Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_19-cv-01718/USCOURTS-azd-2_19-cv-01718-0/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)

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WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Denise Denslow,

Plaintiff,

v. 

Commissioner of Social Security 

Administration,

Defendant.

No. CV-19-01718-PHX-MTM

ORDER 

Plaintiff Denise Denslow (formerly Denise Schatt) seeks review under 42 U.S.C. § 

405(g) of the final decision of the Commissioner of Social Security (“the Commissioner”), 

which denied her disability insurance benefits and supplemental security income under 

sections 216(i), 223(d), and 1614(a)(3)(A) of the Social Security Act. Because the decision 

of the Administrative Law Judge (“ALJ”) is based on legal error and the record is fully 

developed, the Commissioner’s decision will be vacated, and the matter remanded for a 

calculation of benefits. 

I. Background. 

On March 19, 2015, Plaintiff applied for disability insurance benefits and 

supplemental security income, alleging disability beginning November 14, 2014. On 

August 9, 2017, she appeared with her attorney and testified at a hearing before the ALJ. 

A vocational expert also testified. On April 10, 2018, the ALJ issued a decision that 

Plaintiff was not disabled within the meaning of the Social Security Act. The Appeals 

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Council denied Plaintiff’s request for review of the hearing decision, making the ALJ’s 

decision the Commissioner’s final decision. 

II. Legal Standard. 

The district court reviews only those issues raised by the party challenging the ALJ’s 

decision. See Lewis v. Apfel, 236 F.3d 503, 517 n.13 (9th Cir. 2001). The court may set 

aside the Commissioner’s disability determination only if the determination is not 

supported by substantial evidence or is based on legal error. Orn v. Astrue, 495 F.3d 625, 

630 (9th Cir. 2007). Substantial evidence is more than a scintilla, less than a preponderance, 

and relevant evidence that a reasonable person might accept as adequate to support a 

conclusion considering the record as a whole. Id. In determining whether substantial 

evidence supports a decision, the court must consider the record as a whole and may not 

affirm simply by isolating a “specific quantum of supporting evidence.” Id. As a general 

rule, “[w]here the evidence is susceptible to more than one rational interpretation, one of 

which supports the ALJ’s decision, the ALJ’s conclusion must be upheld.” Thomas v. 

Barnhart, 278 F.3d 947, 954 (9th Cir. 2002) (citations omitted). 

III. The ALJ’s Five-Step Evaluation Process. 

To determine whether a claimant is disabled for purposes of the Social Security Act, 

the ALJ follows a five-step process. 20 C.F.R. § 404.1520(a). The claimant bears the 

burden of proof on the first four steps, but at step five, the burden shifts to the 

Commissioner. Tackett v. Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999).

At the first step, the ALJ determines whether the claimant is engaging in substantial 

gainful activity. 20 C.F.R. § 404.1520(a)(4)(i). If so, the claimant is not disabled, and the 

inquiry ends. Id. At step two, the ALJ determines whether the claimant has a “severe” 

medically determinable physical or mental impairment. § 404.1520(a)(4)(ii). If not, the 

claimant is not disabled, and the inquiry ends. Id. At step three, the ALJ considers whether 

the claimant’s impairment or combination of impairments meets or medically equals an 

impairment listed in Appendix 1 to Subpart P of 20 C.F.R. Pt. 404. § 404.1520(a)(4)(iii). 

If so, the claimant is automatically found to be disabled. Id. If not, the ALJ proceeds to 

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step four. At step four, the ALJ assesses the claimant’s residual functional capacity 

(“RFC”) and determines whether the claimant is still capable of performing past relevant 

work. § 404.1520(a)(4)(iv). If so, the claimant is not disabled, and the inquiry ends. Id. 

If not, the ALJ proceeds to the fifth and final step, where he determines whether the 

claimant can perform any other work based on the claimant’s RFC, age, education, and 

work experience. § 404.1520(a)(4)(v). If so, the claimant is not disabled. Id. If not, the 

claimant is disabled. Id.

At step one, the ALJ found that Plaintiff meets the insured status requirements of 

the Social Security Act through December 31, 2022, and that she has not engaged in 

substantial gainful activity since May 2017. At step two, the ALJ found that Plaintiff has 

the following severe impairments: chronic interstitial cystitis, spastic pelvic floor 

syndrome, thyroid disorder, and obesity (20 CFR 404.1520(c)). At step three, the ALJ 

determined that Plaintiff does not have an impairment or combination of impairments that 

meets or medically equals an impairment listed in Appendix 1 to Subpart P of 20 C.F.R. 

