Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_18-cv-03562/USCOURTS-cand-3_18-cv-03562-0/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)

---

ORDER – No. 18-cv-03562-LB

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

San Francisco Division

HUNTER RHIANNON SINUHE,

Plaintiff,

v.

COMMISSIONER OF SOCIAL 

SECURITY,

Defendant.

Case No. 18-cv-03562-LB

ORDER GRANTING PLAINTIFF’S 

MOTION FOR SUMMARY 

JUDGMENT AND DENYING 

DEFENDANT’S CROSS-MOTION FOR 

SUMMARY JUDGMENT

Re: ECF Nos. 28, 31

INTRODUCTION

Plaintiff Hunter Rhiannon Sinuhe appeals a final decision by the Commissioner of the Social 

Security Administration denying her claim for disability insurance benefits, social-security income 

(“SSI”), and medical assistance under Titles II, XVI, XVIII part A, and XIX of the Social Security 

Act (“SSA”).

1

42 U.S.C. §§ 423, 1381, 1395, and 1396. The plaintiff moved for summary 

judgment, the Commissioner filed a cross-motion for summary judgment and opposed the 

plaintiff’s motion, and the plaintiff submitted a reply to the Commissioner’s cross-motion.

2 Both 

 

1 AR 216, 282. Administrative Record (“AR”) citations refer to the page numbers in the bottom right 

hand corner of the Administrative Record.

2 Mot. – ECF No. 28; Cross-Mot. – ECF No. 31; Reply – ECF No. 32. Citations refer to material in the 

Electronic Case File (“ECF”); pinpoint citations are to the ECF-generated page numbers at the top of 

documents.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 1 of 68
ORDER – No. 18-cv-03562-LB 2

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

parties consented to magistrate-judge jurisdiction.3 Under Civil Local Rule 16–5, the matter is 

submitted for decision by this court without oral argument. The court grants the plaintiff’s motion 

for summary judgment and denies the defendant’s motion.

STATEMENT

1. Procedural History

On August 14, 2013, the plaintiff, then age 43, filed an application for disability insurance 

benefits under Title II and part A of Title XVIII of the SSA.

4 She also applied for SSI and medical 

assistance on August 16, 2013 under Title XVI and Title XIX respectively of the SSA.5 She 

alleged a disability starting on December 31, 2009.

6

In her application, the plaintiff identified her 

disability as “mental illness.”

7

The plaintiff’s application was initially denied on December 17, 2013 and on reconsideration 

on July 29, 2014.8 On September 9, 2014, the plaintiff filed a written request for a hearing.9 The 

ALJ E. Alis (the “ALJ”) held a hearing on October 25, 2016.10 During the hearing, the plaintiff 

amended her disability-onset date to August 14, 2013, the date of her disability-insurance benefits 

filing.

11 The administrative record remained open for submission of additional records until 

November 14, 2016.12 On January 5, 2017, the ALJ issued an unfavorable decision.13 The plaintiff 

 

3 Consent Forms – ECF Nos. 2, 13.

4 AR 216.

5 AR 282. 

6 AR 216, 282. 

7 AR 129.

8 AR 18, 153, 161. 

9 AR 18, AR 167.

10 AR 18.

11 Mot. – ECF No. 28 at 1; AR 21. 

12 AR 18. 

13 AR 15.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 2 of 68
ORDER – No. 18-cv-03562-LB 3

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

requested a review of the decision on February 17, 2017, which the Appeals Council denied on 

March 7, 2017.14

The plaintiff timely filed this action for judicial review and moved for summary judgment on 

April 23, 2019.15 The Commissioner filed a cross-motion for summary judgment on June 4, 

2019.16

2. Summary of Administrative Record

2.1 Medical Records

2.1.1. Orchid Women’s Perinatal Treatment Services — Treating

The plaintiff entered Orchid Women’s Perinatal Treatment Services (“Orchid”), a residential 

substance-abuse treatment program, on July 1, 2012, and completed the program on December 31, 

2012.17 During her time at Orchid, the plaintiff “willingly participated in the rigorous structure.”18

She met weekly with a counselor/case manager and continued to “process around her sexual abuse 

as a child, as well as her childhood issues” and “[take] an in-depth look at mistakes she had made 

in the past.”19 The plaintiff resided in Orchid’s Sober Living Facility after completing the 

program.20

2.1.2 Sausal Creek Outpatient Stabilization Clinic — Treating

On May 14, 2012, the plaintiff went to Sausal Creek on referral from Highland General 

Hospital for a “psychiatric eval[uation]” for chronic depr obtain a diagnosis for her SSI

application.

21 The plaintiff smoked a half-pack of cigarettes a day and used cocaine for 

 

14 AR 214; Mot. – ECF No. 28 at 1. 

15 ECF 28.

16 ECF 31.

17 AR 303.

18 Id.

19 Id.

20 Id.

21 AR 358, 361.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 3 of 68
ORDER – No. 18-cv-03562-LB 4

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

approximately 10 years, speed for 20 years, and alcohol “often.”

22 In the mid-1990s, the plaintiff 

overdosed on a combination of her medication and alcohol in an attempt to commit suicide.23 In 

2010, she had a hysterectomy.24

The plaintiff identified “unhappiness, loss of interest, insomnia, [and] isolation” as factors 

contributing to her depression.25 Her anxiety caused her “a lot of discomfort.” 26 The plaintiff took

Trazodone for depression and took a “host” of other anti-depressants.

27 Her mood was 

“depressed,” her affect was “flat,” her insight and judgment were “marginal,” and her thought 

process was “logical.”

28 Her senses were “alert,” her orientation was to time, person, and place, 

her relatedness was “engaged,” her grooming was “fair,” and her speech was “slow.”

29 The

plaintiff had a “problem” with depression but posed no risk to herself or others.30

On May 15, 2012, the plaintiff presented with “depression, hopelessness, anhedonia, insomnia, 

[and] isolat[ion]. [She] [w]ant[ed] to go to therapy, [and did] not want to be on medications. [She 

felt] better when she ha[d] a drink. [She had] significant anxiety, [and] irritability, worr[ied] too 

much, [and had] muscle tension.”31 She was “unable to work” and “[drank] alcohol regularly, 3 

glasses of wine daily.”32 Her medications did not “make a difference.”

33 Dr. Emma Castro 

diagnosed the plaintiff with “Depressive disorder NOS [not otherwise specified], anxiety disorder 

 

22 AR 359, 361.

23 AR 360.

24 AR 359.

25 AR 358. The physician’s name is unreadable in the administrative record.

26 AR 361.

27 AR 358.

28 AR 362.

29 Id.

30 AR 363.

31 AR 367.

32 AR 368.

33 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 4 of 68
ORDER – No. 18-cv-03562-LB 5

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

NOS, alcohol abuse, nicotine dependence, access to healthcare, [and] unemployment.”34 She 

prescribed Citalopram, continued the plaintiff’s Trazodone prescription, and recommended a 

therapy referral.35

On July 6, 2012, the plaintiff said that the medications were working but asked if she could try 

a higher dosage.

36 A physician prescribed Colepra and Celexa, and continued Trazodone.37 The

plaintiff was discharged from Sausal Creek to Orchid House, a residential substance-abusetreatment facility.

38

2.1.3 Crisis Program, Alameda County Mental Health — Treating

On July 11, 2012, Registered Nurse (“RN”) Eve Mihata reported that the plaintiff “ha[d] been 

trying to get meds and therapy for at least the last 6mo. and [was] thwarted due to bureaucratic 

practices, ie she asked Dr. Rose for a referral to ACCESS for therapy but he declined saying that 

he was not a psychiatrist and he didn’t have the time to spend filling a 7 page form.”

39 The

plaintiff took Celexa and Trazodone and felt that her medications were “helpful.”40 She received

food stamps and lived at Orchid House where she was “well into recovery successfully” for 

alcohol abuse.41

The plaintiff was in therapy “off and on” since her mother died when the plaintiff was 17.42

The plaintiff graduated from college.43 Her last gainful employment ended six years before and 

 

34 AR 369. NOS stands for “Not Otherwise Specified.” Ghanim v. Colvin, 763 F.3d 1154, 1158 n.3 

(9th Cir. 2014).

35 AR 369.

36 AR 375.

37 AR 373–75. The physician’s name is unreadable in the administrative record. It is unclear from the 

record if the attending physicians took the plaintiff off of Citalopram.

38 AR 373. 

39 AR 377. 

40 Id.

41 AR 379.

42 AR 377.

43 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 5 of 68
ORDER – No. 18-cv-03562-LB 6

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

she was “underemployed,” had only a “sporadic income, and suffered from “poor access to 

healthcare.”44

The plaintiff exhibited “substantial impairment” in “[d]aily activities, including employment, 

household responsibilities, and attending scheduled programs.”45 She was “oriented x3 and 

superficially cooperative [with] the interview. Mood and affect congruent acknowledges 

depression. Her thoughts [were] linear and unremarkable. Denie[d] [history] of serious [mental 

illness] or of family [history] of [the] same.”46 The plaintiff’s insight and judgment were intact and 

she was “above average intellectually.”47 Angela Callender, M.D., diagnosed the plaintiff with

moderate Major Depressive Disorder, alcohol abuse, a “deferred” personality disorder, poor access 

to health care, underemployment, and a sporadic income. She assessed a score of 55 on the Global 

Assessment of Functioning Scale (“GAF”).

48 Dr. Callender increased the plaintiff’s Celexa dosage 

and continued her on Trazodone for sleep.

49 Dr. Callender and Nurse Mihata referred the plaintiff

to Earth Circle for therapy.50

On July 17, 2012, plaintiff had good hygiene and “managed [her] grooming.”

51 She suffered 

from insomnia, felt miserable and worthless, had no desire and low self-esteem, and engaged in 

self-deprecation.

52 She denied any suicidal or homicidal ideation.53 In the past, she tried numerous 

 

44 AR 377–380.

45 AR 377.

46 AR 378.

47 Id.

48 AR 380. GAF scores rate a subject’s mental state and symptoms. The higher the GAF rating, the 

better the subjects’ coping and functioning skills. See Garrison v. Colvin, 759 F.3d 995, 1002 n.4 (9th 

Cir. 2014) (“[A] GAF score between 41 and 50 describes ‘serious symptoms’ or ‘any serious 

impairment in social, occupational, or school functioning.’”).

49 AR 379.

50 Id.

51 AR 381.

52 AR 382.

53 AR 382–83.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 6 of 68
ORDER – No. 18-cv-03562-LB 7

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

psychotropic medications.54 She last worked at Peet’s in 2006.55 Her longest job was a retail 

position she held for three and a half to four years.56 The plaintiff drank one and half to two bottles 

of wine every evening (and did so for the past two to three years).

57 She denied using other 

drugs.58 The plaintiff appeared cooperative and pleasant, her psychomotor activity and speech was 

“WNL [within normal limits],” she did not have a movement disorder, and her mood was 

dysphoric.59 The plaintiff’s orientation, recent memory, remote memory, abstract thinking, and 

concentration were “WNL,” her level of consciousness was alert, and her level of 

intelligence/knowledge was above average.60 Her thought process was logical, and goal oriented, 

her insight was such that she “[a]ccept[ed] problems [and] want[ed] help,” and her appetite, 

thought content, and judgment were WNL.61 She denied experiencing hallucinations.62 The

plaintiff had a partial response to Celexa with no side effects, and it was unclear whether she 

needed Trazodone.63 Dr. Callender diagnosed the plaintiff with not having a “primary support 

group,” occupational problems, poor access to health care, and economic issues.64 She rated the 

plaintiff’s GAF at 50, five points lower than the highest GAF she experienced over the past year, 

and diagnosed her with depression, anhedonia, insomnia, energy loss, feelings of guilt and 

worthlessness, and an alcohol-substance-abuse-disorder.65

 

54 AR 382.

55 Id.

56 Id.

57 AR 381.

58 Id.

59 Id.

60 Id.

61 AR 383.

62 Id.

63 Id.

64 Id.

65 AR 383–84. “A GAF of 50 reflects a serious limitation on a claimant’s ability to perform basic life 

tasks.” Cravens v. Colvin, No 13–cv–00070–NJV, 2013 WL 5781481, at n.1 (internal citation 

omitted).

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 7 of 68
ORDER – No. 18-cv-03562-LB 8

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

On July 18, 2012, Nurse Mihata described the plaintiff’s mood as “euthymic” and noted that 

she had “concerns regarding her anger and inability to function in the work world.”

66 She was 

three weeks sober, did not express any suicidal or homicidal ideation, exhibited well-constructed 

thoughts,” and did not show any “signs of derailment.”67 Nurse Mihata referred the plaintiff to 

ACCESS for therapy.

68 The plaintiff’s diagnosis of “depression” made her ineligible for a 

discounted bus pass. 69 Nurse Mihata modified the plaintiff’s diagnosis to “Major Depression.”

70

By August 7, 2012, the plaintiff was assigned a therapist.71 The plaintiff expressed concerns

about her SSI application because she received an unfavorable decision, her lawyer stopped 

responding to her, and she felt anxious about her petition for reconsideration.

72 Her mood 

“continue[d] to be depressed.”

73 She was “cooperative” and acknowledged some improvement.74

Her plan was to “[c]ontinue sobriety. Keep [p]rimary care appointment. Follow through w/SSi 

[sic] reconsideration.”75

On August 7, 2012, the plaintiff had side effects from Trazodone including coughing and 

sneezing.76 She did not have any side effects from Celexa and said that her depression improved 

by 25–33%. 77 The medication did not improve her anxiety, which included phobias of “clowns 

 

66 AR 388.

67 Id.

68 Id.

69 AR 390.

70 Id.

71 AR 393.

72 Id.

73 Id.

74 Id.

75 Id.

76 AR 391.

77 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 8 of 68
ORDER – No. 18-cv-03562-LB 9

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

and men.”

78 The plaintiff intended to work on her anxiety in therapy.79 Dr. Callender increased the 

plaintiff’s Celexa prescription and discontinued her Trazodone prescription.80

On September 11, 2012, the plaintiff was doing well at Orchid House and was two-and-a-half 

months’ sober.

81 She was responding to her anti-depressants, had ongoing appointments with her 

therapist, and was receiving her medications from her primary-care physician.

82 The plaintiff was 

concerned about her 2009 SSI application.

83 Nurse Mihata and the plaintiff discussed the 

possibility of “enlisting Mental Health Advocates who may be able to follow up [on her SSI].”84

The plaintiff was “compliant w/her medications,” “following through with [her] goals . . . [and]

movi[ng] up in the program [at Orchid] where she [was] entrusted to travel independent[]ly to 

appointments . . . .”

85 The plaintiff was discharged from Alameda County Behavioral Health Care 

Services and told to continue her therapy sessions.86 She would follow up with Nurse Mihata if 

she found herself in “further difficulty.”87

On September 11, 2012, the plaintiff’s mood was “OK.”

