Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-1_14-cv-02000/USCOURTS-caed-1_14-cv-02000-1/pdf.json

Parties Involved:
Linda Elaine Calisti
Plaintiff
Commissioner of Social Security
Defendant

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UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF CALIFORNIA

LINDA ELAINE CALISTI, 

Plaintiff,

v.

CAROLYN W. COLVIN, 

Acting Commissioner of Social Security,

Defendant.

____________________________________

Case No. 1:14-cv-02000-SKO

ORDER AFFIRMING THE ALJ'S 

DECISION

(Doc. No. 1)

INTRODUCTION

Plaintiff Linda Elaine Calisti ("Plaintiff") seeks judicial review of a final decision of the 

Commissioner of Social Security (the "Commissioner" or "Defendant") denying her application 

for Disability Insurance Benefits ("DIB") and Supplemental Security Income ("SSI") pursuant to 

Titles II and XVI of the Social Security Act. 42 U.S.C. §§ 405(g); 1383. The matter is currently 

before the Court on the parties' briefs, which were submitted, without oral argument, to the 

Honorable Sheila K. Oberto, United States Magistrate Judge.1

 

1

 The parties consented to the jurisdiction of a U.S. Magistrate Judge. (Docs. 7, 8.)

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FACTUAL BACKGROUND

Plaintiff filed an application for DIB on March 29, 2012, and for SSI on April 17, 2012, 

alleging disability beginning on June 9, 2010, caused by Grave's Disease, Hepatitis C, PostTraumatic Stress Disorder ("PTSD"), and Obsessive Compulsive Disorder ("OCD"). 

(Administrative Record ("AR") 278.)

A. Relevant Evidence

Plaintiff sought treatment for anxiety and depression at the River Valley Primary Care 

("River Valley") facility in Arkansas. (AR 571-91.) In December 2009, she reported the recent 

death of a friend, and that she was experiencing problems with her temper and felt hopeless. 

(AR 575.) She was continued on her prescription for Lexapro. (AR 576.) In January 2010, she 

followed-up at River Valley and indicated she did "not get her unemployment," but reported she 

had been to a psychiatrist about a disability determination the previous day. (AR 574.) She 

appeared stressed and unable to sit still; it was noted she had not taken her Seroquel prescription

that day, although she had been taking it every night since she picked it up. (AR 574.) She also 

indicated she had run out of her prescription for Paxil. (AR 574.) In February 2010, Plaintiff 

returned again to River Valley for a follow-up appointment, and it was noted that she came in to 

order more Seroquel, but she had no money and stated she would come back. (AR 574.) On

March 30, 2010, Plaintiff was a "no-show" for her appointment. (AR 574.)

In May 2010, she returned to River Valley for a follow-up. (AR 572-73.) She reported 

she had stopped Seroquel because she did not like that she was eating all the time as a side effect. 

(AR 573.) She denied any depression and only minimal anxiety, although she was noted to be 

hyperactive and agitated. (AR 573.) 

Plaintiff sought treatment at Denton County, Texas, MHMR Center. (AR 501-50.) At an 

examination in November 2010, she reported anxiety and depression and indicated she had 

previously been prescribed Paxil and Seroquel, but neither of those medications worked for her. 

(AR 530.) Plaintiff was prescribed Prozac, Restoril, Buspar, and Levoxyl (AR 541); at her next 

appointment she reported the medications had decreased her symptoms, and she was noted to be 

clinically improving (AR 442-43). 

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On December 21, 2010, she again reported to her treating physician at Denton County 

MHMR that she was taking her medication as prescribed (AR 504), and it was noted she was 

stable beyond being upset about her daughter who had stolen money from her (AR 505). 

On January 31, 2011, state agency physician John Ferguson, Ph.D., reviewed Plaintiff's 

medical records and completed a Mental Residual Functional Capacity ("MRFC") form. (AR 492-

94.)2 He checked boxes indicating moderate limitations in Plaintiff's ability to understand, 

remember, and carry out detailed instructions, maintain attention and concentration for extended 

periods, work in coordination with or proximity to others without being distracted, accept 

instructions and respond appropriately to criticism from supervisors, get along with co-workers or 

peers without distracting them or exhibiting behavioral extremes, and to respond appropriately to 

changes in the work setting. (AR 493.) In the report, Dr. Ferguson provided a narrative of his 

opinion:

Claimant retains the ability to understand, remember and carry out detailed but not 

complex instructions, make decisions, attend and concentrate for extended periods, 

accept instructions, and respond appropriately to changes in routine work settings.

The claimant does have more than minimal limitations associated with her 

conditions; however, these limitations do not wholly compromise her functional 

abilities. The alleged limitations caused by the claimant's symptoms are partially 

supported by [evidence of record].

(AR 494.)

On July 21, 2012, Plaintiff was seen by Deborah DiGiaro, Ph.D., for a comprehensive 

psychiatric evaluation. (AR 594-98.) Plaintiff was driven to the appointment by a friend, and was 

able to complete the psychiatric questionnaire at Dr. DiGiaro's office in a "detailed manner." 

(AR 594.) Plaintiff described several childhood and adult stressors that contributed to her 

depression and anxiety, she reported no history of psychiatric hospitalizations or suicide attempts, 

and she indicated she was seen for counseling in 2010 but it had resulted in no significant 

improvement of her symptoms. (AR 595.) 

 

2 Dr. Ferguson's January 31, 2011, MRFC form pre-dates Plaintiff's current application for DIB and SSI. It appears 

this opinion was associated with a prior application for benefits, but the record does not reflect any prior claims 

Plaintiff made for DIB or SSI. Nonetheless, the opinion relates to Plaintiff's condition during the relevant period.

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Plaintiff reported daily activities including her personal care, light shopping and cooking, 

laundry, and caring for her dog. (AR 596.) She also watches TV, and she likes artwork hobbies 

but lacks the funds for the supplies. (AR 596.) Dr. DiGiaro described Plaintiff as neatly and 

casually dressed with good hygiene. Her motor activity was within normal limits, she maintained 

good eye contact, but she was irritable and angry about the evaluation because she had done it 

before. Dr. DiGiaro noted Plaintiff "is not dumb, and she can add and subtract and be retrained. 

