Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-1_18-cv-06031/USCOURTS-cand-1_18-cv-06031-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 15:78m(a) Securities Exchange Act

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Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

EUREKA DIVISION

STEPHANIE HIEN VY,

Plaintiff,

v.

ANDREW SAUL,

Defendant.

Case No. 18-cv-06031-RMI 

ORDER ON MOTIONS FOR 

SUMMARY JUDGMENT

Re: Dkt. Nos. 19, 20, 21

Plaintiff seeks judicial review of an administrative law judge (“ALJ”) decision denying her 

application for disability insurance benefits under Title II. On February 2, 2016, Plaintiff filed her 

application for disability insurance benefits alleging an onset date of January 1, 2015. See 

Administrative Record1(“AR”) at 574-76. The ALJ denied the application on August 15, 2017. Id.

at 13-32. Plaintiff’s request for review was denied by the Appeals Council on September 29, 2017 

(id. at 1-7), and thus, the ALJ’s decision is the “final decision” of the Commissioner of Social 

Security which this court may review. See 42 U.S.C. §§ 405(g), 1383(c)(3). Both parties have 

consented to the jurisdiction of a magistrate judge (dkts. 8, 10), both parties have moved for 

summary judgment (dkts. 19, 20), and Plaintiff filed a reply (dkt. 21). For the reasons stated 

below, the court will grant Plaintiff’s motion for summary judgment, and will deny Defendant’s 

motion for summary judgment.

LEGAL STANDARDS

The Commissioner’s findings “as to any fact, if supported by substantial evidence, shall be 

1 The AR, which is independently paginated, has been filed in several parts as a number of attachments to 

Docket Entry #12. See (dkts. 12-1 through 12-38).

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conclusive.” 42 U.S.C. § 405(g). A district court has a limited scope of review and can only set 

aside a denial of benefits if it is not supported by substantial evidence or if it is based on legal

error. Flaten v. Sec’y of Health & Human Servs., 44 F.3d 1453, 1457 (9th Cir. 1995). Substantial 

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

conclusion.” Biestek v. Berryhill, 139 S. Ct. 1148, 1154 (2019); Sandgathe v. Chater, 108 F.3d 

978, 979 (9th Cir. 1997). “In determining whether the Commissioner’s findings are supported by 

substantial evidence,” a district court must review the administrative record as a whole, 

considering “both the evidence that supports and the evidence that detracts from the 

Commissioner’s conclusion.” Reddick v. Chater, 157 F.3d 715, 720 (9th Cir. 1998). The 

Commissioner’s conclusion is upheld where evidence is susceptible to more than one rational 

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

SUMMARY OF THE RELEVANT EVIDENCE

Plaintiff’s application alleged disability due to low back pain, right shoulder pain, and 

anxiety. AR at 587. The ALJ found that Plaintiff’s degenerative disc disease of the lumbar spine, 

right shoulder tendinosis, depression, anxiety, somatoform disorder, and breast cancer status post 

lumpectomy and radiation were severe. Id. at 19. 

Medical Evidence from Treating Providers

Dr. Lornalyn Carillo referred Plaintiff to physical therapy (“PT”) for low back pain in 

2014, and Plaintiff began PT at Seton Medical Center Rehabilitation Services (“SMCR”) on 

August 11, 2014. AR at 795. At that visit, Plaintiff reported left sided low back pain existing for 

one year, and her most recent flare up occurred two weeks prior to the appointment. Id. She stated 

that her pain was constant but worse with weight bearing on the left, rolling in bed, and bending 

movements. Id. Plaintiff also complained of numbness of the left leg to her ankle. Id. At that time, 

Plaintiff was working part-time serving coffee. Id. After eight appointments at SMCR, Plaintiff 

was referred back to Dr. Carillo and advised to seek a spine specialist for her continuing low back 

pain. Id. at 797. 

On August 18, 2014, Plaintiff was admitted to the emergency room at Seton Medical 

Center (“SMC ER”) for low back pain radiating to her feet since April. Id. at 751-58. A MRI 

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revealed “mild disc disease at L4-5 with a left posterolateral annular fissure and small annular disc 

bulge. No central stenosis. Mild right foraminal narrowing.” Id. at 749. Dr. Carlos Zorrilla 

reported that there was “no evidence of spinal cord compression or cauda equina syndrome.” Id. at 

752. Plaintiff was prescribed pain medication. Id. Two days later, Plaintiff was hospitalized for 

“acute on chronic low back pain” and required an overnight stay. Id. at 762. On January 1, 2015, 

Plaintiff was once again admitted at SMC ER. Id. at 773-91. An X-Ray of the lumbosacral spine 

revealed “evidence of acute change and some degenerative changes mainly facet at L4-5.” Id. at 

773. The straight leg raise test for both lower extremities was normal, and there was mild 

tenderness over the lumbosacral area with mild muscle spasms. Id. at 774. Plaintiff received pain 

medication which reduced her pain but did not provide complete relief. Id. 

On January 29, 2015, Plaintiff began treatment with Renata Jarosz, DO at the 

musculoskeletal clinic at San Mateo Medical Center. Id. at 725. Dr. Jarosz reported that Plaintiff’s 

low back pain began approximately “6 years ago and has been excruciating since.” Id. She noted 

that Plaintiff was “quite emotional/tearful throughout today’s evaluation due to moderate level of 

pain and poor (pain related) ability to move, including standing, sitting, walking.” Id. Plaintiff had 

an antalgic gait and was not able to perform a heel-toe, or tandem walking test, even with

assistance, due to pain. Id. at 726. She had limited range of motion of the lumbar spine and 

tenderness over the L4-5 intradiscal space. Id. Plaintiff was unable to tolerate the seated straight 

leg raise test on the left.2Id. Plaintiff was also unable to “tolerate sitting for more than 10 min at a 

time and look[ed] for a comfortable position, attempting to transfer weight. This same applies to 

walking.” Id. at 725. Dr. Jarosz reviewed Plaintiff’s MRIs from April 18, 2014, and commented 

that they “demonstrate[] left L4-5 disc annular tear w/ HIZ3/ disc content extrusion.” Id. at 726. 

