F OR P UBLICATION



### UNIT E D ST AT E S CO URT O F APPE AL S FO R T H E NINT H CIRCUIT

K A R E N S. G A R

R I S O N , Plaintiff-Appellant

,

v

.

C A R O L Y N W

. C O L

V I N , Commissioner of Social Security Administration, Defendant-Appellee

. N o. 12-15103

D.C. No. 2:10-cv-02484- J W S

OPI NI ON

A ppeal from the United States District Court for the District of Ariz o na J ohn W . Sedwick, District J udg e, Presiding

Arg ued and Submitted March 10, 2014—San F rancisco, California

F iled J uly 14, 2014

B efore: J e r ome F arris, Stephen Reinhardt, and A. W allace Tashima, Circuit J udg es.

Opinion by

J udg e ReinhardtG A R R I S O N V

. C O L

V I N 2

SUMMARY *

Social Security

The panel reversed the district court’s o r d er remanding the c ase to the Commissioner of So cial Security Administration for further proceeding s, a nd inste a d r e m a

n d ed with instructions to the administrative law judg e to calculate and award Social Security disability benefits to the c laimant.

The p anel h eld that the administrative law judg e (“AL J ”) erred in a ssessing the medical opinion evidence. The panel also held that the AL J erred b y failing to offer specific, clear, and convincing r easons for d i s crediting the claimant’s
sy mptom testimony concerning her phy s i c a l and mental impairments.

The panel outlined the three-part credit-as-true standard, each part of which must be satisfied in order for a c o u r t t o remand to a

n AL J with instructions to calculate a n d award benefits: (1) the record has been fully developed and f urther administrative proceeding s w ould serve no useful purpose; (2) the AL J has failed to provide leg ally sufficient reasons for rejecting evidence, whether claimant testimony or m edical opinion; and (3) if the improperly discredited evidence were credited as true, the AL J would be re q u ired to find the claimant disabled on remand. The panel held that the district
court abused its discret ion by remanding for f urther proceeding s wher e t h e credit-as-true rule was satisfied a nd the record a fforded no r eason to believe that the claimant was

* T h is su m m ary co n stitu

tes n o part o f th e o p in io n o f th e co u rt. It h as b een p rep ared b y

co u rt staf

f f o r th e co n v en i en ce o f

th e read er.G A R R I S O N V

. C O L

V I N 3

not, in fact, disabled. The panel he l d t h a t a remand f or a calculation and award of benefits was required.

COUNSEL

Mark C a l d w ell, Caldwell & Ober, Phoenix

, A riz ona, for Plaintiff-Appellant.

L aura H. Holland (arg

u ed), Special Assistant United Sta tes Attorney
, S o cial Security Administration, Office of the General Counsel, Denver, Colorado; J ohn S. L e o nardo, United States Attorney
, Michael A. J ohns, Assistant U n i t e d States Attorney
, United States A ttorney s’ Office, Phoenix

, Ariz ona; J ohn J ay L ee (of c ounsel), Reg ional Chief Counsel, Reg ion VI I I
, Social Security Administration, Office of the General Counsel, Denver, Colorado, for Defendant

- A p p e l lee.

OP INION

REI NHARDT, Circuit J udg e:

Karen Garrison appeals f rom a d e nial of Social Security benefits, arg u ing that the Administrative L aw J udg e (“AL J ”)

err e d in rejecting her sy

mptom testimony and in assig ning little weig h t to the opinions of he r treating medical
caret a k e r s. I n a decision that the Commissioner does not contest, the d i s t r ict court determined that the AL J erred in

as s e s s i ng the medical opinion evidence and remanded the

case f or further proceeding s. W e conclude that the AL J also erred in discrediting G arrison’s sy mptom testimony

, and that the distri ct court abused its discretion in remanding for further proc eeding s. A pply ing our settled “credit-as-true”G A R R I S O N V

. C O L

V I N 4

rule, w e reverse the judg ment below with i n s t ru ctions to remand this case to the AL J for the calculation and award of benefits.

BACK G ROUND

I

Karen Garrison was born in 1970. I n an applica t ion for disability insurance benefits f iled o n September 7, 2007, she stated that she has been disabled since April 17, 2007 due to

a combination of phy sical and mental impairments. B efore her stated d isability onset date, s h e w o r ked as a bus driver, bus monitor, cashier, p iz z a cook, convenience store c lerk, a nd customer service manag er.

After Garrison’s application for b e n efits w as d enied on J anuary 4, 2008, and after h er request for reconsideration was denied on March 12, 2008, she requested a hearing b efore an AL J

. At the hearing

, which was held on J uly 14, 2009, Garrison presented ex tensive medical records to support her claim of disability and testified at lengt h about h o w her impairments affect he r d a i l y life. The AL J also heard
t estimony from a vocational ex pert (“VE”). The eviden c e presented at the hearing

covered the period from April 2007
to J une 2009, and comprehensively a ddressed G arrison’s phy sical and mental health.

A. P hysical Im pairm ents

Since 2 006, as shown by the records of Dr. Christopher L abban, her primary ca re provider, Garrison has suffered from a variety

of phy sical ailments—including chronic neck and back pain, deg enerative joint disease, sciatica, obesity

,G A R R I S O N V

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asthma, and herniated d iscs. L abban’s notes from late 2006 and early -to

- mid 2007 reveal that, despite a variety o f attempted treatments, many of these medical conditions persisted or worsened. 1 Ga rr i son’s chronic neck and back pain was an e specially s erious problem: nothing seemed to help, it beg an interfering with h er daily life, and t he p ain started slowly creeping into her shoulders, arms, and leg s. I n respon s e , L abban referred Garrison to Dr. Georg e W ang , a neurolog ist. W ang started t r ea t ing Garrison in September 2007 and continued treating her throug h J une 2009, the date of the last medical record in this case. 2

W h en W a

ng first e valuated Garrison, he noted that she reported severe neck and back pain that radiated outward a nd caused other sy

mptoms; the neck pain radiated into her upper

arms and caused numbness and ting ling , and the lower back
p ain caused a burning sensation that radiated into her le gs

. He observed that prolong ed standing ag g ravated her pain, a s did turning h er head. I n h is assessme n t , W a ng noted that MRI results confirmed that Garrison suffered from spinal disc protrusions and determined that her pain sy mptoms involved “radicular features.” He a lso r emarked t h at Garrison h ad

1 In early 2 0 0 7, a n

u m ber o f MRI scan s co n f

irm ed d isc p ro tru s io n s in Garriso n ’ s sp in e. A ro u n d th e s a m e tim e, Garriso n b rief ly receiv ed
p h y sical t h e r a p y , th e treatm en t reco rd s f o r w h ich assessed “ sig n s an d
sy m p to m s co n sisten t [w ith ] lo w b ack p ain d u e to pelv ic in stab ility an d d eceased p ro x im al m

u scu latu re stren g th /stab i lity .” P h y sic a l th erap y p ro v id ed o n ly p artial rel i e f, h o w ev er, an d Garriso n w as f o rced to sto p at t e n d i n g af

t er f o u r sessio n s d u e to in su

ran ce restrictio n s an d f

in an cial
tro u b l es.

2 So m e o f W an g ’ s treatm en t reco rd s are sig n ed b y Nu rse P rac t i t io n er L au ra Kin n ey , w ith an ad v isem en t th at s h e w as actin g u n d er h i s d irectio n

o r su p erv isio n in p rep arin g th e n o tes.G A R R I S O N V

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V I N 6

decreased muscle streng th of the left triceps a nd decreased streng th of the lower e x tremities more d istally

, sy mptoms that he viewed as “sug g estive of cervical and lumbar radiculopathy .” F ollow-up tests performed on October 1, 2007 supported his initia l d i ag nosis o f cervical and lumbar radiculopathy

.

W a ng further noted in September 2007 that Garrison reported e x periencing what she described as “seiz u r es,” in which her mind went blank, her body seiz ed up, s h e started shaking u ncontrollably

, and she heard voices y elling at her. W a n g theoriz ed that she was suffering from panic attacks.

Garrison ’ s s y

m p t o ms g rew worse between September a nd December 2007. W an g’ s treatment notes indicate that Ga r r i s o n r e p o r

t e d h aving ex perienced another “seiz ure” while
at the g rocery store, causing her to seiz e up, f eel like most o f h e r b o dy was burning

, slur her speech, and collapse. Garrison also stated that, at nig h t, she felt sustained twitching in her b ody

, “like electronic current z aps throug h her h ead.” More sig nificant, her burning and aching neck p ain continued
to radiate into her shoulders at a 10/10 level of intensity ; Garrison stated that “ she h as electric jolts g oing up to her head when she moves her neck” and that her arms kept falling

a s l eep. G arrison’s lower back p ain, too, rated 10/10 in intensity

, and W ang observed that it was m a de worse b y prolong ed standing

. Noting that G arrison was v e r y drowsy from all o f the pain medication she was taking —medication that did not effectively control her pain—W a ng cleared Ga rrison for epidural shots. H e also modified the medications she was tak i n g , which at the time included Teg r etol, Neurontin, and B aclofen.G A R R I S O N V

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V I N 7

I n November 2 007, Dr. E rnest Griffin, a state ag ency consultin g phy sician who never ex amined Garrison, completed a phy sical residual functional capacity assessment. His r e port consists of a n swers to a series of check-box questions and a few lines of e x planation that do not r e ference
most of Garrison’s treatment records or any of her statements. Griffith noted in his repo rt that he did not consider any statements by Garrison’s treating and ex amining p hy sicians. Gr iffin opined that Garrison c ould occasionally lift or carry 20 pounds, frequently lift or carry 1 0 pounds, stand and/or walk for about 6 h o u r s in an 8 -hour workday

, a nd push o r pull without limitation. He added that she could o ccasionally

c l i mb ramps and stairs, kneel, crouch, and crawl, and could frequently stoop. He opined that she had no limitations with respect to c old, heat, wetness, humidity

, noise, and vibration, but should avoid concentrat e d ex posure to fumes, o dors, dusts, g ases, poor ventilation, and haz a r ds.

I n J anuary 2008, consistent with his treatment records a nd
t h o s e o f L abban over the p rior months, W ang noted that Garrison’s sy

mptoms of “seiz ures” and unbearable p ain persisted unabated. Her neck and ba c k p a i n still rated at 10/10 in intensity

, still radiated into her arms, shoulders, a nd leg s, and still caused a mix of burning

, numbness, a nd
t i ng ling

. G arrison also reported intense fatig ue due to insomnia and frequent twitching at nig ht, as well as ong oing “seiz ures” that disrupted her daily activities

. One such “seiz ure,” in l a t e J a

nuary 2 008, c aused her to shake on the left side of her body and was accompa n i e d b y a spell o f confusion and st u t tering

. T hese sy mptoms, in turn, were

ex a c erbated by drowsiness from her medications, e pisodes o f

wea k ness, and a persistence in decreased muscle streng th in her left arm and lower ex tremities.G A R R I S O N V

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V I N 8

As of F ebruary 2008, Garrison’s pain sy mptoms were only marg ina lly less severe: she r eported that her neck p ain remained at 8/10 in intensity

, with jerking

, numbness, a nd ting ling in her arms that frequently caused her to drop thing s, and stated that her back pain was a t 7/10 in intensity

, with a burning sensation that radiated into her leg s. These a nd other
sy mptoms often caused her to lose her balance and to lean to one side. 3

Summariz ing his assessment of Garrison’s sy mptoms on F ebruary 20, 2008, W ang sta ted as follows in a “Pain F unctional Capacity (PF C) Questionnaire” that posed a series of questions followed by check-box es: Garrison did have pain; this pain was “moderately severe (pain seriously affects ability t o f

u nction)”; and this pain was reasonably ex pected
to result f

rom objective clini c a l o r diag nostic finding s documented in Garrison’s medical records. W ang noted that Garrison’s pain was precipitated by chang ing w eather, movement, overuse, stress, a nd cold, a n d w as “frequently ”

severe enoug h to interfere with Garrison’s attention a nd concentration. W ang added that, due to her pain sy mptoms, G a r r i s o n “ f

r e q u e n t l y” e x p e r i e n c e d d e f i c i e n c i e s o f concentration, persistence or pace that resulted in a failure to complete tasks in a timely manner.

I n March 2008, Dr. Eric F eldman, to whom Garrison h ad been sent for a consultation, remarked that Garrison had been

ex p eriencing neck and back pain “for the past y ear,” and that she had suffered “a fairly severe pain throug hout the neck, scapular area, thoracic and lumbar spine.” F eldman observed that n either phy sical therapy nor a cervical epidural steroid

3 In Feb ru ary

2 0 0 8 , an EEG test larg ely ru led o u t seizu res as th e cau s e

o f Garriso n ’ s sp ells o f

j erk in g , stu tterin g , co n f

u sio n , an d h allu cin atio n s.G A R R I S O N V

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V I N 9

injection h ad afforded Garrison much relief, that her burning pain remained constant, and that s h e was still ex p e riencing ting ling in both hands and leg pain. H is phy sical ex amination revealed tenderness over the cervical paraspinal musculature and facet joints, as w ell as over the suprascapular a nd periscapular musculatu r e. Noting limited cervical rang e o f motion, a variety of spinal issues, and limited rotation bilaterally

, F eldman stated that his impressions included fibromy alg ia, central hy

peralg esia, and disc protrusions a nd disc space narrowing

.

