Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_18-cv-02226/USCOURTS-cand-3_18-cv-02226-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:405 Review of HHS Decision (SSID)

---

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

RICHARD AJANI,

Plaintiff,

v.

COMMISSIONER OF SOCIAL 

SECURITY,

Defendant.

Case No. 18-cv-02226-SI 

ORDER RE: CROSS-MOTIONS FOR 

SUMMARY JUDGMENT

Re: Dkt. Nos. 12, 17

The parties have filed cross-motions for summary judgment in this Social Security appeal. 

Dkt. Nos. 12, 15. Having considered the parties’ papers and the administrative record, the Court 

hereby GRANTS plaintiff’s motion for summary judgment and DENIES defendant’s cross-motion 

for summary judgment. The matter is REMANDED for immediate payment of benefits.

BACKGROUND

I. Administrative Proceedings

In September 2013, plaintiff Richard Ajani applied for Disability Insurance Benefits and 

Supplemental Security Income under Titles II and XVI of the Social Security Act. Administrative 

Record (“AR”) at 152, 365, 372. He alleged a disability onset date of June 5, 2000. Id. at 365, 

372. His applications were denied originally and upon reconsideration. Id. at 282, 287, 298. 

Plaintiff’s applications were then heard by Administrative Law Judge (“ALJ”) E. Alis at a hearing 

on October 27, 2016. Id. at 152. The ALJ denied plaintiff’s claims in a decision dated January 5, 

2017. Id. at 163. 

The Appeals Council denied review of plaintiff’s claims on March 19, 2018, rendering 

ALJ Alis’s denial the final decision of the Commissioner. Id. at 1-4. In denying review, the 

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 1 of 29
2

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

Appeals Council considered medical records that plaintiff submitted from Dr. Lisa Kalich, Psy.D., 

dated January 19, 2017; and from Lifelong Medical Care, dated December 2 through 28, 2016. Id.

at 2. The Appeals Council found “this evidence does not show a reasonable probability that it 

would change the outcome of the decision” and so the Appeals Council “did not consider and 

exhibit this evidence.”1 Id. The Appeals Council also reviewed medical records from Alta Bates 

Emergency dated May 22, 2017, and LifeLong Medical Care dated February 3 through August 24, 

2017, but found that these records “do[] not relate to the period at issue” because the ALJ decided 

plaintiff’s case through January 5, 2017. Id. 

On April 13, 2018, plaintiff filed this action for judicial review pursuant to 42 U.S.C. 

§ 405(g). Docket No. 1. Plaintiff moved for summary judgment and defendant cross-moved for 

summary judgment. Docket Nos. 12, 15. Briefing was completed when plaintiff filed a reply on 

February 22, 2019. Dkt. No. 20.

II. Medical History

By the time of the administrative hearing, plaintiff was a forty-two-year-old man with at 

least a high school education. AR at 162, 219, 450. His past work experience included part-time 

work doing deliveries, as a computer representative, and as a YMCA sales representative, 

concluding sometime in 1999. Id. at 416, 422-23, 435-37. He had not engaged in substantial 

gainful activity since June 5, 2000. Id. at 154. He had been homeless on and off since about 1998 

or 1999. Id. at 893.

Plaintiff applied for disability benefits on the basis of lupus, breathing problems, and 

asthma. Id. at 216. In his hearing before the ALJ, his attorney stated that he had “severe medical 

conditions including psoriatic arthritis, moderate to severe persistent asthma, fatigue, general 

anxiety disorder, and major depressive disorder.” Id. at 500. He has been diagnosed with asthma, 

bronchitis, celiac disease, a benign tumor in his back, psoriasis, and psoriatic arthritis. Id. at 915, 

 

1 The Court has likewise reviewed the assessment by Dr. Kalich and finds there is no 

reason to disturb the Appeals Council’s decision on this point. Dr. Kalich’s assessment repeats 

much of what is already found elsewhere in the record and its inclusion would not alter the Court’s 

decision in today’s Order. 

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 2 of 29
3

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

923, 1336. At the hearing before the ALJ, he reported having panic attacks almost daily. Id. at 

194, 201. 

III. Medical and Vocational Evidence

Plaintiff’s medical records include numerous records from plaintiff’s emergency room 

visits. The records show that plaintiff visited the emergency room over forty times for asthma 

exacerbation between 2013 and 2016. See id. at 1333; Pl.’s Mot. at 2 (citing record). The record 

also includes treatment notes from LifeLong Medical Care, where plaintiff began receiving 

treatment in May 2015 and where he began seeing Dr. Matthew Fentress, M.D., beginning in 

February 2016.

In addition to reviewing treatment records, the ALJ considered the opinions of five nontreating practitioners: Dr. R. Mitgang, M.D., the state agency non-examining physician who 

rendered an opinion at the agency’s initial stage of review on July 2, 2014; Dr. Katherine Wiebe, 

Ph.D., an examining psychologist who assessed plaintiff on December 1, 2014; Dr. Margaret 

Pollack, Ph.D., the state agency non-examining psychologist who rendered an opinion at the 

agency’s reconsideration stage of review on February 5, 2015; Dr. Alan Coleman, M.D., the state 

agency non-examining physician who rendered an opinion at the agency’s reconsideration stage of 

review on February 24, 2015; and Dr. Emily Cohen, M.D., an examining physician who assessed

plaintiff on September 7, 2016.

A. R. Mitgang, M.D. (Non-Examining Physician)

In July 2014, Dr. Mitgang rendered an opinion as part of the SSA’s initial review of 

plaintiff’s disability application. Dr. Mitgang reviewed medical records from plaintiff’s visits to 

Highland Hospital from September 2013 through February 2014. AR at 229. In assessing 

plaintiff’s physical residual functional capacity, Dr. Mitgang determined that plaintiff had no 

limitations except the following environmental limitation: that he should avoid even moderate 

exposure to fumes, odors, dusts, gases, and poor ventilation. Id. at 231-32.

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 3 of 29
4

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

B. Katherine Wiebe, Ph.D. (Examining Psychologist)

In December 2014, Dr. Katherine Wiebe, Ph.D., Licensed Clinical Psychologist, assessed 

plaintiff upon referral by his attorney. Id. at 892. During the assessment, Dr. Wiebe noted that 

plaintiff had a normal affect and normal speech and maintained good eye contact. Id. at 895. Dr. 

Wiebe determined that plaintiff had intellectual functioning in the average range; mild impairment 

in functioning in attention/concentration/persistence; moderate impairment in executive 

functioning; severe impairment in memory functioning (in the <0.1 percentile of performance on 

the RBANS Immediate Memory Index and at the 0.2 percentile of performance on the RBANS 

Delayed Memory Index); normal language abilities; normal visual/spatial abilities; and mild 

impairment in sensory/motor abilities. Id. at 895-97. She found marked limitations in plaintiff’s

ability to: understand, remember, and carry out very short and simple instructions; understand, 

remember, and carry out detailed instructions; respond appropriately to changes in a routine work 

setting and deal with normal work stressors; complete a normal workday and workweek without 

interruptions from psychologically based symptoms; and maintain regular attendance and be 

punctual within customary, usually strict tolerances.2 Id. at 906. Dr. Wiebe concluded that 

plaintiff’s “likely diagnosis” included: Generalized Anxiety Disorder; Major Depressive Disorder, 

Recurrent, Moderate; Avoidant Personality Traits, Obsessive Compulsive Personality Traits, 

Depressive Personality Features, and Paranoid Personality Features; and Rule-out Unspecified 

Neurocognitive Disorder. Id. at 902. She stated that plaintiff “would have some difficulties 

consistently attending to, remembering, and following through with directions and tasks in a job 

situation.” Id. She also found that “[h]is psychiatric and personality disorder problems, including 

relational problems with social avoidance and anxiety, could impair his ability to effectively 

participate in relationships, including with supervisors, co-workers, and the public in a work 

environment.” Id. She further found, “It is considered likely that the combination of Mr. Ajani’s 

cognitive, psychiatric disorder, and somatic symptoms will continue to make him likely unable to 

 

2 The report defined “marked” limitations as indicating that “Mr. Ajani is unable to 

perform the activity on a sustained basis in a 5 day a week, 8 hour a day, normal work setting.” 