She added that “this can certainly explain [Plaintiff’s] moderate to severe pain and lead to current 

depression/anxiety.” Id. 

2 A seated straight leg raise test is a test used to evaluate compression of spinal nerves. See Seated Straight 

Leg Raising Test, Evidence Based Medicine Consult (March 20, 2020), 

https://www.ebmconsult.com/articles/straight-leg-raising-test

3 Plaintiff added that HIZ stands for high intensity zone or “a bright area on an MRI often associated with 

annular tear herniation.” See Pl.’s Mot. (dkt 19) at 7.

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From March to July 2015, Plaintiff attended physical therapy, but she continued to have 

limited mobility due to her lower back pain. Id. at 798-803. On May 7, 2015, Dr. Henry Brodkin 

examined Plaintiff and noted a positive straight leg raise test on the left. Id. at 717. Plaintiff 

complained of left leg numbness. Id. She could barely stand on her heels and toes, and almost all

motion of the spine produced pain. Id. Dr. Brodkin referred Plaintiff to neurosurgery because she 

was “incapacitated by pain into the left lower extremity, positive left seated straight leg raise on 

the left, pain on weight bearing on left, numb left lower extremity which has persisted for 6 years”

without relief from conservative treatment which included pain medications and epidural 

injections. Id. at 718. 

On May 10, 2015, Plaintiff went to the emergency room at San Mateo Medical Center for

low back pain radiating to her left buttock and foot. Id. at 731-35. She followed up with Dr. Jarosz 

on May 27, 2015 after her first lumbar epidural injection which provided some temporary 

improvement, but the pain returned. Id. at 809. Plaintiff’s physical exam revealed limited range of 

motion; tenderness to palpation over the L4-5 inner disc space; and decreased nerve reflexes of the 

left hip and leg. Id. at 810. Dr. Jarosz noted that Plaintiff did not find relief from PT, oral pain 

medications, topical agents, ice/heat modalities, and had minimal relief with transforaminal 

epidural steroid injections. Id. at 811. She performed trigger point injections at this visit. Id. 

On July 3, 2015, Plaintiff began pain management treatment with Abhishek Gowda, MD. 

Id. at 1779. Plaintiff reported that trigger point injections by Dr. Jarosz and epidural steroid 

injections improved her pain. Id. Dr. Gowda noted that Plaintiff could not find a comfortable 

position sitting or standing, and Plaintiff stated that she cannot sit for more than 20 minutes before 

she experiences pain. Id. Plaintiff described the pain as sharp, stabbing, burning, and numbness of

the left lower extremity. Id. On physical examination, Plaintiff had an antalgic gait, tenderness at 

L4 and L5, and the seated straight leg raise was positive on the left. Id. at 1780. Sensation was 

diminished to light touch at the left L4 and L5. Id. Dr. Gowda recommended Plaintiff follow up 

with Dr. Jarosz for injections; repeat MRI of the lumbar spine; wean off pain medications; and 

substitute new medications. Id. at 1781. 

On July 8, 2015, Plaintiff had a follow up visit with Dr. Gowda for a treatment proposal. 

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Id. at 1777-78. Plaintiff was tearful due to her low back pain. Id. 1777. Dr. Gowda referred 

Plaintiff to Dr. Eliashof for interventions such as hypnosis and mindfulness, and highly 

recommended aquatic therapy. Id. at 1778.

Beginning in July of 2015, Dr. Melissa Fledderjohann, Ph.D., a pain psychotherapist, and 

Dr. Bruce Eliashof, MD, a pain psychiatrist, performed a detailed, multipart psychiatric intake

evaluation. Id. at 1519-22; 1541-1550. Plaintiff had her first visit with Dr. Fledderjohann on July 

3, 2015. Id. at 1546. Plaintiff reported that pain medications were not helpful and physical therapy 

caused her pain to increase, but she had some relief with epidural steroid injections. Id. Plaintiff 

reported that her pain was constant, and her pain level was a 7 out of 10, while her average pain 

level was 6 and, at its worst, was an 8. Id. Lying down, taking medications, and thinking about 

something else decreased her pain, but walking, exercising, and sitting increased her pain. Id. 

Plaintiff explained that she is unable to work or do household chores and must lie down every 15 

minutes due to the pain. Id. at 1547. “She spends the majority of her day trying to get 

comfortable.” Id. Plaintiff denied a history of depression and anxiety prior to living with chronic 

pain and stated that she had never received any psychiatric treatment. Id. She scored a 13/21 on 

the Hospital Anxiety and Depression (“HADS”) scale for depression and a 15/21 for anxiety 

which indicated clinically elevated depression and anxiety. Id. at 1548. On the Pain Disability 

Index (“PDI”), Plaintiff obtained a score of 38/70 and considered herself totally disabled in two 

categories – family and home responsibilities and occupation. Id. Dr. Fledderjohann noted that 

Plaintiff was tearful throughout the evaluation and had to stand. Id. at 1549. Plaintiff’s treatment 

plan consisted of the following: “1) weekly participation in [] Pain Management Group or 

individual pain education due to language barr[iers]; 2) weekly participation in group physical 

therapy; 3) medication changes, including reducing opioid use; [and] 4) individual pain 

psychiatry.” Id. The psychological goals for Plaintiff were: “1) [r]eduction of fear avoidance of 

activity; 2) [r]eduction of depression and anxiety symptoms; 3) [i]ncreased self-management 

strategies for pain control; 4) [i]ncreased socialization; [and] 5) [p]repare her for readiness to 

return to work/volunteer work.” Id. On July 8, 2015, Dr. Fledderjohann conducted the second part 

of the evaluation, and recommended Plaintiff attend group physical therapy in two weeks and 

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schedule individual psychiatric therapy appointments. Id. at 1545. 

