Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_05-cv-03521/USCOURTS-azd-2_05-cv-03521-1/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:205 Denial Social Security Benefits

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WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

JILL T. HOLDER, )

)

Plaintiff, ) 

) No. CIV 05-3521 PHX RCB

vs. ) 

) O R D E R

LINDA S. MCMAHON, )

Acting Commissioner of Social )

Security )

)

Defendant. ) )

On November 2, 2005, Plaintiff Jill T. Holder filed the

above-entitled action pursuant to 42 U.S.C. § 405(g) for judicial

review of a final decision of the Commissioner of Social Security

(the "Commissioner") denying her application for disability

insurance benefits under Title II of the Social Security Act (the

"Act"). Compl. (doc. # 1). Currently pending before the Court are

Plaintiff's motion for summary judgment (doc. # 25) and Defendant's

cross-motion for summary judgment (doc. # 30). On February 21,

2007, Plaintiff filed a reply in support of her motion and in

opposition to Defendant's motion. Reply (doc. # 39). Having 

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1

 For reasons unknown to the Court, the ALJ also elicited

testimony regarding the current vocation of Plaintiff's daughter and

son-in-law with whom she lived at that time. Admin. R. at 445-46.

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carefully considered the arguments raised, the Court now rules.

I. BACKGROUND

On June 25, 2002, Plaintiff filed an application for

disability insurance benefits under Title II of the Act,

complaining of fibromyalgia, a pituitary macro adenoma, recurrent

renal stones, and osteoperosis with a disability onset date of

September 25, 2001. See Admin. R. (doc. # 6) ("Admin. R.") at 53. 

After Plaintiff's application was denied initially and on

reconsideration, she sought review by an Administrative Law Judge

("ALJ"). See id. at 17.

On May 19, 2004, a hearing was held before an ALJ where

testimony was heard from Plaintiff, as well as medical expert 

Sami Nafoosi, M.D., vocational expert Stephen Berry, and

Plaintiff's son-in-law Peter Harrison. Id. at 441-42. In her

examination of Plaintiff, the ALJ developed testimony regarding

Plaintiff's educational and vocational background, family history,

and mental health.1 Id. at 444-41. Dr. Nafoosi, a non-examining

medical expert, then asked Plaintiff questions concerning her

pituitary tumor, kidney stones, osteoperosis, and related

surgeries. Id. at 452-54. Based on that testimony, and his review

of the medical record, Dr. Nafoosi testified that Plaintiff's

medically determinable conditions did not individually or

collectively meet or equal a listed disability, and that there was

no objective evidence for a diagnosis of fibromyalgia. Dr. Nafoosi

went on to opine that Plaintiff could perform jobs where she would

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2

 It is difficult to understand why Plaintiff would be able to

lift 10 pounds less frequently than she would be able to lift 20

pounds, as Dr. Nafoosi stated. See Admin. R. at 456. It seems that

he had meant to say that Plaintiff could lift 10 pounds frequently,

not "less frequently," and that is how his testimony was construed

and treated at the hearing by the ALJ and Plaintiff's counsel. See

id. at 458, 460, 463.

3

 Although the transcript reflects counsel as referring to an

exhibit number corresponding to an opinion from Dr. Geier, which was

largely consistent with the opinion of Dr. Hamilton, the Court notes

that the limitations specified in counsel's hypothetical question

directly correspond to those limitations identified three pages

earlier in the record in Dr. Hamilton's opinion. See Admin. R. at

459-60; compare id. at 423 (opinion of Dr. Hamilton) with id. at 426

(opinion of Dr. Geier).

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have to lift 20 pounds occasionally; lift 10 pounds less

frequently2; sit for 8 hours of an 8-hour day; walk or stand for 6

hours of an 8-hour day; complete an 8-hour day, 40-hour work week

without requiring more than 3 breaks per day; and not miss more

than 3 work days per month on account of her impairments or

treatment. Id. at 454-57. Based on these limitations, the ALJ

then posed a hypothetical question to the vocational expert who

opined that Plaintiff, while unable to perform her past relevant

work, could perform other light work. See id. at 457-59.

Plaintiff's counsel then posed a second hypothetical question

to the vocational expert based on limitations set forth in a

medical opinion from Plaintiff's treating physician, Shawn

Hamilton, M.D..3 Based on Dr. Hamilton's assessment, which was

less optimistic than that of Dr. Nafoosi, the vocational expert

testified that there would be no jobs available in the national

economy for Plaintiff. Id. at 459-60. Before the hearing was

concluded, further testimony was also heard from Plaintiff as well

as her son in law, Peter Harrison. See id. at 465-85.

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On July 29, 2004, the ALJ issued a decision finding Plaintiff

not disabled. Id. at 14-25. The ALJ discredited Plaintiff's

testimony as well as that of her son in law, and rejected the

medical opinion evidence from Plaintiff's treating physicians,

treating psychologist, and examining rheumatologist. The ALJ did

not discuss the medical opinion of Plaintiff's treating

psychiatrist. At the second step of the sequential evaluation

process, the ALJ concluded that there was no credible evidence of

fibromyalgia. At the fifth step of the sequential evaluation

process, the ALJ determined that Plaintiff retains the residual

functional capacity ("RFC") to engage in light work as a

cleaner/housekeeper, inspector, or assembly line worker, and was

therefore not disabled. See id. at 17-25.

On September 27, 2004, Plaintiff filed a timely administrative

appeal of the ALJ's decision with the Appeals Council of the Social

Security Administration ("SSA") and submitted additional evidence

for review. Id. at 12-13. The Appeals Council then issued its

decision denying Plaintiff's request for review and adopting the

ALJ's decision as the Commissioner's final decision. Id. at 5-7;

see 20 C.F.R. § 404.981; Tackett v. Apfel, 180 F.3d 1094, 1097 (9th

Cir. 1999).

On November 2, 2005, Plaintiff sought review in this Court

pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3). Compl. (doc. # 1). 

Cross-motions for summary judgment have been filed and fully

briefed. Mot. (doc. # 25); Mot. (doc. # 30); Reply (doc. # 39).

