Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-1_17-cv-06487/USCOURTS-cand-1_17-cv-06487-0/pdf.json

Parties Involved:
Nancy Berryhill
Defendant
Elizabeth Marie Brinkman
Plaintiff

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United States District Court

Northern District of California

UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

EUREKA DIVISION

ELIZABETH MARIE BRINKMAN,

Plaintiff,

v.

NANCY BERRYHILL,

Defendant.

Case No. 17-cv-06487-RMI 

ORDER RE MOTIONS FOR

SUMMARY JUDGMENT

Re: Dkt. Nos. 15, 16

Plaintiff Elizabeth Marie Brinkman seeks judicial review of an Administrative Law Judge 

(“ALJ”) decision denying her application for benefits under Title XVI of the Social Security Act. 

Plaintiff’s request for review of the ALJ’s unfavorable decision was denied by the Appeals 

Council. See (dkt. 14) Administrative Record (“AR”) 1-5). The ALJ’s decision is therefore the 

“final decision” of the Commissioner of Social Security, which this court may review. See 42 

U.S.C. §§ 405(g), 1383(c)(3). Both parties have consented to the jurisdiction of a magistrate judge 

(dkts. 8, 9) and both parties have moved for summary judgment (dkts. 15, 16). For the reasons 

stated below, the court will grant Plaintiff’s motion for summary judgment in part, deny 

Defendant’s motion for summary judgment in part, and remand for further proceedings.

LEGAL STANDARDS

The Commissioner’s findings “as to any fact, if supported by substantial evidence, shall be 

conclusive.” 42 U.S.C. § 405(g). A district court has a limited scope of review and can only set 

aside a denial of benefits if it is not supported by substantial evidence or if it is based on legal

error. Flaten v. Sec’y of Health & Human Servs., 44 F.3d 1453, 1457 (9th Cir. 1995). Substantial 

evidence is “more than a mere scintilla but less than a preponderance; it is such relevant evidence 

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as a reasonable mind might accept as adequate to support a conclusion.” Sandgathe v. Chater, 108 

F.3d 978, 979 (9th Cir. 1997). “In determining whether the Commissioner’s findings are supported 

by substantial evidence,” a district court must review the administrative record as a whole, 

considering “both the evidence that supports and the evidence that detracts from the 

Commissioner’s conclusion.” Reddick v. Chater, 157 F.3d 715, 720 (9th Cir. 1998). The 

Commissioner’s conclusion is upheld where evidence is susceptible to more than one rational 

interpretation. Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir. 2005).

PROCEDURAL HISTORY

Plaintiff filed an application for Title XVI disability benefits on July 23, 2014, alleging a

disability onset of June 1, 2010. (AR 160-69). Plaintiff’s application was denied initially on 

December 26, 2014. (AR 16, 83). Plaintiff filed a request for hearing with an ALJ and a hearing 

was held on October 14, 2016. (AR 36-59). The ALJ issued an unfavorable decision on January 9, 

2017. (AR 13-30). Plaintiff requested review by the Appeals Council and the request for review 

was denied on September 12, 2017. (AR 1-5).

THE FIVE STEP SEQUENTIAL ANALYSIS FOR DETERMINING DISABILITY

A person filing a claim for social security disability benefits (“the claimant”) must show

that she has the “inability to do any substantial gainful activity by reason of any medically

determinable physical or mental impairment” which has lasted or is expected to last for twelve or

more months. See 20 C.F.R. §§ 416.920(a)(4)(ii), 416.909. The ALJ must consider all evidence

in the claimant’s case record to determine disability (see id. § 416.920(a)(3)), and must use a five

step sequential evaluation process to determine whether the claimant is disabled (see id. §

416.920). “[T]he ALJ has a special duty to fully and fairly develop the record and to assure that

the claimant’s interests are considered.” Brown v. Heckler, 713 F.2d 441, 443 (9th Cir. 1983).

Here, the ALJ evaluated Plaintiff’s application for benefits under the required five-step evaluation 

process. (AR 13-30).

At Step One, the claimant bears the burden of showing she has not been engaged in 

“substantial gainful activity” since the alleged date she became disabled. See 20 C.F.R. § 

416.920(b). If the claimant has worked and the work is found to be substantial gainful activity, the 

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claimant will be found not disabled. See id. The ALJ found that Plaintiff had not engaged in 

substantial gainful activity since July 23, 2014, her application date. (AR 18).

At Step Two, the claimant bears the burden of showing that she has a medically severe 

impairment or combination of impairments. See 20 C.F.R. § 416.920(a)(4)(ii), (c). “An 

impairment is not severe if it is merely ‘a slight abnormality (or combination of slight 

abnormalities) that has no more than a minimal effect on the ability to do basic work activities.’” 

Webb v. Barnhart, 433 F.3d 683, 686 (9th Cir. 2005) (quoting S.S.R. No. 96–3(p) (1996)). The 

ALJ found that Plaintiff suffered from the following severe impairments: obesity, anxiety 

disorder, and affective disorder. (AR 18).