On July 28, 2015, Dr. Eliashof conducted the first part of Plaintiff’s psychiatric evaluation. 

Id. at 1521-22. Plaintiff stated she had a 7-year history of back pain shooting into her left leg. Id. 

at 1521. The pain was “intermittent until the past 1 to 2 years when it became constant.” Id. The 

pain is relieved by rest and lying down. Id. Throughout the visit, Plaintiff grimaced in pain and 

“need[ed] to stand up often to alleviate muscle cramping and pain.” Id. Dr. Eliashof’s impressions 

included chronic pain and depressed mood and sadness over loss of function. Id. On August 10, 

2015, Dr. Eliashof conducted the second part of the evaluation. Id. at 1519-20. Plaintiff reported 

massage and epidural steroid injections helped the pain slightly, but she still struggled with pain 

and an inability to do things she liked to do. Id. 1519. Dr. Eliashof prescribed Cymbalta and 

ordered Plaintiff to follow up in 3 weeks. Id. at 1519.

Plaintiff saw Dr. Gowda on August 5, 2015. Id. at 1774-76. Plaintiff was doing well after 

an epidural steroid injection. Id. at 1774. Dr. Gowda reviewed a MRI of the lumbar spine 

performed on July 31, 2015 and noted L4-5 mild disc degeneration with small bulging left 

posterior protrusion, smaller than on the 2014 exam, and no spinal stenosis. Id. at 1775. Plaintiff 

was ordered to continue with medications, group therapy and individual therapy, and begin aquatic 

therapy. Id. at 1776. 

From August of 2015 to May of 2016, Plaintiff had frequent visits for pain management 

therapies with Drs. Eliashof, Fledderjohann, Washburn, and Van De Water. Id. at 911-1378. Dr. 

Eliashof conducted weekly therapy sessions with Plaintiff and consistently diagnosed her with 

chronic pain. Id. at 1323-26; 1339-41; 1348-50; 1519-22. Dr. Fledderjohann and Dr. Washburn 

worked together to provide Plaintiff with individual pain management sessions. Id. at 1326-38; 

1342-48; 1523-50; 1782-1872; 1892-1922. Dr. Emily Van de Water, PTD, conducted group 

physical therapy sessions. Id. at 1310-11; 1317-18.

On August 26, 2015, Dr. Gowda noted that Plaintiff’s back pain appeared to improve. Id.

at 1771. On physical exam, Plaintiff exhibited moderate to severe tenderness of the left lumbar 

and cervical paraspinal muscles; a positive Spurling’s test on the left side of the neck; and 

decreased range of motion of the neck. Id. at 1772. Dr. Gowda recommended Plaintiff continue 

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with medications and physical therapy. Id. On September 1, 2015, Plaintiff began physical and 

aquatic therapy at Mills Health Center. Id. at 1506-10. She continued with therapy through 

January of 2017. Id. at 1471-72. Plaintiff consistently reported to have low back pain, and, as 

recent as January 13, 2017, she rated her pain at a 6 out of 10. Id. at 1472. 

On March 30, 2016, Dr. Gowda performed a medical source statement. Id. at 891-96. He 

reported that Plaintiff could occasionally to frequently lift less than 10 pounds. Id. at 891. Plaintiff 

could stand and walk less than 2 hours in an 8-hour day. Id. She could sit or stand for 20 minutes 

before needing to change positions to relieve pain and needs “the opportunity to shift at will from 

sitting or standing/walking.” Id. at 892. Plaintiff would also need to lie down at unpredictable 

intervals during a work shift approximately 1-2 times per day. Id. He reported that Plaintiff could 

occasionally crouch and climb stairs, but she could never twist, stoop, or climb ladders. Id. at 894. 

Plaintiff’s ability to reach and push/pull were impaired due to her pain. Id. Dr. Gowda stated that 

the MRI of Plaintiff’s lumbar spine, findings in physical therapy, and clinical exams support these 

limitations. Id. He noted, “[p]atient has pain with movement so exposure to [environmental]

extremes could be dangerous, and exacerbate her symptoms.” Id. at 896. Plaintiff was also limited 

due to pain from long distance ambulation, reaching, squatting, lifting, pushing and pulling. Id. Dr. 

Gowda anticipated Plaintiff’s impairment would cause her to be absent from work more than three 

times a month. Id. 

On January 18, 2017, Plaintiff’s pain was stable, and she was attending a pain management 

clinic consistently. Id. at 1727. A month later, Plaintiff had another follow up visit with Dr. 

Gowda where she complained that her back and leg pain was getting worse. Id. at 1714. She had 

experienced severe pain down the left lower extremity over the previous month. Id. Dr. Gowda 

noted her “[f]unction [was] poor” and physical therapy was having little effect on her lumbar spine 

pain. Id. Plaintiff had a positive straight leg raise test on the left and tenderness to palpation at the 

left lumbar spine. Id. at 1715. Dr. Gowda recommended that if there was no improvement in 

Plaintiff’s pain in the next two weeks, he would consider a referral for surgery. Id. at 1716. 

