Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-3_15-cv-08054/USCOURTS-azd-3_15-cv-08054-0/pdf.json

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

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WO 

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Masako Ko, 

Plaintiff, 

v. 

Carolyn W. Colvin, 

Acting Commissioner of Social Security, 

Defendant.

No. CV-15-08054-PHX-BSB

ORDER 

 Masako Ko (Plaintiff) seeks judicial review of the final decision of the 

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

under the Social Security Act (the Act). The parties have consented to proceed before a 

United States Magistrate Judge pursuant to 28 U.S.C. § 636(b), and have filed briefs in 

accordance with Rule 16.1 of the Local Rules of Civil Procedure. For the following 

reasons, the Court reverses the Commissioner’s decision and remands for a determination 

of benefits. 

I. Procedural Background 

 On February 15, 2012, Plaintiff filed an application for a period of disability and 

disability insurance benefits under Title II of the Act. (Tr. 12.)1

 Plaintiff alleged that she 

had been disabled since July 1, 2011. (Id.) After the Social Security Administration 

(SSA) denied Plaintiff’s initial application and her request for reconsideration, she 

 

1

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

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requested a hearing before an administrative law judge (ALJ). (Tr. 71-72.) After 

conducting a hearing, the ALJ issued a decision finding Plaintiff not disabled under the 

Act. (Tr. 12-21.) This decision became the final decision of the Commissioner when the 

Social Security Administration Appeals Council denied Plaintiff’s request for review. 

(Tr. 1–6; see 20 C.F.R. § 404.981 (explaining the effect of a disposition by the Appeals 

Council).) Plaintiff now seeks judicial review of this decision pursuant to 

42 U.S.C. § 405(g). 

II. Administrative Record 

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

treatment related to Plaintiff’s alleged impairments. The record also includes opinions 

from state agency physicians who reviewed the records related to Plaintiff’s impairments, 

but who did not examine Plaintiff or provide treatment. 

A. Medical Treatment Evidence 

 In June 2011, Plaintiff began treatment with Vasilios Kaperonis, M.D., at 

Mediterranean Mental Health Center, P.C. (Mediterranean). (Tr. 347-49.) During her 

first appointment with Dr. Kaperonis, Plaintiff reported having problems with a 

supervisor at work. (Tr. 347.) Plaintiff complained of anxiety attacks that lasted up to 

twenty minutes at a time. (Id.) On a mental status examination, Dr. Kaperonis noted that 

Plaintiff was well dressed, well groomed, and oriented. (Tr. 348.) Her mood was sad 

and anxious, and she had a tearful affect. (Id.) Plaintiff had no hallucinations, delusions, 

or suicidal ideations. (Id.) Dr. Kaperonis diagnosed anxiety disorder not otherwise 

specified, and prescribed Xanax. (Id.) Dr. Kaperonis also recommended that Plaintiff 

take an antidepressant, but she “was somewhat hesitant to do that at [that] time.” (Id.) 

 During a July 8, 2011 appointment, Plaintiff reported that the day before her 

supervisor was scheduled to return to work she developed cold sores and decided “to take 

vacation time off and be away for a month . . . .” (Tr. 346.) Plaintiff reported that she 

had “a hard time motivating herself, a hard time concentrating, [was] easily derailed and 

distracted, [and did] not complete tasks . . . .” (Id.) Dr. Kaperonis observed that Plaintiff 

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was adequately groomed, alert, and oriented. (Id.) She had no delusions, hallucinations, 

or suicidal ideations. (Id.) Dr. Kaperonis continued Plaintiff’s prescription for Xanax 

and also prescribed Viibryd. (Id.) Dr. Kaperonis later adjusted Plaintiff’s medications 

because she reported experiencing headaches after she started taking Viibryd, (Tr. 345.) 

 During an August 21, 2011 appointment, Plaintiff reported that she was reluctant 

to return to work. (Tr. 344.) She reported that she was sleeping better. (Id.) On a 

mental status examination, Plaintiff was well dressed, well groomed, cooperative, and 

alert. (Id.) She had an anxious mood and a constricted affect. (Id.) She had no 

delusions, hallucinations, or suicidal ideations. (Id.) During an August 29, 2011 

appointment, Plaintiff reported anxiety and depression and stated that she “dread[ed] the 

idea of being back at work with a supervisor that she [could not] possibly work with.” 

(Tr. 343.) Plaintiff reported disturbed sleep with nightmares and “occasional anxiety 

attacks.” (Id.) Plaintiff stated that she had a hard time motivating herself and staying on 

task. (Id.) On examination, Plaintiff was adequately groomed, alert, and oriented. (Id.) 

She had no delusions, hallucinations, or suicidal ideations. (Id.) Dr. Kaperonis continued 

Plaintiff’s medications and stated that she would “not be able to return to work at least for 

two years.” (Id.) Treatments notes from an October 3, 2011 appointment include the 

same complaints and observations. (Tr. 342.) 

