Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_14-cv-02905/USCOURTS-casd-3_14-cv-02905-0/pdf.json

Nature of Suit Code: 863
Nature of Suit: Social Security - DIWC/DIWW (405(g))
Cause of Action: 42:0405id Review of HHS Decision (SSID)

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UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF CALIFORNIA

GUILLERMINA FRANCISCO,

Plaintiff,

v.

CAROLYN W. COLVIN, Acting 

Commissioner of Social Security,

Defendant.

Case No.: 14-cv-2905-BAS (WVG)

REPORT AND 

RECOMMENDATION ON 

CROSS-MOTIONS FOR 

SUMMARY JUDGMENT

(Doc. Nos. 14 and 15)

I.

INTRODUCTION

This is an action for judicial review of a decision of the Commissioner of Social 

Security (“the Commissioner”) denying plaintiff Guillermina Francisco (“Francisco”) 

disability insurance benefits and supplemental security income benefits under Title II and

Title XVI of the Social Security Act, 42 U.S.C. § 301, et seq. The parties have filed crossmotions for summary judgment and the matter is before the undersigned magistrate judge 

for preparation of a report and recommendation, which will be submitted to the Honorable 

Cynthia Bashant, U.S. District Judge. See 28 U.S.C. § 636; CivLR 72.1(c). For the reasons 

stated below, the Court recommends that Francisco’s motion for summary judgment be 

granted, that the Commissioner’s motion be denied, and that the matter be remanded for 

further administrative proceedings.

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II.

BACKGROUND

A. Procedural History

On June 20, 2011, Francisco filed a Title II application for a period of disability and 

disability insurance benefits and a Title XVI application for supplemental security income.

(Tr. 144-54.) Francisco claimed to suffer from chronic low back pain radiating to the lower 

extremities status post fusion at L5-S1, left medial epicondylitis status post bilateral ulnar 

nerve release, bilateral median neuropathy at the wrists status post bilateral carpal tunnel 

syndrome release, asthma, hypertension, anxiety, depression, and chronic headaches. (Id.)

Francisco’s applications were initially denied on October 20, 2011, and were denied 

on reconsideration on April 18, 2012. (Tr. 45-74.) Francisco sought further review. On 

May 31, 2013, Francisco, who was represented by an attorney, appeared and testified at a 

hearing in San Diego, California before Administrative Law Judge Howard K. Tremblin 

(“the ALJ”). (Tr. 28-44.) On August 13, 2013, the ALJ issued a written decision finding 

that Francisco was not disabled and denying Francisco benefits. (Tr. 10-27.) The Appeals 

Council denied Francisco’s appeal on October 6, 2014. (Tr. 1-9.)

Francisco filed this action on December 9, 2014. (Compl., Doc. No. 1.) The 

Commissioner answered the complaint on April 27, 2015. (Ans., Doc. No. 11.) Francisco 

filed her motion for summary judgment on June 29, 2015. (Pltf. Mot., Doc. No. 14.) The 

Commissioner filed her cross-motion on July 29, 2015. (Def. Mot., Doc. No. 15.)

B. Medical Records

The administrative record before the ALJ contained the following medical records 

relating to Francisco’s alleged impairments1:

Francisco saw Robert E. Scott, M.D. at least seven times between January 17, 2007 

and September 24, 2007. (Tr. 578-602.) Dr. Scott noted that Francisco suffered lower back 

 

1 The Court here summarizes only the records relied on by the ALJ in his written decision, and by the 

parties in their cross-motions, as well those other records that the Court regards as particularly relevant. 

The Court has reviewed the entire administrative record.

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pain following a slip and fall at work on September 22, 2006. (Tr. 598.) Dr. Scott noted 

that Francisco’s situation was complicated by a prior low back injury sustained in the late 

1990s, for which Francisco had lumbar fusion surgery. (Tr. 599.) Dr. Scott noted “limited” 

lumbar spine motion and “generalized lumbar paraspinal tenderness.” (Tr. 579.)

Francisco saw David M. Kupfer, M.D. on thirty-four occasions between January 17, 

2008 and November 18, 2010. (Tr. 290-410.) On first examining Francisco, Dr. Kupfer 

noted “carpal tunnel findings” and “ulnar neuropathy,” with symptoms worse on the left 

side than the right. (Tr. 409.) On September 19, 2008, Dr. Kupfer noted that Francisco 

reported “significant increase in the pain and numbness especially in the left hand.” (Tr. 

388.) On January 22, 2009, Dr. Kupfer noted that the discomfort was “now significant 

enough to result in significant sleep disruption.” (Tr. 380.) In a preoperative report, dated 

January 21, 2010, Dr. Kupfer noted that Francisco “admits to marked mood swings with 

significant periods of depression as a result of the chronic pain in both arms and the 

difficulty obtaining treatment including the prescribed medication.” (Tr. 344.) Dr. Kupfer 

also noted that Francisco “is plagued with substantial insomnia as a result of this pain ...

and admits to suicidal ideation.” (Id.) Dr. Kupfer performed carpal tunnel decompression 

surgery on Francisco’s right arm on February 4, 2010. (Tr. 342.) On May 6, 2010, Dr. 

Kupfer noted sustained improvement in all symptoms in Francisco’s right arm. (Tr. 328.)

Dr. Kupfer performed carpal tunnel decompression surgery on Francisco’s left arm on June 

24, 2010. (Tr. 321.) On September 9, 2010, Dr. Kupfer noted that Francisco was 

“substantially improved after the surgery for both arms but does have some residual pain,” 

principally in the left wrist. (Tr. 309.) On October 6, 2010, Dr. Kupfer found that Francisco 

was “capable of resuming her preinjury position albeit in a modified manner.” (Tr. 302.) 

Dr. Kupfer found that Francisco “would be restricted from combined highly repetitive hand 

and wrist activity such as typing data entry or other comparative behaviors exceeding 30 

minutes per hour.” (Id.) Dr. Kupfer also noted his recommendation that Francisco “be 

provided with a limited course of psychological counseling given the obvious clinical 

depression emanating from the chronic pain accentuated by the inappropriate delay in 

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providing surgical intervention.” (Id.) On November 18, 2010, Dr. Kupfer opined that 

maximal medical improvement had been achieved as of September 29, 2010. (Tr. 294.) 

On October 5, 2010, Francisco was evaluated by Lawrence S. Pohl, M.D. (Tr. 290-

93.) Dr. Pohl found that “the right carpal tunnel and right cubital tunnel have significantly 

improved.” (Tr. 292.) Dr. Pohl noted, however, that Francisco suffered from “mild constant 

pain in the left hand, wrist and elbow which becomes moderate with repetitive use of the 

hand.” (Tr. 291.) Dr. Pohl found that Francisco’s upper extremity symptoms had reached 

“maximal medical improvement.” (Id.) Dr. Pohl opined that Francisco could return to 

work, “although not to her usual and customary duties,” as “[s]he would not be able to do 

repetitive use of the hand for more than 30 minutes out of a 60 minute period.” (Id.) Dr. 

Pohl opined that Francisco “should avoid repetitive use of the hands including typing, data 

inputting, gripping and grasping for approximately 30 minutes in an hour.” (Id.) Dr. Pohl 

also concurred with Dr. Kupfer’s opinion that Francisco would need “psychological 

evaluation and possibly some short term psychological treatment.” (Tr. 292.) 

