dr. Ridge].” Tr. 21. This finding is belied by the record. Plaintiff received treatment

for chronic headaches numerous times over a three-year period. Tr. 139, 200-02, 206-07,

214-16, 229-30, 236-37, 241-43, 248-49, 253, 255-57, 289-92, 295-98, 344-49, 352-53.

The headaches were described as intractable and problematic. Tr. 141, 214, 230, 253.

A physical examination revealed significant muscle spasms around the neck, jaw, and

forehead. Tr. 253. Dr. Ridge prescribed Plaintiff Fioricet, a strong pain reliever and relaxant

used to treat tension headache symptoms. Plaintiff was prescribed the drug over a prolonged

period of time and was “taking a fairly significant dosing[.]” Tr. 291. Dr. Ridge specifically

found that Plaintiff was under a lot of stress and that this was “causing her a significant

amount of headache[s].” Tr. 248; see Tr. 289. Dr. Ridge concluded that Plaintiff’s stressinduced headaches precluded her from working as a court clerk. Tr. 139-41, 200, 249, 351.

The ALJ herself acknowledged that Dr. Ridge’s treatment records documented ongoing care

for headaches and psychological stress, noting that Plaintiff had “reported experiencing more

headaches and escalating psychological symptoms due to stress.” Tr. 19 (citing Tr. 343-53).

This evidence is more than “sufficient to pass the de minimis threshold of [the severity

determination].” Webb, 433 F.3d at 687; see Edlund v. Massanari, 253 F.3d 1152, 1158 (9th

Cir. 2001) (holding that the ALJ’s non-severity finding was not supported by substantial

evidence under the “de minimis screening” standard); see also Keller v. Shalala, 26 F.3d 856,

858 (8th Cir. 1994) (migraine headaches could “constitute an impairment that is more than

slight or minimal”).

The ALJ found that Plaintiff’s asthma was not severe because she “did not have

severe or frequent asthma attacks requiring medical intervention, emergency room treatment,

or hospitalization.” Tr. 21. The ALJ fails to explain why the lack of emergency room care

or hospitalization shows that the asthma was only a slight abnormality, and her finding that

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the asthma did not require medical intervention is not supported by the record as a whole.

On numerous occasions Plaintiff was diagnosed with and treated for acute asthma and severe

reactive airway disease. See, e.g., Tr. 135, 164, 171, 205-07, 228-30, 282, 289, 295. Plaintiff

suffered from forced and prolonged expiratory wheezes, and her frequent coughing caused

chest pain. Tr. 206, 216, 228-30, 241, 248, 289, 291, 295-98, 351-53. In August 2003,

Dr. Ridge found that Plaintiff wheezed continuously and that she was unable to work

“[b]ecause of her significant shortness of breath and cough from her wheezing[.]” Tr. 200.

Dr. Ridge confirmed in May 2004 that Plaintiff was “just not able to do her job as a court

clerk” due in part to the symptoms of her respiratory problems. Tr. 351. Considering

Plaintiff’s medical records in their entirety, as the Court must do, the Court concludes that

substantial evidence does not support a finding that Plaintiff’s asthma had no more than a

minimal effect on her ability to work. See Robbins, 466 F.3d at 882 (“[A] reviewing court

must consider the entire record as a whole and may not affirm simply by isolating a ‘specific

quantum of supporting evidence.’”) (quoting Hammock, 879 F.2d at 501); Day v.

Weinberger, 522 F.2d 1154, 1156 (9th Cir. 1975) (same); see also Burnside v. Apfel, 223

F.3d 840, 844-45 (8th Cir. 2000) (short breath may significantly limit the ability to work).

Defendant contends that the ALJ properly found that Plaintiff did not have a severe

physical impairment because Plaintiff testified at the initial hearing that her psychological

condition prevented her from working. Dkt. #27 at 2 (citing Tr. 394). This issue goes to

credibility , which the Court will address below. For purposes of the severity determination,

however, the fact that Plaintiff’s psychological impairments were disabling does not mean

that her physical impairments were not severe. The law requires that the combined effect of

all impairments be considered in determining whether Plaintiff is disabled. See Smolen, 80

F.3d at 1290. Indeed, the Appeals Council’s remand order explicitly required the ALJ to

address whether Plaintiff’s physical impairments were severe. Tr. 332.

