Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_12-cv-02781/USCOURTS-casd-3_12-cv-02781-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:206 Social Security Benefits

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UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF CALIFORNIA

TERRY ANN NASH,

Plaintiff,

v.

CAROLYN W. COLVIN, Acting

Commissioner of Social

Security,

Defendant. 

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Civil No. 12cv2781 GPC(RBB)

REPORT AND RECOMMENDATION

GRANTING PLAINTIFF'S MOTION

FOR SUMMARY JUDGMENT [ECF NO.

11] AND DENYING DEFENDANT'S

CROSS-MOTION FOR SUMMARY

JUDGMENT [ECF NO. 13]

On November 16, 2012, Plaintiff Terry Ann Nash filed a civil

Complaint against Defendant Commissioner of Social Security,

Michael J. Astrue, challenging Defendant's denial of Plaintiff's

claim for disability insurance benefits [ECF. No. 1]. Defendant

filed an Answer and the Administrative Record on January 18, 2013

[ECF. Nos. 7, 9].

On March 25, 2013, Nash filed a Motion for Summary Judgment

[ECF No. 11]. Commissioner's Cross-Motion for Summary Judgment was

filed on April 19, 2013 [ECF No. 13]. The Defendant's Motion

indicates that Carolyn W. Colvin has replaced Astrue as the Acting

Commissioner of Social Security. Colvin is therefore substituted

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for her predecessor pursuant to Federal Rule of Civil Procedure

25(d). Both Plaintiff and Defendant filed Replies [ECF Nos. 14,

15]. 

The Court has taken the motions under submission without oral

argument [ECF No. 16]. For the following reasons, the Court

recommends that Plaintiff's Motion for Summary Judgment be GRANTED,

Defendant's Cross-Motion for Summary Judgment be DENIED, and the

case be REMANDED for an award of benefits. 

I. PROCEDURAL BACKGROUND

On January 8, 2009, Plaintiff Terry Ann Nash filed

applications for disability insurance benefits and supplemental

security income under Titles II and XVI of the Social Security Act,

alleging she has been disabled since June 25, 1997. (Admin. R. 26,

ECF No. 9.) Plaintiff alleged she suffers from Meniere's disease,

depression, anxiety disorder, vertigo, as well as back and neck

problems. (Id. at 263.) She alleged she last worked as a

temporary administrative assistant in July of 2008. (Id. at 271,

284.) Her applications were denied on initial review and again on

reconsideration. (Id. at 126-30, 131-35, 136-40.) 

A hearing before the Administrative Law Judge Eve Godfrey was

held on July 2, 2010. (Id. at 47.) Plaintiff, along with her

attorney, appeared, and Nash testified at the hearing. (Id. at

26.) A medical expert and a vocational expert also testified. 

(Id.) On July 30, 2010, the administrative law judge issued a

decision finding that the Plaintiff was not entitled to a period of

disability or disability insurance benefits under sections 216(i),

223(d), and 1614(a)(3)(A) of the Social Security Act. (Id. at 26-

38.)

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On September 3, 2010, Plaintiff requested that the Appeals

Council reconsider the decision of the administrative law judge. 

(Id. at 21.) On September 26, 2012, the Office of Hearings and

Appeals sent notice that the Appeals Council had upheld the

decision. (Id. at 1-7.)

II. FACTUAL BACKGROUND

A. Medical Evidence

1. UCSD Medical Center

Plaintiff Terry Ann Nash was twenty-eight years old on the

alleged onset date of her disability on June 25, 1997. (Id. at

246.) Nash testified that she was diagnosed with Meniere's

disease, a condition that causes vertigo. (Id. at 65.) In

connection with this disorder, on June 25, 1997, she underwent a

left endolymphatic shunt procedure at the UCSD Medical Center in

San Diego, California. (Id. at 407.) It was performed by doctors

Jeffrey Harris and Drew Horlbeck. (Id. at 407-08.) On October 20,

1997, Nash returned to UCSD Medical Center and was seen by Gita

Mehta, M.D. and David Reynaldo, M.D. (Id. at 409.) Clinical notes

reflect that Plaintiff continued to experience persistent vertigo

up to six times a day even after the surgical intervention. (Id.) 

During that visit, Nash requested a referral to psychiatry because

"several of her physicians have recommended this in the past," even

though she denied being depressed or suicidal. (Id.) 

2. Exodus Recovery Center

Triage notes from the Exodus Recovery Walk-In Assessment

Center, a division of San Diego County Mental Health Services,

indicate that on January 15, 2009, Nash was seen as a walk-in for

depression, suicidal ideation, and complaints of Meniere's disease. 

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(Id. at 388.) She reported she felt helpless and defeated and had

been standing by the train tracks. (Id.) She also stated that she

"can't seem to keep work," was homeless but staying on the floor of

her cousin's apartment, and had applied for section 8 housing. 

Although she was observed to be hyperverbal and "talked quite a bit

about her situation," case management was unable to complete her

follow-up plan. The notes attribute this to Nash being "dizzy from

not eating." (Id. at 387.) Because of her suicidal thoughts, the

center assisted Plaintiff with a safety plan, which she gladly

accepted. (Id.) When Nash returned to Exodus on January 23, 2009,

she continued to speak at a rapid pace, with a sad affect and

moments of anger. (Id. at 385). On January 29, 2009, Plaintiff

called to cancel her next appointment because her car broke down. 

She sounded tearful and reported feeling panicky, sad, and

overwhelmed. (Id. at 384).

3. Dr. Rodarte

On February 16, 2009, Nash began treating with Dr. Gabriel

Rodarte, M.D., a psychiatrist at Neighborhood Healthcare --

Behavioral Health department. (Id. at 484-85, 502.) Plaintiff

initially reported a history of vertigo, depression, and being very

sensitive to medications. She also complained of consistent

suicidal ideation since 2007. (Id. at 484.) 

Dr. Rodarte's exam notes from February 16, 2009, indicate fast

and pressured speech; agitated behavior; a self-reported tendency

to get angry and aggressive; a euthymic affect; a tangential and

circumstantial thought process; and suicidal ideation chronically

over the preceding two years but with no current plan or intent. 

(Id. at 485.) The psychiatrist also noted that Nash was taking

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fish oil and vitamins, and had "lots of odd beliefs."1 (Id. at

484).

Dr. Rodarte's initial diagnosis for Plaintiff was a mood

disorder with the need to rule out bipolar disorder, major

depressive disorder, and schizophrenia type I. (Id. at 485.) 

Progress notes from March 5, 2009, indicate that Nash wanted to

continue herbal medications but would consider lithium orotate in

the future. (Id. at 483.) At her follow-up appointment on April

1, 2009, Nash was in a better mood, her behavior was calm, but her

thought process was tangential with poor insight. (Id. at 482.) 

On April 21, 2009, Plaintiff exhibited fast speech, a down

mood, tangential thought processes, suicidality, hallucinations,

and continued "odd beliefs." (Id. at 481.) Nash's response to her

medication regimen was poor, so Dr. Rodarte recommended Abilify. 

(Id.) On May 5, 2009, Plaintiff had mildly pressured speech, a

calmer mood, a tangential thought process, and continued "odd

beliefs." (Id. at 480.) Dr. Rodarte diagnosed psychosis not

otherwise specified and ruled out bipolar disorder. (Id.) He

noted Plaintiff's insistence on using only natural products, and

her unwillingness to try Abilify. (Id.) At that time, Nash was

taking remedies prepared by her acupuncturist. (Id.) 

 On June 29, 2009, Nash had mildly pressured speech, agitated

behavior, a depressed mood, a restricted affect, suicidality, and

fair insight and judgment. (Id. at 561.) Progress notes from that

visit reflect that Plaintiff took Abilify for one week but stopped

1

 Because the photocopy of the handwritten notes from Dr.

Rodarte is difficult to read, the Court was assisted by the summary

provided in Plaintiff's Memorandum of Points and Authorities. 

(Pl.'s Mot. Summ. J. Attach. #1 Mem. P. & A. at 10-11, ECF No. 11.) 

 

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due to nausea. (Id.) Dr. Rodarte discontinued Abilify and

prescribed lithium at 300 milligrams. (Id.) The next month, Nash

reported "some sedation" from taking lithium. (Id. at 560.) Her

response to medication was fair, and her exam showed motor

retardation, a restricted affect, fair insight and judgment, and

suicidality. (Id.) Dr. Rodarte recommended that Nash continue

taking 300 mg of lithium. (Id.) 

By August 31, 2009, Nash was taking 600 milligrams of lithium,

and Dr. Rodarte increased her dosage to 900 milligrams. (Id. at

559.) On September 21, 2009, she reported not feeling like

herself, drinking lots of water, and having blurry vision. Because

of these side effects, she decreased her dosage of lithium from 900

to 300-600 milligrams per day. (Id. at 558.) She stated that

lithium was helping with the "'chatter' in her head." (Id.) She

had one episode of suicidal ideation since the prior visit. (Id.) 

At the next session on October 29, 2009, Nash was taking 300

milligrams of lithium and demonstrated disorganization of thought,

mild agitation, mildly rapid speech, and fair judgment and insight. 

(Id. at 557.) By December 22, 2009, she reported feeling suicidal

"due to some social stressors," despite taking between 300 and 600

milligrams of lithium a day. (Id. at 555.) Plaintiff had rapid

speech, a "bad" mood, and reported auditory hallucinations that

told her to "kill [her]self." (Id. at 555.) By February 16, 2010,

the auditory hallucinations had receded, but her speech was rapid

and she had labile affect. (Id. at 554.) Dr. Rodarte noted her

response to treatment was fair. (Id.) On March 29, 2010, Nash

showed a circumstantial thought process, as well as poor insight

and judgment, despite taking 300-600 mg of lithium. (Id. at 553). 

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Dr. Rodarte authored several reports describing his diagnosis

and treatment of Plaintiff. In a letter dated May 7, 2009, Dr.

Rodarte explained that since he began treating Nash on February 16,

2009, she exhibited symptoms of a thought disorder, along with

pressured speech and tangential and disorganized thought processes,

which made it "somewhat difficult to come up with a diagnosis right

away." (Id. at 502). After having seen her five times, he

diagnosed her as suffering from bipolar I disorder with psychotic

features. (Id.) Dr. Rodarte described the effects of Nash's

diagnosis as follows:

She has a long history of inability to maintain

employment secondary to her symptoms. She has not worked

at a permanent or full time job since 1997, due to her

illness. She has no history of alcohol or drug use. She

has never been married and has no children. She has had

difficulty even maintaining a residence bouncing from

place to place. Given her current symptoms I do not

believe she could succeed in a work environment.

(Id.) In another summary report from August 3, 2009, the doctor

confirmed the same diagnosis of bipolar I disorder with psychotic

features of such severity that "she has chronic suicidality," and

repeated that she could not succeed in a work environment due to

her symptoms. (Id. at 543.)

Several months later, on May 12, 2010, Dr. Rodarte completed a

psychiatric/psychological impairment questionnaire regarding his

treatment of Nash. (Id. 571-78.) He affirmed the diagnosis of

bipolar I disorder with psychotic features and a current global

assessment of functioning ("GAF") score of 50. (Id. at 571.) Her

primary symptoms included pressured speech, tangential thought

processes, mood swings with psychotic features, suicidal ideation,

depression, and hypomania. (Id. at 573.) In Dr. Rodarte's

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opinion, these symptoms were severe enough to impair Nash's work,

social and personal functioning, and required emergency treatment

in January 2009 at the Exodus Mental Health Recovery center. (Id.)