On November 19, 2010, Francisco saw Luis Sandoval, M.D., at Neighborhood 

Healthcare in Escondido, California. (Tr. 518-520.) Dr. Sandoval noted that Francisco 

presented with depression and anxiety. (Tr. 518.) Dr. Sandoval noted that Francisco 

admitted that “currently she wants to end her life, though she does not have a plan at the 

moment, but in the past she has tried to overdose on pills and has gotten into car accidents 

purposefully.” (Id.) Dr. Sandoval noted past instances of self-harm. (Tr. 519.) Dr. Sandoval 

noted that, in the previous week, Francisco had “contemplated running [her] car into 

propane truck, but thought of [her] daughter and decided not to.” (Id.) Dr. Sandoval noted 

that Francisco reported a two-month hospitalization for depression, a history of sexual 

abuse as a teenager, and physical and verbal abuse in her marriage. (Id.) Dr. Sandoval 

concluded that Francisco required immediate hospitalization. (Tr. 520.) Escondido police 

were called to escort Francisco to hospital. (Id.)

Between January 19, 2011 and November 9, 2012, Francisco saw Rogelio 

Samorano, M.D., also at Neighborhood Healthcare, on over twenty occasions. (Tr. 454-

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513.) On January 19, 2011, Dr. Samorano noted that Francisco reported experiencing a 

“running commentary” of negative audio hallucinations on a daily basis. (Tr. 512.) Dr. 

Samorano diagnosed Francisco with “major depressive disorder, recurrent, severe with 

psychotic features.” (Tr. 513.) On February 9, 2011, Dr. Samorano noted that Francisco 

presented with “severe major depression with command auditory hallucinations” and 

suicidal ideation. (Tr. 511.) Dr. Samorano noted that Francisco was 

“unresponsive/catatonic for 5 minutes during the visit, not responding to verbal or visual 

cues.” (Id.) Emergency services were again called. (Id.) Following the February 9, 2011 

office visit, Francisco saw Dr. Samorano on over twenty occasions. (Tr. 463-509.) Over 

that period, Francisco continued to present with auditory hallucinations and a “restricted, 

dysphoric” affect, but she no longer exhibited suicidal ideation. (Id.) Dr. Samorano 

continued to assess Francisco as suffering from major depressive disorder. (Id.) On at least 

one occasion, Francisco presented to Neighborhood Healthcare outside of her regularly 

scheduled visits because of feeling “overwhelmed.” (Tr. 481.) Dr. Samorano noted that 

Francisco informed him that she had been raped when she was sixteen and that her oldest 

daughter was the product of this incident. (Id.) Dr. Samorano also noted that Francisco 

reported that she had been raped by her father while pregnant. (Id.) On June 29, 2011, Dr. 

Samorano completed a “check-the-box”-type mental capacity assessment in which he 

opined that Francisco had “marked” limitation in twenty areas of functional capacity,

grouped under four headings: understanding and memory, sustained concentration and 

persistence, social interaction, and adaptation. (Tr. 454-56.) “Marked” limitation, for the 

purposes of Dr. Samorano’s assessment, means that “[t]he individual cannot generally 

perform satisfactorily in this area.” (Tr. 454.)

On September 21, 2011, at the request of the Department of Social Security, 

Francisco was evaluated by Romualdo R. Rodriguez, M.D., a board eligible psychiatrist. 

(Tr. 437-43.) Dr. Rodriguez noted that Francisco “appear[ed] genuine and truthful” and 

that there was “no evidence of exaggeration or manipulation.” (Tr. 440.) Dr. Rodriguez 

noted that Francisco reported a history of physical abuse as a child and teenager and a 

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history of hospitalization, possibly for psychiatric reasons. (Tr. 438.) Dr. Rodriguez noted 

that Francisco “lives in a house at a campground with her husband” and that “[Francisco] 

and her husband take care of the campground in exchange for staying in the house.” (Tr. 

439.) Regarding Francisco’s daily activities, Dr. Rodriguez noted:

[Francisco] uses a ride from others or drives a car, runs errands, goes to 

the store, cooks and makes snacks, participates in household chores and 

dresses and bathes herself. Outside activities and hobbies include TV. 

She can leave home alone, handle her own cash and pay her own bills. 

She described a good relationship with family, relative, friends, 

neighbors and others. She denied any other significant activities.

(Id.) Dr. Rodriguez noted that Francisco “makes good eye contact and good interpersonal 

contact” and was “generally cooperative.” (Tr. 439-40.) Dr. Rodriguez noted that Francisco 

was not delusional, that there was no evidence of psychotic thought content and “no current 

suicidal, homicidal, or paranoid ideation.” (Tr. 440.) Dr. Rodriguez noted that Francisco’s 

mood was “depressed” and her affect “sad and tearful.” (Id.) Dr. Rodriguez noted that 

Francisco reported feeling “helpless, hopeless, worthless, and guilty.” (Id.) Dr. Rodriguez 

diagnosed Francisco with post-traumatic stress disorder, but opined that with proper 

treatment, Francisco “could easily recover from her symptoms in the next twelve months.” 

(Tr. 441-42.) Dr. Rodriguez found that Francisco was “[a]ble to understand, remember, and 

carry out simple one or two-step job instructions”; “[a]ble to do detailed and complex

instructions”; “[s]lightly limited in her ability to relate and interact with supervisors, 

coworkers and the public”; “[s]lightly limited in her ability to maintain concentration and 

attention, persistence and pace”; “[s]slightly limited in her ability to adapt to the stresses 

common to a normal work environment”; “[s]lightly limited in her ability to maintain 

regular attendance in the work place and perform work activities on a consistent basis”; 

“[s]lightly limited in her ability to perform work activities without special or additional 

supervision”. (Tr. 442-43) (emphasis in original).

On October 4, 2011, Francisco was evaluated by Thomas J. Sabourin, M.D., an

orthopedic surgeon. (Tr. 445-49.) Dr. Sabourin noted that Francisco exhibited a 

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“generalized tenderness in the left forearm” (Tr. 447), but that the “severity and duration 

of her symptoms in the upper extremities [was] disproportionate to the determinable 

condition” (Tr. 449). Dr. Sabourin noted that Francisco had “no true neurological deficit.” 

(Id.) Dr. Sabourin opined that “based on [Francisco’s] back problem, she does have some 

significant limitations.” (Id.) Dr. Sabourin continued:

She could only lift and carry 20 pounds occasionally and 10 pounds 

frequently. She could stand and walk up to six hours in an eight-hour 

workday and sit for six hours in an eight-hour workday. Push and pull 

limitations are equal to lift and carry limitations. She could climb, 

stoop, kneel, and crouch only occasionally. She does have manipulative 

limitation due to her surgeries. She can do gross or fine manipulation 

only frequently [sic] using the right or left hand. She has no need for 

assistive devices.

(Id.)

On June 17, 2013, Francisco was evaluated by Thomas A. Schweller, M.D., a 

neurologist. (Tr. 871-73.) Dr. Schweller noted his impression that Francisco suffered from 

chronic low back pain, bilateral median neuropathy at the wrists, left medial epicondylitis, 

chronic depression, chronic headaches and incompletely controlled hypertension. (Tr. 

873.) Regarding Francisco’s functional capacity, Dr. Schweller opined that:

[Francisco] would be able to sit, stand, and walk for six hours out of an 

eight-hour day. She would be able to lift 20 pounds occasionally and 

10 pounds frequently, with occasional limits in bending, stooping, and 

squatting. She would have no kneeling or crawling limitations. She 

would have no upper extremity fine or gross manipulation limitations 

... Her headaches do not appear to be neurologic in nature. They do not 

appear to be typical migraine headaches but appear to be a combination 

of tension headaches and possibly poorly controlled hypertension. It 

does appear that she has evidence for depression, which contributes to 

her condition.” 

(Id.)

C. Francisco’s Testimony

Francisco testified at a hearing before the ALJ on May 31, 2013. Francisco testified 

that she was forty-six years old and had a seventh grade education. (Tr. 31.) She testified 

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that she last worked in 2007. (Id.) She testified that her responsibilities in her most recent 

employment had initially been shipping, receiving and restocking, and that she had 

subsequently been placed in accounting. (Id.) She testified that she stopped working in 

2007 after having back surgery and that the decision to terminate her employment was 

made by her employer. (Tr. 32.) She also testified that she had undergone bilateral surgery 

on her arms and elbows. (Id.)