II. STANDARDS OF REVIEW

A. Fed. R. Civ. P. 56

Summary judgment is appropriate "when there is no genuine

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issue of material fact" such that "the moving party is entitled to

judgment as a matter of law." Fed. R. Civ. P. 56. In determining

whether to grant summary judgment, a district court must view the

underlying facts and the inferences to be drawn from those facts in

the light most favorable to the nonmoving party. See Matsushita

Elec. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986).

If a party will bear the burden of proof at trial as to an

element essential to its claim, and fails to adduce evidence

establishing a genuine issue of material fact with respect to the

existence of that element, then summary judgment is appropriate. 

See Celotex Corp. v. Catrett, 477 U.S. 317, 322-23 (1986). Not

every factual dispute is capable of defeating a properly supported

motion for summary judgment. Rather, the party opposing the motion

must show that there is a genuine issue of material fact. See

Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48 (1986). A

factual dispute is genuine if the evidence is such that a rational

trier of fact could resolve the dispute in favor of the nonmoving

party. Id. at 248. A fact is material if determination of the

issue might affect the outcome of the case under the governing

substantive law. Id. Thus, a party opposing a motion for summary

judgment cannot rest upon bare allegations or denials in the

pleadings, but must set forth specific facts demonstrating a

genuine issue for trial. See id. at 250. If the nonmoving party's

evidence is merely colorable or not significantly probative, a

court may grant summary judgment. See id. at 249; see also Cal.

Architectural Build. Prods., Inc. v. Franciscan Ceramics, 818 F.2d

1466, 1468 (9th Cir. 1987).

Finally, the fact that both parties have moved for summary

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judgment does not alter these standards. "It is well settled that

a court's duty to ascertain whether facts remain in contention is

not obviated by cross motions for summary judgment." Eby v. Reb

Realty, Inc., 495 F.2d 646, 649 (9th Cir. 1974).

B. 42 U.S.C. § 405(g)

The Commissioner's denial of benefits is subject to judicial

review pursuant to 42 U.S.C. § 405(g). The decision of the

Commissioner must be affirmed if it is supported by

substantial evidence and the Commissioner applied the correct legal

standards. Bayliss v. Barnhart, 427 F.3d 1211, 1214 n.1 (9th Cir.

2005); Benton v. Barnhart, 331 F.3d 1030, 1035 (9th Cir. 2003);

Tackett, 180 F.3d at 1097; Reddick v. Chater, 157 F.3d 715, 720

(9th Cir. 1998). Factual determinations by the Commissioner,

acting through an ALJ, must be affirmed if supported by substantial

evidence. See Celaya v. Halter, 332 F.3d 1177, 1180 (9th Cir.

2003); Saelee v. Chater, 94 F.3d 520, 521 (9th Cir. 1996).

Substantial evidence 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). It is more than a

"mere scintilla," but less than a preponderance. Richardson, 402

U.S. at 401 (1971) (internal quotations omitted); Connett v.

Barnhart, 340 F.3d 871, 873 (9th Cir. 2003); Tackett, 180 F.3d at

1098; Reddick, 157 F.3d at 720; Sorenson v. Weinberger, 514 F.2d

1112, 1119 n.10 (9th Cir. 1975).

 In reviewing the Commissioner's decision, the district court

must "consider the evidence as a whole, weighing both the evidence

that supports and the evidence that detracts from the

Commissioner's conclusion." Smolen v. Chater, 80 F.3d 1273, 1279

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(9th Cir. 1996). If the evidence can reasonably support either

affirming or reversing the Commissioner’s conclusion, the district

court may not substitute its judgment for that of the Commissioner

and must affirm. See McCartey v. Massanari, 298 F.3d 1072, 1075

(9th Cir. 2002); Tackett, 180 F.3d at 1098; Reddick, 157 F.3d at

720; Andrews v. Shalala, 53 F.3d 1035, 1039-40 (9th Cir. 1995). 

Finally, "[a] decision of the ALJ will not be reversed for

errors that are harmless." Stout v. Comm'r, SSA, 454 F.3d 1050,

1054 (9th Cir. 2006) (citation omitted); accord Burch v. Barnhart,

400 F.3d 676, 679 (9th Cir. 2005); Curry v. Sullivan, 925 F.2d

1127, 1131 (9th Cir. 1991). Thus, errors that are inconsequential

to the ALJ's ultimate determination as to disability are not

reversible. Stout, 454 F.3d at 1055. However, the error of

silently disregarding testimony about how an impairment limits a

claimant's ability to work has never been held harmless. See id.

at 1055-56.

III. DISCUSSION

A person is considered disabled under the Act when he or she

becomes unable "to engage in any substantial gainful activity by

reason of any medically determinable physical or mental impairment

. . . which has lasted or can be expected to last for a continuous

period of not less than twelve months." 42 U.S.C. § 423(d)(1)(A). 

In an administrative proceeding to determine eligibility for

disability insurance benefits, the Commissioner conducts a

five-step sequential evaluation process to determine whether a

claimant is disabled within the meaning of the Act. See 20 C.F.R.

§ 404.1520(b)-(f). If at any of those five steps the Commissioner

can find the claimant disabled or not, the inquiry ends. 20 C.F.R.

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§ 404.1520(a).

In this case, Plaintiff's diagnosis of fibromyalgia was found

not to constitute a "severe medically determinable physical . . .

impairment" at the second stage of the sequential evaluation

process, 20 C.F.R. § 404.1520(a)(4)(ii), Admin. R. at 20, 24, and,

as a result, Plaintiff was found "not disabled" at the fifth stage

of the sequential evaluation process when the ALJ determined that

Plaintiff retains the RFC to engage in light work as a

cleaner/housekeeper, inspector, or assembly line worker, Admin. R.

at 24, 20 C.F.R. § 404.1520(g). Plaintiff's foremost objection to

the finding of non-disability is that the ALJ erred by not

considering her diagnosis of fibromyalgia to be a severe medically

determinable impairment, thereby failing to incorporate that

limitation in her hypothetical question to the vocational expert or

consider the diagnosis in her RFC determination. Mot. (doc. # 25)

at 2-7, 13. This argument is best evaluated in the context of

Plaintiff's broader claim that the ALJ did not set forth adequate

reasons for ignoring or rejecting the medical opinions of her

treating and examining sources.