 During a November 4, 2011 appointment, Plaintiff reported that “Xanax has 

helped her anxiety.” (Tr. 341.) On examination, Plaintiff was well dressed, well 

groomed, alert, and oriented. (Id.) She had no delusions or hallucinations. (Id.) Plaintiff 

“denied suicidal intentions despite occasional suicidal thoughts.” (Id.) During a 

December 5, 2011 appointment, Plaintiff reported a “lessening of her anxiety with the 

adjustment of her medications.” (Id.) Plaintiff reported that she “was trying to keep 

herself occupied and [was] spending more time with other people but still tend[ed] to 

isolate significantly.” (Tr. 340.) Plaintiff “talked about playing the piano and hiking.” 

(Id.) On examination, Plaintiff was well dressed, well groomed, alert, and oriented. (Id.) 

She had no delusions, hallucinations, or suicidal ideations. (Id.) 

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 During a January 27, 2012 appointment, Plaintiff reported being more active 

during the day, talking with friends, and feeling calmer. (Tr. 339.) Dr. Kaperonis noted 

that Plaintiff “still isn’t sleeping well, having nightmares and awakening with anxiety 

attacks.” (Id.) Plaintiff was tearful on examinaton. (Id.) She admitted having suicidal 

thoughts without a specific plan. (Id.) Dr. Kaperonis prescribed Remeron in addition to 

Xanax and Lexapro. (Id.) During a March 27, 2012 appointment, Plaintiff reported that 

she was calmer on Lexapro, but that she was more motivated when she took Wellbutrin. 

(Tr. 337.) Plaintiff reported that she was hiking “on occasions up to 4 miles a day and 

this seems to help.” (Id.) She reported that she was still having problems with her 

appetite, anxiety, depression, and “her interests.” (Id.) On examination, Plaintiff was 

well dressed, well groomed, alert, and oriented. (Id.) Her mood was anxious and she had 

a tense affect. She avoided eye contact. (Id.) She had no delusions, hallucinations, or 

suicidal ideations. (Id.) Dr. Kaperonis continued Lexapro and Xanax, and added 

Wellbutrin XL. (Id.) 

 In April 2012, Plaintiff reported feeling “more stable.” (Tr. 336.) She was hiking 

once a week and was considering volunteering at a senior center. (Id.) Plaintiff reported 

that she checked on an elderly neighbor twice a day. (Id.) Plaintiff also reported that she 

continued to have nightmares and occasionally awoke with panic attacks. (Id.) On 

examination, Plaintiff was well dressed, well groomed, alert, and oriented. (Id.) Her 

mood was anxious, she had a tense affect, and she continued to avoid eye contact. (Id.) 

She had no delusions, hallucinations, or suicidal ideations. (Id.) Dr. Kaperonis continued 

Plaintiff’s medications. (Id.) 

 In July 2012, Plaintiff reported visiting a friend in South Dakota and stated that 

she “seemed to relax while she was there.” (Tr. 335.) However, she ran out of Lexapro 

and Wellbutrin for two and a half weeks, during which time she felt more depressed and 

anxious. (Id.) Dr. Kaperonis renewed Plaintiff’s prescriptions for those medications. 

(Id.) Plaintiff reported that she still tried to take care of her elderly neighbor. (Id.) On 

mental status examination, Plaintiff was well dressed, well groomed, alert, and oriented. 

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(Id.) Her “mood was sad and anxious and her affect was tense.” (Id.) She had no 

delusions, hallucinations, or suicidal ideation. (Id.) During an August 14, 2012 

appointment Plaintiff’s mental status examination was the same. (Tr. 334.) She reported 

that she was trying to stay active, but it was difficult. (Id.) She reported having difficulty 

with decision-making and memory. (Id.) Plaintiff also reported depression, lack of 

confidence, anxiety, and panic attacks. (Id.) Dr. Kaperonis continued Plaintiff’s 

medications. (Id.) In September 2012, Plaintiff reported that she was “trying to be more 

active but still experience[d] anxiety and ha[d] difficulty making decisions and ha[d] 

memory problems.” (Tr. 333.) On mental status examination, Plaintiff was well dressed, 

well groomed, alert, and oriented. (Id.) Her mood was “somewhat anxious and sad and 

her affect was tense.” (Id.) She avoided eye contact. (Id.) She had no delusions, 

hallucinations, or suicidal ideations. (Id.) Dr. Kaperonis continued Plaintiff’s 

medications. 

 During a November 1, 2012 appointment, Plaintiff reported that she continued to 

experience anxiety and depression and was not sleeping well. (Tr. 332.) She reported 

that she was not very active and had been socially withdrawn. (Id.) On examination, 

Plaintiff was well dressed, well groomed, alert, and oriented. (Id.) Her “cognitive 

functioning [was] grossly intact.” (Id.) Plaintiff’s “recent and remote and immediate” 

memory were “overall good.” (Id.) She had a sad and anxious mood and her affect was 

“broad in range.” (Id.) “There [was] no loosening of associations[,] no pressure of 

speech[,] and no flight of ideas.” (Id.) There was no thought blocking. (Id.) Plaintiff had 

no delusions, hallucination, referential thoughts, or suicidal thoughts. (Id.) Plaintiff had 

good insight and judgment, and her “reality testing” was intact. (Id.) Dr. Kaperonis 

continued Plaintiff’s medications. (Id.) A November 7, 2012 treatment note includes 

similar findings on mental status examination. (Tr. 331.) 