AR at 905.

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 4 of 29
5

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

function effectively and consistently in a regular work environment, for two years.” Id. 

C. Margaret Pollack, Ph.D. (Non-Examining Psychologist) 

On February 5, 2015, Dr. Pollack conducted a psych case review as part of plaintiff’s 

application for benefits at the reconsideration stage. Dr. Pollack considered the December 2014 

assessment from Dr. Wiebe as well as the medical records that were before Dr. Mitgang and Dr. 

Coleman (see below). See id. at 252-53. Dr. Pollack concluded that “[m]emory problems appear 

to pose the most significant limitations on [plaintiff’s] functional abilities.” Id. at 253. In 

assessing plaintiff’s mental residual functional capacity, Dr. Pollack found plaintiff markedly 

limited in his ability to understand and remember detailed instructions and found him moderately 

limited in the following areas: ability to carry out detailed instructions, ability to maintain 

attention and concentration for extended periods, ability to complete a normal workday and 

workweek without interruptions from psychologically based symptoms and to perform at a 

consistent pace without an unreasonable number and length of rest periods, ability to interact 

appropriately with the general public, and ability to respond appropriately to changes in the work 

setting. Id. at 258-60.

D. Alan J. Coleman, M.D. (Non-Examining Physician)

On February 24, 2015, Dr. Coleman reviewed plaintiff’s medical records at the 

reconsideration stage of plaintiff’s benefits application. Dr. Coleman reviewed the records that 

were available to Dr. Mitgang as well as records from the Order of Malta Clinic dated October 

2013 and May 2014; Alameda County Medical Center records from January 2011; records 

regarding symptoms of systemic lupus from October 2013 through May 2014; and records from 

March, May, and July 2014 Emergency Room visits. Id. at 251. Dr. Coleman concluded that 

plaintiff did not have systemic lupus, that he may have psoriasis but that he did not seem to have 

psoriatic arthritis, and that “[h]e does have chronic asthmatic bronchitis for which he needs 

avoidance of pulmonary irritants.” Id. at 253. In assessing plaintiff’s physical residual functional 

capacity, Dr. Coleman determined that plaintiff was capable of carrying 50 pounds occasionally 

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 5 of 29
6

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

and 25 pounds frequently, that he could stand or walk more than 6 hours in an 8-hour workday, 

that he could sit 6 hours in an 8-hour workday, and that he should avoid even moderate exposure 

to fumes, odors, dusts, gases, and poor ventilation due to his asthma. Id. at 256-57.

E. Emily Cohen, M.D. (Examining Physician)

In September 2016, Dr. Cohen examined plaintiff for the purpose of providing information 

to the state disability office for use in making a disability determination. Id. at 1332. In doing so, 

she reviewed medical records from Alameda County Medical Center dated 2007-2016, from the 

Order of Malta Clinic from 2013-2014, and from Alta Bates Summit Medical Center from 2014-

2016. Id. Dr. Cohen listed the following impressions: “1) Psoriatic arthritis[;] 2) Moderate to 

severe persistent asthma, very poorly controlled. Pulmonary function tests pending. Claimant 

was advised to see his primary care provider for further management as soon as possible[;] 3) 

Tinea pedis [athlete’s foot].” Id. at 1336. Dr. Cohen determined that plaintiff could walk and/or 

stand 4 to 6 hours out of an 8-hour workday, sit for 6 hours in an 8-hour workday, and lift and 

carry 10 pounds frequently, 20 pounds occasionally, and 50 pounds rarely. Id. However, Dr. 

Cohen explained that “when he is experiencing shortness of breath due to his asthma, he will only 

be able to walk and/or stand for less than two hours in an eight hour workday and lift about ten 

pounds.” Id. Dr. Cohen predicted that plaintiff was “likely to experience these episodes multiple 

times monthly during cold weather and once monthly at other times.” Id. She further opined, “I 

anticipate that he will be absent from work at least three times per month in the winter due to his 

asthma and polyarthritis flares.” Id. She found plaintiff’s work environment should be free from 

pulmonary irritants and that he should not be exposed to cold temperatures. Id.

LEGAL STANDARD

I. Standard of Review 

The Social Security Act authorizes judicial review of final decisions made by the 

Commissioner. 42 U.S.C. § 405(g). Here, the decision of the ALJ stands as the final decision of 

the Commissioner because the Appeals Council declined review. 20 C.F.R. § 416.1481. The 

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 6 of 29
7

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

Court may enter a judgment affirming, modifying or reversing the decision of the Commissioner, 

with or without remanding the case for a rehearing. 42 U.S.C. § 405(g).

Factual findings of the Commissioner are conclusive if supported by substantial evidence. 

Batson v. Comm’r of Soc. Sec. Admin., 359 F.3d 1190, 1193 (9th Cir. 2001). The Court may set 

aside the Commissioner’s final decision when that decision is based on legal error or where the 

findings of fact are not supported by substantial evidence in the record taken as a whole. Tackett 

v. Apfel, 180 F.3d 1094, 1097-98 (9th Cir. 1999). Substantial evidence is “more than a mere 

scintilla but less than a preponderance.” Id. at 1098. Substantial evidence means “such relevant 

evidence as a reasonable mind might accept as adequate to support a conclusion.” Molina v. 

Astrue, 674 F.3d 1104, 1110 (9th Cir. 2012) (internal quotation marks and citations omitted). To 

determine whether substantial evidence exists, the Court must consider the record as a whole, 

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

conclusion. Tackett, 180 F.3d at 1098. “Where evidence is susceptible to more than one rational 

interpretation,” the ALJ’s decision should be upheld. Burch v. Barnhart, 400 F.3d 676, 679 (9th 

Cir. 2005).

II. Disability Benefits

A claimant is “disabled” under the Social Security Act if: (1) the claimant “is unable to 

engage in any substantial gainful activity by reason of any medically determinable 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 twelve months,” and (2) the impairment is “of such 

severity that he is not only unable to do his previous work but cannot, considering his age, 

education, and work experience, engage in any other kind of substantial gainful work which exists 

in the national economy.” 42 U.S.C. § 1382c(a)(3)(A)-(B). The SSA regulations provide a fivestep sequential evaluation process for determining whether a claimant is disabled. 20 C.F.R. 

§ 416.920(a)(4). The claimant has the burden of proof for steps one through four and the 

Commissioner has the burden of proof for step five. Tackett, 180 F.3d at 1098. 

The five steps of the inquiry are:

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 7 of 29
8

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

1. Is claimant presently working in a substantially gainful activity? 

If so, then the claimant is not disabled within the meaning of the 

Social Security Act. If not, proceed to step two. See 20 C.F.R. 

§§ 404.1520(b), 416.920(b). 

2. Is the claimant’s impairment severe? If so, proceed to step three. 

If not, then the claimant is not disabled. See 20 C.F.R. 

§§ 404.1520(c), 416.920(c). 

3. Does the impairment “meet or equal” one of a list of specific 

impairments described in 20 C.F.R. Part 220, Appendix 1? If so, 

then the claimant is disabled. If not, proceed to step four. See 20 

C.F.R. §§ 404.1520(d), 416.920(d). 

4. Is the claimant able to do any work that he or she has done in the 

past? If so, then the claimant is not disabled. If not, proceed to step 

five. See 20 C.F.R. §§ 404.1520(e), 416.920(e). 

5. Is the claimant able to do any other work? If so, then the claimant 

is not disabled. If not, then the claimant is disabled. See 20 C.F.R. 

§§ 404.1520(f), 416.920(f). 

Bustamante v. Massanari, 262 F.3d 949, 954 (9th Cir. 2001). The ALJ has an affirmative duty to 

assist the claimant in developing the record at every step of the inquiry. Tackett, 180 F.3d at 1098 

n.3. 

