Decker v. Commissioner Social Security Administration

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF OREGON

SARA D.,1 No. 6:24-cv-1147-HL

Plaintiff, OPINION & ORDER

v.

COMMISSIONER, SOCIAL

SECURITY ADMINISTRATION,

Defendant.

HALLMAN, Magistrate Judge:

Plaintiff Sara D. brings this action under the Social Security Act (the “Act”), 42 U.S.C. §

405(g), to obtain judicial review of a final decision of the Commissioner of Social Security (the

“Commissioner”). The Commissioner denied Plaintiff’s application for Disability Insurance

Benefits (“DIB”) under Title II of the Act. 42 U.S.C. § 401 et seq. The Court has jurisdiction

over this matter pursuant to 42 U.S.C. § 405. For the following reasons, the Commissioner’s

1 In the interest of privacy, this opinion uses only the first name and the initial of the last name of

the nongovernmental party in this case.

decision is REVERSED, and this case is REMANDED for immediate calculation and payment

of benefits.

STANDARD OF REVIEW

42 U.S.C. § 405(g) provides for judicial review of the Social Security Administration’s

disability determinations: “The court shall have power to enter ... a judgment affirming,

modifying, or reversing the decision of the Commissioner of Social Security, with or without

remanding the cause for a rehearing.” The court must affirm the Commissioner’s decision if it is

based on proper legal standards and the findings are supported by substantial evidence in the

record. Hammock v. Bowen, 879 F.2d 498, 501 (9th Cir. 1989). Substantial evidence means only

“such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.

Biestek v. Berryhill, 139 S. Ct. 1148, 1150 (2019) (internal quotation marks omitted). The court

must weigh “both the evidence that supports and detracts from the [Commissioner’s]

conclusion.” Martinez v. Heckler, 807 F.2d 771, 772 (9th Cir. 1986). “Where the evidence as a

whole can support either a grant or a denial, [the court] may not substitute [its] judgment for the

ALJ’s.” Massachi v. Astrue, 486 F.3d 1149, 1152 (9th Cir. 2007) (citation omitted); see also

Burch v. Barnhart, 400 F.3d 676, 680-81 (9th Cir. 2005) (holding that the court “must uphold the

ALJ’s decision where the evidence is susceptible to more than one rational interpretation”). “[A]

reviewing court must consider the entire record as a whole and may not affirm simply by

isolating a specific quantum of supporting evidence.” Orn v. Astrue, 495 F.3d 625, 630 (9th Cir.

2007) (quotation omitted).

BACKGROUND

I. Plaintiff’s Application

Plaintiff alleges disability based on the combined effects of her diabetes, high cholesterol,

torn tendons in her left shoulder, depression, anxiety, and agoraphobia. Tr. 263.2 At the time of

Plaintiff’s alleged onset date, September 18, 2019, she was 40 years old. Tr. 227-28. Plaintiff

applied for DIB in September, 2021, alleging disability beginning September 18, 2019. Tr. 227-

28. Her applications were denied initially and on reconsideration. Tr. 115-37. Plaintiff

subsequently requested a hearing, which was held on September 12, 2023 before Administrative

Law Judge (ALJ) Bill Laskaris. Tr. 51-77. Plaintiff appeared and testified at the hearing,

represented by counsel. Tr. 51-77. On October 10, 2023, the ALJ issued a decision denying

Plaintiff’s claims. Tr. 27-46. Plaintiff requested Appeals Council review, which was denied on

May 15, 2024. Tr. 1-7. Plaintiff then sought review before this Court.3

II. Sequential Disability Process

The initial burden of proof rests upon the claimant to establish disability. Howard v.

Heckler, 782 F.2d 1484, 1486 (9th Cir. 1986). To meet this burden, the claimant must

demonstrate an “inability to engage in any substantial gainful activity by reason of any medically

determinable physical or mental impairment which can be expected ... to last for a continuous

period of not less than 12 months.” 42 U.S.C. § 423(d)(1)(A).

The Commissioner has established a five-step process for determining whether a person

is disabled. Bowen v. Yuckert, 482 U.S. 137, 140 (1987); 20 C.F.R. §§ 404.1520, 416.920. At

step one, the Commissioner determines whether a claimant is engaged in “substantial gainful

2 Citations to “Tr.” are to the Administrative Record, ECF No. 8.

3 The parties have consented to the jurisdiction of a Magistrate Judge pursuant to 28 U.S.C. §

636. ECF No. 1.

activity”; if so, the claimant is not disabled. Yuckert, 482 U.S. at 140; 20 C.F.R. §§ 404.1520(b),

416.920(b).

At step two, the Commissioner determines whether the claimant has a “medically severe

impairment or combination of impairments.” Yuckert, 482 U.S. at 140-41; 20 C.F.R. §§

404.1520(c), 416.920(c). A severe impairment is one “which significantly limits [the claimant’s]

physical or mental ability to do basic work activities[.]” 20 C.F.R. §§ 404.1520(c), 416.920(c). If

not, the claimant is not disabled. Yuckert, 482 U.S. at 141.