Dr. Rodarte found Plaintiff markedly limited in her abilities

to understand, remember, and carry out detailed instructions; to

maintain attention and concentration for extended periods; to work

in coordination with or proximity to others; to complete a normal

work week without interruptions from psychological symptoms; and to

perform at a consistent pace without rest periods of unreasonable

length and frequency. (Id. at 574-76.) He found her moderately

limited in the abilities to remember locations and work-like

procedures; to understand, remember, and carry out simple

instructions; to perform activities within a schedule; to maintain

regular attendance and be reasonably punctual; to sustain ordinary

routine without supervision; to respond appropriately to changes in

the work setting; and to travel to unfamiliar places or use public

transportation. (Id. at 574-76.) 

Dr. Rodarte noted that Nash had past episodes of deterioration

that exacerbated her symptoms due to work-related stress; she would

be incapable of tolerating even a "low-stress" work environment;

and she would likely miss two to three workdays a month. (Id. at

576-78.) The doctor noted that Plaintiff was taking 300-600 mg. of

lithium daily, but blurred vision, the loss of appetite, and

feeling numb were side effects of the medication. (Id. at 576.)

4. Dr. Suozzo

On August 3, 2009, J.M. Suozzo, Jr., a supervising

psychologist with the Neighborhood Healthcare in Escondido,

California, and a psychology intern, Stephanie Knatz, wrote a

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letter confirming they have treated Nash for anxiety and depression

since January 22, 2008. (Id. at 545.) They noted that Plaintiff

had been seen sixteen times, was diligent and punctual in

scheduling and keeping her appointments, and was "motivated to

continue to seek out help for her symptoms . . . ." (Id.) In a

subsequent letter dated June 29, 2010, Dr. Suozzo and psychology

intern Mary Elizabeth Skoch confirmed having individual weekly to

biweekly psychotherapy sessions with Nash since September of 2009,

and they described her condition as follows:

Ms. Nash presents with aggravated distress in relation to

her experience of Bipolar I Disorder with psychotic

features. As evidenced by her mood disturbances (cycling

between depression and hypomanic episodes), hostility and

irritability, suicidal ideations, and emotional lability. 

Ms. Nash's symptoms cause clinically important distress,

impairing her ability to function across all areas of her

life.

(Id. at 580.) Dr. Suozzo and Skoch noted that Nash's response to

individual therapy and daily lithium of 300 to 600 milligrams was

"fair," and given her diagnosis and symptoms, Plaintiff would "need

to continue to manage her mood disorder on an ongoing basis by

continuing treatment indefinitely." (Id.)

5. Dr. Glassman

California's Department of Social Services, Disability and

Adult Programs, referred Nash for a psychiatric evaluation to Dr.

Jaga Nath Glassman, a board-certified psychiatrist. (Id. at

430-35.) On March 21, 2009, Dr. Glassman prepared a report with

his findings based on his interview of Plaintiff and a review of

her records. (Id. at 430, 433-34.) He noted that Nash's

understanding of the reason for her evaluation was "'[b]ecause

everyone else says I have mental problems! Which I don't!'" (Id.

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at 430.) Although Plaintiff admitted to Dr. Glassman that she

drove to the railroad tracks with a plan to kill herself, Nash

denied having mental problems and seemed to attribute her issues to

Meniere's disease. (Id. at 430-31.) 

The interview with Dr. Glassman revealed Plaintiff to be "a

very poor historian, very scattered and somewhat disorganized." 

(Id. at 431.) The consulting psychiatrist noted her rapid and

pressured speech, and observed that she was almost impossible to

redirect. (Id.) Nash believed her dizziness was related to her

diet, which caused her to be very restrictive in her food choices. 

(Id.) The psychiatrist concluded that Nash appeared "too thin" and

was "certainly in anorectic weight range." (Id.) During the

evaluation, Plaintiff acknowledged she was being treated by a

psychiatrist and a psychologist, and that she took various

supplements and "'a plant-based Lithium.'" (Id. at 432.) She

explained her refusal to take any prescription medications by

stating, "'I don't want to be on psychiatric meds! You can tell

I'm not psychotic! Your stupid friggin' medical community,' etc." 

(Id.) She also admitted to having problems with anger and temper. 

(Id. at 431.)

Dr. Glassman observed that Nash’s intellectual functioning was

above average, but her thought process was "disorganized,

tangential, with a near-frantic quality." (Id. at 433.) She

appeared "very hyper, with rapid, pressured speech, hyperverbal." 

(Id.) Plaintiff's demeanor was intrusive, controlling, and

demanding. The psychiatrist sensed "significant underlying anger." 

(Id.) At the end of the interview, she refused to leave, demanding

to know Dr. Glassman's findings. (Id.) When the psychiatrist did

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not reveal his opinion, Nash became angry and overly intrusive, and

he was forced to set "firm limits" to get her to leave. (Id.)

Dr. Glassman's clinical impression was that Nash suffered from

a severe borderline personality disorder, an associated eating

disorder, and severe somatic preoccupation/somatization. (Id. at

434.) He assessed her GAF at 45, finding that "[s]he has major

problems functioning." (Id.) Dr. Glassman summarized his

evaluation of Plaintiff:

This is a sad case of a severely decompensated

Borderline Personality Disorder patient with severe

somatization and a severe eating disorder. She has been

unable to maintain any stability in her life with chronic

homelessness that she blames on her "dizziness" and

"autoimmune diseases" and food preoccupations. 

She has significant impairments in her capacity to

function in a workplace setting. She is likely to have

marked impairments in her capacity to get along

adequately with others, with her hyper, intrusive and

angry quality. She has difficulty regulating her affect

states and associated difficulty behaving in a socially

appropriate manner. She is likely to have difficulty

understanding and following even simple instructions

consistently, as she is so disorganized and frantic and

"hyper." She is not likely to be capable of maintaining

concentration, persistence and pace for even simple

tasks. 

(Id.) He also found that she is likely not capable of managing her

own funds due to her "extremely poor judgment." (Id.)

6. Medical expert testimony

Dr. Alfred G. Jonas, a psychiatrist, testified as a medical

expert at the administrative hearing. (Id. at 93-113, 224-227.) 

Dr. Jonas first noted that Nash suffers from a wide range of

psychiatric impairments that could possibly be classified under

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sections 12.03,2 12.04,3 12.06,4 12.07,5 and 12.086 of the listed

impairments, and observed that "[t]his is a very complicated case." 

(Id. at 93-94.) He also noted that Meniere's disease was

Plaintiff's only nonpsychiatric issue. (Id. at 93.) After

reviewing the medical evidence and listening to Nash's testimony,

the medical expert concluded that "12.03 [schizophranic, paranoid

and other psychotic disorders] is the best way to summarize this

case." (Id. at 94.) Dr. Jonas acknowledged that the treating

physician's diagnosis was under section 12.04 -- pertaining to

affective disorders -- and explained that in his opinion, the

correct diagnosis was under section 12.03, although "the other

disorder is lurking in there partially." (Id.)

The medical expert noted that Nash had "a pretty significant

range of impairments" that affect her activities of daily living,

but she seemed to improve after finding a stable residence. (Id.

at 94-95.) As to her social functioning, however, Dr. Jonas

observed a "distortion of interpersonal relating" that based on the

record was "at or near the listing level" most of the time. (Id.

at 95.) He described Plaintiff's interactions with others as

"dependent relationships" and stated that "[s]he does not come

across as a socially fully functional person in these episodes of

interpersonal relating." (Id. at 96.) The expert concluded that

2

 Schizophrenic, paranoid and other psychotic disorders. See

20 C.F.R. pt. 404, subpt. P, app. 1, § 12.03 (2013). 

3 Affective disorders. Id. § 12.04.

4

 Anxiety-related disorders. Id. § 12.06.

5 Somatoform disorders. Id. § 12.07.

6

 Personality disorders. Id. § 12.08.

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despite her treatment with lithium, "Ms. Nash is really a kind of a

marginal social person and really can only function in sort of

primitive ways that are relatively structured and allow her to be

somewhat dependent within the system." (Id. at 99-100.)

B. Plaintiff's Testimony

Plaintiff was forty-one years old at the time of the hearing

on July 2, 2010. (Id. at 45, 50.) She had never been married and

had no children. (Id. at 100, 430.) Plaintiff appeared in person

and testified at the hearing before Judge Godfrey. The transcript

of her testimony reveals that Nash provided an erratic account of

her personal history and frequently could not remember dates or

other pertinent information: 

Q. When was the last time that you worked, Ms. Nash?

A. Oh my goodness, I think – I'm not lying on purpose, I

think it was –

Q. What do you mean you're not lying on purpose?

A. I mean if I make the year, it may not be the correct

one. I think it was 2006, 2007. It was for a temp

agency I think was the last one I worked for.

(Id. at 51.) She worked as a part-time bilingual instructional

aide to high school students and also taught English to adults for

five years until 1997. (Id. at 54-56.) Starting in 1997, Nash

worked as a customer service representative for a hospital supply

company for several years until she was let go. (Id. at 55-56.) 

Plaintiff later held part-time administrative and clerical

positions through a temp agency, including working for the County

of Riverside for several weeks in 2006 and then again in 2007. 

(Id. at 51, 60.) After her temp assignments ended, she applied to

secretarial and food service jobs, but could not find another

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position. (Id. at 52.) Nash testified she subsequently received

unemployment until 2009: "I think I, I think I was on 2008 to 2009

I believe it was, I believe. I have so many numbers in my head,

your honor, I honestly can't remember but I do believe it was till

2009." (Id. at 52-53.)

When Judge Godfrey inquired whether Nash would be able to work

if she found a job, Plaintiff stated:

Well the thing is, as I was explaining to Lori [Nash's

attorney], I usually – after the temp job I think I was

off a few months and I worked six weeks for the county of

Riverside and my supervisor told me off-the-record that I

was too slow and not cut out for it and that always seems

to be the problem. I don't catch on fast enough, I'm too

slow, I take too many notes, I don't understand, they

have to repeat themselves 50 times. So it isn't that – I

don't think it's finding the job, it's keeping the job

that is always the problem for me.

(Id. at 53.) Nash explained that she received similar feedback

even when the work was less demanding: "[T]hey always use the word

slow. Slow, I just can't catch on. Even though I'm articulate

when I speak I'm slow. And I carry a note pad with me everywhere I

go at work taking notes and it always seems to be a problem for

people." (Id. at 54.)

In 2005, Plaintiff obtained a bachelor of arts degree in

political science from San Diego State University. (Id. at 86,

269.) It took her fourteen years to complete her degree, and she

required special accommodations from the school to study and take

exams:

Q. And where did you get [your degree] from?

A. San Diego State University. Yeah, I was with – it

took me, you know, I talked to – I had done the State of

California Rehabilitation Program years ago. I think you

probably won't have records for that. And at any rate,

you know, with my depression and just with everything I 

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was going through, everyone including her, the rehab

counselor had all suggested, you know, maybe you could

look at going to college and getting something if you

can't work outside the home, maybe you can work in the

home. And that didn't even work out for me. But at any

rate I wound up – I got taken in by disabled students and

I was with the[m] for 14 years but I did it, I did it and

I got my, you know, 14 years later but.

(Id. at 86-87.) 

Plaintiff's Meniere's disease made her feel "so bad [she]

wasn't walking." (Id. at 65, 74.) She testified she struggled

with depression her entire life. (Id. at 75.) Her condition

caused her auditory hallucinations and suicidal ideation. (Id. at

65, 79.) Although she tried "regular medication" to treat her

depression, the treatment "exasperated [her] condition and made it

worse." (Id. at 65.)