In between the third and fourth steps, the ALJ must determine the claimant’s Residual 

Functional Capacity (“RFC”). 20 C.F.R. §§ 404.1520(a)(4), (e), 416.945(a)(5)(1). To determine

the RFC, the ALJ considers the impact of the claimant’s symptoms on his or her ability to meet 

the physical, mental, sensory, and other requirements of work. Id. §§ 404.1545(a)(4), 416.945(e). 

The ALJ will evaluate all the claimant’s symptoms and the extent to which these symptoms are 

consistent with evidence in the record. Id. The evidence can include the claimant’s own 

statements about his or her symptoms, but such statements must be adequately supported by the 

record in order to establish a disability. Id. In order to determine whether the claimant’s 

statements are adequately supported, the ALJ must first determine whether the claimant has a 

medical impairment that could reasonably be expected to produce his or her symptoms, and then 

must evaluate the intensity and persistence of the claimant’s symptoms. Id. When evaluating 

intensity and persistence, the ALJ must consider all of the available evidence, including the 

claimant’s medical history, objective medical evidence, and statements about how the claimant’s 

symptoms affect him or her. Id. The ALJ cannot reject statements about the intensity and 

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 8 of 29
9

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

persistence of symptoms solely because no objective medical evidence substantiates the 

statements. Id. §§ 404.1529(c)(2), 416.929(c)(2). The ALJ must also consider factors relevant to 

the claimant’s symptoms, such as the claimant’s daily activities, the claimant’s medications and 

treatment, any other measures the claimant uses to alleviate symptoms, precipitating and 

aggravating factors, and any other factors relevant to the claimant’s limited capacity for work due 

to his or her symptoms. Id. § 416.929(c)(3)(i)-(vii). After determining the RFC, the ALJ proceeds 

to steps four and five of the disability inquiry.

ALJ’S DECISION

Plaintiff was represented by counsel at the hearing before the ALJ.

3

 AR at 152. The ALJ 

heard testimony from plaintiff as well as from vocational expert (“VE”) John P. Kilcher. No 

medical expert testified.

On January 5, 2017, the ALJ issued a decision finding that plaintiff was not disabled 

within the meaning of the Social Security Act from June 5, 2000, through the date of the decision. 

In determining plaintiff’s disability status, the ALJ applied the five-step disability analysis in 

accordance with 20 C.F.R. §§ 404.1520(a) and 416.920(a). Id. at 153-54. At step one, the ALJ 

determined that plaintiff had not engaged in substantial gainful activity since June 5, 2000, the 

alleged onset date of plaintiff’s disability. Id. at 154. At step two, the ALJ found that plaintiff 

suffered severe impairment from asthma, psoriasis, psoriatic arthritis, and an anxiety disorder. Id.

At step three, the ALJ found that plaintiff’s impairments did not meet or equal the severity of any 

impairment in the Listing of Impairments, including Listings 3.03 (Asthma), 8.05 (Dermatitis), 

14.09 (Inflammatory Arthritis), or 12.06 (Affective Disorder). Id. at 156-57.

Before proceeding to step four, the ALJ examined plaintiff’s RFC. Id. at 157. In assessing 

plaintiff’s RFC, the ALJ evaluated plaintiff’s testimony and the medical evidence and weighed the 

opinions of the examining doctors and non-examining doctors. The ALJ gave “great weight” to 

the conclusions of the state agency non-examining doctors, Dr. Coleman and Dr. Pollack, who 

 

3 The same counsel now represents plaintiff in this appeal.

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 9 of 29
10

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

found plaintiff capable of performing medium work with moderate limitations. Id. at 160. The 

ALJ gave “little weight” to the opinion of state agency physician Dr. Mitgang. Id. The ALJ gave 

“partial weight” to the opinion of examining psychologist Dr. Wiebe, explaining that her 

conclusions were “inconsistent with the absence of mental health treatment” and “inconsistent 

with the claimant’s reported activities, including his ability to use public transportation, go 

shopping and go to the bookstore.” Id. The ALJ also gave “partial weight” to the opinion of 

examining physician Dr. Cohen, finding that the limitations she found were “out of proportion to 

the objective medical findings, including the absence of any objective findings on repeated chest 

x-rays” and that any reliance on a finding of psoriatic arthritis was “equivocal with diffuse joint 

pain associated with psoriatic arthritis not well-documented in the record.” Id. As to plaintiff’s 

own testimony, the ALJ determined that the plaintiff’s medically determinable impairments could 

reasonably be expected to cause the alleged symptoms, but the ALJ found that plaintiff’s 

testimony regarding the symptoms’ severity was not entirely credible. Id. at 161-62.

In light of the above assessment, the ALJ found plaintiff had the RFC to perform medium

work as defined in 20 C.F.R. §§ 404.1567(c) and 416.967(c),4 with the following limitations: 

no concentrated exposure to cold, heat, dampness, work outdoors, fumes, odors, 

dust, gases or work settings with poor ventilation, but without a need for a 

clean/sterile environment, and a limitation to work involving simple routine tasks, 

simple work-related decisions, occasional interaction with supervisors and 

coworkers, no tandem/team/group work; no interactions with the public, and a need 

for a stable work environment, meaning that there would be few, if any, changes in 

the day-to-day work setting, and in the tools and/or work processes used to 

accomplish tasks. 

Id. at 157. 

Continuing to step four, the ALJ found that plaintiff had no past relevant work. Id. at 162. 

 

4 Social Security regulations provide that the term “medium work” has the following 

definition, mirroring that used in the Dictionary of Occupational Titles:

Medium work involves lifting no more than 50 pounds at a time with frequent 

lifting or carrying of objects weighing up to 25 pounds. If someone can do medium 

work, we determine that he or she can also do sedentary and light work.

20 C.F.R. §§ 404.1567(c), 416.967(a).

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 10 of 29
11

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

At step five, the ALJ relied on testimony from the vocational expert to find that jobs existed in 

significant numbers in the national economy that plaintiff could perform, and therefore a finding 

of “not disabled” was appropriate. Id. at 162-63.

DISCUSSION

Plaintiff argues that the ALJ erred in evaluating medical opinion testimony, particularly by 

giving “partial weight” to the opinions of the examining doctors, Dr. Cohen and Dr. Wiebe, while 

giving the most weight to the non-examining doctors, Dr. Coleman and Dr. Pollack. Second, he 

contends the ALJ erred in discrediting plaintiff’s testimony by failing to provide specific, clear 

and convincing reasons based on substantial evidence in the record. Third, plaintiff states that as a 

result of the above errors the ALJ erred in determining plaintiff’s RFC and in finding at step five 

that plaintiff could perform other work in the national economy. Plaintiff requests the Court order 

an immediate award of benefits or, in the alternative, remand for further administrative 

proceedings. Defendant contends that substantial evidence supports all of the ALJ’s findings and 

conclusions and that the ALJ’s decision is free from reversible error. 

I. Medical Opinions 

Courts “distinguish among the opinions of three types of physicians: (1) those who treat 

the claimant (treating physicians); (2) those who examine but do not treat the claimant (examining 

physicians); and (3) those who neither examine nor treat the claimant (nonexamining physicians).” 

Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995), as amended (Apr. 9, 1996). Generally, the 

opinion of a treating physician should be given greater weight than that of an examining or nonexamining physician. Id. Similarly, an examining physician’s opinion usually should be given 

more weight than that of a physician who has not examined the claimant. Ryan v. Comm’r of Soc. 

Sec., 528 F.3d 1194, 1198 (9th Cir. 2008). For claims filed before March 27, 2017, such as 

plaintiff’s, “[t]he medical opinion of a claimant’s treating physician is given ‘controlling weight’ 

so long as it ‘is well-supported by medically acceptable clinical and laboratory diagnostic 

techniques and is not inconsistent with the other substantial evidence in [the claimant’s] case 

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 11 of 29
12

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

record.’” Trevizo v. Berryhill, 871 F.3d 664, 675 (9th Cir. 2017) (quoting 20 C.F.R. 

§ 404.1527(c)(2)). 