To summarize, Plaintiff complains that the ALJ erred by (1)

either silently ignoring or not according sufficient weight to the

medical opinions of her treating and examining sources, id. at 2-5,

8-11, (2) not according sufficient weight to her subjective

testimony regarding her physical and mental limitations, id. at 11-

12, (3) not according sufficient weight to the lay testimony of her

son-in-law, Peter Harrison, id. at 13, (4) not posing a complete

hypothetical question to the vocational expert, id., and (5) not

considering all of her limitations in determining her RFC, id. at

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5-8. The Court considers each argument in turn.

A. Medical Opinions of Treating Sources

Under the Social Security Regulations (the "Regulations"),

evidence of a claimant's impairment may be provided by either an

"acceptable medical source" or "other source." 20 C.F.R. §§

404.1513(a), 404.1513(d). Only an acceptable medical source can

provide medical opinions. 20 C.F.R. § 404.1527(a)(2). 

Weight is accorded differently to medical opinions depending

on whether the source providing the opinion is the claimant's

treating source, examining source, or a source who neither

examined nor treated the claimant ("non-examining source"). 

Generally, an uncontradicted opinion from a treating source must be

given controlling weight, 20 C.F.R. § 404.1527(d)(2), and greater

weight must also be given to the opinion of an examining source

than that of a non-examining source, Pitzer v. Sullivan, 908 F.2d

502, 506 n.4 (9th Cir. 1990). The uncontradicted opinion and

ultimate conclusions of a treating or examining source may not be

rejected unless the ALJ provides clear and convincing reasons

supported by substantial evidence in the record for doing so. 

Baxter v. Sullivan, 923 F.2d 1391, 1396 (9th Cir. 1991); Embrey v.

Bowen, 849 F.2d 418, 422 (9th Cir. 1988). If controverted by other

medical evidence, the ALJ may disregard the opinion only by setting

forth specific and legitimate reasons supported by substantial

evidence in the record for doing so. See 20 C.F.R. 

§ 416.927(f)(2)(ii); Andrews, 53 F.3d at 1043.

In the present case, Plaintiff complains that the ALJ did not

accord sufficient weight to the medical opinions of (1) her

examining rheumatologist, Kelly Portnoff, M.D., Mot. (doc. # 25) at

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2-5, (2) her treating psychiatrist, Chona Bader Green, M.D., id. at

8-9, (3) her treating psychologist, Karen Rabin, Ph.D., id. at 10,

and (4) her treating physicians, Elizabeth Traynor, M.D., Shawn

Hamilton, M.D., and John Geier, M.D., id. at 9-11.

1. Opinion of Dr. Portnoff, Examining Rheumatologist

Plaintiff's foremost objection to the Commissioner's finding

of non-disability is that the ALJ erred by not considering her

diagnosis of fibromyalgia to be a severe medically determinable

physical impairment. Mot. (doc. # 25) at 2-5. On referral from

her treating physician, Plaintiff was examined by Dr. Portnoff, a

rheumatologist, and diagnosed with fibromyalgia based on a physical

examination revealing 18 out of 18 myofascial tender points. 

Admin. R. at 388-89. "Rheumatology is the relevant medical

specialty for fibromyalgia," Benecke v. Barnhart, 379 F.3d 587, 594

n.4 (9th Cir. 2004), and the SSA has long recognized the tenderpoint criteria established by the American College of Rheumatology

as establishing a medically determinable impairment of

fibromyalgia. See 64 Fed. Reg. 23380, 23382 n.3 (Apr. 30, 1999);

see also SSA Memorandum, Fibromyalgia, Chronic Fatigue Syndrome,

and Objective Medical Evidence Requirements for Disability

Adjudication, at 5 (May 11, 1998) (explaining that the signs for

fibromyalgia "are primarily the tender points"). Plaintiff thus

argues that the ALJ erred by not according sufficient weight to Dr.

Portnoff's opinion, and, as a result, finding that her diagnosis of

fibromyalgia did not constitute a severe medically determinable

physical impairment. Mot. (doc. # 25) at 2-5.

Defendant contends that Plaintiff failed to substantiate any

impairment or functional limitation from her fibromyalgia, and

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argues that the ALJ appropriately rejected Dr. Portnoff's opinion

by setting forth specific and legitimate reasons supported by

substantial evidence in the record. Mot. (doc. # 30) at 4-6. The

Court disagrees.

The ALJ's decision does not set forth legally sufficient

reasons for rejecting Dr. Portnoff's opinion. In her rheumatologic

evaluation, Dr. Portnoff diagnosed Plaintiff with probable

fibromyalgia based on a physical examination that revealed 18 out

of 18 myofascial tender points. Admin. R. at 388-89. The ALJ

summarily rejected this diagnosis, noting only that "there ha[d]

been no mention or documentation of such tender points prior to

[Dr. Portnoff's] evaluation, nor ha[d] there been any subsequent

corroborating findings." Id. at 20. Stripped of its innuendo,

this statement says nothing more than the fact that Dr. Portnoff's

fibromyalgia diagnosis, while not corroborated by subsequent

findings, is an uncontradicted medical opinion from an examining

physician-- one that should have been given controlling weight by

the ALJ. See Widmark v. Barnhart, 454 F.3d 1063, 1065 (9th Cir.

2006) ("[T]he mere absence of a corroborating opinion cannot in

itself constitute a conflict among the medical opinions."); see

also Baxter, 923 F.2d at 1396; Embrey, 849 F.2d at 422. Instead,

the ALJ chose to ignore Dr. Portnoff's opinion simply because there

was not more evidence like it. The only other possible

justification offered by the ALJ is the conclusory assertion that

"Dr. Portnoff's assessment is inconsistent with the substantial

evidence of record." Admin. R. at 20. None of this "substantial

evidence" is mentioned or cited in that discussion, and, given that

Dr. Portnoff was the only rheumatologist to examine Plaintiff for

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fibromyalgia, the Court questions whether any such evidence exists. 

See id.