Over the nex t two months, G arris o n’s pain improved

s o m ew hat. She had a hy sterectomy , some of her ot h e r sy mptoms aba ted, a

nd a transforaminal epidural steroid injection temporari l y reduced her b a ck and leg pain. However, she c o ntinued to ex perience sy mptoms o f radiculopathy

, including sharp p ain in he r n eck, arms, a nd shoulders.

W a ng ’s rec ords show that, by J u ne 2008, Garrison, w ho had stopped a few o f her medications, was ag ain ex p e riencing numbness, ting ling

, and sharp pain i n h er hands, arms, a nd neck. She had also ex perienced a “seiz ure” on J une 15, 2008. W a n g instructed Garrison to resume some of her medications and ordered her not to d

rive for at least three months. A few weeks later, Garrison once ag ain ex perienced a “seiz ure,” a nd reporte d t o W ang that, despite the Percocet that she was taking every six hours, she was still in p ain. B y A ug ust 2008, Garrison was ag ain ex periencing intense pain in her neck a nd rig ht shoulder—and received only partial, short-live d relief from the Percocet.

I n September 2008, F eldman performed another epidural steroid shot, but this time the shot led to only a f ew day s o fG A R R I S O N V

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V I N 10

relief from the ag ain-chronic burning back pain, which soon started shooting down f

r o m Garrison’s lower back into her thig hs and leg s. T his and other sy mptoms led Garrison to have trouble k eeping h e r b alance. W ang prescribed more Percocet and also told G arrison to start using a r olling w alker for her g ait instabilit y

. G a rrison saw little improvement in the months that followed. I n O ctober 2008, even wit h Percocet three times a day for pain, she reported feeling a lot of p ain r adiating from the r ig ht side of h er lower back into her rig ht leg

, causing numbness a nd ting ling

. Then, in N ovember 2008, W ang noted a mild limp, tension h eadaches escalating
to mig raines, and ong oing cervical and lumbar r adiculopathy

.

After a short-lived respite from the back pain (thoug h not other sy mptoms) in December 2008—the result of another epidural shot—Garrison ag ain report ed severe back pain in J anuary 2009. F eldman’s records reveal that, b y this poi nt, Percocet had b ecome less effective, providing partia l relief for only a few hours per dose. Garris o n ’ s neck continued “bothering her sig n ificantly ,” and the p a i n f rom her neck started radiating into her occipital r eg ion. Garrison was started o n new pain medications, inc l u d i n g MS Contin, but continued to feel numbness and ting ling in her arms and leg s. These sy mptoms, as well as severe h eadaches, persisted into F ebruary 2009.

I n April 2009, W ang noted that G arrison’s h eadaches h ad finally ceased, but also observed that she had ex perienced an increase in h er back pain and that this pain was still radiating down h er leg s. Garrison told W ang tha t i t f e l t like her feet “are on fire,” adding that she could n o t walk o r s tand for a long time a

nd that h er feet were tender to the touch. W ang opined that Garrison’s “p ai n i s affecting her ability to function.”G A R R I S O N V

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V I N 11

Garrison’s last medi c a l r e cord is from J une 2009. I n it, W a n g states a s follows: “The patient states she [ continues]
to have c onstant pain to her lower b ack and neck rated a s 6 on 0– 1 0 pain scale. She continues to have numbness a nd ting ling to her bilateral lower ex tremities, g reater on the rig ht. The patient states she continues to have some lower ex tremity weakness. She stat e s h e r p ain is ag g ravated by sitting a nd standing for long periods.” W a ng o nce ag ain recorded his impression that Garrison’s p ain “is affecting h e r ability to function,” noting that her drug s were n ot providing adequate relief.

B. Mental Health Issues

Throug hout the relevan t time period, Garrison strug g led with a variety of d iag nosed mental i m p a irments, including bipolar disorder, a

nx iety

, bouts of insom n ia, auditory a nd visual hallucinations, and paranoia. Her treating medical caretakers also came to view her “seiz ures” (so m e t i m e s called “pseudo-seiz ures” in her treatme nt records) as the result of psy chiatric issues.

I n September 2007, Ga r r i s on v isited Nurse Practitioner Susan Anders o n for the first time. Anderson, who would become G arrison’s primary psy chiatric care g iver, noted that Garrison suffered from insomnia, anx iety

, d epressive
sy mptoms, nig htmares, a

nd flashbacks. Anderson diag n osed post-traumatic stress disorder and possible bipolar d i s o rder. She also r ecorded a Global Assessment of F unction (GAF )

score of 50. 4 L ater that month, Anderson noted that Garrison

4 “ A G A F sco re is a ro u g h estim ate o f an in div id u al’ s p s y ch ol o gi c a l,

so cial, an d occu

p atio n al f u n ctio n in g u s ed t o ref

lect th e in div id u al’ s n eed f o r treatm en t .” Va rg as v. L a mb ert , 1 5 9 F.3 d 1 1 6 1
, 1 1 6 4 n .2 (9 th Cir.G A R R I S O N V

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V I N 12

had recently suffered another “seiz ure” and, more important, that Ga rr i s on was having trouble w ith her medication. Garrison stated that she felt electric shocks g oing throug h her body

, a nd added that she alternated between f eelin g very depressed and feeling like she had superpowers that would let her lift piles of wood in the heat.

Two months later, in November 2007, Dr. W ay ne General

ex a mined Garrison at the behest o f a state ag ency

. He concluded that her full scale I Q was 77, placing her in the 6th percentile, and observed that “Karen is currently functioning in the rang e of borderline intellig ence.” General then noted
t h at G arrison’s “overall short-term memory is in t h e b o rderline rang e” and that h er “concentration is in the l o w averag e rang e.” W hen subjected to f urther t e s t s , Garrison performed in “ the lower a v erag e rang e” on simple tasks a nd

“ v e r y poorly ” o n more complex tasks requiring concentrati o n

.

1 9 9 8 ). A cco rd in g to t h e DSM- IV, a GA F sco re b etw een 4 1 an d 5 0 d escrib es “ serio u s s y m

p t o m s” o r “ an y serio u s im p airm en t in so cial,

o ccu p atio n al, o r sch o o l f

u n ctio n in g .” A GA F sco re b etw een 5 1 to 6 0 d escrib es “ m o d erate s y m p to m s” o r an y m o derate d if f icu lty in so cial,

o ccu p atio n al, or sch o ol f

u n ctio n in g .” A lth o u g h GA F sco res, st a n d in g alo n e, d o n o t co n t

ro l determ in atio n s of w h eth er a p erso n ’ s m en t al im p airm en ts rise to th e l e ve l o f a d isab ility (o r in teract w ith p h y sical im p airm en ts to create a d i sab ility ), th ey m ay b e a u sef u l m easu rem en t. W e n o te, h o w ev er, th at GA F sco res are ty p ically assessed in c o n tro lled

, c l in ical settin g s th at m ay d if f er f ro m w o rk en v iro n m en ts i n im p orta n t resp ects. S

ee, e.g

. , T

i t l e s II & XVI: C

a p a b ility to Do Oth er W o rkTh emed i ca l -Vo ca tio n a l Ru les As A Fra mewo rk fo r Eva lu a tin g S o l e l y No n exertio n a l Imp a irmen ts , SSR 8 5

- 1 5
, 1 9 8 3

- 1 9 9 1 So c. Sec. R ep

. Serv

. 3 4 3 (S.S.A 1 9 85 ) (“ T h e m e n t a lly im p aired m ay cease to f

u n ctio n ef f ectiv ely w h en f acin g su ch d em an d s as g ettin g t o w o rk reg u l arly

, h av in g th eir perf o rm an ce su

p erv ised

, an d rem ain in g in th e w ork place f o r a f u l l d ay .”).G A R R I S O N V

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V I N 13

Assessing Garrison’s overall mental well-being

, General made a number of diag

noses:

Ax is I : 296.52 B ipol a r I Di s o r d e r , M ost

R e c e n t E p i s o d e D e p r e s s e d

, Moderate

995.50 V ictim of Phy sical o r Sex u al Abuse as a Child

995.81 Victim o f Phy sical o r Sex u al Abuse as an Adsult

3 0 9

. 8 1 P o s t t r a u m a t i c S t r e s s Disorder, Acu

t e , C h r o nic, Delay ed Onset

3 0 4

. 8 0 P o l y s u b s t a n c e D e p e n d e n c e , A l c o h o l

, Amphetamines, Cann a b i s a nd C o c a i n e i n F u l l

, S u s t a i n e d Remission by

self-report

Ax is I I : V 6 2

. 8 9 B o r d e r l i n e In t e l l e c t u a l

F unctioning , by

ex amination

Ax is I I I : O v e r w e i gh t , j o i n t d i se a s e ( n e c k

and back) and arthritis, by referral history ; mig raine cephalg ia b y self-report

General concluded that Garrison’s “prog nosis for returning to work is currently poor, as she had difficulty mainta i n i n g concentration and manifested a borderline short-termG A R R I S O N V

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V I N 14

memory

. She did not have sufficient emotional control, and broke into tears three times during test administra tion. Her ability to perform work-related tasks is cur rently inadequate based on cog nitive functions such as attention, concentration, processing speed and short-term memory .”

I n December 2007, Anderson noted that Garrison’s mood

was “unstable,” that G arrison was dealing with several family issues, and that Garrison was ex p eriencing intens e anx iety and severe racing thoug hts. Anderson a ssessed a GAF score of 55, with a continued dia gnosis of B ipolar D isorder I I a nd PTSD. Garrison’s a ttention a n d concentration, as well as her insig ht and judg ment, were only “ f air.” Garrison’s condition did not materiall y ch a n ge over the nex t few months. I n J anuary 2008, despi t e s l i g ht improvement due to use o f Abilify

, Anderson’s records s how that Garrison remained

anx ious and deeply

paranoid, with a GAF score of 55–60.

That month, D r. Adrianne Gallucci, Psy .D., a state ag ency consultant, reviewed some of Anderson’s m e d i c a l r e c o r ds a nd filled o ut a check-box form to state her conclusions. Gallucci
op i ned that Garrison’s impairments were “severe but not

ex p ected to last 12 months,” and identifie d “ [ c ] oex isting [ n] onmental [ i] mpairme n t(s) that require referral to another medical specialty

. ” Gallucci checked off the box es for affective di s orders, mental retardation, and anx iety -related disorders. Under affective disorders, Gallucci marke d b i polar disorder. I n a summary section, Gallucci checked box es for “mild” deg ree of limitation o f f u nction in “restriction o f activities of daily living ” a nd “difficulties in mai n t a i ning social f unctioning .” Gallucci c h e c ked box es for “moderate” deg ree of di f

ficulties in “maintaining concentration, persistence, or pace.” I n a brief ex planation section, Gallucci remarked that G arrison had e x p e rienced a g o od initialG A R R I S O N V

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response to some medication and had started mental health treatment, a n d for these reasons was n ot likely to suffer an impairment lasting more than 12 months.

Anderson’s records show that, in F ebruary 2008, Garrison’s G AF dropped to 55. I n her visit, Garrison reported hearing g hosts and spirits calling her n ame, a variety of oth e r auditory and visual hallucinations, nig htmares,

severe anx iety

, obsessive p reoccupations, and p ersistent insomnia. Her attention and c o ncentration, as w e l l a s her insig ht and judg ment, remained only “fair.”

That month, A nderson completed a “Medical Assessment of the Patient’s Ability to Perform Work Rel ated A ctivity ” (“the 2008 A ssessme n t ” )

. I n it, Anderson reported a

mo d erate impairment in Garrison’s ability to relate to other people; to perform d aily activities; to understand, carry out, and remember instructions; to respond ap p ropriately to supervision; to respond appropriately to c o -workers; and to perform varied tasks. Anderson report ed moderately severe constriction of interests, including in Garrison’s ability to

re spond to customary w ork pressures; ability to perform

c o m p l e x t a s k s ; a b i l i t y t o c o m p l e t e a n o r m a l

w o r k d a y / w o r k w e e k w i t h o u t i n t e r r u p t i o n s f r o m psy cholog ically based sy

mptoms; and ability

to perform at a

cons i s t e nt p ace without an unreasonable number/leng th o f
rest p eriods. Anderson che c ked “ Yes” when asked, “Have the above limitations lasted or can they be ex pected to last for 12 months or long e r? ” Anderson also filled out the comment section o f the form, writing as follows: “Client h as poor coping s kills, auditory hallucinations, unstable moods, a nd

severe anx iety

. These psy chiatric sy mptoms are complicated by multiple medical problems.”G A R R I S O N V

. C O L

V I N 16

I n J uly 2008, after a short respite f rom some of her more

severe mental health p roblems—thoug h she did ex perience at least one “seiz ure” du ring that respite 5 —Garrison ag ain returned to A nderson w ith hallucinations, panic at t acks, insomnia, racing thoug hts, blackouts, unstable mood, a nd paranoia. Anderson asse s s e d GAF scores o f 45–50 a nd determined that Garrison’s attention and concentrat ion, a s well as h er insig ht a

nd judg ment, were “limited.” One month la t e r , Garrison collapsed and then fainted in the middle of a counseling sessi o n , and c ontinued to r eport auditory hallucinations, anx iety

, and racing thoug hts. Anderson’s records show that Garrison’s a ttention and concentration, a s well as her insig ht and judg ment, remained “limited.”