88 “Some of her issues [were] stirred 

up [in therapy] but that’s good in her estimate.”89 Dr. Callender advised the plaintiff to continue 

Celexa, continue therapy, and continue to visit her primary-care physician.

90

 

78 Id.

79 Id.

80 Id.

81 AR 395.

82 Id.

83 Id.

84 Id.

85 Id.

86 Id.

87 Id.

88 AR 394.

89 Id.

90 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 9 of 68
ORDER – No. 18-cv-03562-LB 10

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

2.1.4 Alameda County Medical Center — Treating

From May 22, 2012 to July 22, 2013, the plaintiff was admitted the Highland Campus 

Emergency Department of the Alameda County Medical Center for various physical ailments.91

On January 28, 2013 the plaintiff saw Sharone A. Abramowitz, M.D..

92 The plaintiff told Dr. 

Abramowitz that she was previously treated for depression and PTSD, was emotionally abused 

and molested as a child, and was raped during her early twenties.93 The plaintiff “fe[lt] triggered 

by men in certain con[texts], such as, male cashiers. She had a couple of past flashbacks, she 

avoid[ed] intimacy with men, ha[d] insomnia, and c[ould] be irritable.”94 Citalopram “allow[ed]

her to tolerate being in public.”95 She was six months’ sober.

96 After Orchid House, she entered an 

outpatient-recovery program facilitated by East Oakland Recovery, which she attended three times 

a week in addition to Alcoholics Anonymous (“AA”) meetings.97 Stress increased her desire to 

drink but this desire only surfaced about once a week.98

The plaintiff was “neatly groomed, cooperative, and polite.”

99 Her speech was “articulate, not 

slow or pressured.”100 She had a “[b]road affect. Not manic. Somewhat anxious.”101 She

“[s]eem[ed] committed to sobriety.”

102 She had no suicidal ideation, homicidal ideation, 

hallucinations, or delusions currently.”103 She did not exhibit any signs of a “formal thought 

 

91 AR 401, 412, 414, 418, 420, 422, 424.

92 AR 408.

93 Id.

94 Id.

95 Id.

96 Id.

97 Id.

98 Id.

99 AR 409.

100 Id.

101 Id.

102 Id.

103 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 10 of 68
ORDER – No. 18-cv-03562-LB 11

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

disorder” and appeared “[g]oal directed and coherent.”104 Her judgment and insight were “good” 

and from a cognitive standpoint she seemed “[a]lert and oriented x3,” showing no signs of “gross 

memory abnormalities.”105

Dr. Abramowitz diagnosed the plaintiff with PTSD, “[a]lcohol dependence,” a [h]istory of 

childhood and adult abuse,” and “[s]tatus post hysterectomy in 2010 and anemia.”

106 The plaintiff 

did well with psychotherapy in the past, “want[ed] more session[s] via [the hospital’s Health 

Professions Advisory Committee, or “HPAC”],” and “need[ed] a social worker to complete the 

HPAC re-application.”107 The plaintiff used to take Trazodone, which left her feeling sedated, and 

Amitriptyline, which was unhelpful.108 Dr. Abramowitz prescribed Gabapentin for anxiety 

management and alcohol recovery and continued her on Citalopram for sleep.109 She 

recommended that the plaintiff’s primary-care physician prescribe Naltrexone if she started

craving alcohol.110 Dr. Abramowitz referred the plaintiff to Keturah Hood, MSW, so that the 

plaintiff could continue working with her psychotherapist through HPAC.

111 Because of the 

plaintiff’s mood disorder and alcohol history, Dr. Abramowitz recommended that the plaintiff’s

“thyroid function test, her B12, folate, her liver functions tests, [] her lipids,” and her “MCV, 

LFTs, and triglycerides” be checked because “if they have gone down, [that could] possibly 

reinforce[] her sobriety.”

112

On June 14, 2013, the plaintiff was “neatly groomed, [had a] broad affect, stable mood, [and] 

mild anxiety with some dysthymia, as [she] face[d] emotions without use of alcohol.”

113 She 

 

104 Id.

105 AR 409–10.

106 AR 410. 

107 Id.

108 AR 409.

109 AR 410.

110 Id.

111 Id.

112 AR 410–11. 

113 AR 403.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 11 of 68
ORDER – No. 18-cv-03562-LB 12

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

“denie[d] significant alcohol cravings.”114 Her affect regulation in particular proved difficult “as 

she face[d] life clean and sober.”115 The plaintiff attended AA meetings three times per week, was

working with a sponsor, and saw her therapist every other week.116 She was living in a sober 

environment.117 Her boyfriend was in jail.118 The plaintiff took Gabapentin for anxiety, which, 

along with Citalopram, appeared to be controlling some of her symptoms.119 Dr. Abramowitz 

increased the plaintiff’s Gabapentin dosage to help her “cope with affect regulation while sober” 

and taught her some abdominal breathing techniques.120 She continued the plaintiff’s Citalopram 

prescription and referred her to East Bay Meditation Center.121

On August 14, 2013, Babaria Palav, M.D., reported that the plaintiff felt well overall but 

“continue[d] to have some poor sleep.”122 Melatonin alleviated her insomnia “intermittently” and 

she drank coffee “numerous” times throughout the day, finishing her final cup around 6 or 7 p.m. 

each night.123 Dr. Palav counselled “improved sleep hygiene,” including avoiding caffeine late in 

the day.124 The plaintiff was one year sober and attended AA meetings.125 She took Citalopram for 

depression and said that it was becoming increasingly less effective.

126 The plaintiff requested a 

behavioral-health referral, and Dr. Palav directed her to Dr. Abramowitz.127 The plaintiff was 

 

114 Id.

115 Id.

116 Id.

117 Id.

118 Id.

119 Id.

120 Id.

121 AR 404.

122 AR 398.

123 Id.

124 AR 400. 

125 AR 398.

126 Id.

127 AR 399.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 12 of 68
ORDER – No. 18-cv-03562-LB 13

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

nearing the end of her twelve insurance-approved therapy sessions.

128 Dr. Palav agreed to help 

contact her insurance to see whether the plaintiff could secure coverage for an additional few 

months of therapy.129

2.1.5 Lesleigh Franklin, Ph.D. — Examining

On December 13, 2013, Elizabeth Walser, MSW, Psy.D., examined the plaintiff, and Lesleigh 

Franklin, Ph.D., supervised and made the final determination about the plaintiff’s “current 

cognitive and emotional functioning.”130

The plaintiff was an only child. “Her mother reportedly expressed negative feelings about 

being a parent, and [the plaintiff] felt unloved and unwanted.”131 She was bullied because of her 

ethnicity and was “targeted within her own family.”132 “Her cousins made fun of her and picked 

on her. One cousin sexually abused her. This occurred on multiple occasions.”133 She did not tell 

her parents about the assault because she feared her mother would blame her and her father would 

be “disappointed in her.”134

The plaintiff’s mother died of cancer when she was a teenager.

135 She became depressed and 

dealt with “severe” anxiety and grief but did not seek treatment.136 Her anxiety heightened after 

she was raped at age twenty-one and she started experiencing panic attacks and attempted to 

commit suicide.137 She received SSI for her depression in the 1990s.

138 In her twenties, she 

 

128 Id.

129 Id.

130 AR 462.

131 AR 463.

132 Id.

133 Id.

134 Id.

135 Id.

136 Id.

137 AR 462–63.

138 AR 462.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 13 of 68
ORDER – No. 18-cv-03562-LB 14

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

received treatment at Oakland Therapy and Bay Area Women Against Rape (BWAR).139 In her 

thirties, she developed depressive symptoms and started drinking to “[calm] down enough so that 

she could date.140 This led to “some risky sexual behaviors.”141 In 2012, she entered Orchid 

Women’s Recovery Center and, after graduating, entered a sober-living program that offered her 

“weekly case management support.”142 As of December 2013, she was seventeen months’ sober 

and regularly attended AA meetings.143

The plaintiff got her AA from the Art Institute in Denver and her BA in 2008.144 She had

summer jobs during high school and worked “at a photo lab and a second hand clothing store”

during college.145 Later, she worked at various music stores, at Peet’s Coffee, and as an “in home 

caregiver.”146 Her last job ended in 2010.

147 The plaintiff “complained of sadness, low self-esteem, 

anxiety, dissociation, and sleep problems.”148

On a questionnaire, the plaintiff described her quality of life as being “somewhere between 

satisfactory and in need of improvement.”149 She had a license, a car, a few friends, and a 

boyfriend.150 She felt “uncomfortable with sex and affection” and, with the exception of her father, 

was estranged from most of her family members.151

 

139 AR 463.

140 AR 462–64.

141 AR 464. 

142 Id.

143 Id.

144 AR 463.

145 Id.

146 Id.

147 AR 462.

148 AR 462, 464.

149 AR 464.

150 Id.

151 AR 462, 464.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 14 of 68
ORDER – No. 18-cv-03562-LB 15

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

Dr. Franklin and Dr. Walser administered a clinical interview and numerous tests.152 On the 

day of the evaluation, the plaintiff’s mood was depressed, she had a “restricted range of affect,” 

her thought processes were “normal,” she did not exhibit any signs of hallucinations, and she 

“denied suicidal and homicidal ideation.”153 The plaintiff took Celexa (for depression) and 

Gabapentin (for anxiety).

154 She was “adequately groomed” and had “no overt gross motor 

slowing.”

155

“[H]er fine motor skills were normal except that she exhibited a tremor under 

pressure in the cognitive testing. . .[and she] became excessively sweaty.”156 The plaintiff could 

pay “sufficient attention to complete the evaluation” but there were some “gaps in her memory” 

about parts of her past.157 She was sufficiently oriented “to person, place, time, and situation” and 

as the evaluation progressed, she became less anxious and more forthcoming.

158 She seemed

“emotionally disengaged from the material she presented.”159 The plaintiff showed “adequate 

insight into her difficulties” and was able to articulate her coping mechanisms.

160 Her judgment 

was “fair” and she did not consume “alcohol or drugs on the day of the evaluation.”161

The Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II) measures 

intelligence functioning.162 Overall, the plaintiff’s intellectual skills were “solid.”163 She exhibited 

“superior” verbal-comprehension skills, “average” perceptual reasoning, and “average” full-scale 

 

152 AR 462.

153 AR 465.

154 AR 464.

155 AR 465.

156 Id.

157 Id.

158 Id.

159 Id.

160 Id.

161 Id.

162 Id.

163 AR 466.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 15 of 68
ORDER – No. 18-cv-03562-LB 16

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

intelligence.164 Her IQ was 107, placing her in the “68th percentile in the Average Range.”165 Dr. 

Walser and Dr. Franklin indicated that “[t]here was moderate variability between index scores” 

and that the IQ score should “be interpreted with caution.”166

The Repeatable Battery for the Assessment of Neuropsychological Statues (RBANS)-Form A

measures “cognitive functioning in the areas of memory, attention, visuospatial abilities, and 

language functioning.”167 The plaintiff’s scores for immediate memory, language, attention, and 

delayed memory were average and her visuospatial/constructional score was “far below 

average.”168 Her overall score was 92, which placed her in the 30th percentile or “average” 

range.

169

The Mini Mental State Examination (MMSE) screens for cognitive impairment.170 The 

plaintiff’s overall MMSE score “was 28/30, placing her in the Intact Functioning range.”171 She 

successfully followed instructions and could spell words backwards, understand abstractions, 

repeat phrases back exactly, and recall words upon delay.172

The Trail Making A & B screens for executive functioning.173 The plaintiff was able to connect 

a series of numbers without error “within normal limits” and could shift from number to letter at an 

“adequate pace.”174 These results did not suggest “significant problems with executive 

functioning.”175

 

164 Id.

165 Id.

166 Id.

167 Id.

168 Id.

169 AR 466–67.

170 AR 467.

171 Id.

172 Id.

173 Id.

174 Id.

175 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 16 of 68
ORDER – No. 18-cv-03562-LB 17

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

The Miller Forensic Assessment of Symptoms (M-Fast) measures whether someone is prone to 

overstating or exaggerating their symptoms.176 The plaintiff’s M-FAST score “indicat[ed] that she 

[was] in a higher level of distress [depression] then is seen in the general population, but there is a 

very low probability that she is malingering.”177

The Beck Depression Inventory, Second Edition (BDI-II) measures depressive symptoms.

178

The plaintiff’s BDI scored in the “severe range for depressive symptoms.”179 Her symptoms 

included sleep disturbance, exhaustion, lack of energy, poor appetite, and no sex drive. 180 She 

often felt like crying and felt “foggy, dizzy, and unable to think.”181 She could concentrate when 

necessary.182 She was indecisive, ignored her problems, felt “sad, guilty, and pessimistic, about her 

future,” “compare[d] herself to others,” and fe[lt] “damaged and worthless.” 183“She struggle[d] 

with anhedonia, but she blame[d] herself for this and [thought] if she tried harder, she would have 

more fun and so would the other people around her.”

184

The Beck Anxiety Inventory (BAI) measures anxiety.

185 Her score indicated a “severe anxiety 

disorder[] . . [that] has its roots in her trauma history.”186

The Posttraumatic Stress Checklist-Civilian Version (PCL-C) measures post-traumatic stress in 

the civilian population.187 Her score indicated civilian PTSD.188 “[S]he [had] recurrent intrusive 

 

176 Id.

177 Id.

178 Id.

179 Id.

180 AR 468.

181 Id.

182 Id.

183 Id.

184 Id.

185 Id.

186 Id.

187 Id.

188 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 17 of 68
ORDER – No. 18-cv-03562-LB 18

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

memories and dreams about the past,” “experience[d] some physiological reactivity to even mild 

triggers, and [got] dizzy, tremulous, wobbly, and excessively sweaty.”

189

“Her triggers [were] not 

just sexual. When someone put[] pressure on her, she [could] be triggered into a state of panic.”

190

As a result, she isolated herself, avoided being in situations “where she experience[d] pressure,”

and performed better in one-on-one interactions.

191 The plaintiff worked on her PTSD in individual 

therapy (she found group therapy “threatening”) because she “ha[d] enough insight to know that 

avoiding treatment ma[de] her worse.”192 She found “emotional work slow and painful” and often 

dissociated during her sessions.193“She [believed] she disassociated a lot in her late twenties and 

thirties” and continued to disassociate as she aged.

194 The plaintiff struggled to develop “normal 

relationships with men. 195 The plaintiff was “not psychotic, and there was no evidence presented 

that there have been episodes of mania. [The plaintiff] reported a history of being visited by spirits, 

but in the context of her family and Native American culture, these experiences were not 

interpreted as delusional. Her situation [was] no longer complicated by substance abuse.”