 During a January 16, 2013 appointment, Plaintiff continued to report anxiety, 

“symptoms of panic and problems with sleep.” (Tr. 380.) On mental status examination, 

Dr. Kaperonis made findings similar to those he made on November 1, 2012. (Compare

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Tr. 380 with Tr. 332.) Dr. Kaperonis continued Plaintiff’s medications. (Tr. 380.) 

During a February 26, 2013 appointment, Plaintiff reported feeling tired, unmotivated, 

and depressed. (Tr. 377.) She was worried about her memory and thought it was getting 

worse. (Id.) On examination, Dr. Kaperonis made findings similar to those he made on 

November 1, 2012 and January 16, 2013. (Compare Tr. 377 with Tr. 380 and Tr. 332.) 

Dr. Kaperonis continued Plaintiff’s medications with some adjustments. (Tr. 377.) 

 During a March 26, 2013 appointment, Plaintiff reported some increased energy 

and activity on a new dosage of Wellbutrin. (Tr. 376.) She reported experiencing 

anxiety attacks “almost weekly.” (Id.) Dr. Kaperonis’s examination findings were 

similar to those he made in November 2012 and in January and February 2013. (See

Tr. 376, 332, 380, 377.) Dr. Kaperonis continued Plaintiff’s medications. (Tr. 376.) An 

April 25, 2013 treatment note includes reports and findings similar to the March 26, 2013 

treatment note. (Compare Tr. 375 with Tr. 376.) 

B. Medical Opinion Evidence 

 1. Winston Brown, M.D. 

 On June 1, 2012, Dr. Brown reviewed the record and completed a Mental Residual 

Functional Capacity (RFC) Assessment as part of the initial determination on Plaintiff’s 

application for benefits. (Tr. 283-86.) Dr. Brown opined that Plaintiff was moderately 

limited in the following areas: her ability to accept instructions and respond appropriately 

to criticism from supervisors; her ability to get along with co-workers or peers without 

distracting them or exhibiting extreme behavior; her ability to respond appropriately to 

changes in the work setting; and her ability to set realistic goals or make plans 

independently of others. (Tr. 285.) Dr. Brown found that the medical record and 

Plaintiff’s activities of daily living (ADLs) “show[ed] some motivational deficit. 

Moderate ADLs/Sx’s [symptoms] are credible.” (Tr. 286.) 

 On June 1, 2012, Dr. Brown also completed a Psychiatric Review Technique form. 

(Tr. 287.) Dr. Brown identified Plaintiff’s diagnosis as anxiety disorder not otherwise 

specified. (Tr. 287, 292.) Dr. Brown opined that Plaintiff was mildly limited in her 

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activities of daily living and in her ability to maintain concentration, persistence, or pace. 

(Tr. 297.) Dr. Brown found Plaintiff moderately limited in her ability to maintain social 

functioning. (Id.) 

 2. Sheri L. Simon, Ph.D 

On December 17, 2012, as part of the reconsideration determination, Dr. Simon 

reviewed the record and completed a Case Analysis form. (Tr. 352) Dr. Simon stated 

that she “reviewed all of the evidence in the file.” (Tr. 352.) She concluded that Plaintiff 

was “functional.” (Id.) She stated that “[w]hile there are some difficulties, the [Plaintiff] 

is independent in personal care, makes simple meals, does [household] chores, drives, 

goes out alone, shops, manages finances, socializes with 1 friend.” (Id.) Dr. Simon 

found that “[w]hile [Plaintiff] does have some difficulties there is no objective evidence 

to indicate significant worsening or marked impairments.” (Id.) 

 3. Vasilios Kaperonis, M.D. 

 On September 2011, Dr. Kaperonis completed a Lake Havasu City Certification of 

Health Care Provider. (Tr. 281-82.) He stated that Plaintiff had anxiety and depression. 

(Tr. 281.) He opined that Plaintiff was “incapacitated and [would] be incapacitated for 

two years,” and could not perform any work. (Tr. 281-82.) 

 On December 30, 2011, Dr. Kaperonis completed an Attending Physician’s 

Statement of Disability. (Tr. 279.) Dr. Kaperonis noted that Plaintiff had post-traumatic 

stress disorder, anxiety disorder, major depression, suicidal thoughts, and difficulty 

concentrating. (Id.) He opined that Plaintiff was incapacitated by severe depression, 

anxiety, and feelings of hopelessness. (Id.) 