Defendant argues that the ALJ's rejection of Dr. Portnoff's

opinion could have been validly based on the allegedly conflicting

opinion of the Commission's non-examining medical expert, Sami

Nafoosi, M.D., who indicated finding "no objective basis for a

diagnosis of fibromyalgia." Mot. (doc. # 30) at 4-8; Admin. R. at

21, 452-54, 463-64. This argument fails, because the ALJ did not

refer to Dr. Nafoosi's opinion as a basis for rejecting Dr.

Portnoff's opinion. Id. at 20. Even if the ALJ had been so

explicit in her analysis, Dr. Nafoosi's opinion does not provide a

sufficient basis to disregard Dr. Portnoff's fibromyalgia

diagnosis. As a rheumatologist, Dr. Portnoff's opinion was

entitled to "greater weight than those of the other physicians

because it [wa]s an 'opinion of a specialist about medical issues

related to his or her area of specialty.'" Benecke, 379 F.3d at

594 n.4 (quoting 20 C.F.R. § 404.1527(d)(5)). Dr. Portnoff's

opinion was also entitled to greater weight by virtue of the fact

that she, unlike Dr. Nafoosi, was an examining source. See Baxter,

923 F.2d at 1396; Embrey, 849 F.2d at 422. In any event, Dr.

Nafoosi's observation that there was "no objective basis for a

diagnosis of fibromyalgia," Admin. R. at 21, is meaningless, as it

is well known that the "cause or causes [of fibromyalgia] are

unknown, there is no cure, and . . . its symptoms are entirely

subjective." See Sarchet v. Chater, 78 F.3d 305, 306 (7th Cir.

1996) (Posner, C.J.). Therefore, without having conducted a

physical examination for tender points or at least considered the

evidence of such findings by Dr. Portnoff, Dr. Nafoosi's conclusion

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that there is "no objective basis for a diagnosis of fibromyalgia"

is at odds with the SSA's own standards for determining the

presence of fibromyalgia. See 64 Fed. Reg. 23380, 23382 n.3 (Apr.

30, 1999); see also SSA Memorandum, Fibromyalgia, Chronic Fatigue

Syndrome, and Objective Medical Evidence Requirements for

Disability Adjudication, at 5 (May 11, 1998). 

In sum, neither the reasons expressly stated by the ALJ nor

the opinion expressed by Dr. Nafoosi offers any legitimate basis to

dispute the diagnosis by Dr. Portnoff-- a specialist whose

examination of Plaintiff revealed findings recognized by the SSA as

sufficient proof of fibromyalgia. While the ALJ has made her

general skepticism with regard to fibromyalgia and Plaintiff's

claims known, "[s]heer disbelief is no substitute for substantial

evidence." See Benecke, 379 F.3d at 594.

2. Opinion of Dr. Green, Treating Psychiatrist

As evidence of her impairments in the case at hand, Plaintiff

provided the SSA with medical records from her treating

psychiatrist, Chona Bader Green, M.D., Admin. R. at 232-304, but

the ALJ did not discuss this evidence in her decision, Id. at 17-

25. Plaintiff thus argues that the ALJ erred by completely

ignoring Dr. Green's opinion. Mot. (doc. # 25) at 8-9.

Defendant claims that the ALJ's failure to consider Dr.

Green's opinion was harmless error, relying on the ALJ's

consideration of an opinion from Plaintiff's psychologist, Karen

Rabin, Ph.D., who worked at the same practice as Dr. Green. Mot.

(doc. # 30) at 10-11. Defendant believes that the ALJ's rejection

of Dr. Rabin's opinion for lack of "objective medical evidence"

applies by proxy to the silently disregarded opinion of Dr. Green. 

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4

 The Employment Development Department administers the state

disability insurance program for California workers. Employment Dev.

Dep't, Disability Insurance, at http://www.edd.ca.gov/eddhome.htm

(last visited Mar. 2, 2007).

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This is Defendant's theory of harmless error. Id.

The Regulations state that "[r]egardless of its source, [the

SSA] will evaluate every medical opinion [it] receive[s]." 20

C.F.R. § 404.1527(d). As a licensed treating physician, Dr. Green

was a source whose opinion should have been discussed-- even

accorded controlling weight-- yet the ALJ ignored Dr. Green's

findings without comment, let alone specific and legitimate reasons

supported by substantial evidence in the record for discrediting

that evidence. In view of the numerous disability certifications

furnished by Dr. Green to the Employment Development Department of

the State of California4 and, on one occasion, to a jury

commissioner, see Admin. R. at 253, 262, 265, 269, 291, the Court

cannot find that the ALJ's error in failing to consider her opinion

was harmless. See Stout, 454 F.3d at 1055. Because the error of

silently disregarding lay testimony about how an impairment limits

a claimant's ability to work has never been held harmless, see id.

at 1055-56, it is difficult to countenance a similar excuse for the

error of silently disregarding a treating physician's opinion.

Defendant's post hoc rationale suggesting that the ALJ

conflated the opinions of Drs. Green and Rabin based on the

interdisciplinary nature of their practice, and is thereby excused

for having failed to discuss Dr. Green's opinion, is of dubious

merit. Not only does the decision fail to mention any such

rationale, see Admin. R. at 17-25, but the fact that the ALJ

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rejected Dr. Rabin's opinion based on her perception that it was

unsupported by "objective medical findings," id. at 20, belies the

more likely truth that the ALJ was unaware of, or deliberately

ignored, the interdisciplinary nature of the practice.

3. Opinion of Dr. Rabin, Treating Psychologist

The Court finds that the ALJ has not set forth specific and

legitimate reasons supported by substantial evidence in the record

for rejecting the opinion of Plaintiff's treating psychologist, Dr.

Rabin. After citing a four-page opinion from Dr. Rabin, the ALJ

concluded that the psychologist's assessment "is not fully

credible." Id. at 20. In support of this position, the ALJ relied

on a prior mental examination that found no significant

limitations, and her general impression that Dr. Rabin relied

solely on Plaintiff's subjective complaints rather than an actual

mental status examination. See id. There is no citation to the

record for these assertions, making it difficult to ascertain the

validity of the decision. Id. Moreover, the ALJ's failure to

consider the mental status examinations and disability opinions of

Plaintiff's treating psychiatrist, Dr. Green, with whom Dr. Rabin

practiced, see Part III.A.2, supra, diminishes the credibility of

her rationale that Dr. Rabin's opinion lacked a medical basis. The

record contains over seventy pages of treatment notes from Drs.