She thought that the questions were purposeless for her." (AR 596.) Her mood was angry and 

depressed. (AR 597.) Dr. DiGiaro diagnosed major depression and a personality disorder and 

assigned her a Global Assessment of Functioning ("GAF") score of 60.3 Dr. DiGiaro provided the 

following discussion:

This is a claimant who has had depression on and off for the last 19 years due to 

multiple external factors with [a] history of sexual abuse and abusive 

relationship[s]. She has difficulty getting along with others due to emotionality. 

She has difficulty maintaining relationships. She is emotionally over[-]reactive. 

She has [a] history of conduct disorder during childhood. She has had psychiatric 

treatment in Texas by County Mental Health with some improvement. She has 

been diagnosed with major depression at that setting. She continues to have 

depressed mood complicated by underlying personality issues, which contribute to 

her mood instability and difficulty with relationships at work and in her personal 

life. Her prognosis is fair.

(AR 598.) Dr. DiGiaro opined Plaintiff is able to manage her own funds; perform simple and 

repetitive tasks; detailed and complex tasks; accept instructions from supervisors; and work on a 

consistent basis without special or additional instructions. Plaintiff's ability to interact with coworkers and the public is mildly impaired. Plaintiff is moderately impaired in her abilities to 

maintain regular attendance in the workplace; complete a normal workday or workweek without 

interruptions from a psychiatric condition; and deal with stress encountered in a competitive work 

environment. (AR 598.)

 

3

The GAF scale is a tool for "reporting the clinician's judgment of the individual's overall level of functioning." Am. 

Psychiatric Ass'n, Diagnosis & Statistical Manual of Mental Disorders 32 (4th ed. 2000). The clinician uses a scale of 

zero to 100 to consider "psychological, social, and occupational functioning on a hypothetical continuum of mental 

health- illness," not including impairments in functioning due to physical or environmental limitations. Id. at 34. A 

GAF score between 51 and 60 indicates moderate symptoms or moderate difficulty in social, occupational, or school 

functioning. Id. 

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In April 2013, state agency non-examining physician E. Aquino-Caro, M.D., reviewed 

Plaintiff's record and completed an MRFC form. (AR 156-58.) He noted moderate limitations in 

Plaintiff's abilities to remember or carry out detailed instructions, work in coordination with others 

without being distracted by them, interact with the general public, get along with co-workers or 

peers, and respond appropriately to supervisors. (AR 157.) He noted no adaptation limitations 

such as the ability to respond to changes in work setting, be aware of normal hazards and take 

precautions, to travel in unfamiliar places or use public transportation, or to set realistic goals and 

make plans independent of others. (AR 158.) He opined in narrative form that, despite any 

moderate limitations noted, Plaintiff retained the ability to perform simple, repetitive tasks with 

limited public contact. (AR 157-58.)

B. Plaintiff's Disability Report Statements

On June 6, 2012, Plaintiff completed an adult disability report which asked various 

questions about her conditions, symptoms, and activities. (AR 296-303.) She reported she cared

for a small dog, and considered him her "mental companion." (AR 297.) Her sleeping is 

disturbed; sometimes she does not sleep at all and other times she sleeps for "days at a time." 

(AR 297.) She performs minimum household duties, preparing food only when she feels hungry. 

(AR 298.) She is easily sidetracked and it takes her too long to do simple chores. (AR 298.) 

Being in crowds "bothers" her, and she has no patience to wait in lines at checkouts. (AR 299.) 

Her balance is "bad" and she falls, she can walk only about one half block before needing to rest, 

her attention span is short, and she sometimes quits something she has started before she is 

finished. (AR 301.) She does not handle stress or changes in her routine well. (AR 302.)

C. Administrative Proceedings

The Commissioner denied Plaintiff's application initially and again on reconsideration; 

consequently, Plaintiff requested a hearing before an Administrative Law Judge ("ALJ"). (AR 77-

102, 129-60, 185-89, 197-99.) A hearing was held on June 26, 2014, before an ALJ. (AR 30-76.) 

1. Plaintiff's Hearing Testimony

Plaintiff testified she currently lives in a tent in the backyard of a friend, and she has a dog. 

(AR 35.) She has a driver's license but not a car, so she takes public transportation to get around. 

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(AR 39.) She attended cosmetology school in Kansas, but she was involved in a car accident and 

could not finish the schooling because of pain in her back. (AR 39.) Currently she is prevented 

from working because she "can't deal with people." (AR 47.) She has anxiety issues, avoids 

confrontation and pressure, and she does not like to work with the public at all. (AR 47.) She 

cannot control her temper and she becomes emotional. (AR 47.) She is seeing a psychologist for 

these issues, hoping that it will help. (AR 47.)

She had interferon treatment for her Hepatitis C, but she did not complete the treatment so 

she believes she will have to go through it again in the future. (AR 48.) She still experiences 

symptoms from the Hepatitis C including joint aches and pains, feeling worn out, and bloating. 

(AR 51.) 

She experiences headaches three times per week for which she takes Imitrex. (AR 51.) 

Her headaches last up to a week, and she experiences them about two to three times per week. 

(AR 52.) When she has a migraine, she lies down or sits in a reclined position, she tries to use ice 

and put it on her head, she takes hot tea, and she tries baths. (AR 53.)

She often has panic attacks, sometimes three or four per day. (AR 48.) Her medication 

was just changed to Xanax to see if that would help. (AR 48.) When she experiences a panic 

attack, she runs off, cries, and hugs her dog. (AR 48.) Sometimes she experiences a "spinning" 

feeling, falls for no reason, and hurts herself. (AR 49.) Her panic attacks are triggered by 

different things such as sirens. (AR 50.) She was in a tornado in the past and ever since then 

sirens trigger panic attacks. (AR 50.) These attacks last about a half hour with three or four 

occurrences on some days. (AR 50.)