At step three, the Commissioner determines whether the impairments meet or equal “one

of a number of listed impairments that the [Commissioner] acknowledges are so severe as to

preclude substantial gainful activity.” Id.; 20 C.F.R. §§ 404.1520(d), 416.920(d). If so, the

claimant is conclusively presumed disabled; if not, the analysis proceeds. Yuckert, 482 U.S. at

141. At this point, the Commissioner must evaluate medical and other relevant evidence to

determine the claimant’s “residual functional capacity” (“RFC”), an assessment of work-related

activities that the claimant may still perform on a regular and continuing basis, despite any

limitations his impairments impose. 20 C.F.R. §§ 404.1520(e), 404.1545(b)-(c), 416.920(e),

416.945(b)-(c).

At step four, the Commissioner determines whether the claimant can perform “past

relevant work.” Yuckert, 482 U.S. at 141; 20 C.F.R. §§ 404.1520(e), 416.920(e). If the claimant

can work, he is not disabled; if he cannot perform past relevant work, the burden shifts to the

Commissioner. Yuckert, 482 U.S. at 146 n.5.

Finally, at step five, the Commissioner must establish that the claimant can perform other

work that exists in significant numbers in the national economy. Id. at 142; 20 C.F.R. §§

404.1520(e) & (f), 416.920(e) & (f). If the Commissioner meets this burden, the claimant is not

disabled. 20 C.F.R. §§ 404.1566, 416.966.

III. The ALJ’s Decision

At step one, the ALJ found that Plaintiff had not engaged in substantial gainful activity

since September 18, 2019, the alleged onset date. Tr. 32. At step two, the ALJ found Plaintiff

had the following severe, medically determinable impairments: Major depressive disorder,

bipolar; Generalized anxiety disorder/agoraphobia; Diabetes; Obesity; Degenerative disc disease

of the cervical spine; Degenerative joint disease of the left shoulder. Tr. 32-33. At step three, the

ALJ found no impairment met or equaled the severity of any impairment listed in 20 C.F.R. Part

404, Subpart P, Appendix 1. Tr. 33. The ALJ assessed Plaintiff’s residual functional capacity

(“RFC”), as follows:

to perform medium work as defined in 20 CFR 404.1567(c) as lifting/carrying 50

pounds occasionally and 25 pounds frequently, standing/walking six of eight

hours and sitting six of eight hours. However, the claimant also has the following

additional limitations: occasional left overhead reach; frequent, but not constant,

operation of foot controls; simple, routine and repetitive tasks performed in a low

stress job defined as only occasional decision-making required, occasional

changes in the work-setting, and no strict production rate requirements; no

interaction with the public and occasional interaction with co-workers,

supervisors.

Tr. 35.

At step four, the ALJ determined that Plaintiff was unable to perform any past relevant

work. Tr. 39. At step five the ALJ determined that considering Plaintiff’s age, education, work

experience, and residual functional capacity, jobs exist in significant numbers in the national

economy that Plaintiff can perform, such as laundry worker, cleaner, and packer. Tr. 40. The

ALJ therefore found Plaintiff not disabled. Tr. 41.

DISCUSSION

Plaintiff argues the ALJ committed three harmful errors. She contends the ALJ erred by

(1) discounting her subjective symptom testimony without a clear and convincing reason for

doing so, (2) rejecting lay witness testimony without a germane reason, and (3) improperly

evaluating the medical opinions of William Morris, DNP, PMHNP, and Indra Dissanayake, LPC.

For the reasons that follow, the Court finds the ALJ erred, and reverses.

I. Symptom Testimony

Plaintiff first asserts that the ALJ improperly rejected her subjective symptom testimony.

Pl.’s Opening Br. at 3-11. This Court agrees.

A. Legal Standards

The ALJ is responsible for evaluating symptom testimony. SSR 16-3p, 2017 WL

5180304, at *1 (Oct. 25, 2017). There is a two-step process for evaluating a claimant’s testimony

about the severity and limiting effect of his symptoms. Vasquez v. Astrue, 572 F.3d 586, 591 (9th

Cir. 2009). First, the claimant must produce objective medical evidence of one or more

impairments that could reasonably be expected to produce some degree of symptoms.

Lingenfelter v. Astrue, 504 F.3d 1028, 1036 (9th Cir. 2007). The claimant need not show that the

impairment could reasonably be expected to cause the severity of the symptoms, but only show

that it could reasonably have caused some degree of the symptoms. Id.

Second, the ALJ must assess the claimant’s testimony regarding the severity of the

symptoms. Id. The ALJ can reject the claimant’s testimony “only by offering specific, clear and

convincing reasons for doing so.” Id. Thus, the ALJ must specifically identify the testimony that

they do not credit and must explain what evidence undermines the testimony. Holohan v.

Massanari, 246 F.3d 1195, 1208 (9th Cir. 2001). In other words, the “clear and convincing”

standard requires an ALJ to “show [their] work.” Smartt v. Kijakazi, 53 F.4th 489, 499 (9th Cir.

2022).

General findings are insufficient to support an adverse determination; the ALJ must rely

on substantial evidence. Holohan, 246 F.3d at 1208. To discredit a plaintiff’s testimony

regarding the degree of impairment, the ALJ must make a “determination with findings

sufficiently specific to permit the court to conclude that the ALJ did not arbitrarily discredit

claimant’s testimony.” Thomas v. Barnhart, 278 F.3d 947, 958 (9th Cir. 2002). The question is

not whether ALJ’s rationale convinces the court, but whether their rationale “is clear enough that

it has the power to convince.” Smartt, 53 F.4th at 499.