Plaintiff claimed that despite conventional medical treatment

she continued to "hear voices, more voices." (Id.) The "different

voices" in her head were "menacing" and sometimes told her to kill

herself. (Id. at 80.) Nash stated that she suffers from

nightmares and sometimes has crying spells that can last for

several days. (Id. at 82-83.) She experienced manic periods when

her mood would be either really high to really low. (Id. at 78.) 

Nash testified that her Meniere's disease causes episodic

vertigo and makes her feel dizzy, almost as if she were drunk. 

(Id. at 74.) Plaintiff explained that she has a disabled placard

for her car because of the vertigo and panic attacks. (Id. at 88-

89.) She claimed that dizziness medication always causes her to

have "more vertigo," and she manages her symptoms by exercise and

meditation. (Id. at 89.) Her current regimen involves exercise

five days a week, supplements, meditation, and eating well. (Id.

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at 65.) She also is in therapy every week, and sees her

psychiatrist, Dr. Rodarte, once or twice a month. (Id. at 66.) 

Dr. Rodarte prescribed her lithium which she takes daily, her dose

ranging from 300 to 600 milligrams. (Id. 67.) 

The ALJ inquired: "Well now with this Lithium that you take,

you don't have these highs and lows anymore right?" (Id. at 79.) 

Plaintiff replied: 

I do, it stabilizes me more but I guess I told Dr.

Rodarte that I want something that's going to totally

completely rectify my situation and take away the voices

and take away all the stuff. And he said that that's not

really feasible. I'm doing better on the Lithium with

the therapy and the Lithium but he said his goal is just,

there isn't anything that he can do that, you know, to

stop period. I will probably struggle with it the rest

of my life since I have been my entire life. That's what

he told me. I don't know if it's true. I don't know. I

just want a little nob, just to click, to shut it off,

that's it.

(Id.) Despite being on medication, Nash testified that she had a

"really rough last two weeks" when an event triggered a memory from

her past, resulting in an emotional setback. (Id. at 68-69.) When

describing her feelings of anger related to the setback, Plaintiff

became disturbed by the presence of Mr. Cummings, the vocational

expert, and the hearing had to be interrupted so he could leave the

room. (Id.)

Nash testified the last time she was in a relationship was

three years ago, but her boyfriend dumped her because she did not

believe in premarital sex. (Id. at 100.) When Judge Godfrey asked

Plaintiff about her friendships, she stated: "I just have one

friend that calls me, April, and I met her in rehab, State of

California Rehabilitation 15 years ago and she calls me every day

to check on me." (Id. at 101.) Nash explained that she gets phone

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calls from her sister sometimes, and she visits her former boss

"because she happens to be on the reservation" where Plaintiff is

able to receive dental care. (Id.) 

C. The ALJ's Findings

The ALJ found that Plaintiff satisfied the insured status

requirements of the Social Security Act through September 30, 2002. 

(Id. at 28.) Judge Godfrey also found that Nash engaged in

substantial gainful activity from 2000 through 2003 and 2005

through mid-2008. (Id. at 29.) The ALJ concluded that Plaintiff

has the following severe impairments: Meniere's disease,

depression, and a personality disorder. (Id.) Judge Godfrey,

however, determined that Nash does not have an impairment or

combination of impairments that meets or equals a listing. (Id.) 

In her decision, the ALJ noted that the medical expert, Dr.

Jonas, conducted a "thorough review of the medical records and the

claimant's testimony" and concluded that Nash "has psychiatric

issues, possible impairments include a schizoaffective disorder, an

affective disorder, an anxiety-related disorder, a somatoform

disorder, and a personality disorder." (Id. at 33.) The ALJ

acknowledged the expert's testimony that Plaintiff "did meet

medical listing 12.03 based on the record[,]" however, she rejected

his opinion. (Id. at 34-35.) The ALJ gave the following reasons

for rejecting Dr. Jonas's opinion: (1) the expert disagreed with

the treating psychiatrist's assessment that Plaintiff's social

functioning was unimpaired; (2) Dr. Jonas referenced the

consultative evaluation by Dr. Glassman that was performed "before

the claimant started on Lithium and there is no doubt that she has

had a significant improvement with the Lithium[]"; (3) Nash "seems

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to function reasonably well ADL wise, as long as she has an

available place to stay[]"; and (4) the ALJ's uncertainty over

whether Plaintiff is "really functionally deteriorated" or whether

Nash is "right in saying that if she could only find somebody who

would hire her, that she could do the job." (Id. at 34-35.) 

Judge Godfrey also acknowledged that board-certified

psychiatrist, Dr. Glassman, opined that Plaintiff suffered from a

"severe borderline personality disorder, an associated eating

disorder, and severe somatic preoccupation/somatization." (Id. at

31-32.) The ALJ gave less weight to Dr. Glassman's opinion because

he saw Nash "on March 21, 2009, which was before she was stabilized

on Lithium." (Id. at 34.) In discussing the treating

psychiatrist's conclusions, the ALJ stated that Dr. Rodarte's notes

are "mostly illegible; and therefore, not able to be used." (Id.

at 31.) Judge Godfrey observed that Dr. Rodarte wrote several

letters explaining that Plaintiff had a bipolar I disorder with

psychotic features and was unable to maintain employment due to her

symptoms. (Id. at 32-33.) She stated that the doctor's letters

appeared to be identical. (Id. at 32.) The ALJ then discussed the

psychiatric impairment questionnaire completed by Dr. Rodarte,

including his findings of "social withdrawal," "markedly limited

abilities in several of the areas of functioning," and inability to

tolerate even low work-related stress. (Id. at 33.) The decision

appears to dismiss these findings as not being supported by

laboratory of diagnostic tests. (Id.) 

Without referencing dates or physicians' names, Judge Godfrey

noted that the medical records contain "requests to [Nash's]

doctor's [sic] to fill out forms or otherwise support her in

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obtaining housing, food stamps, general relief and supplemental

security income. (Id. at 35.) Judge Godfrey expressed a concern

that the claimant's doctors "appear[ed] to be advocates for the

claimant and not acting in their roles of treating doctors." (Id.) 

On this basis, the ALJ concluded that the doctors' "contemporaneous

notes" were more credible. (Id.) 

The ALJ found Plaintiff's testimony about her subjective

symptoms not credible, enumerating the following reasons for this

finding: (1) Nash's activities of daily living are not indicative

of a disabling impairment; (2) Plaintiff denied being depressed or

suicidal on October 20, 1997; (3) as of October 20, 1997, records

showed that Plaintiff's Meniere's disease symptoms were slowly

improving; (4) Nash represented to staff at the Neighborhood

Healthcare Center on January 14, 2009, and to Dr. Glassman on March

21, 2009, that she had not worked since 1996; however, her earnings

records show otherwise; (5) Plaintiff refused to take psychiatric 

or other medications on December 16, 2008, which is not consistent

with a disabling level of impairment; (6) Nash took college courses

at the graduate level until 2005, which is inconsistent with

inability to work; (7) Plaintiff's only medications were vitamins,

amino acids, and fish oil, which is inconsistent with a disability;

(8) Nash told a consultative internist that she was "doing fine"

until she entered menopause and started to have more vertigo

attacks; (9) no physician has ever opined that a listing level

limitation was met or equaled; (10) objective evidence in the

medical record does not establish impairments that could produce

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limitations likely to last for twelve or more months.7 (Id. at 35-

36.)

Next, the ALJ found that Nash was unable to perform her past

relevant work based on the testimony of a vocational expert, Alan

E. Cummings. (Id. at 36.) Given Plaintiff's age, education, work

experience, and residual functional capacity, Judge Godfrey found

that Nash was capable of performing other jobs that existed in

significant numbers in the national economy. (Id. at 37.)

III. DISCUSSION

A. Legal Standards

To qualify for disability benefits under the Social Security

Act, an applicant must show two things: (1) He or she suffers from

a medically determinable impairment that can be expected to last

for a continuous period of twelve months or more, or would result

in death; and (2) the impairment renders the applicant incapable of

performing the work that he or she previously performed or any

other substantially gainful employment that exists in the national

economy. See 42 U.S.C.A. §§ 423(d)(1)(A), (2)(A) (West 2011). An

applicant must meet both requirements to be classified as

"disabled." Id.

The Commissioner makes this assessment by a five-step analysis

outlined in 20 C.F.R. § 404.1520 (West 2012). See also Tackett v.

Apfel, 180 F.3d 1094, 1098-99 (9th Cir. 1999) (describing five

steps). First, the Commissioner determines whether a claimant is

engaged in "substantial gainful activity." If so, the claimant is

7

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credible; however, the opinion omits reason number eight from the

list; as a result, reason number seven is followed by reason number

nine. (See Admin. R. 36, ECF No. 9.)

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not disabled. 20 C.F.R. § 404.1520(b). Second, the Commissioner

determines whether the claimant has a "severe impairment or

combination of impairments" that significantly limits the

claimant's physical or mental ability to do basic work activities. 

If not, the claimant is not disabled. Id. § 404.1520(c). Third,

the medical evidence of the claimant's impairment is compared to a

list of impairments that are presumed severe enough to preclude

work; if the claimant's impairment meets or equals one of the

listed impairments, benefits are awarded. Id. § 404.1520(d). 

Fourth, if the impairment meets or equals one of the listed

impairments, the Commission determines whether the claimant can do

his past relevant work. If the claimant can do his past work,

benefits are denied. Id. § 404.1520(e). If the claimant cannot

perform her past relevant work, the burden shifts to the

Commissioner. In step five, the Commissioner must establish that

the claimant can perform other work. Id. § 404.1520(f). If the

Commissioner meets this burden and proves that the claimant is able

to perform other work that exists in the national economy, benefits

are denied.

Sections 405(g) and 421(d) of the Social Security Act allow

unsuccessful applicants to seek judicial review of a final agency

decision of the Commissioner. 42 U.S.C.A. §§ 405(g), 421(d) (West

2011). The scope of judicial review is limited, however, and the

denial of benefits "'will be disturbed only if it is not supported

by substantial evidence or is based on legal error.'" Brawner v.

Sec'y of Health & Human Servs., 839 F.2d 432, 433 (9th Cir. 1988)

(quoting Green v. Heckler, 803 F.2d 528, 529 (9th Cir. 1986)).

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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.'" 

Sandqathe v. Chater, 108 F.3d 978, 980 (9th Cir. 1997) (quoting

Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir. 1995)). The court

must consider the entire record, including the evidence that

supports and detracts from the Commissioner's conclusions. 

Desrosiers v. Sec'y of Health & Human Servs., 846 F.2d 573, 576

(9th Cir. 1988). If the evidence supports more than one rational

interpretation, the court must uphold the ALJ's decision. Allen v.

Heckler, 749 F.2d 577, 579 (9th Cir. 1984). When the evidence is

inconclusive, "'questions of credibility and resolution of

conflicts in the testimony are functions solely of the Secretary.'" 

Sample v. Schweiker, 694 F.2d 639, 642 (9th Cir. 1982) (quoting

Waters v. Gardner, 452 F.2d 855, 858 n.7 (9th Cir. 1971)).

The ALJ has a special duty in social security cases to fully

and fairly develop the record in order to make an informed decision

on a claimant's entitlement to disability benefits. DeLorme v.

Sullivan, 924 F.2d 841, 849 (9th Cir. 1991). Because disability

hearings are not adversarial in nature, the ALJ must "inform

himself about the facts relevant to his decision," even if the

claimant is represented by counsel. Dixon v. Heckler, 811 F.2d

506, 510 (10th Cir. 1987) (quoting Heckler v. Campbell, 461 U.S.

458, 471 n.1 (1983) (Brennan, J., concurring).