At Step Three, the ALJ compares the claimant’s impairments to the impairments listed in 

appendix 1 to subpart P of part 404. See 20 C.F.R. § 416.920(a)(4)(iii), (d). The claimant bears the 

burden of showing her impairments meet or equal an impairment in the listing. Id. If the claimant 

is successful, a disability is presumed and benefits are awarded. Id. If the claimant is unsuccessful,

the ALJ proceeds to Step Four. See id. § 416.920(a)(4)(iv), (e). Here, the ALJ found that Plaintiff 

did not have an impairment or combination of impairments that met or medically equaled one of 

the listed impairments. (AR 19).

At Step Four, the ALJ must determine the claimant’s residual functional capacity (“RFC”) 

and then determine whether the claimant has the RFC to perform the requirements of her past 

relevant work. See id. § 416.920(e) and 416.945. The ALJ found Plaintiff had the RFC to do the 

following: 1) lift and carry twenty pounds occasionally and ten pounds frequently; 2) sit for six 

hours in an eight-hour day; 3) stand and walk for three hours in an eight-hour day; 4) climb ramps 

and stairs occasionally but never climb ladders, ropes, or scaffolds; and 5) balance, stoop, kneel, 

crawl, and crouch occasionally. (AR 21). The ALJ further found that Plaintiff must never work at 

unprotected heights. Id. The ALJ found that Plaintiff is limited to the performance of simple, 

routine tasks and limited to simple work-related decisions. Id. Finally, the ALJ found that 

Plaintiff can respond appropriately to coworkers and the public only on a brief, casual basis, no 

more than ten percent of the time. Id. 

At Step Five, the ALJ must determine whether the claimant is able to do any other work 

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considering her RFC, age, education, and work experience. See 20 CFR § 416.920(g). If the 

claimant is able to do other work, she is not disabled. The ALJ found that there were jobs that 

existed in significant numbers in the national economy that Plaintiff could perform, including 

assembler and lens inserter. (AR 29). Thus, the ALJ found Plaintiff was not disabled since July 23, 

2014, the date the application was filed. (AR 30.)

FACTUAL SUMMARY

Plaintiff was 27 years old at the time she filed her application for Title XVI disability 

benefits. (AR 60). Though she graduated from high school with a diploma, it took her five years to 

complete high school as a result of the onset of anxiety symptoms. (AR 47-48, 583). Plaintiff has 

an Associate’s Degree is Social Sciences from Laney College, but has never been employed. (AR

583). She has lived with her mother her entire life. (AR 583).

Plaintiff has a long history of chronic depression, anxiety, and self-mutilating behaviors, 

which began in adolescence following the death of her sister from cancer. (AR 584). She tended to 

isolate at home, did not socialize with peers, and suffered from excessive sleeping, depressed 

mood, agoraphobia, and panic attacks. (AR 373-377). From August 2006 to May 2012, Plaintiff 

received intensive outpatient mental health treatment from STARS Community Services including 

medication management, therapy, and case management. (AR 369-389). She was diagnosed with 

Major Depressive Disorder, Recurrent, Severe; Dysthymic Disorder; Anxiety Disorder; Panic 

Disorder with Agoraphobia; Social Anxiety Disorder; and Borderline Personality Disorder, and 

was prescribed Lamictal, Benadryl, Xanax, and Prozac. (AR 370, 378). In November 2010 and 

again in March 2011, Plaintiff was hospitalized at John George Psychiatric Pavilion for passive 

suicidal ideation, social isolation, and cutting herself in order to “feel in control,” “release stress,” 

and “focus the pain in another part of her body.” (AR 32, 322). Through active engagement in 

treatment at STARS, Ms. Brinkman’s symptoms stabilized to some degree, but she continued 

cutting herself one to two times per month and having recurrent panic attacks on public 

transportation and in classrooms. (AR 380-381, 373). After aging out of the STARS program in 

May 2012, Plaintiff continued to take psychiatric medication prescribed by her providers at 

Highland Hospital and Sausal Creek Outpatient Stabilization Clinic to manage her ongoing 

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symptoms. (AR 440, 443-448, 458-468).

In February 2014, Plaintiff became a patient of Elisabeth Collins, PMHNP, at Pathways to 

Wellness, where she received ongoing psychiatric care and was diagnosed with Major Depressive 

Disorder, Social Anxiety Disorder, and Attention Deficit Hyperactivity Disorder. (AR 394-417, 

469-490). In December 2014, Plaintiff began receiving weekly psychotherapy with Carlos Ponce, 

LMFT, at Multilingual Counseling Center. (AR 451-456, 491-580). As of the date of hearing, 

October 14, 2016, Plaintiff had attended over 57 individual therapy sessions with Mr. Ponce. (AR

491-574). Despite being actively engaged in treatment and medication compliant, Plaintiff had 

“little success” in curbing her agoraphobia and continued to experience urges to cut herself, 

chronic depression, anxiety, and problems with attention. (AR 580, 491-574, 487). In addition to 

therapy and psychiatric medication treatment, Plaintiff attended a one-time psychological 

evaluation with Katherine Wiebe, Ph.D. on April 25, 2016. (AR 581-596).

DISCUSSION

Evaluation of Medical Opinions

Examining Psychologist, Katherine Wiebe, Ph.D.