 On January 23, 2013, Dr. Kaperonis completed a Supplemental Questionnaire as 

to Residual Functional Capacity (RFC Questionnaire). (Tr. 378-79.) Dr. Kaperonis 

opined that Plaintiff was moderately limited in her abilities to understand, remember, and 

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related decisions.”2 (Tr. 378.) He found Plaintiff markedly limited in her ability to 

understand and remember detailed instructions, interact appropriately with the public and 

co-workers, and respond appropriately to work pressures in a usual work environment 

and to changes in a routine work setting. (Tr. 378-79.) Finally, he found Plaintiff 

extremely limited in her ability to interact appropriately with supervisors. (Tr. 379.) 

Dr. Kaperonis explained that Plaintiff had “severe symptoms of anxiety and panic and her 

thinking [was] clouded by depressive symptomology (ie sadness, decreased concentration 

and difficulty focusing, crying spells fatigue, etc.).” (Id.) 

III. Plaintiff’s Subjective Complaints and the Administrative Hearing

 As part of her application for benefits, Plaintiff completed a Function Report. 

(Tr. 192-199.) She stated that she was unable to work because of her lack of focus and 

concentration, caused by anxiety and depression. (Tr. 192.) She stated that her 

impairments affected her memory, concentration, and her abilities to understand, follow 

instructions, and complete tasks. (Tr. 197.) She stated that she did not “finish what [she] 

start[ed].” (Id.) In response to a question asking “[h]ow well do you follow” written and 

spoken instructions, Plaintiff answered “not well.” (Id.) Plaintiff stated that she handled 

stress “terribl[y]” and did not respond well to changes in routine. (Tr. 198.) She also 

stated that she was “nervous” around authority figures, such as “bosses.” (Id.) 

 Plaintiff reported that she “rarely” spent time with others, but talked with her “one 

good friend” “almost daily.” (Tr. 196.) Plaintiff reported that she had “problems getting 

along with family, friends, neighbors, or others.” (Tr. 197.) Plaintiff explained that she 

had lost confidence and that her “social life [had] decreased tremendously.” (Id.) 

 Plaintiff testified during the administrative hearing. Plaintiff was 52 years old at 

the time of the administrative hearing and the ALJ’s decision. (Tr. 19.) She had a high 

school education. (Id.) Plaintiff had past relevant work as an associate faculty member 

 

2

 The RFC questionnaire defined the ratings as follows: (1) moderate, “[m]oderate 

limitations, claimant’s impairments reduce ability to function (10% off task)”; (2) marked, “[s]erious limitations, claimant’s ability to function is severely limited (11- 15% off task)”; (3) extreme, “[m]ajor limitations, claimant has no useful ability to function (greater than 15% off task).” (Tr. 378.) 

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and a recreation supervisor. (Tr. 19, 40.) Plaintiff testified that she had not worked since 

July 2011. (Tr. 40.) She explained that she could not return to her job because she had 

difficulty concentrating, getting along with people, and interacting with the public. 

(Tr. 43-44.) She testified that she took several medications to help with anxiety. (Tr. 44-

45.) Plaintiff testified that she had been seeing Dr. Kaperonis since 2011, but her issues 

had not improved and her inability to focus and stay on task prevented her from 

completing a regular work day. (Tr. 48-50.) 

 A vocational expert testified at the administrative hearing. (Tr. 50-56.) The ALJ 

asked the vocational expert to assume work that included “no exertional limitation; the 

work would be nonpublic, noncomplex; there would be no ladders, ropes, or scaffolds; no 

hazardous machinery; and no unprotected heights.” (Tr. 51.) The vocational expert 

testified that an individual with Plaintiff’s education, work experience, and skills could 

perform this type of work, which would include laundry laborer, cleaner, and hand 

packager. (Tr. 51-52.) The vocational expert testified that an individual with the 

moderate and marked limitations that Dr. Kaperonis identified in 2013 would be unable 

to perform sustained work.3

 (Tr. 52-55, 378-79.) 

IV. The ALJ’s Decision

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

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

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

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

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

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

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

See 20 C.F.R. §§ 404.1520, 416.920. 

 

 

3

 Based on the limitations identified in Dr. Kaperonis’s 2013 opinion, the ALJ estimated that Plaintiff would be “off task . . . more than half the day.” (Tr. 54-55.) 

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A. The Five-Step Sequential Evaluation Process 

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

demonstrate (1) that she is not presently engaged in a substantial gainful activity, and 

(2) that her medically determinable impairment or combinations of impairments is severe. 

20 C.F.R. §§ 404.1520(b) and (c), 416.920(b) and (c). If a claimant meets steps one and 

two, there are two ways in which she may be found disabled at steps three through five. 

At step three, she may prove that her impairment or combination of impairments meets or 

equals an impairment in the Listing of Impairments found in Appendix 1 to Subpart P of 

20 C.F.R. Part 404. 20 C.F.R. §§ 404.1520(a)(4)(iii) and (d), 416.920(d). If so, the 

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

20 C.F.R. §§ 404.1520(e), 416.920(e). At step four, the ALJ determines whether a 

claimant’s RFC precludes her from performing her past relevant work. 

