FOR PUBLICATION

UNITED STATES COURT OF APPEALS

FOR THE NINTH CIRCUIT

LAURIE L. WELLINGTON,

Plaintiff-Appellant,

v.

NANCY A. BERRYHILL, Acting

Commissioner Social Security,

Defendant-Appellee.

No. 16-15188

D.C. No.

1:14-cv-01207-

SMS

OPINION

Appeal from the United States District Court

for the Eastern District of California

Sandra M. Snyder, Magistrate Judge, Presiding

Argued and Submitted September 14, 2017

San Francisco, California

Filed December 29, 2017

Before: Ronald M. Gould and Paul J. Watford, Circuit 

Judges, and W. Louis Sands,* District Judge.

Opinion by Judge Gould;

Dissent by Judge Watford

 * The Honorable W. Louis Sands, United States District Judge for 

the Middle District of Georgia, sitting by designation.
2 WELLINGTON V. BERRYHILL

SUMMARY**

Social Security

The panel affirmed the district court’s order affirming 

the Social Security Administration Commissioner’s denial 

of a claimant’s application for Social Security Disability 

Insurance benefits and partial denial of the claimant’s 

application for Supplemental Security Income benefits.

The panel rejected claimant’s contention that Social 

Security Ruling (“SSR”) 82-30 required the administrative 

law judge (“ALJ”) to call a medical advisor at the hearing to 

help determine claimant’s disability onset date. The panel 

held that under ordinary circumstances, an ALJ was 

equipped to determine a claimant’s disability onset date 

without calling on a medical advisor. The panel held that 

because the record was adequate even before claimant saw a 

mental health specialist and no reasonable medical expert 

could have inferred that her disability began before May 

2010, SSR 83-20 did not require the ALJ to consult a 

medical advisor before determining claimant’s disability 

onset date.

Judge Watford dissented. Because the evidence was 

ambiguous as to when claimant’s impairments became 

disabling, Judge Watford would hold that the ALJ erred in 

determining that the record conclusively supported May 26, 

2010 as the date claimant’s impairments became severe 

enough to prevent her from engaging in substantial gainful 

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

has been prepared by court staff for the convenience of the reader.
WELLINGTON V. BERRYHILL 3

activity; and he would remand for the ALJ to appoint a 

medical advisor in the case.

COUNSEL

Lawrence D. Rohlfing (argued), Santa Fe Springs, 

California, for Plaintiff-Appellant.

Elizabeth Firer (argued) and Marcelo Illarmo, Special 

Assistant United States Attorney; Deborah Lee Stachel, 

Regional Chief Counsel, Region IX; Phillip A. Talbert, 

Acting United States Attorney; Social Security 

Administration, San Francisco, California; for DefendantAppellee.

OPINION

GOULD, Circuit Judge:

Laurie Wellington appeals from the district court’s order 

affirming the Social Security Administration 

Commissioner’s denial of her application for Social Security 

Disability Insurance benefits and partial denial of her 

application for Supplemental Security Income benefits. The 

Administrative Law Judge concluded that Wellington was 

not disabled until May 26, 2010, after both the period in 

which she was insured for SSDI benefits and the date on 

which she applied for SSI benefits. On appeal, Wellington 

contends that the ALJ erred by not calling a medical advisor 

at the hearing to help determine the onset date of her 

disabilities. We reject this contention and we affirm.
4 WELLINGTON V. BERRYHILL

I

Wellington experienced psychological trauma 

throughout her life. As a child, she suffered chronic sexual 

abuse and shielded her younger siblings from domestic 

violence at home. As an adult, she was regularly beaten by 

an ex-boyfriend over the course of eight years, was 

emotionally abused by her ex-husband during their twelveyear relationship, and was stalked by this ex-husband after 

their divorce. Wellington has been diagnosed with posttraumatic stress disorder and an unspecified anxiety 

disorder.