196

Dr. Franklin diagnosed the plaintiff with PTSD with “[d]epersonalization and [d]erealization,” 

moderate major depressive disorder, alcohol use disorder (in remission), partner relational 

problems, occupational problems, housing problems, and low income.197 The plaintiff was 

competent, “emotionally disconnected from her experiences,” and suffered from “hypervigilance, 

fear, sadness, and dissociation in her adulthood.”198 She scored in the “severe” range for 

 

189 Id.

190 Id.

191 Id.

192 Id.

193 Id.

194 Id.

195 AR 469.

196 Id.

197 Id.

198 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 18 of 68
ORDER – No. 18-cv-03562-LB 19

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

depression and anxiety and presented with PTSD symptoms.199 The plaintiff had “poor” selfesteem, “average intelligence,” “mostly adequate neurocognitive skills,” “mild cognitive slowing,” 

and a lower performance on visuospatial constructional tasks “then would be expected given her 

other skills and abilities.”200 The plaintiff could “manage her money appropriately,” and her 

alcohol abuse issues appeared to be under control, meaning she would not require a payee if 

awarded SSI.201

Regarding the plaintiff’s functional abilities in the workplace, Dr. Franklin found the 

following:

[The plaintiff] has been able to live independently and work in the past, but she has 

not worked in a full time job since 2006. Based on the testing results, it is likely that 

[the plaintiff] would have no difficulty remembering and following sample 

instructions while at work and she would likely have mild trouble remembering and 

following complex directions. Her ability to pay attention is good on formal 

measures, but in an emotionally laden situation, she could have moderate difficulties. 

Her ability to perform tasks at a reasonable pace would be mildly impaired. Her 

ability to get along with the public and coworkers would be moderately impaired due 

to her anxiety and inhibitions, and her ability to accept criticism and redirection form 

supervisors would likely be moderately impaired. Her ability to get to work and 

follow a schedule has been very poor in recent years. Her work at Peet’s ended due 

to conflicts over attendance, and she left her last informal job because she could not 

manage the schedule. [The plaintiff] isolates when under stress, therefore her work 

would be markedly impacted by her mental health situation. Her mental health 

symptoms could markedly interfere with appropriate work functioning if she were to 

overcome her anxiety and find work. In the face of normal work stressors, [the 

plaintiff] could dissociate or simply leave in order to manage any uncomfortable 

feelings that might arise. This situation has lasted for the last 8 years, and even with 

intensive treatment, it is likely she will continue to have significant difficulties in the 

future.202

The plaintiff showed mild difficulties “[u]nderstand[ing], remember[ing], and carry[ing] out 

detailed instructions” and “perform[ing] at a consistent pace without an unreasonable number and 

 

199 Id.

200 Id.

201 AR 470.

202 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 19 of 68
ORDER – No. 18-cv-03562-LB 20

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

length of rest periods.” 203 She showed moderate difficulties “maintain[ing] attention and 

concentration for two-hour segments,” “get[ting] along and work[ing] with others,” “interact[ing] 

appropriately with the general public,” “accept[ing] instructions and respond[ing] appropriately to 

criticism from supervisors.”

204 She showed marked difficulties “respond[ing] appropriately to 

changes in a routine work setting and deal[ing] with normal work stressors,” “complet[ing] a 

normal workday and workweek without interruptions from psychologically based symptoms,” 

“maintain[ing] regular attendance,” and “be[ing] punctual within customary, usually strict 

tolerances.”205

On July 10, 2014, Dr. Franklin filed out a “Mental Impairment Questionnaire.”206 She 

diagnosed the plaintiff with “maj depression,” PTSD, “alcohol use, sustained remission,” and 

difficulties in aspects of her life including “social, occupational, housing, economic.”207 The 

plaintiff suffered from the following symptoms: “[a]nhedonia or pervasive loss of interest in 

almost all activities,” “[a]ppetite disturbance with weight change,” “[d]ecreased energy,” flat 

affect, “[f]eelings of guilt or worthlessness,” [g]eneralized persistent anxiety,” “[m]ood 

disturbance,” “[r]ecurrent and intrusive recollections of a traumatic experience, which [we]re a 

source of marked distress,” “[p]ersistent disturbances of mood or affect,” “[a]pprehensive 

expectation,” “[e]motional withdrawal or isolation,” “[v]igilance and scanning,” and “[s]leep 

disturbance.”208 Gabapentin, “[could] have implications for working” because side effects include 

dizziness and fatigue.209 The plaintiff’s MMSE score (28/30) reflected a “mild impairment[;] 

however[,] this d[id] not take into account social difficulties presented by [the] client.”210 The

 

203 AR 471.

204 Id.

205 Id.

206 AR 472.

207 Id.

208 Id.

209 Id.

210 AR 473. 

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 20 of 68
ORDER – No. 18-cv-03562-LB 21

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

plaintiff was not a “malingerer,” her impairments were not caused by substance abuse, she did not 

have a low IQ, and her mental condition did not exacerbate her “experience of pain or any other 

physical symptom.”211

The plaintiff had a number of impairments that impacted her ability to do “work-related 

activities on a day-to-day basis in a regular work setting” and Dr. Franklin estimated that the 

plaintiff’s impairments would make her absent from work “more than four days per month.”212 The 

plaintiff exhibited mild impairments carrying out simple instructions and being cognizant of 

“normal [work] hazards and tak[ing] appropriate precautions.”213 She exhibited moderate 

impairments maintaining attention for two hours, sustaining an “ordinary routine without special 

supervision,” working in close proximity to others “without being unduly distracted,” making 

“simple work related decisions,” performing “at a consistent pace without an unreasonable number 

and length of rest periods,” asking basic questions or asking for help, “accept[ing] instructions and 

respond[ing] appropriately to criticism from supervisors,” and getting along with co-workers 

without “unduly distracting them or exhibiting behavioral extremes.”214 She exhibited marked 

difficulties attending work regularly and being punctual “within customary, usually strict 

tolerances” and finishing a normal workday/workweek “without interruptions from 

psychologically based symptoms.”215 She exhibited extreme difficulties coping with “normal work 

stress.”216

The plaintiff had a mild impairment “carry[ing] out detailed instructions” and marked 

impairments “set[ting] realistic goals or mak[ing] plans independently of others” and coping with 

work stress.217

 

211 AR 472.

212 AR 472, 474 (emphasis in the original).

213 AR 474. 

214 Id.

215 Id.

216 Id.

217 AR 475.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 21 of 68
ORDER – No. 18-cv-03562-LB 22

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

She had moderate impairments interacting “appropriately with the general public,” maintaining 

“social[ly] appropriate behavior,” travelling in unfamiliar places, and using public 

transportation.218

Dr. Franklin concluded that the plaintiff had moderate deficiency in “concentration, 

persistence[,] or pace” and marked difficulty in maintaining her social functioning.219 Dr. Franklin 

did not identify any episodes of decompensation.

220

On September 29, 2016, Dr. Franklin supervised a psychological evaluation of the plaintiff

conducted by Dionne Childs, MS.”

221

Regarding her occupational history, the plaintiff said:

[S]he tend[ed] to get fired from office positions because she [was] ‘not good at desk 

jobs.’ She reported that she last worked at the end of 2014 in a day program for 

developmentally delayed adults and dealt with difficult and violent clients there. She 

stated she did well at this job, but “lateness and paperwork” became a problem and 

at the time she had recently begun the alcohol recovery process. She indicated that 

persistent obstacles to obtaining and maintaining gainful employment are related to 

the fact that she experiences periods where she progressively zones out while 

completing job tasks and then progressively returns to a state where she is able to 

resume the task. 222

In addition to a clinical interview, Dr. Franklin and Ms. Child administered the M-FAST, 

MMSE, RBANS, and Trail Making A & B tests.

223 Throughout the evaluation, the plaintiff had a 

pleasant disposition and was engaged and open about her experiences.224 She was oriented to 

“person, place and time,” her attention was normal, she “worked at a rate that was adequate as 

compared with peers,” and she was able to sustain attention well enough to remember short strings 

 

218 AR 475.

219 Id.

220 AR 475–76.

221 AR 546.

222 AR 547.

223 AR 546.

224 AR 548.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 22 of 68
ORDER – No. 18-cv-03562-LB 23

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

of information.”225 She exhibited delayed and immediate memory.226 Her speech was normal, her 

affect was appropriate, her mood was anxious, and her insight and judgment were both fair.227

“Her fund of knowledge, intelligence and abstraction appear[ed] to be within the average range” 

and she “was able to converse in a manner that was suitable for the evaluator to collect [the 

necessary] information.”228 Dr. Franklin wrote that the results of the assessment were a “valid 

representation of [the plaintiff’s] psychological and cognitive functioning.”229

The plaintiff scored 100 on the RBANS Language index, which was in the 50th percentile.

230

On the RBANS Visuospatial/Constructional index, she scored 81, which placed her in the 10th

percentile, “Low Average range.”231 She scored an 87 on the RBANS Immediate Memory index, 

placing her in the 19th percentile, “Low Average range.”232 On the RBANS Delayed Memory 

index, she scored an 83, which placed her in the 13th percentile.233 She scored a 106 on the RBANS 

Attention index, placing her in the 66th percentile, average range.234

The plaintiff said that “experience[d] frequent and unpredictable periods of dissociation 

coupled with the ability to function within average range on attention measures when outside of 

this dissociative state.”235 The plaintiff showed “impaired performance on measures of executive 

functioning, which involves the cognitive ability to preview, plan, sequence, and modify 

actions.”236 Her Trails A performance was within normal limits and her Trails B performance was 

 

225 Id.

226 Id.

227 Id.

228 Id.

229 AR 549.

230 Id.

231 Id.

232 Id.

233 Id.

234 AR 550.

235 Id.

236 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 23 of 68
ORDER – No. 18-cv-03562-LB 24

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

impaired.237 “On the MMSE, [the plaintiff] was unable to count backward by sevens. She was able 

to spell the word ‘world’ backward.”238 Her overall MMSE score was 29/30, “suggesting no 

impairment.”239 Her overall cognitive assessment score was in the 16th percentile low average 

range.240

The plaintiff scored a 2 on M-FAST, showing that she “was not prone to overstate the severity 

of her symptoms. . . . she was generally telling the truth and putting forth adequate effort.”241 The 

plaintiff reported experiencing the following symptoms:

[D]epressive symptoms that included: depressed mood, loss of interest, sleep 

disturbance, psychomotor retardation, fatigue, feelings of worthlessness/guilt, poor 

concentration, and suicidality. She endorsed additional symptoms related to 

Posttraumatic Stress Disorder: a traumatic event where death or serious injury was 

intensely feared; reexperiencing of the event; avoidance of associated stimuli, 

reduced interest in participating in activities, feeling detached or estranged, and a 

sense of foreshortened future; and increased arousal or angry outbursts, 

hypervigilance, and exaggerated startle response. Additionally[,] she reported 

extreme difficulty with focus and attention to the point that multiple times per day 

she experiences periods of dissociating and zoning out and then returning to previous 

functioning. Dissociation is often seen as a response to emotional trauma. 242

The plaintiff “[wa]s a hermit” and was generally “‘leery of people.’”243

Dr. Franklin diagnosed the plaintiff with major depressive disorder, PTSD, unspecified 

dissociative disorder, relational problems, occupational problems, and low income.244 “Global 

Assessment of Functioning would describe [the plaintiff] as having serious impairment in social 

and occupational functioning.”245 Regarding her employment in particular, Dr. Franklin wrote: 

 

237 Id.

238 Id.

239 Id.

240 Id.

241 Id.

242 AR 551.

243 Id.

244 Id.

245 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 24 of 68
ORDER – No. 18-cv-03562-LB 25

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

“the frequent and unpredictable nature of her dissociative states is quite problematic despite a 

snapshot of attention scores that suggest otherwise average functioning.”

246

“[S]he has had 

difficulty maintaining and obtaining employment. She has had difficulty remembering and 

following instructions, low frustration tolerance, and trouble consistently complying with strict 

workplace expectations.”247 He noted that there was “no evidence of substance use on the day of 

the evaluation and no evidence that she was exaggerating her symptoms for personal gain.”248

Regarding “Mental Abilities and Aptitudes Needed To Do Unskilled Work,” the plaintiff showed 

mild impairments getting along with others and working with others, interacting appropriately 

with others, “accept[ing] instructions[,] and respond[ing] appropriately to criticism from 

supervisors.”249 She showed marked impairments understanding, recalling, and following simple 

instructions and “respond[ing] appropriately to changes in a routine work setting and deal[ing] 

with normal work stressors.”250 She showed extreme impairments understanding, recalling, and 

following detailed instructions, maintaining concentration for more than two hours, “perform[ing] 

at a consistent pace without an unreasonable number and length of rest periods,” “complet[ing] a 

normal workday and workweek without interruptions from psychologically based symptoms,” and 

regularly attending work and being punctual within “customary, usually strict tolerances.”251

2.1.6 Pathways to Wellness – Treating

On October 23, 2014, the plaintiff had an “Initial Assessment” at Pathways to Wellness.252 The 

plaintiff said her medications did not work.

253 The plaintiff worked at a “development facility for

 

246 Id.

247 Id.

248 Id.

249 AR 553.

250 Id.

251 Id.

252 AR 537. The physician’s signature is illegible.

253 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 25 of 68
ORDER – No. 18-cv-03562-LB 26

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

[developmentally disabled] adults” and wanted to “achieve more in her life.”254 Her mood was 

depressed, her affect was “appropriate and engaged, cooperative,” her thought process was linear, 

and her abstract reasoning was good.255 She did not have delusions, hallucinations, or 

obsessions.256 She had depression, feelings of worthlessness and guilt, crying spells, and 

anxiety.257 She had “difficulties in education/employment/day/social activities” and a “history of 

recurring substantial functional impairments.”258 Her psychiatric history demonstrated that 

“without mental health service there is a high risk of recurrence to a level functional 

impairment.”259 She took Celexa and Gabapentin.

260 The plaintiff had moderate limitations in 

“maintaining concentration, persistence of place,” marked limitations in “[r]estriction of activities 

of daily living” and “difficulties maintaining social functioning/relationships,” and extreme 

episodes of decompensation and increased symptoms of extended duration.261 The attending 

psychiatrist decreased her Celexa dosage, started her on Lexapro, continued her on Gabapentin, 

and diagnosed her with “recurrent psychosis” and “recurring ETOH.”262 The plaintiff had a GAF 

of 65.263

Ruth Nunez, MA, MFT filled out the plaintiff’s “Client Plan” for Pathways to Wellness.264 She 

diagnosed the plaintiff with Major Depressive Disorder (“MDD”), Posttraumatic Stress Disorder

(“PTSD’), Alcohol Use Disorder (“ETOH use DO”), “h/0 abuse” and moderate social and 

 

254 AR 537, 541.

255 AR 540.

256 Id.

257 AR 542.

258 Id.

259 Id.

260 AR 538.

261 AR 541.

262 AR 542.

263 AR 541.

264 AR 532.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 26 of 68
ORDER – No. 18-cv-03562-LB 27

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

economic issues.265 Her social issues stemmed from her “ongoing issues with mixed moods,” 

which led to “interpersonal conflicts and struggles to maintain social connections.”266 The 

plaintiff’s economic problems stemmed from her unemployment and limited source of income.267

Her strengths included being “resilient, resourceful, responsible” and having “articulate needs.”268

She had symptoms “7 days/week with severe intensity.”269 Pathways anticipated transitioning the 

plaintiff to a lower level of care roughly “6 months after [the] onset of treatment.”270

On November 12, 2014, the plaintiff saw Michael [unreadable]. The plaintiff’s Lexapro trial

made her feel “horrible.”271 They put her on a new medication [unreadable].272 Her symptoms 

included “crying, low self[-]esteem, [and] feel[ing] worthless.”273

In November [unreadable] 2014, the plaintiff appeared healthy, adequately groomed,

cooperative, and calm and she spoke normally, and was in an anxious mood.