B. Plaintiff’s Testimony

At the administrative hearing, Plaintiff testified that she reduced her work hours and

began receiving short-term disability compensation as of her alleged onset date based on her

psychiatrist’s recommendation, and she stopped working in March 2020, at which time she

began receiving long-term disability compensation due to worsened depression with suicidal

ideation. Tr. 56, 60- 62, 70. Her anxiety was “overriding everything” at work; she was tearful

and unable to take calls. Tr. 57. She had panic attacks at work. Tr. 62. She had not tried to return

to work since that job ended. Tr. 57. She lived with her parents. Tr. 63. She was able to drive

herself to equine therapy at a farm where her boyfriend worked. Tr. 63-64. She attended equine

therapy for an hour or two four times a week. Tr. 64. She grocery shopped with her mother or

boyfriend; she did not go alone because of panic attacks. Tr. 65. She did not have any friends. Tr.

65. She spent most of her time at home. Tr. 66. She testified that she could not be “reliable” or

“consistent” to attend work daily because of her mental symptoms. Tr. 67. She received weekly,

in-clinic Spravato treatments that put her in an altered mental status; she could not to drive for

twenty-four hours after each treatment. Tr. 70. She slept a lot when depressed. Tr. 70- 71. She

could not get out of bed at least half the days out of each month. Tr. 71. She struggled to attend

early morning appointments. Tr. 71. She had word finding difficulties. Tr. 71.

In written testimony, Plaintiff reported experiencing periods when she was unable to

leave her bed “for days at a time.” Tr. 278. She experienced “[a]nxiety attacks at unexpected

times, at work, in public, on the couch.” Tr. 278. She was “[u]nable to remember to complete

daily living requirements, ie medication, showers/self hygiene, food.” Tr. 278. She was

exhausted “all the time.” Tr. 278. In a typical day, she woke, possibly watched television, took

medications, ate meals that her partner prepared, napped, and attended medical appointments as

scheduled. Tr. 279. She lacked motivation to bathe. Tr. 279. Her partner prepared her meals and

reminded her to take her medications and complete personal care activities. Tr. 279-80. Plaintiff

did not do any household chores. Tr. 280. She left home only when necessary; her anxiety

worsened in public. Tr. 281, 282. She grocery shopped in store or via computer. Tr. 281. Her

hobbies interests included quilting, crochet, cross stitch, writing, and photography, but she had

not done any of these activities in years. Tr. 282. She socialized with others through texts and

otherwise avoided engaging with others. Tr. 282. She struggled with low energy levels. Tr. 283.

Her impairments impacted her ability to walk, talk, remember things, complete tasks,

concentrate, understand, and follow instructions. Tr. 283. She could not follow spoken

instructions, tolerate stress, or handle changes in routine. Tr. 283-84.

Describing her physical symptoms, Plaintiff testified to left shoulder pain, but that she

did not have difficulty using her non-dominant left arm. Tr. 68-69. The shoulder pain impacted

her sleep. Tr. 69. She did not think she was limited in lifting and carrying but had not tried to lift

much. Tr. 69. She also had neuropathy in her feet that limited her ability to stand and walk. Tr.

69. She also experienced aching and throbbing left shoulder pain that was exacerbated by

changing positions, and which impacted her capacity to perform reaching activities. Tr. 275-76.

The ALJ determined that Plaintiff’s “statements concerning the intensity, persistence and

limiting effects of these symptoms are not entirely consistent with the medical evidence and

other evidence in the record for the reasons explained in this decision.” Tr. 36. Specifically, the

ALJ discussed the objective medical evidence, Plaintiff’s conservative course of treatment, and

her activities of daily living when discounting her subjective symptom testimony. Tr. 35-36. This

Court addresses each rationale in turn.

C. Objective Medical Evidence

An ALJ may reject a claimant’s symptom testimony if that testimony is contradicted by

evidence in the medical record. Carmickle, 533 F.3d at 1161; see also Smartt, 53 F.4th at 498

(“When objective medical evidence in the record is inconsistent with the claimant’s subjective

testimony, the ALJ may indeed weigh it as undercutting such testimony.”). While an ALJ may

also consider the lack of corroborating objective medical evidence as one factor in “determining

the severity of the claimant’s pain,” Rollins, 261 F.3d at 857, they cannot reject subjective pain

testimony solely on that basis. Robbins v. Soc. Sec. Admin., 466 F.3d 880, 883 (9th Cir. 2006);

see also 20 C.F.R. § 404.1529(c)(2) (the Commissioner “will not reject your statements about the

intensity and persistence of your pain or other symptoms or about the effect your symptoms have

on your ability to work solely because the available objective medical evidence does not

substantiate your statements”). In sum, “an ALJ cannot effectively render a claimant’s subjective

symptom testimony superfluous by demanding positive objective medical evidence ‘fully

corroborat[ing]’ every allegation within the subjective testimony.” Smartt, 53 F.4th at 498

(quoting Burch, 400 F.3rd at 681).