Francisco testified that, despite the surgery, she still had back pain, as well as chronic 

pain in her legs, and cramps. (Id.) She testified that the pain in her right arm had improved, 

but that her left hand was sometimes sleepy. (Tr. 32-33.) She also testified to forearm pain. 

(Tr. 33.) She testified that she is “sometimes” free from pain, but “only when [she is] 

sleeping.” (Tr. 34.) 

Francisco testified that she has had migraine headaches “for many years” and as 

often as “two times a week.” (Tr. 33.) She testified that she also has depression and anxiety. 

(Tr. 34.) She testified that she has sleep apnea and frequently feels tired. (Id.) Francisco 

testified that she takes medication for pain and to help her with her anxiety and depression. 

(Tr. 33-34.) 

Francisco testified that she can lift a gallon of milk with either hand, but “only for a 

little time.” (Tr. 35.) She testified that she sometimes drops things from her left hand. (Id.) 

She testified that she gets cramps in her arms and shoulders when she lifts her hands above 

her head. (Tr. 35.) She testified that she begins to feel pain after sitting for more than twenty 

minutes. (Id.) She testified that walking causes her pain in her back and legs. (Id.) She 

admitted that it has been several years since she tried to use a keyboard over a prolonged 

period. (Id.) 

Francisco testified that she has difficulty concentrating and remembering things. (Tr. 

36-37.) She testified that she generally does not have difficulty interacting with people. 

(Tr. 37.) Francisco testified that she lives with her husband, who works, and her fourteenyear old daughter. (Id.) She testified that during the day she stays home, cleans “a little,” 

sits down, walks and waters her plants. (Tr. 38.) 

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D. The Vocational Expert’s Testimony

Behnush Barzegarian, a vocational expert, also testified at the hearing. (Tr. 41-43.)

The ALJ asked Mr. Barzegarian about two hypotheticals. First, the ALJ asked Mr. 

Barzegarian to assume “an individual with [Francisco’s] age, education, past work[,] who 

can lift and/or carry ten pounds frequently, 20 pounds on occasion; can sit, stand or walk 

six hours; occasional postural activity; grasping, fingering, feeling, gross and fine 

manipulation frequent; no significant mental limits.” (Tr. 42.) Mr. Barzegarian testified that 

the person described in the hypothetical could perform Francisco’s past relevant work as an 

office clerk. (Id.) 

The ALJ then changed the hypothetical to an individual of the “same age, education, 

past work, sit, stand, walk; eight pounds occasionally with the right dominant, the left no 

lifting or carrying; no overhead activity; grasping, fingering, keyboarding is rarely; sitting, 

standing, walking about 20 minutes at a time with the need to change at will; bending is 

rarely; because of concentration problems, not able to understand, remember and carry out 

even simly tasks.” (Tr. 42-43.) Mr. Barzegarian testified that no work was available for the 

individual described in the second hypothetical. (Tr. 43.)

E. The ALJ’s Decision

The ALJ issued a written decision on August 13, 2013. (Tr. 13-22.) The decision 

follows the five-step process established by the Social Security Administration for 

determining whether an individual is disabled.2(Tr. 14-15.)

 

2

See 20 C.F.R. §§ 416.920, 404.1520; Tackett v. Apfel, 180 F.3d 1094, 1098-99 (9th Cir. 1999) 

(summarizing five-step process). In the first step of this five-step process, the ALJ must first determine 

whether the claimant has engaged in “substantial gainful activity.” A positive finding at this step 

disqualifies the claimant from benefits. At the second step, the ALJ determines whether the claimant has 

one or more “severe” impairments. A negative finding at this step disqualifies the claimant from benefits. 

At the third step, the ALJ determines whether the claimant’s impairment(s) is equal in severity to one of 

the “listed impairments” under the regulations. If so, then the claimant must be found to be disabled. If 

not, then the ALJ moves on to step four. Prior to step four, the ALJ must assess the claimant’s residual 

functional capacity (“RFC”), and must determine whether the claimant’s RFC permits the claimant to do 

his or her past relevant work. A positive finding at this step disqualifies the claimant from benefits. If the 

ALJ finds that that the claimant cannot do his or her past relevant work, then the ALJ must, at step five, 

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At step one, the ALJ found that Francisco was not engaged in “substantial gainful 

activity.” (Tr. 15.) The ALJ accordingly proceeded to step two.

At step two, the ALJ found that Francisco had the following severe impairments: 

chronic pain in the lower back and lower extremities, pain in the left arm, and pain in both 

wrists. (Tr. 15-17.) The ALJ also found that the following claimed impairments were not 

severe: asthma, hypertension, anxiety, depression, and chronic headaches.3(Id.) The ALJ 

accordingly proceeded to step three.

At step three, the ALJ found that Francisco did “not have an impairment or 

combination of impairments that meets or medically equals one of the listed impairments.” 

(Tr. 17.) The ALJ found that “[n]o treating or examining physician has indicated findings 

that would satisfy the severity requirements for any listed impairment .... [and] the state 

agency physicians have opined that the claimant’s condition does not meet or equal any 

listing.” (Id.) The ALJ accordingly proceeded to step four.

Before addresssing step four, the ALJ found that Francisco had the residual 

functional capacity to perform light work as defined in 20 C.F.R. 404.1567(b) and 

416.967(b). (Tr. 17-18.) The ALJ found that:

[Francisco] can lift and carry 20 pounds occasionally, 10 pounds 

frequently, stand/walk for six hours in an eight-hour workday and sit for 

six hours in an eight-hour workday with postural limitations including 

occasional climbing, stooping, kneeling and crouching as well as 

manipulative limitations including frequent use of the bilateral hands for 

gross or fine manipulation, and the claimant retains the capacity to 

perform the work-related mental activities generally required by 

competitive, remunerative work, and specifically, the claimant retains 

the ability to understand, carry out and remember simple one-to-two step 

as well as detailed and complex instructions; with mild limitations in her 

ability to: interact, relate and respond appropriately to supervisors, 

 

consider whether the claimant is capable of doing any other work available in the national economy. If 

the ALJ makes a negative finding at step five, then the claimant is found to be disabled. 

3

In what appears to be a typographical error, the ALJ listed asthma, hypertension and chronic headaches 

among the impairments he found to be severe. (Tr. 15.) The ALJ’s discussion of these conditions, (Tr. 16) 

however, makes clear that he actually found these conditions to be non-severe. 

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coworkers, the general public and work situations; maintain 

concentration and attention, persistence and pace; maintain regular 

attendance in the workplace and perform work activities on a consistent 

basis; perform work activity without special or additional supervision; 

and deal with changes and adapt to stresses common in a routine work 

setting.

(Id.) In making this determination, the ALJ expressly rejected the opinion of Francisco’s 

treating psychiatrist, Rogelio Samorano, M.D., finding that the opinion was in the form of 

a checklist, was unsupported by objective evidence, and was contradicted by the opinion 

of “nearly every examining physician of record.” (Tr. 21.) The ALJ also found that 

Francisco’s testimony “concerning the intensity, persistence and limiting effects of [her] 

symptoms [was] not entirely credible.” (Tr. 20.)

At step four, the ALJ considered the testimony of the vocational expert and found 

that Francisco was able to perform her past relevant work as an office clerk. (Tr. 22.) As 

such, the ALJ found that Francisco was not disabled. (Id.)

III.

STANDARD OF REVIEW

A district court has the “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 case for a rehearing.” 42 U.S.C. § 405(g). 