Green and Rabin documenting Plaintiff's treatment as far back as

January 11, 2001, id. at 232-304, as well as several disability

opinions from Dr. Green, id. at 253, 262, 265, 269, 291, yet none

of this is discussed in the decision, id. at 17-25. It is apparent

that the ALJ's failure to consider Dr. Green's opinion flawed her

analysis of Dr. Rabin's opinion, and the reasons provided in the

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decision for rejecting Dr. Rabin's opinion do not cure this error.

4. Opinion of Drs. Traynor, Hamilton, and Geier

Plaintiff also provided the SSA with medical records from her

treating physicians, Elizabeth Traynor, M.D., Shawn Hamilton, M.D.,

and John Geier, M.D.. Id. at 213-14, 217-91. Licensed physicians

are acceptable medical sources. 20 C.F.R. § 404.1513(a)(1)-(2). 

Plaintiff thus argues that the ALJ should have either given

controlling weight to the opinions of her treating sources or

explained in the decision her reasons for not doing so. Mot. (doc.

# 10) at 9-11. Defendant maintains that the ALJ appropriately

rejected the treating physicians' opinions by setting forth

specific and legitimate reasons supported by substantial evidence

in the record revealed from a "thorough review of all relevant

medical evidence." Mot. (doc. # 30) at 11-15.

With respect to the ALJ's rejection of Dr. Traynor's opinion,

the Court finds that the ALJ did not set forth legally sufficient

reasons. Dr. Traynor opined that Plaintiff is "disabled from

regular work" and "bedridden" due to pain in her chest and spine,

headaches for 7-10 days per month, pituitary tumor, kidney stones,

high blood pressure, and insomnia. Admin. R. at 402. The ALJ,

without citing to any record evidence, stated that the medical

evidence did not establish an objective basis for any problems

arising from Plaintiff's pituitary tumor, kidney stones, or blood

pressure. Id. at 21. Counsel has with great alacrity scoured the

record and the decision to provide the Court with citations to the

specific portions of the record to which the ALJ may have tacitly

intended to refer. Mot. (doc. # 30) at 15 (discussing opinions of

Drs. Gruenefelder and Geier). While the effort is admirable, it

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 The Court also notes that the ALJ attempted to refute Dr.

Traynor's opinion as to Plaintiff's bedridden condition by injecting

her personal opinion that Plaintiff's "status is due to a lifestyle

choice and not due to any medical condition." Id. (emphasis added).

Even if sufficient reasons had been set forth to reject Dr. Traynor's

opinion, the Court questions the usefulness of expressions such as

this that add nothing to the legal analysis and tend to undermine the

Commissioner's appearance of impartiality.

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does not save the ALJ's decision from its fatal lack of specific

reasons for discrediting Dr. Traynor's opinion. The problem is

best illustrated by the inconsistency of the post hoc rationale

offered with respect to the issue of Plaintiff's blood pressure. 

Counsel suggests that the ALJ may have validly relied on Dr.

Geier's opinion that Plaintiff's endocrine system functioned

adequately. Mot. (doc. # 30) at 15. Considering that the ALJ

expressly rejected Dr. Geier's assessments as "simply not

credible," it is difficult to accept this justification. Admin. R.

at 21. Given the ease with which the ALJ's oblique reasons for

rejecting Dr. Traynor's testimony can lead Defendant's counsel to

such incompatible results, it is clear that the decision does not

adequately set forth specific and legitimate reasons for rejecting

Dr. Traynor's testimony. Furthermore, the decision's reference to

the lack of objective medical findings to support Dr. Traynor's

findings of chest and spinal pain, see id., may have been

misinformed by the ALJ's failure to properly consider Plaintiff's

fibromyalgia diagnosis, as explained in Part III.A.1, supra.5

With respect to the opinions of Drs. Hamilton and Geier, the

Court finds that the reasons set forth in the decision are

insufficient to support the ALJ's conclusion that the doctors'

"assessments are simply not credible." See Admin. R. at 21. The

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ALJ raises one factual argument-- that the Plaintiff "consistently

has full motion in all areas without significant neurological

findings." Id. Again, there is no citation to the record for this

assertion. Id. Moreover, both doctors based their assessments of

Plaintiffs' limitations on her diagnosis of fibromyalgia, which the

ALJ failed to properly consider. See id. at 423-24, 427.

In reaching a final decision on disability, it is the ALJ's

responsibility to discuss the relevant evidence and provide

sufficient reasons explaining the weight given to that evidence. 

Neither has happened here, and the Court will not accept counsel's

post hoc rationalizations or sift through the record for evidence

to substantiate assertions that the ALJ failed to support by proper

citation. For all of the foregoing reasons, the Court finds that

the ALJ did not set forth legally sufficient reasons for her

decision to discredit the opinions of Drs. Portnoff, Green, Rabin,

Traynor, Hamilton, and Geier.

B. Testimony of Plaintiff

Plaintiff also argues that the ALJ did not provide legally

sufficient reasons for rejecting her hearing testimony regarding

her limitations. Mot. (doc. # 25) at 11-12.

A claimant's pain testimony must be considered in the

disability determination process "so long as the pain is associated

with a clinically demonstrated impairment." Howard v. Heckler, 782

F.2d 1484, 1488 n.4 (9th Cir. 1986). The ALJ cannot discount a

claimant's subjective complaints of excess pain without making

specific findings regarding the claimant's credibility. Morgan v.

Comm'r of the Soc. Sec. Admin., 169 F.3d 595, 599 (9th Cir. 1999);

Johnson v. Shalala, 60 F.3d 1428, 1433 (9th Cir. 1996). These

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6

 Because Social Security Ruling 96-7p is a reasonable

interpretation of 20 C.F.R. §§ 404.1529 and 416.929 to which this

Court owes deference, see Chevron U.S.A., Inc. v. Natural Res. Def.