In some circumstances, an ALJ may reject subjective complaints where the claimant's

“statements at her hearing do not comport with objective medical evidence in her medical

record.” Bray v. Comm'r of Soc. Sec. Admin., 554 F.3d 1219, 1227 (9th Cir. 2009). However,

especially in the mental health context, an ALJ may not cherry-pick isolated instances of

favorable psychological symptoms when the record as a whole reflects long-standing

psychological disability. See Ghanim, 763 F.3d at 1164; see also Garrison, 759 F.3d at 1017.

Moreover, a lack of objective evidence may not be the sole basis for rejecting a claimant's

subjective complaints. See Rollins v. Massanari, 261 F.3d 853, 856 (9th Cir. 2001).

Substantial evidence does not support the ALJ’s decision to discount Plaintiff’s mental

health testimony for its purported conflict with the record. While conflict with objective medical

evidence can be a sufficient basis for discounting a claimant’s testimony, an ALJ may not

disregard the forest by focusing on only a few trees. Smartt, 53 F.4th at 498. For example, the

ALJ relied on a few “normal” objective findings from various points during the relevant period,

and one December 2021 appointment where Plaintiff reported feeling “pretty good” with

moderate depression levels, less anxiety, and generally good sleep. Tr. 36 (citing Tr. 523, 529,

542, 575). As an initial matter, the ALJ erred by failing to specify exactly which of Plaintiff’s

statements these records conflict with. Tr. 36 (noting “objective findings” were inconsistent with

“significant complaints of anxiety.”). When discounting testimony, an ALJ must “identify the

testimony she found not credible,” and “link that testimony to the particular parts of the record

supporting her non-credibility determination.” Brown-Hunter v. Colvin, 806 F.3d 487, 494 (9th

Cir. 2015). Citing “complaints of anxiety” does not clarify for this Court which of Plaintiff’s

statements are being discounted, and why; this is error. Id. The ALJ further erred by isolating a

few “normal” objective findings from a record otherwise replete with evidence of more

significant mental health symptoms. Compare Def. Br. at 5-6 with Pl. Br. at 9-10. As such, the

ALJ failed to supply legally sufficient reasoning to reject Plaintiff's testimony about her mental

health on her subjective complaints alone.

The ALJ further erred in discounting Plaintiff’s allegations of physical limitations

because he identified objective medical evidence not actually inconsistent with Plaintiff’s

testimony. Plaintiff testified that her left shoulder pain impacted her ability to sleep, lie down

comfortably, and reach. Tr. 275-76. The ALJ discounted this testimony by citing records

showing Plaintiff’s “normal strength in the upper extremities” and essentially normal imaging

studies. Tr. 37. Plaintiff’s testimony describes difficulties reaching and with lying down, not with

strength, which does not conflict with the imaging or other objective evidence the ALJ cites.

Compare Tr. 44-47 with Tr. 560. Because the medical evidence the ALJ cited does not conflict

with Plaintiff’s symptom testimony this was not a clear and convincing reason for the ALJ to

rely upon to discount Plaintiff’s allegations of physical limitations either.

D. Conservative Treatment

The ALJ also rejected Plaintiff’s testimony concerning her mental health symptoms

because the evidence demonstrated only conservative treatment. Tr. 36. Conservative treatment

can be sufficient to discount a claimant’s subjective testimony regarding the limitations caused

by an impairment. Parra v. Astrue, 481 F.3d 742, 750-51 (9th Cir. 2007). Not seeking an

“aggressive treatment program” permits the inference that symptoms were not as all-disabling as

the claimant reported. Tommasetti v. Astrue, 533 F.3d 1035, 1039 (9th Cir. 2008). The amount of

treatment is “an important indicator of the intensity and persistence of [a claimant’s] symptoms.”

20 C.F.R. § 416.929(c)(3). If, however, the claimant has a good reason for not seeking more

aggressive treatment, conservative treatment is not a proper basis for rejecting the claimant's

subjective symptoms. Carmickle v. Comm'r, Soc. Sec. Admin., 533 F.3d 1155, 1162 (9th Cir.

2008).

The ALJ erred by rejecting Plaintiff’s symptom testimony because her treatment for those

symptoms was “conservative.” While conservative treatment can be a sufficient reason to

discount a Plaintiff’s symptom testimony, the ALJ must provide more justification than he did

here. The ALJ summarized Plaintiff’s treatment as “overall conservative . . . , including

medication and therapy.” Tr. 36. He noted that she did not engage in “inpatient treatment . . . or

intensive outpatient programs.” Tr. 36. He also noted that Plaintiff “receives a nasal spray for

depression.” Tr. 36. Because the ALJ did not specify what more aggressive treatment options

were appropriate or available, it would be illogical to discredit Plaintiff “for failing to pursue

non-conservative treatment options where none exist.” Lapeirre-Gutt v. Astrue, 382 F. App'x

662, 664 (9th Cir. 2010).

Moreover, the absence of a recommendation to pursue more aggressive treatment is

typically a good reason for a plaintiff not to pursue more aggressive treatment. See Alfredo C. v.