274 Her affect was 

constricted, her thought process was linear, and her memory was intact.275 Her 

attention/concentration was “good,” her judgment and insight were “fair,” and she did not appear 

to pose a danger to herself or others.276 [Most of this report is unreadable.]

On December 12, 2014, the plaintiff felt “shitty” and was attending all of her AA meetings.277

She had side effects, including anxiety and insomnia, from her Abilify medication.278 The 

 

265 AR 530.

266 Id.

267 Id.

268 Id.

269 Id.

270 AR 531.

271 AR 528.

272 AR 529.

273 AR 536.

274 AR 526.

275 AR 527.

276 Id.

277 AR 524.

278 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 27 of 68
ORDER – No. 18-cv-03562-LB 28

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

plaintiff’s complaints were categorized as “attention getting,” and she was prescribed a new 

medication, Celexa.279

On December 30, 2014, t the plaintiff was generally “okay.”280 Her depression had decreased 

since switching to a new medication.

281 She denied anxiety, mania, and suicidal or homicidal 

ideation, was sleeping “okay,” and had low energy and a low appetite.282 She attended therapy, 

exercised, and had a support system via AA and her sober friends.283

On January 27, 2015, the plaintiff saw Seamus McCoy, N.P., for a medication follow-up.284

“[Her] moods ‘evened out,’ sadness continue[d], irritability decreased, sleep adequate, energy low, 

appetite normal, libido low, concentration poor, ‘zone[d] out’ sometimes – has occurred as long as 

20 yrs ago, ‘racing thought[s],’ worrying, negative thoughts, anxiety (decreased w gabapentin), no 

nightmares or flashbacks, feelings of guilt, denie[d] SI/HI.”285 She lost her job two months prior to 

this appointment and subsequently began receiving unemployment income.286 She was continuing 

therapy, AA, and CODA.287 The plaintiff appeared adequately groomed, cooperative, and calm,

and she spoke normally and was in a sad mood.

288 Her affect was sad, her thought process was

linear, her thought content was within normal limits, and her memory was intact.289 Her judgment,

attention/concentration, and insight were “fair” and she did not appear to pose a danger to herself 

or others.290 The plaintiff failed trials with Lexapro, Abilify, and Remeron and had bad reactions 

 

279 AR 525. The rest of the text surrounding this is unreadable so the context is unclear.

280 AR 522.

281 Id.

282 Id.

283 Id.

284 AR 520.

285 Id.

286 Id.

287 Id.

288 Id.

289 AR 521.

290 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 28 of 68
ORDER – No. 18-cv-03562-LB 29

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

to Wellbutrin.291 Nurse McCoy started her on Lamictal (25 mg) and encouraged her to work out 

three times a week rather than once a week.292 The plaintiff’s risk of decompensation was high 

because of her “recent unemployment and trauma work in groups and 1:1 therapy.”293

On February 24, 2015, the plaintiff saw Nurse McCoy for another medication follow-up.294

The plaintiff had “racing thoughts [that] continue[d] all day long, d[id] not prevent [the plaintiff]

from falling asleep, concentration remain[ed] poor, mood improved, energy improved ‘good,’ 

anxiety ‘comes and goes’ same as last visit, continue[d] w absence of nightmares or flashbacks 

(last was about 2 months ago), possible dissociation, denie[d] SI/HI.”295 The plaintiff thought that 

her Lamictal prescription might be causing some side effects including “upset[ting] her balance . . 

. [and] mak[ing] racing thoughts worse.”296 She attended therapy (which was “helpful”) and AA 

and CODA meetings.297 She received unemployment income.298 She drank five cups of coffee per 

day, and she smoked eight cigarettes per day.299 The plaintiff was adequately groomed, 

cooperative, and calm, and she spoke normally and was in a sad and anxious mood.

300 Nurse 

McCoy decreased her Lamictal dosage and recommended that she decrease her coffee 

consumption from five to four cups per day and exercise five times a week.

301

On March 3, 2015, the plaintiff reported having flashbacks, feeling hypervigilant, and 

experiencing moderate anxiety, feelings of PTSD and avoidance, poor concentration, racing 

thoughts, irritability, “sleep onset [at] 4:30 or 5am,” a depressed mood, low energy, and “passive 

 

291 Id.

292 Id.

293 Id.

294 AR 518.

295 Id.

296 Id.

297 Id.

298 Id.

299 Id.

300 Id.

301 AR 518-19.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 29 of 68
ORDER – No. 18-cv-03562-LB 30

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

[suicidal ideation] – no plan or intent.”302 She was healthy looking, was cooperative and calm,

spoke normally, and was in an apathetic mood.

303 Nurse McCoy prescribed Effexor.304 He wanted

to taper the plaintiff off of Citalopram, continue Gabapentin, decrease her caffeine consumption, 

and “consider adding new med for sleep onset.”305

On April 28, 2015, the plaintiff saw Marina Obolnikov, M.D. The plaintiff drank roughly four 

cups of coffee a day and smoked eight cigarettes a day.

306 The plaintiff appeared healthy, 

adequately groomed, cooperative, and calm, spoke normally, and was in a sad mood, though her 

degree of sadness was “close to average.”307 The plaintiff was in the process of “tapering off 

Celexa and starting Effexor XR.”308 She was doing well on her medications and indicated “no 

disorientation . . . no psychosis, no racing thoughts, [and] no safety risk.”309

On May 26, 2015, the plaintiff reported that she had adequate sleep, had energy, low 

concentration, and “thoughts about past trauma daily or every other day.”310 She felt less 

depressed and anxious.311 Her therapist was not helpful, and she was looking for a new one.

312

Nurse McCoy increased her Effexor prescription and decreased her Celexa dosage.

313 The

plaintiff’s MDD symptoms decreased “significantly,” and her PTSD symptoms decreased 

 

302 AR 516.

303 Id.

304 AR 517.

305 Id.

306 AR 514.

307 Id.

308 AR 515.

309 Id.

310 AR 512.

311 Id.

312 Id.

313 AR 513.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 30 of 68
ORDER – No. 18-cv-03562-LB 31

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

“somewhat” with medications.314 Her feelings of sadness and anxiety still persisted but were

“decreased.”315

On July 7, 2015, the plaintiff had a “depressed mood, low energy, poor concentration, 

nightmares, flashbacks, anxiety, feelings of guilt.”316

On July 7, 2015, during another medication follow-up with Nurse McCoy, the plaintiff was 

sleeping “okay,” felt less depressed, had low energy, a normal appetite, poor concentration, and

fewer nightmares, and felt anxious, and her flashbacks “decreased to approx. once per week.”317

She felt “‘spacey.”318 Nurse McCoy reported that this may be a side effect of her medications.319

The plaintiff’s symptoms of “MDD and STPD decreased with current medication.”320 Nurse 

McCoy increased her Effexor dosage and decreased her Celexa dosage.321 Overall, he indicated a 

“fair” prognosis.322

On August 4, 2015, the plaintiff felt “somewhat sedated w increased Effexor, [her] anxiety 

remain[ed] moderate, decreased depression, [and] concentration moderate.”323 She felt “slightly 

more ‘spacey,’” and her “flashbacks decreased to less than 1x per week.”324 The plaintiff’s MDD 

and PTSD symptoms were “mildly improved” with her recent Effexor dosage increase.325 Nurse 

 

314 Id.

315 Id.

316 AR 535.

317 AR 510.

318 Id.

319 Id.

320 AR 511.

321 Id.

322 Id.

323 AR 508.

324 Id.

325 AR 509.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 31 of 68
ORDER – No. 18-cv-03562-LB 32

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

McCoy did not change her medications but recommended that the plaintiff decrease her caffeine 

intake “due to excess anxiety.”326

On September 29, 2015, the plaintiff’s symptoms included “nightmares, flashbacks, 

hypervigilance, avoidance, racing thoughts, feel[ing] more ‘spacey and less present’, depression, 

crying spells, guilt, feelings of worthlessness, low energy, poor concentration, anxiety, irritability, 

[and] passive SI-no plan or intent.”327 The plaintiff’s updated treatment plan included using 

monthly medication management to reduce occurrences of these symptoms by 50% “within the 

next 12 months.”328

On September 29, 2015, the plaintiff had interrupted sleep, low energy, and improved 

anxiety.

329 Her “spacey” feeling was getting worse, she experienced flashbacks once a week, and 

she did not have any nightmares.330 She mentioned a job but did not elaborate about it.

331 She met

with a sponsor once a month, went to therapy, and exercised..

332 She had medication side effects 

including “forgetfulness [and] low energy.”333 Nurse McCoy decreased the plaintiff’s Effexor

dosage.334 He did not alter her Gabapentin dosage because she noted that her “‘memory issue 

[was] not that bad.’”335 Her MDD and PTSD symptoms decreased.336

On November 24, 2015, the plaintiff was sleeping “okay” and had continual flashbacks “once 

per week,” and Effexor alleviated some of the “spacey feeling[s].”

337 She was looking for a new 

 

326 Id.

327 AR 534.

328 Id.

329 AR 505.

330 Id.

331 Id.

332 Id.

333 Id.

334 AR 507.

335 Id.

336 Id.

337 AR 504.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 32 of 68
ORDER – No. 18-cv-03562-LB 33

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

therapist.

338 Nurse McCoy noted that on her current medication, the plaintiff’s MDD and PTSD 

symptoms were “low” and did not alter her medications.

339

On January 21, 2016, the plaintiff had low energy, moderate anxiety, and flashbacks, though 

she had not had one “in a while.”340 Her MDD and PTSD symptoms were “currently low.”341 She 

declined changes to her medication and noted that the side effects of “higher dose Effexor [were] 

intolerable.”342 Nurse McCoy’s prognosis was that the plaintiff was doing “fair.”343 He continued 

her Gabapentin prescription, increased her Effexor dosage, and encouraged her to continue her 

weekly therapy sessions.344

On February 19, 2016, the plaintiff saw Nurse McCoy for an updated “Treatment Plan which

involved “reduc[ing] her depression and anxiety by 10% in [the] next six months.”345

On April 7, 2016, the plaintiff reported that she was a part-time dog worker and described her 

alleviating factors as “meds, therapy, AA 3/7, sponsor.”346 The plaintiff had “poor control of 

symptoms and affective flattening with current meds” and was thinking about “coming down on 

the Effexor.”347 Nurse Collins instructed her to taper off of Venlafaxine and start Paroxetine.

348

 

338 Id.

339 AR 506.

340 AR 502.

341 Id.

342 Id.

343 Id.

344 Id.

345 AR 533.

346 AR 500.

347 AR 500–01.

348 AR 501.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 33 of 68
ORDER – No. 18-cv-03562-LB 34

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

On May 6, 2016, the plaintiff saw Hiawatha Harris, M.D., for a prescription refill and 

evaluation.

349 The plaintiff’s response to medication was “adequate.”350 Dr. Harris’s overall 

prognosis was that the plaintiff was doing “fair.”351

On June 8, 2016, the plaintiff felt tired, stressed, and depressed and was “triggered by [her] 

ACA [adult children of alcoholics] group.”352 Her mood was “stable, [with] moderate depression 

and high anxiety” and she suffered from flashbacks on a weekly basis.353 The plaintiff gained 

weight and had “poor concentration,” and her appetite/energy was “high/low.”354 She identified 

“therapy, meds, sponsor, [and her] adult children of alcoholics group” as alleviating factors.355 The 

plaintiff stopped taking Gabapentin because her therapist told her Gabapentin was only prescribed 

as-needed.

356 Nurse Collins recommended that the plaintiff try Buproprion instead.357 The

plaintiff’s PTSD and depression were “not controlled by meds and therapy.”

358

On June 21, 2016, the plaintiff was on Gabapentin and felt “fair” but had a discussion with 

Nurse Collins about potential options for treating agitation and anxiety by either increasing her 

Gabapentin dosage or trying a medication called Desvenlafaxine.359 The plaintiff had “mild 

symptoms.”360

 

349 AR 498.

350 Id.

351 AR 499.

352 AR 496. 

353 Id.

354 Id.

355 Id.

356 Id.

357 AR 496–97.

358 AR 497.

359 AR 494. 

360 AR 495.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 34 of 68
ORDER – No. 18-cv-03562-LB 35

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

On July 27, 2016, the plaintiff was taking Pristique “without clear benefit” and Gabapentin.

361

Her mood was stable and “euthymic,” and she showed signs of depression and anxiety.362 Nurse 

Collins increased the plaintiff’s dosages of Pristique and Gabapentin and noted that the plaintiff 

“demonstrate[d] insight that meds will only do so much and that she would benefit from continued 

therapy.”363

2.1.7 Alameda County Social Services Agency — Examining

On January 17, 2013, Martha Helms, MFT, examined the plaintiff for “mental health 

conditions that may prevent [her]from being able to work.”

364 The plaintiff’s work limitations 

stemmed from her chronic depressive disorder, her PTSD, her “long-term alcohol abuse,” and her 

“low tolerance for stress.”365 She had “not significant” limitations carrying out simple instructions,

completing a normal workday/work-week, getting along with coworkers “without unduly

distracting them or exhibiting behavioral extremes,” and being aware of workplace hazards and 

taking appropriate precautions against them.

366 She had moderate limitations in understanding and 

memory, maintaining attention for more than two hours at a time, maintaining an ordinary routine 

without special supervision, asking basic questions and asking for assistance, and responding 

appropriately to changes in a routine work setting.367 She had marked limitations in regularly 

attending work and being punctual within customary tolerances, completing a normal workday 

and work-week without interruptions from psychologically based symptoms, performing at a

consistent pace without an unreasonable number and length of rest periods, and accepting 

instructions and responding appropriately to criticism from supervisors.368 The plaintiff could not 

 

361 AR 492. 

362 Id.

363 AR 492–93.

364 AR 544.

365 AR 545.

366 AR 544.

367 Id.

368 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 35 of 68
ORDER – No. 18-cv-03562-LB 36

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

work for one year and had work restrictions related to her “lower tolerance for stress: 10 year 

pattern of coping with stress, emotional pain with alcohol use,” and the plaintiff’s recovery from 

alcohol abuse was recent, which made her “vulnerable to relapse.”369

2.1.8 Cheryl Cranshaw LMFT — Treating

Ms. Cranshaw started treating the plaintiff in December 2015.370 At the time of her meetings 

with Ms. Cranshaw, the plaintiff was unemployed and was four years’ sober.

