FOR PUBLICATION

UNITED STATES COURT OF APPEALS

FOR THE NINTH CIRCUIT

HEATHER ROUNDS,

Plaintiff-Appellant,

v.

COMMISSIONER SOCIAL SECURITY 

ADMINISTRATION,

Defendant-Appellee.

No. 13-35505

D.C. No.

3:12-cv-00342-

MA

OPINION

Appeal from the United States District Court

for the District of Oregon

Malcolm F. Marsh, Senior District Judge, Presiding

Submitted May 7, 2015*

Portland, Oregon

Filed August 4, 2015

 * The panel unanimously concludes this case is suitable for decision 

without oral argument. See Fed. R. App. P. 34(a)(2).

 
2 ROUNDS V. COMM’R OF SOC. SEC.

Before: William A. Fletcher and Andrew D. Hurwitz,

Circuit Judges and Michael M. Baylson,

** Senior District 

Judge.

Opinion by Judge Baylson

SUMMARY***

Social Security

The panel affirmed in part, and vacated in part, the 

district court’s affirmance of the Commissioner of Social 

Security Administration’s denial of claimant’s application 

for Supplemental Security Income, and remanded for 

further proceedings.

The panel held that the Administrative Law Judge 

(“ALJ”) failed to reconcile an apparent conflict between a 

vocational expert’s testimony and the Dictionary of 

Occupational Titles, and that the error was not harmless. 

The panel remanded for the ALJ to determine whether 

there was a reasonable explanation to justify relying on the 

vocational expert’s testimony.

 ** The Honorable Michael M. Baylson, Senior District Judge for the 

U.S. District Court for the Eastern District of Pennsylvania, sitting by 

designation.

 *** This summary constitutes no part of the opinion of the court. It 

has been prepared by court staff for the convenience of the reader.

 
ROUNDS V. COMM’R OF SOC. SEC. 3

The panel held that the ALJ must determine whether 

the claimant established fibromyalgia as a medically 

determinable impairment under the 2010 diagnostic 

criteria, and because the ALJ had not yet made this 

determination it may moot claimant’s other arguments 

concerning her fibromyalgia diagnosis. The panel, 

accordingly, did not reach claimant’s other arguments 

concerning her fibromyalgia diagnosis. 

The panel held that the ALJ’s residual functional 

capacity determination adequately incorporated the 

opinions of Dr. McKenna and Dr. Boyd. The panel also 

held that the ALJ did not improperly reject claimant’s 

testimony. The panel further held that the ALJ did not err 

in the consideration of lay witness testimony.

COUNSEL

Tim Wilborn, Wilborn Law Office, P.C., Las Vegas, 

Nevada, for Plaintiff-Appellant.

S. Amanda Marshall, United States Attorney, Ronald K. 

Silver, Assistant United States Attorney, David Morado, 

Regional Chief Counsel, Region X, and Thomas M. 

Elsberry, Assistant Regional Counsel, Seattle, Washington, 

for Defendant-Appellee.
4 ROUNDS V. COMM’R OF SOC. SEC.

OPINION

BAYLSON, District Judge:

Appellant Heather Rounds appeals from the district 

court’s affirmance of the decision of a Social Security 

Administration Administrative Law Judge (ALJ) denying 

her application for Supplemental Security Income (SSI). 

Although we find no error in the ALJ’s rulings on several 

issues, we vacate in part and remand because the ALJ 

failed to reconcile an apparent conflict between a 

vocational expert’s (VE) testimony and the Dictionary of 

Occupational Titles.

BACKGROUND

I. Rounds’ Self-Reported Activities and 

Limitations

At the time of her SSI application, Rounds was 22 years 

old, a high school graduate, and the mother of a five-yearold daughter. She was living with her daughter, a 

roommate/boyfriend named Gavin Lipscomb, and her two 

cats. In the function report accompanying her application, 

Rounds described difficulties with social interactions, 

leaving the house, sleeping, remembering to eat and care 

for herself, and remembering instructions. Nevertheless, 

she stated that she was able to care for her daughter and her 

cats, prepare simple meals, share house work with her 

roommate, shop for groceries, and pay bills. Lipscomb 

submitted a third-party function report that described 

Rounds in similar terms, although he also noted that she 

“sees no reason to want to work.” During her oral 

testimony in August 2010, Rounds described similar daily 

activities but also testified to experiencing intermittent 

severe pain in her shoulders, neck, and back.
ROUNDS V. COMM’R OF SOC. SEC. 5

Rounds’ work history is limited to two short-lived jobs 

as a cashier at a gas station and at a fast food restaurant. 