Saul, 2020 WL 836833, at *5 (D. Or. Feb. 20, 2020) (“The ALJ in this case does not cite any

statement by a medical professional suggesting that Plaintiff's course of treatment was

conservative.”). The ALJ does not point to any recommendations Plaintiff failed to follow, or

more significant treatment she should have pursued. See Tr. 36. Furthermore, the lack of

inpatient hospitalization is not evidence of conservative treatment in the context of complex

mental health disorders. See, e.g., Choat v. Berryhill, 2018 WL 2048332, at *5 (D. Or. Apr. 30,

2018) (so stating and collecting cases). Indeed, record in this case documents consistent, frequent

psychiatric medication management and therapy with limited benefit such that Plaintiff’s

therapist eventually concluded that her depression was treatment resistant and referred her to

another provider. See, e.g., Tr. 1237, 1092, 1109, 1107, 1083, 1062, 1050. For these reasons, the

ALJ’s conclusion that Plaintiff’s subjective symptom testimony is undermined by a history of

conservative treatment is not supported by substantial evidence.

E. Activities of Daily Living

The ALJ also discounted Plaintiff’s subjective symptom testimony because it was

inconsistent with her daily activities. Tr. 36. Activities of daily living can form the basis for an

ALJ to discount a claimant’s testimony in two ways: (1) as evidence a claimant can work if the

activities “meet the threshold for transferable work skills,” or (2) where the activities “contradict

[a claimant’s] testimony.” Orn v. Astrue, 495 F.3d 625, 639 (9th Cir. 2007). The relevant

regulations require an ALJ to consider a claimant’s daily activities when evaluating subjective

symptom statements. 20 C.F.R. §§ 404.1529(c)(3)(i), 416.929(c)(3)(i). The Ninth Circuit has

even found such routine activities as playing video games, using public transportation, and

preparing meals to undercut a claimant’s testimony of disabling limitations. Ahearn v. Saul, 988

F.3d 1111, 1117 (9th Cir. 2021). A claimant, however, need not be utterly incapacitated to

receive disability benefits, and sporadic completion of minimal activities is insufficient to

support a negative credibility finding. Vertigan v. Halter, 260 F.3d 1044, 1050 (9th Cir. 2001);

see Reddick v. Chater, 157 F.3d 715, 722 (9th Cir. 1998) (requiring the level of activity to be

inconsistent with the claimant’s alleged limitations to be relevant to his or her credibility).

The ALJ failed to adequately identify transferable work skills or inconsistencies between

Plaintiff’s daily activities and symptom testimony, and therefore erred. The Ninth Circuit has

instructed that a modest level of activity is not sufficient to reject subjective complaints.

Vertigan, 260 F.3d at 1050 (“This court has repeatedly asserted that the mere fact that a Plaintiff

has carried on certain daily activities, such as grocery shopping, driving a car, or limited walking

for exercise, does not in any way detract from her credibility as to her overall disability. One

does not need to be ‘utterly incapacitated’ in order to be disabled”) (quoting Fair, 885 F.2d at

603). The ALJ found Plaintiff’s “alleged severity of anxiety with panic attacks” inconsistent with

her ability to “drive and spend[] 1-2 hours four times a week at equine therapy.” Tr. 36. The ALJ

further cited Plaintiff’s ability to “eat[] in restaurants and shop[] in stores with family,” “use[] a

cellphone for the internet,” “use[] a computer for shopping online, manage[] finances, and use[]

a cellphone for texting.” Tr. 36. He also noted evidence that Plaintiff “went to the gym to work

out,” asserted that she did this “three times a week,” and also highlighted reports that she

“walked her dogs most days.” Tr. 36. The ALJ’s discussion of Plaintiff’s ability to use

technology or leave the house with family failed to explain “what symptom testimony [was] not

credible and what facts in the record lead to that conclusion.” Smolen, 80 F.3d at 1284; see

Dodrill, 12 F.3d at 918. Nor do the activities the ALJ cites meaningfully conflict with Plaintiff’s

testimony about anxiety. Her ability to engage in some exercise during the relevant period or

leave the home accompanied does not undermine the allegations of significant anxiety and

depression, and their limitations on Plaintiff’s ability to work. See Tr. 56-70. Other than

summarizing Plaintiff’s activities, the ALJ did not explain how the activities undermined

Plaintiff’s subjective symptom testimony about exertional limitations; the ALJ merely concluded

that these activities were inconsistent with Plaintiff’s allegations. Tr. 36. This was error.

In sum, the ALJ erred in rejecting Plaintiff’s subjective symptom testimony because he

failed to provide specific, clear, and convincing reasons as to why her testimony contradicted, or

was undermined by, the objective medical record and her activities of daily living.

II. Lay Witness Testimony

Plaintiff next asserts that the ALJ improperly rejected lay witness testimony from

Plaintiff’s mother and sister without providing germane reasons for doing so. Pl. Br. at 19-20.

This Court agrees.