The decision of the Commissioner, however, should only be disturbed if it is not supported 

by substantial evidence or if it is based on legal error. Burch v. Barnhart, 400 F.3d 676, 

679 (9th Cir. 2005). Substantial evidence is evidence that a reasonable mind would accept 

as adequate to support the conclusion. Id.; see also Bayliss v. Barnhart, 427 F.3d 1211, 

1214 n.1 (9th Cir. 2005) (“[It] is more than a mere scintilla but less than a preponderance.”) 

Where evidence is susceptible to more than one rational interpretation, the ALJ’s decision 

should be upheld. Andrews v. Shalala, 53 F.3d 1035, 1039-40 (9th Cir. 1995).

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IV.

DISCUSSION

Francisco contends: (1) that the ALJ erred at step two when he found that Francisco 

did not suffer from a severe mental impairment; (2) that the ALJ erred at step three when 

he failed to find that Francisco suffered from a mental impairment that qualified as an 

affective disorder under the listings; (3) that the ALJ erred in assessing her residual 

functional capacity by (a) improperly determining that Francisco’s testimony was not fully 

credible, (b) failing to properly assess Francisco’s mental impairment, (c) failing to develop 

the record regarding the opinion of treating physician Robert E. Scott, M.D., and (d) failing

to conduct an individualized assessment of the impact of obesity; and (4) that the 

hypothetical that the ALJ posed to the vocational expert did not accurately reflect 

Francisco’s true residual functional capacity.

Francisco’s arguments concerning the ALJ’s credibility determination and the ALJ’s 

decision to discount the opinion of Francisco’s treating psychiatrist are at the center of each 

of Francisco’s major contentions. The Court will accordingly address these two arguments 

first and then move on to Francisco’s remaining points. 

A. The ALJ’s determination that Francisco’s testimony was not fully 

credible was erroneous.

The Court first addresses Francisco’s contention that the ALJ erred by finding

Francisco’s testimony was not entirely credible. Francisco argues that the ALJ improperly 

made a general determination regarding Francisco’s credibility and failed to provide 

specific, clear and convincing reasons for discrediting Francisco’s testimony. As explained

below, the Court finds that the ALJ’s credibility determination was erroneous.

“In assessing the credibility of a claimant’s testimony regarding subjective pain or 

the intensity of symptoms, the ALJ engages in a two-step analysis.” Molina v. Astrue, 674 

F.3d 1104, 1112 (9th Cir. 2012). The ALJ initially must determine whether there is 

“objective medical evidence of an underlying impairment which could reasonably be 

expected to produce the pain or other symptoms alleged.” Id. “When an [ALJ] determines 

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that a claimant for Social Security benefits is not malingering and has provided objective 

medical evidence of an underlying impairment which might reasonably produce the pain 

or other symptoms she alleges, the ALJ may reject the claimant’s testimony about the 

severity of those symptoms only by providing specific, clear, and convincing reasons for 

doing so.” Brown-Hunter v. Colvin, 806 F.3d 487, 488-89 (9th Cir. 2015).

“In determining credibility, an ALJ may engage in ordinary techniques of credibility 

evaluation, such as considering claimant’s reputation for truthfulness and inconsistencies 

in claimant’s testimony.” Burch, 400 F.3d at 680. The ALJ must also consider, as relevant 

in the particular case, the factors listed in Social Security Ruling 88-13, which include 

“[t]he nature, location, onset, duration, frequency, radiation, and intensity of any pain,” 

“[p]recipitating and aggravating factors,” “[t]ype, dosage, effectiveness, and adverse sideeffects of any pain medication,” “[t]reatment, other than medication, for relief of pain,” 

“[f]unctional restrictions,” and “[t]he claimant’s daily activities.” Id. Although the ALJ 

may consider the extent to which the claimant’s subjective complaints are supported by 

objective medical evidence, “an ALJ may not reject a claimant’s subjective complaints 

based solely on a lack of medical evidence to fully corroborate the alleged severity of the 

pain.” Id. (citing Bunnell v. Sullivan, 947 F.2d 341, 345 (9th Cir. 1991)). 

The clear and convincing standard is “the most demanding required in Social 

Security cases” and “is not an easy requirement to meet.” Garrison v. Colvin, 759 F.3d 

995,1015 (9th Cir. 2014) (quoting Moore v. Comm’r of Soc. Sec. Admin., 278 F.3d 920, 

924 (9th Cir. 2002)). To permit meaningful judicial review of the credibility determination,

the ALJ must “specify which testimony she finds not credible, and then provide clear and 

convincing reasons supported by evidence in the record to support that credibility 

determination.” Brown-Hunter, 806 F.3d at 488-89; see also SSR 96-7p at *4 (“The 

determination or decision must contain specific reasons for the finding on credibility, 

supported by 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.”). “General findings are 

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insufficient; rather, the ALJ must identify what testimony is not credible and what evidence 

undermines the claimant’s complaints.” Reddick v. Chater, 157 F.3d 715, 722 (9th Cir. 

1998); see also Holohan v. Massanari, 246 F.3d 1195, 1208 (9th Cir. 2001) (“[T]he ALJ 

must specifically identify the testimony she or he finds not to be credible and must explain 

what evidence undermines the testimony.”).

Here, the ALJ expressly found that “[Francisco’s] medically determinable 

impairments could reasonably be expected to cause the alleged symptoms.” (Tr. 20.) This 

finding satisfied the first step of the credibility analysis. The ALJ also made no finding of 

malingering. Therefore, before discrediting Francisco’s testimony, the ALJ was required

to “specify which testimony [he found] not credible, and then provide clear and convincing 

reasons supported by evidence in the record to support that credibility determination.” 

Brown-Hunter, 806 F.3d at 489. 

As an initial matter, the ALJ’s highly generalized adverse credibility determination 

failed to identify the specific statements that the ALJ found unworthy of belief and so did 

not provide the basic information necessary to ensure meaningful judicial review. The 

Ninth Circuit has repeatedly instructed that the ALJ must “specify which testimony [the 

ALJ] finds not credible.” Brown-Hunter, 806 F.3d at 489; see id. at 493 (holding that the 

ALJ erred by making only a single general finding that “claimant’s statements concerning 

the intensity, persistence and limiting effects” of symptoms were not credible); Treichler 

v. Comm’r of Soc. Sec. Admin., 775 F.3d 1090, 1102-03 (9th Cir. 2014) (same). Here, the 

ALJ wrote that “[Francisco’s] statements concerning the intensity, persistence and limiting 

effects of [her] symptoms are not entirely credible” and that “[Francisco’s] allegations of 

disabling pain and limitation are inconsistent with the evidence of record and are, therefore, 

not fully credible.” (Tr. 20-21.) Although Francisco testified to several different physical 

and mental impairments, the ALJ did not specify which specific parts of Francisco’s 

testimony he discredited. This error alone is fatal to the credibility determination.

The Court also finds that the ALJ failed to identify with sufficient clarity the specific 

reasons underpinning his decision to discount Francisco’s testimony. In her submission to 

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this Court, the Commissioner identifies several reasons for the ALJ’s credibility 

determination. (Def. Mot. 17-18.) These include a lack of objective medical support for 

Francisco’s allegations of disabling limitation and inconsistencies between Francisco’s 

claims and her “ordinary activities of daily living.” (Id.) 