Garrison’s GAF score dropped ag a in in September 2008, this time to 50, and Anderson ag a in recorded issues including hallucinations, insomnia, a nx iety

, and r acing thoug hts. B y late September, Garrison’s issues ex panded to i n c lude overwhelming depression and paranoia. Throug ho u t t his period, her attention and concentration, a s well as h e r insig ht and jud gm ent, remained “limited.” Then, from N ovember 2008 to F e bruary 2 009, G arrison’s mental health i m p roved somewhat. Anderson r ecorded GAF scores rang ing from 55
to 61 in this period, noting that, althoug h Garrison remained

anx ious and was at times tearful, treatment was h elping to alle v i a te Garrison’s more severe sy mptoms, including her panic attacks, paranoia, and hallucinations.

5 Fro m Feb ru ary 2 0 0 8 to Ju n e 2 00 8
, w h ile o n a b reak f

ro m so m e of h er

m ed i catio n s, Garriso n w o rk ed f ou r to f iv e tim es as an “ o n call” teach er’ s aid e an d also w o rk ed a f

ew h o u rs p er d ay as a b u s m o n ito r. Sh e w as f ired b y th e sch o o l d istrict af

ter h av in g a “ seizu re” o n

th e b u s

.G A R R I S O N V

. C O L

V I N 17

As before, thoug h, this short-lived and limited uptick in Garrison’s mental h ealth soon en d e d

. B y April 2009, Garrison was suicidal a nd p anicked, ag ain reported racing thoug hts and pseudo-seiz ures , and ag ain stated that she was having trouble with—and had stop p e d some of—her medications. L ate in A pril 2 009, A nderson assessed a GAF

score o f 5 0 and noted that Garrison was display ing hy pomanic sy

mptoms, sleepin g less, and had only “partial” insig ht and judg ment.

Garrison’s GAF score r e m ained 50 in May 2009. That month, Anderson observed that Garrison had f ainted on several o ccasions when upset, w as s t i l l e xp e r i e n c i ng insomnia

a nd racing thoug hts, and still h ad only partial insig ht a n d judg ment. I n J une 2009, Garrison felt a bit better, but was still “up and down.” H er GAF score remained 5 0, an indication of “serious sy

mptoms” or “seri o u s i mpairment in social, occupational, o r school functioning ,” she was still
t roubled by bouts of racing thoug h ts and a nx iety

, a nd Anderson wa s still try ing

, apparently with only mix ed success, to adjust her medications.

II

At t he J une 14, 2009 hearing before the AL J
, Garrison testified a

bout how he r phy sical and mental impairments

a f fect her daily life. A VE also testified, main l y b y answering

a series of hy

pothetical questions.

A. G arrison’s Testim ony

A t the J une 14, 2009 hearing

, Garrison testified th a t s h e stopped working in Ap r i l 2 007 b ecause she was “having problems with [ h er] back and [ her] neck,” rising to the levelG A R R I S O N V

. C O L

V I N 18

of “severe back pain.” She described her neck pain as a “real sharp, b urning pain,” that g rew worse w hen she slept wrong , picked stuff u

p , or bent over, and that r adiated into h er a rms. S h e added that neither phy sical therapy nor injections h a d helped her neck pain; to the contrary , the neck injections h ad caused a n a llerg ic reaction that required hospitaliz ation. She testified that h e r b a c k pain is sharp, nag g ing

, and constant, that it shoots d o w n t o the back sides of her leg s, that she
cannot be nd down to lift or pick thing s up unless she is sitting

, a nd that the pain is ex acerbated by standing or sitting for mor e t h a n 2 0 to 30 minutes. She added that the pain is often so bad that she must lie down e very three to f our h ours, that she naps three hours per day because she is tired from the pain, and that the pain p rohibits her f r om picking up her daug hter, h er laundry

, or heavy bag s of g roceries. Garrison
st a t ed that phy sical therapy did not alleviate her back p ain and that the epidural injections she had received helped f o r only a short while. She a lso stated that she had g a i n ed o ne hundred pounds from her medication.

Turning to her mental impairments, Garrison testified, “I have a lot o f a n x i e ty ” a n d “a lot of ups and downs a nd depression.” She stated that s h e ex periences panic attacks that sometimes cause h e r t o pass out, and that these attacks

a r e trig g ered by tasks like g r ocery shopping alone. She avoi d s t a lking to p e o ple to prevent stress, o ccasionally

ex p eriences suicidal thoug h t s , and, when she is feeling de p ressed, spends day s alone in her room with the lig h t out. W h en she feels “up,” however, she c annot sleep for day s at a time and ex periences auditory hallucinations in which voices criticiz e her for ruining her life. Garrison n o t e d that her “seiz ure” condition has improved somewhat since she started taking Proz ac.G A R R I S O N V

. C O L

V I N 19

G ar r ison testified that h er mother takes care of he r, including taking her to church, to d octors, and to the g rocery store, an d d oing her laundry

. She stated that, althoug h she

can carry a f

ive pound b ag of potatoes, she cannot c arry a ten pound bag (or a watermelon), and that she a lway s carries the lig htest g r oceries. Describing a ty pical day

, Garrison stated: “J u s t ge t up, feed my daug hter, call Griffey the turtle. Sometimes I water the plants. Get my self dressed, g et her dressed. Then b y the time lunc h t i m e comes around, I ’ m down for a g ood two, three hours. And then I ’ll g et back up and make sure she’s had dinner. My mom watches her while I ’m sleeping

. I ’ll make sure she has dinner, and then usually I ’m back to sleep by

7:30, 8:00.”

B. The Vocational Expert’s Testim ony

The VE answered a series of questions posed by the AL J and by Garrison’s lawy er about a hy pothe t i cal person’s ability e ither to perform past relevant work or sustain the demands of work.

The AL J first posed this hy pothetical question:

I ’m asking y ou to consider a hy pothetical
person the same a g e, education, and w ork history as Ms. Garrison. T h e first question is, this hy pothetical person could perform work fr eq uently lifting a

n d carry ing 10 pounds, occasionally 20 pounds; could sta n d and/or walk with normal breaks about six out of eig ht hours; sit with normal breaks about six out o f eig ht hours; no limits in pushing or pulli n g;

can never c limb ladder s , ropes, or scaffolds;

can occa s i o nally climb ramps and stars;G A R R I S O N V

. C O L

V I N 20

occasionally stoop, kneel, crouch, and crawl. This person can o ccasionally reach overhead. The person must a v o id concentrated ex posure to f umes, odors, dust, g asses, poor ventilation, and haz ards. This person is restricted to performing simple w ork. Could this hy pothetical p er s o n perform any of the past relevant work?

The VE repli e d t h at such a person could perform the past relevant work of “[ t] he cashier/checker, bus monitor, teacher’s aide, and the piz za maker.”

Nex t, the AL J posed this question to the VE: “I ’d ask y ou to consider the sam e h y p o thetical person. This person frequently had d eficiencies o f concentration, persistence, o r pace resulting in failure to complete tasks in a timely manner. W o uld that person be able to sustain the m ental demands o f work? ” The VE replied, “No.”

Garrison’s lawy er then posed the f ollowing hy

pothetical question:

[ P] lease a ssume an individual the claimant’s
ag e, education, and work ex perience, but

assume they were limited as follows.

. . . The
person had a moderately severe limitation, and that’s defined as an impai rment which seriously affects the ability to function, a nd that w ould be in the following areas; ability to

u n d e r s t a n d

, c a r r y o u t , an d r e m e m b e r i n s t r u c t i o n s ; r e s p o n d a p p r o p r i a t e l y t o

s u p e r v i s i o n ; r e s p o n d

, [ s i c

. ] r e s p o n d appropriate[ ly ] to co-w o r kers; respond toG A R R I S O N V

. C O L

V I N 21

customary

work pressures; and to complete a normal w ork day and work week without interruptions from p sy cholo gically based
sy mptoms; to p erf

o rm at a consistent p ace without an unreasonable number and leng th o f
rest periods. Do y ou ag ree that the cumulat ive effect of those moderately severe limitations would prec l u d e b o t h t h e c laimant’s past relevant work and, and all other works?

The VE replied, “I

would.”

F inally

, G arrison’s l aw y er asked, “Given the limitations testified to [by Garrison]

, were t h ey c redible, would y ou ag ree those would preclude both the claimant’s past relevant work and all other work? ” The VE replied, “Yes.”

III

On O ctober 2 9, 2009, the AL J issued a decisi on concluding that Garrison was not disabled within the meaning of the Social Security Act. At step one o f the five-step sequential evaluation process, 6 the AL J d e termined that

6 W e d escrib e th e f

iv e- step seq u en tial p ro cess at g reater len g th in fra

. Fo r a su m m ary o f th e p ro cess, see K en n ed y v. Co lvin

, 7 3 8 F.3 d 1 1 7 2
, 1 1 7 5 (9 th Cir. 2 0 1 3 ) (“ T h e f iv e- step p ro cess f

o r d isab ility d eterm in atio n s b eg i n s b y ask in g w

h eth er a claim an t is en g ag ed in ‘ su b stan tial g ain f

u l activ ity ’ an d co n sid erin g th e sev erity o f th e claim an t’ s im p airm en ts. S

ee 2 0 C.F.R. § 4 1 6.9 2 0 (a)(4 )(i)– (ii). If th e in q u i ry co n tin u es b ey o n d th e

seco n d s t ep , th e th ird step ask s w h eth er th e claim an t’ s i m p airm en t or

co m bin atio n o f im

p airm en ts m eets o r eq u als a listin g u n d er 2 0 C.F.R. p t. 4 0 4
, su b p t

. P
, ap p

. 1 an d m eets th e d u ratio n req u i rem en t. S ee id

. § 4 1 6.9 2 0 (a)(4 )(iii). If s o, t h e claim an t is co n sid ered d i sab led an d b en ef its

are aw ard ed

, en d in g th e i n q u iry

. S ee id

. If th e pro cess co n tin

u es b ey o n dG A R R I S O N V

. C O L

V I N 22

Garrison had not eng ag ed in substantial g ainful activity since April 17, 2007, the alleg e d onset date. 7 At step two, the AL J found t h a t Garrison had the following medically determinable

severe impairments: “bo r d e rline intellectual functioning

, b i p o l a r d isorder, posttraumatic stress d i s o r d e r s , p o l y s u b s t a n c e dependence (in sustained remission), deg enerative disc disease of the lumbar, c ervical and thoraic spine, obseity

, a nd asthma.” At step three, the AL J concluded that Garrison did not meet or medically

equal any of the listed impairments in 20 C.F .R. Part 404, Subpart P, Appendix 1. At step four, the AL J determined t h a t G arrison has the residual functional capacity to perform the ex ertional requirements of lig ht work

as defined in 20 C.F .R. § 404.1567(a), adding t h a t , due to various limitations, Garrison is limited to simple work. She concluded that Gar rison is capable of p erforming past relevant work as a school bus monitor, cashier/chec ker, a nd piz z a maker. According ly

, the AL J determined that Garrison had not been under a disability from April 17, 2007 throug h October 29, 2009.

I n assessing Garrison’s residual functional capacity

, the AL J started by discrediting part o f G arrison’s testimony

. The AL J concluded that, while Garr ison’s medically determinable impairments c o u l d reasonably be e x pected to p roduce the alleg ed sy

mptoms, G arrison’s “statements concerning the

th e th ird step , th e f

o u rth an d f

if t h step s co n sid er th e claim an t’ s ‘ resid u al f u n ctio n al cap acity ’ in d eterm in i n g w h eth er th e claim an t can still do past relev an t w o rk o r m ak e a n a d j u stm en t t o o th er w ork

. S ee id

. § 4 1 6 .9 2 0 (a)(4 )(iv )– (v ).”).

7 T h e A L J n o ted th at Garriso n h ad w o r k e d fo u r to f iv e tim es as a teach er’ s aid e an d p art tim e as a b u s m o n ito r in early 2 0 0 8
, b u t co n clu ded th at “ [t]h is w o rk activ ity d o es n o t rise to th e l ev el o f p resu m p tiv e m o n th ly SGA u n d er th e Reg u latio n s.”G A R R I S O N V

. C O L

V I N 23

intensity

, persistence, and limiting effects of these sy mptoms

are not c redible to t h e e x t e n t they are inconsistent with finding that the claimant has no severe impairment o r combination of impairments

. . . . ” The AL J r easoned that, althoug h Garrison h ad suf f e r e d m e n t a l impairments rendering h er “ non functional for a g ood part of the period fr o m A p r i l 2007 to the end of 2007,” Garrison’s mental health h ad improv e d with medication. The AL J added that G arrison’s mental health deteriorated when she stopped taking her medication, noted that Garrison’s GAF score had reached 60 in November 2008, and point ed out that Garrison told A n d e rson in F ebruary 2009 that she was stable with h e r medications.