Counsel, Inc., 467 U.S. 837, 842-43 (1984), the Commissioner's

interpretive commentary is controlling.

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findings must be based on clear and convincing reasons that are

supported by substantial evidence in the record as a whole. 

Johnson, 60 F.3d at 1433. "Clear and convincing" reasons to reject

a claimant's credibility may include internal inconsistencies in

the claimant's testimony, Light v. Soc. Sec. Admin., 119 F.3d 789,

792 (9th Cir. 1997), "the claimant's reputation for lying, prior

inconsistent statements concerning the symptoms, and other

testimony by the claimant that appears less than candid;

unexplained or inadequately explained failure to seek treatment or

to follow a prescribed course of treatment; and the claimant's

daily activities," Smolen, 80 F.3d at 1284. In evaluating the

claimant's credibility, the ALJ must also consider the "location,

duration, frequency, and intensity of the [claimant's] pain or

other symptoms," any precipitating and aggravating factors, and the

"type, dosage, effectiveness, and side effects of any medication

the [claimant] takes or has taken to alleviate pain or other

symptoms." SSR 96-7p.6 The ALJ cannot, however, discredit a

claimant's pain testimony based solely on a lack of corroborating

medical evidence. Bunnel v. Sullivan, 947 F.2d 341, 345 (9th Cir.

1991) (en banc); Cotton v. Bowen, 799 F.2d 1403, 1407 (9th Cir.

1986) ("'Excess pain' is, by definition, pain that is unsupported

by objective medical findings."); 20 C.F.R. §§ 404.1529, 416.929;

SSR 88-13; SSR 96-7p.

A reviewing court may not speculate as to the basis for the

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ALJ's credibility determination. See Bunnel, 947 F.2d at 346 (en

banc) (citation omitted). "The ALJ must state specifically which

symptom testimony is not credible and what facts in the record lead

to that conclusion." Smolen, 80 F.3d at 1284 (citation omitted);

see also Dodrill v. Shalala, 12 F.3d 915, 918 (9th Cir. 1993)

("It's not sufficient for the ALJ to make only general findings; he

must state which pain testimony is not credible and what evidence

suggests the complaints are not credible."). 

In this case, the ALJ held that Plaintiff "ha[d] not

established a medically determinable impairment which would

reasonably be expected to produce [the] limitations" of which she

complained. Admin. R. at 21. The ALJ relied on the lack of

"credible evidence of fibromyalgia," id., but, as explained above,

the record was replete with evidence that was rejected or ignored

without adequate legal justification. Accordingly, the Court

rejects the ALJ's suggestion that Plaintiff's pain is not

associated with a clinically demonstrated impairment, and will

instead look to the other reasons provided by the ALJ for

discrediting Plaintiff's testimony.

Having carefully reviewed the decision and the record in this

case, including Plaintiff's hearing testimony, the Court is not

clearly convinced by the ALJ's reasons for rejecting Plaintiff's

pain testimony. The ALJ relied principally on the lack of medical

evidence linking Plaintiff's impairments to her pituitary and renal

problems, and notes that "[h]er hypertension is well controlled"

and that she has a "full range of motion on physical exams without

neurological deficits." Admin. R. at 21. The ALJ did not cite to

the record for any of these assertions, id., and, in any event, the

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7

 See, e.g., Wikipedia, Vicodin, at http://en.wikipedia.org/

wiki/Vicodin#Addiction (last visited Mar. 12, 2007) (explaining the

addictive nature of the opiate derivative, hydrocodone, contained in

Vicodin); Wikipedia, Fiorinal, at http://en.wikipedia.org/wiki/

Fiorinol (last visited Mar. 12, 2007) (discussing the risk of

dependency associated with the barbiturate, butalbital, contained in

Fiorinal).

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ALJ cannot discredit Plaintiff's pain testimony based solely on a

lack of corroborating medical evidence. See Bunnel, 947 F.2d at

345 (en banc); Cotton, 799 F.2d at 1407; 20 C.F.R. § 404.1529; SSR

88-13; SSR 96-7p. Thus, the legitimacy of the ALJ's decision lies

in the balance of the evidence supporting the other reasons for her

credibility determination. The Court finds those other reasons

neither clear nor convincing.

The ALJ faulted Plaintiff for not having received more

extensive treatment and therapy, and for having failed to regularly

consume "strong medication" to overcome her limitations. Admin. R.

at 21-22. These unsupported assertions are materially inconsistent

with the record. Plaintiff has taken a number of medications,

including the narcotic analgesics Vicodin and Fiorinol. Id. at

348, 386, 394, 433. Given the well-known risk of physical and

psychological dependence associated with these potent substances,

the Court is disturbed by the ALJ's dangerous suggestion that

Plaintiff should have consumed even stronger medications and on a

more regular basis.7 Furthermore, in light of evidence that

Plaintiff lacked prescription drug coverage and money to undergo

extensive physical therapy, see id. at 389, 394, the Court does not

find that the ALJ's personal opinion on what may have constituted

more effective treatment presents a clear and convincing reason to

discredit Plaintiff's pain testimony. See Smolen, 80 F.3d at 1284.

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The ALJ also claimed that Plaintiff's hearing testimony was

inconsistent, apparently because "[s]he first stated that her

treatment was helpful, but later claimed it was not." Admin. R. at

22. The ALJ may have been referring to Plaintiff's account of her

psychiatric and psychological treatment. See id. at 444-451. 

Plaintiff testified that she found her group therapy helpful in

terms of allowing her to vent her frustrations before an empathetic

audience, but indicated that her depression was worse overall after

three years of treatment. Id. at 448-49. As Plaintiff explained,

she went in and out of major depression. Id. at 449-50. Her

testimony presents a completely plausible scenario of an individual

suffering episodes of depression. The fact that Plaintiff was not

fortunate enough to chart a positive linear path of recovery from

her depression without any relapse does not reveal any

inconsistency in her testimony as the ALJ insinuates.