“If a treating or examining doctor’s opinion is contradicted by another doctor’s opinion, an 

ALJ may only reject it by providing specific and legitimate reasons that are supported by 

substantial evidence.” Ryan, 528 F.3d at 1198. This is necessary “because, even when 

contradicted, a treating or examining physician’s opinion is still owed deference and will often be 

‘entitled to the greatest weight . . . even if it does not meet the test for controlling weight.’” 

Garrison, v. Colvin, 759 F.3d 995, 1012 (9th Cir. 2014) (quoting Orn v. Astrue, 495 F.3d 625, 633 

(9th Cir. 2007)). “The opinion of a nonexamining physician cannot by itself constitute substantial 

evidence that justifies the rejection of the opinion of either an examining physician or a treating 

physician.” Lester, 81 F.3d at 831 (citing Pitzer v. Sullivan, 908 F.2d 502, 506 n.4 (9th Cir. 1990); 

Gallant v. Heckler, 753 F.2d 1450, 1456 (9th Cir. 1984)).

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

and conflicting clinical evidence, stating his interpretation thereof, and making findings.” 

Magallanes v. Bowen, 881 F.2d 747, 751 (9th Cir. 1989). Conclusory statements by the ALJ are 

insufficient; she “must set forth her own interpretations and explain why they, rather than the 

doctors’, are correct.” Id. An ALJ errs if he “does not explicitly reject a medical opinion or set 

forth specific, legitimate reasons for crediting one medical opinion over another[.]” Garrison, 759 

F.3d at 1012-13 (citing Nguyen v. Chater, 100 F.3d 1462, 1464 (9th Cir. 1996)). 

A. Opinions Regarding Physical Limitations

Plaintiff argues that the ALJ erred in giving “great weight” to the opinion of nonexamining physician Dr. Coleman while giving “partial weight” to the opinion of examining 

physician Dr. Cohen. In particular, plaintiff challenges the ALJ’s rejection of Dr. Cohen’s 

opinions regarding the functional limitations associated with plaintiff’s asthma and psoriatic 

arthritis. Plaintiff also challenges the rejection of Dr. Cohen’s opinion that plaintiff’s conditions 

would cause him to miss at least three days of work per month during the winter. For the reasons 

that follow, the Court finds the ALJ committed error by not sufficiently supporting the weight 

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 12 of 29
13

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

given to the medical opinions of Dr. Cohen and Dr. Coleman. 

Dr. Cohen’s opinion regarding plaintiff’s functional limitations was contradicted by Dr. 

Coleman, who found plaintiff capable of performing medium work with only the environmental 

limitation of avoiding exposure to dust, odors, gases, etc. As such, in order to give greater weight 

to the opinion of Dr. Coleman (a non-examining doctor) than to that of Dr. Cohen (an examining 

doctor), the ALJ needed to “provid[e] specific and legitimate reasons that are supported by 

substantial evidence.” See Ryan, 528 F.3d at 1198. 

In determining the RFC, the ALJ found, in relevant part:

. . . I give great weight to the conclusions of State Agency medical consultants Dr. 

Coleman and Dr. Pollock [sic] who found upon reconsideration of the case that the 

claimant can perform medium work with moderate limitations in his ability to meet 

some of the mental demands of work (Exhibit 6A). Their findings are consistent 

with the record as a whole.

. . .

Partial weight is . . . given to the conclusions by Dr. Cohen. To the extent that they 

are consistent with the above residual functional capacity finding they are 

supported by the objective medical evidence of record and the claimant’s history. 

Dr. Cohen’s finding that the claimant would generally be limited to lifting of 10 

pounds frequently and 20 pounds occasionally, and would be limited to 

walking/standing for less than 2 hours and lifting 10 pounds when he is short of 

breath are out of proportion to the objective medical findings, including the absence 

of any objective findings on repeated chest x-rays. Moreover, to the extent that Dr. 

Cohen relied upon a finding of psoriatic arthritis and [sic] finding the claimant 

limited to performing less than a full range of light work, I note that the findings of 

psoriatic arthritis are equivocal with diffuse joint pain associated with psoriatic 

arthritis not well-documented in the record.

AR at 160.

The ALJ’s assignment of greater weight to Dr. Coleman’s opinion than to Dr. Cohen’s was 

erroneous for several reasons. First, it appears the ALJ reached a determination on the RFC and 

then selectively weighed the medical opinions based on which ones supported the RFC assigned.

The ALJ accepted unspecified portions of Dr. Cohen’s opinion only to the extent they were 

“consistent with the above residual functional capacity finding,” explaining generally that in this 

way they were “supported by the objective medical evidence of record and the claimant’s history.” 

See id. Similarly, the ALJ gave no specific reasons for giving great weight to Dr. Coleman’s 

opinion, stating only broadly that his “findings are consistent with the record as a whole.” See id. 

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 13 of 29
14

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

It thus appears that the ALJ weighed Dr. Coleman’s opinion more heavily because it comported 

with the RFC that the ALJ assigned. This was error. The ALJ is charged with evaluating the 

medical evidence and then using that to determine the RFC, not the other way around. Cf. Revels 

v. Berryhill, 874 F.3d 648, 666 (9th Cir. 2017) (“The ALJ took a backward approach to 

determining [the claimant’s] credibility. . . . To determine the RFC first and then assess the 

claimant’s testimony is to ‘put[ ] the cart before the horse.’”) (quoting Laborin v. Berryhill, 867 

F.3d 1151, 1154 (9th Cir. 2017)).

Second, the reasons that the ALJ gave for partially rejecting Dr. Cohen’s opinion are not 

specific and legitimate nor are they supported by substantial evidence. The only specific reason 

the ALJ cited for rejecting Dr. Cohen’s assessment regarding lifting/carrying limitations and 

limitations when plaintiff was short of breath was “the absence of any objective findings on 

repeated chest x-rays.” See AR at 160. Earlier in the decision, the ALJ elaborates, stating that the 

“severity of plaintiff’s asthma-related symptoms has been variable[,]” citing in part to a series of 

chest x-rays from December 2002 to April 2016 that “were all unremarkable[.]” Id. at 157-58. 

Plaintiff argues that in doing this, the ALJ has “improperly substituted his own lay medical 

opinion for that of the examining physician.” Pl.’s Mot. at 9. The Court agrees. The ALJ 

provides no reason why plaintiff’s chest x-ray results are inconsistent with Dr. Cohen’s 

assessment regarding asthma-related limitations. To the extent the ALJ understood 

“unremarkable” chest x-rays to be inconsistent with an asthma diagnosis, that assumption is belied 

by the medical records themselves. For instance, Dr. Cohen considered chest x-ray results from 

April 2013 and November 2015 that showed nothing more than “mild pulmonary hyperinflation.” 

See AR at 1333. Yet Dr. Cohen still reached the conclusion that plaintiff had poorly controlled, 

moderate to severe persistent asthma that would limit his ability to walk and stand and lift more 

than ten pounds multiple times monthly during cold weather and monthly at other times. See id. at 

1336. Likewise, hospital records show diagnoses of asthma at the same time that chest x-ray 

results turned up “No acute cardiopulmonary radiographic findings.” See id. at 708, 711. The 

ALJ’s reliance on unremarkable chest x-rays is not a specific and legitimate reason for rejecting 

Dr. Cohen’s asthma-related findings. See Nguyen v. Chater, 172 F.3d 31, 35 (1st Cir. 1999) (“As 

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 14 of 29
15

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

a lay person, . . . the ALJ was simply not qualified to interpret raw medical data in functional 

terms and no medical opinion supported the documentation.”).

The ALJ also rejected Dr. Cohen’s opinion to the extent that she relied on psoriatic 

arthritis to support her conclusion that plaintiff was “limited to performing less than a full range of 

light work[.]” AR at 160. The regulations define “light work” as “lifting no more than 20 pounds 

at a time with frequent lifting or carrying of objects weighing up to 10 pounds.” 20 C.F.R. 