B. The Weighing of Medical Opinions.

The ALJ gave little weight to the opinions of Dr. Ridge and examining physician

Dr. Carlos Vega. Tr. 23. Plaintiff argues that the ALJ erred in doing so. Dkt. #21 at 8-11.

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The Court agrees.

1. Dr. Ridge.

Dr. Ridge diagnosed Plaintiff with, among other things, asthma, chronic headaches,

major depression, anxiety, and adjustment and panic disorders. See, e.g., Tr. 200, 205,

229-30, 236, 253, 291, 351, 353. In October 2001, Dr. Ridge placed Plaintiff on off-work

status for a period of four to six weeks due to her headaches and symptoms of depression and

adjustment disorder. Tr. 141. Dr. Ridge decided in December 2001 to keep Plaintiff off

work for a few more weeks to see if a new medication would help. Tr. 249. Dr. Ridge

opined in August 2003 that Plaintiff was unable to work for the foreseeable future due to the

combination of her physical and mental impairments. Tr. 200.

“The medical opinion of a claimant’s treating physician is entitled to ‘special

weight.’” Rodriguez v. Bowen, 876 F.2d 759, 762 (9th Cir. 1989) (quoting Embrey v. Bowen,

849 F.2d 418, 421 (9th Cir. 1988)). “The rationale for giving the treating physician’s opinion

special weight is that he is employed to cure and has a greater opportunity to know and

observe the patient as an individual.” McCallister v. Sullivan, 888 F.2d 599, 602 (9th Cir.

1989)). An ALJ may reject “the treating physician’s opinion, but only by setting forth

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

evidence.’” Rodriguez, 876 F.2d at 762 (quoting Cotton v. Bowen, 799 F.2d 1403, 1408

(1986)).

The ALJ gave little weight to Dr. Ridge’s opinion on the ground that it “[did] not

provide specific limitations, [did] not cite specific findings to support his conclusions, and

[was] inconsistent with the medical evidence in [the] file.” Tr. 23. Dr. Ridge’s opinion

included findings that Plaintiff had chronic headaches, a progressively worsening reactive

airway disease, and deep depression with a significant anxiety component. Dr. Ridge noted

that Plaintiff wheezed continuously despite taking strong medications, including steroids, and

that she had a very difficult time concentrating due to her headaches and anxiety. He

concluded that these symptoms and limitations precluded Plaintiff from working. Tr. 200.

The ALJ does not explain, and it is unclear to the Court, why the specific findings and

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limitations provided by Dr. Ridge do not support his ultimate conclusion of disability.

Moreover, while the evidence in this case includes 100 pages of medical records from

Dr. Ridge (see Tr. 134-41, 199-62, 288-305, 343-53), the ALJ does not address them in

concluding that Dr. Ridge’s opinion was not supported by findings and was not consistent

with the medical evidence. See Tr.23. 

“‘The ALJ must do more than offer [her] own conclusions. [She] must set forth [her]

own interpretations and explain why they, rather than [Dr. Ridge’s], are correct.’”

Regennitter v. Comm’r of the Soc. Sec. Admin., 166 F.3d 1294, 1298-99 (9th Cir. 1999)

(citation omitted); see Embrey v. Bowen, 849 F.2d 418, 422 (9th Cir. 1988) (“[I]t is

incumbent on the ALJ to provide detailed, reasoned, and legitimate rationales for

disregarding the physicians’ findings.”). The ALJ’s reasons for rejecting Dr. Ridge’s opinion

are not supported by substantial evidence. See Holohan v. Massanari, 246 F.3d 1195, 1205

(9th Cir. 2001) (holding that the ALJ erred in rejecting a treating physician’s opinion that the

claimant’s depression and anxiety rendered her disabled).

2. Dr. Vega.

Plaintiff was examined by Dr. Vega in May 2003. Dr. Vega diagnosed Plaintiff with

major depression in partial remission and a personality disorder that required treatment.