She described such work as “hard and exhausting” due to 

not fitting in with her co-workers and struggling to interact 

with customers.

II. Rounds’ Medical History

For purposes of this appeal, we focus on whether 

Rounds was disabled between March 10, 2009, the date of 

her application, and September 3, 2010, the date of the 

ALJ’s decision.1 In January 2009, Rounds visited Dr. 

Molly McKenna for a comprehensive neuropsychological 

examination. Dr. McKenna diagnosed Rounds with 

(a) major depressive disorder, moderate, recurrent, in 

partial remission, (b) social phobia, (c) pervasive 

developmental disorder NOS (not otherwise specified), and 

(d) cognitive disorder NOS. She also noted schizotypal 

personality traits, recurrent headaches, and a variety of 

psychosocial stressors. Dr. McKenna noted that Rounds 

believed she related better to cats than to people, had a 

difficult childhood, suffered abuse during a prior 

relationship, and had a history of depression. Nevertheless, 

she concluded Rounds is “independent for all activities of 

daily living” and the “primary impediments to returning 

[her] to full-time gainful employment are her severe social 

anxiety, unusual beliefs and perceptions, limited verbal and 

working memory, and poor mental organization.” Dr. 

McKenna opined that “[w]ith appropriate placement in 

 1 See 20 C.F.R. § 416.335 (SSI can only be paid beginning the month 

after an application is filed).

 
6 ROUNDS V. COMM’R OF SOC. SEC.

training or employment, she is a good candidate to return to 

work.”

In March and April 2009, Rounds attended five mental 

health diagnostic and counseling sessions at the Multnomah 

County Health Department.2 During her initial 

appointment, she told the treating physician that she was 

mainly interested in getting a letter so she could keep her 

two cats. At various times she also stated that she did not 

want to take medication due to a prior bad experience with 

Prozac and that she was disinterested in therapy but willing 

to try it.

Rounds’ medical records were reviewed in May 2009 

by Dr. Joshua Boyd and Dr. Richard Alley, whose opinions 

were used in the initial decision to deny her SSI claim. Her 

records were reviewed again in July 2009 by Dr. Robert 

Henry and Dr. Martin Kehrli, whose opinions were used in 

the denial of Rounds’ request for reconsideration.

From August 2009 through at least August 2010, 

Rounds met with a counselor from Lifeworks NW, Nicole 

Warren. Warren diagnosed Rounds with generalized 

anxiety disorder and dysthymic disorder, and treated her for 

depression and anxiety. During these sessions, Rounds 

twice admitted that one reason for seeking therapy was to 

have documentation for her disability claim. However, 

Warren also noted that Rounds “under reports her 

problems” to medical providers and “can never think of 

what to say at the doctor’s.” Rounds described to Warren 

 2 Although the final chart note in these records is signed and dated 

August 3, 2009, the final date of contact was April 24, 2009.

 
ROUNDS V. COMM’R OF SOC. SEC. 7

physical and lifestyle problems including severe shoulder 

pain, difficulty interacting with other people, a possible 

psychotic break while living in Virginia, and her inability 

to pay to heat her apartment.

In February 2010, Rounds learned about the symptoms 

of fibromyalgia.3 Suspecting that she might be afflicted 

with fibromyalgia, she returned to the Multnomah County 

Health Department and was treated by Dr. Robert 

Henriques. In February or March 2010, after noting that 

Rounds “[c]ries with exam and recoils to minimal contact” 

and had “multiple Tender points on exam,” it appears that 

Dr. Henriques diagnosed Rounds with chronic fibromyalgia 

syndrome and recommended yoga.4 The fibromyalgia 

 3 Fibromyalgia has previously been described by this Court as “a 

rheumatic disease” with symptoms that include “chronic pain 

throughout the body, multiple tender points, fatigue, stiffness, and a 

pattern of sleep disturbance that can exacerbate the cycle of pain and 

fatigue.” Benecke v. Barnhart, 379 F.3d 587, 589-90 (9th Cir. 2004). 