As the Commissioner concedes, a lack of medical support for a claimant’s 

allegations regarding the extent of her pain or limitations cannot, on its own, suffice to 

discredit the claimant’s testimony. (Def. Mot. at 17, Doc. No. 15-1.) See Burch, 400 F.3d 

at 680. The ALJ’s written decision, however, does not identify with specificity any reasons 

for his credibility determination other than a lack of consistent medical findings. Instead, 

the ALJ simply stated his credibility determination and then summarized the medical 

evidence, which included a summary of Francisco’s reported daily activities. This was 

legal error. See Brown-Hunter, 806 F.3d at 494 (“[T]he ALJ’s written decision reveals that 

she did not specifically identify any ... inconsistencies [between the claimant’s testimony 

and the record]; she simply stated her non-credibility conclusion and then summarized the 

medical evidence supporting her [residual functional capacity] determination.”); see also 

Hernandez v. Colvin, 2014 WL 185742, at *3 (C.D. Cal. Jan. 15, 2014) (“Whether accurate 

or inaccurate, the ‘reasons’ gleaned by [the Commissioner] but not specifically and 

expressly stated by the ALJ as the reason(s) for the credibility determination cannot 

properly form the basis for a judicial affirmance of the credibility determination.”).

Moreover, even assuming arguendo that the ALJ did identify an inconsistency 

between Francisco’s testimony and her activities of daily living, the record did not provide 

grounds to discount Francisco’s testimony on this basis. The Ninth Circuit has long 

recognized that “a specific finding” that “a claimant is able to spend a substantial part of 

his day engaged in pursuits involving the performance of physical functions that are 

transferable to a work setting ... may be sufficient to discredit an allegation of disabling 

excess pain.” Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989); see also Molina, 674 F.3d 

at 1112-13 (finding that claimant’s daily activities including attending church and shopping 

undermined testimony that that she was incapable of being around people without suffering 

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panic attacks). The law does not, however, require a claimant to be “utterly incapacitated” 

before he or she is adjudged disabled. Id. The Ninth Circuit therefore has repeatedly 

cautioned that “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); see also Garrison, 759 F.3d at 1016 (“We have repeatedly warned that 

ALJs must be especially cautious in concluding that daily activities are inconsistent with 

testimony about pain, because impairments that would unquestionably preclude work and 

all the pressures of a workplace environment will often be consistent with doing more than 

merely resting in bed all day.”); Orn v. Astrue, 495 F.3d 625, 639 (9th Cir. 2007) (finding 

no evidence that claimant’s activities were transferable to workplace or that claimant 

engaged in such activities for a substantial part of the day); Reddick, 157 F.3d at 722 

(“[D]isability claimants should not be penalized for attempting to lead normal lives in the 

face of their limitations.”).

Here, the ALJ did not make specific findings regarding the nature of Francisco’s 

daily activities, the transferability of these activities to the workplace, or whether these 

activities were inconsistent with Francisco’s testimony. Instead, the ALJ simply 

summarized notes taken by the consultative psychiatric evaluator, Dr. Rodriguez, 

regarding Francisco’s activities:

Dr. Rodriguez indicated that [Francisco] lives in a house at a 

campground with her husband and she and her husband take care of the 

campground in exchange for housing. She continues to drive and runs 

errands, goes to the store, cooks, makes snacks, and participates in 

household chores. [Francisco’s] hobbies include watching television. 

She can leave home alone and handle her own cash as well as pay her 

own bills. [Francisco] described a good relationship with family, 

relatives, friends, neighbors, and others. She continues to maintain her 

own personal hygiene and can dress herself.

(Tr. 21.) Neither this summary, nor Dr. Rodriguez’s notes themselves, gave the ALJ a valid

basis to doubt the credibility of Francisco’s testimony. Rather, the references to driving, 

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running errands, cooking and participating in household chores are the kind of generalized, 

non-detailed observations that cannot, without more, support an adverse credibility 

determination.

To the extent that the ALJ relied on Dr. Rodriguez’s notation that “[Francisco] and 

her husband take care of the campground in exchange for staying in the house,” (Tr. 439), 

this was error. Dr. Rodriguez’s notation is entirely too ambiguous to provide the ALJ with 

a basis to doubt the credibility of Francisco’s testimony. Dr. Rodriguez’s note does not 

specify what, if anything, Francisco does around the campground. Indeed, it is unclear, on 

this record, whether Francisco does work around the campground or whether she simply 

benefits from the work that her husband does. When asked by the ALJ about her daily 

activities, Francisco testified that she “stay[s] home ... clean[s] a little ... sit[s] down ... 

walk[s] ... [waters her] plants.” (Tr. 38.) The ALJ did not further develop Francisco’s 

testimony on this point.

The Commissioner’s reliance on Burch v. Barnhart is also misplaced. In Burch, the 

Ninth Circuit reviewed an ALJ’s finding that a claimant’s daily activities—which included 

caring for her personal needs, cooking, cleaning, shopping, and interacting with family 

members—were inconsistent with her allegations of disabling limitation. 400 F.3d at 680-

681. The Ninth Circuit held that “[a]lthough the evidence of [the claimant’s] daily activities 

may also admit an interpretation more favorable to [the claimant], the ALJ’s interpretation 

was rational, and ‘[w]e must uphold the ALJ’s decision where the evidence is susceptible 

to more than one rational interpretation.’” Id. (quoting Magallanes v. Bowen, 881 F.2d 747, 

750 (9th Cir. 1989)). 

This case is readily distinguishable from Burch. Critically, in Burch the ALJ made 

a specific finding that the claimant’s testimony about her daily activities “suggest[ed] that 

[the claimant] [was] quite functional.” Id. at 680. Here, in contrast, the ALJ made no 

finding whatsoever regarding the nature of Francisco’s daily activities or the extent to 

which those activities were inconsistent with Francisco’s testimony. The ALJ in Burch also 

parsed the claimant’s testimony and provided specific reasons for discrediting specific 

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pieces of testimony. Id. at 680-81. The ALJ in this case, in contrast, made a single 

generalized determination that Francisco’s testimony was not fully credible. Further, in

Burch the ALJ relied on the claimant’s own direct testimony regarding her daily activities. 

Id. In this case, the ALJ ignored Francisco’s testimony regarding her daily activities and 

relied instead on Dr. Rodriguez’s notes. Finally, in Burch, as the Ninth Circuit expressly 

pointed out, the ALJ “did not solely rely on the minimal objective evidence and [the 

claimant’s] daily activities in discrediting her testimony ... [but] made additional specific 

findings to support his credibility determination,” including detailed findings regarding the 

claimant’s failure to seek treatment for her ailments. Id. at 680-81. Here, in contrast, the 

ALJ relied solely on the lack of objective medical evidence and on the alleged 

inconsistencies between Francisco’s testimony and her reported daily activities.

4

Francisco’s reported daily activities therefore provided the ALJ with no proper basis 

to discredit Francisco’s testimony. As the Commissioner concedes, a lack of objective 

support for the severity of a claimant’s complaints cannot alone support an adverse 

credibility determination. (Def. Mot. at 17, Doc. No. 15-1.) The ALJ therefore failed to 

provide specific, clear and convincing reasons for disbelieving Francisco’s testimony, and 

the ALJ’s credibility determination must be set aside. 

B. The ALJ failed to provide specific and legitimate reasons for rejecting the 

opinion of Francisco’s treating psychiatrist. 

The Court next addresses Francisco’s contention that the ALJ improperly 

disregarded the opinion of her treating psychiatrist, Dr. Samorano, who opined that 

Francisco had “marked” impairment in numerous areas of mental functioning. As 

explained below, the Court finds that the ALJ failed to provide specific and legitimate 

reasons supported by substantial evidence for disregarding Dr. Samorano’s opinion. 

“Generally, the opinion of a treating physician must be given more weight than the 

 

4

In an appropriate case, of course, an inconsistency between a claimant’s testimony and his or her 

activities of daily living could, without more, support an adverse credibility determination. The sparse 

record and insufficient findings here means that this is not such a case. 