Plaintiff contends that the ALJ erred by not giving sufficient weight to the opinion of 

examining psychologist Katherine Wiebe, Ph.D. Dr. Wiebe conducted a comprehensive 

psychological evaluation of Plaintiff, which lasted a total of two hours and included ten diagnostic 

tests, a clinical interview, and a review of all of the medical evidence in the record at the time the 

evaluation was conducted. (AR 585-586). Testing revealed mild to moderate impairments in 

attention and concentration, moderate to severe impairments in memory, and moderate to severe 

impairments in social functioning. (AR 586-587, 595). Plaintiff reported severe symptoms of 

depression, a history of self-harming behavior, problems with social anxiety, and fears of leaving 

the house and taking public transportation. (AT 587-589, 585). As a result of Plaintiff’s reported 

symptoms, psychiatric history, and performance on the MCMI-III, Dr. Wiebe diagnosed her with 

Major Depressive Disorder, Recurrent, Severe; Generalized Anxiety Disorder; Schizoid 

Personality Disorder; and Dependent Personality Disorder with Avoidant and Depressive 

Personality Traits. (AR 589-593). Ultimately, Dr. Wiebe assessed primarily moderate and marked 

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impairments in mental abilities needed to perform unskilled work. (AR 596). Plaintiff argues that 

the results of testing could reasonably support Dr. Wiebe’s diagnosis and her assessment of Ms. 

Brinkman’s functional impairments. 

The ALJ gave little weight to the opinion of Dr. Wiebe, stating that “as the report of Dr. 

Wiebe, clearly, was prepared at the request of the claimant’s attorney to assist with the claimant’s 

disability claim, it is somewhat suspect.” (AR 25). The Ninth Circuit has expressly held that 

“[t]he Secretary may not assume that doctors routinely lie in order to help their patients collect 

disability benefits.” Lester v. Chater, 81 F.3d 821, 832 (9th Cir. 1996). “An examining doctor’s 

findings are entitled to no less weight when the examination is procured by the claimant than 

when it is obtained by the Commissioner.” Id. In Reddick v. Chater, 157 F.3d 715, 726 (9th Cir. 

1998), the Ninth Circuit found that “in the absence of other evidence to undermine the credibility 

of the medical report, the purpose for which the report was obtained does not provide a legitimate 

basis for rejecting it.” Similarly, in Nguyen v. Chater, 100 F.3d 1462, 1464 (9th Cir. 1996), the 

court found the ALJ had erred in rejecting an examining psychologist’s opinion on the basis that it 

was solicited by the claimant’s attorney, finding there was no indication of “actual impropriety” 

and the psychologist’s report was based on an examination of a battery of tests. 

In this case, the ALJ noted no indication of any impropriety with respect to the opinion of 

Dr. Wiebe, whose report specifically affirms that “in accordance with the ethical laws of my 

profession as well as my personal ethics, I have not entered into any arrangement where the 

amount or payment of my fees is in any way dependent on the outcome of the case” and “the 

opinions I have expressed represent my true and complete professional opinion.” (AR 595). 

Accordingly, it was error for the ALJ to reject Dr. Wiebe’s opinion on the ground that it was 

solicited by the claimant.

The ALJ provides two other reasons for discounting Dr. Wiebe’s opinion, finding that it 

“overstates the claimant’s functional limitations” and is “not consistent with the evidence as a 

whole.” (AR 25). It is impossible for the court to determine what weight the ALJ gave these two 

additional reasons in forming his decision regarding Dr. Wiebe’s opinion. It is therefore 

impossible for the court to determine whether the ALJ’s decision would have been different had 

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he based his decision only on these two additional reasons. The court must therefore conclude that 

the ALJ’s decision to give little weight to Dr. Wiebe’s opinion was not supported by substantial 

evidence. This is particularly true in light of the court’s analysis, set forth below, as to the weight 

given to the other medical opinions.

Treating Therapist, Carlos Ponce, LMFT

Plaintiff contends that the ALJ erred in assigning little weight to the opinion of treating 

Licensed Marriage and Family Therapist, Carlos Ponce. The ALJ noted that therapists are not 

considered “acceptable medical sources” under the Regulations. (AR 26). He also concluded that 

“the evidence of record does not support [Mr. Ponce’s] opinion. Id. The ALJ found as follows:

As for the opinion of Mr. Ponce (Exhibit 7F), the undersigned notes that therapists are not 

considered an “acceptable medical source” in the Regulations, whose opinions are entitled 

to weighing as a medical source opinion (20 CFR 416.913). In addition, the evidence of 

record does not support this opinion. As discussed above, the evidence fails to document 

ongoing problems with sleep, significant memory loss, or substantial concentration 

deficits, which would prevent the claimant from finding and keeping a job. To the 

contrary, repeatedly, records from Pathways to Wellness Medication Clinic document 

intact memory and fair or good concentration, contrary to the assertions of Mr. Ponce. The 

GAF score of Mr. Ponce also is inconsistent with his ultimate findings, as it suggests that 

the claimant only has a moderate level of symptoms. Further, Mr. Ponce is not a 

vocational expert. As such, his opinion that the claimant’s anxiety prevents all work is 

suspect. Thus, even though the opinion of Mr. Ponce has been duly considered, in view of 

the evidence as a whole, it is not found to be persuasive.

(AR 26).