The ALJ also discussed Plaintiff's daily activities of driving

and shared housework such as cooking, citing a psychiatric

consultative examination by a government medical expert conducted

nearly two years prior to the decision, and impliedly suggests that

these activities belie Plaintiff's claimed impairments. Id. at 22. 

The Court disagrees. Plaintiff's testimony made clear that she

does not drive much and that her memory problems and lack of

strength frequently prevent her from consistently performing these

daily activities. Id. at 468-69. Her son-in-law testified that

Plaintiff no longer does any of the cooking and that he would

sometimes drive Plaintiff to her medical appointments. Id. at 477,

480. In any event, the ALJ's selective reading of the testimony

regarding Plaintiff's daily activities does not detract from

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Plaintiff's credibility regarding her limitations. See Reddick,

157 F.3d at 722 ("[D]isability claimants should not be penalized

for attempting to lead normal lives in the face of their

limitations."); see also Smolen, 80 F.3d at 1284 n.7 ("The Social

Security Act does not require that claimants be utterly

incapacitated to be eligible for benefits . . . ."); Cooper v.

Bowen, 815 F.2d 557, 561 (9th Cir. 1987) (Disability claimants need

not "vegetate in a dark room" in order to be deemed eligible for

benefits).

In sum, the ALJ's reasons for rejecting Plaintiff's pain

testimony are not clear and convincing, and are not adequately

supported by the record. The decision does not point toward any

evidence that Plaintiff magnified her symptoms, or cite to any

evidence in support of the ALJ's credibility determination. The

ALJ was wrong to reject Plaintiff's pain testimony based on the

reasons provided in the decision.

C. Lay Testimony of Plaintiff's Son-in-Law

Plaintiff also argues that the ALJ improperly rejected the

testimony of her son-in-law, Peter Harrison, with whom she lived at

the time of her hearing. Mot. (doc. # 25) at 13; Admin. R. at 476. 

The ALJ rejected Mr. Harrison's testimony because, "while shedding

light on the character of the claimant, [it] offered little insight

into her actual medical condition." Admin. R. at 22. Plaintiff

objects to this explanation, contending that Mr. Harrison's

testimony was intended to provide insight into Plaintiff's

inability to function on a daily basis rather than directly explain

her medical condition. Mot. (doc. # 25) at 13. Defendant does not

address this point, maintaining only that "the ALJ provided

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specific, persuasive reasons" to reject Mr. Harrison's testimony. 

Mot. (doc. # 30) at 19.

Under the Regulations, Mr. Harrison's opinion is treated as

"other source" evidence under 20 C.F.R. § 404.1527(d). Under Ninth

Circuit law, lay testimony such as that provided by Mr. Harrison

may only be rejected if the ALJ "expressly determines to disregard

such testimony and gives reasons germane to each witness for doing

so." Lewis v. Apfel, 236 F.3d 503, 511 (9th Cir. 2001).

Having examined the hearing transcript, it is apparent to the

Court that the ALJ improperly recharacterized Mr. Harrison's

testimony, and also failed to provide sufficient reasons to reject

that testimony as recharacterized. For example, the ALJ stated

that Mr. Harrison "testified that the claimant drives herself to

her doctors' appointments," Admin. R. at 22, but does not

acknowledge the fact that Mr. Harrison also drove Plaintiff to many

of those appointments, see id. at 477. The ALJ apparently heard

Mr. Harrison as testifying that Plaintiff "ha[d] no apparent

difficulty . . . carrying her food/coffee up stairs [to her room],"

id. at 22, yet the transcript reveals testimony from Mr. Harrison

that Plaintiff would frequently drop such items as "cups, plates,

food, [and] coffee," id. at 484. The only other aspect of Mr.

Harrison's testimony mentioned by the ALJ was the innocuous fact of

the "little dog that lives with [Plaintiff] in her room." Id. at

22. It is noteworthy that the ALJ commented on the keeping of this

animal as it apparently shed "light on the character of the

claimant," yet she declined to comment on Mr. Harrison's daily

observations of Plaintiff's depression, his account of how he would

do most of the shopping and cooking, and his lay opinion, based on

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the limitations he saw, that he could not rely on Plaintiff to

watch his child when she lived with him. See id. at 476-84. These

omissions in the ALJ's summary of Mr. Harrison's testimony seem

more to recharacterize it than analyze it. Cf. Bergfeld v.

Barnhart, 361 F. Supp. 2d 1102, 1115 (D. Ariz. 2005) ("Here, the

ALJ did not simply weigh the evidence; he recharacterized it.").

The ALJ's assertion that the testimony of Mr. Harrison, a real

estate broker, "offered little insight into [Plaintiff's] actual

medical condition" rings hollow. See Admin. R. at 22, 476. 

Individuals who are not acceptable medical sources, while

testifying about other relevant considerations such as a claimant's

daily activities, are rarely if ever going to provide specific

insight into a claimant's medical condition. That is why Ninth

Circuit law requires the ALJ to "give[] reasons germane to each

witness" when explaining the weight given to lay testimony. See

Lewis, 236 F.3d at 511. For these reasons, the Court finds that

the ALJ improperly rejected Mr. Harrison's testimony based on

reasons not germane to his testimony.

D. Hypothetical Question Posed to Vocational Expert

Plaintiff contends that the ALJ also erred by posing an

incomplete hypothetical question to the vocational expert who

testified at her hearing by excluding the functional limitations

resulting from her fibromyalgia. Mot. (doc. # 25) at 13. 

Defendant contends that the ALJ's hypothetical question properly

excluded limitations resulting from Plaintiff's fibromyalgia. Mot.

(doc. # 30) at 19-20. In making this argument, Defendant relies on

the validity of the ALJ's conclusion that Plaintiff did not

demonstrate her fibromyalgia to be a severe medically determinable

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impairment. Id.

"In order for the testimony of a [vocational expert] to be

considered reliable, the hypothetical posed must include all of the

claimant's functional limitations, both physical and mental

supported by the record." Thomas v. Barnhart, 278 F.3d 947, 956

(9th Cir. 2002) (internal quotations and citation omitted). As

explained in Parts III.A.1 and III.A.4, supra, the ALJ did not

provide legally sufficient reasons for rejecting medical opinion

evidence from Plaintiff's treating and examining sources which, if

properly credited, would have proven significant functional

limitations arising from her fibromyalgia. The Court therefore

concludes that the ALJ erred by asking the vocational expert an

incomplete question that excluded those relevant limitations. 