She has neck pain caused by a disc problem. The pain moves up the back of her neck and 

runs through the back of her head. (AR 53.) She also has pain in her wrists which runs all the 

way to her elbows and feels like she is having a heart attack. (AR 53.) Her lower back also 

causes her pain, particularly if she lies down too long, moves around, or sits too much. (AR 53.) 

She has stomach problems from colitis and she has to be careful what she eats. 

Hemorrhaging sometimes results from her colitis problem, and she is then required to go to the 

hospital. (AR 54.) She also has pain in her hips, knees, and other joints because of the Hepatitis, 

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but also because her thyroid has been removed. (AR 54.) She does not absorb calcium anymore,

which causes her bones to thin. (AR 54.) She takes Norco for her joint pain, but it sometimes 

causes her stomach to become upset. (AR 56.) 

In describing a "normal" day, Plaintiff indicated she does not sleep much. (AR 57.) When 

she wakes, she takes her thyroid medication, has a cup of coffee, spends time with her dog, 

watches television, straightens out her tent, takes a nap and does as little as possible. (AR 57.) 

She does only light housework such as dishes and some laundry, but no yardwork. Socially, she 

attends church "every now and then," but that is "about it." (AR 59.) She sees a counselor once a 

week and her physician once a month if something is wrong. (AR 59.) 

2. Testimony of Vocational Expert at the Hearing

At the hearing, the ALJ solicited testimony from a Vocational Expert ("VE") about 

Plaintiff's past work and her ability to perform other work. (AR 61-68.) The VE testified Plaintiff 

had four jobs in the past 15 years. (AR 64.) The VE characterized the first job as that of a fast 

food cook, Dictionary of Occupational Titles ("DOT") 313.374-010, a short order cook, DOT 

313.374-014; a kitchen helper, DOT 318.687-010; and as an oven operator, DOT 526.685-070. 

(AR 65-66.)

The ALJ then posed a series of hypotheticals for the VE to consider. The ALJ asked the 

VE to consider a person of the same age, education, and experience in background as Plaintiff for 

each hypothetical. (AR 67.) In the first hypothetical, the ALJ asked the VE to consider a person 

who could lift up to 50 pounds occasionally, and 25 pounds frequently; stand or walk for 

approximately six to eight hours; sit for approximately six to eight hours; is limited to simple, 

repetitive tasks, only occasional interaction with co-workers and supervisors, must also avoid 

temperature extremes; can frequently climb ramps, stairs, ladders, ropes, and scaffolds; can 

frequently balance, stoop, kneel, crouch, and crawl, and can frequently engage in bilateral 

handling; but should avoid concentrated exposure to workplace hazards such as unprotected 

machinery, unprotected heights, and uneven and slippery terrain. (AR 67-68.) The VE testified 

that the limitation for temperature extremes would preclude Plaintiff's past work as it related to 

ovens, but there were other work that such an individual could perform including hand-packager, 

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DOT 920.587-018, which would need to be reduced by 50% to account for environmental 

limitations; as a marker, DOT 369.687-026, with a 50% erosion; and as a garment bagger, DOT 

920.687-018, with a 50% erosion due to environmental hazards. (AR 70.)

In a second hypothetical, the ALJ asked the VE to consider an individual with the same 

limitations as described in the first hypothetical, but with a reduced lifting capacity of 20 pounds 

occasionally, and up to 10 pounds frequently. (AR 71.) The VE testified such a person could not 

perform Plaintiff's past relevant work, but could perform other alternative work as a garment 

sorter, DOT 222.687-014. (AR 72.)

The ALJ posed a third hypothetical which assumed the same limitations as the first 

hypothetical, but included a limitation to sedentary work only. (AR 72.) The VE testified such a 

person could not perform Plaintiff's past relevant work, but could perform alternative work as an 

assembler, DOT 734.687-018; a leaf tier, DOT 529.687-138; and as a packaging hand bander, 

DOT 920.687-030.

The ALJ posed a fourth hypothetical asking the VE to consider a hypothetical individual 

who could rarely lift more than 15 pounds in an eight-hour day, and occasionally lift 15 pounds; 

must be allowed to lie down or recline about three hours in an eight-hour day, sit up to one hour at 

a time within an eight-hour day; must be allowed to take unscheduled work breaks at least two to 

three times within an eight-hour day for a duration of 10 to 15 minutes each; can engage in 

occasional handling fingering, overhead reaching; and may be absent from work five days or more 

per month on average. (AR 73-74.) The VE testified such a person could not perform Plaintiff's 

past work or other alternative work. (AR 74.)

Plaintiff's counsel asked the VE to clarify whether the hand packer job the VE testified 

could be performed by someone with the limitations described in the first hypothetical required 

someone to frequently or constantly engage in bilateral handling. (AR 74.) The VE responded 

that in his experience, bilateral handling could be required up to six hours a day, which would 

qualify as constant, but that would be different from what the DOT states are the typical job 

requirements. (AR 74-75.) Plaintiff's counsel posed a hypothetical, asking the VE to consider a 

person who was moderately impaired in the ability to maintain regular attendance in the 

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workplace, complete a normal workweek without interruptions, and deal with stress encountered 

in a competitive environment. (AR 75.) Plaintiff's counsel defined moderate limitation as being 

off-task 10% of the time, and the VE testified that such a person would not be able to complete 

Plaintiff's past relevant work or any other alternative work. (AR 75.)

3. The ALJ's Decision 

On August 1, 2014, the ALJ issued a decision, finding Plaintiff not disabled from June 9, 

2010, through the date of decision. (AR 12-23.) Specifically, the ALJ found that Plaintiff (1) had 

not engaged in substantial gainful activity since her alleged onset date of June 9, 2010 (AR 14); 

(2) had severe impairments including major depressive disorder, recurrent, severe without 

psychosis, anxiety disorder, chronic pain syndrome, osteoarthritis, and migraine headaches 

(AR 14); (3) did not have an impairment or combination of impairments that met or medically 

equaled one of the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1 (AR 15); and

(4) had the residual functional capacity ("RFC")

4

to perform medium exertional level work, and 

had the ability to lift and carry up to 50 pounds occasionally, and 25 pounds frequently; stand, 

walk, and sit approximately six to eight hours; frequently climb, balance, stoop, kneel, crouch, 

crawl, and engage in bilateral handling, but must avoid temperature extremes, concentrated 

exposure to excessive noise, workplace hazards such as dangerous machinery, unprotected 

heights, and uneven or slippery terrain; and she is limited to simple, repetitive tasks without any 

public contact and with only occasional interaction with co-workers or supervisors. (AR 16.) The 

ALJ found that Plaintiff was unable to perform her past relevant work (AR 21), but she retained 

the ability to perform other work such as a hand packager, marker, and garment bagger. (AR 22).