Medical Reports of Examining & Non-Examining Consultants

On October 28, 2015, Dr. Calvin Pon performed a consultative orthopedic disability 

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evaluation at the request of the Social Security Administration. Id. at 828-31. Dr. Pon noted that

Plaintiff had low back pain for approximately 6 years, and she complained of associated left lower 

extremity pain and numbness. Id. at 828. Plaintiff had a sitting tolerance of “approximately 15 to 

20 minutes; standing tolerance 10 to 15 minutes; and walking tolerance approximately half a 

block.” Id. Her gait was stable, but the velocity and stride length were less than normal, and she 

had a slight limp on the left; Plaintiff was able to squat 1/3 of the way down limited by low back 

pain and left lower extremity pain and numbness. Id. at 829. Dr. Pon noted that Plaintiff had a 

reduced range of motion; reduced motor muscle testing in the lower extremities due to pain; and a 

positive straight leg raise test both laying down and seated. Id. at 829-30. He diagnosed Plaintiff 

with chronic low back pain with left leg pain and numbness and probable lumbar disc disease with 

degenerative changes of the lumbar spine. Id. at 830-31. Plaintiff was weight bearing on her right 

leg and had a slight limp on the left, a positive straight leg raise test, and some atrophy of the left 

thigh. Id. Dr. Pon found that Plaintiff was limited to standing and walking for a total of 2 to 4 

hours in an 8-hour day; sitting for 6 hours out of an 8-hour day; occasionally to frequently lifting

10 pounds; occasionally stooping and crawling; and rarely to occasionally climbing stairs,

crouching, kneeling and squatting. Id. 

Two agency consultants opined on Plaintiff’s impairments. First, Dr. E.L. Gilpeer MD 

reviewed Plaintiff’s medical records on December 7, 2015 and opined Plaintiff did not have a 

severe mental impairment but did have severe physical impairments due to degenerative disc 

disease of the low back. Id. at 486-92. He also opined that Plaintiff could occasionally lift and/or 

carry 20 pounds; frequently lift and/or carry 10 pounds; stand and/or walk for a total of 6 hours in 

an 8-hour workday; and sit for a total of 6 hours in an 8-hour workday. Id. at 488-89. The 

following the postural limitations were noted: Plaintiff could occasionally climb ramps/stairs; 

climb ladders, ropes, and scaffolds; occasionally stoop, kneel, crouch, and crawl. Id. at 489. On 

June 6, 2016, a second non-examining consultant – C. Friedman MD – gave a medical opinion 

about Plaintiff’s impairments. Id. at 494-506. Plaintiff had severe degenerative disc disease of the 

low back. Id. at 499. Dr. Friedman confirmed Dr. Gilpeer’s determination about Plaintiff’s 

limitations and residual functional capacity. Id. at 501-06. 

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Function Reports

On July 24, 2015, Plaintiff’s husband, Ben Nguyen, submitted a function report. Id. at 606-

14. He wrote that Plaintiff had back pain every day and “[s]he can’t sit, stand or walk long.” Id. at 

606. Plaintiff cries and cannot concentrate because of her back pain and depression. Id. Because of 

constant pain and numbness, she can no longer cook for the family or run their coffee shop. Id. at 

607. In addition, Plaintiff turns a lot in her sleep, stays in her pajamas rather than dress herself, 

cannot do housework, and can only drive short distances. Id. at 607, 609. Plaintiff only goes 

grocery shopping with her husband twice a week for about 20 minutes each time. Id. at 609. 

Plaintiff’s pain has affected her ability to: lift, squat, bend, stand, reach, walk, sit, kneel, 

climb stairs, complete tasks, concentrate, and follow instructions. Id. at 611. Plaintiff can walk 10 

feet with her back brace on, must rest every 10 minutes, and needs her back brace daily which she 

received from the ER in 2014. Id. at 611-12. 

Hearing Testimony

At the ALJ hearing on April 20, 2017, Plaintiff was not provided an interpreter although 

Plaintiff’s non-attorney representative indicated one was required for the hearing. Id. at 428-29. 

The ALJ asked whether a continuance was necessary, but Plaintiff was eager to get the hearing 

done so they proceeded. Id. at 429. The Vocational Expert (“VE”) was present by telephone 

throughout the hearing. Id. at 428. 

Plaintiff testified that she had attained a ninth-grade education. Id. at 432; 453-54. 

Plaintiff’s pain began in 2009, and she last worked in January of 2015 in a coffee shop that she 

owned with her husband. Id. at 432, 434. Plaintiff stated the coffee shop was open 7 days a week

from 6 a.m. to 5 p.m., and she made sandwiches and coffee and sometimes worked as the cashier. 

Id. at 432-33. Plaintiff closed the coffee shop due to her back problems and difficulty walking and 

moving. Id. at 433.

Before owning the coffee shop, Plaintiff worked in a beauty salon as a manicurist. Id. at 

435. She had also previously worked as a cashier at a restaurant where she took orders. Id. at 436. 

Plaintiff testified that she could not return to her previous jobs because of her low back pain that 

radiated to her left leg and foot with tingling sensation. Id. at 437. Plaintiff stated that she had pain 

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all the time and rated it at an 8 out of 10. Id. She has pain all the way up her leg and cannot walk 

well. Id. at 438. In 2015, her doctors advised that she may need surgery, but she declined the 

surgery because she did not have insurance. Id. at 438-39. Plaintiff received epidural injections, 

medications, physical therapy, and aquatic therapy with only minimal pain relief. Id. at 439-40. 

Plaintiff could sit for about 10 to 15 minutes at a time and could walk only half a block due 

to the pain. Id. at 44. She tried to walk because her doctor recommended it, but it caused her pain. 