Thomas, 278 F.3d at 956.

E. Residual Functional Capacity Determination

An RFC determination reflects a claimant's ability to work in

spite of the physical and mental limitations arising from the

claimant's impairments and related symptoms. See 20 C.F.R. §

404.1545(a). A claimant's RFC is determined based on all of the

claimant's limitations and in light of all relevant evidence in the

record. Id.

Plaintiff challenges the ALJ's ultimate finding of "not

disabled," arguing that the ALJ wrongly excluded evidence of her

limitations in making her RFC determination at the fifth step of

the sequential evaluation process. Mot. (doc. # 25) at 5-8. 

Plaintiff's point is well taken. The preceding discussion makes it

abundantly clear that the ALJ improperly disregarded substantial

credible evidence of Plaintiff's impairments and limitations

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without providing legally sufficient explanations for those

credibility determinations. The Court will now consider the

appropriate action to be taken on remand. 

F. Remand for Payment of Benefits

Plaintiff argues that further administrative proceedings are

unnecessary, and that the matter should be remanded for immediate

payment of benefits. Mot. (doc. # 25) at 14 (citing Smolen, 80

F.3d at 1292).

In Smolen, the Ninth Circuit held that improperly discredited

evidence may be credited as true and an immediate award of benefits

directed when the following criteria are established:

(1) the ALJ has failed to provide legally

sufficient reasons for rejecting such evidence,

(2) there are no outstanding issues that must

be resolved before a determination of

disability can be made, and (3) it is clear

from the record that the ALJ would be required

to find the claimant disabled were such

evidence credited.

Smolen, 80 F.3d at 1292. Even if the record contains evidence that

the ALJ, if given a second chance, might use to articulate a sound

basis to discredit the evidence, remand for determination and

payment of benefits under Smolen is warranted. Harman v. Apfel,

211 F.3d 1172, 1179 (9th Cir. 2000). The court's discretionary

power to remand for immediate payment of benefits under Smolen

serves as a deterrent to "an unfair 'heads we win; tails, let's

play again' system of disability benefits adjudication" by

encouraging more thoughtful analysis in the first instance. See

Benecke, 379 F.3d at 595. If grounds exist to support the ALJ's

credibility determination, "it is both reasonable and desirable to

require the ALJ to articulate them in the original decision." 

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Harman, 211 F.3d at 1179 (internal quotations and citation

omitted). Ultimately, the court may base its decision on whether

to remand for further proceedings on "the likely utility of such

proceedings." See id. (citing Lewin v. Schwieker, 654 F.2d 631,

635 (9th Cir. 1981)).

As explained above, the ALJ did not provide legally sufficient

reasons for rejecting the testimony of Plaintiff or her son-in-law,

or any of the medical opinion evidence from Plaintiff's treating

and examining physicians, psychiatrist, and psychologist. At the

hearing, Plaintiff's counsel elicited testimony from the vocational

expert by posing a hypothetical question that, unlike the one posed

by the ALJ, incorporated all of Plaintiff's functional limitations. 

Admin. R. at 459-60. Because the vocational expert has already

testified that there would be no jobs available in the national

economy for an individual with Plaintiff's functional limitations

as outlined by Dr. Hamilton, see id., it is clear from the record

that the ALJ would be required to find Plaintiff disabled after

crediting the improperly discredited evidence. See Smolen, 80 F.3d

at 1292.

Defendant does not point toward any outstanding issues that

must be resolved before a determination of benefits can be made. 

See id. Instead, Defendant claims that "Plaintiff has only

identified alleged factual errors by the ALJ," and, on that basis,

argues that the case should be "remand[ed] for further development

of the record rather than reversal for payment of benefits." Mot.

(doc. # 30) at 21. In support of this position, Defendant relies

solely on Salvador v. Sullivan, 917 F.2d 13, 15 (9th Cir. 1990),

where the Ninth Circuit exercised its discretion not to award

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benefits due to the possible existence of evidence in the record

"to which the ALJ can point to provide the requisite specific and

legitimate reasons for disregarding [the opinion of the claimant's

treating physician]." However, more recent authority from the

Ninth Circuit expressly states that remand for payment of benefits

under Smolen is warranted even where the record may contain

evidence that could support the ALJ's credibility determinations. 

See Harman, 211 F.3d at 1179.

Although the Court has the discretion to remand this matter

for further administrative proceedings where the ALJ could make

additional factual findings, the Court does not perceive any useful

purpose for protracted administrative hearings here. See Harman,

211 F.3d at 1179. Defendant has not specified any outstanding

issues under Smolen that would benefit from further factual

development. See Mot. (doc. # 30) at 21. More importantly, the

ALJ has acknowledged that her findings were based on her "careful

consideration of the entire record." Admin. R. at 18, 23. Under

these circumstances, it is speculative whether there would be any

real value in more proceedings that would only subject Plaintiff's

application for benefits to further unwarranted delay. Finally,

the Court disagrees with Defendant's characterization of the ALJ's

errors as being merely factual in nature. See Mot. (doc. # 30) at

21. The preceding discussion outlines numerous errors that are

both factual and legal in nature. As the Smolen factors are

satisfied, the matter will therefore be remanded for immediate

payment of benefits.

IV. CONCLUSION

In light of the foregoing analysis,

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IT IS ORDERED that Plaintiff's motion for summary judgment

(doc. # 25) is GRANTED.

IT IS FURTHER ORDERED that Defendant's cross-motion for

summary judgment (doc. # 30) is DENIED.

IT IS FURTHER ORDERED remanding this matter to the Social

Security Administration for payment of benefits, using a disability

onset date of September 25, 2001.

IT IS FINALLY ORDERED directing the Clerk of the Court to

enter judgment in favor of Plaintiff and terminate this case.

DATED this 27th day of March, 2007.

Copies to counsel of record

Case 2:05-cv-03521-RCB Document 41 Filed 03/27/07 Page 30 of 30