Although licensed marriage and family therapists are not “acceptable medical sources” 

under 20 C.F.R. § 404.1513(a), they are “other sources” under 20 C.F.R. § 404.1513(d), and the 

ALJ may only disregard their testimony if he “gives reasons germane to each witness for doing 

so.” Turner v. Comm’r of Soc. Sec. 613 F.3d 1217, 1223-24 (9th Cir. 2010). SSR 06-03p provides: 

“Information from such ‘other sources’ may be based on special knowledge of the individual and 

may provide insight into the severity of the impairment(s) and how it affects the individual’s 

ability to function.” SSR 06-03p further provides that non-acceptable medical sources should be 

evaluated under the same factors as all other medical opinions set forth in 20. C.F.R. § 

404.1527(d). Significantly, SSR 06-03p notes that “it may be appropriate to give more weight to 

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the opinion of a medical source who is not an ‘acceptable medical source’ if he or she has seen the 

individual more often than the treating source and has provided better supporting evidence and a 

better explanation for his or her opinion.” Plaintiff contends that the ALJ failed to give germane 

reasons to justify disregarding Mr. Ponce’s treatment notes, and failed to evaluate his opinions 

under the proper factors.

Specifically, Plaintiff argues first that the ALJ did not consider the first factor listed in SSR 

06-03p, which is how long the treating source has known and how frequently the source has seen 

the individual. Mr. Ponce had provided weekly psychotherapy to Plaintiff since January 5, 2017. 

(AR 574). Mr. Ponce is a licensed marriage and family therapist with a master’s degree in 

transpersonal psychology from John F. Kennedy University. (AR 318). At the time of the hearing, 

Plaintiff had attended over 57 individual therapy sessions with Mr. Ponce. (AR 491-575). Plaintiff 

argues that as Plaintiff’s primary weekly therapist for two years, Mr. Ponce is in an excellent 

position to provide an opinion about Plaintiff’s symptoms and functional limitations during that 

time period.

Plaintiff argues second that the ALJ did not consider the third factor listed in SSR 06-03p, 

which is the degree to which the treating source presents evidence to support his opinion. Mr. 

Ponce’s treatment notes chronicle Plaintiff’s fear of leaving the house by herself, her difficulty 

doing so without her mother present, ongoing symptoms of depression, anxiety, and social 

isolation, and recurrent urges to harm herself. (AR 491-574). In these notes Plaintiff is frequently 

described as anxious, depressed, tense, restless, fidgety, avoidant, isolative, unable to calm herself, 

and having difficulty focusing on a topic. (AR 491-574). Throughout therapy, she struggled

through periodic urges to cut herself, and on one occasion in March 2016, Plaintiff called her 

therapist to report an incident of self-cutting. (AR 514, 516, 540-541, 544-546, 552). These 

observations are consistent with Mr. Ponce’s stated opinions that Plaintiff becomes “panicky and 

gets paralyzed with fear,” and is “unable to control her anxiety,” leave her house or take public 

transportation by herself, “even if she takes medication to reduce her symptoms.” (AR 579, 575, 

580, 491). It is Mr. Ponce’s opinion that despite being actively engaged in therapy and medication 

compliant, Plaintiff has made “very limited progress,” in curbing her agoraphobia and it is Mr. 

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Ponce’s “clinical impression” that she would not tolerate the pressures of either full-time or parttime employment. (AR 500, 580). Ultimately, Mr. Ponce found marked or extreme impairments in 

functioning, with particular deficits in social functioning. (AR 577-579). The court must agree 

with Plaintiff that other than briefly summarizing the evidence, the ALJ did not meaningfully 

examine the degree to which Mr. Ponce’s opinion is supported by progress notes from their twoyear therapeutic relationship.

Third, the ALJ dismissed Mr. Ponce’s treatment notes and opinion statement as “not 

consistent with the evidence as a whole,” but neglected to discuss the evidence which is consistent 

with Mr. Ponce’s opinion. (AR 26). In support of his findings, the ALJ points to records from 

Pathways to Wellness, which reported global assessment of functioning (“GAF”) scores between 

50 and 60, and mental status examinations finding intact memory and fair to good judgment, 

attention, concentration and insight. (AR 23, 25). However, GAF scores offer a mere snapshot of 

a patient’s functioning at that moment in time and Social Security has cautioned against their use 

in determining disability because they are “neither standardized nor based on normative data” and 

“the actual number assigned can be misleading because the score does not quantify differences in 

function between people.” Administrative Memorandum, AM-13066(D)(1). As such, “GAF 

ratings assigned by different clinicians are inconsistent” and “adjudicators cannot draw reliable 

inferences from the difference in GAF ratings assigned by different clinicians or from a single 

GAF score in isolation.” AM-13066(D)(1). While the ALJ relies heavily on these GAF scores, he 

does not discuss the observations by Plaintiff’s psychiatric provider at Pathways to Wellness, 

Elisabeth Collins, RN, MS, PMHNP, who noted poor sleep, “profound anxiety,” difficulty with 

social interactions, thoughts of cutting, agoraphobia, inability to leave the house without her 

mother, and “significant functional impairment” which “prevents client from being able to work,” 

despite medication compliance. (AR 44, 475, 477, 479, 484, 408-410).