Tr. 177-80. Dr. Vega opined that Plaintiff had no ability to behave in an emotionally stable

manner or relate predictably in social situations. Tr. 176. He further opined that Plaintiff

was seriously limited in her ability to, among other things, follow work rules, use judgment,

maintain concentration, demonstrate reliability, and relate to co-workers and supervisors.

Tr. 175-76. 

The ALJ asserted three reasons for giving little weight to Dr. Vega’s opinion, but none

of them is supported by substantial evidence. First, the ALJ noted that Dr. Vega’s

examination revealed no discernable cognitive or memory impairment. Tr. 23. The ALJ,

however, does not explain why the lack of such impairments undermines Dr. Vega’s opinion.

The limitations found by Dr. Vega were based on Plaintiff’s depression and personality

disorder, not a lack of cognitive functioning. See Tr. 175-80. Moreover, the ALJ erred by

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selectively relying on only some of Dr. Vega’s statements and failing to read his statements

in the “context of the overall diagnostic picture he [drew].” Holohan, 246 F.3d at 1205;

see Edlund, 253 F.3d at 1158-60 (holding that the ALJ’s rejection of an examining

psychologist’s opinion was in error and not supported by substantial evidence where the ALJ

selectively focused on aspects of the opinion suggesting non-liability and failed to discuss

the findings that the plaintiff’s anxiety disorder seriously limited his ability to relate to other

people and respond appropriately to supervision and work pressures).

Second, the ALJ cited Dr. Vega’s comments that most of Plaintiff’s major psychiatric

difficulties occurred the year before the examination and that Plaintiff had a tendency to be

overly emphatic regarding her symptoms. Tr. 23. But Dr. Vega specifically found that the

psychiatric difficulties Plaintiff was experiencing severely limited her ability to cope in a

work environment. Tr. 175-76. He also found that Plaintiff’s tendency to exaggerate her

symptoms was consistent with the presence of a personality disorder. Tr. 178.

Third, the ALJ relied heavily on the opinions of the state agency consulting physicians

who found limitations less significant than those found by Dr. Vega. Tr. 23; see Tr. 181-98,

263-280. An ALJ generally should give more weight to the opinion of an examining

physician than to opinions of non-examining, consulting physicians. Andrews v. Shalala,

53 F.3d 1035, 1040-41 (9th Cir. 1995); 20 C.F.R. § 416.927(d)(1). Opinions of nonexamining physicians may constitute substantial evidence for rejecting the opinion of an

examining physician “when they are supported by other evidence in the record and are

consistent with it.” Morgan v. Comm’r of Soc. Sec., 169 F.3d 595, 600 (9th Cir. 1999). “The

ALJ can meet this burden by setting out a detailed and thorough summary of the facts and

conflicting clinical evidence, stating [her] interpretation thereof, and making findings.’” Id.

at 600-01 (citations omitted).

The ALJ rejected Dr. Vega’s opinion in favor of the consulting physicians’ opinions

on the grounds that they were consistent with Plaintiff’s global assessment of functioning

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A GAF score is an estimate of a person’s psychological, social, and occupational

functioning used to reflect the person’s need for treatment. See Morgan, 169 F.3d at 598 n.1;

Vargas v. Lambert, 159 F.3d 1161, 1164 n.2 (9th Cir. 1998). A GAF score of 41 to 50

indicates severe symptoms or severe difficulty in functioning and a GAF score of 51 to 60

indicates moderate symptoms or moderate difficulty in functioning. See id. 

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(“GAF”) scores and the assessment of nurse practitioner Rose Garduño. Tr. 23.1

 Plaintiff’s

medical records show that she had fluctuating GAF scores, with a low of 25 and a high of

65. Tr. 135, 147, 174, 282. The ALJ does not explain how this range of GAF scores

supports the consulting physicians’ opinions.

Nor does the ALJ explain why Ms. Garduño’s assessment of Plaintiff is more

consistent with the consulting physicians’ opinions than with Dr. Vega’s opinion.

Ms. Garduño diagnosed Plaintiff with an anxiety disorder and major depression-recurrent.