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opinion of an examining physician, and the opinion of an examining physician must be 

afforded more weight than the opinion of a reviewing physician.” Ghanim v. Colvin, 763 

F.3d 1154, 1160 (9th Cir. 2014); 20 C.F.R. § 404.1527(c). “If a treating or examining 

doctor’s opinion is contradicted by another doctor’s opinion, an ALJ may only reject it by 

providing specific and legitimate reasons that are supported by substantial evidence.” Ryan 

v. Comm’r of Soc. Sec. Admin., 528 F.3d 1194, 1198 (9th Cir. 2008). In determining how 

much weight to afford to a treating physician’s opinion, the ALJ must consider, among 

other things, the “[l]ength of the treatment relationship and the frequency of examination” 

by the treating physician, the “[n]ature and extent of the treatment relationship,” the 

“[s]upportability of the physician’s opinion with medical evidence, and the consistency of 

the physician’s opinion with the record as a whole. 20 C.F.R. § 404.1527(c)(1)-(6); see 

generally Orn, 495 F.3d at 631 (discussing factors that ALJ should consider in weighing 

opinion of treating physician). “[A]n ALJ errs when he rejects a medical opinion or assigns 

it little weight while doing nothing more than ignoring it, asserting without explanation 

that another medical opinion is more persuasive, or criticizing it with boilerplate language 

that fails to offer a substantive basis for his conclusion.” Garrison, 759 F.3d at 1012-13.

Here, the ALJ gave three related reasons for disregarding Dr. Samorano’s opinion. 

First, the ALJ found that Dr. Samorano’s diagnosis of mental impairment was “based 

primarily on [Francisco’s] self-reports of voices.” (Tr. 21.) Second, the ALJ found that the 

opinion was in the form of a checklist and was unsupported by objective evidence. (Id.) 

Third, the ALJ found that Dr. Samorano’s opinion was “contradicted by ... nearly every 

examining physician of record.” (Id.) None of these reasons are supported by substantial 

evidence. 

The first reason that the ALJ gave for discrediting Dr. Samorano’s opinion is that 

Dr. Samorano’s diagnosis was based primarily on Francisco’s self-reported auditory 

hallucinations. Under Ninth Circuit law, an ALJ may discount a treating provider’s opinion 

when the “treating provider’s opinions are based ‘to a large extent’ on an applicant’s selfreports and not on clinical evidence, and the ALJ finds the applicant not credible.” Ghanim, 

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763 F.3d at 1162; see also Tommasetti v. Astrue, 533 F.3d 1035, 1041 (9th Cir. 2008) (ALJ 

properly rejected treating physician’s opinion was proper where opinion was based largely 

on claimant’s reports of pain and ALJ made adverse credibility determination). However, 

“when an opinion is not more heavily based on a patient’s self-reports than on clinical 

observations, there is no evidentiary basis for rejecting the opinion.” Ghanim, 763 F.3d at 

1162. Similarly, an ALJ may not discount a physician’s opinion on the grounds that it is 

based primarily on the claimant’s own subjective reports when the ALJ has not provided 

specific, clear and convincing reasons for discrediting the claimant’s testimony. Burrell v. 

Colvin, 775 F.3d 1133, 1141 (9th Cir. 2014).

Here, the record does not support the ALJ’s finding that Dr. Samorano 

inappropriately relied on Francisco’s self-reported auditory hallucinations. First, review of 

Dr. Samorano’s treatment notes demonstrates that the psychiatrist relied on his own 

observations, diagnoses and prescriptions, in addition to Francisco’s consistent reporting 

of auditory hallucinations. (Tr. 454-513.) Second, as already discussed, the ALJ’s adverse 

credibility finding was not proper, and there is no evidence of any sort that Francisco falsely 

reported her symptoms to her psychiatrist. Indeed, the government’s own psychiatric 

evaluator, Dr. Rodriguez, found Francisco to be “genuine and truthful,” and her account to 

be free from any evidence of “exaggeration or manipulation.” (Tr. 440.) This part of the 

ALJ’s reasoning accordingly must be set aside.

The second reason that the ALJ gave for disregarding Dr. Samorano’s opinion is that 

the opinion was in the form of a checklist unsupported by objective evidence. (Tr. 21.) This 

reason was also improper. It is quite true that “an ALJ may discredit treating physicians’ 

opinions that are conclusory, brief, and unsupported by the record as a whole or by 

objective medical findings.” Batson v. Comm’r of Soc. Sec. Admin., 359 F.3d 1190, 1195 

(9th Cir. 2004). However, an ALJ may not discredit a treating physician’s opinion, even a 

conclusory one, if it is supported by the record as a whole and by the physician’s treatment 

notes. See Burrell, 775 F.3d at 1140 (“Dr. Riley’s assessments are of the ‘check-box’ form 

and contain almost no detail or explanation. But the record supports Dr. Riley’s opinion’s 

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because they are consistent both with claimant’s testimony at the hearing and with Dr. 

Riley’s own extensive treatment notes which ... the ALJ largely overlooked.”); Esparza v. 

Colvin, — F. App’x —, 2015 WL 7567408, at *2 (9th Cir. Nov. 25, 2015) (“Although the 

treating physician’s opinions were in the form of check-box questionnaires, that is not a 

proper basis for rejecting an opinion supported by treatment notes. The treating physician’s 

extensive notes are consistent with the check-box forms and provide the basis for his 

opinion.”)

Here, Dr. Samorano’s opinion was indeed in the form of a check-box list and 

contained no supporting detail or explanation. However, in finding that Dr. Samorano’s 

opinion lacked objective support, the ALJ largely ignored or overlooked Dr. Samorano’s 

own treatment notes and those of Dr. Samorano’s colleagues at Neighborhood Healthcare.

The evidence that the ALJ overlooked these treatment notes is compelling. Notably, the 

ALJ wrote that Dr. Samorano’s notes “revealed no significant abnormalities” with “no 

suicidal/homicidal ideation.” (Tr. 21.) But Dr. Samorano’s notes are to the contrary. On 

February 9, 2011, for instance, Dr. Samorano noted that Francisco presented with “severe 

major depression with command auditory hallucinations,” accompanied by suicidal 

ideation. (Tr. 511.) Dr. Samorano diagnosed Francisco with “major depressive disorder, 

recurrent, severe with psychotic features.” (Tr. 513.) During this visit, Francisco became 

“unresponsive/catatonic for 5 minutes ... not responding to verbal or visual cues” and 

emergency services were called. (Tr. 511.) The ALJ did not mention this episode. The ALJ 

also failed to mention the medical notes of two of Dr. Samorano’s colleague at 

Neighborhood Healthcare, Dr. Rodarte and Dr. Sandoval, both of which indicated suicidal 

ideation. (Tr. 518-21.) Clearly, the ALJ “cherry picked” Dr. Samorano’s notes, choosing 

to accept only those that aligned with his conclusion and ignoring or rejecting those that 

ran contrary.

The third reason that the ALJ gave for disregarding Dr. Samorano’s opinion is that 

it was “contradicted by ... nearly every examining physician of record.” (Tr. 21.) This is 

not an accurate characterization of the record. Most tellingly, while Dr. Samorano and Dr. 

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Rodriguez disagreed as to the extent of Francisco’s mental impairment, Dr. Rodriguez did 

not, by any measure, give Francisco a clean bill of mental health. Dr. Rodriguez noted, for 

instance, that Francisco’s mood was “depressed” and her affect “sad and tearful.” (Tr. 440.) 

Dr. Rodriguez noted that Francisco reported feeling “helpless, hopeless, worthless, and 

guilty.” (Id.) Based on his evaluation, Dr. Rodriguez diagnosed Francisco with posttraumatic stress disorder and opined that Francisco was “slightly limited” in numerous 

areas of mental functioning. (Tr. 441-43.) Evidence in the record concerning treatment by 

other medical providers also speaks to Francisco’s mental difficulties. This includes the

treatment notes of Dr. Sandoval, who, like Dr. Samorano, diagnosed Francisco with major 

depressive disorder, recurrent, severe with psychotic features. (Tr. 519.) Also relevant 

were the evaluations of Dr. Pohl and Dr. Kupfer, who both diagnosed Francisco with postinjury or pain related depression. (Tr. 290, 293.) Dr. Schweller also found “evidence of 

depression.” (Tr. 873.) In evaluating an ALJ’s decision, courts must weigh “both the 

evidence that supports and the evidence that detracts from [the ALJ’s] conclusion.” 