Mr. Ponce’s treatment notes and opinion are also consistent with the assessment of Dr. 

Wiebe, who observed Plaintiff to be anxious, depressed, restricted in affect, evincing alexithymia, 

problems with self-esteem and nervous fidgeting of hands. (AT 585). Dr. Wiebe remarked that 

Plaintiff seldom leaves home, relies upon her mother for support, avoids taking public 

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transportation due to fear of anxiety attacks and exhibits “problems with judgment, insight and 

reasoning that affect her ability to make sound decisions and manage her personal affairs.” Id. 

Despite the ALJ’s contention that the evidence fails to document significant memory loss or 

deficits in concentration, Dr. Wiebe reported scores in the borderline to extremely low range on 

the Immediate Memory and Delayed Memory Indexes of the Repeatable Battery for the 

Assessment of Neuropsychological Status (“RBANS”). Because the ALJ did not address this 

evidence in his opinion, it is impossible for the court to determine the extent to which the ALJ 

considered it. See, e.g. Holohan v. Massanari, 246 F.3d 1195, 1207-1208 (9th Cir. 2001) 

(holding that an ALJ may not selectively rely on some entries and ignore others “that indicate 

continued, severe impairment”). 

In summary, the court finds that nothing in his opinion indicates that the ALJ considered 

the significance of how long Mr. Ponce had known and treated Plaintiff (the first factor listed in 

SSR 06-03p). The court further finds that the ALJ’s analysis of the degree to which Mr. Ponce’s 

notes supported his opinions (the third factor listed in SSR 06-03p), and the degree to which the 

evidence as a whole was consistent with Mr. Ponce’s opinion were incomplete. These three

factors addressed by Plaintiff were particularly important, as Mr. Ponce was the medical 

professional with whom Plaintiff had the longest relationship. Under these circumstances, the 

court must conclude that the ALJ’s rejection of Mr. Ponce’s opinion is not supported by 

substantial evidence.

S. Talwar, M.D.

The ALJ assigned “great weight” to the opinion of Dr. S. Talwar, who opined that Plaintiff

had no more than “moderate” impairments in activities of daily living, social functioning, and 

concentration, persistence and pace. (AR 22, 25-26, 415). Dr. Talwar is a psychiatrist at the 

outpatient clinic, Pathways to Wellness, and the opinion to which the ALJ refers is the initial 

assessment conducted when Plaintiff first began receiving treatment at that clinic on February 26, 

2014. (AR 411-417). Dr. Talwar only examined Plaintiff once, at that first initial visit. (AR 417, 

395-396). After that, Plaintiff’s primary treating provider at Pathways to Wellness was Nurse 

Practitioner, Elisabeth Collins. (AR 396, 469-470). During the 60-minute assessment, Dr. Talwar 

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conducted a clinical interview and mental status exam. (AR 411-417). He did not review any of 

Plaintiff’s other medical records or perform any other diagnostic tests. (AR 411-417). 

Plaintiff contends that because Dr. Talwar met with Plaintiff only once, his opinion should 

be evaluated by the same standard as any other examining, but non-treating source. 20 C.F.R. § 

416.927. The court agrees with Plaintiff that substantial evidence does not support the ALJ’s 

decision to afford great weight to the opinion of this putative “treating” physician who saw 

Plaintiff once. 

Non-examining Physician Brady Dalton, Psy.D.

Plaintiff contends that the ALJ erred in assigning great weight to the opinion of nonexamining medical consultant, Brady Dalton, Psy.D. (AR 25-26, 65-66, 68-70.) Dr. Dalton wrote 

that while Plaintiff’s “anxiety is noted to wax and wane, recent notes describe it as mild” and 

“significant treatment gains are evident with medication adherence.” (AR 65). In support, Dr. 

Dalton notes Plaintiff is independent for self-care and independently uses public transportation. 

(AR 65). Ultimately, Dr. Dalton assessed Plaintiff with mild impairments in activities of daily 

living, and moderate impairments in social functioning and concentration, persistence, and pace. 

(AR 65, 68-70, 25). He suggested she should have no more than brief public contact and only 

superficial and non-collaborative contact with supervisors and coworkers. (AT 69, 25). Plaintiff 

argues that Dr. Dalton’s opinion should have been afforded the least weight as it was not based on 

either a treating or an examining relationship with Plaintiff and was based on a very limited 

record. 

Social Security policy dictates that a medical consultant’s opinion be more strictly 

scrutinized than that of a treating or examining source:

The regulations provide progressively more rigorous tests for weighing opinions as 

the ties between the source of the opinion and the individual become weaker. For example, 

the opinions of physicians or psychologists who do not have a treatment relationship with 

the individual are weighed by stricter standards, based to a greater degree on medical 

evidence, qualifications, and explanations for the opinions, than are required of treating 

sources.

SSR 96-6p; 20 C.F.R. § 416.927(d)(3).

Dr. Dalton’s opinion was based on the limited records presented at the initial level of this 

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claim. (AR 61-62). He did not have the opportunity to review records from Sausal Creek 

Outpatient Stabilization Clinic, the evaluation of Dr. Wiebe, updated progress notes from 

Pathways to Wellness or the extensive therapy progress notes from Multilingual Counseling, all of 

which were submitted at the reconsideration and hearing stages. (AR 34-35). In particular, Dr. 