Wellington has several physical ailments as well. She 

primarily suffers from chronic muscle pain, and she was 

diagnosed with fibromyalgia in 2009. She also has a history 

of back pain and chest pain, and some less serious 

conditions.

Despite her psychological and physical impairments, 

Wellington was able to lead a productive life for many years. 

She dropped out of high school and apparently did not work 

in her 20s, but she obtained her GED at age 32. She then 

completed a nine-month college program in medical 

assisting and worked as a certified nursing assistant for three 

years until she hurt her back. The extent of this injury is not 

clear from the record, but Wellington stayed out of the work 

force for six years. In 2005, she returned to work as a cashier 

at a convenience store, where she worked for two and a half 

years. Wellington kept this job until she was required to 

work 50-hour weeks, which aggravated her back pain. She 

then worked part-time at a department store for eight 

months.

In December 2008, however, Wellington repeatedly took 

medical leave and was fired from her department store job 
WELLINGTON V. BERRYHILL 5

when she did not return to work. In the month before she 

was fired, Wellington went to the emergency room eight 

times, and on one occasion admitted herself for a three-day 

inpatient stay. She appeared anxious or complained of 

anxiety-related symptoms in half of these visits, while the 

other visits involved treatment for vertigo, migraine 

headaches, or abdominal pain.

In the month after losing her job, Wellington went back 

to the emergency room four times, again exhibiting or 

complaining of anxiety in half of these visits while seeking 

unrelated treatment—for vertigo, ringing in her ears, and 

arm numbness—in the rest. An emergency doctor gave 

Wellington a prescription for Xanax to manage her anxiety, 

and she did not return to the ER for a month afterward. In 

the next visit she said her anxiety was “better now” and she 

was treated for acute vomiting. Wellington returned a week 

later requesting more Xanax and appearing anxious. She ran 

out of medication three weeks later and again went back to 

the emergency room, where she was prescribed a different 

drug.

On March 16, 2009, Wellington went to a health center 

for the first time on record and was given a two-month 

Klonopin prescription. Subsequent medical records show 

routine treatment of her anxiety disorder. Wellington 

received a one-month refill of Klonopin in May, but the 

prescription was not renewed at her appointment the 

following month. Wellington requested and received 

another one-month refill in July. But the prescription again 

was not renewed the following month. Wellington 

complained of increased life stressors and anxiety in 

September, so she received a stronger prescription that was 

increased once more in October. The prescription was 

decreased in December when Wellington had no complaints 
6 WELLINGTON V. BERRYHILL

of anxiety, and it was not renewed in January 2010, the last 

record from this office. These treatment notes indicate that 

Wellington “doesn’t like taking medication,” though she 

recognized that her prescriptions did “help with the pain and 

the anxiety.”

Wellington first saw a specialist for her mental health 

troubles on May 26, 2010. Dr. Cushman described 

Wellington as moderately anxious, but he noted that she last 

took a leftover Klonopin a month ago and that “[s]he does 

find it helpful in managing her anxiety.” He concluded that 

Wellington will “have difficulties with regular attendance 

and consistent participation at this time, with complaints of 

pain, anxiety and malaise.” Still, Dr. Cushman assigned 

Wellington a Global Assessment of Functioning (“GAF”) 

score of 55, indicating that he believed Wellington had only 

moderate psychological symptoms.1 Dr. Cushman also 

noted that Wellington would benefit from counseling.

Wellington took a turn for the worse over the next 

several months. She began seeing a therapist in June, and in 

July she reported that she was having more panic attacks 

because her ex-husband was trying to contact her. In 

August, Wellington was tearful during most of her 

counseling session, and she described being emotionally 

overwhelmed because her father had developed terminal 

cancer, other family members were not getting along, and 

she recently had to put her dog down. Wellington was 

advised to restart Klonopin and was given a new 

 1 The Social Security Administration has said that GAF scores 

“should be considered as medical opinion evidence under 20 C.F.R. 