The ALJ concluded that Plaintiff was not disabled as defined by the Social Security Act at any 

time from June 9, 2010, through the date of decision. (AR 23.) 

Plaintiff sought review by the Appeals Council on August 22, 2014. (AR 13-16.) The 

Appeals Council denied Plaintiff's request for review on October 29, 2014. (AR 1-6.) Therefore, 

 

4 RFC is an assessment of an individual’s ability to do sustained work-related physical and mental activities in a work 

setting on a regular and continuing basis of 8 hours a day, for 5 days a week, or an equivalent work schedule. Social 

Security Ruling 96-8p. The RFC assessment considers only functional limitations and restrictions that result from an 

individual’s medically determinable impairment or combination of impairments. Id.

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the ALJ's decision became the final decision of the Commissioner. 20 C.F.R. §§ 404.981; 

416.1481.

C. Plaintiff's Argument on Appeal

On December 16, 2014, Plaintiff filed a complaint before this Court seeking review of the 

ALJ’s decision. Plaintiff argues the ALJ failed to incorporate limitations opined by Drs. Ferguson 

and DiGiaro, and also asserts the ALJ failed to state clear and convincing reasons to discredit her 

symptom testimony.

SCOPE OF REVIEW

The ALJ's decision denying benefits "will be disturbed only if that decision is not 

supported by substantial evidence or it is based upon legal error." Tidwell v. Apfel, 161 F.3d 599, 

601 (9th Cir. 1999). In reviewing the Commissioner's decision, the Court may not substitute its 

judgment for that of the Commissioner. Macri v. Chater, 93 F.3d 540, 543 (9th Cir. 1996). 

Instead, the Court must determine whether the Commissioner applied the proper legal standards 

and whether substantial evidence exists in the record to support the Commissioner's findings. See

Lewis v. Astrue, 498 F.3d 909, 911 (9th Cir. 2007). "Substantial evidence is more than a mere 

scintilla but less than a preponderance." Ryan v. Comm'r of Soc. Sec., 528 F.3d 1194, 1198 (9th 

Cir. 2008). "Substantial evidence" means "such relevant evidence as a reasonable mind might 

accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1971) 

(quoting Consol. Edison Co. of N.Y. v. NLRB, 305 U.S. 197, 229 (1938)). The Court "must 

consider the entire record as a whole, weighing both the evidence that supports and the evidence 

that detracts from the Commissioner's conclusion, and may not affirm simply by isolating a 

specific quantum of supporting evidence." Lingenfelter v. Astrue, 504 F.3d 1028, 1035 (9th Cir. 

2007) (citation and internal quotation marks omitted).

APPLICABLE LAW

An individual is considered disabled for purposes of disability benefits if he or she is 

unable to engage in any substantial, gainful activity by reason of any medically determinable 

physical or mental impairment that can be expected to result in death or that has lasted, or can be 

expected to last, for a continuous period of not less than twelve months. 42 U.S.C. 

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§§ 423(d)(1)(A), 1382c(a)(3)(A); see also Barnhart v. Thomas, 540 U.S. 20, 23 (2003). The 

impairment or impairments must result from anatomical, physiological, or psychological 

abnormalities that are demonstrable by medically accepted clinical and laboratory diagnostic 

techniques and must be of such severity that the claimant is not only unable to do her previous 

work, but cannot, considering her age, education, and work experience, engage in any other kind 

of substantial, gainful work that exists in the national economy. 42 U.S.C. §§ 423(d)(2)-(3), 

1382c(a)(3)(B), (D).

The regulations provide that the ALJ must undertake a specific five-step sequential 

analysis in the process of evaluating a disability. In the First Step, the ALJ must determine 

whether the claimant is currently engaged in substantial gainful activity. 20 C.F.R. §§ 

404.1520(b), 416.920(b). If not, in the Second Step, the ALJ must determine whether the claimant 

has a severe impairment or a combination of impairments significantly limiting her from 

performing basic work activities. Id. §§ 404.1520(c), 416.920(c). If so, in the Third Step, the ALJ 

must determine whether the claimant has a severe impairment or combination of impairments that 

meets or equals the requirements of the Listing of Impairments ("Listing"), 20 C.F.R. 404, 

Subpart P, App. 1. Id. §§ 404.1520(d), 416.920(d). If not, in the Fourth Step, the ALJ must 

determine whether the claimant has sufficient residual functional capacity despite the impairment 

or various limitations to perform her past work. Id. §§ 404.1520(f), 416.920(f). If not, in the Fifth 

Step, the burden shifts to the Commissioner to show that the claimant can perform other work that 

exists in significant numbers in the national economy. Id. §§ 404.1520(g), 416.920(g). If a 

claimant is found to be disabled or not disabled at any step in the sequence, there is no need to 

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

404.1520, 416.920.

DISCUSSION

A. The ALJ's RFC Assessment Encompassed All of Plaintiff's Limitations

Plaintiff argues the ALJ failed to incorporate several limitations opined by Drs. DiGiaro 

and Ferguson. Specifically, Dr. DiGiaro found Plaintiff moderately limited in her ability to 

maintain attendance, complete a normal workday without interruptions from a psychiatric 

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condition, and deal with stress. Although the ALJ included a limitation for simple, repetitive work 

in the RFC, this does not adequately capture the limitations opined by Dr. DiGiaro. Also, state 

agency non-examining physician, Dr. Ferguson, found Plaintiff has adaptation limitations, but 

nothing in the RFC adequately captures these limitations. The work identified by the VE requires

the ability to manage some form of change in terms of work duties. A moderate limitation in 

Plaintiff's ability to adapt to change – as opined by Drs. DiGiaro and Ferguson – would impact 

Plaintiff's ability to perform the identified jobs; thus, the ALJ's failure to incorporate the 

limitations into the RFC was material to the disability determination.