“Fibromyalgia’s cause is unknown, there is no cure, and it is poorlyunderstood within much of the medical community.” Id. at 590. It is 

“diagnosed entirely on the basis of patients’ reports of pain and other 

symptoms” and “there are no laboratory tests to confirm the diagnosis.” 

Id.

 4 The record is unclear but it appears that an undated, incomplete 

chart note that described multiple tender points and diagnosed 

fibromyalgia corresponds to an appointment on February 24, 2010 

during which Rounds also had blood work done. This initial visit was 

also noted by Rounds’ therapist. However, a “problem list” from the 

Health Department indicates that fibromyalgia was first diagnosed on 

March 12, 2010. The chart notes from the March 12 appointment do 

not mention any tender points or fibromyalgia, but are also incomplete 

and do not include the section “Assessment/Plan” where fibromyalgia 

is mentioned after other appointments.

 
8 ROUNDS V. COMM’R OF SOC. SEC.

diagnosis was also mentioned in chart notes for 

appointments on April 13, 2010 and May 13, 2010, during 

which Dr. Henriques recommended exercise and stretches. 

He also prescribed medications for pain, nausea, and sleep.

III. Procedural History

Rounds applied for SSI in March 2009, with a 

protective filing date of March 10, 2009. She alleged that 

she had been disabled since June 1, 2005, and listed her 

disabilities as depression, schizophrenia, social phobias, 

learning disabilities, cognitive problems, and recurring 

headaches. Rounds’ claim was denied on initial review and 

again after reconsideration. While awaiting a hearing 

before an ALJ, Rounds submitted an update alleging that in 

February and March 2010 she was diagnosed with chronic 

fibromyalgia syndrome.

In August 2010, an ALJ conducted a hearing and, in 

September 2010, the ALJ issued his decision denying 

Rounds’ claim. The ALJ followed the five-step evaluation 

process set out at 20 C.F.R. § 416.920. At Step One, the 

ALJ found that Rounds had not engaged in substantial 

gainful activity since March 10, 2009. At Step Two, the 

ALJ determined that Rounds had severe impairments 

consisting of major depressive disorder, social phobia, 

pervasive developmental disorder NOS and cognitive 

disorder NOS. The ALJ concluded that the record was 

insufficient to support a finding that fibromyalgia was a 

medically determinable impairment.

At Step Three, the ALJ determined that Rounds had 

mild restrictions in activities of daily living, marked 

difficulties in social functioning, moderate difficulties with 

concentration, persistence or pace, and no episodes of 

decompensation. As a result, Rounds’ impairments did not 

meet or equal one of the impairments listed in the Social 
ROUNDS V. COMM’R OF SOC. SEC. 9

Security Regulations at 20 C.F.R. Part 404, Subpart P, 

Appendix 1.

The ALJ determined that Rounds had the residual 

functional capacity (RFC) to “perform a full range of work 

at all exertional levels but with the following nonexertional 

limitations: she can perform one to two step tasks with no 

public contact, no teamwork and limited coworker 

contact.” At Step Four, the ALJ determined that Rounds 

had no past relevant work. Finally, at Step Five, the ALJ 

relied on a vocational expert’s testimony that someone with 

Rounds’ RFC could perform jobs that exist in the national 

and local economy, including kitchen helper, hand 

packager, and recycler/reclaimer. As a result, the ALJ 

found Rounds was not disabled.

The Social Security Administration Appeals Council 

denied Rounds’ appeal, making the ALJ’s decision the final 

decision of the Commissioner. Rounds appealed to the 

District Court, which considered the five issues presented 

for review in this appeal and affirmed the ALJ’s decision.

JURISDICTION

The District Court had jurisdiction under 42 U.S.C. 

§ 405(g). This Court has jurisdiction under 28 U.S.C. 

§ 1291.

STANDARD OF REVIEW

This Court “review[s] the district court’s order 

affirming the ALJ’s denial of social security benefits de 

novo, and reverse[s] only if the ALJ’s decision was not 

supported by substantial evidence in the record as a whole 

or if the ALJ applied the wrong legal standard.” Molina v. 

Astrue, 674 F.3d 1104, 1110 (9th Cir. 2012) (citing 

Tommasetti v. Astrue, 533 F.3d 1035, 1038 (9th Cir. 2008), 

and Stone v. Heckler, 761 F.2d 530, 531 (9th Cir. 1985)). 
10 ROUNDS V. COMM’R OF SOC. SEC.