§§ 404.1527(a)(2) and 416.927(a)(2) if they come from an acceptable 

medical source.” Soc. Sec. Disab. Claims Handbook § 2:15 n.40 (citing 

AM-13066 REV).
WELLINGTON V. BERRYHILL 7

prescription. Her father passed away the following month. 

At her next counseling appointment, Wellington showed up 

in a robe, pajamas, and hospital slippers, and she would not 

make eye contact. In December, Wellington reported that 

“everything got worse” after her father died. The next 

month, January 2011, the therapist observed that 

Wellington’s depression was only getting worse and that her 

anxiety had reached new heights.

Wellington filed for SSDI and SSI benefits on December 

24, 2009, alleging a disability onset date of December 24, 

2008. Her date last insured for SSDI was December 31,

2008. Wellington’s claims were initially denied, but after an 

appeal and voluntary remand, an ALJ issued a partially 

favorable decision. The ALJ found that Wellington’s 

disability onset date was May 26, 2010, making her 

ineligible for SSDI but eligible for SSI from that date 

forward. The ALJ determined Wellington’s disability onset 

date without calling a medical expert at the hearing. He 

reasoned that medical records beginning on this date—with 

Dr. Cushman’s psychological examination—showed that 

Wellington became unable to complete a normal workday up 

to seven days a quarter due to pain and anxiety. The district 

court affirmed the ALJ’s decision, and Wellington appeals.

II

We review de novo the district court’s order affirming 

the Commissioner’s denial of benefits. Berry v. Astrue, 

622 F.3d 1228, 1231 (9th Cir. 2010). We will affirm the 

Commissioner’s decision unless it is not supported by 

substantial evidence or is based on a legal error. Id.
8 WELLINGTON V. BERRYHILL

III

On appeal, Wellington contends that the ALJ erred by 

finding that her disability began the day she was examined 

by Dr. Cushman. She argues that Social Security Ruling 

(“SSR”) 82-30 required the ALJ to call a medical advisor at 

the hearing to help determine her disability onset date. We 

disagree.

A

The onset date of a disability can be critical to an 

individual’s application for disability benefits. A claimant 

can qualify for SSDI only if her disability begins by her date 

last insured, and these benefits can be paid for up to 

12 months before her application was filed. See 42 U.S.C. 

§ 423(a)(1), (c)(2), (d)(1)(A). In contrast, a claimant is 

eligible for SSI once she becomes disabled, but she cannot 

receive benefits for any period before her application date. 

See 42 U.S.C. §§ 1382(c)(2), (c)(7), 1382c(a)(3)(A). For 

both programs, the onset date is the date when the claimant 

is unable to engage in any substantial gainful activity due to 

physical or mental impairments that can be expected to last

for at least 12 months. 42 U.S.C. §§ 423(d)(1)(A), 

1382c(a)(3)(A).

As we recently explained in Diedrich v. Berryhill, “[t]he 

ALJ is responsible for studying the record and resolving any 

conflicts or ambiguities in it.” 874 F.3d 634, 638 (9th Cir. 

2017) (citing Treichler v. Comm’r of Soc. Sec. Admin, 

775 F.3d 1090, 1098 (9th Cir. 2014)). “But in circumstances 

where the ALJ must determine the date of disability onset 

and medical evidence from the relevant time period is 

unavailable or inadequate, Social Security Ruling (“SSR”) 

83-20 states that the ALJ should call a medical advisor.” Id. 

SSR 83-20 provides:
WELLINGTON V. BERRYHILL 9

Medical reports containing descriptions 

of examinations or treatment of the 

individual are basic to the determination of 

the onset of disability. The medical evidence 

serves as the primary element in the onset 

determination. . . .

With slowly progressive impairments, it 

is sometimes impossible to obtain medical 

evidence establishing the precise date an 

impairment became disabling. Determining 

the proper onset date is particularly difficult, 

when, for example, the alleged onset and the 

date last worked are far in the past and 

adequate medical records are not available. 