The Commissioner argues the ALJ's RFC assessment need only be consistent with the 

physician's assessed limitations, not identical to them. The ALJ in this case translated the 

moderate limitation opined by Dr. DiGiaro into a concrete functional limitation to simple, 

repetitive work without any public contact and only occasional interaction with co-workers and 

supervisors. In other words, the ALJ synthesized the medical evidence into an RFC that 

accommodated the limitations stemming from Plaintiff's medical conditions. Regarding Dr. 

Ferguson, the Commissioner contends the ALJ was not required to identify explicitly in her RFC 

the "moderate" adaptation limitations Dr. Ferguson assessed in completing the mental residual 

functional capacity form. The Commissioner further argues the narrative portion of Dr. 

Ferguson's report does not contain any adaptation limitations.

1. The Adaptation Limitation Opined by Dr. Ferguson

On January 31, 2011, Dr. Ferguson completed an MRFC form in assessing Plaintiff's 

mental functional abilities. (AR 492-94.) The MRFC's Section I is comprised of check boxes to 

record "summary conclusions derived from the evidence in the file" and contains four subsections 

regarding areas of function: understanding and memory, sustained concentration and persistence, 

social interaction, and adaptation. (AR 492-93.) Each subsection contains categories of skills and 

abilities the physicians is to check-mark as "not significantly limited," "moderately limited," 

"markedly limited," "no evidence of limitation in this category," or "not ratable on available 

evidence." Section II provides space for the physician to document any needed additional 

documentation. (AR 493.) Finally, Section III is for the physician to record a functional capacity 

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assessment only after Section I is completed, and it is to include any additional information which 

clarifies the claimant's limitation or function. (AR 494.) The Social Security's Program 

Operations Manual System ("POMS") directs adjudicators to Section III of the MRFC form, rather 

than Section I. POMSDI24510.060(B)(4), available at https://secure.ssa.gov/poms.

nsf/lnx/0424510060. POMS states that Section III contains the "actual mental RFC assessment is 

recorded, explaining the conclusions indicated in [S]ection I, in terms of the extent to which these 

mental capacities or functions could or could not be performed in work settings." DI 

24510.060(B)(4); see Nathan v. Colvin, No. 12-35797, 551 Fed. Appx. 404, 408 (9th Cir. 2014) 

(unpublished) (Section I of the MRFC does not contain the physician's RFC opinion and ALJ 

properly considered only Section III narrative opinion of MRFC form).

Dr. Ferguson completed Section I by checking boxes indicating Plaintiff was "moderately 

limited" in several categories, such as the ability to understand, remember, and carry out detailed 

instructions, the ability to maintain attention and concentration for extended periods, work in 

coordination with or in proximity to others without being distracted by them, accept instructions 

and respond appropriately to criticism from supervisors, get along with co-workers or peers 

without distracting them or exhibiting behavior extremes, and respond appropriately to changes in 

the work setting. (AR 492-93.) In Section III, Dr. Ferguson opined that Plaintiff retained the 

ability to understand and remember detailed instructions, make decisions, attend and concentrate 

for extended periods, accept instructions, and respond appropriately to changes in routine work 

settings. (AR 494.) 

Plaintiff contends the moderate limitations noted in Section I of Dr. Ferguson's MRFC 

form should have been included in the ALJ's RFC, but the ALJ failed to explain the weight given 

to Dr. Ferguson's opinion and why these moderate adaptation limitations were rejected. Dr. 

Ferguson's narrative description of Plaintiff's limitations in Section III indicates Plaintiff retained 

the ability to attend and concentrate for extended periods and respond appropriately to changes in 

a work setting. (AR 494.) It is this narrative that is to be given weight, according to POMS, 

rather than the Section I check-boxed conclusions. Thus, the ALJ's RFC limiting Plaintiff to 

simple, repetitive tasks with no public contact sufficiently incorporates Dr. Ferguson's narrative 

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opinion in Section III of his MRFC. Even if the ALJ erred in failing to give express consideration 

to Dr. Ferguson's January 31, 2011, MRFC form opinion, the error was harmless because the RFC 

reflected the abilities Dr. Ferguson provided in Section III of the MRFC form.

2. The Limitations Opined by Dr. DiGiaro

Plaintiff contends the ALJ's RFC failed to include Dr. DiGiaro's opinion that Plaintiff was 

moderately limited in her ability to maintain attendance, complete a normal workday without 

interruptions from a psychiatric condition, and deal with stress. Plaintiff maintains POMS defines 

the mental abilities needed for any job which includes the ability to maintain attention for 

extended periods, maintain regular attendance, complete a normal workday and workweek without 

interruptions from psychologically based symptoms, and respond appropriately to changes in a 

routine work setting. POMS 25020.010(B)(3). Because Dr. DiGiaro opined Plaintiff had

limitations in these areas, those limitations necessarily impacted Plaintiff's ability to perform the 

alternative work identified by the VE. Plaintiff also cites Brink v. Comm'r Soc. Sec. Admin., 

343 Fed. Appx. 211, 212 (9th Cir. 2009) (unpublished), arguing the Ninth Circuit remanded that 

case based on similar facts presented here.

The Commissioner argues that the moderate limitation opined by Dr. DiGiaro was 

incorporated into the RFC by including the limitation to simple, repetitive tasks without any public 

contact and only occasional interaction with coworkers and supervisors. The Commissioner also 

concludes that Plaintiff's reliance on Brink is "misplaced."

The ALJ is required to formulate the RFC based on the entire record. 20 C.F.R. 