Dalton did not review progress notes documenting Plaintiff’s increased anxiety and social 

isolation, panic attacks on public transportation, her need to be accompanied by her mother when 

leaving the house, and the episode of cutting in 2016. (AR 469-580). 

In arguing that the ALJ properly weighed the opinion evidence of Dr. Dalton, Defendant 

argues that the ALJ noted that the record evidenced only limited treatment during a four-year 

period from 2009 to 2013. (AR 22). Defendant argues that this gap in treatment “was especially 

problematic because her medical records showed her symptoms improved or were stable when she 

took her prescribed medication.” See (dkt. 16 at 4.) Contrary to Defendant’s assertions, the 

medical evidence shows that Plaintiff has consistently been receiving mental health treatment, 

with the exception of a period in 2013 when she lost her insurance. Plaintiff received psychiatric 

medication management and weekly therapy through the STARS program from August 10, 2006 

until her discharge in June 2012. (AR 370). In complying with the Department of Social Services’ 

records request, STARS sent copies of Plaintiff’s discharge summary, her most recent treatment 

plan dated December 2011, and her most recent psychiatric progress note dated May 31, 2012. 

(AR 369-389). These records show that despite being “actively engaged in tx and med 

compliance” from 2009 through her discharge in 2012, Plaintiff “continued to have panic attacks 

on public transit and crowded classrooms,” one to two episodes of self-cutting per month, and two 

contacts with emergency psychiatric services in 2010 and 2011 respectively. (AR 373, 377, 321-

332). Plaintiff lost her insurance in 2013, but sought out medication refills from her primary care 

provider at Highland Hospital and Sausal Creek Outpatient Stabilization Center until she was 

referred for psychiatric services at Pathways to Wellness in February 2014. (AR 440, 458-468). 

Thus, Defendants’ argument of “years-long lack of treatment” is a mistaken characterization of the 

facts. 

Under these circumstances, the court finds that substantial evidence does not support the 

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ALJ’s decision to give great weight to the opinion of this non-examining physician, while 

discounting the opinions of examining source Dr. Wiebe, and treating therapist Carlos Ponce.

Credibility of Plaintiff and Her Mother

Plaintiff contends that the ALJ erred in evaluating the credibility of statements made by 

claimant and her mother. The ALJ discredited the testimony of Plaintiff and a written third party 

function form prepared by Plaintiff’s mother on the ground that Plaintiff’s pattern of treatment 

was inconsistent with that of an individual who suffers from debilitating symptoms. The ALJ 

noted there were no recurrent emergency room visits or psychiatric hospitalizations and few 

changes to Plaintiff’s medication regimen, hypothesizing that if she suffered from uncontrollable, 

debilitating symptoms, she would require recurrent emergency room treatment and repeated 

adjustments to her medications to obtain better control. (AR 28). Secondly, the ALJ found that 

Plaintiff’s allegations of difficulty with memory and concentration were not supported by mental 

status examinations describing her memory as intact and her attention and concentration as being 

fair or good. (AR 28). Lastly, the ALJ found that the record contains inconsistent statements about 

the claimant’s activities and ability to function outside the home, pointing to a comprehensive 

adult function form that Plaintiff filled out on her own behalf as proof that she does not suffer 

from debilitating deficits in concentration. (AR 28). Defendant argues that the ALJ therefore

provided specific and legitimate reasons supported by substantial evidence for discounting some 

of Plaintiff’s and her mother’s claims. 

The ALJ must accept a claimant’s testimony as credible to the extent that it is consistent 

with other evidence in the record. 20 C.F.R. § 404.1529(c)(4). In order to support a determination 

that a claimant’s testimony regarding subjective symptoms such as pain is not credible, “[g]eneral 

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

evidence undermines the claimant’s complaints.” Lester, 81 F.3d at 834. When there is no 

affirmative evidence of malingering, an ALJ may not reject the claimant’s testimony about the 

severity of symptoms without providing “clear and convincing” reasons for doing so. Reddick, 157 

F.3d at 722. In addition, “allegations concerning the intensity and persistence of pain or other 

symptoms may not be disregarded solely because they are not substantiated by objective medical 

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evidence.” SSR 96-7p. The ALJ must consider the entire case record in weighing the credibility of 

the claimant’s statements. 20 C.F.R. § 416.929; Penny v. Sullivan, 2 F.3d 953, 958-959 (9th Cir. 

1993); SSR 96-7p. Factors the ALJ must consider include: the medical signs and laboratory 

findings; diagnosis; prognosis; and other medical opinions provided by treating or examining 

physicians or psychologists and other medical sources; and statements and reports from the 

individual and from treating or examining physicians or psychologists and other persons about the 

individuals medical history, treatment and response, prior work record and efforts to work, daily 

activities, and other information concerning the individual’s symptoms and how the symptoms 

affect the individual’s ability to work. SSR 96-7p.