Reddick, 157 F.3d at 720. The Court finds that the ALJ failed to consider probative 

evidence that contradicted his conclusion regarding Dr. Samorano’s opinion.

For the reasons stated, the Court finds that the ALJ’s rejection of Dr. Samorano’s 

opinion was not supported by the record. 

C. The ALJ was not under a duty to develop the record by obtaining a 

treating source opinion from Dr. Robert E. Scott

The Court next addresses Francisco’s argument that the ALJ failed to meet his duty 

to develop the record by requesting a treating source opinion of limitations from Dr. Robert 

E. Scott. As explained below, the Court finds that the ALJ was not under a duty to request 

a treating source opinion from Dr. Scott. 

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.” 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 the represented as well as to the unrepresented claimant, but 

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is heightened when the claimant is unrepresented or may be mentally ill and unable to 

protect her own interests. Tonapetyan v. Halter, 242 F.3d 1144, 1150 (9th Cir. 2001). The 

ALJ’s duty to develop the record is not unlimited and is triggered only by “[a]mbiguous 

evidence, or the ALJ’s own finding that the record is inadequate to allow for proper 

evaluation of the evidence.” Id.; see also Mayes v. Massanari, 276 F.3d 453, 459 (9th Cir. 

2001). “The ALJ may discharge this duty in several ways, including: 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. 

Francisco argues that the length of Dr. Scott’s treating relationship with Francisco 

and the “complexities of Francisco’s medical history” imposed on the ALJ a duty to request 

a medical source statement from Dr. Scott. (Pltf. Mot. 17.) Francisco does not, however, 

explain how the extensive and detailed medical records provided by Dr. Scott were 

ambiguous or inadequate to allow for proper evaluation of the evidence. Moreover, the 

Court’s own review of these medical records does not disclose any significant ambiguities 

or gaps that required the ALJ to further develop the record. See McLeod v. Astrue, 640 F.3d 

881, 884 (9th Cir. 2010) (holding that ALJ had no duty to request more information from 

treating physicians where substantially all the medical records from their treatment of the 

claimant were before the ALJ and there was nothing unclear or ambiguous about those 

records).

The Court therefore finds that the ALJ had no duty to obtain a treating source opinion 

from Dr. Scott. The ALJ’s failure to discuss Dr. Scott’s records at all is another matter. 

Should the District Court adopt this Court’s recommendation and remand this matter to the 

SSA, the ALJ should give due consideration to the the treatment records provided by Dr. 

Scott that are already in the record. See Marsh v. Colvin, 792 F.3d 1170, 1172-73 (9th Cir. 

2015) (“Because a court must give ‘specific and legitimate reasons’ for rejecting a treating 

doctor’s opinions, it follows even more strongly that an ALJ cannot in its decision totally 

ignore a treating doctor and his or her notes, without even mentioning them.”); cf. Howard 

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ex rel. Wolff v. Barnhart, 341 F.3d 1006, 1012 (9th Cir. 2003) (“[T]he ALJ is not required 

to discuss evidence that is neither significant nor probative.”).

D. The ALJ did not err by failing to explicitly address Francisco’s obesity.

The Court next addresses Francisco’s contention that the ALJ erred by not 

considering the impact of Francisco’s obesity on Francisco’s functioning. As explained 

below, the Court finds that the ALJ was not required to explicitly address Francisco’s 

obesity.

The Ninth Circuit has held that, under certain circumstances, an ALJ is required to 

include a claimant’s obesity in the analysis of the claimant’s functional capacity, regardless 

of whether the claimant raises obesity as a disabling factor. See Celaya v. Halter, 332 F.3d 

1177, 1181-83 (9th Cir. 2003); see also Social Security Ruling 96-8p (“In assessing RFC, 

the adjudicator must consider limitations and restrictions imposed by all of an individual’s 

impairments, even those that are not ‘severe.’”). On the other hand, “the mere presence of 

a mention in the record that the claimant was obese is insufficient to require the ALJ to 

explicitly consider the issue in his or her written opinion.” Aguilar v. Colvin, 2014 WL 

1653109, at *7 (S.D. Cal. April 22, 2014) (Benitez, J.) (citing Burch, 400 F.3d at 681-84).

In Celaya, the Ninth Circuit looked to three factors in holding that the ALJ had a 

duty to consider the impact of obesity on the claimant’s other impairments: (1) obesity was 

raised implicitly in the claimant’s reported symptoms; (2) the claimant’s obesity was close 

to the listing criterion5and was a condition that could exacerbate her reported illnesses; (3) 

the claimant was illiterate and unrepresented. Id. at 1182. In Burch, however, the Ninth 

Circuit carefully distinguished and limited its earlier holding. 400 F.3d at 681-84. The

Burch court found that that the record before it “[did] not indicate that [the claimant’s] 

obesity exacerbated her other impairments.” Id. “[M]ore significantly,” the court noted, the 

 

5 As Celaya explained, obesity was a listed impairment until 1999, when the Social Security 

Administration removed it from the listing of impairments. 332 F.3d at 1181 n.1 (citing 64 Fed. Reg. 46, 

122). “Obesity may still enter into a multiple impairment analysis, but only by dint of its impact upon the 

claimant’s musculoskeletal, respiratory, or cardiovascular system.” Id. 

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claimant was represented by counsel before the ALJ. Id. at 682. The court also noted that 

the ALJ had at least acknowledged the evidence regarding the claimant’s obesity. Id. at 

684. The court therefore rejected the claimant’s argument that the ALJ had failed to 

properly consider the impact of her obesity on her other impairments. Id.; see also Burton 

v. Astrue, 310 F. App’x. 960, 961 n.1 (9th Cir. 2009) (rejecting argument that ALJ failed 

to adequately consider obesity where ALJ did consider obesity in his overall assessment 

and claimant failed to specify how his obesity limited his functional capacity); Hoffman v. 

Astrue, 266 F. App’x. 623, 625 (9th Cir. 2008) (“The ALJ’s failure to consider [the 

claimant’s] obesity in relation to his [residual functional capacity] was proper because [the 

claimant] failed to show how his obesity in combination with another impairment increased 

the severity of his limitations.”).

In this case, the ALJ’s failure to address Francisco’s obesity was not reversible error. 

First, Francisco was represented by counsel before the ALJ and did not raise obesity at the 

hearing or in her disability application. Second, although several medical providers noted 

that Francisco was obese, Francisco fails to point to evidence showing that her obesity 

exacerbated her other symptoms. Third, even before this Court, Francisco “has not pointed 

to any evidence of functional limitations due to obesity which would have impacted the 

ALJ’s analysis.” Burch, 400 F.3d at 683.

The Court therefore finds that the ALJ did not commit error by failing to address 

Francisco’s obesity in his written decision.

E. The ALJ’s hypothetical was defective.

The Court’s determination that the ALJ improperly discredited Francisco’s 

testimony and improperly rejected Dr. Samorano’s opinion means that the Court, of 

necessity, agrees with Francisco’s contention that the hypothetical that formed the basis of 

the vocational expert’s decisive opinion was defective. (Pltf. Mot. at 21-22, Doc. No. 14-

1.) The Court additionally finds that the ALJ’s hypothetical failed to incorporate significant 

limitations on Francisco’s fine manipulation abilities found by Francisco’s treating 

physician, Dr. Kupfer, who opined that Francisco should “be restricted from combined 

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highly repetitive hand and wrist activity such as typing data entry or other comparative 

behaviors exceeding 30 minutes per hour.” (Tr. 302.) Dr. Kupfer performed surgery on 

both of Francisco’s arms and treated Francisco on numerous occasions over more than two 

years. Dr. Kupfer was therefore in a strong position to evaluate Francisco’s arm and wrist 

limitations. Nevertheless, the ALJ did not discuss why he might have disregarded Dr. 