Substantial evidence is “such relevant evidence as a 

reasonable mind might accept as adequate to support a 

conclusion,” and “must be ‘more than a mere scintilla,’ but 

may be less than a preponderance.” Id. at 1110–11 (quoting 

Valentine v. Comm’r Soc. Sec. Admin., 574 F.3d 685, 690 

(9th Cir.2009)). This Court “must consider the evidence as 

a whole, weighing both the evidence that supports and the 

evidence that detracts from the Commissioner’s 

conclusion.” Smolen v. Chater, 80 F.3d 1273, 1279 (9th 

Cir. 1996). However, if “the evidence is susceptible to 

more than one rational interpretation, we must uphold the 

ALJ’s findings if they are supported by inferences 

reasonably drawn from the record.” Molina, 674 F.3d at 

1111. In addition, this Court “may not reverse an ALJ’s 

decision on account of an error that is harmless.” Id.

Overall, the standard of review is “highly deferential.” 

Valentine, 574 F.3d at 690.

DISCUSSION

Rounds contends that the ALJ erred by discrediting her 

fibromyalgia diagnosis, ignoring opinions from two 

psychologists, discounting her testimony, discounting other 

lay witness testimony, and wrongly concluding at Step Five 

that she could perform jobs that exceed her RFC. We begin 

by discussing the ALJ’s Step Five findings because we 

hold that they require remand to the ALJ.

I. The ALJ’s Step Five Findings

At Step Five, “the Commissioner has the burden ‘to 

identify specific jobs existing in substantial numbers in the 

national economy that [a] claimant can perform despite 

[his] identified limitations.’” Zavalin v. Colvin, 778 F.3d 

842, 845 (9th Cir. 2015) (quoting Johnson v. Shalala,

60 F.3d 1428, 1432 (9th Cir. 1995)). Based on a VE’s 

testimony, the ALJ concluded that Rounds was capable of 
ROUNDS V. COMM’R OF SOC. SEC. 11

performing at least three jobs: kitchen helper, hand 

packager, and recycler/reclaimer. According to the 

Dictionary of Occupational Titles (DOT), these jobs require 

a GED Reasoning Level of Two. DOT (4th ed. 1991) 

§ 318.687-010, 1991 WL 672755 (kitchen helper); id. 

§ 920.587-018, 1991 WL 687916 (hand packager); id.

§ 929.687-022, 1991 WL 688172 (salvage laborer).

There are six GED Reasoning Levels that range from 

Level One (simplest) to Level Six (most complex). Id., 

App. C, § III, 1991 WL 688702. The lowest two levels are:

Level 1: Apply commonsense understanding 

to carry out simple one- or two-step 

instructions. Deal with standardized 

situations with occasional or no variables in 

or from these situations encountered on the 

job.

Level 2: Apply commonsense understanding 

to carry out detailed but uninvolved written 

or oral instructions. Deal with problems 

involving a few concrete variables in or 

from standardized situations.

Id. Rounds argues that the ALJ erred because her RFC 

limitation to “one to two step tasks” exactly matches the 

Level One standard of carrying out “simple one- or twostep instructions” and is exceeded by the Level Two 

standard of carrying out “detailed but uninvolved written or 

oral instructions.”

This Court’s recent Zavalin opinion held that “[w]hen 

there is an apparent conflict between the vocational 

expert’s testimony and the DOT—for example, expert 

testimony that a claimant can perform an occupation 

involving DOT requirements that appear more than the 
12 ROUNDS V. COMM’R OF SOC. SEC.

claimant can handle—the ALJ is required to reconcile the 

inconsistency.” Zavalin, 778 F.3d at 846 (citing Massachi 

v. Astrue, 486 F.3d 1149, 1153–54 (9th Cir. 2007)). 

Pursuant to Social Security Ruling (SSR) 00-4p, the ALJ 

has an affirmative duty to “ask the expert to explain the 

conflict and ‘then determine whether the vocational 

expert’s explanation for the conflict is reasonable’ before 

relying on the expert’s testimony to reach a disability 

determination.” Id. (quoting Massachi, 486 F.3d at 1152–

54); SSR 00-4p, 2000 WL 1898704, at *2, *4 (Dec. 4, 

2000).