20 C.F.R. §§ 404.1520(f), 416.920(f). If the claimant establishes this prima facie case, 

the burden shifts to the government at step five to establish that the claimant can perform 

other jobs that exist in significant numbers in the national economy, considering the 

claimant’s RFC, age, work experience, and education. 20 C.F.R. §§ 404.1520(g), 

416.920(g). If the government does not meet this burden, then the claimant is considered 

disabled within the meaning of the Act. 

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

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

had not engaged in substantial gainful activity since the alleged disability onset date, July 

1, 2011. (Tr. 14.) At step two, the ALJ found that Plaintiff had the following severe 

impairments: “anxiety disorder, with depression (20 CFR § 404.1520(c)).” (Id.) At step 

three, the ALJ found that Plaintiff did not have an impairment or combination of 

impairments that met or equaled the severity of a listed impairment. (Id.) The ALJ next 

found that Plaintiff had the RFC to “perform a full range of work at all exertional levels 

but with the following nonexertional limitations: non-public, non-complex work; no 

ladders, ropers, or scaffolds; and the claimant must avoid hazardous machinery and 

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unprotected heights.” (Tr. 16.) The ALJ found that Plaintiff could not perform her past 

relevant work, but could perform other work that existed in significant numbers in the 

national economy. (Tr. 19-20.) He concluded that Plaintiff had not been under a 

disability as defined in the Act from July 1, 2011 through the date of his decision. 

(Tr. 21.) Therefore, the ALJ denied Plaintiff’s application for a period of disability and 

disability insurance benefits. (Id.) 

V. Standard of Review 

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

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

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

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

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

and it is free from legal error. Smolen v. Chater, 80 F.3d 1273, 1279 (9th Cir. 1996); 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Andrews, 53 F.3d at 1041). 

VI. Plaintiff’s Claims 

 Plaintiff raises the following claims: (1) the ALJ erred “by rejecting the 

assessments of [Plaintiff’s] long-time treating psychiatrist [and] instead relying on 

assessment forms completed by state agency doctors,” and (2) the ALJ erred by rejecting 

Plaintiff’s symptom testimony without providing clear and convincing reasons. (Doc. 23 

at 1, 2) The Commissioner asserts that the ALJ’s decision is free from harmful error and 

is supported by substantial evidence. (Doc. 32.) The Court considers Plaintiff’s claims 

below and finds that the ALJ erred in rejecting the 2013 opinion of Plaintiff’s treating 

physician. Because the Court concludes that this error was not harmless, the Court does 

not address Plaintiff’s second claim that the ALJ erred by rejecting Plaintiff’s symptom 

testimony. 

A. Weight Assigned to Medical Source Opinions

 Plaintiff argues that the ALJ erred in weighing the medical source opinion 

evidence. (Doc. 23 at 1, 16-25.) In weighing medical source opinion evidence, the Ninth 

Circuit distinguishes between three types of physicians: (1) treating physicians, who treat 

the claimant; (2) examining physicians, who examine but do not treat the claimant; and 

(3) non-examining physicians, who neither treat nor examine the claimant. Lester v. 

Chater, 81 F.3d 821, 830 (9th Cir. 1995). Generally, more weight is given to a treating 

physician’s opinion. Id. The ALJ must provide clear and convincing reasons supported 

by substantial evidence for rejecting a treating or an examining physician’s 

uncontradicted opinion. Id.; see also Reddick v. Chater, 157 F.3d 715, 725 (9th Cir. 

1998). An ALJ may reject the controverted opinion of a treating or an examining 

physician by providing specific and legitimate reasons that are supported by substantial 

evidence in the record. Bayliss v. Barnhart, 427 F.3d 1211, 1216 (9th Cir. 2005); 

Reddick, 157 F.3d at 725. 

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

opinions from treating or examining physicians. Lester, 81 F.3d at 831. Although an 

ALJ generally gives more weight to an examining physician’s opinion than to a nonexamining physician’s opinion, a non-examining physician’s opinion may nonetheless 

constitute substantial evidence if it is consistent with other independent evidence in the 

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

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

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

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

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

 As previously stated, Plaintiff argues that the ALJ erred by assigning no weight to 

treating physician Dr. Kaperonis’s 2011 and 2013 opinions without providing legally 

sufficient reasons. (Doc. 23 at 16-25.) Plaintiff states that the ALJ’s rejection of the 

2013 opinion is the most significant issue because the vocational expert’s testimony that 

Plaintiff could not sustain regular employments is based on that opinion. (Doc. 23 at 17.) 

The Court agrees that the 2013 opinion is the most significant opinion. The parties 

dispute whether Dr. Kaperonis’s 2013 opinion was uncontradicted, which would require 

the ALJ to provide clear and convincing reasons for discounting the physician’s opinion, 

rather than specific and legitimate reasons. (Doc. 23 at 16; Doc. 32 at 7.) The Court does 

not need to resolve this issue because the ALJ’s reasons for rejecting Dr. Kaperonis’s 

2013 opinion do not satisfy either standard. As discussed below, the Court finds that the 

ALJ erred in rejecting the treating physician’s 2013 opinion. Therefore, the Court does 

not need to consider whether the ALJ also erred in rejecting Dr. Kaperonis’s 2011 

opinion. 