§§ 404.1567(b), 416.967(b). Light work may also involve a job that “requires a good deal of 

walking or standing[.]” Id. Dr. Cohen assessed plaintiff as being able to perform such light work 

(e.g., walking and/or standing for 4-6 hours of an 8-hour work day, lifting 10 pounds frequently, 

20 pounds occasionally, and 50 pounds rarely). AR at 1336. She assessed him as being limited to 

less than this range “when he is experiencing shortness of breath due to asthma[.]” Id. (emphasis 

added). Thus, nothing in Dr. Cohen’s functional assessment limits plaintiff to doing less than the 

full range of light work on the basis of psoriatic arthritis. 

Nor was the ALJ’s outright rejection of Dr. Cohen’s impression of psoriatic arthritis 

supported by substantial evidence. The ALJ rejected this impression, stating that “findings of 

psoriatic arthritis are equivocal with diffuse joint pain associated with psoriatic arthritis not welldocumented in the record.” Id. at 160. However, in July 2016 treating physician Dr. Fentress at 

LifeLong Medical Care assessed plaintiff as having psoriatic arthritis despite the fact that plaintiff 

was “not really complain[ing] of much joint pain, just some clicking[,]” and that the main 

manifestation of the condition was dermatologic. Id. at 1193; see also id. at 1188 (same, in 

August 2016), 1199 (noting rheumatologist’s provisional diagnosis of psoriatic arthritis and 

absence of joint pain, in April 2016). Thus, as with the chest x-rays above, the ALJ appears to 

have “succumb[ed] to the temptation to play doctor and make [his] own independent medical 

findings” when the treating and examining physicians in the record noted nothing inconsistent 

about a diagnosis of psoriatic arthritis without accompanying complaints of joint pain. See Rohan 

v. Chater, 98 F.3d 966, 970 (7th Cir. 1996).

The Court further notes that Dr. Coleman had access to only a limited set of medical

records that did not include the treatment records from LifeLong Medical Care. Dr. Coleman 

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 15 of 29
16

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

found in February 2015 that plaintiff “may have psoriasis but that he did not seem to have 

psoriatic arthritis.” AR at 253. But his limited record access undermines both Dr. Coleman’s 

assessment regarding psoriatic arthritis as well as any limitations based on plaintiff’s asthma. Dr. 

Coleman’s review did not include any records after July 2014 and so did not include records of 

plaintiff’s more than thirty visits to the emergency room for asthma exacerbation since that date. 

See id. at 1333. As Dr. Cohen noted in her September 2016 review, which did include such 

records, the records corroborate plaintiff’s “report of more frequent exacerbations in the winter 

months and over the past two years.” See id. 

For all of these reasons, the Court concludes that the ALJ failed to provide specific and 

legitimate reasons supported by substantial evidence for according great weight to the opinion of 

Dr. Coleman while according partial weight to the opinion of Dr. Cohen. In this way, the ALJ 

erred.5

B. Medical Opinions Regarding Mental Limitations

Plaintiff also argues the ALJ erred in according “great weight” to the opinion of nonexamining psychologist Dr. Pollack while according “partial weight” to the opinion of examining 

psychologist Dr. Wiebe. As the ALJ did with Dr. Coleman, the ALJ found Dr. Pollack’s opinion 

entitled to “great weight” because it was “consistent with the record as a whole.” See AR at 160. 

With regard to Dr. Wiebe, the ALJ determined: 

Partial weight is given to the conclusions by Dr. Wiebe to the extent that they are 

consistent with the above residual functional capacity assessment as, to that extent, 

they are consistent with the results of her examination and the record as a whole. 

To the extent that Dr. Wiebe found the claimant more limited, her conclusions are 

not persuasive as they are inconsistent with the absence of mental health treatment 

at any time relevant to the claimant’s applications and are also inconsistent with the 

 

5 Defendant forwards a number of arguments in support of the weight the ALJ accorded 

the various medical opinions. For instance, defendant argues that the records show plaintiff 

required emergency treatment after he had lapsed in taking his asthma medication, that his asthma 

improved after treatment, and that plaintiff smoked regularly. However, none of these arguments 

are ones that the ALJ provided in weighing the opinions of Dr. Coleman and Dr. Cohen. 

Defendant may not now supply a reason for the ALJ’s decision that the ALJ himself did not cite, 

particularly where the ALJ is required to give specific and legitimate reasons to support the

finding. This is precisely the sort of speculation that the Court is to avoid on judicial review. See 

Brown-Hunter v. Colvin, 806 F.3d 487, 489 (9th Cir. 2015). 

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 16 of 29
17

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

claimant’s reported activities, including his ability to use public transportation, go 

shopping and go to the bookstore.

Id. 

Dr. Wiebe found that plaintiff had marked limitations in a number of areas related to his 

mental abilities and aptitudes needed to do unskilled work and determined that the combination of 

his “cognitive, psychiatric disorder, and somatic symptoms will continue to make him likely 

unable to function effectively and consistently in a regular work environment, for two years.” Id. 

at 902, 906. Dr. Pollack found plaintiff to have at most moderate limitations, except in his ability 

to understand and remember detailed instructions, and found that he would adapt best to a 

stable/routine work-like environment. Id. at 258-60. Because Dr. Wiebe’s opinion regarding 

plaintiff’s limitations is contradicted by the opinion of Dr. Pollack, the ALJ needed to provide 

specific and legitimate reasons supported by substantial evidence for rejecting Dr. Wiebe’s 

opinion. See Ryan, 528 F.3d at 1198. The Court again concludes that the ALJ failed to do so and 

therefore erred in rejecting the opinion of Dr. Wiebe in favor of that of Dr. Pollack. 

The first reason the ALJ gave for rejecting Dr. Wiebe’s opinion was “the absence of 

mental health treatment at any time relevant to the claimant’s applications[.]” AR at 160. In 

Nguyen v. Chater, the Ninth Circuit found that the ALJ failed to provide a specific and legitimate 

reason for favoring the opinion of a non-examining psychologist over that of an examining 

psychologist. 100 F.3d at 1464. The ALJ had discounted the examining doctor’s finding of 

severe depressive disorder by citing to the non-examining doctor’s statement that “the evidence 

was devoid of any findings or complaints relative to a mental disorder” during a three-and-a-halfyear period. Id. In reversing and remanding the case, the appellate court quoted from a Sixth 

Circuit decision, explaining that the claimant “may have failed to seek psychiatric treatment for 

his mental condition, but it is a questionable practice to chastise one with a mental impairment for 

the exercise of poor judgment in seeking rehabilitation.” Id. at 1465 (quoting Blankenship v. 

Bowen, 874 F.2d 1116, 1124 (6th Cir. 1989)); but see Molina, 674 F.3d at 1113-14 (finding no 

error for the ALJ to conclude the level of treatment was inconsistent with the level of complaints, 

where the claimant failed to follow physician assistant’s repeated efforts to persuade her to seek 

counseling, and claimant failed to assert a good reason for not seeking treatment). Additionally, in 

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 17 of 29
18

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

the context of a claimant’s pain testimony, the Ninth Circuit has found that an ALJ errs in finding 

the testimony inconsistent with a lack of treatment, where the record shows the claimant did not 

seek treatment because he could not afford it. Regennitter v. Comm’r of Soc. Sec. Admin., 166 

F.3d 1294, 1296-97 (9th Cir. 1999).

The Court concludes that under the circumstances of this case, the ALJ’s citation to the 

absence of mental health treatment does not constitute a specific and legitimate reason for 

rejecting Dr. Wiebe’s findings. For much of the relevant time period, the record is 

overwhelmingly clear that plaintiff’s main access to the medical system was through the 

emergency room, where he regularly received treatment for his asthma exacerbations and other 

issues. Plaintiff consistently reported feelings of anxiety and depression, see, e.g., AR at 194, 201,

1188, 1201, 1334, but the record shows that he lacked the means to obtain treatment. Plaintiff was 

homeless “on and off” since 1998 or 1999. Id. at 893. He states that he was uninsured until May 

2015, and the records show no consistent primary care treatment before this time. See Pl.’s Mot. 

at 13; see also AR at 923 (Medi-Cal was cut off). And there are repeated notes from his 

emergency room visits showing that he did not fill his asthma prescriptions because of a lack of 

money. See, e.g., AR at 675, 885, 923, 930, 936. Given plaintiff’s history of homelessness and 

lack of consistent, non-emergency medical treatment of any kind, the Court finds that the ALJ 

erred in relying on the absence of mental health treatment as a basis for rejecting Dr. Wiebe’s 

opinion.6 

The second reason the ALJ gave for the weight accorded Dr. Wiebe’s opinion was that it 

was “inconsistent with the claimant’s reported activities, including his ability to use public 

 

6 Elsewhere in the decision, the ALJ stated that while “Dr. Wiebe . . . diagnosed a major 

depressive disorder in December 2014, the claimant appeared only mildly depressed at that time 

and that diagnosis has not been corroborated (Exhibit 8F).” AR at 155. This portion of the 

assessment states, in full, “His mood was mildly depressed and anxious; he was somewhat tense.” 