Sections 205(g) and 1631(c)(3) of the Social Security Act

allow applicants whose claims have been denied by the Social

Security Administration to seek judicial review of the

Commissioner's final agency decision. 42 U.S.C.A. §§ 405(g),

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1383(c)(3). The district court may affirm, modify, or reverse the

Commissioner's decision. Id. The court should affirm the decision

unless "it is based upon legal error or is not supported by

substantial evidence." Bayliss v. Barnhart, 427 F.3d 1211, 1214

n.1 (9th Cir. 2005) (citing Tidwell v. Apfel, 161 F.3d 599, 601

(9th Cir. 1999)).

A district court may remand a Social Security disability

decision under sentence four of 42 U.S.C. § 405(g). Hoa Hong Van

v. Barnhart, 483 F.3d 600, 605 (9th Cir. 2007). That provision

states, "The court shall have power to enter, upon the pleadings

and transcript of the record, a judgment affirming, modifying, or

reversing the decision of the Commissioner of Social Security, with

or without remanding the cause for a rehearing." 42 U.S.C.A.

§ 405(g). "A remand under sentence four is 'essentially a

determination that the agency erred in some respect in reaching a

decision to deny benefits[]' . . . ." Hoa Hong Van v. Barnhart,

483 F.3d at 605 (quoting Akopyan v. Barnhart, 296 F.3d 852, 854

(9th Cir. 2002)). After a case is remanded and an additional

hearing is held, the Commissioner may modify or affirm the original

findings of fact or the decision. 42 U.S.C.A. § 405(g).

A remand to the Commissioner for further proceedings or to

award benefits is within the court's discretion. McAllister v.

Sullivan, 888 F.2d 599, 603 (9th Cir. 1989). "'If additional

proceedings can remedy defects in the original administrative

proceedings, a social security case should be remanded. Where,

however, a rehearing would simply delay receipt of benefits,

reversal [and an award of benefits] is appropriate.'" Id.

(alteration in original) (quoting Lewin v. Schweiker, 654 F.2d 631,

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635 (9th Cir. 1981)). As a matter of administrative law, "the

proper course, except in rare circumstances, is to remand to an

administrative agency for additional investigation or explanation." 

INS v. Ventura, 537 U.S. 12, 16 (2002) (internal quotation marks

and citation omitted).

B. Plaintiff's Claims

In her Motion for Summary Judgment, Plaintiff asks the Court

to reverse the Commissioner's final decision and remand the case

for an award of benefits or, alternatively, for further

proceedings. (Pl.'s Mot. Summ. J. Attach. #1 Mem. P. & A. 1, 27-

28,8 ECF No. 11.) Nash advances three arguments in support of her

motion. First, she argues that the ALJ improperly discredited

testimony from medical expert Dr. Jonas that Plaintiff's

psychiatric condition meets the criteria of listing 12.03. (Id. at

16-20.) Plaintiff also contends that Judge Godfrey erred in

rejecting the functional capacity opinions of treating psychiatrist

Dr. Rodarte and consultative psychiatrist Dr. Glassman. (Id. at

20-23.) Finally, Nash claims that the Commissioner committed legal

error in finding Plaintiff's subjective complaints were not

credible, and that this finding was not supported by substantial

evidence. (Id. at 23-27.)

1. ALJ's rejection of the medical expert opinion

Plaintiff argues that the ALJ's determination at step three

that Nash's condition does not meet or equal the criteria of

listing 12.03 was error. (Id. at 16.) Nash points out that Dr.

Jonas, the testifying medical expert and board-certified

8

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paginated, the Court will cite to it using the page numbers

assigned by the electronic case filing system.

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psychiatrist and neurologist, thoroughly reviewed the record and

listened to her testimony, and he opined that her psychiatric

condition meets the criteria of listing 12.03. (Id.) Plaintiff

contends that the ALJ's reasons for rejecting Dr. Jonas's

conclusion are not supported by the record. (Id. at 17.)

In the Cross-Motion, Defendant generally argues that the

Commissioner's decision should be affirmed because it is supported

by substantial evidence and is free from legal error. (Cross-Mot.

Summ. J. Attach. #1 Mem. P. & A. 3-12, ECF No. 13.) Defendant also

briefly contends that the ALJ properly discredited Dr. Jonas's

"unclear" opinion and concluded that Nash's impairments do not meet

or equal the criteria of listing 12.03. (Id. at 11.) 

The Code of Federal Regulations describes the standards for

evaluating medical opinion evidence. 20 C.F.R.

§ 404.1527(a)(2)–(b) (2012). The regulations provide that although

the Commissioner will consider opinions from medical sources on

issues such as the claimant's functional capacity and whether the

claimant has an enumerated impairment, "the final responsibility

for deciding these issues is reserved to the Commissioner." Id. at

§ 404.1527(d)(2). Because the ALJ has the sole responsibility of

making the determination whether a claimant meets the statutory

definition of a disability, "[a] statement by a medical source that

[he is] 'disabled' or 'unable to work' does not mean that [the ALJ]

will determine that [he is] disabled." Id. at (d)(1).

The ALJ acknowledged Dr. Jonas's testimony that Nash "did meet

medical listing 12.03 based on the record." (Admin. R. 34, ECF No.

9.) Nonetheless, Judge Godfrey rejected the expert's opinion:

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[T]here were two things that appear to interfere with

that opinion, first is that [Nash] seems to function

reasonably well ADL wise, as long as she has an available

place to stay. The other is a question of whether she is

really functionally chronically deteriorated in a way

that would be the same as listing C criteria or is that

claimant right in saying that if she could only find

somebody who would hire her, that she could do the job.

(Id.) Nash is critical of the ALJ taking Plaintiff's assessment of

her social functioning at face value without viewing it "through

the prism of psychiatric expertise." (Pl.'s Mot. Summ. J. Attach.

#1 Mem. P. & A. 17, ECF No. 11.) Defendant responds that the ALJ

properly discredited Dr. Jonas's opinion because it was "unclear

and inexplicable, particularly in light of Plaintiff's improvement

with treatment and permanent housing." (Cross-Mot. Summ. J.

Attach. #1 Mem. P. & A. 10, ECF No. 13.) 

The stated rationale for the ALJ's rejection of the medical

expert's opinion appears to be the Plaintiff's self-assessment of

her condition. This is troubling for a number of reasons. First,

Nash's beliefs regarding her ability to work are less optimistic

than Judge Godfrey described. Plaintiff repeatedly explained that

she had problems staying employed: "I don't think it's finding the

job, it's keeping the job that is always the problem for me." 

(Admin. R. 53, ECF No. 9.) "I can't maintain employment as

evidenced by my sporadic work history and all my years of

homelessness"; "I could never maintain a job and I was always

moving around." (Id. at 62.) Nash also stated that most of her

employers criticized her for being slow and unable to prioritize

tasks, and that adversely affected her job performance. (Id. at

53, 85.) Second, Nash's subjective symptom testimony, which the

ALJ ultimately rejected as not credible, was that despite her

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ongoing treatment, Plaintiff still hears voices, has manic periods

when she becomes aggressive, hostile, and angry, as well as periods

when her mood is low, to the point where she does not leave the

apartment. (See id. at 65, 78-80, 93.) 

Additionally, a review of the transcript reveals that the

reasons stated for rejecting Dr. Jonas's opinion were actually

observations made by the medical expert himself during his

examination by the claimant's attorney:

Q.: So then is it your testimony that she does in fact

meet 12.03 doctor?

A.: I think she does based on the record. And as I said

[w]hat interferes with that are two things, are the fact

that she seems to function reasonably well ADL wise as

long as she has an available place to stay. . . . . And

the other thing that interferes is the question of

whether she's really sort of functionally chronically

deteriorated in the way that would be the same as the

listing level for item 4B criteria or is she in some

sense right that if she could only find somebody to hire

her that she could do the job.

(Id. at 109.) Once the medical expert heard more testimony

regarding Nash's housing and food stamp assistance, he concluded

that Plaintiff's ADL levels were only minimally impaired "at best. 

When things have not been the best then we would be looking

[INAUDIBLE] level." (Id. at 113.)

Judge Godfrey also rejected Dr. Jonas's testimony, claiming

she "did not understand the medical expert's disagreement with the

assessment by Dr. Rodarte, the claimant's treating psychiatrist,

who assessed her social functioning at unimpaired." (Id. at 34.) 

This statement, however, is factually inaccurate. Nash points out

that ALJ failed to cite to any part of the record that reflects

such a finding by Dr. Rodarte. (Pl.'s Mot. Summ. J. Attach. #1

Mem. P. & A. 18, ECF No. 11.) On the contrary, Dr. Rodarte opined

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that her symptoms caused "clinically important distress, impairing

work, social and personal functioning," and found Nash markedly

limited in her ability to work with others without being distracted

by them. (Admin. R. 573-74, ECF No. 9.) Dr. Jonas's opinion

appears to be largely consistent with that of Plaintiff's treating

physician. The medical expert felt that Plaintiff was not a

"socially fully functional person" due to a distortion in

interpersonal relating. (Id. at 96.) As an opinion supported by

other medical evidence and consistent with the record as a whole,

the medical expert's conclusion was entitled to more weight. 20

C.F.R. § 404.1527 (c)(3)-(4). 

Finally, the ALJ also rejected Dr. Jonas's opinion and his

reliance on the evaluation by consultative psychiatrist Dr.

Glassman, stating that Dr. Glassman evaluated Nash before she began

treatment with lithium. (Admin. R. 34, ECF No. 9.) Yet, the ALJ

overlooked Dr. Jonas's testimony that even with lithium treatment,

Dr. Rodarte found Nash exhibiting disordered thoughts and

pressured, tangential, and disorganized speech. (Id. at 99.) 

This, according to the medical expert, "has to be reflected to

social functioning." (Id.)

Defendant's argument that the medical opinion of Dr. Jonas is

"unclear" is not well taken. First, the ALJ did not advance this

as a reason for rejecting the opinion. Tommasetti v. Astrue, 533

F.3d 1035, 1039 n.2 (9th Cir. 2008); see also Pinto v. Massanari,

249 F.3d 840, 847-48 (9th Cir. 2001). Second, the ALJ in a social

security case has an independent "duty to fully and fairly develop

the record and to assure that the claimant's interests are

considered[,]" Tonapetyan v. Halter, 242 F.3d 1144, 1150 (9th Cir.

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2001) (internal quotation marks omitted), even where a claimant is

represented by counsel. Id. This duty is triggered when the

record reflects ambiguous evidence, or the ALJ finds that the

record is inadequate for a proper evaluation. Id. (internal

citations omitted). Thus, if the ALJ believed the medical expert

opinion was ambiguous, she had a duty to clarify it. 

The ALJ chose to reject the opinion of Dr. Jonas, which was

consistent with those of Dr. Rodarte, Plaintiff's treating

physician. Although Judge Godfrey relies on Nash's testimony

regarding her condition, the ALJ states that Plaintiff's "lack of

honesty calls all of the claimant's credibility into question." 

(Admin. R. 35, ECF No. 9.) The ALJ "may reject the opinion of a

nonexamining physician by reference to specific evidence in the

medical record." Sousa v. Callahan, 143 F.3d 1240, 1244 (9th Cir.

1998). Viewing the record as a whole, the ALJ's decision does not

articulate adequate reasons supported by substantial evidence for

rejecting the opinion of the impartial medical expert. See Davis

v. Astrue, 444 F. App'x 151, 152 (9th Cir. 2011) (finding that ALJ

erred by failing to provide legally adequate reasons for rejecting

the testimony of a medical expert that was largely consistent with

opinion of claimant's treating psychologist). 

2. Standards for reviewing the consultative psychiatrist's

and treating psychiatrist's opinions

Nash also contends that ALJ Godfrey erred in rejecting the

functional capacity opinions of treating psychiatrist Dr. Rodarte

and consultative psychiatrist Dr. Glassman. (Pl.'s Mot. Summ. J.