A. Legal standards

Lay testimony as to a claimant’s symptoms is competent evidence that the Secretary must

take into account.” Nguyen v. Chater, 100 F.3d 1462, 1467 (9th Cir. 1996) (citation omitted); 20

C.F.R. §§ 404.1529(c)(1), 416.929(c)(1) (“In evaluating the intensity and persistence of your

symptoms, we consider all of the available evidence from your medical sources and nonmedical

sources about how your symptoms affect you.”). Under the 2017 regulations, the ALJ is not

“required to articulate how [they] considered evidence from nonmedical sources” using the same

criteria required for the evaluation of medical sources. 20 C.F.R. §§ 404.1520c(d), 416.920c(d).

The ALJ must give reasons “germane to the witness” when discounting the testimony of

lay witnesses. Valentine, 574 F.3d at 694.4 But the ALJ is not required “to discuss every

witness’s testimony on an individualized, witness-by-witness basis.” Molina, 674 F.3d at 1114,

superseded on other grounds by 20 C.F.R. § 404.1502(a). If the ALJ gives valid germane reasons

for rejecting testimony from one witness, the ALJ may refer only to those reasons when rejecting

similar testimony by a different witness. Id. Additionally, where “lay witness testimony does not

describe any limitations not already described by the claimant, and the ALJ’s well-supported

4 The Court notes that this issue is currently under consideration in the Ninth Circuit. See

Hudnall v. Dudek, 130 F.4th 668, 671 (9th Cir. March 7, 2025) (vacated and withdrawn, 2025

WL 1024393, at *1 (9th Cir. Apr. 7, 2025). Unless and until the Ninth Circuit provides contrary,

binding guidance on the interpretation of the 2017 regulations, the Court will continue to require

ALJs to state a germane reason for disregarding lay witness testimony. Valentine, 574 F.3d at

694.).

reasons for rejecting the claimant’s testimony apply equally well to the lay witness testimony,”

any error by the ALJ in failing to discuss the lay testimony is harmless. Id. at 1117, 1122.

B. Analysis

The lay witness testimony from Plaintiff’s mother and sister described mental and

physical health-related limitations that tracked Plaintiff’s own allegations. See Tr. 323-24, 328.

The ALJ rejected the lay testimony for the same reasons he discounted Plaintiff’s. See Tr. 35-37.

The ALJ did not rely on substantial evidence when disregarding Plaintiff’s mother’s and

sister’s testimony, and therefore erred. As discussed above, the ALJ failed to supply legally

sufficient reasons for rejecting Plaintiff’s subjective complaints, and these same rationales do not

support the decision to discount the lay witness testimony either. The ALJ erred in rejecting the

lay testimony in this case. Garrison, 759 F.3d at 1020-23.

III. Medical Opinion Evidence

Plaintiff also argues the ALJ did not properly consider William Morris, DNP, PMHNP,

or Indra Dissanayake, LPC’s medical opinions. Pl. Br. at 11-18.

A. Legal Standards

For claims filed on or after March 27, 2017, ALJs are no longer required to give

deference to any medical opinion, including treating source opinions. 20 C.F.R. § 404.1520c.

Instead, the agency considers several factors. 20 C.F.R. § 404.1520c(a). These are:

supportability, consistency, relationship to the claimant, specialization, and “other factors.” 20

C.F.R. § 404.1520c(c)(1)-(5). The “most important” factors in the evaluation process are

supportability and consistency. 20 C.F.R. § 404.1520c(b)(2).

Under this framework, the ALJ must “articulate ... how persuasive [they] find all of the

medical opinions” from each doctor or other source. 20 C.F.R. § 404.1520c(b)(2). In doing so,

the ALJ is required to explain how supportability and consistency were considered and may

explain how the other factors were considered. 20 C.F.R § 404.1520c(b)(2). The supportability

and consistency factors require ALJs to consider the persuasiveness of a medical opinion based

on how “relevant the objective medical evidence and supporting explanations presented by a

medical source are to support her or her medical opinion,” and its consistency with other sources.

20 C.F.R. § 404.1520c(c)(1-2). When two or more medical opinions or prior administrative

findings “about the same issue are both equally well-supported ... and consistent with the record

... but are not exactly the same,” the ALJ is required to explain how the other factors were

considered. 20 C.F.R. § 404.1520c(b)(3). “Even under the new regulations, an ALJ cannot reject

an examining or treating doctor’s opinion as unsupported or inconsistent without providing an

explanation supported by substantial evidence.” Woods v. Kijakazi, 32 F.4th 785, 792 (9th Cir.

2022).

The new regulations do not, however, upend the Ninth Circuit’s entire body of caselaw

relating to medical evidence, which remain binding on this Court. For example, it remains true

that ALJs may not cherry-pick evidence in discounting a medical opinion. Ghanim, 763 F.3d at

1162; see also Holohan v. Massanari, 246 F.3d 1195, 1207 (9th Cir. 2001) (reversing ALJ’s

selective reliance “on some entries in [the claimant's records while ignoring] the many others that

indicated continued, severe impairment”). Nor may ALJs dismiss a medical opinion without

providing a thorough, detailed explanation for doing so. Regennitter v. Comm'r of Soc. Sec.

Admin., 166 F.3d 1294, 1299 (9th Cir. 1999) (citation omitted).