In Zavalin, this Court remanded to the ALJ because 

“there [was] an apparent conflict between the residual 

functional capacity to perform simple, repetitive tasks, and 

the demands of Level 3 Reasoning,” which the ALJ had not 

recognized and reconciled before relying on the VE’s 

testimony. Id. at 846–48. We conclude that Zavalin—this 

Court’s most recent holding regarding the review of a VE’s 

testimony—controls the analogous facts of this case.

Here, the ALJ stated at the outset of the VE’s testimony 

that “unless you tell me otherwise, I’ll assume that your 

testimony is based on your knowledge, education, training, 

and experience consistent with the DOT, does that work for 

you, sir?”, to which the VE replied “Yes, sir.” Based on 

that exchange, the ALJ concluded that the VE’s testimony 

was consistent with the DOT. As a result, although the 

VE’s testimony was ostensibly consistent with the DOT, he 

never directly addressed whether Rounds’ limitation to 

one- to two-step tasks was consistent with jobs requiring 

Level Two reasoning and, if so, why.

Under these circumstances, Zavalin is controlling. 

There was an apparent conflict between Rounds’ RFC, 

which limits her to performing one- and two-step tasks, and 
ROUNDS V. COMM’R OF SOC. SEC. 13

the demands of Level Two reasoning, which requires a 

person to “[a]pply commonsense understanding to carry out 

detailed but uninvolved written or oral instructions.” The 

conflict between Rounds’ RFC and Level Two reasoning is 

brought into relief by the close similarity between Rounds’ 

RFC and Level One reasoning. Level One reasoning 

requires a person to apply “commonsense understanding to 

carry out simple one- or two-step instructions.” The 

Commissioner resists the obvious similarity between 

Rounds’ RFC and Level One reasoning, and the 

concomitant contrast between Rounds’ RFC and Level 

Two reasoning, by stressing that “task” and “instruction” 

are different terms. In the Commissioner’s view, Rounds’ 

inability to complete multi-step tasks does not necessarily 

contradict the VE’s opinion that she has the ability to 

follow detailed instructions, as required in Level Two jobs. 

Based on the record, we disagree. Only tasks with more 

than one or two steps would require “detailed” instructions. 

And these are precisely the kinds of tasks Rounds’ RFC 

indicates she cannot perform.

Because the ALJ did not recognize the apparent conflict 

between Rounds’ RFC and the demands of Level Two 

reasoning, the VE did not address whether the conflict 

could be resolved. As a result, we “cannot determine 

whether substantial evidence supports the ALJ’s step-five 

finding.” Id. at 848 (quoting Massachi, 486 F.3d at 1154). 

On remand, the ALJ must determine whether there is a 

reasonable explanation to justify relying on the VE’s 
14 ROUNDS V. COMM’R OF SOC. SEC.

testimony.5 See id. at 846–48; Massachi, 486 F.3d at 1153–

54; see also Tommasetti, 533 F.3d at 1042 (“[A]n ALJ 

‘may rely on expert testimony which contradicts the DOT, 

but only insofar as the record contains persuasive evidence 

to support the deviation.’” (quoting Johnson, 60 F.3d at 

1435)).

The ALJ’s failure to reconcile this apparent conflict 

was not harmless. In his RFC assessment, the ALJ did not 

merely restrict Rounds to “simple” or “repetitive” tasks.6

Instead, he expressly limited her to “one to two step tasks,” 

apparently to address her “moderate” problems with 

memory and concentration. There is no explanation in the 

record as to why the VE or the ALJ may have believed that 

Rounds’ specific limitation to “one to two step tasks” 

should not be taken at face value. As such, the record does 

not support a conclusion that the ALJ’s failure to resolve 

this apparent conflict was harmless error. This Court 

“cannot affirm the decision of an agency on a ground that

the agency did not invoke in making its decision.” Zavalin, 

 5 Alternatively, the VE may be able to identify other jobs that require 

Level One reasoning and are suitable for someone with Rounds’ other 

limitations.

 6 Unpublished decisions of panels of this Court and opinions from 

some of our sister circuits have concluded that an RFC limitation to 

“simple” or “repetitive” tasks is consistent with Level Two reasoning. 

See Moore v. Astrue, 623 F.3d 599, 604 (8th Cir. 2010); Abrew v. 

Astrue, 303 F. App’x 567, 569 (9th Cir. 2008) (unpublished); Lara v. 