§ 1545(a)(3) (the RFC is based on all the relevant evidence, including diagnoses, treatment, 

observations, and opinions of medical sources, as well as observations by family members and the 

claimant's own subjective symptoms). The RFC findings need only be consistent with the relevant 

assessed limitations and not identical to them. See Turner v. Comm'r of Soc. Sec., 613 F.3d 1217, 

1222-23 (9th Cir. 2010). 

Here, the ALJ credited the opinions of Dr. DiGiaro, state agency examining physician and 

state agency non-examining physician Dr. Aquino-Caro. (AR 19.) Dr. Aquino-Caro opined in 

April 2013 that Plaintiff had moderate limitations in several areas of Section I on the MRFC form, 

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but in narrative form, indicated the moderate limitations noted did not preclude Plaintiff from the 

ability to complete simple, repetitive tasks with limited public contact. (AR 156-58.) Although 

Dr. DiGiaro noted moderate limitations in the ability to maintain regular attendance, complete a 

normal workday, and deal with stress, she too opined Plaintiff was able to perform simple, 

repetitive tasks. (AR 598.) The ALJ may synthesize these opinions in creating the RFC, and there 

is no indication the ALJ failed to include a moderate limitation either of the doctors felt could not 

be encompassed by a limitation to simple, repetitive tasks with limited contact with supervisors, 

co-workers, and the public. 

Plaintiff's citation to Brink, an unpublished Ninth Circuit memorandum decision, for the 

proposition that the simple, repetitive task limitation does not encompass moderate functional 

limitations such as concentration, persistence, and pace is not persuasive. In Brink, the ALJ 

apparently accepted medical evidence that the claimant had moderate difficulty maintaining 

concentration, persistence, or pace. However, the ALJ did not include this moderate limitation in 

posing a hypothetical to the VE and only referenced a limitation for simple, repetitive work. The 

court held this was error and rejected the Commissioner's contention that the limitation to simple, 

repetitive work encompassed the claimant's difficulties with concentration, persistence, and pace. 

Id. The court distinguished Stubbs-Danielson v. Astrue, 539 F.3d 1169 (9th Cir. 2008), which 

reached the opposite conclusion, reasoning that in Stubbs-Danielson there were no established 

limitations in concentration, persistence, or pace whereas in the case before it, Brink, there was 

evidence of such limitations. The court concluded Stubbs-Danielson was therefore inapposite. Id. 

The reasoning offered in Brink to distinguish Stubbs-Danielson is not persuasive. In 

Stubbs-Danielson, two doctors opined the claimant had limitations in pace: Dr. McCollum 

determined Plaintiff had "slow pace, both with thinking and her actions" and found the claimant 

"moderately limited" in the ability to perform at a consistent pace without an unreasonable number 

and length of rest periods; Dr. Eather also identified "a slow pace, both in thinking & actions." 

Stubbs-Danielson, 539 F.3d at 1173. The Stubbs-Danielson court concluded, however, that the 

pace limitations were adequately translated into the only "concrete restrictions available" which 

was a restriction to simple tasks that matched the conclusion of Dr. Eather. Id. (citing Howard v. 

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Massanari, 255 F.3d 577, 582 (8th Cir. 2001)). Distinguishing Stubbs-Danielson on the ground 

that there was no evidence of functional limitation in concentration, persistence, and pace is not 

persuasive, and, as an unpublished memorandum decision, Brink is not controlling authority. 

Here, Dr. DiGiaro opined Plaintiff had moderate limitations in the ability to attend work, 

complete a normal workweek, and deal with stress in a workplace, but nonetheless concluded 

Plaintiff would be able to perform simple and repetitive tasks. This matched Dr. Ferguson's 

conclusions that, despite moderate limitations in concentration and her ability to deal with stress, 

Plaintiff ultimately maintained adequate abilities in these areas. Dr. Aquino-Caro found Plaintiff 

had no adaptation limitations. (AR 158.) Thus, the ALJ's RFC was a combination of Drs. 

Ferguson, DiGiaro, and Aquino-Caro's opinions, which he synthesized in creating the RFC. 

Moreover, like Stubbs-Danielson, the ability to do simple, repetitive work adequately captures 

moderate deficiencies in certain adaptation abilities where, as here, the examining and nonexamining physicians DiGiaro, Ferguson, and Aquino-Caro all opined Plaintiff retained the ability 

to perform simple, routine tasks despite any moderate limitations in adaptation abilities noted by 

Dr. DiGiaro and Ferguson. 

B. The ALJ's Consideration of Plaintiff's Symptom Testimony

Plaintiff notes the ALJ rejected her symptom testimony based on her daily activities and 

lack of compliance with medical treatment, which Plaintiff contends were legally insufficient 

reasons. The Commissioner argues the reasons stated by the ALJ were proper, and the ALJ's 

credibility determination should be upheld.

1. Legal Standard

In evaluating the credibility of a claimant's testimony regarding subjective pain, an ALJ 

must engage in a two-step analysis. Vasquez v. Astrue, 572 F.3d 586, 591 (9th Cir. 2009). First, 

the ALJ must determine whether the claimant has presented objective medical evidence of an 

underlying impairment that could reasonably be expected to produce the pain or other symptoms 

alleged. Id. The claimant is not required to show that her impairment "could reasonably be 

expected to cause the severity of the symptom she has alleged; she need only show that it could 

reasonably have caused some degree of the symptom." Id. (quoting Lingenfelter, 504 F.3d at 

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1036). If the claimant meets the first test and there is no evidence of malingering, the ALJ can 

only reject the claimant's testimony about the severity of the symptoms if he gives "specific, clear 

and convincing reasons" for the rejection. Id. As the Ninth Circuit has explained:

The ALJ may consider many factors in weighing a claimant’s credibility, including 

(1) ordinary techniques of credibility evaluation, such as the claimant’s reputation 

for lying, prior inconsistent statements concerning the symptoms, and other 

testimony by the claimant that appears less than candid; (2) unexplained or 

inadequately explained failure to seek treatment or to follow a prescribed course of 

treatment; and (3) the claimant’s daily activities. If the ALJ’s finding is supported 

by substantial evidence, the court may not engage in second-guessing.