In such cases, it will be necessary to infer the 

onset date from the medical and other 

evidence that describe the history and 

symptomatology of the disease process.

. . . .

In some cases, it may be possible, based 

on the medical evidence to reasonably infer 

that the onset of a disabling impairment(s) 

occurred some time prior to the date of the 

first recorded medical examination, e.g., the 

date the claimant stopped working. How 

long the disease may be determined to have 

existed at a disabling level of severity 

depends on an informed judgment of the facts 

in the particular case. This judgment, 

however, must have a legitimate medical 

basis. At the hearing, the administrative law 
10 WELLINGTON V. BERRYHILL

judge (ALJ) should call on the services of a 

medical advisor when onset must be inferred.

SSR 83-20, 1983 WL 31249, at *2–3.

Although Social Security Rulings do not carry the “force 

of law,” they are nevertheless binding on ALJs. Molina v. 

Astrue, 674 F.3d 1104, 1113 n.5 (9th Cir. 2012). These 

Rulings “reflect the official interpretation of the [Social 

Security Administration] and are entitled to some deference 

as long as they are consistent with the Social Security Act 

and regulations.” Id. (citation omitted).

Our cases have given some guidance as to situations in 

which SSR 83-20 requires an ALJ to seek a medical 

advisor’s help before determining a claimant’s disability 

onset date.

In DeLorme v. Sullivan, 924 F.2d 841 (9th Cir. 1991), 

we considered the case of a man with long-term disabling 

depression. Id. at 844. Although DeLorme’s incapacitating 

depression was not diagnosed until he belatedly saw a 

mental health specialist, it was “possible that the depression 

diagnosed [then] might be found to have an onset date at 

some other time prior to the expiration of insured status” two 

years earlier. Id. at 847–49. We held that on these facts, 

“SSR 83-20 requires the administrative law judge to call 

upon the services of a medical advisor and to obtain all 

evidence which is available to make the determination.” Id.

at 848.

Similarly, in Morgan v. Sullivan, 945 F.2d 1079 (9th Cir. 

1991), we reversed the ALJ’s determination of the onset date 

of the claimant’s mental disorders because the ALJ did not 

consult a medical advisor. Id. at 1082–83. While the 

claimant’s mental disability may have been triggered by a 
WELLINGTON V. BERRYHILL 11

hernia operation in 1977, the “first unambiguous evidence in 

the record of a mental impairment” occurred only in January 

1980, when he was treated at a clinic for anxiety and then 

referred to a counselor. Id. at 1081–82. Then in March 1980 

a rheumatologist characterized the claimant as “nearly 

incapacitated by severe depression and chronic anxiety.” Id.

at 1082. Examinations in 1984 revealed possible 

schizophrenia, which was confirmed in 1985. Id. On this 

record the panel thought hospital visits in 1979 showed 

“perhaps early evidence of progressive mental illness,” and 

that there were “indications that Morgan’s mental condition 

was disabling prior to December 31, 1979,” his date last 

insured for SSDI. Id. at 1082.

Next, in Armstrong v. Commissioner of Social Security,

160 F.3d 587 (9th Cir. 1998), we held that the ALJ was 

required to call a medical advisor to assist in determining the 

onset date where “Armstrong’s depression could have been 

disabling long before” it was diagnosed. Id. at 590. After 

his wife left him in 1986, Armstrong began drinking alcohol 

excessively, living in his truck, and recycling aluminum cans 

to gain income. Id. at 588. In 1991 or 1992, he began 

suffering crying spells. Id. at 590. So even though 

Armstrong was not diagnosed with mental health disorders 

until 1994, a medical expert could have helped the ALJ infer 

a disability onset date before Armstrong’s date last insured 

in 1992. Id. at 588–89.