 As previously noted, on the January 2013 RFC Questionnaire, Dr. Kaperonis 

opined that Plaintiff was moderately limited in her abilities to understand, remember, and 

carry out short, simple instructions and her ability to make “judgments on simple workrelated decisions.” (Tr. 378.) He also found Plaintiff markedly limited in her ability to 

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understand and remember detailed instructions, interact appropriately with the public and 

co-workers, and respond appropriately to work pressures in a usual work environment 

and to changes in a routine work setting. (Tr. 378-79.) Finally, he found Plaintiff 

extremely limited in her ability to interact appropriately with supervisors. (Tr. 379.) 

 The ALJ gave Dr. Kaperonis’s 2013 opinion no weight because the ALJ 

concluded that it appear[ed] to have been completed as an accommodation to the 

[Plaintiff].” (Tr. 18.) The ALJ also rejected the 2013 opinion because it was provided on 

a checklist-style form, and the ALJ believed that Dr. Kaperonis’s treatment notes did not 

support the level of impairment assessed. (Id.) Plaintiff asserts that the ALJ erred by 

rejecting Dr. Kaperonis’s 2013 opinion on these grounds. As set forth below, the Court 

agrees. 

 1. Accommodation for Plaintiff 

 Plaintiff asserts that the ALJ erred by rejecting Dr. Kaperonis’s opinion based on 

the ALJ’s conclusion that it was given as an accommodation for Plaintiff. (Doc. 23 at 19-

20.) The Commissioner argues that there was no error because an ALJ may consider the 

motivation for an opinion. (Doc. 32 at 12-13.) The Court finds that the ALJ erred. 

 The regulations state that when considering medical evidence, the Agency will 

consider, among other things, “factors . . . which tend to support or contradict the 

opinion.” 20 C.F.R. § 404.1527(c)(6). Based on that regulation, and on the Ninth 

Circuit’s decision in Greger v. Barnhart, 464 F.3d 968, 972 (9th Cir. 2006), the 

Commissioner asserts that the ALJ did not err by rejecting Dr. Kaperonis’s opinion on 

the ground that it was given as an accommodation for Plaintiff. (Doc. 32 at 12-13.) In 

Greger, the court affirmed the ALJ’s rejection of a lay witness’s testimony about the 

claimant’s symptoms based on the ALJ’s conclusion that the lay witness had a “close 

relationship” with the claimant and was “possibility influenced by her desire to help 

him.” Greger, 464 F.3d at 972. 

 The Ninth Circuit’s decision in Greger does not support the Commissioner’s 

defense of the ALJ’s rejection of Dr. Kaperonis’s opinion for two reasons. First, Greger

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found that a close relationship with the claimant was a “germane” reason for discounting 

a lay witness’s opinion. Greger, 464 F.3d at 972. However, that decision did not 

indicate whether a medical source’s close relationship with a claimant would constitute 

either “specific and legitimate” or “clear and convincing” reasons that are required to 

reject a treating physician’s opinion. See Bayliss, 427 F.3d at 1216; Reddick, 157 F.3d at 

725. Second, unlike the ALJ in Greger, the ALJ in this case assumed without providing 

any supporting reasons — such as the existence of a close relationship — that the ALJ 

gave the 2013 opinion as an accommodation. (Tr. 18.) 

 Moreover, the Ninth Circuit recognizes that an ALJ may not reject a medical 

opinion that is favorable to the claimant merely because the ALJ suspects that the doctor 

is sympathetic to the claimant. See Reddick v. Chater, 157 F.3d 715, 727 (9th Cir. 1998) 

(“[T]he mere fact that a medical report is provided at the request of counsel or, more 

broadly, the purpose for which an opinion is provided, is not a legitimate basis for 

evaluating the reliability of the report.”); Lester, 81 F.3d at 832 (“The [Commissioner] 

may not assume that doctors routinely lie in order to help their patients collect disability 

benefits,” but may “introduce evidence of actual improprieties” in physicians’ opinions). 

Because the ALJ concluded that Dr. Kaperonis’s 2013 opinion was given as an 

accommodation for Plaintiff without providing any support for that conclusion, the ALJ 

improperly rejected Dr. Kaperonis’s opinion on that basis. 

 2. Checklist-Style Form 

 The ALJ also explained that he rejected Dr. Kaperonis’s 2013 opinion because it 

was on a “checklist-style form” and included conclusions without any rationale. (Tr. 18.) 

Plaintiff asserts that the ALJ erred by rejecting the 2013 opinion on this basis. (Doc. 23.) 

The Commissioner defends this rationale. (Doc. 32 at 13.) As set forth below, the Court 

finds that the ALJ erred. 

 As the ALJ noted, Dr. Kaperonis’s 2013 opinion is provided on a check-box form. 

(Tr. 378-79.) The ALJ criticized the opinion because it consisted of “only conclusions 

regarding functional limitations without any rationale for those conclusions.” (Tr. 18.) 