Id. at 442. Plaintiff testified that she began treatment with a team of doctors at a pain management 

clinic in 2015, and had appointments three times a week. Id. at 442-43. Physical therapy class 

would begin at 9 a.m. and continued for 2 hours followed by one hour of education about how to 

deal with pain. Id. at 444. She testified that at some appointments she had to lie down because she 

could not sit for long periods of time. Id. She sleeps 2-3 hours a night and when she gets up she 

has back pain and numbness of her hands. Id. at 445. Plaintiff testified that she cannot do 

housework like dusting, vacuuming, or mopping, and her husband and children performed the 

housework. Id. at 446. Plaintiff typically would not drive, except if her children needed her to take 

them to and from school which is 3 miles from her home. Id. Plaintiff lives in an upstairs 

apartment, and she can only walk halfway up and crawls the rest of the way. Id. at 447. 

Plaintiff takes pain medication, but it makes her tired and dizzy and only relieves her pain 

for about 2 hours. Id. During her testimony, Plaintiff began having left leg pain and needed to 

elevate her leg on a chair. Id. at 448. She explained that she had to elevate her leg every time she is 

seated or lying down. Id. at 449. She stated that she is very depressed because she cannot do 

anything. Id. at 451. 

Next, the ALJ posed hypotheticals to the VE. Plaintiff’s past relevant work consisted of 

fast food cook; a sandwich maker; a waitress; a cashier; management in fast food; and a 

manicurist. Id. at 456. The first hypothetical supposed an “individual of the claimant’s age, 

education, and work history” who “is limited to light exertional level and can stand and walk a 

total of four hours in an eight-hour day and sit for six; can occasionally stoop, crouch, kneel and 

squat; can occasionally climb stairs; and can never climb ladders; can occasionally crawl; and can 

frequently push with the let (sic) – push and pull with the left upper extremity; and can 

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occasionally push and pull with the left lower extremity; and can occasionally reach with the left 

per (sic) extremity.” Id. at 457. The ALJ asked if such a person could perform any of the past 

relevant work described above. Id. The VE stated that only the manicurist job could be performed 

under the hypothetical standing and walking limitations, but the VE added that, based on his 

professional experience, small product assembler, collator, and information clerk in transportation

were jobs that would accommodate the hypothetical limitations. Id. at 458-61. The ALJ’s second 

hypothetical assumed an individual with the previous limitations “but also the limitation that they 

communicate with very little English,” and the VE stated that all except for information clerk 

would be available. Id. at 461. The VE added that cleaner and polisher are jobs that would be 

available to such a person. Id. at 462. 

The final hypothetical added the limitation that the individual would be absent from work 

three days per month. Id. at 466. The VE testified that none of the jobs would be available to such 

a person. Id. The ALJ had no further hypotheticals and asked Plaintiff’s counsel if she had any 

questions for the VE. Id. at 467. Counsel asked to clarify whether the hypotheticals included 

limitations due to depression, and the ALJ responded that the limitation to simple, routine tasks

was sufficient. Id. 

THE FIVE STEP SEQUENTIAL ANALYSIS FOR DETERMINING DISABILITY

A person filing a claim for social security disability benefits (“the claimant”) must show 

that she has the “inability to do any substantial gainful activity by reason of any medically 

determinable physical or mental impairment” which has lasted or is expected to last for twelve or 

more months. See 20 C.F.R. § 404.1505(a). The ALJ must consider all evidence in the claimant’s 

case record to determine disability (see id. § 404.1520(a)(3)), and must use a five-step sequential 

evaluation process to determine whether the claimant is disabled (see id. § 404.1520(a)(4)). “[T]he 

ALJ has a special duty to fully and fairly develop the record and to assure that the claimant’s 

interests are considered.” Brown v. Heckler, 713 F.2d 441, 443 (9th Cir. 1983).

Here, the ALJ evaluated Plaintiff’s application for benefits under the required five-step 

sequential evaluation. AR at 16-26. At Step One, the claimant bears the burden of showing she has 

not been engaged in “substantial gainful activity” since the alleged date the claimant became 

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disabled. See 20 C.F.R. § 404.1520(b). If the claimant has worked and the work is found to be 

substantial gainful activity, the claimant will be found not disabled. See id. The ALJ found that 

Plaintiff had not engaged in substantial gainful activity since the alleged onset date. AR at 18.

At Step Two, the claimant bears the burden of showing that she has a medically severe 

impairment or combination of impairments. See 20 C.F.R. § 404.1520(a)(4)(ii), (c). “An 

impairment is not severe if it is merely ‘a slight abnormality (or combination of slight 

abnormalities) that has no more than a minimal effect on the ability to do basic work activities.’” 

Webb v. Barnhart, 433 F.3d 683, 686 (9th Cir. 2005) (quoting S.S.R. No. 96–3(p) (1996)). The 

ALJ found that Plaintiff has the following severe impairments: degenerative disc disease of the 

lumbar spine, right shoulder tendinosis, depression, anxiety, somatoform disorder, and breast 

cancer status post lumpectomy and radiation. AR at 19.

At Step Three, the ALJ compares the claimant’s impairments to the impairments listed in 

appendix 1 to subpart P of part 404. See 20 C.F.R. § 404.1520(a)(4)(iii), (d). The claimant bears 

the burden of showing her impairments meet or equal an impairment in the listing. Id. If the 

claimant is successful, a disability is presumed and benefits are awarded. Id. If the claimant is 

unsuccessful, the ALJ assesses the claimant’s residual functional capacity (“RFC”) and proceeds 

to Step Four. See id. § 404.1520(a)(4)(iv), (e). Here, the ALJ found that Plaintiff did not have an 

impairment or combination of impairments that met or medically equaled one of the listed 

impairments. AR at 19-20. Next, the ALJ determined that Plaintiff retained the RFC to perform 

light work except she can stand and walk a total of 2-4 hours and sit a total of 6 in an 8-hour 

workday; occasionally stoop and crawl; rarely to occasionally climb stairs, crouch, kneel, and 

squat; never climb ladders; and can perform simple, routine tasks. Id. at 20-24.