371 The plaintiff was 

“oppositional, depressed, anxious and chronically lethargic.” 372 She struggled to concentrate and 

dissociated daily.373 She experienced unpredictable mood swings, quickly going from cooperative 

to “oppositional and argumentative,” with “bouts of intense, inappropriate anger,” and 

hypersomnia, where she could not get out of bed.374 Her hypersomnia led to fights with her father 

and she was “on the verge of homelessness.”375 The plaintiff experienced “frequent and terrifying”

episodes of “intense psychological reactivity, [and] increased heart rate.”376 At times, she felt like 

she was dying.377“Because these episodes c[ould] be daily, intense and unpredictable, she [was]

fearful of going into public spaces suggesting agoraphobic features.”

378

“She ha[d] no friends or 

close relationships.”

379

 

369 AR 545.

370 AR 554.

371 Id.

372 Id.

373 Id.

374 Id.

375 Id.

376 Id.

377 Id.

378 Id.

379 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 36 of 68
ORDER – No. 18-cv-03562-LB 37

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

The plaintiff recalled an incident when she sought out her mother’s attention as a toddler, and 

her mother “responded with a kick.”380 Her mother told her that she never wanted any children.381

Though the plaintiff’s father knew she was being physically and emotionally abused as a child, he 

never protected her from it.382 She was bullied and abused at school because of her physical 

appearance.383 Her alcohol, depression, and anxiety problems developed while she was providing 

hospice care for her mother as a teenager.384 She resented her father for leaving her to care for her 

dying mother.385 “She [could not] recount a time when she was happy and not depressed, nor a 

time when she had any meaningful relationships.”386 Her medication “d[id] not sufficiently control 

her symptoms.”387

Regarding the plaintiff’s employment history, Ms. Crenshaw found:

Despite her desire to work[,] she was unsuccessful . . . . In two situations, dissociation 

was a problem[.] [S]he was reprimanded for “staring into space” rather than working. 

She was eventually terminated because of her inability to focus. She was terminated 

from the second job because she was late. However, in this instance her tardiness 

was also related to dissociation. On several occasions, while she was preparing for 

work she would dissociate causing her to arrive late for work. During the termination 

discussion, she did not relate to her employer that she frequently dissociates because 

she was embarrassed.

In [a] third attempt at employment[,] she was let go after she argued with her 

supervisor who told her that her attitude was not right for the job.388

The plaintiff never had “successful or [sus]stained employment” and “felt heavily criticized 

because of her inability to maintain attention and concentration.”

389 She failed to remember 

 

380 AR 555.

381 Id.

382 Id.

383 Id.

384 Id.

385 Id.

386 AR 556.

387 AR 555.

388 AR 556.

389 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 37 of 68
ORDER – No. 18-cv-03562-LB 38

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

instructions or carry out work tasks and argued with her supervisors.”390 “She ha[d] poor insight 

and d[id] not recognize her inability to accept supervision from her superiors as a symptom of 

mental illness. She [was] defensive and sensitive to the slightest correction. She [was] unable to 

interact appropriately with her superiors.”391

The plaintiff was anxious and tense, her “thought[,] mood[,] and affect [were] depressed and 

irritable,” her speech was monotone, and her judgment and insight were poor.

392

“She [could] 

become inappropriately argumentative, when she fe[lt] that her requests may not be met.”393 She 

had suicidal and homicidal ideation “with no plan.”394 The plaintiff’s “pattern of instability in 

interpersonal relationships, impulsivity, intense episodic dysphoria, chronic feelings of emptiness, 

and dissociative symptoms, all point[ed] to a diagnosis of Borderline Personality Disorder.”

395 She 

had “long-term or chronic traits that are likely to have persisted for several years prior to this 

assessment.”

396

The plaintiff ranked in the severe range on the Beck Depression and Anxiety Inventory.397 She 

was “chronically depressed,” had a GAF score of 51, and had “impaired reality testing and major 

impairments in social, psychological[,] and occupational functioning.”398 The plaintiff’s symptoms 

contributed to her “past failures.”

399 Those failures “reinforce[d] her feelings of worthlessness, 

[and made] her hopeless, [and] unable to strategize, develop, or pursue employment goals and 

aspirations.”400 The plaintiff’s “lack of insight; inability to conform behavior to the workplace, 

 

390 Id.

391 Id.

392 Id.

393 Id.

394 Id.

395 Id.

396 AR 556–57.

397 AR 557.

398 Id.

399 Id.

400 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 38 of 68
ORDER – No. 18-cv-03562-LB 39

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

oppositional behavior and dissociation ha[ve] interfered with her ability to work.”401 Ms. 

Cranshaw concluded that the plaintiff’s condition warranted “a careful plan of action including ongoing psychiatric visits and medication management, weekly psychotherapy[,] and support 

groups.”402 She recommended Assertive Community Treatment, which provided “community 

based psychiatric treatment, rehabilitation[,] and support[,] especially around housing and 

employment,” and Reinforcement and Modeling Techniques meant to minimize the plaintiff’s

symptoms of “dissociation, social isolation, irritability[,] and oppositional behavior.”403

2.1.9 Eugenie Arnold, MFT, Psy.D. — Treating

Dr. Arnold saw the plaintiff once a week from September 26, 2016 to November 16, 2016.404

Dr. Arnold filled out a “Mental Impairment Questionnaire.”

405 She diagnosed the plaintiff with

recurrent major depressive disorder, generalized anxiety disorder, avoidant personality disorder, 

and dissociative disorder and concluded that these conditions were likely to last more than twelve 

months.406 The plaintiff took Pristiq, Gabapentin, and Benadryl.407 The plaintiff was not a 

malingerer, could manage her finances in her own best interest, did not have a low IQ, and did not 

have any physical symptoms.408

The plaintiff’s symptoms included “appetite disturbance with weight change,” decreased 

energy, “feelings of guilt or worthlessness,” generalized persistent anxiety, mood disturbance, 

“difficulty thinking or concentrating,” “recurrent and intrusive recollections of a traumatic 

experience, which are a source of marked distress,” “persistent disturbances of mood or affect,” 

personality changes, apprehensive expectation, “paranoid thinking or inappropriate 

 

401 Id.

402 Id.

403 Id.

404 AR 558.

405 AR 558–561.

406 AR 558.

407 Id.

408 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 39 of 68
ORDER – No. 18-cv-03562-LB 40

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

suspiciousness,” “recurrent obsessions or compulsions[,] which are a source of marked distress,” 

“emotional withdrawal or isolation,” “persistent irrational fear of a specific object, activity, or 

situation which results in a compelling desire to avoid the dreaded object, activity or situation,”

“intense and unstable interpersonal relationships and impulsive and damaging behavior,” 

disorientation regarding time and place, “perceptual or thinking disturbances,” motor tension, easy 

distractibility, short-term memory impairment, and sleep disturbance.409 Dr. Arnold put a question 

mark next to “[l]oss of intellectual ability of 15 IQ points or more.”410

The plaintiff’s impairments had a mild effect on work-related mental activities such as making 

simple decisions, sustaining an ordinary routine without special supervision, accepting instructions 

and responding appropriately to criticism from supervisors, working with or near others without 

being unduly distracted or distracting them, “interacting appropriately with coworkers and the 

general public, responding appropriately to changes in a routine work setting, and adhering to 

basic standards of neatness and cleanliness.”

411 Her impairments had a moderate effect on her

ability to understand, remember, and carry out simple instructions, a marked effect on her ability 

to maintain attention for two-hour segments, perform at a constant pace without an unreasonable 

number and length of rest periods, and deal with normal work stress, and an extreme effect on her 

ability to complete a normal workday and workweek without interruptions from psychologically 

based symptoms. 412 The plaintiff had moderate difficulties in maintaining social functioning, and

“repeated episodes of decompensation within [a] 12-month period, each of at least two weeks 

duration,” and extreme “deficiencies of concentration, [and] persistence or pace.”413

 

409 AR 559.

410 Id.

411 AR 560.

412 Id.

413 AR 561.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 40 of 68
ORDER – No. 18-cv-03562-LB 41

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

2.1.10 Disability Determination Explanations — Non-Examining

Barbara Moura, Psy.D., and Brady Dalton, Psy.D., conducted disability-determination 

explanations (“DDEs”) during the administrative process.414 One addressed the plaintiff’s initial 

claim for disability, and the second addressed her claim on reconsideration.415 In both DDEs, the 

non-examining physicians found that the plaintiff was not disabled.416

Barbara Moura, Psy.D., reviewed the plaintiff’s medical records and determined that her

impairments were not severe individually or in combination.

417 Dr. Moura described the plaintiff’s 

symptoms as “mostly stable now that [she is] one year sober and compliant w/ [treatment] 

([medications] and AA)” and said that although the plaintiff may continue to experience residual 

symptoms, they “do not appear more than mild in severity.”418 Dr. Moura found that the plaintiff 

had mild “restrictions in activities of daily living,” “difficulties maintaining social functioning,” 

and “difficulties in maintain concentration, persistence or pace.”419 The plaintiff did not have any 

repeated episodes of decompensation of extended duration.420 Dr. Moura concluded that “if [the 

plaintiff] continues sober, 12.04 [her affective disorders] and 12.06 [her anxiety] are nonsevere”

and her impairments would not “significantly limit [the plaintiff’s] physical or mental ability to do 

basic work activities.421 Dr. Moura found that the plaintiff’s medically determinable impairments 

could reasonably be expected to produce the plaintiff’s symptoms but that the plaintiff’s 

statements about the “intensity, persistence, and functionally limiting effects of the symptoms” 

 

414 AR 129–151.

415 Id.

416 AR 137; AR 151.

417 AR 135.

418 AR 132.

419 AR 136.

420 Id.

421 AR 132; 135–36.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 41 of 68
ORDER – No. 18-cv-03562-LB 42

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

were not substantiated by the medical evidence.422 She described the plaintiff’s statements as 

“[p]artially [c]redible.”

423 She concluded that the plaintiff was not disabled.424

On reconsideration, the plaintiff alleged that her condition changed, in that she could not 

concentrate, got easily distracted, and felt that people were judging her.425 On July 29, 2014, 

Brady Dalton, Psy. D. reviewed the plaintiff’s records and affirmed the initial determination that 

the plaintiff was not disabled.426 Because the plaintiff did not attend additional psychological visits 

as scheduled, Dr. Dalton did not have updated insights into the plaintiff’s mental capacity, which 

precluded an assessment of her claim of worsening symptoms on reconsideration.427 He found that 

Dr. Franklin’s December 13 opinion “reflect[ed] no significant cognitive impairments” despite Dr. 

Franklin’s findings of “marked impairments in all functional domains.”428 He found the plaintiff’s 

statements about her symptoms “[p]artially [c]redible.”429

2.2 Non-Medical Evidence

2.2.1 Function Report

The plaintiff completed a Function Report in conjunction with her application for disability 

benefits.

430 The plaintiff had difficulty concentrating for long periods, got distracted by her 

thoughts, felt that others were judging her (which made her “very anxious”), and was triggered 

when a “current event remind[ed] [her] of an unpleasant past event.”

431 Her depression, PTSD, 

and anxiety impacted her memory, ability to complete tasks, concentration, and ability to follow 

 

422 AR 137.

423 Id.

424 Id.

425 AR 145.

426 AR 148.

427 Id.

428 Id.

429 AR 149.

430 AR 312–20.

431 AR 312.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 42 of 68
ORDER – No. 18-cv-03562-LB 43

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

instructions because her thoughts wandered a lot.

432 She could pay attention for five to thirty 

minutes at a time.433 She followed written instructions “pretty well” but did not follow spoken 

instructions well because of her less-than-good short-term memory.434

The plaintiff took care of her personal needs, grooming, medications, meals, laundry, shopping 

and housecleaning.435 She did not cook and typically made sandwiches or microwave popcorn.

436

Her housemates complained that she did not contribute sufficiently to chores around the house.437

She did not have the “energy or desire” to complete housework or yardwork.438 She plaintiff went 

outside three to five times per week.439 She managed her own finances.

440 She read daily, but got 

distracted and needed to take breaks.

441 She spoke to friends on the phone three to five times per 

week and attended AA meetings and outpatient recovery groups about three times per week.442

She preferred to be alone and “rarely ha[d] the desire to spend time with others.”

443

Interactions with the police gave her anxiety but she otherwise got along “ok” with authority 

figures.444 She did not handle stress well.445 She used to deal with it by drinking alcohol, but after

she became sober, she would just “shut down” when stressed.446 The plaintiff required advance

 

432 AR 316.

433 Id.

434 Id.

435 AR 313–14.

436 AR 313. 

437 Id.

438 AR 314.

439 Id.

440 Id.

441 AR 315.

442 Id.

443 AR 315–16.

444 AR 317.

445 Id.

446 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 43 of 68
ORDER – No. 18-cv-03562-LB 44

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

notice of changes in routine, sometimes got anxious around men, talked to herself occasionally, 

and found herself staring into space a lot.447

The plaintiff lived in a sober environment, saw a therapist, was diagnosed with PTSD, chronic 

depression, and anxiety and took psychiatric medications.448 Her disorders and sobriety made it 

difficult for her to “function ‘normally’ on a day to day basis.”449 Both her “therapist and the 

county (from whom [she] received general assistance) deemed [her] unable to work for at least 

one year.”450

Her daily activities typically included showering, grooming herself, going to outpatient 

addiction groups when necessary, reading, occasionally going to AA meetings, and going to 

sleep.451 Before the alleged onset of her conditions, the plaintiff was able to “have a social life” 

and stay focused for “more than a few minutes at a time.”452 Her thoughts were always running 

and she struggled to tune them out and fall asleep.453

3. Administrative Hearings

3.1 Hearings Before to October 25, 2016

The plaintiff was found not disabled after two disability hearings, in decisions dated July 25, 

2011 and February 6, 2012. On January 7, 2017. Judge Alis found that the plaintiff’s 

circumstances changed such that the presumption of disability created by the prior ALJ denials 

was overcome but concluded that she was not disabled.

454

 

447 Id.

448 AR 318.

449 Id.

450 Id.

451 AR 319.

452 Id.

453 Id.

454 AR 19.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 44 of 68
ORDER – No. 18-cv-03562-LB 45

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

3.2 Administrative Hearing Held October 25, 2016

3.2.1 Pre-Hearing Memorandum

Before the October 25, 2016 hearing before the ALJ, the plaintiff’s counsel submitted a brief 

to the ALJ.455 He summarized the medical evidence and argued that the ALJ should find that she 

was disabled based on the five-step inquiry.

456

3.2.2 Administrative Hearing

At the hearing, the plaintiff’s attorney asked the ALJ to reopen the plaintiff’s prior claim for 

dysthymia based on new evidence regarding “depression, and anxiety, and post-traumatic stress 

disorder, which wasn’t claimed in the prior application.”