Id. at 895. For the ALJ to determine that this observation is inconsistent with a diagnosis of major 

depressive order was an improper substitution of the ALJ’s lay medical opinion for that of the 

examining psychologist. See Nguyen, 172 F.3d at 35; see also Regennitter, 166 F.3d at 1299 

(finding examining expert’s diagnoses of major depression, panic disorder, PTSD, and nightmare 

disorder were not inconsistent with what ALJ characterized as “benign Mental Status Exam,” 

where expert did not call the exam benign and where exams noted claimant “to be tearful and sad, 

with a monotone and hypophonic voice and psychomotor retardation” and noted “blunted affect 

and uncontrolled crying”). 

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 18 of 29
19

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

transportation, go shopping and go to the bookstore.” Id. at 160. The ALJ did not cite the specific 

source of information for these reported activities, but earlier in the decision the ALJ found that 

plaintiff had moderate restriction in activities of daily living. Id. at 156. The ALJ cited the 

following: 

The claimant testified that he is able to take the bus or BART to get around, goes to 

the bookstore, goes shopping and, does his own laundry (see, hearing testimony). 

He told Dr. Wiebe in December 2014 that the primary reason he could not 

accomplish activities of daily living, was homelessness (Exhibit 8F/4). In 

September 2016, he told Dr. Cohen that he could perform his basic activities of 

daily living including cooking, cleaning, going grocery shopping and doing laundry 

(Exhibit 13 F/3).

Id. 

The ALJ’s reliance on plaintiff’s activities of daily living was not supported by substantial 

evidence in the record. At the hearing, plaintiff testified that he was able to do the activities the 

ALJ cited only on certain days when his symptoms permitted and that he structured his daily 

activities around his symptoms and with the goal of minimizing his asthma attacks. See id. at 

198. For instance, while plaintiff testified that he “sometimes” goes to visit his mother in Oakland 

(from Berkeley), and that he does so by bus or BART, he also testified that about “half of the time 

I’m able to go out and do stuff. But the other half, you know, the medication won’t have any 

effect, and I just stay at home. And I watch TV all day long.” Id. at 186, 189. He testified that he 

is sometimes “really fatigued” in the morning from waking up in the middle of the night with an 

asthma attack. Id. at 189. When the ALJ asked what plaintiff does on the days when he can go 

out, plaintiff testified, “Sometimes I go to the bookstore; watch a movie; I do, you know[,] go to 

the grocery store. I try to go to the grocery store once a week. A little bit of socializing with my 

friends. I might go over to a friend’s house for an hour or two. Other than that, I’m not too active 

right now.” Id. at 189-90. When asked whether he can do his own laundry, plaintiff answered in 

the affirmative. Id. at 190. He later testified that he is unable to leave his home one to three times 

a week due to fatigue. Id. at 197. He also clarified that there were “definitely” days when he was 

unable to do activities such as grocery shopping, cleaning the house, and doing laundry, because 

he is “just in a like a catatonic state.” Id. at 197-98.

In this context, the activities of using public transportation, shopping, and going to the 

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 19 of 29
20

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

bookstore are “not consistent with regularly attending a full-time job.” See Popa v. Berryhill, 872 

F.3d 901, 906-07 (9th Cir. 2017) (analyzing the claimant’s activities of grocery shopping, TV 

watching, and weekly church attendance in the past). As the Ninth Circuit has explained:

The Social Security Act does not require that claimants be utterly incapacitated to 

be eligible for benefits, see, e.g., Howard v. Heckler, 782 F.2d 1484, 1488 (9th 

Cir.1986) (claim of pain-induced disability not gainsaid by capacity to engage in 

periodic restricted travel); Gallant, 753 F.2d at 1453 (ordering award of benefits for 

constant back and leg pain despite claimant’s ability to cook meals and wash 

dishes), and many home activities are not easily transferable to what may be the 

more grueling environment of the workplace, where it might be impossible to 

periodically rest or take medication.

Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989). The ALJ’s reliance on plaintiff’s activities of 

daily living are not a specific and legitimate reason to discount the opinion of Dr. Wiebe. This is 

particularly so where the ALJ gave “great weight” to Dr. Pollack’s conflicting opinion without any 

explanation other than a general statement that the opinion was “consistent with the record as a 

whole.” See AR at 160. 

II. Plaintiff’s Symptom Testimony

Plaintiff also contends that the ALJ improperly discounted his testimony regarding his

intermittently severe symptoms of asthma, fatigue, and anxiety. Pl.’s Mot. at 16. 

The Ninth Circuit has established a two-step analysis for determining how to credit a 

claimant’s symptom testimony:

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. . . . 

If the claimant satisfies the first step of this analysis, and there is no evidence of 

malingering, the ALJ can reject the claimant’s testimony about the severity of her 

symptoms only by offering specific, clear and convincing reasons for doing so. 

This is not an easy requirement to meet: The clear and convincing standard is the 

most demanding required in Social Security cases.

Trevizo, 871 F.3d at 678 (quoting Garrison, 759 F.3d at 1014-15).7 If the ALJ finds the 

claimant’s allegations of severity are not credible, “[t]he ALJ must state specifically which 

 

7 Defendant disputes that the clear and convincing reasons standard applies to review of a 

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 20 of 29
21

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

symptom testimony is not credible and what facts in the record lead to that conclusion.” Smolen v. 

Chater, 80 F.3d 1273, 1284 (9th Cir. 1996). “These findings, properly supported by the record, 

must be sufficiently specific to allow a reviewing court to conclude the adjudicator rejected the 

claimant’s testimony on permissible grounds and did not arbitrarily discredit a claimant’s 

testimony regarding pain.” Bunnell v. Sullivan, 947 F.2d 341, 345-46 (9th Cir. 1991) (internal 

quotation marks and citation omitted).

At the first step of the credibility test, the ALJ found that plaintiff’s “medically 

determinable impairments could reasonably be expected to produce the . . . alleged symptoms[.]” 

AR at 161. The ALJ made no finding of malingering, though the ALJ did reference “some 

suggestion[] that the claimant has been less than truthful with respect to his reported symptoms as 

Dr. Fentress observed in April 2016.” See id. at 161. The ALJ was referencing the following 

statement from Dr. Fentress’s April 21, 2016 treatment notes: “Patient expresses [symptoms] of 

both depression and anxiety. He also seems overly concerned with his health, although patient 

may not agree with this. There is even some concern from this interviewer that patient may have 

tried to get this prescriber to prescribe him toxic treatments for lupus by not telling the full truth 

about what the rheumatologist told him.” Id. at 1201. In Ghanim v. Colvin, 763 F.3d 1154 (9th 

Cir. 2014), the Ninth Circuit noted that there is some tension in its case law regarding whether the 

“specific, clear and convincing” standard applies unless an ALJ makes an actual finding of 

malingering or whether evidence of malingering will suffice. 763 F.3d at 1163 n.9. In that case, 

the government did not argue that a lesser standard should apply, and so the Ninth Circuit did not 

address “whether mere evidence of malingering might justify a lesser standard” and applied the 

specific, clear and convincing standard. Id. Here, defendant has also made no argument on this 

point, and the Court will likewise apply the specific, clear and convincing standard to this case. 