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As Plaintiff argues, that statement is inaccurate because Dr. Kaperonis explained that the 

limitations he assessed on the form were based on Plaintiff’s “severe symptoms of 

anxiety and panic.” (Tr. 379.) Dr. Kaperonis further stated that Plaintiff’s “thinking is 

clouded by depressive symptomology (i.e. sadness, decreased concentration and 

difficulty focusing, crying spells, fatigue etc.).” (Id.) Accordingly, the ALJ’s conclusion 

that Dr. Kaperonis did not explain the basis for his opinions on the RFC Questionnaire is 

not supported by the record. See Orn, 495 F.3d at 629 (permitting reliance on “Multiple 

Impairment Questionnaire[s]” completed by treating physician). 

 Additionally, the ALJ failed to recognize that Dr. Kaperonis’s opinions expressed 

on the checklist-style form were based on his several year treatment history with Plaintiff. 

Dr. Kaperonis’s treatment notes frequently mention Plaintiff’s social withdrawal, 

problems with a supervisor, and anxiety. (Tr. 332, 333, 336, 340, 343, 346, 347, 376, 

380.) Therefore, Dr. Kaperonis’s opinions were entitled to weight that an “otherwise 

unsupported and unexplained check-box form would not merit.” Garrison v. Colvin, 759 

F.3d 995, 1013 (9th Cir. 2014); see also Mansour v. Astrue, 2009 WL 272865, at *6 n.14 

(C.D. Cal. Feb. 2, 2009) (rejecting contention that a treating physician’s opinion on a 

“check-the-box” form lacked supporting evidence to substantiate the responses on the 

form because the physician’s treatment notes in the record supported his finding on the 

opinion form). 

 3. Unsupported by Treatment Record 

 Finally, the ALJ rejected Dr. Kaperonis’s 2013 opinion because he believed it was 

unsupported by Dr. Kaperonis’s “treating record.” (Tr. 18.) To support this conclusion, 

the ALJ cited the following passage from an April 25, 2013 treatment note: 

The patient is well-dressed and well-groomed. Cognitive functioning is grossly intact. The patient is alert and oriented to all spheres. Memory recent and remote and immediate 

overall good. The mood is sad and the affect is broad in 

range. There is no loosening of associations no pressure of speech and no flight of ideas. There is no thought blocking. There are no delusions and no hallucinations as well as no 

referential thoughts. There is no suicidal thinking and no homicidal thinking. Insight is good and judgment is good and reality testing is intact. 

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(Tr. 18-19 (citing Admin. Hrg. Ex. 14F at 1).) As the Commissioner notes (Doc. 32 at 

14), this passage is included in several other treatment notes. (Tr. 331, 332, 372, 376, 

380). The ALJ, however, did not explain how this passage detracted from 

Dr. Kaperonis’s 2013 opinion. (Tr. 18-19.) Dr. Kaperonis found Petitioner markedly 

limited in her abilities to interact appropriately with the public and co-workers, respond 

appropriately to work pressures in a usual work setting, and respond appropriately to 

changes in a routine work setting. (Tr. 379.) He also found Plaintiff extremely limited in 

her ability to respond appropriately to supervisors. (Id.) The ALJ did not explain how 

Dr. Kaperonis’s findings regarding Plaintiff’s appearance, cognitive functioning, 

memory, insight, judgment, and thought content, which were included in the April 25, 

2013 treatment note that the ALJ cited, detracted from Dr. Kaperonis’s opinions 

regarding limitations in Plaintiff’s abilities to interact with others and respond to changes 

in a work setting. See Ghanin, 763 F.3d at 1164 (noting that “observations of cognitive 

functioning during therapy sessions do not contract Ghanin’s reported symptoms of 

depression and social anxiety.”). The ALJ’s failure to “build a bridge between the 

evidence cited and [his] conclusions” is error. See Scott v. Astrue, 647 F.3d 734, 740 (7th 

Cir. 2011). 

VII. Summary and Remedy 

 Considering the record as a whole, the Court concludes that the ALJ erred in 

rejecting the treating physician’s 2013 opinion. That error was not harmless because the 

vocational expert testified that an individual with the limitations identified in that opinion 

would be unable to sustain work. (Tr. 52-55, 378-79.) Therefore, the Court reverses the 

Commissioner’s disability determination. 

 Because the Court has decided to vacate the Commissioner’s decision, it has the 

discretion to remand the case for further development of the record or for an award 

benefits. See Reddick v. Chater, 157 F.3d 715, 728 (9th Cir. 1998). The decision to 

remand for benefits is controlled by the Ninth Circuit’s “three-part credit-as-true 

standard.” Garrison v. Colvin, 759 F.3d 995, 1020 (9th Cir. 2014). Under that standard, 

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evidence should be credited as true and an action remanded for an immediate award of 

benefits when each of the following factors are present: “(1) the record has been fully 

developed and further administrative proceedings would serve no useful purpose; (2) the 

ALJ has failed to provide legally sufficient reasons for rejecting evidence, whether 

claimant’s testimony or medical opinion; and (3) if the improperly discredited evidence 

were credited as true, the ALJ would be required to find the claimant disabled on 

remand.” Id. (citing Ryan v. Comm’r Soc. Sec., 528 F.3d 1194, 1202 (9th Cir. 2008)); see 

also Benecke v. Barnhart, 379 F.3d 587, 595 (9th Cir. 2004). As discussed below, 

Plaintiff has satisfied all three factors of the credit-as-true rule. 