Astrue, 305 F. App’x 324, 326 (9th Cir. 2008) (unpublished); Hackett 

v. Barnhart, 395 F.3d 1168, 1176 (10th Cir. 2005); Money v. Barnhart, 

91 F. App’x 210, 215 (3d Cir. 2004) (unpublished). These decisions are 

inapposite because they did not consider a specific limitation to “one to 

two step tasks.”

 
ROUNDS V. COMM’R OF SOC. SEC. 15

778 F.3d at 848 (quoting Stout v. Comm’r, Soc. Sec. 

Admin., 454 F.3d 1050, 1054 (9th Cir. 2006)) (holding that 

ALJ’s failure to reconcile apparent conflict between RFC 

and DOT was not harmless error).7

II. The ALJ’s Consideration of the Fibromyalgia 

Diagnosis

Rounds argues that the ALJ erred by (a) failing to 

develop the record of her fibromyalgia diagnosis, 

(b) relying on the opinions of medical experts who 

reviewed her records before the fibromyalgia diagnosis or 

who question the existence of fibromyalgia, and 

(c) substituting the ALJ’s own assessment of the 

fibromyalgia diagnostic criteria for that of her treating 

physician. However, we need not reach these arguments.8

 7 In addition to the contentions discussed here, Rounds also contends 

that the ALJ erred at Step Five because the hypotheticals presented to 

the VE omitted limitations related to fibromyalgia, the medical 

opinions of Dr. McKenna and Dr. Boyd, and the lay testimony of 

Rounds, Lipscomb, and Davidson. She further argues, without citation, 

that the kitchen helper job conflicts with her RFC because it may 

involve extensive co-worker contact. As discussed below, the ALJ 

appropriately considered and incorporated the evidence from Dr. 

McKenna, Dr. Boyd, Rounds, Lipscomb, and Davidson. If the ALJ 

determines on remand that Rounds has proven that fibromyalgia is a 

medically determinable impairment, the ALJ will need to determine 

whether and, if so, how that diagnosis changes Rounds’ RFC and the 

Step Five analysis.

 8 We also do not reach the Commissioner’s argument, adopted by the 

District Court, that the ALJ fulfilled any duty to develop the record by 

leaving the record open for two weeks after the hearing.

 
16 ROUNDS V. COMM’R OF SOC. SEC.

After the ALJ’s decision in this case, the Commissioner 

adopted SSR 12-2p, which designates two separate sets of 

diagnostic criteria that can establish fibromyalgia as a 

medically determinable impairment. SSR 12-2p, 2012 WL 

3104869, at *2–3 (Jul. 25, 2012). These criteria, published 

by the American College of Rheumatology in 1990 and 

2010, were both available at the time of Rounds’ August 

2010 hearing and the ALJ’s September 2010 decision.9

However, it appears that the ALJ considered only the 1990 

diagnostic criteria and did not consider the 2010 criteria.10

Many of Rounds’ symptoms (e.g., cognitive and memory 

problems, poor sleep, depression, anxiety, headaches, 

fatigue, dizziness, and nausea) appear to fit the 2010 

criteria better than the 1990 criteria. Id. at *2–3 & n.9. To 

be fair to Rounds, and to be consistent with the 

Commissioner’s binding ruling in SSR 12-2p that applies 

on remand, the ALJ must determine whether Rounds 

 9 The 2010 diagnostic criteria were published in Frederick Wolfe, et 

al., The American College of Rheumatology Preliminary Diagnostic 

Criteria for Fibromyalgia and Measurement of Symptom Severity, 

62 Arthritis Care & Research 600 (May 2010), available at 

https://www.rheumatology.org/ACR/practice/clinical/classification/fibr

omyalgia/2010_Preliminary_Diagnostic_Criteria.pdf.

 10 The ALJ concluded that fibromyalgia’s “signs are primarily the 

tender points” and that “merely stating ‘multiple’ tender points were

positive is not enough.” However, in contrast to the 1990 criteria, the 

2010 diagnostic criteria do not require a specific number of tender 

points in specific locations. See SSR 12-2p, 2012 WL 3104869, at *2–

3. As the Commissioner later ruled, the 2010 criteria can be used to 

determine that fibromyalgia is a medically determinable impairment “if 

the case record does not include a report of the results of tender-point 

testing, or the report does not describe the number and location on the 

body of the positive tender points.” Id. at *3 n.6.