457 The ALJ determined that even though 

the plaintiff’s previous SSI claim was denied, she would “take into account everything that I see in 

your record, as well as all the testimony that I’ve heard today both from you and the [VE], and 

then I will make my own independent determination.”458

The plaintiff appeared and testified at the hearing.459 The plaintiff’s last job ended in October 

2014 after six months.460 She worked as an “educator” at a behavioral center for developmentally 

delayed adults and helped “two or three emotionally and mentally disabled adults” with skill 

development, grocery shopping, and “fun activities.”

461 As part of the job, she was required to fill 

out paperwork and was typically responsible for two clients at a time.462 The plaintiff was 

ultimately fired due to lateness, which the plaintiff testified was caused by her depression and 

“mental lapses,” and “not very good looking paperwork.”463 She was between five and 20 minutes 

 

455 AR 345.

456 AR 345–356.

457 AR 58, 61.

458 AR 101.

459 AR 58.

460 AR 67.

461 Id.

462 Id.

463 AR 68.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 45 of 68
ORDER – No. 18-cv-03562-LB 46

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

late “at least twice a week.”

464 The plaintiff rented a room at her father’s house.465 She had

difficulty focusing when she got ready for work in the morning, because she would be “putting on 

socks, or something simple, and then look at the clock and five minutes have passed, and I’m still 

with the one sock on, and I don’t know why. . . . I don’t know, I just lose time.”

466

The plaintiff drove herself to work and sometimes drove 90 or so minutes away to Watsonville 

to watch her friend’s dogs.467 She did this a couple of times per year.468 She fed, walked, and 

cleaned the dogs.469

When asked why she believed she was unable to work, the plaintiff said “[t]he main reason 

[was] the lapses.”

470 She described the lapses as follows: 

I just go somewhere else in my head. It was actually brought up to me by an employer 

some years ago. I was given a performance review, and she said, you know, you’re 

a great worker, and you’re friendly, but sometimes you’re working and you kind of 

slow down like your batteries are low, and you’ll stop, and then you’ll slowly start 

up and keep going.471

The plaintiff did this “all the time.”472 The plaintiff was unaware of when it happens, except 

when she notices that an activity took a particularly long time, or when the clock shows “five or 

ten minutes have passed.”473 She believed that her PTSD rendered her disabled.474 She got 

“triggered by things” and would feel fearful of “commonplace” activities like “driving and 

someone almost runs into [her].”475 That fear would then take her back the fear associated with the 

 

464 Id.

465 Id.

466 AR 69.

467 AR 70. 

468 AR 71.

469 Id.

470 AR 72.

471 Id.

472 Id.

473 Id.

474 Id.

475 AR 73.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 46 of 68
ORDER – No. 18-cv-03562-LB 47

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

rape she experienced in her twenties, the molestation she experienced as a child, or the abuse she 

endured from her mother.

476

The plaintiff saw therapists on and off since the 1980s.477 She attended therapy regularly 

starting in 2012 when she got sober.478 At the time of the hearing, she had been seeing Eugenia 

Arnold for about six weeks and a psychiatrist (Liz Collins) about “once every six weeks to two 

months.”479 She took Gabapentin for anxiety and Prestiq for depression, which made her feel 

“stabilized.”

480

The plaintiff volunteered at the AA central office in Oakland and participated in AA meetings 

in the women’s prison in Dublin.481 She volunteered at the office once a week for a few hours per 

day, answering the phones and talking to members when they came into the office.

482 She 

volunteered at the prison once a month, to offer “support from the outside world.”483

The plaintiff volunteered as the “back-up secretary” for AA meetings at Gladman Hospital, a 

psychiatric facility in Oakland.484 She worked from 12 p.m. to 2 p.m., but typically arrived at 

12:07 or 12:15 because she “just c[couldn’t] get it together.”485 She tried “to give [herself] two full 

hours to – you know, from the time I get up to the time I have to leave the house. Like I said, 

sometimes I lapse out, getting dressed, or it will take me a really long time to find something to 

 

476 Id.

477 Id.

478 Id.

479 AR 73–74.

480 AR 74.

481 AR 75.

482 Id.

483 AR 76.

484 AR 75.

485 AR 77.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 47 of 68
ORDER – No. 18-cv-03562-LB 48

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

wear. Not that I’m trying to look fantastic, or anything, just trying to make decisions, or something 

as simple as that, that takes a long time.”486 She drank “a lot of coffee.”487

The plaintiff did not like to go home between volunteering and going to her own AA meetings

because it took her “forever to get back out of the house,” so she “stay[ed] out and [found]

something to do, go to the library, or window shopping, or go to a coffee shop ad read a book, or 

something.”488 She could finish books and understand them, but sometimes had to re-read the 

same sentence or paragraph repeatedly to comprehend.

489

The plaintiff first started experiencing depression in her teens.490 She felt “[t]ired, low energy, 

low motivation, rather spaced out, feelings of worthlessness, not being good enough, insecurity 

issues, [and] self-esteem issues.”491 When asked what caused her depression, she cited being 

abused by her mother as a child, the two or three incidents of molestation she remembered 

experiencing as a seven or eight-year-old, and the rape she experienced in her early twenties.492

The plaintiff had trouble falling asleep.

493 In the weeks before the hearing, she fell asleep 

between 4:00 and 6:00 a.m.494 She did not ever have any energy.495 She felt worthless when she 

was around people, which led her to “spend as much time by [herself] as possible.”496 She tried to 

“keep the socializing to a minimum because there’s too many trigger possibilities.”497

 

486 AR 77.

487 AR 78.

488 Id.

489 AR 79, 81.

490 AR 80.

491 Id.

492 Id.

493 AR 82.

494 Id.

495 Id.

496 Id.

497 AR 83.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 48 of 68
ORDER – No. 18-cv-03562-LB 49

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

The plaintiff had not experienced thoughts of suicide lately.498 When she got anxious, her 

heartrate increased, she felt “real tense feelings like [she] need[ed] to flee,” and she tried to leave 

the place that triggered her as quickly as possible.499 The plaintiff said that “almost anything” can 

trigger her.500 “I heard a baby crying in Walgreen’s one time, and for some reason it popped into 

my head I wonder if I cried like that when I was a little kid, and that – I started to kind of panic, 

and just – I just in my head was I got to get out of here.”501 She had flashbacks to her childhood 

abuse and her rape as a young adult.502 She had difficulty concentrating while getting ready in the 

morning or reading.503 Her brain was “trying to go other places on [her].” The plaintiff was late to 

her volunteer shift at AA approximately fifty percent of the time and on her long drives to 

Watsonville, she did not need to pull over or take breaks.504

3.3 Vocational Expert (“VE”)

Thomas Linvill, a VE, testified at the hearing.505 Mr. Linvill identified the plaintiff’s past work 

positions according as follows: dog groomer (DOT code 418.674-010, medium work, SVP 4); 

sales clerk (DOT code 279.357-054, light work, SVP 3); barista or “counter attendant” (DOT code 

311.677-010, light work, SVP 2); and program aide (DOT code 195.227-010, light work, SVP 

6).506 The VE said that the plaintiff did not perform “program aide” work at the SVP 6 level 

because she worked as a behavioral specialist only for about five months and therefore “was on 

the way to developing skills at that level, but did not work long enough to develop skills for that 

 

498 AR 84.

499 Id.

500 Id.

501 AR 84–85.

502 AR 85.

503 Id.

504 AR 86.

505 AR 88.

506 AR 88, 90.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 49 of 68
ORDER – No. 18-cv-03562-LB 50

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

level.”507 Instead, he ranked her time as a behavioral specialist at SVP level 3 or 4, the “semiskilled range.”508

The ALJ asked the VE whether a person — who “can perform work across all exertional 

levels” but is limited to “performing simply, routine tasks, but not at a production-rate,” making 

only “simple work related decisions,” and working in “stable work environment” that involves 

only minimal changes in the “day-to-day work setting, and in the tools and/or work processes that 

are used to accomplish the work” — could perform the plaintiff’s past jobs.509 The VE did not 

believe that a person with these limitations could work as a dog groomer, a retail salesperson, a 

program aide, or a barista.510 A person with such limitations could work successfully in other 

positions, for example, as a kitchen helper (DOT code 318.687-010, medium work, SVP 2), a 

hand packager (DOT code 920.587-018, medium work, SVP 2), and a stapling-machine operator 

(DOT code 692.685-202, medium work, SVP 2).511 The VE reported that there were 190,000 

kitchen helper jobs, 450,000 packer jobs, and 40,000 stapling-machine operator jobs nationally.512

The ALJ asked a second hypothetical that was identical to the first except “this individual is 

limited to having frequent interactions with supervisors, coworkers, and the public, and those 

interactions with the public should be superficial in nature, and by that I’m talking about things 

like pleasantries, and greetings.”513 The VE offered the same DOT titles and did not adjust the 

numbers because of the change in the hypothetical.514 The VE said, “the DOT doesn’t clearly state 

the intensity of interaction with supervisors, and coworkers, and the public. . . that’s the secondary 

 

507 AR 88.

508 AR 89.

509 AR 90.

510 AR 91.

511 Id.

512 Id.

513 AR 92.

514 AR 93.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 50 of 68
ORDER – No. 18-cv-03562-LB 51

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

evaluation the vocational rehabilitation counselor needs to make when considering an 

occupational source.”515

The ALJ asked whether, with respect to either hypothetical, there were any jobs that an 

individual who required hourly reminders to complete tasks could perform.516 The VE responded 

that he believed this would likely be a “problem for sustaining employment” because it would lead 

the employer to question whether the individual could successfully do the work.517

She then asked whether an individual who arrives late to work “on a weekly basis two times a 

week up to five minutes late” could perform work.518 The VE testified that the DOT does not offer 

guidance on the issue of lateness.519 Based on his experience, he said that “missing five minutes of 

work a couple of times a week is not going to take away from work enough that a person couldn’t 

be effectively productive on-the-job. So I would say at that level that [it] is going to irritate the 

employer, but it’s not necessarily going to keep the person from working.”520 Assuming the 

individual was “suitably productive” throughout the rest of the day, she could perform the jobs 

that the VE listed for the first hypothetical.521 If the individual were twenty minutes late to work 

twice a week, the VE said, “I don’t think [missing 40 minutes of work per week] takes away 

enough time to keep productivity from happening” but the individual could be terminated if the 

employer counselled them to be punctual and they consistently failed to do so.522 When pressed on 

this point by the plaintiff’s attorney, the VE said that a person who is consistently late would be 

 

515 Id.

516 Id.

517 AR 94.

518 Id.

519 Id.

520 Id.

521 Id.

522 AR 95.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 51 of 68
ORDER – No. 18-cv-03562-LB 52

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

“jeopardizing their employment” but being consistently late would not necessarily “preclude the 

employment.”523 He said that there is generally “some flexibility in terms of lateness.”524

The plaintiff’s attorney objected to Mr. Linvill’s testimony regarding lateness as being 

contrary to what any other VE would say.525 The ALJ overruled this objection.526

The VE noted that an individual that was off task for thirty percent of the day “is not going to 

meet minimum productivity requirements, and certainly is not going to be continued in the job.”527

The VE said that the DOT did “not make any statements about being off task” specifically.528

The plaintiff’s attorney asked whether someone who missed four days a month was still 

employable.529 The VE again noted that the DOT does not provide guidance on this point but said 

that from his experience, “allowable absence is at maximum about a day a month.”530 Someone 

who was absent four times a month would “certainly” be terminated.531

When asked whether someone who cannot maintain concentration for two-hour segments 

could sustain employment, the VE responded, “that’s a problem that’s going to impact 

productivity. . . [and] cause difficulty for that employee.”532 This would certainly put the employee 

in jeopardy of losing his or her job.533

 

523 AR 97.

524 AR 99.

525 Id.

526 AR 100.

527 AR 96.

528 Id.

529 Id.

530 AR 97.

531 Id.

532 AR 100.

533 AR 101.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 52 of 68
ORDER – No. 18-cv-03562-LB 53

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

3.4 The ALJ Decision

On January 5, 2017, the ALJ issued an unfavorable ruling.534 The prior decision by Judge 

Sleater “create[d] an ongoing presumption that the claimant was able to work beyond the date of 

that decision . . . .”535 “After careful consideration of all the evidence,” the ALJ found that the 

plaintiff “made a showing of ‘changed circumstances’ rebutting the presumption of continued nondisability following the prior decision.”536 The ALJ followed the five-step sequential-evaluation 

process to determine whether the plaintiff was disabled and concluded that she was not.

537

At step one, the ALJ found that the plaintiff engaged in substantial gainful activity when she 

worked at the Harambee Kinship Center from May 2014 to October 2014.538 During that period, 

she made roughly $1,488.89 per month, which was well over the $1,070 need to show substantial 

gainful employment.539 There was less than 12 months between the alleged onset date, which was 

amended to the date of her filing (August 14, 2013) and the start of her employment at the Kinship 

Center, precluding a finding of disability before November 1, 2014.540 After November 1, 2014, 

there was a continuous twelve-month period when the plaintiff did not engage in substantial 

gainful activity, meaning that the plaintiff’s application was not completely precluded at step 

one.541

At step two, the ALJ found that the plaintiff had severe impairments that significantly limited 

her ability to perform basic work activities: “a depressive disorder, a posttraumatic stress disorder, 

and an anxiety disorder (20 CFR 416.920(c)).”542

 

534 AR 15–29.

535 AR 19.

536 Id.

537 Id.

538 AR 20–21.

539 AR 21.

540 Id.

541 Id.

542 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 53 of 68
ORDER – No. 18-cv-03562-LB 54

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

At step three, the ALJ found that the plaintiff “[did] not have an impairment or combination of 

impairments that meets or medically equals the severity of one of the listed impairments”: 12.04 

(affective disorders) or 12.06 (anxiety related disorders).543 To make this finding, the ALJ 

considered whether the “paragraph B” criteria were satisfied.544 To satisfy this criteria, a plaintiff 

would have to show that her mental impairments result in two or more of the following: “marked 

restriction of the activities of daily living; marked difficulties in maintaining social functioning; 

marked difficulties in maintaining concentration, persistence, or pace; or repeated episodes of 

decompensation, each of extended duration.”545 Based on the record and hearing, the ALJ found 

that the plaintiff had no restriction in the activities of daily living because she lived independently, 

did chores around the house, and could walk, drive, shop, read, interact with friends, and attend 

AA meetings and medical appointments.546 The ALJ found that the plaintiff had moderate 

difficulties with social functioning and concentration, persistence, and pace because she was able 

to interact with others and reads and can comprehend what she reads.547 The plaintiff did not 

experience any episodes of decompensation of an extended duration.548

The ALJ determined that the plaintiff had the residual-functional capacity to perform a “full 

range of work at all exertional levels but with the following nonexertional limitations: the claimant 

was limited to simple, repetitive tasks with simple work-related decisions in a stable work 

environment, meaning few changes, if any, in the day-to-day work setting.”549 She could have

only “superficial” frequent interactions with customers, co-workers, and supervisors and “could 

not perform work at a production rate.”550

 