Finally, in Diedrich v. Berryhill we held that the Social

Security Commissioner erred by not calling a medical 

advisor at the hearing to help determine the precise onset 

date of Diedrich’s disability under the circumstances there 

presented. 874 F.3d at 639. The majority reasoned that SSR 

83-20 required a medical advisor because there were large 

gaps in the medical records documenting slow progress of 
12 WELLINGTON V. BERRYHILL

illness; “the alleged onset and the date last worked are far in 

the past”; and the ALJ’s assessment of the disability onset 

date would have been “mere speculation without the aid of a 

medical expert.” Id. at 638–39.

Throughout our cases, we have observed that “SSR 83-

20 only requires that the ALJ assist the claimant in creating 

a complete record . . . which forms a basis for [the] onset 

date.” Armstrong, 160 F.3d at 590; see also DeLorme, 

924 F.2d at 849. The ALJ must develop an incomplete 

record by calling on a medical advisor when “medical 

evidence from the relevant time period is unavailable or 

inadequate.” Diedrich, 874 F.3d at 638. This requirement 

most readily applies when an incomplete record clearly 

could support an inference that a claimant’s disability began 

when there were no contemporaneous medical records. See, 

e.g., DeLorme, 924 F.2d at 847, 851 (holding that “the ALJ 

must fully develop the record” when the first examination by 

a psychiatrist documented a “long term functional 

nonpsychotic disorder” preventing the claimant from 

working). Because SSR 83-20 applies when “it may be 

possible” to infer disability onset during a significant gap in 

the medical records, the ALJ should also enlist a medical 

expert’s help when “the evidence is ambiguous regarding the 

possibility that the onset of her disability occurred” at that 

time. Grebenick v. Chater, 121 F.3d 1193, 1201 (8th Cir. 

1997).

In those circumstances, “an ALJ’s assessment of the 

disability onset date would be mere speculation without the 

aid of a medical expert.” Diedrich, 874 F.3d at 639. “The 

requirement that, in all but the most plain cases, a medical 

advisor be consulted prior to inferring an onset date is merely 

a variation on the most pervasive theme in administrative 

law—that substantial evidence support an agency’s 
WELLINGTON V. BERRYHILL 13

decisions.” Bailey v. Chater, 68 F.3d 75, 80 (4th Cir. 1995). 

Under SSR 83-20, “medical advisors are the prescribed 

mechanism for reaching the required evidentiary threshold.” 

Id.

B

Although in our prior cases we concluded that a medical 

advisor’s appointment was necessary, we decline to do so 

here. Under ordinary circumstances, an ALJ is equipped to 

determine a claimant’s disability onset date without calling 

on a medical advisor. We conclude that this case does not 

present the unusual circumstances envisioned by SSR 83-20, 

and so the ALJ did not err by determining Wellington’s onset 

date without calling on a medical advisor.

Wellington contends that SSR 83-20 applies under our 

case law because her onset date could be retroactively 

inferred before the date of Dr. Cushman’s examination. The 

first hospital visit that could potentially cast a shadow of 

disability back in time is the first relevant examination by a 

qualified examiner. See Morgan, 945 F.2d at 1081–82; 

DeLorme, 924 F.2d at 843–44, 849. Accordingly, the date 

of Dr. Cushman’s psychological examination could trigger 

SSR 83-20’s requirements because this was the first 

examination by a doctor with expertise in mental health 

problems. Although Wellington was previously seen many 

times by emergency room physicians and health center 

medical providers, none of these doctors was specially 

trained to evaluate mental health, nor did any of these 

doctors rigorously evaluate Wellington’s psychological 

impairments.

Here, the ALJ did not violate SSR 83-20 by finding that 

Wellington’s disability onset date coincided with the date of 

Dr. Cushman’s examination. An ALJ need not call on a 
14 WELLINGTON V. BERRYHILL

medical advisor when the available evidence clearly could 

not support an inference of disability onset during a gap in 

the medical records. After all, “[t]he Ruling’s language does 

not expressly mandate that the ALJ consult a medical 

advisor in every case where the onset of disability must be 

inferred.” Bailey, 68 F.3d at 79.