She found that Plaintiff had poor functioning due to multiple stressors. Tr. 284-87. The ALJ

notes that Ms. Garduño believed Plaintiff’s “impairment was not expected to be long term.”

Tr. 23. But the ALJ herself acknowledged that Ms. Garduño found Plaintiff disabled as of

April 2002 and expected the disability to last for at least three to six months. Tr. 23; see Tr.

284-87. The fact that Ms. Garduño simply could not predict whether Plaintiff would be able

to return to work beyond this time period does not render her assessment of Plaintiff

consistent with the consulting physicians’ opinions. Those opinions found only mild to

moderate limitations. Tr. 181-98, 263-280. Ms. Garduño, by contrast, found Plaintiff

disabled, noting that she had made “limited progress” and that her “prognosis [was]

guarded.” Tr. 286-87.

The ALJ’s reasons for rejecting Dr. Vega’s opinion are not supported by substantial

evidence. See Holohan, 246 F.3d at 1205.

C. Plaintiff’s Testimony.

Plaintiff testified at the initial hearing that she stopped working as a court clerk in

October 2001 due to the limitations imposed by her mental impairments. Tr. 385. Plaintiff

stated that her depression and anxiety led to bouts of constant crying and caused her to feel

hopeless, isolated, and tired. Tr. 385-90. Plaintiff further stated that her stress caused

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debilitating headaches and that she was unable to cope with work-related stress. Tr. 390.

The ALJ found this testimony not fully credible. Tr. 21-22, 25 ¶ 5.

“Once a claimant produces objective medical evidence of an underlying impairment,

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 [the symptoms].” Moisa v.

Barnhart, 367 F.3d 882, 885 (9th Cir. 2004) (citation and alterations omitted); see Smolen,

80 F.3d at 1282 (“The claimant need not . . . produce objective medical evidence of the

causal relationship between the medically determinable impairment and the symptom.”)

(citing Bunnell, 947 F.2d at 345-48); 20 C.F.R. § 404.1529(c)(2) (“[W]e will not reject your

statements about the intensity and persistence of your . . . symptoms or about the effect your

symptoms have on your ability to work solely because the objective medical evidence does

not substantiate your statements.”); SSR 96-7p, 1996 WL 374186, at *1 (July 2, 1996)

(same); see also SSR 95-5p, 1995 WL 670415, at *1 (Oct. 31, 1995) (“Because symptoms

sometimes suggest a greater severity of impairment than can be shown by objective medical

evidence alone, careful consideration must be given to any available information about

symptoms.”). In addition, and significantly for this case, unless the ALJ “makes a finding

of malingering based on affirmative evidence thereof, he or she may only find [the claimant]

not credible by making specific findings as to credibility and stating clear and convincing

reasons for each.” Robbins, 466 F.3d at 883. “‘General findings are insufficient; rather, the

ALJ must identify what testimony is not credible and what evidence undermines the

claimant’s complaints.’” Reddick, 157 F.3d at 722 (quoting Lester v. Chater, 81 F.3d 821,

834 (9th Cir. 1995)).

The ALJ found that Plaintiff had a medically determinable impairment that could

reasonably be expected to produce her alleged symptoms. Tr. 21, 25 ¶ 5. Because the ALJ

made no finding of malingering, she was required to give clear and convincing reasons in

support of her adverse credibility findings. See Robbins, 466 F.3d at 883. This clear and

convincing standard “is the most demanding required in Social Security cases.” Moore v.

Comm’r of Soc. Sec. Admin., 278 F.3d 920, 924 (9th Cir. 2002).

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The ALJ asserted multiple reasons for rejecting Plaintiff’s testimony. The Court

concludes that none of them is convincing or supported by substantial evidence.

First, the ALJ found that the alleged intensity, persistence, and limiting effects of

Plaintiff’s psychological symptoms were inconsistent with the medical evidence. Tr. 21.