 
ROUNDS V. COMM’R OF SOC. SEC. 17

established fibromyalgia as a medically determinable 

impairment under the 2010 diagnostic criteria. See

20 C.F.R. § 402.35(b)(1) (providing that SSRs “are binding 

on all components of the Social Security Administration”). 

Because the ALJ has not yet made this determination and it 

may moot Rounds’ other arguments regarding her 

fibromyalgia diagnosis, we need not reach Rounds’ other 

arguments at this time.

III. The ALJ’s Evaluation of Medical Opinions

Rounds argues that the ALJ erred by ignoring Dr. 

Boyd’s opinion (also adopted by Dr. Rullman) that Rounds 

has moderate limitations in her ability to accept instructions 

and respond appropriately to criticism from supervisors. 

This “opinion” was a checkbox in Dr. Boyd’s “Summary 

Conclusions” and was not repeated in his narrative 

“Functional Capacity Assessment.” Although it was 

unpublished, we find persuasive the opinion of a panel of 

this Court that rejected a similar argument and commented 

that interpreting such a checkbox to be an “opinion” “is 

strained.” Israel v. Astrue, 494 F. App’x 794, 797 & n.1 

(9th Cir. 2012) (unpublished) (noting that the agency 

describes the “Summary Conclusions” as “merely a 

worksheet . . . and does not constitute the RFC 

assessment”). In any event, the ALJ explicitly noted that 

Dr. Boyd had checked this box and gave Dr. Boyd’s 

opinions “great weight” in crafting Rounds’ RFC.

Rounds also argues that the ALJ improperly rejected 

some of Dr. McKenna’s “Treatment Recommendations” 

that Rounds should (a) avoid math or use a calculator, 

(b) write information down and use various memory aids, 

(c) request that instructions be repeated and provided both 

verbally and in writing, and (d) limit customer or public 

contact. However, Dr. McKenna’s formal conclusions were 
18 ROUNDS V. COMM’R OF SOC. SEC.

set out in a separate section of her report subtitled “Clinical 

Formulation/Prognosis” and Rounds does not contend that 

the ALJ ignored those conclusions. An ALJ may rationally 

rely on specific imperatives regarding a claimant’s 

limitations, rather than recommendations. Carmickle v. 

Comm’r, Soc. Sec. Admin., 533 F.3d 1155, 1165 (9th Cir. 

2008). In addition, the ALJ is responsible for translating 

and incorporating clinical findings into a succinct RFC. See 

Stubbs-Danielson v. Astrue, 539 F.3d 1169, 1174 (9th Cir. 

2008).

We hold that the ALJ’s RFC determination—which 

limited Rounds to “one to two step tasks with no public 

contact, no teamwork and limited coworker contact”—

adequately incorporated the opinions of Dr. McKenna and 

Dr. Boyd.

IV. The ALJ’s Consideration of Rounds’ 

Testimony

Rounds argues that the ALJ improperly rejected her 

testimony. Having determined that Rounds’ medically 

determinable impairments could reasonably be expected to 

cause her alleged symptoms, “the ALJ may reject the 

claimant’s testimony regarding the severity of her 

symptoms only if he makes specific findings stating clear 

and convincing reasons for doing so.” Smolen, 80 F.3d at 

1284. “The ALJ must state specifically which symptom 

testimony is not credible and what facts in the record lead 

to that conclusion.” Id. To assess a claimant’s credibility, 

the ALJ may consider, among other factors, “ordinary 

techniques of credibility evaluation,” “inadequately 

explained failure to seek treatment or to follow a prescribed 

course of treatment,” and “the claimant’s daily activities.” 

Id. The ALJ must also consider factors including the 

“observations of treating and examining physicians and 
ROUNDS V. COMM’R OF SOC. SEC. 19

other third parties regarding . . . the claimant’s symptom[s]; 

. . . functional restrictions caused by the symptoms; and the 

claimant’s daily activities.” Id.

Here, the ALJ considered Rounds’ written and oral 

testimony and concluded that Rounds’ “statements 

concerning the intensity, persistence and limiting effects of 

[her] symptoms are not credible to the extent they are 

inconsistent with the above residual functional capacity 

assessment.” The ALJ explicitly did “not discount the 

claimant’s consistent report of significant difficulties, 

particularly with interpersonal relationships.” In support of 

these conclusions, the ALJ reviewed and summarized the 

lay and expert testimony in the record. To justify 

discounting Rounds’ testimony about the severity of her 

symptoms, the ALJ concluded that her medical records 

show a higher level of functionality, that she has been 

uncooperative regarding use of medications and engaging 

in therapy, and that she appears to access support resources 

only when she has secondary motivations.