Tommasetti v. Astrue, 533 F.3d 1035, 1039 (9th Cir. 2008) (citations and internal quotation marks 

omitted); see also Bray v. Comm’r of Soc. Sec. Admin., 554 F.3d 1219, 1226-27 (9th Cir. 2009); 

20 C.F.R. §§ 404.1529, 416.929. Other factors the ALJ may consider include a claimant's work 

record and testimony from physicians and third parties concerning the nature, severity, and effect 

of the symptoms of which he complains. Light v. Soc. Sec. Admin., 119 F.3d 789, 792 (9th Cir. 

1997).

2. Analysis

a. The ALJ Properly Considered Plaintiff's Daily Activities

Plaintiff first contends the ALJ's assessment of her daily activities as inconsistent with her 

symptom testimony is improper. The activities Plaintiff performs are not transferrable to the 

workplace, and the ALJ provided no analysis how her daily activities are transferrable to the 

workplace. The Commissioner argues Plaintiff's daily activities are not offered by the ALJ to 

show Plaintiff's ability to perform sustained work activity, but were noted instead because they 

bear on Plaintiff's believability: Plaintiff alleges a degree of incapacity incompatible with the 

activities in which she engages. 

There are two recognized grounds for using daily activities to form the basis of an adverse 

credibility determination: the activities contradict other testimony; or the activities meet the 

threshold for transferable work skills. Orn v. Astrue, 495 F.3d 625, 639 (9th Cir. 2007) (citing 

Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989)). When the ALJ uses daily activities to show the 

claimant maintains activities that meet the threshold for transferable work skills, the ALJ must 

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make specific findings that the claimant is able to spend a substantial part of his day engaged in 

pursuits involving performance of physical functions that are transferable to a work setting. Thus, 

in Orn, the court rejected the Commissioner's argument that reading, watching television, and 

coloring in coloring books were activities that bore a meaningful relationship to the activities of 

the workplace. Id. 

Here, the ALJ noted Plaintiff's daily activities in relation to the first ground: that the 

activities were inconsistent with her statements of limitation. (AR 20.) Even where activities of 

daily living suggest some difficulty functioning, they may still be grounds for discrediting the 

claimant's testimony to the extent they contradict claims of a totally debilitating impairment. 

Turner, 613 F.3d at 1225; Valentine v. Comm'r Soc. Sec. Admin., 574 F.3d 685, 693 (9th Cir. 

2009). Thus, whether Plaintiff's daily activities were transferable to a workplace setting is 

irrelevant to the reasoning offered by the ALJ. The question is whether there is substantial 

evidence to support the inconsistencies between Plaintiff's activities and her allegation of totally 

disabling impairment noted by the ALJ. 

Plaintiff testified at the hearing she is primarily precluded from work because of her 

inability to "deal with people." (AR 47.) She cannot control her temper, ends up crying, and 

running away. (AR 47.) She also experiences regular panic attacks, which triggers her to "want to 

hide and find a safe place to be." (AR 50.) She states she experiences headaches three times a 

week, which last a couple of hours with medication and occur about two to three times per week. 

(AR 52.) She also has pain in her neck, which runs through the back of her head; and she has pain 

in her wrists and hip joints. (AR 53.) On an average day, she wakes, takes her thyroid 

medication, spends time with her dog, watches some television, takes a nap, and does as little as 

possible. (AR 57.)

Yet, the wide breadth of her reported daily activities could be reasonably construed as 

inconsistent with the degree of limitation she reported. As the ALJ noted, Plaintiff reported 

visiting with friends, taking care of her small dog, preparing simple meals, and shopping one- to 

two-times per month. She reported to Dr. DiGiaro that she took care of her own grooming, 

performed light shopping, cooking, and laundry. Plaintiff also testified she does light house work, 

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cleans the bathroom, goes to church occasionally, visits friends, and sees her counselor once a 

week. Thus, there is substantial evidence the ALJ could reasonably interpret as inconsistent with 

the degree of limitation to which Plaintiff claimed. 

b. The ALJ Permissibly Considered Plaintiff's Failure to Appear for 

Treatment

In making an adverse credibility determination as to Plaintiff's lay testimony, the ALJ 

noted Plaintiff failed to follow through with mental health treatment appointments. (AR 20.) She 

cancelled for failed to show up for appointments to treat her depressive disorder and anxiety at 

Tulare County Mental Health and was discharged due to non-compliance. He concluded this 

failure to follow through with treatment undermines the credibility of her subjective reports of her 

symptoms. (AR 20.)

Plaintiff contends the ALJ impermissibly considered her failure to appear for treatment 

sessions as a basis for the adverse credibility determination. Plaintiff's failure to attend various 

medical appointments is a feature of her mental condition and not a proper basis to discount her 

credibility. (Doc. 13, 14:20-15:4 (citing, e.g., Nguyen v. Chater, 100 F.3d 1462, 1465 (9th Cir. 

1996).) The Commissioner argues the ALJ's credibility analysis was proper. Specifically, the 

ALJ is permitted to consider a failure to attend treatment appointments in assessing credibility.

On the one hand, in making a credibility determine, an ALJ may consider a claimant's 

unexplained or inadequately explained failure to seek treatment or comply with a treatment 

regime. Tommasetti, 533 F.3d at 1039. According to Agency rules, "the individual's statements 

may be less credible if the level or frequency of treatment is inconsistent with the level of 

complaints, or if the medical reports or records show that the individual is not following the 

treatment as prescribed and there are no good reasons for this failure." Social Security Ruling 

("SSR") 96-7p. On the other hand, in cases of mental impairment, it may be inappropriate to place 

too much emphasis on a failure to follow treatment or seek treatment where there is evidence the 

failure to do so was a feature of the impairment itself. See Molina v. Astrue, 674 F.3d 1104, 1113-

14 (9th Cir. 2012).