 

claimant’s subjective symptom testimony, though defendant acknowledges that this standard is the 

law of the Ninth Circuit. Def.’s Cross-Mot. at 15 n.6. The Ninth Circuit has repeatedly rejected 

defendant’s position in recent years, reaffirming the continued validity of the clear and convincing 

reasons standard. See Brown-Hunter, 806 F.3d at 493 (citing Burrell v. Colvin, 775 F.3d 1133, 

1136-37 (9th Cir. 2014)).

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 21 of 29
22

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

Moving to the second step of the credibility analysis, the ALJ found plaintiff’s “statements 

concerning the intensity, persistence and limiting effects of these symptoms are not entirely 

consistent with the medical evidence and other evidence in the record for the reasons explained in 

this decision.” AR at 161-62. 

A. Asthma

The ALJ discredited plaintiff’s “allegations of an inability to perform all work due to 

asthma-related symptoms” for four reasons: (1) that his “chest x-rays have consistently failed to

identify any positive objective findings[;]” (2) “that his medical records document repeated 

instances in which he sought emergency room treatment for shortness of breath, and other 

symptoms only after he had been non-compliant with medication that had been prescribed for his 

asthma[;]” (3) that “while the claimant reported that he has been hospitalized for asthma ‘on and 

off’ for the past 25 years, his medical records do not corroborate that report, instead, indicating 

that the claimant has had no recent hospitalizations on the basis of asthma[;]” and (4) that plaintiff 

“continues to be compliant [sic] with his physicians’ admonitions to stop smoking.” Id. at 161. 

The Court will address each of these in turn.

First, the Court does not find the lack of “any positive objective findings” on plaintiffs’ 

chest x-rays to be a clear and convincing reason to find plaintiff’s asthma related symptoms not 

credible, for the reasons explained in Section I.A, above. 

Second, as the Court has also noted, the Ninth Circuit has found error where an ALJ 

discredits a claimant’s symptom testimony based on a failure to seek or comply with treatment 

where the record indicates the failure was rooted in the inability to pay. See Regennitter, 166 F.3d 

at 1296-97. The record here shows numerous instances of plaintiff seeking emergency medical 

treatment for his asthma because his Medi-Cal was cut off or because he was unable to fill his 

prescription due to lack of money. See, e.g., AR at 675, 885, 923, 930, 936. Further, the record 

shows that plaintiff made visits to the emergency room for asthma exacerbation even during 

periods of compliance with his medication. See id. at 505.

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 22 of 29
23

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

Third, the ALJ misinterpreted plaintiff’s statements when the ALJ stated that plaintiff

reported having been hospitalized for asthma on and off for the past 25 years. See id. at 161. In 

an asthma questionnaire dated November 10, 2013, plaintiff responded to the following question: 

6. Have you ever been to the emergency room because of an asthma attack? (when 

and where?)

[Answer:] I’ve been hospitalized on and off for the past 25 years mainly at 

Highland Hospital Oakland.

Id. at 433. In the context of the overall record and plaintiff’s hearing testimony, the ALJ erred in 

interpreting this answer as saying that plaintiff has required in-patient hospitalization for the past 

25 years. The record shows that plaintiff has consistently explained that he makes frequent visits 

to the emergency room for asthma treatment but that he reported only one hospitalization that 

required overnight admission (even if his recollection of the year of the hospitalization varies). 

For instance, at the hearing, plaintiff referred to “one specific time in the hospital in 2006 where I 

had trouble breathing and they kept me for two days.” See id. at 193. In a disability report from 

September 2013, he noted only one overnight hospital stay in 2011. Id. at 418. And in his 

assessment with Dr. Cohen, plaintiff reported that “[h]e has never been intubated and has only had 

one short hospital admission for an asthma exacerbation. However, he reports that he often has to 

go to the emergency department for treatment of his shortness of breath . . . .” Id. at 1333. What 

the ALJ cited was a matter of semantics, not credibility. This does not constitute a clear and 

convincing reason to reject plaintiff’s symptom testimony. 

Finally, the Court finds that plaintiff’s smoking is not a clear and convincing reason to 

reject plaintiff’s testimony, under the facts of this case. Plaintiff testified at the hearing that he 

smokes “like, one or two cigarettes a day.” Id. at 204. He reported to Dr. Cohen in September 

2016 that he smokes two cigarettes daily and he filed a declaration that he has attempted to quit 

completely but that the cigarettes help with his anxiety, sometimes preventing a full-blown panic 

attack. Id. at 504, 1334. It appears that the ALJ interpreted plaintiff’s smoking as a failure to 

follow his physicians’ prescribed treatment. However, before denying benefits because of a 

failure to follow treatment, the ALJ must conduct an inquiry into the circumstances of the noncompliance and whether the treatment prescribed can restore the plaintiff’s ability to work. See

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 23 of 29
24

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

Byrnes v. Shalala, 60 F.3d 639, 641 (9th Cir. 1995) (explaining, in response to government 

argument that the claimant’s diabetes would have been controllable if he followed doctors’ advice 

and stopped smoking, that “before basing a denial of benefits on noncompliance, the ALJ must 

‘examine the medical conditions and personal factors that bear on whether [a claimant] can 

reasonably remedy’ his impairment and must make specific findings”) (quoting Dodrill v. Shalala, 

12 F.3d 915, 919 (9th Cir. 1993)) (alteration in original). “Also ‘[e]ssential to a denial of benefits 

pursuant to [the regulation governing need to follow prescribed treatment] is a finding that if the 

claimant followed her prescribed treatment she could return to work.’” Id. (quoting Rousey v. 

Heckler, 771 F.2d 1065, 1069 (7th Cir. 1985)) (alteration in original); see also Shramek v. Apfel, 

226 F.3d 809, 812-13 (7th Cir. 2000) (finding that failure to quit smoking despite evidence that 

smoking worsened the claimant’s condition was not a reason to discredit claimant’s testimony, 

where no evidence supported a finding that claimant would be able to return to work if she 

stopped smoking). Here, the ALJ failed to conduct this inquiry. Accordingly, the Court finds that 

plaintiff’s smoking is not a clear and convincing reason to reject his symptom testimony.

B. Psoriatic Arthritis

With regard to plaintiff’s “allegations of disabling psoriatic arthritis,” the ALJ found that 

plaintiff’s “medical records do not reflect consistent complaints of the diffuse joint paint.” AR at 

161. The ALJ also cited to Dr. Fentress’s note from April 2016 regarding whether he had “been 

less than truthful with respect to his reported symptoms[.]” Id. Neither of these constitutes a clear 

and convincing reason to discredit the plaintiff. As explained above in Section I.A., Dr. Fentress 

diagnosed plaintiff with psoriatic arthritis even without noting significant joint pain. Essentially, 

the ALJ discounted plaintiff’s testimony that he had psoriatic arthritis on the basis of a lack of

symptoms, where the treating doctor who diagnosed the condition did not find the lack of those 

symptoms to be preclusive. 

It is unclear from the ALJ’s decision whether the comment regarding Dr. Fentress’s April 

2016 note was a reason to discredit plaintiff’s allegations of psoriatic arthritis or whether it was a 

statement regarding plaintiff’s credibility overall. If the former, the note is unrelated to psoriatic 

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 24 of 29
25

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

arthritis. And if the latter, the Court has doubts about whether the note is an indictment on 

plaintiff’s credibility so much as it is a statement regarding plaintiff’s psychological state. Dr. 

Fentress wrote the note in the context of a psychiatric plan, and it appears to support the doctor’s 

perception that plaintiff was “overly concerned with his health[.]” See id. at 1201. The Court 

finds this oblique reference in one treatment note, without further explication from the ALJ, does 

not rise to the level of a clear and convincing reason to discredit plaintiff’s symptom testimony. 

In sum, the ALJ did not support the credibility finding with specific, clear and convincing 

reasons.

III. Residual Functional Capacity Finding and Step Five

Finally, plaintiff argues that the ALJ erred with respect to the RFC finding and at step five 

of the five-step analysis. In light of the errors the Court has found in the ALJ’s weighing of the 

opinions of the examining and non-examining doctors, and in the weighing of plaintiff’s symptom 

testimony, the Court agrees. The ALJ made the above errors in the context of determining 

plaintiff’s RFC, and the RFC does not account for many of the limitations that the examining 

doctors identified. The failure to determine the correct RFC then led to error at step five, when the 

ALJ determined that jobs exist in the national economy that plaintiff can perform. 