Taken in context, the ALJ’s determination of Rounds’ 

RFC was based on the totality of Rounds’ and her 

roommate’s testimony about her daily activities and the 

opinions of Dr. McKenna and Dr. Boyd regarding her 

functional capabilities. This evidence provides clear and 

convincing reasons for discounting Rounds’ testimony 

regarding the severity of her symptoms. See Molina, 

674 F.3d at 1112–14 (affirming ALJ’s decision to discount 

claimant’s testimony based on inconsistencies with her 

daily activities and the medical evidence, and her failure to 

seek or follow prescribed treatment); Matney ex rel. 

Matney v. Sullivan, 981 F.2d 1016, 1020 (9th Cir. 1992) 

(affirming ALJ’s decision to discount claimant’s pain 

testimony based on his doctor’s report, his daily activities, 

and his secondary motive to seek disability benefits). We 
20 ROUNDS V. COMM’R OF SOC. SEC.

discern no error in the ALJ’s consideration of Rounds’ 

testimony.

V. The ALJ’s Consideration of Lay Witness 

Testimony

Rounds argues that the ALJ improperly rejected lay 

witness testimony from Rounds’ roommate, Lipscomb, 

who stated that Rounds needs instructions repeated and has 

trouble focusing on and finishing tasks. She also argues that 

the ALJ ignored a lay witness statement from an Oregon 

state employee, Gary Davidson, who noted that Rounds had 

memory problems and concluded that she was unable to 

work outside a sheltered work environment. “[C]ompetent 

lay witness testimony ‘cannot be disregarded without 

comment’” and “in order to discount competent lay witness 

testimony, the ALJ ‘must give reasons that are germane to 

each witness.’” Molina, 674 F.3d at 1114 (quoting Nguyen 

v. Chater, 100 F.3d 1462, 1467 (9th Cir. 1996) and Dodrill 

v. Shalala, 12 F.3d 915, 919 (9th Cir. 1993)) (emphasis 

omitted).

With respect to Lipscomb, the ALJ described his 

statement as generally consistent with Rounds’ testimony 

and statements, accepted it “as descriptive of his 

perceptions,” but concluded that “it does not provide 

sufficient support to alter the RFC arrived at herein.” The 

ALJ also noted that Lipscomb’s statement indicated that 

Rounds sees no reason to want to work, suggesting a 

secondary motive for applying for SSI. It is not clear that 

the ALJ rejected Lipscomb’s statement at all. The ALJ 

limited her RFC to one- to two-step tasks, which addressed 

her memory and focus problems. Even if the ALJ 

discounted his statement, Lipscomb’s admission that 

Rounds has a secondary motive for seeking SSI was a 

germane reason for doing so.
ROUNDS V. COMM’R OF SOC. SEC. 21

As for Davidson, even assuming that he was a 

“competent lay witness,” the ALJ’s failure to consider his 

comments was harmless. Davidson was Rounds’ appointed 

representative for filing her SSI claim. As her advocate, he 

was not a typical lay witness. Even if he qualified as a lay 

witness, most of his comments were in the form of 

conclusions that Rounds is disabled and unable to work 

outside of a sheltered work environment. These are 

ultimate determinations reserved to the ALJ. See 

Tonapetyan v. Halter, 242 F.3d 1144, 1148 (9th Cir. 2001) 

(noting that even a treating physician’s opinion is not 

binding on the ultimate determination of disability). 

Davidson’s non-conclusory comments refer to “memory 

problems” and were addressed in the RFC by limiting 

Rounds to one- to two-step tasks. Accordingly, to the 

extent the ALJ may have failed to consider Davidson’s lay 

witness evidence, the error was harmless because it was 

“inconsequential to the ultimate nondisability 

determination.” Molina, 674 F.3d at 1115.

CONCLUSION

We affirm in part, vacate in part, and remand to the 

District Court so that it may remand to the agency for 

further proceedings consistent with this opinion.

AFFIRMED IN PART, VACATED IN PART, AND 

REMANDED. Each party shall bear its own costs on 

appeal.