Substantial evidence does not support the ALJ’s finding. The ALJ noted that Plaintiff was

doing better in January 2002, and that while she subsequently received in-patient psychiatric

care and continued to complain of depression and anxiety in response to situational stress,

she reported some improvement in November 2002. Tr. 21. “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 her ability to function in a

workplace.” Holohan, 246 F.3d at 1205. The ALJ does not explain, and it is unclear to the

Court, why the fact that Plaintiff occasionally experienced some improvement renders her

description of disabling impairments incredible. This Circuit has made clear that an ALJ’s

rejection of testimony is in error and not supported by substantial evidence where the ALJ

has “selectively focused on aspects of [medical records] which tend to suggest nondisability[.]” Edlund, 253 F.3d at 1159-60; see Holohan, 246 F.3d at 1205. The ALJ erred

by relying on selective medical records and failing to consider the evidence as a whole. See

id.

Second, the ALJ found that Plaintiff had failed to adequately justify her inability to

pay for mental health treatment. Tr. 21-22. The ALJ noted that Plaintiff received $2,000 a

month in long term disability benefits, but does not address how this amount would enable

Plaintiff to afford both her living expenses and the cost of all her medical care. Moreover,

the ALJ’s finding is not supported by the evidence. Plaintiff testified that she could not

afford psychological counseling due to the loss of her medical insurance. Tr. 399-400. She

stated that in addition to her utility and other personal bills, she paid $400 a month in rent,

$300 a month for her medications, and $150 each time she visited Dr. Ridge. Tr. 398-99.

A review of the entire record confirms Plaintiff’s financial problems, as well as the resulting

stress and anxiety. Dr Ridge’s records note that Plaintiff was “very anxious” because she

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The ALJ also noted that Plaintiff could not name any places she had contacted to try

to obtain low cost psychological treatment. Tr. 21. To the contrary, Plaintiff identified two

specific clinics. Plaintiff could not afford the first one and was on a waiting list for the

second one. Tr. 399-400.

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“was no longer on insurance” and “[could not] afford her medications,” that she was “off of

her insurance, which cause[d] her problems,” and that she had “a lot of economic problems.”

Tr. 291, 295, 297. Other records note that Plaintiff was behind in her payments, was

bouncing checks, and had “mounting financial problems,” including being evicted from her

home and being liable for a $16,000 judgment. Tr. 146, 149, 157, 166. One record states

that Plaintiff “often pays for meds rather than food.” Tr. 147. Her healthcare providers tried

to help by giving her free sample medications and recommending that she contact

pharmaceutical companies to inquire about discounts. Tr. 147, 291, 295, 297, 345, 347.

Considering the record as a whole and in the proper context, the Court concludes that

substantial evidence does not support the ALJ’s finding that Plaintiff failed to justify her

inability to pay for psychological treatment.2

Third, the ALJ found Plaintiff not credible on the ground that she failed to comply

with her prescribed treatment plan and often canceled doctor appointments or simply did not

show up for scheduled visits. Tr. 22. Plaintiff’s failure to obtain or follow through on her

mental health treatment is not a valid reason for rejecting her testimony. This Circuit has

explicitly “criticized the use of lack of treatment to reject mental complaints both because

mental illness is notoriously underreported and because it is a questionable practice to

chastise one with a mental impairment for the exercise of poor judgment in seeking

rehabilitation.” Regennitter, 166 F.3d at 1299-1300 (citations omitted). Moreover, there is

evidence that Plaintiff had to cancel appointments due to migraine headaches and her

inability to cover even minimal co-payments. Tr. 145, 151. 

Fourth, the ALJ concluded that there was an inconsistency in the treatment notes

regarding Plaintiff’s diminished appetite and weight loss. The ALJ stated that while Plaintiff

reported that she forced herself to eat, the treatment notes show that her weight had remained

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“relatively stable.” Tr. 22. The ALJ does not explain what she means by “relatively stable.”

On October 17, 2001 – the alleged onset date of disability – Plaintiff weighed 170 pounds.

Tr. 262. She lost 11 pounds over the next three months, weighing 159 pounds in January

2002. Tr. 240. Other weight changes are reflected in the medical records. For example,

Plaintiff weighed 162 pounds on May 15, 2002 and 159 pounds eighteen days later. Tr.