A. The First Factor 

 On the first factor, there is no need to further develop the record. See Garrison, 

759 F.3d at 1021 (citing Benecke, 379 F.3d at 595) (“Allowing the Commissioner to 

decide the issue again would create an unfair ‘heads we win; tails, let’s play again’ 

system of disability benefits adjudication.”)). The Commissioner suggests that further 

proceedings are necessary because there are inconsistencies in the record. (Doc. 32 at 

20.) The Commissioner asserts that Dr. Kaperonis’s opinion that Plaintiff had social 

problems conflicts with Plaintiff’s self–reports that did not identify problems getting 

along with others. (Doc. 32 at 20 (citing Tr. 379, 148-50, 196-97).) To support this 

argument, the Commissioner cites two functions reports that Plaintiff completed. On a 

May 12, 2012 report (Tr. 144-151), Plaintiff indicated that she talked to “others” daily 

and got along “fine” with authority figures. (Tr. 148.) These statements on the May 

2012 function report appear inconsistent with Dr. Kaperonis’s 2013 opinion. 

 However, on a November 12, 2012 function report that Plaintiff completed 

approximately three months before Dr. Kaperonis completed the RFC Questionnaire, 

Plaintiff reported that she could not be around people, “rarely” spent time with others, 

talked with her “one good friend” daily, her social life had “decreased tremendously,” 

and authority figures made her nervous. (Tr. 192-97.) Similarly, during a November 1, 

2012 appointment with Dr. Kaperonis, Plaintiff reported that she had not been very active 

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and was socially withdrawn. (Tr. 332.) Additionally, in December 2011, Plaintiff 

reported being socially withdrawn.4

 (Tr. 340.) Contrary to the Commissioner’s 

assertion, these treatment notes are consistent with Plaintiff’s November 2012 function 

report. (Doc. 32 at 20 (citing Tr. 332, 340).) Although Plaintiff’s May 2012 function 

report did not indicate that she had problems getting along with others, Plaintiff reported 

such problems on a November 2012 function report and to Dr. Kaperonis. Therefore, the 

Court does not find an inconsistency between Plaintiff’s self-reports and Dr. Kaperonis’s 

2013 opinion that would require further administrative proceedings. 

B. The Second and Third Factors 

 On the second factor, the Court has concluded that the ALJ failed to provide 

legally sufficient reasons for rejecting the 2013 opinion of treating physician 

Dr. Kaperonis. On the third factor, if the discredited evidence were credited as true, the 

ALJ would be required to find Plaintiff disabled on remand because the vocational expert 

testified that a person with the limitations that Dr. Kaperonis identified would be 

incapable of sustained full-time work. Therefore, based on this evidence, Plaintiff is 

disabled. See Garrison, 759 F.3d at 1022, n.28 (stating that when the vocational expert 

testified that a person with the plaintiff’s RFC would be unable to work, “we can 

conclude that [the plaintiff] is disabled without remanding for further proceedings to 

determine anew her RFC.”). 

 Having concluded that Plaintiff meets the three criteria of the credit-as-true rule, 

the Court considers “the relevant testimony [and opinion evidence] to be established as 

true and remand[s] for an award of benefits[,]” Benecke, 379 F.3d at 593 (citations 

omitted), unless “the record as a whole creates serious doubt as to whether the claimant 

is, in fact, disabled with the meaning of the Social Security Act.” Garrison, 759 F.3d at 

1021) (citations omitted). Considering the record as a whole, there is no reason for 

serious doubt as to whether Plaintiff is disabled. See id. The ALJ failed to set forth 

 

4

 The Commissioner cites to this report and mistakenly states that it was completed “within days” of when Plaintiff completed the function report in November 2012. (Doc. 32 at 20 (citing Tr. 332, 340).) 

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specific and legitimate reasons supported by substantial evidence for rejecting 

Dr. Kaperonis’s 2013 opinions. When a hypothetical question was posed to the 

vocational expert incorporating those limitation, the vocational expert testified that such 

limitations would preclude an individual from sustained work activity. On the record 

before the Court, Dr. Kaperonis’s 2013 opinion should be credited as true and the case 

remanded for an award of benefits. 

 Accordingly, 

IT IS ORDERED that the Commissioner’s decision denying benefits is reversed 

and this matter is remanded for a determination of benefits. 

IT IS FURTHER ORDERED that the Clerk of Court shall enter judgment in 

favor of Plaintiff and terminate this case. 

 Dated this 31st day of May, 2016. 

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