SSR 83-20 does not apply when the record has no 

meaningful gaps. A medical advisor is not required when, 

despite some inadequacies, “a relatively complete medical 

chronology” of the claimant’s condition during the relevant 

time period is available. Pugh v. Bowen, 870 F.2d 1271, 

1278 & n.9 (7th Cir. 1989). In these situations, the ALJ’s 

duty to develop the record is discharged. See Armstrong, 

160 F.3d at 590; DeLorme, 924 F.2d at 849.

Also, a medical advisor is unnecessary when, based on 

“the nature of the impairment (i.e., what medical 

presumptions can reasonably be made about the course of 

the condition),” an ALJ can reasonably and confidently say 

that no reasonable medical advisor could infer that the 

disability began during a period for which the claimant 

lacked medical documentation. SSR 83-20, 1983 WL 

31249, at *3.

Both of those exceptions from to SSR 83-20 apply here. 

The available records, tracking about three dozen encounters 

with medical providers, give an adequate chronology of 

Wellington’s mental health during the seventeen-month 

period between her alleged onset date and first psychological 

examination. These visits occurred at least once every two 

months, except for a three-month gap from February to April 

2010 that ended with visits in which Wellington reported and 

displayed no anxiety. Although her medical providers were 

not mental health professionals, they recognized and treated 

her anxiety. Despite the lag between Wellington’s alleged 
WELLINGTON V. BERRYHILL 15

onset date and the date she was examined by a specialist, 

there are not so few relevant medical records on file as to 

evoke the ALJ’s duty to develop the record under SSR 83-

20.

Moreover, the nature of Wellington’s anxiety disorder is 

such that a medical expert could not reasonably infer that she 

became disabled for the purposes of SSDI or SSI before May 

2010. To be eligible for SSDI, a claimant’s disability must 

“be continuously disabling from the time of onset during 

insured status to the time of application for benefits.” Flaten 

v. Sec’y of Health & Human Servs., 44 F.3d 1453, 1460 (9th 

Cir. 1995). Eligibility for SSI similarly requires continuous 

disability after a claimant’s onset date. See 42 U.S.C. 

§ 1382c(a)(3)(A). The record at the time of Wellington’s 

application reflected that her lifelong chronic anxiety 

disorder was exacerbated by stress and responded well to 

treatment. Her disability finding was based on record 

evidence, beginning with Dr. Cushman’s consultative 

psychological evaluation, the first examination showing 

significant mental limits. After that examination her 

disorder got worse so that even with treatment, unmitigated 

pain and anxiety were expected to keep her from completing 

a normal workday up to seven days a quarter. But the 

available evidence before then contradicts the possibility 

that Wellington’s anxiety was so severe and persistent as to 

keep her out of work continuously before May 2010.

The existing medical record does not support the need 

for a medical advisor because SSR 83-20 states that even 

when onset of a disability can be inferred, that judgment 

requires a “legitimate medical basis.” SSR 83-20, 1983 WL 

31249, at *3. We recognize that Wellington had experienced 

several distressing panic attacks in December 2008. But just 

a few months later, the record shows that Wellington’s 
16 WELLINGTON V. BERRYHILL

disabling symptoms had all but disappeared. In March 2009, 

Wellington began treatment at a health center and stopped 

going to the emergency room. From this time until the end 

of her treatment records in January 2010, Wellington’s 

medical provider prescribed anti-anxiety medication and 

commented in their records about her good progress on the 

drug. The provider renewed the prescription as needed, 

discontinuing the medication three times when Wellington’s 

symptoms faded to the point that she did not need it 

anymore. In January 2010, after Wellington’s last 

prescription ended, she did not complain of anxiety or appear 

to be anxious at her regular appointment or at two visits to 

the emergency room that month for neck pain and bronchitis. 