236-37; see Tr. 290-92 (17 pound change from October to November 2002). A state agency

physician specifically found that Plaintiff’s medical records reflected an “appetite

disturbance with change in weight.” Tr. 184. Substantial evidence does not support the

purported inconsistency between Plaintiff’s diminished appetite and weight loss.

Fifth, the ALJ noted that Plaintiff “was able to represent herself in contested and

protracted probate proceedings, attending court hearing[s] and preparing legal documents

since 1998 when her mother died.” Tr. 22. The ALJ failed to recognize, however, that the

court battle between Plaintiff and her siblings over the sale of their deceased mother’s home

was a cause of Plaintiff’s stress and depression. See Tr. 148-49, 153-59, 163-64, 174, 353.

The proceedings were so stressful that Plaintiff passed out in the courtroom and had to admit

herself to a psychiatric treatment facility following emergency room care. Tr. 170, 240,

402-03. Plaintiff reported that being forced to sell the home, which she helped build, was

the “final straw” leading to her in-patient psychiatric care. Tr. 164. Plaintiff represented

herself in the proceedings only because she could not afford an attorney, and ultimately lost

the dispute resulting in her eviction from the home and a $16,000 judgment against her.

Tr. 149, 157, 166, 397. Plaintiff’s participation in the court proceedings does not support the

ALJ’s adverse credibility finding.

Sixth, the ALJ found that Plaintiff lived alone at times and was able to cook, clean,

shop, receive visitors, and care for her grandson. The ALJ noted that Plaintiff also spent time

watching television or reading and attended church and a bible study group. Tr. 22 (citing

Tr. 99-102). An ALJ “may reject a claimant’s symptom testimony if the claimant is able to

spend a substantial part of her day performing household chores or other activities that are

transferrable to a work setting.” Smolen, 80 F.3d at 1284 n.7 (citing Fair v. Bowen, 885 F.2d

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597, 603 (9th Cir. 1989)). In this case, the ALJ did not address the limited nature of

Plaintiff’s activities or whether such activities were transferrable to the work place.

Moreover, an examination of the entire record “shows that the ALJ has erred in

characterizing statements and documents contained therein to reach the conclusion that

[Plaintiff] exaggerated her symptoms.” Reddick, 157 F.3d at 722.

While Plaintiff indicated in an activities questionnaire that she shopped and did some

house work, she made clear that she shopped only once a month for personal items and often

was unable to finish a household chore due to her poor mental health. Tr. 100. She also

stated that she had little interest in life, lacked the energy to bathe and dress herself, and

spent hours sitting and thinking about what she needed to do but simply could not muster the

energy to do it. Tr. 99. The ALJ’s “paraphrasing of the [activities questionnaire] is not

entirely accurate regarding the content or tone of the [questionnaire]” Reddick, 157 F.3d at

722. Plaintiff’s activities do not contradict her testimony of disabling impairments, nor do

they “meet the threshold for transferable work skills[.]” Orn v. Astrue, 495 F.3d 625, 639

(9th Cir. 2007). 

With respect to Plaintiff’s church activities, she testified that she met weekly

with a small group to pray and talk about the bible. Tr. 401. “Several courts, including

[this Circuit], have recognized that disability claimants should not be penalized for

attempting to lead normal lives in the face of their limitations.” Reddick, 157 F.3d at 722

(citations omitted). The mere fact that Plaintiff participated in her church once a week “does

not in any way detract from her credibility as to her overall disability. One does not need to

be ‘utterly incapacitated’ in order to be disabled.” Vertigan v. Halter, 260 F.3d 1044, 1050

(9th Cir. 2001) (quoting Fair, 885 F.2d at 603); see Orn, 495 F.3d at 639 (citing Vertigan);

Cooper v. Bowen, 815 F.2d 557, 561 (9th Cir. 1987) (noting that a disability claimant need

not “vegetate in a dark room” to be eligible for benefits).

Plaintiff’s medical records show that she occasionally cared for her grandson because

it forced her to “get up and [go] outside” rather than “sitting and crying” all day. Tr. 157.