Turning to Garrison’s testimony concerning her phy sical impairments, the A L J stated that “t h e claimant phy sically i m proved in 2007 and 2008 with conservative medi c al treatment, i.e., phy sical therapy and e pidural injections.” The A L J also observed that Garrison helped prepare meals, cleaned her room, talked on the phone frequently

, and helped

care for her own d aug hter, activities that the AL J deemed inconsistent w ith Garrison’s a lleg ations o f disability

. I n sum, the AL J remarked that “ there may have a [ sic] short time during the adjudicatory period in which the claimant has been non-functional,” b u t “most of these times were when the claimant was either not taking her psy c h otropic medications

or before she had underg one p hy sical therapy fo r her neck/back pain.” 8

8 W ith o u t co n c l u d in g th at Garriso n w as a m alin g erer, th e A L J n o ted a sin g le in co n sisten cy in Garriso n ’ s t e stim o n y : w h ereas Garriso n claim ed
to h av e g a i n e d o n e h u n dred p o u n d s w h ile o n m ed i catio n , th e m ed i cal

reco rd s sh o w ed th at Garriso n h ad g ain ed o n l y ap p r o x im ately tw en ty p o u n d s.G A R R I S O N V

. C O L

V I N 24

Nex t, the AL J considered the m e d i c al evidence. Citing only W a n g’ s PF C Questionnaire from F ebruary 2008, a nd Anderson’s 2008 Assessment (also from F ebruary 2008), the AL J “assig n[ e d] little we i ght to the medical o p inions reflected in these assessme n t s, as Dr. W ang provided no rationale for his medical conclusions and Ms. Anderson, as a

nurse practitioner, is not a psy chiatrist or psy c holog ist.” The AL J added: “ I n ad dition, their finding s d o not comport with the improvement the claimant consistently showed when she adhered to h er medication reg imen. The same c ritique is applied to Ms. Anderson’s m o st recent medical source statement d ated J une 23, 2 009.” A fter rejecting W ang a nd Anderson’s conclusions, the AL J g ave substant i a l weig h t to the conclusions of the state ag ency consultants, Griffith a nd General, r eg arding Garrison’s phy sical and m e n t a l residual functional capacity

. I n the A L J ’ s view, “their finding s limited the claimant to r ang e [ sic] of lig ht, si m p l e w o rk.” Matching this residual functional capacity assessment to the hy pothetical questions posed to the VE
, t h e AL J concluded that Garrison could work as a bus monitor, piz z a maker, a nd cashier/checker, and therefore rejected her application.

IV

After ex hausting administra tive remedies, Garrison
appea l ed to the d istrict court, w hich concluded that her case should b e remanded to the AL J f o r further proceeding s. I n reaching that result, the district court first concluded that the “panoply of reasons” g iven b y the AL J for rejecting Garrison’s sy

mptom testimony was sufficiently specific, clear, and convincing

.

The district court then considered the AL J ’s decision to g ive substantial weig ht to t h e state ag ency consultants,G A R R I S O N V

. C O L

V I N 25

Griffith and G eneral, rather than to Garr i s o n ’s treating medical caretakers, W a

ng and Anderson. F ocusing , like the AL J
, on the two check-box forms that W ang a n d Anderson completed in F ebruary 2008, the district court stated that the AL J had “provided only a perfunctory ex planation of her

reasons for not g iving sig nificant weig ht to the opi n i o ns o f those who had been treating Claimant.” Specificall y , with respect to W ang , the AL J failed to a ddress “any of the particulars of [ W ang ’s] lengt h y t reatment of Claimant a nd

numerous treatment n otes,” said “nothing about whether Dr. W a n g ’s opinion, which was based on the effect of Claimant’s pain, i s c onsistent or inconsistent with other evidence
reg arding Claimant’s pain,” and offered only a “conclusory ” discussio n o f h is treatment records. W ith respect to Anderson, the AL J did not recog niz e that a nurse practitioner is an acceptable medical sou r ce under 2 0 C.F .R. § 404.1523(d) and failed to consider the f actors set forth in 20 C.F .R. § 404.1527(c) 9 in analy z ing her o pinion. T he district
court b elieved that, a s a result of these errors, it was “unable
to assess whether the AL J properly accorded little weig ht” to W a n g and Anderson’s opinions.

Turning to Griffith and General, the district court first noted that “Griffith had no medical records from any treating

o r other e x amining p hy sician to review,” and ag r eed with Garrison that “it is n ot c lear from the AL J ’s decision that she had a n adequate basis for u s i n g Dr. Griffith’s one-time

ex a mination to d i s p lace the opinion of a treating phy sician such as D r. Wang .” The d istrict court added that the AL J h ad misunderstood General’s repo r t which, r ead properly

, “adds
to the balance in favor of finding Claimant disabled, althoug h

9 A t t h e tim e o f th e d istrict co u rt’ s ru lin g , th e relev an t f

acto rs w ere set f o rth in 2 0 C.F.R. § 4 0 4 .1 5 2 7 (d ).G A R R I S O N V

. C O L

V I N 26

the fact that the evaluation was a snapshot of her condition at

a p ar ticular point in time renders the evaluation standi n g alone a n insufficient basis to d etermine that Claimant had a disability of the requisite duration.”

Ultimately

, the d istrict c o urt c oncluded that it lacked a sufficient ex planation from the A L J of why she decl i n e d t o g ive substantial weig ht to the opinions o f W ang a nd Anderson, and why she instead c redited Griffith. The district
court ther e f

o re remanded to the Commissioner, stating that, if the opinions of W a

ng and Anderson were properly g iven little weig h t, Garriso n would not b e e ntitled to an award o f benefits.

Garrison timely appealed this ruling , contending that the district court abused its disc r et i o n in remanding to the Commissioner for further proceeding s instead of remanding for a calculation and award of benefits.

D ISCUSSION

I

42 U.S.C. § 405(g ) provides f o r judicial review of the Social Security Administ r ation’s disability determinations: “The court s h all h ave power to enter

. . . a judg ment affirming

, modify ing

, or r eversing the decision of the Commissioner of Social Security

, with or without remanding the cause for a rehearing

. ”

An A L J ’s disabili t y determination should b e upheld unless it contains leg al error or is not supported by substantial evidence. See Stout v. C o mm ’ r , Soc. S ec. Admin.

, 454 F .3d 1050, 1052 (9th Cir. 2006); 42 U.S.C. §§ 405(g ), 1383(c)(3).G A R R I S O N V

. C O L

V I N 27

“‘Substantial evidence’ means more than a mere scintilla, but less than a p reponderance; it is such relevant evidence a s a reasonable person mig ht accept as a dequate to support a conclusion.” Lingenfelter v. Astrue
, 504 F .3d 1028, 1035 (9th Cir. 2007). “[ W ] e must consider the entire r ecord a s a whole, weig hing both the evidenc e that supports and the evidence that detracts f

rom the Com missioner’s conclusion, and may not affirm simply by isolating a specific quan t u m o f supporting e vidence.” Id. ( c i tations and quotation marks omitted). “The AL J is responsible for d etermining credibility

, resolving conflicts in medical testimony

, and for resolving ambig uities.” Andrews v. Shalala

, 5 3 F. 3 d 1035, 1039 (9th Cir. 1995). W here “th e e v idence can reasonably support either affirming or reversing a decision, we may not substitute our judg ment f or that of t h e [ A L J ] .” Id. (citation omitted). We review only the reaso n s p rovided by the AL J in the disability determination a nd may not affirm the AL J on

a g r o u nd upon which he did not rely

. See Connett v

. Barnhart

, 340 F .3d 871, 874 (9th Cir. 2003).

“[ A] district court’s decision to a ffirm, reverse or modify

a determination of the Social Security Administration is reviewed de novo on appeal. W e also r e v i e w de novo a district court’s determinati o n to remand a case to the Commissioner.” Harman v. A p fel

, 211 F .3d 1172, 1174 (9th Cir. 2000) (citation omitted).

II

W e conclude that the AL J e rr e d i n r ejecting W ang a nd Anderson’s medical opinion s , that she misunderstood General’s opinion of Garrison’s impairments, and th a t s h e failed to meet the requirement of offering specific, clear, a ndG A R R I S O N V

. C O L

V I N 28

convincing reasons for discrediting Garrison’s sy mptom testimony

.

A. The F ive-Step Sequential P rocess

The Social Security A ct d efines “disability ” as the inability to e ng ag e “in a n y substantial g ainful activity b y

reason of any medically determinable phy si c a l or mental impairment which can be ex pected to r esult in death o r which h a s lasted o r c an be ex p ected to last for a continuous p er i o d of not less than 12 months.” 42 U .S.C. § 1382c(a)(3)(A). A claimant “shall be determined to be under a disability only if his phy sical or mental impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his ag e, e ducation, and work e x perience,
eng ag e in any other kind o f substantial g a i n f u l work which

ex ists in the national economy , reg ardles s o f w hether such work e x ists in the immediate area in w h i c h he lives, o r whether a specific job vacancy ex ists for him, or whether he would be hired if he applied for work.” § 1382c(a)(3)(b).

AL J s apply a f

i v e

- step e valuation process to determine whether a claimant q

u alifie s a s d isabled. Ludwig v. Astrue
, 681 F .3d 1047, 1048 n.1 ( 9t h Cir. 2012). That procedure is set forth at 20 C.F .R. § 404.1520(a)(4):

(4) The five-step sequential evalu a t ion
process. The sequential evaluation process is

a series of five “steps” that we follow in a set order

. . . I f w e can find that y ou are disabled

or not disabled a t a step, we make our determination or decision and we do not g o on to the nex t step. I f we cannot find that y ou a re disabled or not disabled at a step, we g o on toG A R R I S O N V

. C O L

V I N 29

the n ex t step. B efore we g o from step three to step four, w e assess y o ur residual functional capacity

. . . . W e u se this residual functional capacity assessment a t both step four and step five when w e evaluate y o ur c laim at these steps. These are the five steps we follow:

(i) At the first step, we consider y our work activity

, if any

. I f y ou are do i n g substantial g a inful activity

, we will find that y ou are not disabled . . .

(ii) At the second step, we consider the medical severity of y our impairment(s). I f
y ou do not ha v e a severe medically d e t e r m i n a b l e p h y s i c a l o r m e n t a l impai r m ent that meets the duration

r e q u i r e m ent in § 404.1509, o r a combination of impairments that is severe and meets the duration requirement, we will find that y o u are not disabled . . .

(iii) At the third step, we also consider the medical severity of y our impairment(s). I f
y ou have an impairme n t (s) that meets o r equals one of our listing s in appendix 1 o f th i s subpart and meets the duration requirement, we will f

i n d that y o u a

re disabled . . .

(iv) At the fourth step, we consider our assessment of y our residua l functional capacity and y o ur p a st relevant work. I fG A R R I S O N V

. C O L

V I N 30

y ou can still do y our past r e l e vant work,

we will find that y ou are not disabled . . .

(v) At the fif

th and last step, we consider

our assessment of y our residual functional capacity and y our ag e, e ducation, a nd work ex perience to see if y ou can make an adjustment to other work. I f y ou can make an adjustment to other w ork, we will find that y ou are not disab l e d. I f y ou cannot make an adjustment to other w ork, we will find that y ou are disabled . . .

20 C.F .R. § 404.1520(a). “ T he burden of proof is on the claimant at steps o ne throug h four, but shifts to the Commissioner at step five.” B r a y v. Comm’r of Soc. Sec. Admin. , 554 F .3d 1219, 1222 (9th Cir. 2009).