B. Mr. Morris and Ms. Dissanayake’s Medical Opinions

In February 2022, Mr. Morris reported in a written statement that he had been treating

Plaintiff since October 2019 and saw her at least monthly for psychopharmacology and brief

therapy. Tr. 700. Relevant signs and symptoms included depressed mood and generalized

anxiety. Tr. 701. Mr. Morris reported that Plaintiff became excessively anxious when working

with others, which was paralyzing. Tr. 701. As a result, she experienced a depressed mood up to

and including suicidal ideation. Tr. 701. Mr. Morris wrote, “I believe Plaintiff’s symptoms are

severe enough to prevent her from maintaining meaningful employment.” Tr. 701.

Mr. Morris opined that when Plaintiff became anxious, her concentration was markedly

impaired, and she would have marked limitations in the ability to understand, remember, and

carry out simple instructions; make judgments on simple work-related decisions; and understand

and remember complex instructions. Tr. 702-03. She would have extreme limitations in the

ability to carry out complex instructions and make judgments on complex work-related

decisions. Tr. 703. She would have marked limitations in the ability to interact appropriately

with the public and co-workers. Tr. 703. She would have extreme limitations in the ability to

interact appropriately with supervisors and respond appropriately to usual work situations and

changes in a routine work setting. Tr. 703-04. Mr. Morris noted that Plaintiff’s anxiety symptoms

affected her internal self-worth, resulting in increased depressed mood and, at times, suicidal

ideation. Tr. 704. He opined that the limitations assessed had been present since January 1, 2020.

Tr. 704. He opined that Plaintiff would be off task at least 15% of a workday due to impaired

concentration and excessive fear/worry secondary to anxiety. Tr. 705. He further opined that

Plaintiff would be absent more than four workdays per month due to excessive fear and worry,

poor concentration, poor sleep, irritability, and occasional suicidal ideation. Tr. 705-06.

In February 2022, Ms. Dissanayake reported in a written statements that she met with

Plaintiff weekly for individual counseling. Tr. 708. Her treatment was designed to improve and

manage Plaintiff’s mental symptoms. Tr. 708. Due to major depressive disorder, Plaintiff

experienced little interest or pleasure in doing things, felt down and depressed all the time,

struggled with making decisions, experienced recurring suicidal ideation with a history of failed

attempts, isolated from others, had trouble concentrating and remember things, and felt like a

failure. Tr. 708. Due to generalized anxiety disorder, Plaintiff felt nervous or on edge, worried

excessively, had trouble relaxing, was easily annoyed or irritable, and feared that something

awful would happen. Tr. 708. She experienced recurring panic attacks related to perceived

extremely stressful situations. Tr. 708. Due to social anxiety disorder, she was unable to be in

crowds, needed to leave the store if there were people in the way of an item she wanted, was

unable to attend coping skills groups due to fear that people were judging her, and had tense fear

in any social situation. Tr. 708.

As a result, Ms. Dissanayake opined that Plaintiff would suffer several work-related

limitations. For example, she has a very hard time interacting with the public, working with

others due to suffering from Social Anxiety that can also cause sudden panic attacks. Struggling

with constant anxiety leading to panic, are big barriers in following through any instructions,

completing detailed tasks, paying attention and completing detailed/complex tasks. Client gets

extremely anxious over simple routine changes leading to freezing and unable to function. Also,

in addition to those challenges, Plaintiff is struggling with depressive symptoms that are making

it difficult, to get up at a regular time and doing 8 hours job 5 times a week. Lack of motivation

and fatigue would hinder any goal-settings, independent planning, decision making etc. Needing

to withdraw, isolate from others and being irritable make it hard, to work with coworkers in a

professional manner. Tr. 709.

The ALJ considered Mr. Morris and Ms. Dissanayake’s medical opinions and rejected

them as unpersuasive. Tr. 38. The ALJ found the opinions were “not supported by the treatment

of record,” including Plaintiff’s lack of inpatient treatment and her ability to complete many

activities of daily living. Id.

An independent review of the record reflects that Mr. Morris and Ms. Dissanayake’s

opinions are amply supported by the record, and the ALJ failed to adequately analyze their

supportability or consistency with the record. As explained, an ALJ may not cherry-pick isolated

instances of favorable psychological symptoms when the record as a whole reflects long-

standing psychological disability. See Ghanim, 763 F.3d at 1164; see also Garrison, 759 F.3d at

1017. First, the two medical opinions are amply supported by the medical record, and consistent

with much of the objective medical evidence. See, e.g. Tr. 479, 658 (dysthymic, anxious, or flat

mood and affect), Tr. 658, 889 (impaired memory), Tr. 655, 1149 (limited attention and

concentration), Tr. 609, 658 (limited to fair judgment and insight). And, the ALJ rejected the two

medical opinions for the same reasons he discounted Plaintiff’s subjective symptom testimony.

See Tr. 38. As indicated above, substantial evidence does not support the bases the ALJ relied

upon. Because the ALJ did not adequately analyze the supportability or consistency of the two

medical opinions, and his stated bases for finding them unpersuasive are not supported by

substantial evidence, the Court finds the ALJ erred by rejecting these medical opinions as well.

III. Remedy

Plaintiff asserts that this case should be remanded for immediate payment of benefits

under the credit-as-true standard. Pl. Br. at 21. Applying the requisite standard, for the reasons

set forth below, the Court finds that the credit-as-true standard is met.