At Step Four, the ALJ determined that Plaintiff was not capable of performing his past 

relevant work. AR at 24-25. Lastly, at Step Five, the ALJ concluded that based on the RFC, 

Plaintiff could perform the requirements of small product assembler, collater, and cleaner/polisher, 

and thus, had not been under a disability as defined in the Social Security Act, from January 1, 

2015, through the date of the issuance of the ALJ’s decision, August 15, 2017. AR at 25-26. 

//

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DISCUSSION

Plaintiff alleges the ALJ erred by: failing to call a medical advisor to establish the 

disability onset date; rejecting portions of Dr. Gowda’s opinion; rejecting Plaintiff’s testimony 

about the limiting effects of her symptoms; failing to consider all of Plaintiff’s limitations in 

determining her RFC; and failing to include all of Plaintiff’s limitations in the hypotheticals posed 

to the VE. Pl.’s Mot. (dkt. 19) at 20-30.

A. Failure to Call a Medical Advisor to Establish Plaintiff’s Disability Onset Date 

Plaintiff argues that the ALJ was required to call a medical advisor to establish her 

disability onset date because she had a chronic condition that worsened over time and that one

agency physician – Dr. Greene – found she met an impairment listing. Pl.’s Mot. (dkt. 19) at 20-

21. As Plaintiff points out, the ALJ rejected Dr. Greene’s opinion because there was insufficient 

medical evidence to support that finding. Id. at 21. Defendant counters that “because the ALJ did 

not find Plaintiff disabled at any point,” the ALJ was not required to call a medical advisor about 

her disability onset date. Def.’s Mot. (Dkt. 20) at 2. Plaintiff’s argument that the ALJ erred by 

failing to call an expert to establish the onset date of her chronic low back pain misses the mark

because the ALJ did not infer the onset of a disabling impairment. 

When the medical evidence is unclear about the disability onset date, the ALJ may only 

make inferences about the onset date based on “the informed judgment of the facts in the 

particular case. This judgment . . . must have a legitimate medical basis.” Morgan v. Sullivan, 945 

F.2d 1079, 1082 (9th Cir. 1991). Thus, in order to make an inference regarding disability onset 

date, the ALJ is required to call on a medical advisor to form the requisite legitimate basis. See id. 

Plaintiff relies on DeLorme v. Sullivan, 924 F.2d 841 (9th Cir. 1991) for the proposition 

that the ALJ did not have the requisite “legitimate medical basis” for determining her disability 

onset date. In DeLorme, the court found that the ALJ erred in failing to call an expert because 

medical reports indicated the claimant suffered mental impairments that “would have met the

criteria set forth in the Listing of Impairments, depending on the duration of his mental problems.” 

Id. at 847. The claimant had one comprehensive report of depression, but a number of earlier 

medical records pertaining to his back problems mentioned depression. Id. at 844. Based on the 

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sporadic yet repeated documentation of depression, the ALJ in DeLorme was required to call a 

medical advisor to ascertain the onset date. Here, on the other hand, Plaintiff presented medical 

records spanning from 2014 to 2016. The question for the ALJ was not when Plaintiff’s low back 

pain became disabling, but rather, whether Plaintiff’s low back pain was disabling or not. Thus, it 

was not necessary for the ALJ to call a medical expert to determine the onset date. 

B. Rejecting Portions of Dr. Gowda’s Opinion

Plaintiff’s second argument is that the ALJ failed to give specific and legitimate reasons 

for rejecting the opinion of Dr. Gowda – Plaintiff’s treating physician – about Plaintiff’s 

functional limitations. Pl.’s Mot. (dkt. 19) at 21-24. Although the ALJ summarized a good deal of 

the medical record, Plaintiff argues that the ALJ did not identify conflicting evidence and did not 

properly weigh Dr. Gowda’s medical opinion. Id. at 23-24. Defendant argues that the ALJ 

provided specific and legitimate reasons by citing to medical evidence which supported Plaintiff’s 

limitations as well as records that showed instances of normal physical exams and mild to 

moderate diagnostic studies. Def.’s Mot. (dkt. 20) at 3-5. 

“As a general rule, more weight should be given to the opinion of a treating source than to 

the opinion of doctors who do not treat the claimant . . . [T]he Commissioner must provide clear 

and convincing reasons for rejecting the uncontradicted opinion of an examining physician.”

Turner v. Comm’r of Soc. Sec., 613 F.3d 1217, 1222 (9th Cir. 2010) (quoting Lester v. Chater, 81 

F.3d 821, 830-31 (9th Cir. 1995)). The reason that an ALJ must accord special weight to a treating 

physician’s opinion is that a treating physician “is employed to cure and has a greater opportunity 

to know and observe the patient as an individual.” Magallanes v. Bowen, 881 F.2d 747, 751 (9th 

Cir. 1989) (citation omitted). If a treating source’s opinions on the issues of the nature and severity 

of a claimant’s impairments are well-supported by medically acceptable clinical and laboratory 

diagnostic techniques, and are not inconsistent with other substantial evidence in the case record, 

the ALJ must give it “controlling weight.” 20 C.F.R. § 404.1527(c)(2). However, if the treating 

physician’s opinion is contradicted by another physician, such as an examining physician, the ALJ 

may reject the treating physician’s opinion by providing specific, legitimate reasons, supported by 

substantial evidence in the record. Id. at 830-31; Orn v. Astrue, 495 F.3d 625, 632 (9th Cir. 2007); 