At steps four and five, the AL J determines a cl ai mant’s

r e s i d u a l f

u n ctional capacity (“RF C”). 20 C

. F. R

. § 416.920(e). RF C is “what [ one] can still do despite [one’s] limitations.” 20 C.F .R. § 416.945(a ) (1 )

. I t is “based on all the r elevant medical and other evidence in [ the] case record.” Id. I f a claimant has multiple impairments

, t h e y are all included in the assessment. § 416.920(a)(2). T h e AL J must consider a claimant’s p hy sical and m e n t al abilities, § 416.920(b) and ( c), as w ell a s the total limiting effects caused by medically determinable impairments and the claimant’s subjective ex p eriences of pain, § 416.920(e). The RF C is used at step four to d etermine if a claimant c an do past relevant work a

n d at step five to determine if a claimant can adjust to other work. Id.G A R R I S O N V

. C O L

V I N 31

I f, at step four, “a c l a i m a n t shows that he or she cannot return to his or her p revious job, the burden of proof shifts to the Secretary to show that the claimant can do other kinds o f work.” Embrey v. Bowen
, 849 F .2d 418, 422 (9th Cir. 1988). Thus, “ [ a] t step five, the AL J can call upon a [ VE] to testify

as to: ( 1) what jobs the claimant, g iven his or her [ R FC ]
, would be able to d o ; a n d (2) the availability o f such jobs in the n a tional economy .” Tackett v. Apfel

, 180 F .3d 1094, 1101 (9th Cir. 1999). T he AL J may pose hy pothetical questions to the ex pert that “set out all o f the claimant’s impairments” for the VE’s consideration. Gamer v

. Secretary of Health and Human Servs.
, 815 F. 2 d 1275, 1279 (9th Cir. 1987). “The AL J ’s depiction o f the c laimant’s disability must be accurate, detailed, and supported by the medical record.” Tackett

, 180 F .3d at 1 101 (citation omitted )

. “The testimony of a [ VE] is valuable only to the e x tent that it is supp o r ted b y medical evidence” and has “no evi d en tiary value if the assumptions in the hy

pothetical are not supported by the record.” Magallanes v. Bowen
, 881 F .2d 747, 756 (9th Cir. 1989) (citations omitted). “ The [ V E] then ‘“translates [ these] factual scenarios into realistic job mar k et probabilities” b y testify ing on the record to what kinds of jobs the claimant still

can perform and whether there is a sufficient number of those jobs available in the claim a n t ’s reg ion or in several other

r e gi o n s of the economy to support a f inding of “no t disabled.”’” Tackett

, 180 F .3d at 1101 (citations omitted) (second alteration in the orig inal).G A R R I S O N V

. C O L

V I N 32

B. The ALJ Erred i n Assigning Little W e ight t o W a n g a n d A n d e r s o n ’ s O p i n i o n s , a n d Misunderstood G eneral’s Opinion

1. Applicable Law

“I n disability benefits ca s e s

. . . phy sicians may render medical, clinical opinions, or they may render opinions on the ultimate issue of disability —the c laimant’s ability to perform work.” Reddick v. Chater

, 157 F .3d 715, 725 (9th Cir. 1 998) (citation omitted). “I n conjunction with the relevant
reg ulations, we have

. . . developed stand a rds that g uide our analy sis o f a

n AL J ’s weig hing o f medical evidence.” Ryan v

. Comm’r of Soc. Sec.
, 528 F .3d 1 19 4
, 1 198 ( 9th Cir. 2008). Specifically

, we “disting uish amon g the o pinions o f three ty pes of phy sicians: (1) those who treat the claimant (treating phy sicians); (2) those who ex ami n e b ut do not treat the claimant ( ex amining phy sicians); and (3) t h o se who neither

ex a mine nor treat the claimant (nonex am i n ing phy sicians).” Lester v. Chater

, 8 1 F .3d 821, 830 (9t h C i r

. 1995). “As a g eneral r ule, more weig ht should be g iven to the opinion o f

a treating source than to the opi n i o n o f doctors who do not treat the claimant.” 1 0 Id. ( c i t i n g W inans v. Bowen
, 853 F .2d 643, 647 (9th Cir. 1987)). W hile the o pinion of a treating phy sician is thus e ntitled to g reater weig ht than that of an

ex a mining phy sician, the opinion of an ex amining phy sician is entitled to g reater weig ht t h a n that o f a non-ex amining

10 S ee also 2 0 C.F.R. § 4 0 4 .1 5 2 7 (c)(2 ) (“ If w e f in d t h at a treatin g

so u rce’ s o p i n i o n o n th e i ssu e(s) o f th e n atu re an d sev erity of y ou r im p airm en t(s) is w ell- su

p p o rted by m e d i c ally accep tab l e clin ical an d lab o rato ry diag n o stic tech n iq u es an d is n o t in co n sisten t w ith th e o th er

su b stan tial ev i d en c e i n y o u r case reco rd

, w e w ill g iv e i t co n tro llin g

w eig h t.”).G A R R I S O N V

. C O L

V I N 33

phy sician. S

ee Ryan
, 528 F .3d at 1198. “ The weig ht afforded

a n on-e x amining p hy sician’s testimony depends ‘on the deg ree to which [ he] provide[ s] supporting ex planations for [ his] opinions.’” Id. (quoting § 404.1527(d)(3)).

“I f a treating or ex a mining doctor’s o p inion is contradicted b y another do c t o r’s opinion, an AL J may only reject it by providing specific and leg itimate reasons that a re supported by substantial evidence.” 1 1 Id. This is so because, even when contradicted, a treating or e x amining phy sician’s opinion is still owed deference and will often be “entitled to the g reatest weig ht

. . . even if it does not meet the test for controlling weig ht.” O rn v. Astrue
, 495 F .3d 625, 633 (9th Cir. 2007). An AL J can satisfy the “ substan t ial evidence” requirement by “setting out a detailed a nd thoroug h summary of the f acts and c o nflicting clinical evidence, sta t i n g h is interpretation thereof, and maki n g finding s.” R eddick

, 157 F .3d at 7 25. “The AL J must d o more than state conclusions. H e must set forth his o wn in t e r p re tations a

nd

ex p lain why they

, rather than the d octors’, are correct.” Id. (citation omitted).

W h ere an AL J does not ex plicitly r eject a medical opinion

or set forth specific, leg i t i m a te reasons for crediting o ne medical opinion over another, h e e rrs. See Nguyen v. Chater

,

1 1 S o cial Secu rity reg u latio n s p ro v i d e th at, w h en a treatin g so u rce’s

o p in io n s are n o t g iv en co n tro llin g w eig h t, A L J s m u st ap p ly th e f

acto rs set f o rth i n 2 0 C.F.R. § 4 0 4 .1 5 2 7 (c)(2 )(i– ii) an d (c)(3

– 6 ) in d eterm in i n g h o w

m u ch w eig h t to g iv e each o p in i o n

. T h ese f acto rs ar e len g th o f th e t r e a t m e n t r e l a t i o n s h i p a n d t h e f r e q u e n c y o f e x a m i n a t i o n , § 4 0 4 .1 5 2 7 (c)(2 )(i), n atu re an d ex ten t o f th e treatm en t relatio n sh ip

, § 4 0 4 .1 52 7 (c)(2 )(ii), “ su p p o rtab i lity ,” § 4 0 4.1 5 2 7 (c)(3 ), co n s i st en cy , § 40 4 .1 5 27 (c)(4 ), sp ecializatio n , § 4 0 4 .1 5 2 7(c)(5 ), an d oth er f acto rs th at ten d to su p p ort o r co n trad ict th e o p in io n , § 4 04 .1 5 2 7 (c)(6 ).G A R R I S O N V

. C O L

V I N 34

100 F .3d 1 462, 1464 ( 9th Cir. 1 996). I n other words, an AL J

errs w hen he rejects a medical opi n i o n or assig ns it little weig ht while doing nothing more than ig noring it, asserting without ex p lanation that another medical opinion i s m ore persuasive, or criticiz ing it with boilerplate lang uag e that f ails to offer a substantive basis for his conclusion. See id.

2. Application of

Law to F act

I n a r ul i n g that the g overnment d oes not contest on appeal, the district court c orrectly concluded that the AL J did
not offer specific and leg itimate r easons supported b y substantial evidence f

or r ejecting the testimony of W ang a nd Anderson. The district court also correctly concluded that the AL J misunderstood General’s opinion reg arding G arrison’s mental health. W e briefly address t h i s i ssue because the AL J ’s sig nificant and numerous errors in evaluating the medical o pinion evidence help clarify why these opinions are, in f act, w orthy of substantial weig ht and why it is appropriate to remand this case for an award of benefits.

I n evaluati n g W ang ’s testimony

, the AL J committed a variety of eg reg ious and impor tant errors: (1) she entirely ig nored most of his treatment records, including reports from Dr. F eldman, doz ens of medical test r esults, and W ang ’s o wn treatment notes; (2) she failed to recog niz e that the opinions

ex p ressed in check-box f o rm in the F ebruary 2008 PF C Questionnaire were based on sig n ificant e x perience with Garrison a

nd supp o r ted b y numerous records, and were therefore entitled to weig ht that an otherwise unsupported a nd

unex p l a i n e d check-box form w ould not merit 1 2 ; (3) she did

12 S ee 20 C .F.R. § 4 0 4 .1 5 2 7 (d )(3 ) (“ T h e b etter an ex p lan atio n a so u rce p ro v id es f

o r an o p in io n , th e m o re w eig h t w e w i ll g iv e th at o p in io n .”).G A R R I S O N V

. C O L

V I N 35

not ex plicitly compare W ang ’s r ecords to o ther medical evidence—and therefore failed to recog niz e t h at no other treating o r ex amining phy sician disag reed with W ang , a nd
t hat Griffin, the consultant whose views differed f r o m W a n g ’s, wrote his check-box report e arly in November 2007,
very early in Garrison’s course of treatment, and admitted in his report that he lacked access to Garrison’s treatment records a nd statements; (4) she did not ev a l u a t e W ang ’s records f o r i nternal consistency or inconsistency in his description of Garrison’s sy mptoms, an evaluation that would have disclosed consistent reports of burning

, ting ling

, a nd numbness radiating f

rom her back a

nd neck into her

ex tremities, causing weakness and intense pain 1 3 ; ( 5) she did
not recog niz e t h at because W ang is a specialist, his opinion is owed g reater weig ht as a matter o f r eg ulation 1 4 ; (6) more g enerally

, she failed to afford the deference to wh i c h W ang

was presumptively entitled under bot h Social Security

r e gu lations and o ur p recedent as Garrison’s treating phy sician 1 5 ; and (6) she manufactured a conflict w ith respect to the outcome of treatment b y asserting that W ang ’s records showed “consistent[ ] ” improvement, when in fact they show consistent cervical and lumbar radiculopathy that responded only very briefly and partially

to treatment. 1 6

13 S ee 2 0 C.F.R. § 4 04 .1 5 1 7(c)(4 ).

14 S ee 2 0 C.F.R. § 4 04 .1 5 1 7(c)(5 ).

15 S ee 2 0 C.F.R. § 4 04 .1 5 1 7(c)(2 ).

16 Fu rth er, th ere is n o ev id en ce th at an y o n e o th er th an th e A L J th o u g h t th at Garriso n ’ s rep o rts to W an g w ere n ot cred ib le; W an g n ev er in d icated h is b elief th at Garriso n w as ex ag g eratin g o r ly in g in h er s elf

- rep o rted p ain
sy m p to m s. Cf. To mma setti v. Astru e , 5 3 3 F.3 d 1 0 3 5
, 1 0 41 (9 th Cir. 2 0 0 8 ).G A R R I S O N V

. C O L

V I N 36

The AL J a lso committed a variety of errors in evaluating Anderson’s opinion e v i d e n c e. Most important, she did not recog niz e that Anderson, as a nurse practitioner, qualified a s

an “other source[ ] ” that “can provide evidence to establish an impairment.” 20 C.F .R. § 404.1513(a) and (d)(1). F urther, the AL J committed many of the same errors in assessing Anderson’s reports that sh e d i d in assessing W ang ’s. F o r

ex a mple, the AL J assig ned little weig ht to Anderson’s 2008 and 2009 summary reports, both o f which stated that Garrison suffered a varie t y of moderate a nd moderately severe impairments ex pected to las t m ore than a y ear, while
apparen t l y f

a iling to recog niz e that those reports were supported by voluminous n otes. The AL J also manufactured

a conflict by identify ing two or three reports of improvement in Garr i s o n ’s mental health and asserting

, without r e ference
to any other t reatment records or a ny o ther ex planation, that Anderson’s considered conclusions about Garrison’s overall
prog n osis merited little weig ht. 1 7

F inally

, the AL J c ompletely misunderstood G eneral’s report. W h ereas the A L J described it as supporting a finding that Garrison is not disabled and is c apable of “lig ht, simple work,”General ex pressly st a t e d t h at Garrison’s “prog nosis for

r e turning to work is currently poor,” “ she does not ha v e sufficient e motional control,” an d “her ability to perform work-related tasks is currently inadequate based on cog nitive

17 W ith resp ect to b o th W an g an d An d erso n ’ s o p in i o n s, th e Co m m i ssio n er su g g ests th at th e A L J w as en titled to rej ect th eir o p in io n s

o n th e g ro u n d th at th ey w ere ref lected in m ere ch e c k -b o x f o rm s—e.g ., W an g ’s 2 0 0 8 P FC Q u estio n n aire an d A n d erso n ’ s 2 0 0 8 an d 2 0 0 9 A ssessm en ts. T h is arg u m en t rests o n a m i stak en f actu al p rem i se. T h e

c h eck

- b ox f

o rm s d i d n o t stan d alo n e: th ey ref lected an d w ere e n t i r e l y

co n sisten t w ith th e h u n dred s o f p ag es o f treatm en t n o tes created b y W an g

an d A n d erso n

in th e co u rse o f

th eir relatio n sh ip w ith

Garriso n

.G A R R I S O N V

. C O L

V I N 37

functions such as a ttention, concentration, processing -speed and short-term memory .” General, a n ex amining phy sician, bolstered these conclusions with diag noses including bipolar disorder, PTSD, and b orderline intellectual functioning

. The AL J ’s belief that General’s report weig h ed ag ainst a finding of disability

was mistaken.