Similarly, “[l]ay testimony as to a claimant’s symptoms is competent evidence that an ALJ 

must take into account, unless he or she expressly determines to disregard such testimony and 

gives reasons germane to each witness for doing so.” Lewis, 236 F.3d at 511. See also, Nguyen, 

100 F.3d at 1462 (finding lay witness testimony as to a claimant’s symptoms or how an 

impairment affects ability to work is competent evidence that cannot be disregarded without 

comment); Dodrill v. Shalala, 12 F.3d 915, 918-919 (9th Cir. 1993) (“friends and family members 

in a position to observe a claimant’s symptoms and daily activities are competent to testify as to 

her condition”).

The court agrees with Plaintiff that it was error for the ALJ to discredit statements by

Plaintiff and her mother on the ground that Plaintiff’s course of treatment was inconsistent with 

that of someone suffering from a debilitating mental illness. Repeated emergency room visits, 

psychiatric hospitalizations, and frequent medication changes are not required for a finding of 

disability. Indeed, one does not need to be “utterly incapacitated to be eligible for benefits.” Fair 

v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989); Redick, 157 F.3d. at 722. Though the ALJ highlights 

reports of Plaintiff doing “well” on her treatment regimen, reports of “improvement” in the 

context of mental health issues must be interpreted “with an awareness that improved functioning 

while being treated and while limiting environmental stressors does not always mean that a 

claimant can function effectively in a workplace.” Garrison v. Colvin, 759 F.3d 995, 1017 (9th 

Cir. 2014), citing Hutsell v. Massanari, 259 F.3d 707, 712 (8th Cir. 2001) (finding doing well for 

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purposes of a treatment program has no necessary relation to a claimant’s ability to work). Here, 

the record shows that while medication has been effective at controlling Plaintiff’s depressive 

symptoms, she has continued to experience significant anxiety that impacts her ability to leave her 

home and function independently in social situations. (AR 469-580). This increased anxiety 

resulted in increased thoughts of cutting herself in July and August of 2015. (AR 544-552). In 

early 2016, Plaintiff experienced an increase in her depression and anxiety symptoms, which 

culminated in an episode of self-cutting in March 2016. (AR 515-523). Despite ongoing therapy 

and medication compliance, Plaintiff continued to suffer and her therapist frequently noted 

diminished interest, difficulty calming herself, social isolation, and “extreme” symptoms which 

“interfere with client’s life.” (AR 509-511). Mr. Ponce remarked that after more than a year of 

treatment, Plaintiff was able to come to weekly sessions only if escorted by her mother. (AR 500). 

According to Mr. Ponce, Plaintiff has tried several strategies to curb her agoraphobia with little 

success. (AR 580). Thus, while the record shows episodic periods of improvement and some 

control of symptoms through medication and therapy, nonetheless Plaintiff nonetheless continued 

to experience debilitating anxiety which markedly impaired her ability to function independently, 

interact socially, and manage her day-to-day needs without considerable support.

Secondly, the ALJ relied upon mental status examinations to justify discounting Plaintiff’s 

complaints of difficulty with memory and concentration, but ignored other evidence of cognitive 

impairment. (AR 28). When evaluated by Dr. Wiebe in May 2016, Plaintiff scored in the 4th 

percentile (borderline range) and 0.2 percentile (extremely low range) on the RBANS Immediate 

and Delayed Memory Indexes, respectively. (AR 586). As a result of these low scores, Dr. Wiebe 

assessed Plaintiff with a moderate to severe impairment in memory functioning. (AR 586). The 

ALJ did not discuss or mention the results of this comprehensive testing. Though Dr. Wiebe found 

mild impairments in attention and concentration, she noted that Plaintiff’s performance on tasks 

under “structured assessment conditions does not necessarily reflect her ability to perform in a 

regular work environment.” (AR 586, 592-593). Indeed, Dr. Wiebe noted that Plaintiff’s 

psychological impairments “would affect her ability to consistently attend to, remember and 

follow through with directions and tasks especially with the demands of an employment 

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situation.” (AR 593). The ALJ failed to consider this evidence when evaluating Plaintiff’s 

allegations of problems with memory and concentration. Likewise, Plaintiff’s ability to complete a 

self-report form describing her symptoms and her functional deficits is not substantial evidence 

that she would be able to concentrate on a sustained basis in a work environment. (AR 28, 249-

259). As the ALJ concedes, the SSA-3373, Adult Function Form, could have been prepared in 

multiple sittings. (AR 28). Indeed, the record does not indicate the amount of time required or how 

many breaks Plaintiff had to take in order to complete the form. Furthermore, Plaintiff completed 

this form at home where she feels comfortable and can isolate herself from social interaction and 

other distractions. Her ability to perform in this kind of low-stress environment, does not mean she 

would be capable of concentrating on a sustained basis in a work environment with increased 

demands.

Lastly, the ALJ discredited testimony by Plaintiff and her mother, citing to allegedly 

inconsistent statements regarding her activities and ability to function outside her home. (AR 28). 

Contrary to the ALJ’s assertions, Plaintiff has consistently reported severe symptoms of 

depression, anxiety, and panic attacks in social settings which makes her fear social interaction. As 

a result, Plaintiff has consistently reported isolating herself at home and difficulty leaving the 

house without her mother for support. In September 2014, Plaintiff reported that she only leaves 

the house when she has an appointment, usually just a few times per month. (AR 253). While she 

reported using public transportation, Plaintiff indicated that she needs her mother to go with her if 

she is experiencing anxiety symptoms. (AR 253). The evidence of record supports this testimony. 