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In Molina, the court found it was permissible for the ALJ to consider an unexplained lack 

of treatment where the claimant reportedly suffered from an anxiety disorder. 674 F.3d 1104. The 

court explained that the record was "filled with evidence" that despite the claimant's physician's 

repeated efforts to persuade the claimant to seek psychiatric treatment, she failed to do so until 

after she applied for disability benefits. Id. "Although Molina provided reasons for resisting 

treatment, there was no medical evidence that Molina's resistance was attributable to her mental 

impairment rather than her own personal preference, and it was reasonable for the ALJ to conclude 

that the 'level or frequency of treatment [was] inconsistent with the level of complaints.'" Id. The 

court noted Molina's reliance on Pate-Fires v. Astrue, 564 F.3d 935, 945 (8th Cir. 2009) was 

misplaced because there the "'evidence overwhelmingly demonstrate[d] Pate-Fire's noncompliance 

was attributable to her mental illness,'" whereas there was no such evidence before the court in 

Molina. Id. 

This case similar to Molina in that, although Plaintiff suggests, without expressly asserting, 

her failure to attend the medical appointments related to her mental health was due to her mental 

health, the record does not corroborate Plaintiff's contention in this regard. Instead, the record 

shows Plaintiff repeatedly failed to attend therapy and counseling sessions to the extent she was 

discharged from treatment in February 2014 at Tulare County Mental Health because of her noshows. (AR 823-24.) Tulare County Mental Health noted Plaintiff had missed follow-up visits 

for medical appointments, rehabilitation appointments, and therapy appointments on November 

19, 2013, December 9 and 30, 2013, and January 28 and 31, 2014. (AR 823.) She was dismissed 

from treatment on February 12, 2014. (AR 824.) Plaintiff does not cite, nor does the record 

reflect, a medical notation that these absences were due to her mental health condition. As such, 

the ALJ was permitted to consider this unexplained failure to follow her mental health treatment

regime in making the credibility determination. Molina, 674 F.3d at 1113-14.

c. Secondary Motives Were Properly Considered by the ALJ

The ALJ also gave less weight to Plaintiff's lay statements because the record suggested 

Plaintiff was seeing physicians primarily in order to generate evidence for her social security 

application. (AR 20.) Plaintiff does not make any contention of error as to this reasoning, and the 

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Commissioner argues secondary motives, rather than actual disability from impairments, is a 

factor that is permissibly considered by the ALJ. (Doc. 14, 12:8-27 (citing, e.g., Matney v. 

Sullivan, 981 F.2d 1016, 1021 (9th Cir. 1992).) At appointments in 2010 and 2012, the ALJ noted 

Plaintiff mentioned her disability applications were pending (AR 382, 620), and in April 2013, the 

first time she was examined by Dr. Kissinger, she requested he complete a disability form to assist 

with her application for benefits. (AR 811.)

Plaintiff does not allege any error regarding this reasoning, and there is substantial 

evidence to support the inference made by the ALJ regarding Plaintiff's motivation to seek 

treatment. 

d. Plaintiff's Medication Non-Compliance Is Not Supported by 

Substantial Evidence

As for Plaintiff's medication compliance, the ALJ found there was evidence Plaintiff had 

not been entirely compliant in taking prescription medication. (AR 20.) For example, on January 

6, 2010, she reported to her treating provider that she had not taken her prescribed Seroquel, and 

she was out of her Paxil medication. (AR 574.) Her medications were refilled on January 29, 

2010, but she was unable to refill them on February 10, 2010, because she had no money. 

(AR 574.) Although she indicated she would return, she was a no-show for her appointment on 

March 30, 2010. (AR 574.) She also failed to appear for an appointment on May 3, 2010 

(AR 573), but was seen the next day on May 4, 2010 (AR 572.) At that appointment, Plaintiff 

reported she had stopped taking the Seroquel because she did not like that she was eating all the 

time. (AR 573.) 

On November 1, 2010, Plaintiff was evaluated at Denton County, Texas, MHMR Center 

upon reporting anxiety and depression. (AR 530-37.) She stated she had previously been 

prescribed Paxil and Seroquel, but neither of those medications worked for her. (AR 530.) 

Plaintiff was prescribed Prozac, Restoril, Buspar, and Levoxyl (AR 541), which she reported on 

November 18, 2010, had decreased her symptoms (AR 396.) She reported on November 24, 

2010, she was taking her medication as prescribed, and it was noted she was clinically improving. 

(AR 442-43.) On December 21, 2010, she again reported to her treating physician at Denton 

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County MHMR that she was taking her medication as prescribed (AR 504), and it was noted that 

she was stable beyond being upset with her daughter who had stolen money from her (AR 505). 

The ALJ noted that Plaintiff's anxiety and symptoms appeared to improve while she was 

consistent with her medication and cites Plaintiff's treatment records from Denton County MHMR. 

While it is true that Plaintiff's condition appeared to improve when her medication was modified 

in November 2010, the evidence noted by the ALJ supporting that Plaintiff was not compliant 

taking her medication is limited to only one notation in January 2010 when Plaintiff reported she 

had not taken her Seroquel. (AR 574.) Plaintiff later reported, however, that she had stopped 

taking the Seroquel due to side effects and ineffectiveness. (AR 573.) There is little evidence 

Plaintiff refused to take her medication, and the ALJ's reasoning in this regard is not clear and 

convincing. Nonetheless, the ALJ offered other clear and convincing reasons to discredit 

Plaintiff's symptom testimony, thus the ALJ's error in this regard is harmless. See Carmickle v. 

Comm'r Soc. Sec. Admin., 533 F.3d 1155, 1163 (9th Cir. 2008) (one erroneous basis to reject 

credibility does not necessarily "negate the validity" of the ALJ's adverse credibility finding).

CONCLUSION

Based on the foregoing, the Court finds that the ALJ’s decision is supported by substantial 

evidence in the record as a whole and based on proper legal standards. Accordingly, the Court 

DENIES Plaintiff’s appeal from the administrative decision of the Commissioner of Social 

Security. The Clerk of this Court is DIRECTED to enter judgment in favor of Defendant Carolyn 

Colvin, Acting Commissioner of Social Security and against Plaintiff Linda Elaine Calisti. 

IT IS SO ORDERED.

Dated: November 20, 2015 /s/ Sheila K. Oberto 

UNITED STATES MAGISTRATE JUDGE

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