C. The ALJ f

a iled to of

f er specif ic, clear, a nd

c o nvincing reasons f

or discrediting G arrison’ s sym ptom testim o ny

The AL J discredited, to the ex tent it w as inconsistent with her f inding that Garrison is not disabled, Garrison’s testimony

a bout the intensity

, persistence, and pace of her sy mptom s

. I n doing so, the AL J erred.

1. Applicable Law

An AL J eng ag es in a two-step analy sis to determine whether a claimant’s testimony reg ardin g s u bjective pain o r sy mptoms is credibl e

. “ First, the AL J must determine whether the claimant has p resented objective medical evidence of an underly ing impairment ‘which could reasonably be ex pected to produce the p a i n or other
sy mptoms alleg ed.’” Lingenfelter

, 504 F .3d at 1035–36 (quoting Bunnell v. Sullivan

, 947 F .2d 341, 344 (9th Cir. 1991) (en banc) ( internal quotation marks omitted)). I n th i s analy sis, t h e claimant is not required to show “that her impairment could re a s onably be ex pected to cause the severity of the sy

mptom she has alleg ed; she need only show that it could reasonably have caused some deg re e o f t h e sy mptom.” Smolen v

. Chater

, 8 0 F .3d 1273, 1282 (9t h C i r. 1996). Nor must a claimant produce “ o b j e ctive medicalG A R R I S O N V

. C O L

V I N 38

evidence of the pain o r fatig ue itself, or the severity thereof.” Id.

I f the claimant satisfies the first step of this analy sis, a nd there is n o e vidence o f maling e r ing

, “the AL J can r eject t h e claimant’s testimony about the severity of her sy mptoms only by offering specific, clear and convincing reas o ns for doing so.” 1 8 Smolen

, 80 F .3d at 1281; see also Robbins v. Soc. Sec. Admin.

, 466 F

. 3d 880, 883 (9th Cir. 2006) (“[ U] nless an AL J makes a finding of maling ering based on affirmative evidence thereof, he or she may

only find an applicant not credible by making specific finding s as to credibility and stating clear a nd

c o n v incing reasons for each.”). T h is is not a n e a s y requirement to meet: “The clear and convinci n g standard is the most demanding required in Social Security cases.” Moore v. Comm’r of

Soc. Sec. A dmin.

, 278 F .3d 920, 924 (9th Cir. 2002).

2. Application of

Law to F act

Garrison testified about h er p hy sical and men t a l health. W e separately address the AL J ’s g rounds for disc rediting each part of Garrison’s testimony

.

a. G arrison’s P ain Testim ony

The AL J rejected Garrison’s pain testimony o n two g rounds: ( 1 ) G arrison improved in 2007 and 2008 with the “conservative” treatments of epidural injections a nd phy sical therapy ; a nd (2) Garrison eng ag ed in daily activities including

18 T h e g o v ern m en t’ s su g g estio n th at w e sh o u ld ap p ly a lesser stan d ard th an “ clear an d c o n v i nc i ng ” lack s an y su p po rt in p reced en t an d m u st b e rej ected

.G A R R I S O N V

. C O L

V I N 39

talking on the phone, p reparing meals, cleaning her r oom, a nd helping to care for her daug hter.

T h e f irst of these reasons is belied by the eviden c e a n d
must be rejected. Garrison ’ s medical records show that phy sical therapy afforded her only partial and short

- lived relief of her lower back pain, and no e f fective r e lief for her radiating n e c k pain. 1 9 Turning to the epidural shots, W ang and F eldman’s records make clear that epidural sh o t s never provided Garrison any relief for her neck pain, and that they relieved Garrison’s back pain for only variable, brief p eriods of time, r ang ing from a couple of months to a few day s. The other treatments prescribed by W ang , includin g p a in pills, caused s i de effects including intense sleepiness a nd drowsiness and, eve n w h e n taken several times per day

, provided only limited periods of r elief from the ot h e r w i seconstant pain.

I n sum, there is no support in the record f or the AL J ’s belief that phy sical therapy and epidu r a l shots alleviated Garrison’s pain enoug h that her testimony reg arding pain was incredible. To the contrary , th e re c o r d shows that, despite W a n g’ s e fforts, Garrison’s neck and back pain, which radiated into h er s h o ulders, arms, a n d leg s, persisted larg ely

19 Garriso n w as f

o rced to d isco n ti n

u e p h y sical th erap y early in 2 0 0 7 b ecau se sh e co u ld n o t af

f ord it. S ee S mo len , 8 0 F.3 d at 1 2 8 4 (“ W h ere a claim an t p ro v id es ev id en ce o f a g o od reaso n f o r n o t tak in g m ed icatio n f or h er sy m p to m s, h er sy

m p t o m t estim o n y c a n n o t b e rej ected f o r n o t d o in g

so .” (citatio n o m itted )). A t n o p oin t in t h e treatm en t reco rd s did W an g or Feld m an in dicate a b elief th at p h y sical th erap y , if resu m ed

, w o u ld p ro v id e Garriso n w ith ad eq u ate relief

.G A R R I S O N V

. C O L

V I N 40

unabated after April 2007. 2 0 G arrison’s testimony that s he

was disabled by near-constant, intense pain is consistent with this evidence, a s is her testimony that she must take f requent rests, has difficulty standing or sitting f or more than 20 to 30 minutes, and cannot carry heavy items.

The AL J ’s other reason for discrediting G arrison’s testimony was its supposed inconsistency with her re p o rted daily activities, which, ag ain, included talking on the phone, preparing m ea l s , cleaning her room, and helping to care for her daug hter. The AL J committed two errors here. F irst, she mischaracteriz ed Garrison’s testimony . Garrison repeatedly emphasiz ed that in performing ma n y daily tasks, including caring for her daug hter, s h e w a s heavily assisted b y her mother. She also made clear that she is reg ularly p rohibited by her pain from eng a g ing in activities such as doing laundry

, picking u p her daug hter, and carry ing bags t h a t weig h more than a few pounds. F inally

, Garrison te s t i f i e d that a fter performing such activities, she often must rest, leading her to nap several hours per day

.
Second, the AL J erred in f inding tha t t h e se activities, if
per f o r med in the manner that Garrison described, a re inconsistent with the pain-related impairments that Garrison described in her testimony

. W e have repeatedly warned that AL J s must be especially cautious in concluding that daily activities are inconsistent with testimony about pain, because impairments that w o u ld u n questionably preclude work and all the press u r e s of a workplace e n vironment will often be consistent with doing more than merely resting in b ed all day

. See, e .g. , Smolen

, 80 F .3d at 1287 n.7 (“The Social Security

20 In an y ev en t, w e d o u b t th at ep id u ral s tero id sh o ts to th e n eck an d lo w er b ack

q u alif y as “ co n serv ativ e” m ed ical treatm en t.G A R R I S O N V

. C O L

V I N 41

Act does n ot require that c laimants be utterly incapacitated to be elig ible for benefits, and many home a ctivities may not be easily transferable to a work e n v i r o n m ent where it mig ht be impossible to rest periodically or take medication.” (citation omitted)); Fair v. Bowen , 885 F .2d 597, 603 (9th Cir. 1 989) (“[ M] any home activities a re not easily transferable t o what
may be the more grueling environment of the workplace, where it mig ht be impossibl e t o p e riodically rest or take medication.”). Recog niz ing that “disability claimants should
not be pen a l i z e d for attempting to lead normal lives in the face o f the i r limitations,” w e have held that “[ o] nly if [her] level of activity were inconsistent w ith [ a claimant’s] claimed limitations would these activities have any bearing on [her] credibility .” R eddick v. Chater

, 157 F .3d at 722 (citations omitted); see also B

jornson v. Astrue
, 671 F .3d 640, 647 (7th Cir. 2012) (“The critical differences between activities o f daily living a

nd a ctivities in a full-time job are that a person has more f

l e x i b i l ity in scheduling the former than the latter,

can g e t help from o ther persons

. . . , and is n o t h e ld to a

m i n imum standard of performance, as she would be by an employ e r. The failure to recog niz e these d ifferences is a

recurr e n t , a n d d e p l o r a b l e , f e a ture of opinions b y administrative law judg es in social security disability cases.” (citations omitted)).

Here, Garrison’s daily activities, as she described them in her testimony

, were c onsistent with her statements about the impairments cau s e d b y h er p ain. The ability to talk on the phone, p repare meals once or twice a day

, occasionally clean one’s room, a

nd, with sig nificant assistance, care f o r one’s daug hter, all while taking frequent hours-long rests, avoiding

a ny heavy lifting

, and ly ing in bed most of the day

, i s

co n sistent with the pain that Garrison described in herG A R R I S O N V

. C O L

V I N 42

testimony

. 2 1 I t is also consistent with an inability to function in a workplace environment. Accordi n gl y , the supposed inconsistencies b etween Garriso n ’s daily activities and her
te s t i m ony do not satisfy the requirement of a clear, convincing

, and specific re a s o n to discredit G arrison’s testimony reg arding her pain-related impairments.

b. G arrison’s Mental Health Testim ony

The AL J discredited Garrison’s mental health testimony mainly on the g round that the record showed that G arrison’s condition h ad impr o v ed due to medication at a few points between April 2007 and J une 2009. T he AL J added that

some of Garrison’s mental impairments were caused b y Garrison g oing off h er medi c a tion. These a re not clear, convincing

, and specific g rounds fo r rejecting G arrison’s testimony that, since April 2007, s h e had suffered panic attacks, “a lot of ups and d owns and d e p ression,” severe

anx iety

, occasional suicidal thoug hts, and bout s o f paranoia

a n d mania—sy

mptoms that caused major difficulties with social functioning and responding to such stresses a s shopping unaccompanied for g roceries.

As we have e mp h a s i z ed while discussing mental health issues, it is e rror to r e

j e c t a claimant’s testimony merely because sy

mptoms wax and wane in the course o f treatment. Cy cles of improvemen t an d debilitating sy mptoms are a

common occurrence, and in such circumstances it is error for

an AL J to pick out a few isol ated instances of improvement

2 1 It is also co n sisten t w ith th e m en t al h ealth im p airm en ts th at Garriso n d escrib ed i n h er testim on y —im p airm en t s th at u n d o u

b t ed ly in teract e d w

i th h er p h y s ical i m

p airm en ts in a m an n er th at m ak es h er testim o n y ev en m ore cred ib le.G A R R I S O N V

. C O L

V I N 43

over a period of months or y ears and to treat them as a basis for concluding a claimant is capable of working

. See, e.g. , Holohan v. Massanari , 246 F

. 3d 1195, 1205 (9th Cir. 2001) (“[ The treating phy sic i a n ’ s ] statements must be read in
contex t of the overall di a g n o stic picture he d raws. That a person who suffers from severe panic a ttacks, a nx iety

, a nd depression makes some improvement does n o t mean that the person’s impairments no long er seriously affect her ability to function in a workplace.”). 2 2 Repo r ts of “improvement” in the contex t of mental health iss u e s must be interpreted with

an understanding of the pat i e n t ’ s overall well-being and the

n a t u re o f h er sy

mptoms. See R

yan , 528 F .3d at 1200– 0 1 (“Nor are the references in [ a doctor’s] note s t h a t Ry an’s

anx iety a n d d epression were ‘improving ’ sufficient to undermine the repeated diagn o sis of those conditions, o r [ another doctor’s] more detailed r eport.”). T h ey must also be interpreted with an awareness that improved functioning while being treated and while limiting environmental
stressors does not alway s mean that a clai m a nt can function effectively in a workplace. See, e.g. , Hutsell

, 259 F

. 3d at 712 (“W e also believe that the Commission e r erroneously relied
too h eavily on indications in the medical record that Hutsell

22 S ee a lso Hu tsell v. M

a ssa n a ri
, 2 5 9 F

. 3 d 7 0 7
, 7 1 1 (8 th Cir. 20 0 1) (“ W ith reg ard to m en tal d iso rd ers, th e Co m m issio n er’ s d ecisio n m

u st tak e in to acco u

n t ev id en ce in d icatin g th at th e claim an t’ s t ru e f u n ctio n al ab ility

m ay b e s u

b st a n t i a l l y l ess th an th e claim an t asserts o r w ish es. Giv en th e

u n p red ictab le co u rse o f m en tal i lln ess, [s]y m p t o m

- f ree in terv als an d b rief

rem issio n s are g en erally o f u n certain d u ratio n an d m ark ed b y th e im p en d in g po ssib ility o f relap se. Mo reo v er, [i]n d iv i d u als w ith ch ro n ic
p sy ch o tic d iso rd ers co m

m o n ly h av e th eir liv es stru ctu red i n su ch a w ay as to m in im ize stress an d red u ce t h eir sig n s an d sy

m p to m s. Su ch in d iv id u als

m ay b e m

u ch m ore im

p aired f o r w o r k th an th eir sig n s an d sy m p to m s

w o u ld i n d icate.” (q u o t a t io n m ark s an d citatio n s o m itted ) (alteratio n s in th e o rig in al)).G A R R I S O N V

. C O L

V I N 44

was ‘doing well,’ because doing well for the purposes of a treatment prog ram has no necessary relation to a claimant’s ability to w ork or to her work-related functional capacity .”). 2 3 Caution in making such an inference is especially appropriate when no doctor or other m e dical ex p e r t has o pined, on the basis of a full review o f all relevant records, that a mental health patient i s c a

pable of w orking or is prepared to return to work. Cf. Rodriguez v. Bowen
, 876 F .2d 759, 763 (9th Cir. 1 989) (“The AL J ’s conclusion that Rodrig uez was r e s p o n d i n g to treatment also does not pr o v ide a clear and convincing

reason for disreg arding Dr. Petting er’s opinion. No phy sician opined that any improvement would allo w Rodrig uez to return to work.”).