Attach. #1 Mem. P. & A. 20-23, ECF No. 11.) Defendant responds

that the ALJ properly assessed and resolved the conflicts in the

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medical opinions, and the decision is supported by substantial

evidence and is free from legal error. (Cross-Mot. Summ. J.

Attach. #1 Mem. P. & A. 7-10, ECF No. 13.) 

Generally, a treating physician's opinion must be accorded

controlling weight if it is "well-supported by medically acceptable

clinical and laboratory diagnostic techniques and . . . not

inconsistent with the other substantial evidence in [the] case

record . . . ." 20 C.F.R. § 404.1527(c)(2). If the treating

physician's opinion is not given controlling weight, the following

factors are applied in determining what weight to give the opinion: 

(1) the length of the treatment relationship and the frequency of

examination, (2) the nature and extent of the treating

relationship, (3) the relevant evidence supporting the opinion, (4)

the consistency of the opinion with the record as a whole, (5) the

specialization of the treating physicican, and (6) any other

factors brought to the attention of the ALJ which tend to support

or contradict the opinion. Id. § 404.1527(c)(2)(i)-(ii), (c)(3)-

(6).

Opinions of treating physicians may only be rejected under

certain circumstances. See Batson v. Comm'r of Soc. Sec. Admin.,

359 F.3d 1190, 1195 (9th Cir. 2004). "Cases in [the Ninth Circuit]

distinguish among the opinions of three types of physicians: (1)

those who treat the claimant (treating physicians); (2) those who

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

(3) those who neither examine nor treat the claimant (nonexamining

physicians)." Lester v. Chater, 81 F.3d 821, 830 (9th Cir. 1995)

(footnote omitted).

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The standard for determining whether an ALJ properly rejected

the opinion of a treating physician varies. If the treating

doctor's opinion is not contradicted by another physician, the ALJ

must give clear and convincing reasons for rejecting it. Thomas v.

Barnhart, 278 F.3d 947, 957 (9th Cir. 2002); see also Spelatz v.

Astrue, 321 F. App'x 689, 692 (9th Cir. 2009); Lester, 81 F.3d at

830. On the other hand, if the treating physician's opinion is

contradicted, "[t]he ALJ must give specific, legitimate reasons for

disregarding the opinion of the treating physician.'" Batson, 359

F.3d at 1195 (quoting Matney v. Sullivan, 981 F.2d 1016, 1019 (9th

Cir. 1992)); see also Orn v. Astrue, 495 F.3d 625, 632 (9th Cir.

2007). An ALJ may discredit opinions "that are conclusory, brief,

and unsupported by . . . objective medical findings." Batson, 359

F.3d at 1195.

The opinion of an examining doctor is entitled to greater

weight than that of a nonexamining doctor. Lester, 81 F.3d at 830

(citing Pitzer v. Sullivan, 908 F.2d 502, 506 (9th Cir. 1990);

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

the regulations give more weight to opinions that are explained

than to those that are not, and to the opinions of specialists

concerning matters relating to their specialty over that of

nonspecialists." Holohan v. Massanari, 246 F.3d 1195, 1202 (9th

Cir. 2001) (citing 20 C.F.R. § 404.1527(d)(3), (5)). As with the

opinion of a treating physician, the opinion of an examining

doctor, if contradicted by another doctor, may be rejected only for

"specific and legitimate" reasons supported by substantial evidence

in the record. Andrews v. Shalala, 53 F.3d at 1043; Lester, 81

F.3d at 830-31. 

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"The opinion of a nonexamining physician cannot by itself

constitute substantial evidence that justifies the rejection of the

opinion of either an examining or a treating physician." Lester,

81 F.3d at 831 (citing Pitzer, 908 F.2d at 506 n.4; Gallant, 753

F.2d at 1456)). "[T]he report of [a] non-treating, non-examining

physician, combined with the ALJ's own observance of [the]

claimant's demeanor at the hearing d[oes] not constitute

substantial evidence" and does not support an ALJ's "decision to

reject the examining physician's opinion that the claimant [is]

disabled." Id. (quoting Gallant, 753 F.2d at 1456) (internal

quotation marks omitted).

a. Consultative psychiatrist

According to Plaintiff, the ALJ's only reason for rejecting

the opinion of the consultative psychiatrist Dr. Glassman was that

Dr. Glassman saw Nash in March 2009, before she was stabilized on

lithium. (Pl.'s Mot. Summ. J. Attach. #1 Mem. P. & A. 21, ECF No.

11.) Nash argues that this reason is based on the incorrect

assumption that her condition stabilized after she started her

lithium treatment. (Id.) Plaintiff points to the medical records

from her treating psychiatrist, Dr. Rodarte, alleging that her

symptoms continued from June 29, 2009, when Nash agreed to take

lithium, to her most recent visit in March of 2010. (Id.) 

In response, Defendant maintains that Nash's condition was

worse in January 2009 but "promptly improved" with treatment. (See

Cross-Mot. Summ. J. Attach. #1 Mem. P. & A. 9, ECF No. 13.) The

Commissioner provides five additional reasons for the ALJ's

decision to give less weight to Dr. Glassman's opinion: (1) Dr.

Glassman did not review any prior mental health records; (2) he

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examined Plaintiff during the time she was refusing to cooperate

with psychiatric treatment; (3) he opined that Nash suffered from

an eating disorder despite the absence of medical records or

testimony of an eating disorder; (4) the treating psychiatrist, Dr.

Rodarte, opined that Nash's social functioning was "mostly

unimpaired"; and (5) Plaintiff gave Dr. Glassman misleading

information regarding her work history and eating disorder. (Id.

at 8-9.) The Commissioner argues that "[t]hose were valid reasons

for discounting Dr. Glassman's opinion." (Id. at 8-9.) 

Nash replies that the Defendant cannot support the ALJ's

decision by marshaling reasons not specifically mentioned by Judge

Godfrey; the Court is required to disregard them. (Pl.'s Reply 4,

ECF No. 14.) Plaintiff points out that the single rationale

actually articulated by Judge Godfrey for assigning less weight to

the consultative psychiatrist was that Nash later stabilized on

lithium. (Id.) Plaintiff argues that Defendant fails to address

her argument that, despite lithium, Nash's symptoms continued and

her condition did not meaningfully improve. (Id.) 

The Court "cannot affirm the decision of an agency on a ground

that the agency did not invoke in making its decision." Pinto, 249

F.3d at 847. Judge Godfrey stated: "The undersigned notes that

the consultative psychiatric evaluation was performed on March 21,

2009, which was before she was stabilized on Lithium; therefore,

less weight can be given to the opinion of Dr. Glassman, the

consultative psychiatrist, than he would ordinarily merit." 

(Admin. R. 34, ECF No. 9.) Because the ALJ did not list any

additional reasons discounting Dr. Glassman's opinions, Defendant's

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later justifications cannot serve as a predicate for the agency

action. Tommasetti v. Astrue, 533 F.3d at 1039 n.2. 

Here, Dr. Glassman, a board-certified psychiatrist, evaluated

Nash on March 21, 2009, and opined that she suffered from a "severe

borderline personality disorder, an associated eating disorder, and

severe somatic preoccupation/somatization." (Admin. R. 434, ECF

No. 9.) Because Dr. Glassman was a specialist who actually

examined Nash, his opinion was entitled to more weight than a

nonexamining physician. Holohan, 246 F.3d at 1202; Lester, 81 F.3d

at 830. Plaintiff continued seeing her treating psychiatrist, Dr.

Rodarte, who diagnosed a bipolar I disorder with psychotic

features. (Admin. R. 502, ECF No. 9.) Even if this difference in

diagnosis is viewed as contradictory, the ALJ was still required to

offer "specific and legitimate" reasons supported by substantial

evidence in the record before she rejected Dr. Glassman's opinion. 

Lester, 81 F.3d at 830-31; Andrews v. Shalala, 53 F.3d at 1043.

The medical records show that Nash started taking lithium in

June 2009. (Admin. R. 561, ECF No. 9.) Although the treating

psychiatrist varied her dosage, the response to treatment was only

fair. (Id. at 553-60.) Despite the lithium treatment, Nash had

poor judgment and insight and her thought process was

"circumstantial at times" as of March 29, 2010. (Id. at 553.) At

the hearing before Judge Godfrey, Plaintiff testified she continues

to hear voices and had a recent emotional setback. (Id. at 79, 68-

69.) In light of this, the ALJ's reference to Plaintiff's own

assessment ostensibly showing a positive response to medication

does not fairly or accurately characterize the mental health

treatment evidence as a whole. See Reddick v. Chater, 157 F.3d

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715, 722–23 (9th Cir. 1998) (holding that the ALJ impermissibly

"developed his evidentiary basis by not fully accounting for the

context of materials or all parts of the testimony and reports[]"). 

Moreover, improvement in Plaintiff's condition does not negate the

possibility that her mental impairment was severe. See 20 C.F.R.

pt. 404, subpt. P, App. 1, § 12.00D(2) (2013) ("The level of [an

individual's] functioning may vary considerably over time. . . . 

Proper evaluation of [a mental impairment] must take into account

any variations in the level of [the individual's] functioning in

arriving at a determination of impairment severity over time.");

Lebus v. Harris, 526 F. Supp. 56, 61 (N.D. Cal. 1981) (explaining

that symptom-free intervals do not compel a finding of

nondisability arising from a mental impairment because "it is

extremely difficult to predict the course of mental illness"). 

Viewing the record as a whole, Judge Godfrey overstated

Plaintiff's positive response to treatment and understated the

evidence that Nash continued to exhibit symptoms of a mental

impairment despite compliance with her medication. Thus, to the

extent Dr. Glassman's opinion was given less weight based on the

assertion that Nash stabilized on lithium, that conclusion is not

supported by the record.

b. Treating psychiatrist 

Nash argues that the ALJ incorrectly rejected the functional

capacity opinion of the treating psychiatrist Dr. Rodarte. (Pl.'s

Mot. Summ. J. Attach. #1 Mem. P. & A. 21-23, ECF No. 11.) The ALJ

stated that Dr. Rodarte's notes are "mostly illegible; and

therefore, not able to be used." (Admin. R. 31, ECF No. 9.) 

Plaintiff argues that this is factually incorrect because the

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progress notes contain check-marked boxes which are easy to

interpret, even if the doctor's handwriting is difficult to read. 

(Pl.'s Mot. Summ. J. Attach. #1 Mem. P. & A. 22, ECF No. 11.) Nash

also contends that the alleged illegibility does not constitute a

valid reason for rejecting Dr. Rodarte's opinion, because the ALJ

had a duty to clarify the contents of the notes instead of

rejecting them altogether. (Id. at 22-23.)

While plaintiff bears the burden of proving disability, the

ALJ in a social security case has an independent "'special duty to

fully and fairly develop the record and to assure that the

claimant's interests are considered.'" Smolen v. Chater, 80 F.3d

1273, 1288 (9th Cir. 1996) (quoting Brown v. Heckler, 713 F.2d 441,

443 (9th Cir. 1983)). This duty extends to represented and

unrepresented claimants. Celaya v. Halter, 332 F.3d 1177, 1183

(9th Cir. 2003); Smolen, 80 F.3d at 1288. "The ALJ's duty to

develop the record fully is also heightened where the claimant may

be mentally ill and thus unable to protect her own interests." 

Tonapetyan v. Halter, 242 F.3d at 1150.

"Ambiguous evidence, or the ALJ's own finding that the record

is inadequate to allow for proper evaluation of the evidence,

triggers the ALJ's duty to 'conduct an appropriate inquiry.'" Id.