Kupfer’s opinion—an opinion in which Dr. Pohl, an evaluating physician, specifically 

concurred. (Tr. 291.) The failure to incorporate into the hypothetical the significant and 

highly material limitation identified by Dr. Kupfer was clear error. 

F. The ALJ’s errors were not harmless.

The Court must next apply harmless error principles to determine whether Francisco 

was prejudiced by the ALJ’s errors. Marsh, 792 F.3d at 1172; Stout v. Comm’r of Soc. Sec. 

Admin., 454 F.3d 1050, 1054 (9th Cir. 2006); Batson, 359 F.3d at 1195-97. Under these 

principles, an ALJ’s errors “are harmless if they are inconsequential to the ultimate 

nondisability determination.” Marsh, 792 F.3d at 1173. “[A] reviewing court cannot 

consider an error harmless unless it can confidently conclude that no reasonable ALJ, when 

fully crediting the testimony, could have reached a different disability determination.” Id.; 

see also McLoed, 640 F.3d at 888 (“[W]here the circumstances of the case show a 

substantial likelihood of prejudice, remand is appropriate so that the agency can decide 

whether re-consideration is necessary. By contrast, where harmlessness is clear and not a 

borderline question, remand for reconsideration is not appropriate.”). 

Here, the ALJ erred by finding that Francisco was not entirely credible and also erred 

by discounting the opinion of Francisco’s treating psychiatrist, Dr. Samorano. Neither error 

can be considered harmless. First, the ALJ’s erroneous credibility determination cannot be 

considered harmless. Francisco testified to several serious physical and mental limitations, 

including difficulty sitting, walking, lifting, fine motor problems, and difficulty 

concentrating and remembering things. (Tr. 35-39.) The limitations described in this

testimony were reflected in the second hypothetical that the ALJ put to the vocational 

expert and the vocational expert testified that no work was available for an individual with 

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such limitations. (Tr. 42-43.) The ALJ’s error in assessing Francisco’s credibility therefore 

was not harmless.

The ALJ’s error in discounting Dr. Samorano’s opinion also was not harmless. Dr. 

Samorano opined that Francisco had marked mental impairments in a number of functional 

areas. If the ALJ had fully credited this opinion, he would have been required to make a

step two finding that Francisco had a severe mental impairment. Even if Francisco had not 

prevailed at step three,6the crediting of Dr. Samorano’s opinion would have changed the 

ALJ’s residual functional capacity assessment and may have led to a finding that Francisco 

was disabled.

Finally, the ALJ’s failure to incorporate into the hypothetical the limitations on 

repetitive hand and wrist activity found by Dr. Kupfer cannot be considered harmless error. 

Notably, the vocational expert’s answer to the ALJ’s second hypothetical indicates that the 

the ALJ may well have found Francisco disabled had the limitations identified by Dr. 

Kupfer been included in the ALJ’s residual functional capacity assessment. See Robbins v. 

Social Security Admin., 466 F.3d 880, 886 (9th Cir. 2006). 

G. Remand for further proceedings is appropriate.

The Court next addresses the question of remedy. Two options are available: (1) 

remand for further proceedings, or (2) remand for an award of benefits. Because 

Francisco’s entitlement to benefits is not clearly established on the present record, remand 

for further proceedings is therefore appropriate. 

The Ninth Circuit has held that “[a] district court may reverse the decision of the 

Commissioner of Social Security, with or without remanding the cause for a rehearing, but 

the proper course, except in rare circumstances, is to remand to the agency for additional 

investigation or explanation.” Dominguez v. Colvin, 808 F.3d 403, 407 (9th Cir. 2015). A

district court may remand directly for an award of benefits only when: “(1) the record has 

 

6 Because the ALJ will reconsider the weight to be given to Dr. Samorano’s opinion on remand, the Court 

does not here address whether the ALJ would be required to find Francisco disabled at step three if Dr. 

Samorano’s opinion were fully credited.

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been fully developed and further administrative proceedings would serve no useful 

purpose; (2) the ALJ failed to provide legally sufficient reasons for rejecting evidence; and 

(3) if the improperly discredited evidence were credited as true, the ALJ would be required 

to find the claimant disabled on remand.” Garrison, 759 F.3d at 1020. Even if these 

requirements are met, the court retains “flexibility” to remand “on an open record for 

further proceedings when the record as a whole creates serious doubt as to whether the 

claimant is, in fact, disabled within the meaning of the Social Security Act.” Dominguez, 

808 F.3d at 408. The district court only abuses its discretion when “all factual issues in the 

record have been resolved, overwhelming evidence establishes that the claimant is 

disabled, and the government points to no evidence to contrary.” Id. at 407; see also 

Burrell, 775 F.3d at 1141.

Here, remand for further proceedings is appropriate because the evidence of 

Francisco’s disability is not “overwhelming” and material factual issues remain 

unresolved. Although the ALJ’s generalized credibility determination was erroneous, the 

record suggests that facts could be developed through further proceedings that may entitle 

the ALJ to discredit certain parts of Francisco’s testimony. The Commissioner asserts, for 

instance, that “the record show[s] that Francisco and her husband “acted as campground 

hosts in exchange for housing.” (Def. Mot. at 18, Doc. No. 15-1.) The Court disagrees with 

the Commissioner’s characterization of what the record shows and also finds that the ALJ 

failed to make sufficiently clear whether he relied on this “fact” in making his credibility 

determination. Dr. Rodriguez’s notation, however, certainly raises a question regarding 

Francisco’s daily activities, and the ALJ may address this question, with the benefit of a 

more fully developed record, on remand. 

Similarly, the ALJ may, with or without further development of the record, be able 

to articulate specific and legitimate reasons that would entitle him to afford less weight to 

the Dr. Samorano’s check-box opinion than would otherwise be required. The record, for 

example, discloses certain inconsistencies between Dr. Samorano’s opinion and his 

treatment notes. For instance, Dr. Samorano consistently noted that Francisco’s appearance 

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was appropriate and her behavior cooperative. (Tr. 454-513.) Dr. Samorano also noted that 

Francisco’s insight and judgment was generally fair. (Id.) In his opinion, however, Dr. 

Samorano found that Francisco has marked limitation in her ability to maintain socially 

appropriate behavior and to adhere to basic standards of neatness and cleanliness. (Tr. 455.) 

The Court does not find, at this stage, that this inconsistency would alone be sufficient 

reason for the ALJ to discredit Dr. Samorano’s opinion. Such a determination is properly 

made by the ALJ on remand.

In short, the Court is unable to conclude that the record is “free from conflicts, 

ambiguities [and] gaps” and that Francisco’s “entitlement to benefits is clear.” Treichler, 

775 F.3d at 1103-04. Remand is therefore appropriate. 

IV.

CONCLUSION

For the reasons stated, the Court recommends that Francisco’s motion for summary 

judgment be granted, that the Commissioner’s motion for summary judgment be denied, 

and that the matter be remanded to the ALJ for further proceedings.

IT IS ORDERED that no later than February 23, 2016, any party to this action may 

file written objections with the Court and serve a copy on all parties. The document should 

be captioned “Objections to Report and Recommendation.”

IT IS FURTHER ORDERED that any reply to the objections shall be filed with 

the Court and served on all parties no later than March 1, 2016.

The parties are advised that failure to file objections within the specified time may 

waive the right to raise those objections on appeal. 

IT IS SO ORDERED.

Dated: February 8, 2016

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