These r u les c larify the n ature of the AL J ’s error. Rather than describe Garrison’s sy mptoms, course of treatment, a nd bouts of remission, a n d thereby chart a course o f improvement, the AL J improperly sing led out a few p eriods of temporary well-being from a sustai n e d period o f impairment and relied on those instances to discredit Garrison. W h ile A L J s obviously must rely on e x a m p les to show why they do not believe that a claimant is credible, the data p oints they choose must in fact c o nstitute ex amples of a

23 S ee a lso Sco t t v. Astru e , 64 7 F .3 d 7 34
, 7 39

– 40 (7 th Cir. 2 0 1 1 ) (“ T h ere

can b e a g reat d istan ce b etw een a p atien t w h o resp o n d s to treatm en t an d

o n e w h o i s ab le to en ter th e w ork f orce, an d th at d if

f eren ce is b o rn e o u t in D r

. T ate’ s treatm en t n o tes. T h o se n o tes sh o w th at alth o u g h Sco t t h a d im p ro v ed w ith t

reatm en t, s h e n ev erth eless co n tin u ed to f req u en tly

ex p erien ce b o u ts o f cry in g an d f eelin g s o f paran o i a

. T h e AL J w as n o t p erm i tted to “ ch erry

- p ick ” f ro m th ose m ix ed resu lts to su p p o rt a d en ial of b en ef its

. . . . T h e v ery

n atu re o f b ip o l ar d iso rd er is th at p eo p le w ith th e d isease ex perien ce f

lu ctu atio n s in th eir sy

m pto m s, so an y sin g le n o tatio n th at a p atien t is f

eelin g b etter or h as h ad a ‘ g o od d ay ’ d o es n o t im p ly th at th e co n d itio n

h as b een treated .” (citatio n s o m itted ))G A R R I S O N V

. C O L

V I N 45

broader development to satisfy the applic a ble “clear a nd

c o n v incing ” standard. Here, the record reveals a tortuo u s path: some sy

mptoms came and went ( e.g. , paranoia, hallucinations, pseudo- s eiz ures), some sy mptoms persisted

n early the whole period ( e.g. , insomnia, bouts of depress i o n and mania), and still other sy mptoms appear to have remained

a co n s t a nt source of impairment ( e.g ., intense anx iety ). Garrison’s diag noses of PTSD and bipolar remained constant

across all treatment records, and her GAFscore consistently hovered a round 50 to 55. She remained in this c ondition even while g oing to g reat leng ths t o m inimiz e stressors in her life—to the point that s h e could not g o to the g rocery store alone—and, when she did try to work for a brief period, was fired b ecause of her mental impairments. Th e AL J erred in concluding that a f

e w s hort-lived periods of temporary improvement in G arrison’s mental health sy mptoms undermined Garrison’s testimony

. 2 4

24 T h e A L J also erred in co n clu d in g th at G arriso n m u st b e d iscred ited on th e g ro u n d th at so m e—th o u g h n o t all—o f

h er b ou ts o f rem issio n ap pear to h av e resu lted f

ro m Garriso n g o in g o f

f s o m e o f h er m ed icatio n s. A s w e h av e rem ark ed

, “ it is a q u estio n ab le practice to ch astise o n e w ith a m en t al im p airm en t f

o r th e ex ercise o f p o o r j u d g m en t in seek in g reh ab ilitatio n .” Ng u yen , 1 00 F.3 d at 14 6 5 (q u otatio n m ark s a n d c itatio n s o m itted ). In

o th er w o rd s, w e d o n o t p u n i sh th e m en tally

ill f o r o ccasio n ally g o in g o f

f th eir m ed icatio n w

h en th e reco rd af

f o rd s co m pellin g reaso n to v iew su ch d ep artu res f

ro m p rescrib ed treatm en t as p art of cla im an ts’ u n d erly in g

m en tal af f lictio n s. See, e.g

. , M

a rtin ez v. Astru e , 6 3 0 F.3 d 6 9 3
, 6 9 7 (7 th Cir. 20 1 1 ); S

p iva v. Astru e , 6 2 8 F.3 d 3 4 6
, 3 5 1 (7 th Cir. 2 0 1 0 ); Pa te-Fires

v. Astru e , 56 4 F .3 d 9 3 5
, 9 4 5 (8 th Cir. 2 00 9 ). H ere, th e reco rd sh o w s th at Garriso n ’ s o ccasio n al d ecisio n s to g o “ o f f h er m ed s” w ere at least in p art

a resu l t o f h er u n d erly in g b i p o lar d iso rd er an d h er o th er p sy ch iatric issu es.G A R R I S O N V

. C O L

V I N 46

c. Conclusion

The AL J did n ot o f

f e r specific, clear, and convincing

reasons for rejecting Ga r rison’s testimony concerning her phy sical and mental impairments. I n fact, the reasons g iven by the AL J n ot only fail this demanding standard, bu t also would fail a f

ar more forg iving inquiry

, as the y ar e p l ainly belied by the record and rest upon mischaracteriz a t i ons o f Garrison’s testimony

.

III

Reviewing for abuse of discretion, see Harman
, 211 F .3d
at 1173, we reverse the district court’s d ecision to remand this

case to the AL J f

or further proceeding s, and instead r em a n d
to the district court with instructions to remand to the AL J for a calculation and award of appropriate benefits.

A. Applicable Law

Usually

, “[ i] f additional p roceeding s can remedy defects in the orig inal administrative p r o c e eding

, a social security

case sh o u ld be remanded.” Lewin v. Schweiker

, 654 F .2d 631, 635 ( 9th Cir. 1981). The Social Security Act, however, makes clear 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 ) (emphasis added). According ly

, e very Court of Appeals has
recog niz ed that in appropriate circumstances courts are f r ee to r everse and remand a d etermination by the Commissioner with instructions to calculate and award benefits. See, e.g. , Gentry v. Comm’r of Soc. S e c

. , 7 4 1 F .3d 708, 7 30 (6th Cir. 2014); Jones v. Astrue
, 6 50 F .3d 772 (D.C. Cir. 2011); Punzio

v. Astrue
, 630 F .3d 704, 713 (7th Cir. 2011); Salazar v

.G A R R I S O N V

. C O L

V I N 47

Barnhart

, 468 F .3d 615, 626 ( 1 0 th Cir. 2006); Hines v

. Barnhart

, 453 F .3d 559, 567 (4th Cir

. 2006); Seavey v

. Barnhart

, 276 F .3d 1 (1st Cir. 2 001) ; W illiams v

. Apfel

, 204 F .3d 48 (2d Cir. 2000); McQueen v. Apfel

, 168 F .3d 152, 1 5 6 (5th Cir. 1999); Davis v. S halala

, 985 F .2d 528, 5 3 4 (11th Cir. 1993); Podedworny v. Harris
, 745 F. 2d 210, 221–22 (3d Cir. 1984); Parsons v. Heckler

, 739 F .2d 1334, 1341 (8th Cir. 1 9 8 4 )

. Courts have g enerally ex ercised this
power when it is clear from t h e record that a claimant is entitled to b enefits, observing o n occasion that inequitable

co n d u ct on the part o f the Commissioner can streng then, thoug h not control, the case for such a remand.

This Circ u i t c larified the scope o f judicial power to remand for an award of benefits in Varney v. Sec’y of Health & Human Servs.
, 859 F

. 2d 1396 (9th Cir. 1988) (“ Varney II ”). There, we held that “where there a r e no outstanding issues that must be resolved before a proper d isability determination can be made, and where i t is clear from the administrative record that the AL J would be req uired to award benefits if the claimant’s ex cess pain testimony were credited, we will not remand solely to allow the AL J to make specific finding s reg arding t h a t testimony

. Rather, we will

. . . take that testimony to be e stablished as true.” I d. at 1401. W e e x plained that this credit-as-true rule is desig n ed to achieve fairness and efficiency :

W e believe [ that this] rule promotes the objectives we have identi fied in p r ior disability ca ses. Requiring the AL J s to

s p e cify any factors discrediting a claimant at t h e first opportunity helps to improve the performanc e of the AL J s by discourag ing them from reaching a c o n clusion first, a ndG A R R I S O N V

. C O L

V I N 48

t hen attempting to justify it by ig noring competent evidence in t

he record that sug g ests

an opposite result. I t helps to ensure that pain testimony will be c a

refully assessed and its i m p ortance recog niz ed. Moreover, it avoid s unnecessary d

uplication in the administrative hearing s and reduces th e administrative b u r d e n c a u s e d b y r e q u i r i n g m u l t i p l e proceeding s in the same case. P erhaps most i m p o r t a n t , b y e n s u r i n g t h a t c r e d i b l e claimants’ testimony is accepted the f irst time around, the rule reduces the delay a nd uncertainty o ften found in this area of the law, and ensures that de serving claimants will receive benefits as soon as possible. A s already noted, applicants for d isability benefits ofte n suffer from painful a nd debilitating conditions, as well as severe economic hardship. Delay ing the pay

ment o f benefits by requiring multiple administrative
p r o c e e d i n g s t h a t a r e d u p l i c a t i v e a n d
unnecessary o nly serves to cause the applicant further damag e—financial, medical, a nd emotional. Such damage c a n never be remedied. W ithout e ndang ering the integ rity of the disability determ i nation process, a principal g o a l of that process must be the speedy resolution o f d i sability applicants’ claims. At the same time, th e r u l e does not unduly burde n the AL J s, n or should it result i n the wrong ful award of benefits

. . . [ I ] f
g rounds for [ concluding that a claimant is not disabled] ex ist, it is both rea s o n a ble a ndG A R R I S O N V

. C O L

V I N 49

desirable to require the AL J to articulate them in the orig inal decision.

Id. at 1398–99 (quotation marks, citations, and alterations omitted). I n lig ht of these concerns, we noted, “[ w] here remand w ould unnecessaril y delay the receipt of benefits, judg ment for the claimant is appropriate.” Id. at 1399. One
y ear later, in Hammock v. Bowen , we held that the credit-astrue rule applies to medical o pinion evidence, not only claimant testimony

. See 879 F .2d 498 (9th Cir. 1989).

Since Varney II

, we h a v e applied the credit-as-true rule in nearly two doz en p u b l i shed opinions. 2 5 I n those cases, we have develop ed a workable and stable framework for apply ing the credit-as-true r u l e. Specifically

, we have devised a three-part credit-as-true standard, e ach part o f

w h i c h must be satisfied in order for a court to remand to a n AL J with instructions to calculate a nd a w ard benefits: (1) the record has been fully developed and fur t h e r administrative proceeding s would serve no useful purpose; (2) the AL J has failed to p rovide leg ally sufficient r e a sons for rejecting evidence, whether claimant testimony or medical o p inion; and ( 3) if the improperly d i scredited evidence were credited

as true, the A L J would b e required to find the claimant disabled on r emand. 2 6 See Ryan
, 528 F .3d at 1202;

25 T h e C o m

m issio n er co n t en ds th at th e cred it- as- tru e ru le is in v alid

. A s h e co n ced es, t

h is arg u m en t is f

o r e c l o sed by p reced en t. O n at least on e

o ccasio n , in f

act, w e h av e sp ecif

ically co n sid ered an d rej ected s o m e o f th e arg u m en ts a d v a n ced an ew in th e Co m m issio n er’ s b rief

. S ee Mo isa v. Ba rn h a r t , 3 6 7 F.3 d 8 82 , 8 86

– 8 7 (9 th Cir. 2 0 0 4 ).

26 T h is th ird req u irem en t n atu rally in co rp o rates w h at w e h av e so m etim es d escrib ed as a distin ct req u irem en t o f th e cred it- as- tru e ru le, n am ely th atG A R R I S O N V

. C O L

V I N 50

Lingenfelter

, 504 F .3d at 104l; Orn
, 495 F .3d at 640; Benecke

v. B arnhart

, 379 F

. 3d 587, 595 ( 9th Cir. 2004); S molen

, 80 F .3d at 1292.