Part 404. At step four, the ALJ found that Plaintiff has the RFC to perform:

light work as defined in 20 CFR 404.1567(b), with the following exceptions: 

occasionally climb ramps and stairs, stoop, kneel, crouch, and crawl; never 

climb ladders, ropes, or scaffolding; frequently balance, avoid concentrated 

exposure to extreme cold, extreme heat, and vibration; no exposure to 

dangerous machinery or unprotected heights.

(AR 37-38).

The ALJ further found that Plaintiff is able to perform her past relevant work as an 

administrative clerk, secretary, and education courses sales representative. At step five, 

the ALJ concluded that, considering Plaintiff’s age, education, work experience, and 

residual functional capacity, there are jobs that exist in significant numbers in the national 

economy that Plaintiff could perform. 

IV. Analysis. 

Both parties agree that the ALJ’s decision is defective for failure to comply with the 

requirements of Social Security Ruling (SSR) 15-1P, 2015 WL 1292257 (March 18, 2015).

As a result, the parties both request that the Court remand the matter to the ALJ. (See Docs.

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14, 16, 17). The only dispute is whether the case should be remanded for calculation of 

benefits or for further administrative proceedings. The Court will address each argument 

below. 

A. Legal Standard. 

The Social Security Act provides that courts are “empowered to affirm, modify, or 

reverse a decision by the Commissioner ‘with or without remanding the case for a 

rehearing.’” Garrison v. Colvin, 759 F.3d 995, 1019 (9th Cir. 2014) (quoting 42 U.S.C. § 

405(g)) (emphasis in original). Courts have the power to remand a determination by the 

Commissioner with instructions to calculate and award benefits “when it is clear from the 

record that a claimant is entitled to benefits . . . .” Id.

In cases where there are no outstanding issues that must be resolved before a 

proper disability determination can be made, and where it is clear from the 

administrative record that the ALJ would be required to award benefits if the 

claimant’s excess pain testimony were credited, we will not remand solely to 

allow the ALJ to make specific findings regarding that testimony. Rather, we 

will . . . take that testimony to be established as true.

Varney v. Sec’y of Health & Human Servs., 859 F.2d 1396, 1401 (9th Cir. 1988). The 

“credit-as-true rule” applies to both claimant testimony and medical opinion evidence.

Garrison, 759 F.3d at 1020 (citing Hammock v. Bowen, 879 F.2d 498 (9th Cir. 1989)).

In order for a district court to exercise its discretion to employ the “credit-as-true” 

rule, three factors must be satisfied: 

(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 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.

Garrison, 759 F.3d at 1020. But even if all three factors are satisfied, a district court retains 

“flexibility” in deciding the appropriate remedy. Id. (citing Connett v. Barnhart, 340 F.3d 

871, 876 (9th Cir. 2003)).

“[A] reviewing court is not required to credit claimants’ allegations regarding the 

extent of their impairments as true merely because the ALJ made a legal error in 

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discrediting their testimony.” Dominguez v. Colvin, 808 F.3d 403, 407-08 (9th Cir. 2015) 

(quoting Treichler v. Comm’r of Soc. Sec. Admin., 775 F.3d 1090, 1106 (9th Cir. 2014)).

Rather, remand for further proceedings may be required “when the record as a whole 

creates serious doubt as to whether the claimant is, in fact, disabled within the meaning of 

the Social Security Act.” Id. (quoting Burrell v. Colvin, 775 F.3d 1133, 1141 (9th Cir. 

2014)) (internal quotation marks omitted). 

In conducting this review, the district court must consider whether there are 

‘inconsistencies between [the claimant’s] testimony and the medical 

evidence in the record,’ or whether the government has pointed to evidence 

in the record ‘that the ALJ overlooked’ and explained ‘how that evidence 

casts into serious doubt’ the claimant's claim to be disabled.

Id., 808 F.3d at 407 (quoting Treichler, 775 F.3d at 1106; Burrell, 775 F.3d at 1141)

(internal citations omitted).

B. The Record is Fully Developed.

Here, the “threshold requirement” of the ALJ’s legal error is met, as the 

Commissioner concedes:

that the Administrative Law Judge (ALJ) did not consider the requirements 

of Social Security Ruling (SSR) 15-1p, Titles II and XVI: Evaluating Cases 

involving Interstitial Cystitis (IC), 2015 WL 1292257 (March 18, 2015), in 

evaluating Plaintiff’s claims. . . . Here, the ALJ found that Plaintiff had the 

severe impairment of IC (Administrative Record (AR) 32), but did not 

comport with the guidance in SSR 15-1p in developing the evidence or 

evaluating the impairment.