A. Standard of Review

Within the Court's discretion under 42 U.S.C. § 405(g) is the “decision whether to

remand for further proceedings or for an award of benefits.” Holohan, 246 F.3d at 1210 (citation

omitted). Although a court should generally remand to the agency for additional investigation or

explanation, a court has discretion to remand for immediate payment of benefits. Treichler v.

Comm'r of the Soc. Sec. Admin., 775 F.3d 1090, 1099-1100 (9th Cir. 2014). The issue turns on

the utility of further proceedings. A court may not award benefits punitively and must conduct a

“credit-as-true” analysis on evidence that has been improperly rejected by the ALJ to determine

if a claimant is disabled under the Social Security Act. Strauss v. Comm'r of the Soc. Sec.

Admin., 635 F.3d 1135, 1138 (9th Cir. 2011).

Generally, where “(1) the record has been fully developed and further administrative

proceedings would serve no useful purpose; (2) the ALJ has failed to provide legally sufficient

reasons for rejecting evidence, whether claimant testimony or medical opinion; and (3) if the

improperly discredited evidence were credited as true, the ALJ would be required to find the

claimant disabled on remand,” the district court should remand for payment of benefits.

Garrison, 759 F.3d at 1020.

In conducting this analysis, the district court first determines whether the ALJ made a

legal error and then reviews the record as a whole to determine whether the record is fully

developed, the record is free from conflicts and ambiguities, and there is any useful purpose in

further proceedings. Dominguez v. Colvin, 808 F.3d 403, 407 (9th Cir. 2015). Only if the record

has been fully developed and there are no outstanding issues left to be resolved does the district

court consider whether the ALJ would be required to find the claimant disabled on remand if the

improperly discredited evidence were credited as true. Id. If so, the district court can exercise its

discretion to remand for an award of benefits. Id.

Even where all the requisites are met, however, a court may still remand for further

proceedings “when the record as a whole creates serious doubt as to whether the claimant is, in

fact, disabled[.] Garrison, 759 F.3d at 1021. “Serious doubt” can arise when there are

“inconsistencies between the claimant's testimony and the medical evidence,” or if the

Commissioner “has pointed to evidence in the record the ALJ overlooked and explained how that

evidence casts serious doubt” on whether the claimant is disabled under the Act. Dominguez, 808

F.3d at 407 (internal quotations and citation omitted).

B. Analysis

On the first prong, the Ninth Circuit has held that remanding for proceedings rather than

for an immediate payment of benefits serves a useful purpose where “the record has [not] been

fully developed [and] there is a need to resolve conflicts and ambiguities.” Treichler, 775 F.3d at

1101 (internal quotations and citations omitted). Here, plaintiff has already attended and testified

at an administrative hearing related to her application. Tr. 51-77. A vocational expert testified as

well. Id. Plaintiff’s medical record, including the additional evidence, contains her entire mental

health history. Defendant has failed to “point[ ] to evidence in the record the ALJ overlooked,”

Dominguez, 808 F.3d at 407, and the Court finds none. The record is therefore fully developed,

and there is no need to resolve any conflict or ambiguity.

The second prong is also satisfied because the ALJ committed harmful legal error. As

discussed above, the ALJ erred by (1) improperly discrediting Mr. Morris and Ms. Dissanayake’s

medical opinions as to Plaintiff's mental health impairments; (2) failing to provide clear and

convincing reasons, supported by substantial evidence, for discounting Plaintiff’s symptom

testimony, and (3) failing to support the decision to reject lay witness testimony with substantial

evidence.

As to the third prong, if the improperly discounted opinion evidence concerning

Plaintiff’s mental health limitations, along with Plaintiff’s subjective symptom testimony were

credited as true, the ALJ would have to find Plaintiff disabled on remand. The vocational expert

testified that a hypothetical individual who was absent two or more days or off task 15% or more

of the workday would not be employable. Tr. 75. Based on the discounted evidence, Plaintiff is

such a hypothetical individual. Accordingly, the ALJ would be required to find plaintiff disabled

on remand.

Considering the record as a whole, the Court does not have serious doubt as to whether

Plaintiff is disabled. Garrison, 759 F.3d at 1020-21 (citations omitted); see also Revels v.

Berryhill, 874 F.3d 648, 668 n.8 (9th Cir. 2017) (explaining that where each of the credit-as-true

factors is met, only in “rare instances” does the record as a whole leave “serious doubt as to

whether the claimant is actually disabled”) (citing Garrison, 759 F.3d at 1021). Quite the

contrary, the record — including Plaintiff's own testimony, that of her family, and the opinions of

her mental health providers — conclusively demonstrates that Plaintiff's mental health conditions

preclude her from sustaining employment.

Because plaintiff has satisfied the credit-as-true standard and the Court does not have

serious doubt as to whether plaintiff is disabled, the Court exercises its discretion to remand this

case for an award of benefits.

CONCLUSION

For the reasons given above, the Commissioner’s decision is REVERSED and this case 1s

REMANDED for calculation and payment of benefits.

DATED this 6th day of May, 2025.

Loum

United States Magistrate Judge

23 — OPINION & ORDER