543 Id.

544 Id.

545 Id.

546 AR 22.

547 Id.

548 Id.

549 Id.

550 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 54 of 68
ORDER – No. 18-cv-03562-LB 55

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

To make this determination, the ALJ considered the plaintiff’s symptoms, finding that “[the 

plaintiff’s] medically determinable impairments reasonably could be expected to cause the alleged 

symptoms; however, the claimant’s statements concerning the intensity, persistence, and limiting 

effects of these symptoms are not entirely consistent with the medical evidence and other evidence 

in the record.”551

The ALJ determined that the opinion of Martha Hunt, LMFT, had “no probative value” 

because it was written “long before the amended alleged onset date.”552 The ALJ assigned little 

weight to Dr. Franklin’s December 2013 report because after the report issued, the plaintiff was 

able to obtain a SGA-level job, undercutting the opinion that she had marked or extreme 

symptoms.553 The ALJ assigned no weight to her July 14, 2014 opinion because “it [was] 

contradicted by the claimant’s ability to work at the SGA level.”554 The ALJ assigned little weight 

to Dr. Franklin’s September 29, 2016 opinion because it was “internally inconsistent and 

inconsistent with treatment records.”555 For instance, Dr. Franklin found that the plaintiff would 

have marked to extreme difficulties following even simple instructions and maintain her focus, 

even though the plaintiff performed well on the administered tests and was able to maintain 

concentration and answer questions with good recall and memory throughout the testing.556

The evidence from Pathways to Wellness suggested that the plaintiff was no more than 

“moderately limited” by her conditions.557 The ALJ took these limitations into account, noting, for

example the plaintiff’s “ability to handle only simple tasks,” her inability to withstand “tight 

 

551 AR 23.

552 AR 24.

553 Id.

554 AR 25.

555 AR 26.

556 Id.

557 AR 25.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 55 of 68
ORDER – No. 18-cv-03562-LB 56

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

production-rate work assignments,” her inability to handle more than “limited changes in the work 

setting,” and her inability to handle more than mere superficial interactions with others.558

The ALJ found the opinion of therapist Cheryl Crenshaw inconsistent with the medical record 

because she opined that the plaintiff had marked symptoms even though the plaintiff’s primary 

treating source at Pathways to Wellness reported GAF scores that indicated only moderate 

symptoms.559 The ALJ accorded Eugenie Arnold’s opinion little weight for the same reason.

560

Overall, the ALJ assigned the greatest evidentiary value to the treatment records.561 In addition 

to evaluating the records, the ALJ noted that the plaintiff’s ability to engage in “regularly daily 

activities and social interactions” informed the decision.562

At step four, the ALJ found that the plaintiff was unable to perform any past relevant work 

because those positions exceeded the residual functional capacity assessed for the plaintiff.563 The 

VE’s testimony informed this decision.564

At step five, the ALJ took into account the plaintiff’s age (she filed her application at age 43, 

rendering her a “younger individual”), education (she had at least a high-school education), work 

experience, and residual-functional capacity and determined that “there [were] jobs that exist in 

significant numbers in the national economy that the claimant [could] perform.”565

STANDARD OF REVIEW

Under 42 U.S.C. § 405(g), district courts have jurisdiction to review any final decision of the 

Commissioner if the claimant initiates a suit within sixty days of the decision. A court may set 

aside the Commissioner’s denial of benefits only if the ALJ’s “findings are based on legal error or 

 

558 Id.

559 AR 26. 

560 Id.

561 Id.

562 AR 27.

563 Id.

564 Id.

565 AR 27–28.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 56 of 68
ORDER – No. 18-cv-03562-LB 57

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

are not supported by substantial evidence in the record as a whole.” Vasquez v. Astrue, 572 F.3d 

586, 591 (9th Cir. 2009) (internal citation and quotation marks omitted); 42 U.S.C. § 405(g). 

“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.” 

Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir. 1995). The reviewing court should uphold “such 

inferences and conclusions as the [Commissioner] may reasonably draw from the evidence.” Mark 

v. Celebrezze, 348 F.2d 289, 293 (9th Cir. 1965). If the evidence in the administrative record 

supports the ALJ’s decision and a different outcome, the court must defer to the ALJ’s decision 

and may not substitute its own decision. Tackett v. Apfel, 180 F.3d 1094, 1097–98 (9th Cir. 1999). 

“Finally, [a court] may not reverse an ALJ’s decision on account of an error that is harmless.” 

Molina v. Astrue, 674 F.3d 1104, 1111 (9th Cir. 2012).

GOVERNING LAW

A claimant is considered disabled if (1) he or she suffers from a “medically determinable 

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

be expected to last for a continuous period of not less than twelve months,” and (2) the 

“impairment or impairments are of such severity that. . . she is not only unable to do [her] previous 

work but cannot, considering [her] age, education, and work experience, engage in any other kind

of substantial gainful work which exists in the national economy. . . .” 42 U.S.C. § 1382c(a)(3)(A) 

& (B). The five-step analysis for determining whether a claimant is disabled within the meaning of 

the Social Security Act is as follows. Tackett, 180 F.3d at 1099 (citing 20 C.F.R. § 404.1520).

Step One. Is the claimant presently working in a substantially gainful activity? If 

so, then the claimant is “not disabled” and is not entitled to benefits. If the claimant 

is not working in a substantially gainful activity, then the claimant’s case cannot be 

resolved at step one, and the evaluation proceeds to step two. See 20 C.F.R. 

§ 404.1520(a)(4)(i). 

Step Two. Is the claimant’s impairment (or combination of impairments) severe? If 

not, the claimant is not disabled. If so, the evaluation proceeds to step three. See 20 

C.F.R. § 404.1520(a)(4)(ii).

Step Three. Does the impairment “meet or equal” one of a list of specified 

impairments described in the regulations? If so, the claimant is disabled and is 

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 57 of 68
ORDER – No. 18-cv-03562-LB 58

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

entitled to benefits. If the claimant’s impairment does not meet or equal one of the 

impairments listed in the regulations, then the case cannot be resolved at step three, 

and the evaluation proceeds to step four. See 20 C.F.R. § 404.1520(a)(4)(iii).

Step Four. Considering the claimant’s RFC, is the claimant able to do any work 

that he or she has done in the past? If so, then the claimant is not disabled and is not 

entitled to benefits. If the claimant cannot do any work he or she did in the past, 

then the case cannot be resolved at step four, and the case proceeds to the fifth and 

final step. See 20 C.F.R. § 404.1520(a)(4)(iv).

Step Five. Considering the claimant’s RFC, age, education, and work experience, 

is the claimant able to “make an adjustment to other work?” If not, then the 

claimant is disabled and entitled to benefits. See 20 C.F.R. § 404.1520(a)(4)(v). If 

the claimant is able to do other work, the Commissioner must establish that there 

are a significant number of jobs in the national economy that the claimant can do. 

There are two ways for the Commissioner to show other jobs in significant 

numbers in the national economy: (1) by the testimony of a vocational expert or 

(2) by reference to the Medical-Vocational Guidelines at 20 C.F.R., part 404, 

subpart P, app. 2.

For steps one through four, the burden of proof is on the claimant. At step five, the burden 

shifts to the Commissioner. Gonzales v. Sec’y of Health & Human Servs., 784 F.2d 1417, 1419 

(9th Cir. 1986).

ANALYSIS

The plaintiff contends that the ALJ erred by (1) incorrectly evaluating the medical-opinion 

evidence, (2) failing to properly consider the plaintiff’s dissociative and personality disorders at 

step two, (3) not basing her step three findings on substantial evidence, (4) failing to credit the 

plaintiff’s testimony, (5) not basing the RFC on substantial evidence, and (6) not basing the step 

five employability finding on substantial evidence. The plaintiff seeks remand for payment of 

benefits or, in the alternative, for further proceedings. 

The court grants the plaintiff’s motion for summary judgment, denies the Commissioner’s 

cross-motion for summary judgment, and remands for further proceedings.

1. Whether the ALJ Erred by Incorrectly Evaluating Medical-Opinion Evidence

The ALJ is responsible for “‘resolving conflicts in medical testimony, and for resolving 

ambiguities.’” Garrison v. Colvin, 759 F.3d 995, 1010 (9th Cir. 2014) (quoting Andrews v. 

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 58 of 68
ORDER – No. 18-cv-03562-LB 59

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

Shalala, 53 F.3d 1035, 1039 (9th Cir. 1995)).566 In weighing and evaluating the evidence, the ALJ 

must consider the entire case record, including each medical opinion in the record, together with 

the rest of the relevant evidence. 20 C.F.R. § 416.927(b); see Orn v. Astrue, 495 F.3d 625, 630 

(9th Cir. 2007) (“[A] reviewing court must consider the entire record as a whole and may not 

affirm simply by isolating a specific quantum of supporting evidence.”) (internal punctuation and 

citation omitted).

“In conjunction with the relevant regulations, [the Ninth Circuit has] developed standards that 

guide [the] analysis of an ALJ’s weighing of medical evidence.” Ryan v. Comm’r of Soc. Sec., 528 

F.3d 1194, 1198 (9th Cir. 2008) (citing 20 C.F.R. §404.1527). Social Security regulations 

distinguish between three types of accepted medical-sources: (1) treating physicians; (2) 

examining physicians; and (3) non–examining physicians. 20 C.F.R. § 416.927(c), (e); Lester v. 

Chater, 81 F.3d 821, 830 (9th Cir. 1995). “Generally, a treating physician’s opinion carries more 

weight than an examining physician’s, and an examining physician’s opinion carries more weight 

than a reviewing [non-examining] physician’s.” Holohan v. Massanari, 246 F.3d 1195, 1202 (9th 

Cir. 2001) (citing Lester, 81 F.3d at 830); accord Smolen v. Chater, 80 F.3d 1273, 1285 (9th Cir. 

1996).

“To reject [the] uncontradicted opinion of a treating or examining doctor, an ALJ must state 

clear and convincing reasons that are supported by substantial evidence.” Ryan, 528 F.3d at 1198

(alteration in original) (internal quotation marks and citation omitted). By contrast, if the ALJ 

finds that the opinion of a treating physician is contradicted, a reviewing court will require only 

that the ALJ provide “specific and legitimate reasons supported by substantial evidence in the 

record.” Reddick v. Chater, 157 F.3d 715, 725 (9th Cir. 1998) (internal quotation marks and 

citation omitted); see also Garrison, 759 F.3d at 1012 (“If a treating or examining doctor’s 

opinion is contradicted by another doctor’s opinion, an ALJ may only reject it by providing 

 

566 The Social Security Administration promulgated new regulations, including a new § 404.1521, 

effective March 27, 2017. The previous version, effective to March 26, 2017, applies based on the date 

of the ALJ’s hearing, November 16, 2016.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 59 of 68
ORDER – No. 18-cv-03562-LB 60

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

specific and legitimate reasons that are supported by substantial evidence.”) (internal quotation

marks and citation omitted).

In addition to the medical opinions of the “acceptable medical sources” outlined above, the 

ALJ must consider the opinions of other “medical sources who are not acceptable medical sources 

and [the testimony] from nonmedical sources.” 20 C.F.R. § 414.1513(a). The ALJ is required to 

consider observations by “other sources” as to how an impairment affects a claimant’s ability to 

work, id.; nonetheless, an “ALJ may discount the testimony” or an opinion “from these other 

sources if the ALJ gives . . . germane [reasons] for doing so.” Molina, 674 F.3d at 1111 (internal 

quotations and citations omitted). An opinion from “a medical source who is not an acceptable 

medical source may outweigh the medical opinion of an acceptable medical source.” 20 C.F.R. § 

404.1527(f)(1). “For example, it may be appropriate to give more weight to the opinion of a 

medical source who is not an acceptable medical source if he or she has seen the individual most 

often than the treating source, has provided better supporting evidence and a better explanation for 

the opinion, and the opinion is more consistent with the evidence as a whole.” Id.

The plaintiff argues that the ALJ incorrectly weighed the medical-opinion evidence. The court 

agrees, and grants the plaintiff’s motion.

1.1 The State Agency Psychological Consultants

The plaintiff argues that the ALJ erred by failing to “mention or weigh” the opinions of the 

state agency psychological consultants.

567 The court agrees.

The ALJ did not mention the DDEs or the medical opinions of the non-examining state-agency 

psychiatrists at all in the opinion.568 “An ALJ is required to consider as opinion evidence the 

findings of the state agency medical consultants; the ALJ is also required to explain in his decision 

the weight given to such opinions.” Sawyer v. Astrue, 303 Fed. Appx. 453, 454 (9th Cir. 2008) 

(citing 20 C.F.R. § 416.927(f)(2)(i)). An ALJ “may not ignore” the opinions of state agency 

 

567 Mot. – ECF No. 28 at 9. 

568 See AR 19–29 .

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 60 of 68
ORDER – No. 18-cv-03562-LB 61

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

medical consultants “and must explain the weight given to the opinions in their decisions.” SSR 

96–6p (1996), 1996 WL 374180, at *2 (S.S.A. 1996).

Here, the court remands for the ALJ to consider the opinions of the state-agency psychologists.

1.2 Lesleigh Franklin, Ph.D.

The plaintiff argues that the ALJ rejected the opinions of Dr. Franklin without providing 

“specific or legitimate reasons” for doing so.569 Dr. Franklin conducted full evaluations of the 

plaintiff twice, once on December 13, 2013 and again on September 29, 2016.570 Dr. Franklin also 

wrote an opinion on July 14, 2014.571

The ALJ gave “little weight” to Dr. Franklin’s first assessment that the plaintiff’s mentalhealth symptoms “could interfere markedly with appropriate work functioning” because “the 

claimant was able to recover sufficiently within a few months and obtain a regular SGA-level 

job.”572 The ALJ said the following about Dr. Franklin’s second opinion:

[Dr. Franklin] opined that the claimant would likely miss more than four days of 

work per month due to her symptoms, she would have marked difficulty with

attendance and completing a normal workday, and she would have extreme difficulty 

dealing with normal work stress. She also would have marked difficulties setting 

realistic goals. Apparently, unknown to Dr. Franklin, the claimant was then working 

at the SGA level, demonstrating that the claimant’s work limitations were not as 

extreme as Dr. Franklin predicted. This opinion is assigned no weight because it is 

contradicted by the claimant’s ability to work at the SGA level, is based on an 

evaluation that was then six months old, and is from the period prior to November 

2014, when the claimant stopped work at the SGA level.573

Finally, in her September 29, 2016 opinion, Dr. Franklin found that the plaintiff would have

marked to extreme difficulties in work-related areas such as carrying out simple instructions, 

completing a normal workday, and maintaining regular attendance.574 The ALJ assigned this 

 

569 Mot. – ECF No. 28 at 10.

570 AR 24–25.

571 AR 25.

572 AR 24.

573 AR 25.

574 AR 26.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 61 of 68
ORDER – No. 18-cv-03562-LB 62

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

opinion little weight because it was “internally inconsistent and inconsistent with treatment 

records.”575 The ALJ explained: “[i]t is unclear on what basis these conclusions could be drawn; 

the claimant was able to maintain attention and concentration for the interview, answer all 

questions with good recall and memory, and performed well on testing. Her treating sources 

indicated improvement with medications and did not describe marked symptoms.”