(Doc. 16 at 1); see Dominguez, 808 F.3d at 408 (holding the threshold was met when it was 

undisputed that the ALJ erred in rejecting a doctor’s opinions). Therefore, we begin by 

reviewing the record and the claimant’s testimony. Plaintiff testified and the ALJ found 

that Plaintiff only had one 13-month period of “substantial gainful activity” in the five 

years since she applied for benefits. (AR 30). There were two periods of unemployment, 

from November 2014 to April 2016, and from May 2017 until the present. (AR 32). Based 

on the Plaintiff’s testimony, the ALJ found that Plaintiff stopped working in 2014 due to 

“severe pain and extreme fatigue from interstitial cystitis, pelvic floor dysfunction, and 

degenerative disc disease.” (AR 32). The ALJ further noted Plaintiff’s testimony that 

Plaintiff was in “constant pain, had pain with urination, bladder muscle spasms, occasional 

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nausea, and poor sleep causing extreme fatigue.” (AR 32). Plaintiff testified this was 

because of her interstitial cystitis, which caused her trouble reading, interpreting, or making 

sense of basic instructions. (AR 51-74). Additionally, she testified that she had to use the

restroom every 20 or 30 minutes. (AR 32, 63, 77). Plaintiff testified that she seeks 

treatment from multiple doctors, has undergone multiple surgeries, engages in physical 

therapy, and takes narcotics, opium, and belladonna for pain, in addition to hormones and 

other supplements. Due to her medications, Plaintiff cannot drive and spends most days 

on the couch or in bed due to fatigue. (AR 67-68).

In reviewing the medical evidence, the ALJ found it “confirms a history of treatment 

for chronic interstitial cystitis and thyroid disorder.” (AR 33). The ALJ found that in 

November 2014, Plaintiff’s primary care doctor completed the necessary paperwork for a 

medical leave of absence due to fatigue from Addison’s disease (although her physicians 

later ruled out the condition), and this medical leave continued through August 2015. (AR 

33). In May 2015, Plaintiff began seeing an endocrinologist for extreme fatigue and the 

doctor confirmed she had hypothyroidism. In the fall of 2015, she was diagnosed with 

chronic cystitis and was given various medications and therapies to treat the condition 

through 2016. In March 2016, a urologist performed bladder irrigation; and Plaintiff 

required emergency room care afterwards for severe pain. Plaintiff continued taking 

vaginal valium and was encouraged to engage in physical therapy. In the fall of 2016, 

under the care of a different urologist, she had an InterStim implantation, but she continued 

to “void every 30 minutes.” (AR 34). In November 2016, the urologist performed 

hydrodistension, a bilateral pudendal nerve block, and a Neurostim placement. Between 

January and May 2017, Plaintiff engaged in six sessions of physical therapy for abdominal 

and pelvic floor exercises and strengthening.

In May 2017, Plaintiff underwent laparoscopic lysis of adhesions, resection of 

endometriosis, and a pudendal nerve block. (AR 989). The ALJ noted that Plaintiff

received work notes to “keep her off work until June 21, 2017, and then to allow work from 

home until June 28, 2017.” (AR 34, 995, 998). Plaintiff received a work status note on 

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July 10, 2017, advising that she could return to work “with restrictions” and a reference to 

the Americans with Disabilities Act (“ADA”) paperwork regarding the restrictions. (AR 

34, 1008).

1 After Plaintiff reported that her bladder pain increased or had not improved, 

Plaintiff was prescribed Botox injections in July 2017. (AR 1011-14). Plaintiff’s current 

treatment includes the pain relievers, Nucynta and Percocet, which are refilled on a 

monthly basis. The ALJ opines that these medications control Plaintiff’s pain 

“reasonabl[y] well, without side effects,” although the Plaintiff testified that she still has 

significant pain, a level five or six, resulting in brain fog, fatigue, difficulty concentrating, 

and an inability to drive. (AR 35, 67, 69). 