(citing Smolen v. Chater, 80 F.3d at 1288; Armstrong v. Comm'r of

Soc. Sec. Admin., 160 F.3d 587, 590 (9th Cir. 1998)). The ALJ may

satisfy this duty "by subpoenaing the claimant's physicians,

submitting questions to the claimant's physicians, continuing the

hearing, or keeping the record open after the hearing to allow

supplementation of the record." Id. (citing Tidwell v. Apfel, 161

F.3d 599, 602 (9th Cir. 1998); Smolen, 80 F.3d at 1288). The ALJ's

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duty to contact a treating physician arises when the evidence

received from that physician is inadequate to determine disability,

contains a conflict, or is ambiguous. See Tonapetyan, 242 F.3d at

1150-51. The responsibility to carry out this duty is triggered by

the inadequacy of the evidence and falls entirely to the ALJ; it is

not part of the claimant's burden. White v. Barnhart, 287 F.3d

903, 908 (10th Cir. 2001).

In this case, the ALJ did not contact Dr. Rodarte for

clarification despite finding his notes illegible. (Admin. R. 31,

ECF No. 9.) Defendant does not address whether the ALJ had a duty

to further develop the record after rejecting Dr. Rodarte's

handwritten progress notes. "Where the medical records are crucial

to the plaintiff's claim, illegibility of important evidentiary

material has been held to warrant a remand for clarification and

supplementation." Miller v. Heckler, 756 F.2d 679, 680 (8th Cir.

1985) (quoting Cutler v. Weinberger, 516 F.2d 1282, 1285 (2nd Cir.

1975). But see Howard v. Astrue, No. ED CV 09-2116-PLA, 2010 U.S.

Dist. LEXIS 112081, at *6 n.6 (C.D. Cal. Oct. 19, 2010) (rejecting

contention that ALJ failed to develop the record by not contacting

treating physician to clarify notes the ALJ found to be illegible). 

In Howard, the court found that the plaintiff's failure to provide

legible copies of treatment notes was a failure to satisfy

plaintiff's burden to provide his disability claim. Id. Even if

the ALJ insisted that the handwritten portions of the progress

notes were not usable, the record in this case was sufficiently

developed with consistent medical evidence from several sources.

Judge Godfrey acknowledged that Dr. Rodarte described

Plaintiff's diagnosis of bipolar I disorder and related symptoms in

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several letters, and opined that Nash was unable to maintain

employment due to her symptoms; however, the ALJ discounted these

letters as identical. (Admin. R. 32, ECF No. 9.) The decision

does not explain why consistent, legible records from the treating

physician were not given appropriate weight. 

Generally, more weight is given to the opinions of treating

physicians because they "are likely to be the medical professionals

most able to provide a detailed, longitudinal picture of [the

claimant's] medical impairment(s) and may bring a unique

perspective to the medical evidence that cannot be obtained from

the objective medical findings alone or from reports of individual

examinations, such as consultative examinations or brief

hospitalizations." 20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2). 

Here, Dr. Rodarte treated Nash regularly for over a year, performed

mental status examinations, and prescribed psychotropic

medications. See 20 C.F.R. §§ 404.1527(c)(2)(i), (ii),

416.927(c)(2)(i), (ii) (stating that weight accorded to a treating

physician's opinion dependent on length of the treatment

relationship, frequency of visits, and nature and extent of

treatment received). Based on the length of the treatment

relationship and his experience with Nash, Dr. Rodarte was in the

best position to opine on Plaintiff's mental condition, which is

supported by the treatment records. See Smolen, 80 F.3d at 1285;

see also 20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2); Lester, 81

F.3d at 833 ("The treating physician's continuing relationship with

the claimant makes him especially qualified to evaluate reports

from examining doctors, to integrate the medical information they

provide, and to form an overall conclusion as to functional

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capacities and limitations, as well as to prescribe or approve the

overall course of treatment.").

The ALJ discussed the questionnaire completed by Dr. Rodarte,

including his findings of social withdrawal, "markedly limited

abilities in several of the areas of functioning," and inability to

tolerate even low work-related stress. (Admin. R. 33, ECF No. 9.) 

The decision dismisses these findings as not supported by

laboratory of diagnostic tests. (Id.) "Courts have recognized

that a psychiatric impairment is not as readily amenable to

substantiation by objective laboratory testing as is a medical

impairment and that consequently, the diagnostic techniques

employed in the field of psychiatry may be somewhat less tangible

than those in the field of medicine." Lebus v. Harris, 526 F.

Supp. at 60 (citations omitted).

Mental disorders cannot be ascertained and verified as

are most physical illnesses, for the mind cannot be

probed by mechanical devices in order to obtain objective

clinical manifestations of mental illness. A strict

reading of the statutory requirement that an impairment

be "demonstrable by medically acceptable clinical and

laboratory diagnostic techniques" is inappropriate in the

context of mental illnesses.

Hartman v. Bowen, 636 F. Supp. 129, 132 (N.D. Cal. 1986) (citations

omitted). When a mental impairment forms the basis for a

disability claim, "'[t]he report of a psychiatrist should not be

rejected simply because of the relative imprecision of the

psychiatric methodology or the absence of substantial

documentation, unless there are other reasons to question the

diagnostic technique.'" See Christensen v. Bowen, 633 F. Supp.

1214, 1220-21 (N.D. Cal. 1986) (citation omitted); see also Montijo

v. Sec'y of Health & Human Servs., 729 F.2d 599, 601 (9th Cir.

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1984) (noting that the ALJ's reliance on the inability of

physicians to support their findings with objective laboratory

findings does not constitute a legally sufficient reason for

rejecting their conclusions) (citation omitted); Day v. Weinberger,

522 F.2d 1154, 1156 (9th Cir. 1975) (holding that "[d]isability may

be proved by medically-acceptable clinical diagnoses, as well as by

objective laboratory findings[]").

The ALJ's conclusion that Dr. Rodarte's opinion should be

given less weight oversimplifies and discounts the value of the

longitudinal history provided by the totality of the treatment

records. The Court finds that the medical evidence, including the

opinion of the evaluating psychiatrist Dr. Glassman and the medical

expert Dr. Jonas, amply support Dr. Rodarte's opinion. Therefore,

the ALJ's decision to assign less weight to Dr. Rodarte's opinion

is not based on legitimate and specific reasons supported by the

record.

3. ALJ's credibility finding

Plaintiff next argues that Judge Godfrey improperly found

Nash's testimony regarding the severity of her symptoms not

credible. (Pl.'s Mot. Summ. J. Attach. #1 Mem. P. & A. 23, ECF No.

11.) Nash contends that the reasons enumerated by the ALJ for

discounting Plaintiff's testimony do not meet the requisite "clear

and convincing" standard. (Id. at 24.) 

"In order for the ALJ to find [claimant's] testimony

unreliable, the ALJ must make 'a credibility determination with

findings sufficiently specific to permit the court to conclude that

the ALJ did not arbitrarily discredit claimant's testimony.'"

Turner v. Comm'r of Soc. Sec., 613 F.3d 1217, 1224 n.3 (9th

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Cir. 2010) (quoting Thomas, 278 F.3d at 958). "In evaluating the

credibility of a plaintiff's testimony regarding subjective pain,

an ALJ must engage in a two-step analysis." Vasquez v.

Astrue, 572 F.3d 586, 591 (9th Cir. 2009) (citing Lingenfelter v.

Astrue, 504 F.3d 1028, 1035-36 (9th Cir. 2007)); see Batson v.

Comm'r of Soc. Sec. Admin., 359 F.3d at 1196). "'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.'" Vasquez,

572 F.3d at 591 (quoting Lingenfelter, 504 F.3d at 1036). Second,

if the first step is satisfied and there is no evidence of

malingering, the ALJ can only reject the claimant's testimony about

the severity of the symptoms by giving "'specific, clear and

convincing reasons'" for doing so. Id. (quoting Lingenfelter, 504

F.3d at 1036); accord Smolen v. Chater, 80 F.3d at 1283-84. 

Notably, "the ALJ may not reject subjective symptom testimony . . .

simply because there is no showing that the impairment can

reasonably produce the degree of symptom alleged." Smolen, 80 F.3d

at 1282 (footnote omitted).

Here, Judge Godfrey concluded that Nash's impairments "could

reasonably be expected to cause the alleged symptoms . . . ." 

(Admin. R. 36, ECF No. 9.) The first prong of the ALJ's inquiry

regarding Plaintiff's credibility is therefore satisfied. See

Vasquez, 572 F.3d at 591. There is no evidence of malingering. 

Consequently, the Court must determine whether Judge Godfrey

provided clear and convincing reasons for the adverse credibility

finding that are supported by the evidence in the record. See

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Reddick v. Chater, 157 F.3d at 722 (quoting Lester v. Chater, 81

F.3d at 834).

To support a finding that the plaintiff was not credible, the

ALJ must "'point to specific facts in the record which demonstrate

that [the plaintiff] is in less pain than she claims.'" Vasquez,

572 F.3d at 592 (quoting Dodrill v. Shalala, 12 F.3d 915, 918 (9th

Cir. 1993)). The ALJ must make specific findings "stat[ing] which

pain testimony is not credible and what evidence suggests the

complaints are not credible." Dodrill, 12 F.3d at 918. A

reviewing court will not speculate as to the ALJ's reasons for

rejecting a plaintiff's allegations of disabling pain. Bunnell v.

Sullivan, 947 F.2d 341, 346 (9th Cir. 1991) (citing Murray v.

Heckler, 722 F.2d 499, 502 (9th Cir. 1983)); see also Steele v.

Barnhart, 290 F.3d 936, 941 (7th Cir. 2002) (explaining that the

ALJ must state an accurate and logical connection between the

evidence and the decision).

In general, questions of credibility are for the ALJ to

resolve. Sample v. Schweiker, 694 F.2d 639, 642 (9th Cir. 1982). 

Courts should not "second-guess" an ALJ's credibility

determination. See Allen v. Heckler, 749 F.2d 577, 580 (9th Cir.

1984) (discussing credibility of medical testimony). If the

evidence is conflicting and could be rationally interpreted more

than one way, the Court must uphold the ALJ's decision. Id. at

579.

Social Security Ruling 96-7p provides the relevant standard:

4. In determining the credibility of the individual's

statements, the adjudicator must consider the entire case

record, including the objective medical evidence, the 

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individual's own statements about symptoms, statements

and other information provided by treating or examining

physicians or psychologists and other persons about the

symptoms and how they affect the individual, and any

other relevant evidence in the case record. An

individual's statements about the intensity and

persistence of pain or other symptoms or about the effect

the symptoms have on his or her ability to work may not

be disregarded solely because they are not substantiated

by objective medical evidence.

5. It is not sufficient for the adjudicator to make a

single, conclusory statement that "the individual's

allegations have been considered" or that "the

allegations are (or are not) credible." It is also not

enough for the adjudicator simply to recite the factors

that are described in the regulations for evaluating

symptoms. The determination or decision must contain

specific reasons for the finding on credibility,

supported by the evidence in the case record, and must be

sufficiently specific to make clear to the individual and

to any subsequent reviewers the weight the adjudicator

gave to the individual's statements and the reasons for

that weight.

SSR 96-7p, 1996 SSR LEXIS 4, at *2-4 (July 2, 1996).

The Ninth Circuit has articulated the grounds on which an ALJ

may properly discredit a claimant's testimony: 

In weighing a claimant's credibility, the ALJ may

consider [claimant's] reputation for truthfulness,

inconsistencies either in his testimony or between his

testimony and his conduct, his daily activities, his work

record, and testimony from physicians and third parties

concerning the nature, severity, and effect of the

symptoms of which he complains.