576

That the plaintiff participated in SGA-level employment during her alleged disability period

can be “a clear and convincing and legitimate reason to discount the opinions of [an examining 

doctor] that the severity of [the p]laintiff’s mental impairments prevented her from working.” 

Colbert v. Berryhill, No. EDVC 16–2613–KS, 2018 WL 1187549, at *10 (C.D. Cal. Mar. 7, 

2018). But, here, the ALJ ignores the fact that the plaintiff was fired from her SGA-level job due 

to some of the limitations that Dr. Franklin described (namely, tardiness and attendance issues and 

an inability to properly complete paperwork).577 This undermines the ALJ’s rationale for 

discounting Dr. Franklin’s first two opinions. The court finds that the ALJ’s reliance on the 

plaintiff’s ability to hold an SGA-level job for some measure of time was not a clear and 

convincing reason for rejecting Dr. Franklin’s opinions.

As for Dr. Franklin’s September 29, 2016 opinion, “[m]erely stating that a treating physician’s 

opinions are not supported by objective findings is insufficient.” Morganti v. Colvin, No. C 12–

03511 CRB, 2013 WL 1758784 at *6 (N.D. Cal. Apr. 24, 2013) (citing Embrey v. Bowen, 849 

F.2d 418, 421 (9th Cir. 1988) (“To say that medical opinions are not supported by sufficient 

objective findings. . . does not achieve the level of specificity our prior cases have required.”). To 

disregard a treating physician’s opinion, the ALJ must provide “a thorough summary of the facts, 

his interpretations thereof, and his findings.” Id. (emphasis in original). The ALJ did not provide 

the requisite specificity here.

 

575 AR 26.

576 Id.

577 AR 68.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 62 of 68
ORDER – No. 18-cv-03562-LB 63

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

Additionally, that the plaintiff maintained attention, performed well on testing, and showed

improvement are not clear and convincing reasons to discount Dr. Franklin’s testimony The Ninth 

Circuit has emphasized that “while discussing mental health issues, it is error to reject a claimant’s 

testimony merely because symptoms wax and wane in the course of treatment.” Id. Incidents of 

improvement must be “interpreted with an awareness that improved functioning while being 

treated and while limiting environmental stressors does not always mean that a claimant can 

function effectively in a workplace.” Id. (citation omitted). “Caution in making such an inference 

is especially appropriate when no doctor or other medical expert has opined. . . that a mental 

health patient is capable of working or is prepared to return to work.” Id. at 1017–18.

The ALJ erred by failing to properly weigh Dr. Franklin’s opinions about the limitations posed 

by the plaintiff’s mental illnesses.

1.3 Martha Helms, LMFT

The plaintiff contends that the ALJ erred by failing to consider or discuss Martha Helms’s 

opinion, completed on January 17, 2013, indicating that the plaintiff’s mental impairments 

precluded employment for at least one year, and that the plaintiff had multiple moderate to marked 

functional limitations.

578 Because Ms. Helms qualifies as an “other medical source,” the ALJ was 

required to give “germane” reasons for discounting her opinion. Molina, 674 F.3d at 1111 

(internal quotations and citations omitted).

The ALJ gave no weight to Ms. Helms’s opinion because it was generated “long before the 

amended alleged onset date” and so it “had no probative value.”579 Treatment records that predate 

the alleged onset date “are not probative evidence of [the] plaintiff’s functional impairments at the 

time [the plaintiff] allegedly became disabled.” Thomas v. Colvin, No. 2:14-cv-1878-EFB, 2016 

WL 1267935, at *3 (E.D. Cal. Mar. 30, 2016) (citing Carmickle v. Comm’r Soc. Sec. Admin., 533 

F.3d 1155, 1164-65 (9th Cir. 2008) and Burkhart v. Bowen, 856 F.2d 1335, 1340 n.1 (9th Cir. 

1988)). This was a germane reason to discount this pre-onset-date opinion.

 

578 Mot. – ECF No. 28 at 12.

579 AR 24.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 63 of 68
ORDER – No. 18-cv-03562-LB 64

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

2. Whether the ALJ Erred by Failing to Consider Whether or Not the Plaintiff’s 

Personality Disorder and Dissociative Disorder Were Severe Impairments at Step Two

The plaintiff argues that the ALJ erred by failing to mention or assess her personality disorder 

and dissociative disorder diagnoses.580 The court agrees.

At step two of the five-step sequential inquiry, the ALJ determines whether the claimant has a 

medically severe impairment or combination of impairments. Smolen v. Chater, 80 F.3d 1273, 

1290 (9th Cir. 1996). The ALJ must consider the record as a whole, including evidence that both 

supports and detracts from its final decision. Reddick v. Chater, 157 F.3d 715, 720 (9th Cir. 1998). 

An impairment is not severe if it does not significantly limit the claimant’s mental or physical 

abilities to do basic work activities. 20 C.F.R. § 404.1521(a). Basic work activities are “abilities 

and aptitudes necessary to do most jobs,” including, for example, “walking, standing, sitting, 

lifting, pushing, pulling, reaching, carrying, or handling.” 20 C.F.R. § 404.1521(b). To determine 

the severity of a mental impairment specifically, the ALJ must consider four broad functional 

areas: (1) activities of daily living; (2) social functioning; (3) concentration, persistence, and pace; 

and (4) episodes of decompensation. 20 C.F.R. § 404.1520a.

“[T]he step two inquiry is a de minimis screening device to dispose of groundless claims.” 

Smolen, 80 F.3d at 1290 (citing Bowen v. Yuckert, 482 U.S. 137 at 153–54 (1987)). Thus, “[a]n 

impairment or combination of impairments can be found ‘not severe’ only if the evidence 

establishes a slight abnormality that has no more than a minimal effect on an individual[‘]s ability 

to work.” Id. (internal quotation marks omitted) (citing SSR 85–28; Yuckert v. Bowen, 841 F.2d 

303, 306 (9th Cir.1988)). 

Here, the ALJ did not mention either the plaintiff’s dissociative or personality disorders at step 

two.581 In Lockwood v. Colvin, the plaintiff was diagnosed with “anxiety disorder, personality 

disorder, borderline traits, manic depression, acute stress disorder, and dissociative disorder.” No. 

12–cv–00496–NJV, 2013 WL 1964923, at *7 (N.D. Cal. May 10, 2013). The ALJ “referenced 

various diagnoses of anxiety disorder, borderline traits, panic attacks and dissociative disorder,” 

 

580 Mot. – ECF No. 28 at 13.

581 See AR 19–29.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 64 of 68
ORDER – No. 18-cv-03562-LB 65

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

but “did not evaluate whether they were severe.” Id. The court held that “to the extent the ALJ’s 

failure to address these impairments can be interpreted as a conclusion that these impairments are 

not severe, the ALJ failed to . . . explain why the conditions were not severe.” Id.

Similarly here, the ALJ was not required to find that the diagnoses were in fact severe 

impairments, but his failure to discuss them at all is reversible error.

3. Whether the ALJ Erred by Finding that the Plaintiff’s Impairments Did Not Meet or 

Equal a Listing at Step Three

At step three of the five-step framework, “[i]f a claimant has an impairment or combination of 

impairments that meets or equals a condition outlined in the “Listing of Impairments,” then the 

claimant is presumed disabled.” Lewis, 236 F.3d at 512 (citing 20 C.F.R. § 404.1520(d)). “An ALJ 

must evaluate the relevant evidence before concluding that a claimant’s impairments do not meet 

or equal a listed impairment. A boilerplate finding is insufficient to support a conclusion that a 

claimant’s impairment does not do so.” Id. (citing Marcia v. Sullivan, 900 F.2d 172, 176 (9th Cir. 

1990)). “Medical equivalence will be found ‘if the medical findings are at least equal in severity 

and duration to the listed findings.’” Marcia, 900 F.2d at 175–76 (quoting 20 C.F.R. § 404.1526). 

Accordingly, at step three, “the ALJ must explain adequately his evaluation of the alternative tests 

and the combined effects of the impairments” to determine whether a claimant equals a Listing. Id.

at 176.

Because the court finds that the ALJ erred by weighing the medical-opinion evidence, 

including opinion evidence that supported one or more listings, the court remands for 

reconsideration of this issue as well.

4. Whether the ALJ Erred by Improperly Rejecting the Plaintiff’s Testimony

The plaintiff argues that the ALJ used “boilerplate” language and failed to identify which parts 

of the plaintiff’s testimony, if any, were inconsistent with the medical record or otherwise not 

credible.582 The court agrees.

 

582 Mot. – ECF No. 28 at 15.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 65 of 68
ORDER – No. 18-cv-03562-LB 66

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

In assessing a claimant’s credibility, an ALJ must make two determinations. Molina, 674 F.3d 

at 1112. “First, the ALJ must determine whether [the claimant has presented] ‘objective medical 

evidence of an underlying impairment which could reasonably be expected to produce the pain or 

other symptoms alleged.’” Id. (quoting Vasquez, 572 F.3d at 591). Second, if the claimant 

produces that evidence, and “there is no evidence of malingering,” the ALJ must provide 

“specific, clear and convincing reasons for” rejecting the claimant’s testimony regarding the 

severity of the claimant’s symptoms. Id. (internal quotation marks and citations omitted). 

“At the same time, the ALJ is not ‘required to believe every allegation of disabling pain, or 

else disability benefits would be available for the asking, a result plainly contrary to 42 U.S.C. § 

423(d)(5)(A).’” Id. at 1112 (quoting Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989)). “Factors 

that an ALJ may consider in weighing a claimant’s credibility include reputation for truthfulness, 

inconsistencies in testimony or between testimony and conduct, daily activities, and unexplained, 

or inadequately explained, failure to seek treatment or follow a prescribed course of treatment.” 

Orn, 495 F.3d at 636 (internal punctuation omitted). “[T]he ALJ must identify what testimony is 

not credible and what evidence undermines the claimant’s complaints.” Burrell v. Colvin, 775 

F.3d 1133, 1138 (9th Cir. 2014); see, e.g., Morris v. Colvin, No. 16-CV-0674-JSC, 2016 WL 

7369300, at *12 (N.D. Cal. Dec. 20, 2016). 

The ALJ found the following about the plaintiff’s testimony:

After careful consideration of the evidence, I find that the claimant’s medically 

determinable impairments reasonably could be expected to cause the alleged 

symptoms; however, the claimant’s statements concerning the intensity, persistence 

and limiting effects of these symptoms are not entirely consistent with the medical 

evidence and other evidence in the record for the reasons explained in this 

decision.583

The ALJ satisfied the first step of the two-step inquiry when he determined that the plaintiff’s 

medically determinable impairments “reasonably could be expected to cause some of the 

symptoms alleged.”584 See Molina, 674 F.3d at 1112. But the ALJ did not provide any evidence or 

 

583 AR 23.

584 Id.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 66 of 68
ORDER – No. 18-cv-03562-LB 67

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

find that the plaintiff was a malingerer. Indeed, her testimony is consistent with the medicalopinion evidence in the record. Accordingly, the ALJ needed to provide “specific, clear, and 

convincing reasons” for rejecting the plaintiff’s testimony regarding the severity of her symptoms. 

Id. (internal quotation marks and citations omitted). 

Because the ALJ discredited the plaintiff’s testimony in part on his assessment of the medicalopinion evidence, including Dr. Franklin’s medical opinion, the court remands on this ground too. 

The ALJ can reassess the plaintiff’s credibility in context of the entire record.

5. The ALJ’s Findings at Steps Four and Five

The plaintiff argues that the ALJ’s findings at steps four and five were not supported by 

substantial evidence.585 The ALJ found that the plaintiff had the following RFC:

After taking into consideration all of the factors, I conclude that she should be able 

to sustain the demands of regular competitive work that is simple and repetitive, with 

simple work-related decisions and not requiring fast-paced production work. To 

address her anxiety, she should be limited to work with few changes. Finally, to 

address her concerns about interactions with others, she should be limited to 

superficial interactions, although she is able to handle more intensive interactions at 

least once a week through AA.586

At step five, the ALJ determined that “considering the [plaintiff’s] age, education, work

experience, and residual functional capacity, there [were] jobs that exist[ed] in significant numbers 

in the national economy that the plaintiff [could] perform.”587

Because the court remands for a reweighing of medical-opinion evidence and the plaintiff’s 

testimony, and because the past-relevant-work and RFC determinations are based on those 

assessments, the court remands on this ground.

 

585 Mot. – ECF No. 28 at 15–17.

586 AR 27.

587 AR 28.

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 67 of 68
ORDER – No. 18-cv-03562-LB 68

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

Northern District of California

6. Whether the Court Should Remand for Further Proceedings or for Determination of 

Benefits

The court has “discretion to remand a case either for additional evidence and findings or for an 

award of benefits.” McCartey v. Massanari, 298 F.3d 1072, 1076 (9th Cir. 2002) (citing Smolen, 

80 F.3d at 1292); McAllister v. Sullivan, 888 F.2d 599, 603 (9th Cir. 1989) (“The decision whether 

to remand for further proceedings or simply to award benefits is within the discretion of [the]

court.”) (citing Winans v. Bowen, 853 F.2d 643, 647 (9th Cir. 1987)). Generally, “‘[i]f additional 

proceedings can remedy defects in the original administrative proceeding, a social security case 

should be remanded.’” Garrison, 759 F.3d at 1019 (quoting Lewin v. Schweiker, 654 F.2d 631, 

635 (9th Cir. 1981)) (alteration in original); see also Dominguez v. Colvin, 808 F.3d 403, 407 (9th 

Cir. 2015) (“Unless the district court concludes that further administrative proceedings would 

serve no useful purpose, it may not remand with a direction to provide benefits.”); McCartey, 298 

F.3d at 1076 (remand for award of benefits is discretionary); McAllister, 888 F.2d at 603 (remand 

for award of benefits is discretionary); Connett, 340 F.3d at 876 (finding that a reviewing court 

has “some flexibility” in deciding whether to remand).

For the reasons described above, the court finds that remand is appropriate so as to “remedy 

defects in the original administrative proceeding.” Garrison, 759 F.3d at 1019 (quoting Lewin v. 

Schweiker, 654 F.2d at 635 (alteration in original)).

CONCLUSION

The court grants the plaintiff’s motion, denies the Commissioner’s cross-motion, and remands 

for further proceedings consistent with this order.

IT IS SO ORDERED.

Dated: August 2, 2019

______________________________________

LAUREL BEELER

United States Magistrate Judge

Case 3:18-cv-03562-LB Document 33 Filed 08/02/19 Page 68 of 68