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

Here, the ALJ assigned only “some weight” to Dr. Gowda’s medical opinion about 

Plaintiff’s limitations while assigning “great weight” to Dr. Pon’s medical opinion. AR at 23-24. In 

rejecting parts of Dr. Gowda’s opinion, the ALJ stated “the medical evidence as a whole, as 

already discussed above, does not support the more extreme limitations that [Dr. Gowda] found 

(i.e. lifting and carrying less than 10 pounds, standing and walking no more than 2 hours, likely to 

be absent more than 3 times per month).” AR at 24. The ALJ stated that Dr. Pon’s opinion was 

“wholly consistent with the medical evidence of record, including the diagnostic studies and 

objective findings from various treating physicians which document some tenderness and reduced 

range of motion in the lumbar spine.” Id. at 23.

There are several defects with the ALJ’s explanation. First, Dr. Gowda had a close 

working relationship with the other “various treating physicians” as they worked at the same 

medical clinic and collaborated with one another regarding Plaintiff’s treatment. Id. at 1702-1882.

Moreover, Dr. Gowda had monthly follow-up visits with Plaintiff for more than a year. Id. at

1702-81. Dr. Pon evaluated Plaintiff one time on October 28, 2015. Id. at 828-33. Second, the ALJ 

stated that “the medical evidence as a whole” did not support some of Dr. Gowda’s opinion but 

failed to identify specific conflicting facts or clinical evidence. In fact, the ALJ’s summation of the 

medical evidence revealed consistent diagnostic exam results and physical exams. For example, 

two MRIs of Plaintiff’s lumbar spine, one performed in August of 2014 and the other performed in 

July of 2015, revealed mild disc disease at L4-5. Id. at 21-22. Additionally, Dr. Pon’s physical 

examination of Plaintiff did not conflict with Dr. Gowda’s – both of which were performed in 

October of 2015. Id. at 828-33, 1765-67. The two physicians found Plaintiff had low back pain 

that radiated down the left leg and a positive straight leg raise test on the left. Id. at 830-31, 1765-

67. Where a treating physician’s opinion is contradicted by an examining professional’s opinion, 

the ALJ may resolve the conflict by relying on the examining physician’s opinion if the examining 

physician’s opinion is supported by different, independent clinical findings. See Andrews v. 

Shalala, 53 F.3d 1035, 1041 (9th Cir. 1995); Orn, 495 F.3d at 632; see also Bayliss, 427 F.3d at 

1216 (if an examining physician’s opinion is contradicted by another physician’s opinion, an ALJ 

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must provide specific and legitimate reasons to reject it). “When an examining physician relies on 

the same clinical findings as a treating physician, but differs only in his or her conclusions, the 

conclusions of the examining physician are not ‘substantial evidence.’” Orn, 495 F.3d at 632. 

Thus, the ALJ failed to provide specific, legitimate reasons supported by substantial evidence to 

justify rejecting Dr. Gowda’s medical opinion. 

C. Rejecting Plaintiff’s Testimony Concerning Intensity, Persistence, and Limiting 

Effects of Symptoms

Plaintiff argues that the ALJ improperly rejected Plaintiff’s testimony concerning intensity, 

persistence, and limiting effects of symptoms, and thus the ALJ’s decision lacks the support of 

substantial evidence. Pl.’s Mot. (dkt. 19) at 24-27. Defendant argues that the ALJ properly rejected 

Plaintiff’s testimony because the ALJ provided legally sufficient reasons and only discounted 

aspects of Plaintiff’s testimony that alleged greater limits than Plaintiff’s RFC. Def.’s Cross Mot. 

(dkt. 20) at 5-6. The ALJ stated that Plaintiff’s allegations were “out of proportion with the 

diagnostic studies” and several providers’ notes stated Plaintiff “engaged in dramatic pain 

behavior.” AR at 23. 

The assessment of a claimant’s credibility regarding the intensity of symptoms requires an 

ALJ to engage in a two-step analysis. See Ghanim v. Colvin, 763 F.3d 1154, 1163 (9th Cir. 2014); 

see also Molina v. Astrue, 674 F.3d 1104, 1112 (9th Cir. 2012); Vasquez v. Astrue, 572 F.3d 586, 

591 (9th Cir. 2009). Initially, 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.” Ghanim, 763 F.3d at 1163 (quoting Vasquez, 572 

F.3d at 591). If the claimant satisfies the first test, and there is no evidence of malingering, the 

ALJ can then reject a claimant’s symptom testimony by giving specific, clear and convincing 

reasons for the rejection. Id.; see also Lingenfelter v. Astrue, 504 F.3d 1028, 1036 (9th Cir. 2007). 

General findings, therefore, will not suffice and an ALJ must identify what testimony is not 

credible and what evidence undermines the claimant’s complaints. Ghanim, 763 F.3d at 1163; see 

also Lester, 81 F.3d at 834. 

Here, because there was no evidence of malingering, the Plaintiff’s testimony regarding the 

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intensity of her symptoms could not be rejected without providing specific, clear, and convincing 

reasons based on substantial evidence. The ALJ’s explanation failed to satisfy that standard. First, 

the ALJ does not specifically identify which portions of Plaintiff’s testimony were being rejected 

as not entirely consistent with the record. Instead, the ALJ stated that Plaintiff’s “statements have 

been found to affect the claimant’s ability to work only to the extent they can reasonably be 

accepted as consistent with the objective medical evidence.” Id. at 21. For instance, it is unclear if 

the ALJ rejected Plaintiff’s testimony that she could not sit for more than 10 to 15 minutes and 

could only walk a half of a block at a time (id. at 441); or that halfway to her upstairs apartment 

Plaintiff must crawl because she cannot walk anymore (id. at 447). 