Plaintiff’s testimony is substantially supported by the medical record. In the 

Commissioner’s Motion to Remand, the Commissioner claims that “further development 

of this case is needed to make sure the [Interstitial Cystitis] evidence was developed in 

accordance with the appropriate agency policy.” (Doc. 16 at 3). However, the 

Commissioner does not list any factual or evidentiary holes in the record or what further 

evidence is necessary. In fact, as noted above, the ALJ found that the current record did

“confirm a history of treatment for chronic interstitial cystitis.” (AR 33).

C. The ALJ Failed to Provide Legally Sufficient Reasons for Discounting

the Evidence Regarding Interstitial Cystitis.

The ALJ found that the “medically determinable impairments significantly limit the 

claimant’s ability to perform basic work activities as required by SSR 85-28 and, in the 

case of obesity, by SSR 02-1p.” (AR 36). The ALJ discussed various conditions of 

Plaintiff, but ultimately found they did not meet the severity of the required listed 

impairments in 20 CFR Part 404, Subpart P, Appendix 1. The ALJ stated that the Plaintiff’s 

“need for chronic pain management arises out of pain related to interstitial cystitis, not 

degenerative disc disease or other back impairment.” (AR 38). Notably, however, the ALJ 

does not discuss the severity of the interstitial cystitis and whether this impairment, taken 

1 The Commissioner does not dispute that the doctor’s orders contained restrictions but, in 

her opinion, the ALJ notes the specific restrictions were not admitted into the record. 

(AR 34).

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with her other impairments, meets the severity requirements of the regulations.

Under step four of the SSA’s policy for evaluating a claimant with interstitial 

cystitis, the ALJ “must consider all of the person’s impairment-related symptoms in 

deciding how such symptoms may affect functional capacity.” SSR 15-1P, 2015 WL

1292257 (Mar. 18, 2015). The policy identifies potential issues relating to interstitial 

cystitis:

For example, many people with IC have chronic pelvic pain, which can affect 

the ability to focus and sustain attention on the task at hand. Nocturia may 

disrupt sleeping patterns and lead to drowsiness and lack of mental clarity 

during the day. Urinary frequency can necessitate trips to the bathroom as 

often as every 10 to 15 minutes, day and night. Consequently, some 

individuals with IC essentially may confine themselves to their homes. 

Id. Based on Plaintiff’s testimony and the ALJ’s own findings, Plaintiff suffered from all

these issues. Plaintiff testified that she had extreme fatigue, brain fog, and trouble “reading 

or interpreting, extrapolating . . .” because she is “always in this much pain and [] always 

this tired.” (AR 65). She also stated she uses “the restroom every 20 to 30 minutes.”

(AR 65). She stated she sees a physical therapist to help with the “pelvic floor dysfunction” 

that creates “muscle spasms around the bladder, make[s] muscle spasms in the vagina, pain 

during sex, dryness.” (AR 66). She testified that her pain medication assists with the pain, 

but it is not “completely under control” and causes her brain fog, fatigue, difficulty in 

concentration, and an inability to drive. (AR 67). She also has “trouble sleeping at night 

so [she’s] usually up to go to the bathroom several times” due to the pain and her frequency 

of urination. (AR 67). She also stated that “on bad days I’m literally in the bed all day or 

on the couch all day.” (AR 68). Plaintiff testified that she was let go from her part-time 

job in 2017 because of her condition. (AR 72). She said her work performance was 

impaired by her necessity to get up and go to the bathroom so frequently. Eventually, this 

led to the employer firing her and telling her the “disability was the reason they were letting 

me go.” (AR 73).

The ALJ did not consider any of these symptoms in determining the severity of 

Plaintiff’s condition, except for confirming “insomnia” due to poor sleep and waking to 

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urinate. (AR 35-36). Such a failure is error under the regulation, which requires the ALJ 

to “consider all of the person’s impairment-related symptoms” in determining the RFC.

SSR 15-1P, 2015 WL 1292257 (Mar. 18, 2015) (emphasis added).

2

D. The ALJ Would be Required to Find the Claimant Disabled on Remand.

The Commissioner argues that the record creates “questions” as to whether the 

Plaintiff is disabled. (Doc. 16 at 3). In support of his position, the Commissioner argues 

that Plaintiff worked at a substantial gainful activity level for over a year after the alleged 

onset date, and that she was cleared to return to work in July 2017. (Id.).

As an initial matter, Plaintiff concedes that she is not eligible for benefits prior to 

May 2017, when she stopped engaging in substantial gainful activity due to her condition.

(Doc. 17 at 2). Plaintiff is not seeking benefits during the time of her employment. By the 

ALJ’s own analysis in step one, the decision “focuses on the periods outside of the work 

activity” i.e. namely from November 2014 to April 2016 and from May 2017 to present.