Light v. Soc. Sec. Admin., 119 F.3d 789, 792 (9th Cir. 1997)

(citations omitted). Where the ALJ's credibility assessment is

supported by substantial evidence, it will not be disturbed even

where some of the reasons for discrediting a claimant's testimony

were improper. Carmickle v. Comm'r, Soc. Sec. Admin., 533 F.3d

1155, 1163 (9th Cir. 2008); see also Tonapetyan v. Halter, 242 F.3d

at 1147-48.

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The ALJ in this case rejected Plaintiff's testimony about her

subjective symptoms as not credible. (Admin. R. 35, ECF No. 9.) 

The decision first explains that Nash's activities of daily living

do not support a finding of disability. Judge Godfrey specified

that "independently caring for her own personal hygiene; light

housework; cooking; laundry duties; taking walks; reading;

attending doctor's appointments; and trying to live a 'normal'

life" were all actions not consistent with having a disabling

condition. (Id.)

Plaintiff argues that none of the activities requires the

"consistent mental acuity attendant to full-time work." (Pl.'s

Mot. Summ. J. Attach. #1 Mem. P. & A. 24, ECF No. 11.) Nash also

points out that although a credibility determination may be based

on a claimant's daily activities, the claimant must engage in them

for a substantial part of the day. (Id.) 

The Ninth Circuit has held the "mere fact that a plaintiff has

carried on certain daily activities, such as grocery shopping,

driving a car, or limited walking for exercise, does not in any way

detract from her credibility as to her overall disability." 

Vertigan v. Halter, 260 F.3d 1044, 1050 (9th Cir. 2001). One does

not need to be "utterly incapacitated" to be disabled. Fair v.

Bowen, 885 F.2d 597, 603 (9th Cir. 1989). "[M]any home activities

are not easily transferable to what may be the more grueling

environment of the workplace, where it might be impossible to

periodically rest or take medication." Id. 

The Ninth Circuit has identified some of the factors for

deciding whether a claimant's daily activities may be the basis for

an adverse credibility determination. Orn v. Astrue, 495 F.3d at

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639. The court will consisder whether a claimant's daily

activities contradict the claimant's other testimony. Id. It will

also determine whether the daily activities meet the threshold for

transferable work skills. Id. "The ALJ must make 'specific

findings relating to [the daily] activities' and their

transferability to conclude that a claimant's daily activities

warrant an adverse credibility determination." Id. (alteration in

original) (quoting Burch v. Barnhart, 400 F.3d 676, 681 (9th Cir.

2005)).

Defendant does not discuss the standard for evaluating Nash's

daily activities or whether the ALJ correctly applied it in this

case. Instead, the Commissioner restates that Plaintiff engages in

normal daily activities, including "getting out every day and

taking walks." (Cross-Mot. Summ. J. Attach. #1 Mem. P. & A. 7, ECF

No. 13.) Although Plaintiff filled out a questionnaire describing

her activities of daily living, (Admin. R. 292-308, ECF No. 9), and

her doctor concluded that Nash was able to carry out activities of

daily living, (id. at 547), Plaintiff stated that during periods of

depression, she sometimes did not leave her apartment. (Id. at

93.) Plaintiff testified that she suffers from manic periods when

she feels either "really high or really low," and sometimes has

crying spells that last for days. (Id. at 78, 83.)

The ALJ does not mention whether Plaintiff's daily activities

contradicted her other testimony. (Id. at 35); see Orn, 495 F.3d

at 639. Furthermore, to rely on a Plaintiff's daily activities to

support an adverse credibility determination, the claimant's daily

activities must correspond to transferable work skills. See Orn,

495 F.3d at 639. Here, Judge Godfrey did not attempt to correlate

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Plaintiff's activities to a particular type of job, nor did she

discuss whether Nash engaged in these physical activities for a

substantial part of the day. See Reddick, 157 F.3d at 722 (holding

that sporadic activities followed by periods of rest are not

inconsistent with subjective complaints of severe pain).

The next two reasons stated by the ALJ for rejecting Nash's

symptom testimony involve her physical impairment. The decision

argues that Nash denied being depressed or suicidal on October 20,

1997, and contemporaneous records showed that Plaintiff's Meniere's

disease symptoms were slowly improving. (Admin. R. 35, ECF No. 9.) 

In her Motion, Plaintiff argues that the records generated by

physicians who treated her for Meniere's disease do not adequately

reflect her psychiatric disorder. (Pl.'s Mot. Summ. J. Attach. #1

Mem. P. & A. 25, ECF No. 11.) 

The medical records from October 20, 1997, reflect Plaintiff's

surgery and follow-up visit in connection with her Meniere's

disease. Plaintiff's Meniere's disease is not the principal basis

of her disability claim. Still, a review of the notes from the

follow-up demonstrates that even though Nash denied being depressed

or suicidal on that day, she nonetheless requested a referral to a

psychiatrist because "several of her physicians have recommended

this in the past." (Admin. R. 409, ECF No. 9.) At the

administrative hearing, Plaintiff testified that she attempted

suicide once when she was twenty. (Id. at 83.)

Evidence in the record about Plaintiff's follow-up visit on

October 20, 1997, is not inconsistent with Nash's testimony

regarding the severity of her symptoms. Additionally, Plaintiff's

lack of insight into her disease is reflected in other medical

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evidence. For example, Nash admitted to Dr. Glassman that she told

her primary care doctor that she had recently driven "to the

railroad tracks" with a plan to kill herself, at the same time

denying having mental problems and attributing her issues to

Meniere's disease. (Id. at 430-31.) Dr. Glassman reported that

"[Nash] has a history of one suicide attempt in her early 20s when

she 'took a butcher knife out.'" (Id. at 432.)

The ALJ also questioned Plaintiff's credibility based on her

statements to staff at the Neighborhood Healthcare Center on

January 14, 2009, and to Dr. Glassman on March 21, 2009, that "she

had not worked since 1996," while her earnings records demonstrated

otherwise. (Id. at 35.) Plaintiff argues that she had no

intention to deceive the medical professionals, and that her actual

statements convey that she has not held a permanent full-time

position since 1997. (Pl.'s Mot. Summ. J. Attach. #1 Mem. P. & A.

25, ECF No. 11.) The Commissioner replies that the ALJ may

consider any inconsistencies between the claimant's testimony and

her work record in assessing Nash's credibility. (Cross-Mot. Summ.

J. Attach. #1 Mem. P. & A. 6, ECF No. 13.) 

"In reaching a credibility determination, an ALJ may weigh

inconsistencies between the claimant's testimony and his or her

conduct, daily activities, and work record, among other factors."

Bray v. Comm'r of Soc. Sec. Admin., 554 F.3d 1219, 1227 (9th Cir.

2009); see Light v. Soc. Sec. Admin., 119 F.3d 789, 792 (9th Cir.

1997). The ALJ's credibility findings "'must be sufficiently

specific to allow a reviewing court to conclude the [ALJ] rejected

[the] claimant's testimony on permissible grounds and did not

arbitrarily discredit the claimant's testimony.'" Moisa v.

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Barnhart, 367 F.3d 882, 885 (9th Cir. 2004) (alteration in

original) (quoting Rollins v. Massanari, 261 F.3d 853, 856-57 (9th

Cir. 2001)). If the ALJ's interpretation of the claimant's

testimony is reasonable and is supported by substantial evidence,

it is not the court's role to "second-guess" it. Rollins, 261 F.3d

at 857.

As an initial matter, the Commissioner does not claim that

Nash misrepresented her work history at the administrative hearing. 

Despite having trouble remembering specific dates, Nash responded

to questions about her relevant work experiences. (See Admin. R.

51-62, ECF No. 9.) The ALJ's decision does not point to any

inconsistencies between Nash's testimony at the hearing and her

work records. 

With regard to Plaintiff's statements to her doctors, the ALJ

failed to explain how those demonstrate that Nash was not candid or

forthcoming regarding her work history. The one-page Neighborhood

Healthcare progress notes from January 14, 2009, state that Nash

"hasn't worked since 1996[.]" (Id. at 397.) It is not clear in

what context Plaintiff made that statement. Statements to Dr.

Glassman are not as damning as the ALJ suggests. Dr. Glassman's

evaluation indicates that Plaintiff "last worked full time in

1997," and her "last temporary job was in June 2008 as an

administrative assistant." (Id. at 430.) Dr. Glassman also noted

that Nash was "a very poor historian, very scattered and somewhat

disorganized." (Id. at 431.)

The fact that Nash did not provide a complete account of her

work history to the Neighborhood Healthcare is not sufficient

reason for discrediting her testimony. At the administrative

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hearing, Nash testified about her various full-time, part-time, and

temporary jobs. (Id. at 51-61.) For example, she described

working at Helix High School for one and one-half hours a day; her

hours increased up to twenty hours a week; and eventually she

worked up to thirty hours a week. (Id. at 54-55.) Plaintiff

disclosed these positions to the Social Security Administration in

the questionnaires she completed. (Id. at 271, 284.) Plaintiff's

spotty work history and variable description of her work history

are consistent with her symptoms of having disorganized and

tangential thought process, as noted by both Dr. Glassman and her

treating psychiatrist, Dr. Rodarte. See Pangus v. Colvin, No. EDCV

12–00103–MAN, 2013 WL 2285343, at *4 (C.D. Cal. May 23, 2013)

("Rather than detracting from plaintiff's credibility, as the ALJ

concluded, plaintiff's inability to recall the details surrounding

the procedures he has undergone and his diagnoses appears to be

consistent with his learning disability and his testimony that he

experiences confusion.") The ALJ's reference to deception is not

supported by the record.

The administrative law judge also found Nash not credible

based on her refusal to take psychiatric medications or medications

for her physical symptoms; as reported on December 16, 2008,

Plaintiff took only vitamins, amino acids, and fish oil at that

time. (Admin. R. 35-36, ECF No. 9.) Plaintiff argues that the

ALJ's reasoning is inconsistent because Judge Godfrey also found

that Nash's condition improved with lithium. (Pl.'s Mot. Summ. J.

Attach. #1 Mem. P. & A. 25-26, ECF No. 11.)

An ALJ may find that a claimant's unexplained or inadequately

explained refusal to seek or follow a course of treatment, that

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would alleviate the alleged disabling symptoms, supports finding

that the claimant's testimony was not credible. See Smolen v.

Chater, 80 F.3d at 1284 (stating that ALJ may consider a claimant's

compliance with her prescribed treatment in assessing the

credibility of a claimant's testimony regarding the severity of her

symptoms); see also Lewis v. Apfel, 236 F.3d 503, 513–14 (9th Cir.

2001) (ALJ properly rejected a treating physician's letter that the

claimant's seizures had not been fully controlled where other

evidence in the record suggested that the claimant had not

consistently complied with his treatment regime); 20 C.F.R.

§ 404.1530(a) (“In order to get benefits, you must follow treatment

prescribed by your physician if this treatment can restore your

ability to work.”); 20 C.F.R. § 404.1530(b) ("If you do not follow

the prescribed treatment without a good reason, we will not find

you disabled . . . ."). In evaluating a claimant's reasons for

failing to follow prescribed treatment, the ALJ must consider,

among other things, the claimant's physical and mental limitations. 

See 20 C.F.R. § 404.1530(c).

Plaintiff's unwillingness to take psychiatric medications in

the past is related to her lack of insight into her disorder. 

During her evaluation with Dr. Glassman, Nash insisted that she was

not psychotic and did not need to take the "psychiatric meds." 