In December 2014, Plaintiff reported to her psychiatric nurse practitioner, Ms. Collins, that she 

was afraid to ride the bus and had been isolating at home. (AR 474). Two months later, she 

reported leaving the house four times per month to go to therapy, but only with her mother. (AR

477). Though Plaintiff has made efforts to get out of the house more, those efforts have been 

repeatedly stymied by her ongoing mental health symptoms. In June 2015 she experienced a panic 

attack while waiting for the bus and was forced to call her mother to pick her up. (AR 553). In a 

February 2016 therapy session with Mr. Ponce, Plaintiff and her mother reported Plaintiff’s 

ongoing difficulty with doing activities alone without mother’s support. (AR 518). In May of that 

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same year, Plaintiff reported to Dr. Wiebe that she relies on her mother’s support, seldom leaves 

home, and has difficulty taking public transportation due to fear of anxiety attacks. (AR 585). 

While the ALJ highlights Plaintiff’s efforts to “push through limitations of anxiety and 

depression,” the Plaintiff “should not be penalized for attempting to lead [a] normal li[fe]” in spite 

of her ongoing struggles and symptoms. (AR 28, 490); Redick, 157 F.3d at 722. 

In light of the above, the court finds that the ALJ erred in rejecting the statements of 

Plaintiff and her mother. 

Impairments Meeting or Equaling a Listing and Residual Functional Capacity

In light of the court’s ruling on the above issues, the court will not address the parties’ 

arguments regarding the ALJ’s decision regarding whether Plaintiff’s condition met or equaled the 

severity of one of the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1, and 

Plaintiff’s RFC. Upon remand, the ALJ must reconsider both of these issues in light of any new 

findings regarding the weight to be given to the opinions of the medical professionals and the 

credibility of Plaintiff and her mother.

Nature of Remand

Having found that various portions of the ALJ’s decision were either erroneous or not 

supported by substantial evidence, the court must now decide if remand for further proceedings is 

appropriate. It is well established that “[i]f additional proceedings can remedy defects in the 

original administrative proceeding, a social security case should be remanded [for further 

proceedings].” Lewin v. Schweiker, 654 F.2d 631, 635 (9th Cir. 1981). It is equally well 

established that courts are empowered to affirm, modify, or reverse a decision by the 

Commissioner, “with or without remanding the cause for a rehearing.” 42 U.S.C. § 405(g); see 

also Garrison v. Colvin, 759 F.3d 995, 1019 (9th Cir. 2014). Generally, remand with instructions 

to award benefits has been considered when it is clear from the record that a claimant is entitled to 

benefits. Id.

The credit-as-true doctrine was announced in Varney v. Sec’y of Health & Human Servs., 

859 F.2d 1396 (9th Cir. 1988) (“Varney II”), where it was held that when “there are no 

outstanding issues that must be resolved before a proper disability determination can be made, and 

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where it is clear from the administrative record that the ALJ would be required to award benefits if 

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

make specific findings regarding that testimony . . . [instead] we will . . . take that testimony to be 

established as true.” Id. at 1401. The doctrine promotes fairness and efficiency, given that remand 

for further proceedings can unduly delay income for those unable to work and yet entitled to 

benefits. Id. at 1398.

The credit-as-true rule has been held to also apply to medical opinion evidence, in addition 

to claimant testimony. Hammock v. Bowen, 879 F.2d 498, 503 (9th Cir. 1989). The standard for 

applying the rule to either is embodied in a three-part test, “each part of which must be satisfied in 

order for a court to remand to an ALJ with instructions to calculate and award benefits: (1) the 

record has been fully developed and further administrative proceedings would serve no useful 

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

whether claimant testimony or medical opinion; and (3) if the improperly discredited evidence 

were credited as true, the ALJ would be required to find the claimant disabled on remand.” 

Garrison, 759 F.3d at 1020.

In this case, the court finds that the third part of the three-part test is not met. Rather, the 

ALJ must reevaluate the medical opinions addressed here, both separately and in light of each 

other, and then also reevaluate the credibility of Plaintiff and her mother. Only then can the ALJ 

properly determine whether Plaintiff meets or equals a listing, and determine Plaintiff’s RFC. The 

court thus rejects Plaintiff’s request to remand this case under the credit-as-true rule.

CONCLUSION

In light of the foregoing, IT IS HEREBY ORDERED as follows:

1) Plaintiff’s motion for summary judgment is GRANTED as to the evaluation of medical 

opinions and as to the credibility of Plaintiff and her mother. 

2) Defendant’s motion for summary judgment is DENIED as to the evaluation of medical 

opinions and as to the credibility of Plaintiff and her mother.

3) The court declines to rule on the issues of whether Plaintiff’s impairments meet or equal a 

listing pursuant to 20 C.F.R. Part 404, Subpart P, Appendix 1 and Plaintiff’s RFC. 

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4) This case is remanded for further consideration consistent with this opinion. A separate 

judgment will issue. 

IT IS SO ORDERED.

Dated: March 4, 2019

ROBERT M. ILLMAN

United States Magistrate Judge

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