(AR 33). Regardless of the ALJ’s finding in step one that Plaintiff had two periods of 

unemployment sandwiching a 13-month period of substantial gainful activity, the ALJ 

proceeded to review the case for those two periods of unemployment, implicitly 

acknowledging Plaintiff may qualify for benefits during those periods.

Plaintiff’s period of employment does not cast doubt on Plaintiff’s disability.

According to Plaintiff, she was only able to work part-time at the prior job and was let go 

due to her disability. The employer stated it was no longer able to provide the significant 

accommodations necessary for her disability. Plaintiff’s testimony, as documented by the 

ALJ, stated that her symptoms worsened over her period of work activity. The relevant 

doctor’s work notes cleared her to return to work “with restrictions.” (AR 1008). Although 

Plaintiff worked and earned “significant amounts,” this was prior to her claim that her 

symptoms were worsening in the May-July 2017 period. 

The Commissioner cites to Burrell v. Colvin, 775 F.3d 1133 (9th Cir. 2014) for the 

2 Although the ALJ noted Plaintiff’s chronic pain management arose from her interstitial 

cystitis, the ALJ only considered whether the degenerative disk disease (which Plaintiff 

admitted did not cause the lion’s share of her pain) “more than minimally limits the 

claimant’s ability to perform basic work activities.” (AR 37).

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proposition that doubts remain as to Plaintiff’s disability and further development of the 

record is necessary. (Doc. 16 at 3). The Commissioner’s argument is not persuasive. First, 

Burrell is inapposite. In that case, the court found that the claimant’s testimony appeared 

to contradict the medical record. Burrell, 775 F.3d at 1141-42 (“We conclude that the 

record as a whole creates serious doubt as to whether Claimant is, in fact, disabled” because 

“evidence in this record not discussed by the ALJ suggests Claimant may not be credible.”). 

But no such contradiction exists here. As discussed above, Plaintiff’s allegations are 

consistent with the medical record. The Commissioner does not “point to anything in the 

record that the ALJ overlooked and explain how that evidence casts into serious doubt 

[Plaintiff’s] claim to be disabled.” Garrison, 759 F.3d at 1022.

Second, the Commissioner’s argument is undermined by the testimony of the 

Vocational Expert (VE) at the hearing. There, the VE testified that if a person was limited 

to light work but would require frequent breaks of five minutes every 20 to 30 minutes, 

they would not “be able to engage in work activity.” (AR at 79). At step five, the “burden 

shifts to the Commissioner to prove that, based on the claimant’s residual functional 

capacity, age, education, and past work experience, she can do other work.” Smolen v. 

Chater, 80 F.3d 1273, 1291 (9th Cir. 1996); Tackett, 180 F.3d at 1098. The VE testified 

that someone with a condition requiring them to get up and go to the bathroom at the 

intervals the Plaintiff necessitates would prohibit them from being able to “engage in work 

activity.” (AR 78). The ALJ’s explanation for finding “inconsistency” with Plaintiff’s 

testimony regarding her frequency of urination was that she was able to return to work for 

over a year, even if only part-time and with significant accommodations. Plaintiff’s ability 

to work for that period, however, does not contradict Plaintiff’s testimony that her 

symptoms worsened during that time, and this was ultimately why she needed additional 

procedures. The doctor’s notes allowing her to return to work after these procedures in 

July 2017 cited ADA restrictions, which provided further support for Plaintiff’s testimony. 

V. Conclusion. 

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In this case, the Commissioner concedesthe ALJ’s decision was based on legal error 

and moves to remand for additional proceedings. The Commissioner, however, does not 

point to any evidence in the record that creates serious doubt as to Plaintiff’s disability. 

“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,” and allow the “ALJ 

to have a mulligan.” Benecke v. Barnhart, 379 F.3d 587, 595 (9th Cir. 2004); Garrison, 

759 F.3d at 1020. The Court, therefore, remands the case for calculation of benefits from 

the amended onset date of May 2017.

IT IS ORDERED that the final decision of the Commissioner of Social Security is 

vacated, and this case is remanded for an award of benefits. The Clerk shall enter 

judgment accordingly and terminate this case.

IT IS FURTHER ORDERED that the Commissioner’s Motion to Remand 

(doc. 16) is denied as moot.

Dated this 6th day of March, 2020.

Honorable Michael T. Morrissey

United States Magistrate Judge

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