The ALJ does not explain how this activity would transfer to the work place. 

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The ALJ also noted that it appeared that Plaintiff attended school. Tr. 22 (citing

Tr. 172). The cited medical record provides, “School: GED & currently @ UOP.” Tr. 172.

“UOP” may be a reference to the University of Phoenix. Plaintiff testified at the hearing,

however, that she had not returned to school or attempted to take any classes. Tr. 401. Even

if the Court were to assume that Plaintiff was enrolled in school, the record does not indicate

whether Plaintiff took classes in person or on-line, whether she took more than one class, or

whether she performed well or poorly. 

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Finally, the ALJ stated that there were indications that Plaintiff looked for work.

Tr. 22 (citing Tr. 143, 170-74). The cited evidence, however, shows that Plaintiff had

“continued stress related to [her] job search” and the decision “whether to remain in [her]

long time job or make life changes.” Tr. 143, 171 (emphasis added). Moreover, “the Social

Security Act and regulations are designed ‘to encourage individuals who have previously

suffered from a disability to return to substantial gainful employment[.]’” Moore, 278 F.3d

at 925 (quoting Flaten v. Sec. of HHS, 44 F.3d 1453, 1458 (9th Cir. 1995)). Plaintiff’s

attempt to find work is an insufficient reason for disbelieving Plaintiff.3

D. The Statement of Plaintiff’s Sister.

Plaintiff’s sister, Dolores Riddle, completed an activities questionnaire corroborating

Plaintiff’s claim of disabling impairments. Ms. Riddle described Plaintiff as extremely

isolated and depressed. She stated that Plaintiff would go days without bathing, would stay

in bed most of the day, and would not leave the house or answer the phone. She further

stated that she regularly checked in on Plaintiff to make sure Plaintiff was eating and taking

her medications. Tr. 103-09.

Plaintiff argues that the ALJ erred in failing to consider this evidence. Dkt. #21 at

11-12. Plaintiff is correct. “In determining whether a claimant is disabled, an ALJ must

consider lay witness testimony concerning a claimant’s ability to work.” Stout v. Comm’r,

Soc. Sec. Admin., 454 F.3d 1050, 1053 (9th Cir. 2006) (citing 20 C.F.R. § 404.1513(d)-(e));

see 20 C.F.R. § 404.1545(a)(3) (“We will . . . consider descriptions and observations of your

limitations from your impairment(s), including limitations that result from your symptoms

. . . provided by you, your family, neighbors, friends, or other persons.”); SSR 06-03p, 2006

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WL 2329939 (Aug. 9, 2006); SSR 96-7p, 1996 WL 374186 (July 2, 1996). “Indeed, ‘lay

testimony as to the claimant’s symptoms or how an impairment affects ability to work is

competent evidence and therefore cannot be disregarded without comment.’” Stout, 454 F.3d

at 1053 (emphasis in original; citation and alteration omitted). “Consequently, ‘if the ALJ

wishes to discount the testimony of lay witnesses, [she] must give reasons that are germane

to each witness.’” Id. (citation and alteration omitted). The ALJ did not expressly determine

to disregard Ms. Riddle’s questionnaire. This constitutes legal error. See id.; Lewis v. Apfel,

236 F.3d 503, 511 (9th Cir. 2001) (“Lay testimony as to a claimant’s symptoms is competent

evidence that an ALJ must take into account, unless he or she expressly determines to

disregard such testimony and gives reasons germane to each witness for doing so.”).

Defendant contends that the error is harmless because the questionnaire actually

supports the ALJ’s decision that Plaintiff’s impairments “did not prevent Plaintiff from her

extensive daily activities.” Dkt. #27 at 6-7. A fair reading of the questionnaire belies this

contention. Ms. Riddle stated that Plaintiff had not shown much interest in her activities

since the onset of disability, could not concentrate or complete a task, and became easily

confused and irritated. Tr. 104-08.

E. The RFC Determination.

The ALJ determined that Plaintiff had the residual functional capacity to perform

simple, repetitive work in an environment with limited social contact. Tr. 24, 25 ¶¶ 6-7.