For instance, Dr. Cohen, whose opinion the ALJ improperly discounted, assessed plaintiff 

as able to lift or carry 10 pounds frequently, 20 pounds occasionally, and 50 pounds rarely. Id. at 

1136. This is inconsistent with the ALJ’s finding that plaintiff had the RFC to perform medium 

work, which requires lifting or carrying of 25 pounds frequently and 50 pounds occasionally. Dr. 

Cohen determined that plaintiff would experience shortness of breath due to his asthma multiple 

times monthly during cold weather and once monthly at other times, and that these episodes would 

limit him to walking/standing for less than two hours and lifting 10 pounds. Id. Critically, Dr. 

Cohen also determined that plaintiff’s asthma and polyarthritis flares would cause him to be 

absent from work at least three times per month in the winter. The ALJ did not address this 

limitation anywhere in the decision.

Dr. Wiebe, the examining psychologist whose opinion the ALJ discounted, also found a 

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 25 of 29
26

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

number of limitations that the ALJ’s RFC finding did not take into account. Again, the ALJ’s 

decision did not address or take into account Dr. Wiebe’s assessment that, for example, plaintiff 

would have marked limitations in his ability to complete a normal workday or workweek without 

interruptions from psychologically based symptoms and in his ability to maintain regular 

attendance and be punctual within customary, usually strict tolerances. See id. at 906. The errors 

the ALJ made in weighing the doctors’ opinions and plaintiff’s symptom testimony necessarily led 

to error at the RFC stage and at step five of the disability evaluation.

IV. Remedy

The remaining question is whether to remand for further administrative proceedings or for 

the immediate payment of benefits under the credit-as-true doctrine. “When the ALJ denies 

benefits and the court finds error, the court ordinarily must remand to the agency for further 

proceedings before directing an award of benefits.” Leon v. Berryhill, 880 F.3d 1041, 1045 (9th 

Cir. 2017) (citing Treichler v. Comm’r of Soc. Sec. Admin., 775 F.3d 1090, 1099 (9th Cir. 2014)). 

However, under the credit-as-true rule, the Court may order an immediate award of benefits if 

three conditions are met. First, the Court asks “whether the ‘ALJ failed to provide legally 

sufficient reasons for rejecting evidence, whether claimant testimony or medical opinion.’” Id.

(quoting Garrison, 759 F.3d at 1020). Second, the Court must “determine whether there are 

outstanding issues that must be resolved before a disability determination can be made, . . . and 

whether further administrative proceedings would be useful.” Id. (citations and internal quotation 

marks omitted). Third, the Court then “credit[s] the discredited testimony as true for the purpose 

of determining whether, on the record taken as a whole, there is no doubt as to disability.” Id.

(citing Treichler, 775 F.3d at 1101). Even when all three criteria are met, whether to make a direct 

award of benefits or remand for further proceedings is within the district court’s discretion. Id.

(citing Treichler, 775 F.3d at 1101). In rare instances, all three credit-as-true factors may be met 

but the record as a whole still leaves doubts as to whether the claimant is actually disabled. 

Trevizo, 871 F.3d at 683 n.11. In such instances, remand for further development of the record is 

warranted. Id.

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 26 of 29
27

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

Here, the Court has already found that the ALJ failed to provide legally sufficient reasons 

for rejecting the medical opinions of Dr. Cohen and Dr. Wiebe and for rejecting the symptom 

testimony of plaintiff. The Court further finds that there are no outstanding issues to resolve and 

that further administrative proceedings would not be useful. The medical record in this case is 

extensive. There are no gaps in plaintiff’s medical records, and the record includes both physical 

and mental evaluations from examining and non-examining doctors. It also includes extensive 

emergency room visit records as well as treatment records from the periods of time when plaintiff 

had access to primary medical care. Defendant does not argue that the record requires further 

development nor does she identify any outstanding issues to be resolved.

Crediting the discredited testimony as true, there is no doubt as to plaintiff’s disability. 

The Ninth Circuit has consistently remanded for an award of benefits in cases where a VE was 

posed a hypothetical that included the RFC that a claimant would possess if improperly 

discredited opinions or testimony were taken as true. See, e.g., Garrison, 759 F.3d at 1022;

Lingenfelter v. Astrue, 504 F.3d 1028, 1041 (9th Cir. 2007); Varney v. Sec’y of Health & Human 

Servs., 859 F.2d 1396, 1401 (9th Cir. 1988). In those cases the claimant’s counsel presented an 

alternative hypothetical to the VE that included the claimant’s limitations and RFC as described 

by medical opinion or the claimant’s testimony. In each case the VE responded to that 

hypothetical by saying that a person with those limitations would be disabled. And in each case,

the Court found that based on that evidence, the ALJ would be required to find the claimant 

disabled on remand if the improperly rejected evidence were credited as true. 

Here, plaintiff’s counsel posed hypothetical questions to the VE that reflected plaintiff’s 

testimony and the opinions of Drs. Cohen and Wiebe as to plaintiff’s RFC. Specifically, 

plaintiff’s counsel asked whether there would be jobs in the national economy for someone of 

plaintiff’s “age, education, and work history, limited to lifting and carrying 10 pounds frequently, 

20 pounds occasionally, and 50 pounds rarely, most of the time; who is able to stand and walk for 

six hours per day, and sit for six hours per day; except that they would be absent three times per 

month during winter or rainy months, and one time per month during other winter months.” AR at 

211. The VE responded that full-time work would not be available for this person. Id. at 211-12. 

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 27 of 29
28

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

Plaintiff’s attorney also asked whether any of the jobs the VE found were available based on the 

ALJ’s hypotheticals would still be available with the added limitations of moderate impairment in 

social functioning (i.e., unable to meet competitive standards 15 percent of the time) and in 

concentration, persistence, or pace (i.e., off task 15 percent of the time of having a 10-15 percent 

reduction in production accomplishment); and missing two days of work per month. Id. at 212. 

The VE testified that the jobs previously identified would not be available for such a person. Id. 

The VE’s testimony provides adequate basis for the Court to conclude that plaintiff is disabled 

without remanding for further proceedings to re-determine her RFC. See Garrison, 759 F.3d at 

1022. 

Nor does the record as a whole leave “serious doubt that [plaintiff] is, in fact, disabled.” 

See id. at 1021. The record shows that plaintiff’s asthma would cause serious interference with his 

ability to maintain a normal work routine. He testified that he usually wakes up in the morning 

with an asthma attack. AR at 187. He takes three asthma medications each morning and after he 

takes his medications he waits to see how his symptoms are before proceeding with his day. Id. at 

187-89. About half the time, the medication has no effect and he is unable to leave home. Id. at 

189. Plaintiff made numerous visits to the emergency room for treatment for his asthma 

exacerbation, including times when he was taking his medication, and these emergency room 

visits increased in the years 2014-2016. See id. at 1333.

After considering defendant’s arguments, the Court sees no basis for serious doubt in the 

record that plaintiff is disabled. The plaintiff would have to be found disabled under Title II and 

Title XVI of the Social Security Act, and thus an award of benefits is appropriate. Moreover, 

remand for benefits is appropriate here where Plaintiff first applied for benefits over five years ago 

and has already experienced lengthy, burdensome litigation. See Vertigan v. Halter, 260 F.3d 

1044, 1053 (9th Cir. 2001).

CONCLUSION

For the foregoing reasons, the Court GRANTS plaintiff’s motion for summary judgment 

and DENIES defendant’s cross-motion for summary judgment. The Court REMANDS this case 

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 28 of 29
29

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

pursuant to sentence four of 42 U.S.C. § 405(g) for an immediate payment of benefits.

IT IS SO ORDERED.

Dated: May 14, 2019

______________________________________

SUSAN ILLSTON

United States District Judge

Case 3:18-cv-02226-SI Document 21 Filed 05/14/19 Page 29 of 29