Second, the ALJ did not provide clear and convincing reasons to reject Plaintiff’s 

testimony. Instead, the ALJ summarized years of medical treatment and diagnostic studies which 

showed Plaintiff suffers from chronic low back pain and degenerative disc disease along with 

clinical findings of positive straight leg raise tests and loss of sensation in the leg and foot. Id. at 

21-23. The ALJ, however, pointed to a single note by Dr. Washburn which stated that Plaintiff’s 

pain was out of proportion to physical findings. Id. at 23, 2250. The ALJ also mentioned other 

medical records which showed Plaintiff having emotional reactions to various events in the 

presence of physicians (e.g. when recalling her journey from Cambodia and her relationship with 

her husband; or when stitches were removed from her leg). Id. at 23. However, the medical 

evidence, as recited by the ALJ, shows Plaintiff suffered for years from L4-5 mild disc disease, 

made several emergency room visits, and underwent prolonged and aggressive pain management 

treatments including physical therapy, epidural injections, pain medications, and psychotherapy –

all of which provided little to no relief. Id. at 21-23. 

The court finds that the ALJ’s rejection of some unspecified portions of Plaintiff’s 

testimony was inherently erroneous. Although the ALJ identified some evidence that could tend to

undermine Plaintiff’s credibility about the intensity of her pain, the decision lacked enough 

specificity for this court to determine exactly what testimony was rejected and why. Thus, the ALJ 

erred in rejecting Plaintiff’s testimony regarding the intensity, persistence, and limiting effects of 

her symptoms. 

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D. Failure to Consider All of Plaintiff’s Limitations in Determining RFC

Plaintiff argues that the ALJ erred in determining her RFC because it did not include her 

non-severe impairments (e.g. changing pain level, emotional instability, social limitations, and 

education). Pl.’s Mot. (dkt. 19) at 27-29. Defendant argues that the ALJ’s RFC finding was proper 

because the RFC assesses a claimant’s functional capabilities, not education level; the RFC 

adequately accounted for difficulties in adaptation and self-management; and mild social 

limitations were not necessary to the RFC assessment. Def.’s Mot. (dkt. 20) at 6-7. 

At Step 3, the ALJ found only “mild limitations in understanding, remembering, or 

applying information; mild limitation in interacting with others mild limitation in concentrating, 

persisting, or maintaining pace; and moderate limitation in adapting or managing oneself.” AR at 

19. Additionally, the ALJ found that the record did not show that Plaintiff had only a minimal 

capacity to adapt to environment or demands not part of Plaintiff’s regular life. Id. at 19-20. The 

ALJ found Plaintiff could perform simple, routine tasks. Id. at 20. 

An ALJ is required to consider non-severe as well as severe impairments when assessing a 

claimant’s RFC. See Celaya v. Halter, 332 F.3d 1177, 1181 (9th Cir. 2003). “The ALJ must 

consider a claimant's physical and mental abilities, § 416.920(b) and (c), as well as the total 

limiting effects caused by medically determinable impairments and the claimant's subjective 

experiences of pain, § 416.920(e).” Garrison v. Colvin, 759 F.3d 995, 1011 (9th Cir. 2014). “[A]n 

ALJ's assessment of a claimant adequately captures restrictions related to concentration, 

persistence, or pace where the assessment is consistent with restrictions identified in the medical 

testimony.” Stubbs-Danielson v. Astrue, 539 F.3d 1169, 1174 (9th Cir. 2008). 

First, the ALJ was not required to consider Plaintiff’s education level to determine her 

RFC. Second, the ALJ’s restriction to simple, routine tasks adequately addressed Plaintiff’s 

restrictions regarding concentration, persistence, and pace. However, the ALJ erred in assessing 

the medical evidence, specifically the rejection of Plaintiff’s treating provider, and thus, failed to 

consider all the relevant medical evidence and restrictions stated therein. Thus, the court finds that 

the ALJ erred by making the above-mentioned errors. 

//

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E. Failure to Include All of Plaintiff’s Limitations in Hypotheticals to VE

Finally, Plaintiff submits that the ALJ erred by failing to include all of Plaintiff’s 

limitations in the hypothetical questions, rendering the VE’s opinion incomplete. Pl.’s Mot. (dkt. 

19) at 29-30. Plaintiff, however, only points to her educational limits in making this argument. Id. 

at 29. Defendant counters that the ALJ properly relied on the VE’s testimony because the 

hypotheticals were based on Plaintiff’s vocational profile and RFC. Def.’s Mot. (dkt. 20) at 8-9. 

The VE was present by phone for the entire hearing, and as such, he heard the ALJ question 

Plaintiff about her level of education on two instances (see AR at 432, 453-54), and the ALJ’s 

hypotheticals to the VE supposed an individual of Plaintiff’s education level (id. at 457). Thus,

Plaintiff’s argument that the ALJ did not consider her education level is without merit. However, 

on remand, the ALJ should address why she rejected Dr. Gowda’s opinion that Plaintiff would be 

absent from work 3 times per month because the VE testified that no jobs would be available to a 

person who would be absent three days per month (id. at 466). 

CONCLUSION

For the reasons stated above, the court GRANTS Plaintiff’s motion for summary 

judgment, DENIES Defendant’s motion for summary judgment, and REMANDS the case for 

further proceedings in accordance with the guidance provided herein.

A separate judgment will issue.

IT IS SO ORDERED.

Dated: March 23, 2020

ROBERT M. ILLMAN

United States Magistrate Judge

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