For the reasons set forth above, the Court cannot conclude that this determination is free from

error or supported by substantial evidence.

F. The Decision to Remand for Further Proceedings or an Award of Benefits.

Having decided to vacate Defendant’s decision, the Court has the discretion to remand

the case for further development of the record or for an award benefits. See Reddick, 157

F.3d at 728. In Smolen, the Ninth Circuit held that evidence should be credited and an action

remanded for an immediate award of benefits when the following three factors are satisfied:

(1) the ALJ has failed to provide legally sufficient reasons for rejecting evidence, (2) there

are no outstanding issues that must be resolved before a determination of disability can be

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At least one Ninth Circuit panel has declined to apply the “credit as true” doctrine.

Connett v. Barnhart, 340 F.3d 871, 876 (9th Cir. 2003). Although this Court would be

inclined to agree with Connett’s approach, the overwhelming authority in this Circuit makes

clear that the “credit as true” doctrine is mandatory. Until an en banc panel reverses course,

this Court must follow Lester, Reddick, Harman, McCartey, Moisa, and Benecke.

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made, and (3) it is clear from the record that the ALJ would be required to find the claimant

disabled were such evidence credited. 80 F.3d at 1292; see Varney v. Sec. of HHS, 859 F.2d

1396, 1400 (9th Cir. 1988) (Varney II) (“In cases where there are no outstanding issues that

must be resolved before a proper determination can be made, and where it is clear from the

record that the ALJ would be required to award benefits if the claimant’s excess pain

testimony were credited, we will not remand solely to allow the ALJ to make specific

findings regarding that testimony.”); Swenson v. Sullivan, 876 F.2d 683, 689 (9th Cir. 1989)

(same); Rodriguez v. Bowen, 876 F.2d 759, 763 (9th Cir. 1989) (“In a recent case where the

ALJ failed to provide clear and convincing reasons for discounting the opinion of claimant’s

treating physician, we accepted the physician’s uncontradicted testimony as true and awarded

benefits.”) (citing Winans v. Bowen, 853 F.2d 643, 647 (9th Cir. 1988)); Hammock, 879 F.2d

at 503 (extending Varney II’s “credit as true” rule to a case with outstanding issues where the

claimant already had experienced a long delay and a treating doctor supported the claimant’s

testimony). 

On many occasions since Smolen, the Ninth Circuit has reaffirmed the rule that

improperly rejected evidence must be credited as true. See Lester, 81 F.3d at 834; Reddick,

157 F.3d at 729; Harman v. Apfel, 211 F.3d 1172, 1178 (9th Cir. 2000); McCartey v.

Massanari, 298 F.3d 1072, 1076-77 (9th Cir. 2002); Moisa, 367 F.3d at 887; Benecke, 379

F.3d at 593-95.4

 Applying these cases, the Court concludes that the improperly rejected

evidence of disabling impairments should be credited as true and the case remanded for an

award of benefits. The ALJ acknowledged that in making her adverse credibility

determinations she had reviewed with care all the documentary evidence of record and had

considered fully the testimony given at the hearing as well as the arguments made on

Plaintiff’s behalf. Tr. 17. Moreover, Plaintiff’s subjective complaints are consistent with the

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medical evidence as a whole. The vocational expert testified that if Plaintiff’s testimony is

credited, a disability finding would be required. Tr. 366-70. Thus, “a remand for further

proceedings would serve no useful purpose.” Reddick, 157 F.3d at 730; see Orn, 495 F.3d

at 640 (remanding for an award of benefits where it was “‘clear from the record that the ALJ

would be required to determine the claimant disabled if he had credited the claimant’s

testimony’”) (quoting Connett, 340 F.3d at 876).

IT IS ORDERED:

1. Plaintiff’s motion for summary judgment (Dkt. #16) is granted.

2. Defendant’s cross-motion for summary judgment (Dkt. #25) is denied.

3. Defendant’s administrative decision denying benefits is reversed.

4. The case is remanded to Defendant for an award of benefits.

5. The Clerk is directed to terminate this action.

DATED this 6th day of November, 2007.

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