The next medical records in May 2010 indicate muscle pain 

without anxiety early in the month, followed by an anxiety 

attack on May 23 and Dr. Cushman finding her anxious three 

days later. Given the increasing severity of Wellington’s 

symptoms and their resistance to treatment in subsequent 

months, substantial evidence supports the ALJ’s finding that 

May 2010, when Dr. Cushman examined Wellington and 

when the ALJ determined disability onset, stands as an 

important change in the course of her disorder, after which 

she could no longer attend work reliably.

Symptoms may wax and wane during the progression of 

a mental disorder. See, e.g., Garrison v. Colvin, 759 F.3d 

995, 1017 (9th Cir. 2014). Those symptoms, however, may 

also subside during treatment. “With adequate treatment 

some individuals with chronic mental disorders not only 

have their symptoms and signs ameliorated, but they also 

return to a level of function close to the level of function they 

had before they developed symptoms or signs of their mental 

disorders.” 20 C.F.R. pt. 404, subpt. P, app. 1 (2014). Such 

evidence of medical treatment successfully relieving 

symptoms can undermine a claim of disability. See 
WELLINGTON V. BERRYHILL 17

20 C.F.R. §§ 404.1520a(c)(1), 416.920a(c)(1). That is what 

happened here until May 2010.

Because the record was adequate even before Wellington 

saw a mental health specialist and no reasonable medical 

expert could have inferred that her disability began before 

May 2010, we conclude that SSR 83-20 did not require the 

ALJ to consult a medical advisor before determining 

Wellington’s disability onset date.

IV

We hold that the ALJ did not err by finding Wellington’s 

disability onset date without calling on a medical advisor at 

the hearing.

AFFIRMED.

WATFORD, Circuit Judge, dissenting:

I agree with the court’s discussion of the legal principles 

that govern resolution of this appeal, but I disagree with the 

ultimate disposition in this case. As the court explains in 

section III.A, SSR 83-20 requires an ALJ to appoint a 

medical advisor to assist in determining a claimant’s 

disability onset date in either of two situations: (1) when 

there is a meaningful gap in the medical records; or (2) when 

the medical records are complete, but the available evidence 

is nonetheless ambiguous as to the onset date. While there 

is no significant gap in Nancy Wellington’s medical records, 

in my view the evidence is ambiguous as to when her 

anxiety, depression, and post-traumatic stress disorder 

became disabling. As a result, I think the ALJ was required 

to appoint a medical advisor here.
18 WELLINGTON V. BERRYHILL

Evidence in the record supports a disability onset date 

before May 26, 2010. In the six weeks leading up to 

December 24, 2008, when Wellington contends she became 

disabled, she visited the emergency room 11 times. In all of 

those visits, Wellington complained of, exhibited signs of, 

or was diagnosed with anxiety. During 2009, Wellington 

visited the emergency room six more times due at least in 

part to her anxiety and other mental disorders. During at 

least eight additional medical visits in 2009, doctors also 

noted and treated her anxiety. Her doctors increased her 

anxiety medication dosage at least three times over the 

course of that year. And on May 4, 2010, Wellington was 

admitted for a multi-day inpatient hospital stay related to 

anxiety, followed by an anxiety attack on May 23 and Dr. 

Cushman’s examination on May 26. This evidence 

demonstrates that Wellington continually struggled with her 

mental impairments for at least a year and a half before the 

date the ALJ determined her disability began.

Because the evidence is ambiguous as to when 

Wellington’s impairments became disabling, I think the ALJ 

erred in determining that the record conclusively supports 

May 26, 2010, as the date Wellington’s impairments became 

severe enough to prevent her from engaging in substantial 

gainful activity. See SSR 83-20, 1983 WL 31249, at *3. I 

would remand for the ALJ to appoint a medical advisor in 

this case.