W e have, in a number of c ases, stated or implied that i t would be an abuse of d i scretion for a district court not to remand for an award of benefits when all of these conditions

are met. See, e.g. , Lingen f elter

, 504 F .3d at 1041; O rn , 495 F .3d at 6 49; McCartey v. M a s sanari
, 298 F .3d 1072, 1076–77 (9th Cir. 2002); Harman
, 211 F .3d at 1178; Smolen

, F .3d at 1292; Lester
, 81 F .3d at 834; Ramirez v. Shalala

, 8 F .3d 1 449, 1455 ( 9th Cir. 1993); S wenson v. Sullivan

, 876 F .2d 683, 6 89 (9th Cir. 1989). I n the 2003 case o f Connett v. Barnhart

, 340 F .3d 871 (9th Cir. 2003), however,

we cautioned that t h e c redit-as-true rule may not be dispositive of the remand question i n a ll cases. Rather,
recog niz ing that this rule, like most, admits of e x ceptions
meant to preserve the rule’s purpose, we noted that the creditas-true doctrine envisions “some f lex ibility .” Id. at 876. Connett then c oncluded that under the circumstances there present a remand for an award of benefits was not mandatory and remanded for further proceeding s. Connett
, however, did
not address when such flex ibility is a ppropriat el y

ex e r cised—in other words, it did not ex plain when rema nd for further p roce e d i n gs r ather than f or an award of benefits would be appropriate even thoug h t h e credit-as-true rule’s conditi o n s a r e met. W e have applied the credit-as-true rule in a number of cases since Co n n e t t , but have not in a published op i nion ex ercised the “flex ibility ” noted in that decision, nor have w e clarified the nature of the “flex ibility ” that we there described. See, e .g. , Lingenfelter

, 504 F .3d at

th ere are n o ou tstan d in g is s u es th at m u st b e reso lv ed b ef

o re a d eterm in atio n

o f d isab ility can b e m ad e. S

ee Smo len , 8 0 F.3 d at 1 2 9 2

.G A R R I S O N V

. C O L

V I N 51

1041; Orn
, 495 F .3d at 649; B enecke

, 379 F .3d at 595; Moisa
, 367 F .3d at 887. W e do so now.

Recalling that, in social security c ases, “the r equired analy sis c enters on what the record evidence shows about the

ex istence or non-ex istence o f a disability ,” Strauss v. Comm’r of the Soc. Sec. Admin.

, 635 F .3d 1135, 1138 (9th Cir. 2011), Connett ’s “flex i b ility ” is properly understood as requiring
courts to remand for further proceeding s when, even thoug h all condit i o ns of the credit-as-true rule are satisfied, an evaluation of the record as a whole creates serious doubt that

a claimant is, in f

act, disabled. That interpretation best alig ns the credit-as-true rule, which preserves e fficiency a nd fairness in a process that can sometimes tak e y ears before benefits a

re awarded to needy claimants, with the basic requirement that a claimant be disabled in o rder to r eceive benefits. Thus, when we conclude that a c l a i m ant is otherwise entitled to an immediate award of benefits under the credit-as-true analy sis, Connett allows flex ibility to remand for further proceeding s when the record as a whole
creates serious doubt as to whether the claimant is, in fact, disabled within the meaning of the Social Security Act.

As we ex plain infra

, here the district court abused its discretion by remanding for further proceedi n gs where the credit-as-true rule i s s a tisfied and the record afforded no reason to believe that Garrison is not, in fact, disabled. 2 7

27 T h e district co u rt’ s erro r is u n d erstan d ab le in lig h t o f o u r p rio r f ailu re to m ak e clear th e relatio n s h ip b etw een Co nn ick an d th e Va rn ey II lin e of

cases. In d eed , sev eral y ears ag o a p an el o f th is Co u rt su g g ested in dicta th at o u r cases h ad d rif

t ed f ar en o u g h ap art t o create an

in tra- circu it sp lit. Va sq u ez v. Astru e , 5 7 2 F.3 d 5 8 6
, 5 9 3 (9 th Cir. 2 0 09 ). Fo llo w in g ou r caref u l stu d y of t

h e relev an t cases, h o w ev er, w e are f irm ly co n v in ced th at th ey m ay b e f u lly an d f airly reco n ciled in th e m an

n er d escrib ed h erein

.G A R R I S O N V

. C O L

V I N 52

B. Application of

Law to F act

Garrison unquestionabl y s atisfies all three conditions o f the credit-as-true rule. Fi rst, there is no need to develop the record or convene furthe r administrative proceeding s. 2 8 Althoug h the Commissioner arg ues that further proceeding s would serve the “useful purpose” of a l l o w i n g the AL J to revisit the medical opinions and testimony that she rejected for leg ally insufficient reasons, o ur precedent a nd the objectives of the credit-as-true r ule foreclose the arg ument that a r e m a n d for the purpose of allowing the AL J to have a mull i ga n qualifies as a remand for a “useful purpose” under the first part of credit-as-true analy sis. See Benecke

, 379 F .3d
at 595 (“Allowing the Commissioner to decide the issue ag ain would create an unfair ‘heads we win; tails, let’s play ag ain’
sy stem of d isability benefits adjudication.”); Moisa
, 367 F .3d

2 8 T h e Co m

m issio n er resists th i s co n clu sio n , arg u i n g th at f u rth er p ro c e e d i n g s are req u ired b ecau se th e A L J did n o t m ak e an RFC d eterm in a t i o n o n th e b asis o f W an g , A n derso n , an d Gen eral’ s o p i n io n s. W ith o u t s u ch an

RFC d eterm i n atio n , th e Co m m issio n er asserts, it w ou ld b e im p o ssib le f

o r u s to d eterm in e w

h eth er Garriso n is d isab led

. T h i s

a r g u m en t is w ith o u t m erit. In n o p rio r cred it- as- t ru e case h a v e w e

su g g ested th at an aw ard o f b en ef i t s i s p ro p er on ly if th e A L J m ad e a f o rm al RFC f

in d in g —an d f

or g oo d reaso n , b ecau se A L J s rarely b ase th eir RFC d eterm in atio n s o n o pin io n s o r testim o n y th at th ey h av e rej ected (an d it w ill alw ay s b e su ch o p in io n s o r t estim o n y th at are at issu e i n cred it- astr u e c a s es). In s tead

, w e h av e co n sid ered w h eth er th e VE an sw ered a q u estio n d escrib in g a h

y po th etical p erso n w ith th e RFC th at th e claim an t

w o u ld p o ssess w ere th e relev an t o p in io n o r testim o n y tak en as tru e. S ee, e.g

. , Lin g en

f elter , 5 0 4 F.3 d at 1 0 4 1 ; Va rn ey II , 8 5 9 F.2 d at 1 4 01

. Here, th e A LJ a n d co u n sel p o sed q u estio n s to th e VE t h at m atch ed bo th Garriso n ’ s testim o n y

an d th e o p in io n s of W an g , A n d erso n , an d Gen eral,

an d i n resp on se th e VE an sw ered th at a p erso n w ith su ch an RFC w ou ld b e u n a b l e t o w o rk

. On th at b asis, w e can co n clu d e th at Garriso n is d isab l ed w ith o u t rem an d in g f o r f u rth er pro ceed in g s to d eterm in e an ew h er RFC.G A R R I S O N V

. C O L

V I N 53

at 887 (“The Commissioner, having lost this appeal, should
not h ave another opportunity to show t h a t Moisa is not credible any more than M o i s a , h ad he lost, should have an opportunity for remand and f urther proceeding s to establish his credibility .” (citation omitted)).

Second, as we have already ex plained at leng th, the AL J failed to provide a leg ally sufficient rea s o n t o reject Garrison’s testimony and the o p i n ions of her treating a nd

ex a mining medical caretakers. We need n o t r epeat this analy sis here.

T hird, if the improperly discredited evidence we r e credited as true, it is clear that the AL J would be required to find Garrison d isabled on remand. 2 9 Our conclusion follows directly from our analy sis of the AL J ’ s errors and the streng th of the improperly discredited evidence, w h i ch we credit a s true: a tr e a t i ng doctor, a treating nurse practitioner, a nd an

ex a mining p sy cholog ist a ll d eemed Garri s o n to be disabled, Garrison testified to an array o f severe p h y sical and mental impairments, and a VE ex plicitly testified that a person with the impairments described b y Garrison or her m e dical caretakers could not work. Ac c ording ly

, Garrison satisfies the requirements of the credit-as-true standard.

Having concluded that Garrison satisfies all three parts o f credit-as-true analy sis, we now turn to the question whether

29 A t th is stag e o f th e cre d i t -a s -t r u e an aly sis, w e d o n ot co n s id er arg u m en ts ag ain st cred itin g ev id en ce th at th e A L J d id n o t m ak e. In o th er

w o rd s , as w e ex

p lain ed in Ha rma n , w e d o n o t co n sid er “ w h eth er t h e A L J mig h t h av e articu lated a j u stif icatio n f o r rej ectin g [a m ed i c a l ] o p in io n .” 2 1 1 F.3 d at 1 1 7 9 (em

p h asis ad d ed ). T h is asp ect o f th e cred i t- as- tru e ru le is g ro u n d ed i n th e p rin cip les s et f o rth in S EC v. Ch en ery Co rp

. , 3 1 8 U .S. 8 0 , 8 7

– 8 8 (1 9 4 3 ).G A R R I S O N V

. C O L

V I N 54

we should nonetheless ex ercise “flex ibility ” under Connet t and remand for further proceeding s. Here, t h e a n swer is clearly no. The C o m m i ssioner simply repeats all of the
arg uments she has already made, asserting that the evidence provided by the doctors and nurse p ractitioner who tr e a t e d Garrison should not be g iven much weig ht and that Garrison’s testimony should not be a ccepted. As b efore, she dwells on the bare handful of records showing slig ht improvement in Garrison’s condition. At no point does she advance any arg ument ag ainst this evidence that we have not already carefully considered and rejected. Nor does she point
to a n y thing in the record that the AL J overlooked and e x plain h o w that evidence casts into serious doubt G arrison’s claim
to b e disabled. 3 0 W e have independently reviewed the entire record and also h ave found nothing that wou l d c r e ate doubt

a s to Garrison’s entitlement to the benefits she seeks. 3 1 T h e record reflects that, since A pril 20 0 7
, G a r rison has been afflicted with a number of severe im pairments, including burning back pain that radiates into her leg s, sharp neck p ain that radiates into her shoulders and arms, intense a nx iety a nd panic a ttacks, bipolar disorder, PTSD, and bouts o f hallucinations, paranoia, and social phobia. Even if some o f

30 F or ex a m

p le, in u rg in g u s to rem an d f o r f u rth er p ro ceed in g s, th e Co m m i ssio n er arg u es th at th e o pin io n s o f W an g , A n d erso n , an d Gen eral sh o u ld b e g iv en little w eig h t b ecau s e s o m e o f th em are ex p ressed in ch eck

- b o x f

o rm

. T h e Co m

m issio n er also arg u es th at so m e perio d s of im p ro v em en t b y Garriso n w h i le sh e w as b ein g t r e a t e d call in to q u estio n

w h eth er sh e w as d isab led

. T h ese arg u m en t s f ail f o r th e sam e reaso n s w e h av e alread y ex p lain ed i n ad d ressin g th e A L J ’ s an aly s is, m o st n otab ly th at th ey are u tterly b elied b y th e reco rd

, i n co n sisten t w ith o u r p reced en t, an d

co n trad icted b y

th e o p in io n s o f

ev ery treatin g an d ex am in in g p h y sician

.

3 1 A lth o u g h w e d o s o h ere, w e d o n o t m ean to su g g est th at, i n e v e r y cred it- as- tru e ca s e, co u rts m u s t u n d ertak e an in d ep en d en t rev iew of th e

en tire reco rd

.G A R R I S O N V

. C O L

V I N 55

these sy mptoms have occasionally abated for brief periods o f time—all whi l e G a r

rison is in ong oing treatment and has sig nificantly minimiz ed environmental stressors

— we, like her numerous medical caretakers, see no reason to doubt that she has b een entirely incapabl e of work since April 2007. 3 2 Thus, considering the Commissioner’s arg um e n ts a nd independently reviewing the record, w e see no basis for serious doubt that Garrison is disabled.

I n sum, w e conclude that G a rr i son satisfies a ll three conditions of the credit-as-true rule and that a careful r eview of the record discloses no reason to serio u s ly doubt that she is, in fact, disabled. A remand for a c alculation and award o f benefits is there fo re required u nder our credit-as-true precedents.

CONCLUSION

W e conclude that the AL J erred in assig ning little w eig ht
to W ang a

nd Anderson’s opin ions, erred in her characteriz ation of General’s opinion

, a n d failed to offer specific, clear, and convincing r easons for discrediting part o f Garrison’s testimony

. W e f u r ther conclude that the district
court abused i t s d i scretion in remanding for f urther proceeding s. W e reverse the judg ment of the district court with instructions to remand to the AL J for the calculation a nd award of benefits.

REVERSED AND REMANDED

32 T h i s co n clu sio n w a s c o n f irm ed by caref

u l q u estio n in g o f th e V E
reg ard in g h y

po th etical p erso n s at th e h earin g b ef o re th e A L J

.