(Admin. R. 432, ECF No. 9.) Plaintiff eventually began taking

lithium and was compliant with her treatment at the time of the

hearing. Judge Godfrey did not take into account Nash's

psychiatric condition as a possible explanation for Plaintiff's

claimed refusal to take psychiatric medications. See 20 C.F.R.

§ 404.1530(c). The conclusion that Nash's prior refusal to take

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medication warrants finding that her testimony is not credible is

not supported by substantial evidence. See Brashears v. Apfel, 73

F. Supp. 2d 648, 652 (W.D. La. 1999) (remanding where evidence from

mental health provider show plaintiff's noncompliance may be beyond

her control); see also Sharp v. Bowen, 705 F. Supp. 1111, 1123–24

(W.D. Pa. 1989) (diabetic who injected insulin into his pillow and

ate junk food rather than prescribed diet did so because of severe

personality disorder, providing justifiable cause for

noncompliance). "The 'reasonable man' standard . . . is clearly

not applicable to [mentally ill claimants]. . . . To deny this

person benefits . . . because he is not acting under a 'reasonable

fear' mocks the idea of disability based on mental impairments." 

Benedict v. Heckler, 593 F. Supp. 755, 761 (E.D.N.Y. 1984) (using a

subjective definition of justifiable cause for refusing treatment). 

Because there is evidence in the record that Nash's prior refusal

to take psychiatric medications was related to her disorder, and

not a result of her conscious choice, the ALJ's finding was error. 

Judge Godfrey also found Nash not credible because she was

able to take college courses until stopping in 2005. (Admin. R.

35, ECF No. 9.) The ALJ concluded that the level of attention

required for graduate courses was inconsistent with an inability to

perform any work. (Id. at 36.) Plaintiff argues that ceasing to

attend college courses does not make a mental disability claim

suspect, and there is no evidence her attendance had been regular. 

(Pl.'s Mot. Summ. J. Attach. #1 Mem. P. & A. 26, ECF No. 11.) 

The evidence in the record does not show that Nash was a fulltime student and spent a substantial period of her day at school or

engaged in school activities. She testified at the hearing that it

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took her fourteen years and special accommodations to obtain her

undergraduate degree. (Id.) The ALJ did not specify how

Plaintiff's attempts to continue schooling demonstrate her ability

to engage in substantial gainful activity. The ability to perform

limited activities such as attending college is not substantial

evidence that her symptoms are not disabling. See 20 C.F.R.

§ 404.1572(c) ("Generally, we do not consider activities like

taking care of yourself, household tasks, hobbies, therapy, school

attendance, club activities, or social programs to be substantial

gainful activity."). Other courts have found that "[a]ttending

college on a part-time basis is not the equivalent of being able to

engage in substantial gainful activity." Parish v. Califano, 642

F.2d 188, 191 (6th Cir. 1981); Cohen v. Sec'y Dept. Health & Human

Servs., 964 F.2d 524, 530 (6th Cir. 1992) (the fact that disability

claimant continued ballroom dancing and attended law school during

period for which she claimed disability benefits did not warrant a

finding that she could maintain substantial gainful employment). 

Furthermore, to the extent the ALJ implied that Plaintiff's

work history was not consistent with a disability, she failed to

consider whether the record indicates a pattern of employment that

establishes Nash's inability to sustain or keep a job due to her

psychiatric limitations. Here, the record establishes that

Plaintiff was last employed in 2006 or 2007 on a part-time basis

through a temporary agency. (Admin. R. 51, ECF No. 9.) After the

temporary work assignments ended, Nash was not able to secure other

employment. (Id. at 52.) Her sporadic work record and her 

testimony corroborate the medical evidence. Nash testified she was

unable to keep a job and that she was terminated from her training

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position with the County of Riverside for being too slow. (Id. at

53.) Dr. Rodarte, her treating psychiatrist, opined that Nash was

unable to work in any field for the next twelve consecutive months

due to her bipolar disorder. (Id. at 549.) 

Even assuming Nash could find employment, it is not clear she

could maintain it for a significant length of time. In Gatliff,

the Ninth Circuit considered whether a claimant who cannot keep a

job for more than approximately two months is considered disabled. 

Gatliff v. Comm'r of Soc. Sec. Admin., 172 F.3d 690, 694 (9th Cir.

1999). In that case, the vocational expert testified that Gatliff

could only be expected to stay in any one job for a "couple of

months" before being fired as a result of his mental impairments,

and that "Gatliff's pattern -- the ability to obtain, but not

maintain, jobs -- would continue." Id. at 691. The court rejected

the Commissioner's argument that Gatliff was capable of substantial

gainful activity because he was not precluded from moving from one

job to the next job. The Ninth Circuit observed that other

circuits have "imposed a durational requirement on the concept of

substantial gainful activity." Id. at 693. The court was

persuaded and stated that "substantial gainful activity means more

than merely the ability to find a job and physically perform it; it

also requires the ability to hold the job for a significant period

of time." Id. at 694; see Pagan v. Bowen, 862 F.2d 340, 350 (D.C.

Cir. 1988) (“The critical question is not whether the claimant has

been stable enough to work for short periods, but whether he or she

is able ‘to hold whatever job he finds for a significant period of

time.’”) (quoting Singletary v. Bowen, 798 F.2d 818, 822 (5th Cir.

1986))); Kangas v. Bowen, 823 F.2d 775, 778 (3rd Cir. 1987)

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(reversing and remanding where ALJ did not consider whether

claimant could maintain "regular, continuing or sustained"

employment in light of his frequent hospitalizations); Parish v.

Califano, 642 F.2d at 192 ("The phrase 'substantial gainful

activity' implies employment with some degree of regularity.");

Wilson v. Richardson, 455 F.2d 304, 305, 307 (4th Cir. 1972)

(finding that claimant's holding eleven jobs in three years "may

demonstrate not his ability, but his inability to engage in

substantial gainful activity[]").

Another stated reason given by the ALJ to discredit

Plaintiff's testimony was that in April of 2009, Nash told Dr.

Tamiry, an internist, that "she was doing fine" until she entered

menopause, which brought more vertigo attacks. (Admin. R. 36, ECF

No. 9.) Plaintiff points out that her statement was made in the

context of a physical evaluation and did not necessarily reflect

her psychological state. (Pl.'s Mot. Summ. J. Attach. #1 Mem. P. &

A. 26, ECF No. 11.) As discussed above, the record is replete with

evidence of Plaintiff's lack of insight into her psychiatric

condition, and her attributing her problems to vertigo or Meniere's

disease. If anything, the statement regarding her "doing fine" is

consistent with that pattern. 

Judge Godfrey also found Nash not credible on the basis that

neither treating physicians nor a state agency doctor opined that a

listing level limitation was met or equaled. (Admin. R. 36, ECF

No. 9.) As mentioned above, Dr. Jonas, the medical expert, opined

that Nash met listing 12.03. (Id. at 94, 109.) Still, he also

observed that Nash suffered from a "range of issues." (Id. at 94.) 

He testified that the range included "12.04 [affective disorder],

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references, at least in the personal testimony to 12.06 [anxietyrelated disorders], some consideration to 12.07 [somatoform

disorders], and in [exhibit] 5F we get 12.08 [personality

disorder]. . . ." (Id.) "[Affective disorder] interestingly is

the working diagnosis for the treater . . . ." (Id.)

Finally, the ALJ made a general statement that the medical

record does not establish impairments that could produce disabling

pain or other limitations as alleged for any period of twelve or

more continuous months. (Id. at 36.) This reason does not

directly support an adverse credibility determination. As

discussed above, the opinions of the treating and consultative

psychiatrists, when properly credited, as well as that of the

medical expert, provide ample evidence of disability.

In sum, the ALJ failed to provide clear and convincing reasons

for finding Plaintiff's testimony not credible. See Reddick v.

Chater, 157 F.3d at 722. This constitutes error. 

C. Remand for Award of Benefits

"Remand for further administrative proceedings is appropriate

if enhancement of the record would be useful." Benecke v.

Barnhart, 379 F.3d 587, 593 (9th Cir. 2004) (citing Harman v.

Apfel, 211 F.3d 1172, 1178 (9th Cir. 2000)). If, however, the

record has been fully developed and further proceedings would serve

no useful purpose, the court should remand for an immediate award

of benefits. Id. at 593 (citing Smolen, 80 F.3d at 1292). 

More specifically, the district court should credit

evidence that was rejected during the administrative

process and remand for an immediate award of benefits if

(1) the ALJ failed to provide legally sufficient reasons

for rejecting the evidence; (2) there are no outstanding

issues that must be resolved before a determination of

disability can be made; and (3) it is clear from the

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record that the ALJ would be required to find the

claimant disabled were such evidence credited. 

Id. (citing Harman, 211 F.3d at 1178).

In this case, the Harman test is satisfied. The ALJ did not

provide legally sufficient reasons for rejecting the opinions of

Dr. Rodarte, Plaintiff's treating psychiatrist; Dr. Glassman, an

examining psychiatrist; and Dr. Jonas, an independent medical

expert. The examining psychiatrist Dr. Glassman assessed her GAF

at 45 in March 2009, finding that "[s]he has major problems

functioning." (Admin. R. 434, ECF No. 9.) The treating

psychiatrist diagnosed bipolar I disorder with psychotic features

and assigned a GAF score of 50 in May of 2010, after Nash began her

lithium treatment. (Id. at 571.) Dr. Rodarte's notes explain that

despite the course of treatment with various doses of lithium,

Plaintiff was severely limited in her functioning due to her mental

impairment. (Id. at 576-78.) At the administrative hearing, the

independent medical expert testified that Nash met the criteria of

listing 12.03. (Id. at 94-113.) It is clear from the record that

the ALJ would be required to find Plaintiff disabled if she had

properly credited Dr. Rodarte's, Dr. Glassman's, and Dr. Jonas's

opinions. 

In Winans v. Bowen, 853 F.2d 643, 647 (9th Cir. 1988), the

Ninth Circuit found that substantial evidence did not support the

conclusion that the claimant's condition did not meet or equal a

listed impairment because the ALJ did not provide specific reasons

for disregarding the opinion of the treating physician. Rather

than remanding for further proceedings, the Ninth Circuit accepted

the treating physician's opinion and ordered the payment of

benefits. Id. In Sprague v. Bowen, 812 F.2d 1226, 1232 (9th Cir.

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1987), the Ninth Circuit awarded benefits because no legitimate

reasons were given for disregarding the physician's opinion and the

Secretary's decision was not supported by substantial evidence. 

Again, in Pitzer v. Sullivan, 908 F.2d 502, 506 (9th Cir. 1990),

the court awarded benefits when the ALJ did not provide legitimate

reasons for disregarding the opinion of the treating physician and

there was "no legitimate conflicting testimony." Accordingly, a

remand for an award of benefits is proper. 

IV. CONCLUSION

For the reasons above, the Court recommends that Plaintiff's

Motion for Summary Judgment be GRANTED, the Commissioner's CrossMotion for Summary Judgment be DENIED, and the case be REMANDED for

an award of benefits. 

This Report and Recommendation will be submitted to the United

States District Court judge assigned to this case, pursuant to the

provisions of 28 U.S.C. § 636(b)(1). Any party may file written

objections with the Court and serve a copy on all parties on or

before February 10, 2014. The document should be captioned

"Objections to Report and Recommendation." Any reply to the

objections shall be served and filed on or before February 20,

2014. The parties are advised that failure to file objections

within the specified time may waive the right to appeal the

district court's order. Martinez v. Ylst, 951 F.2d 1153 (9th Cir.

1991).

IT IS SO ORDERED.

DATED: January 24, 2014 ____________________________

Ruben B. Brooks, Magistrate Judge

United States District Court

cc:

Judge Curiel

All Parties of Record

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