“An ALJ’s failure to cite specific evidence does not 19 indicate that such evidence was not considered[.]”
How later courts described this case
- “An ALJ’s failure to cite specific evidence does not 19 indicate that such evidence was not considered[.]”
- “The ALJ always has a special duty to fully 17 and fairly develop the record” to make a fair determination as to 18 disability, even where, as here, “the claimant is represented by 19 counsel.” (cleaned up)
- requiring 16 the court to consider the entire record, not simply the evidence cited by 17 the ALJ or the parties
Written by the judges who cited it.
The opinion
1 FILED IN THE
U.S. DISTRICT COURT
EASTERN DISTRICT OF WASHINGTON
2 Jan 27, 2026
SEAN F. MCAVOY, CLERK
3
UNITED STATES DISTRICT COURT
4 EASTERN DISTRICT OF WASHINGTON
5
SCOTT T.,1 No. 2:25-cv-197-EFS
6
Plaintiff,
7 ORDER REVERSING THE
v. ALJ’S DENIAL OF BENEFITS,
8 AND REMANDING FOR
FRANK BISIGNANO, MORE PROCEEDINGS
9 Commissioner of Social Security,
10 Defendant.
11
Plaintiff Scott T., who suffers from autoimmune disorders and
12
other impairments, asks the Court to reverse the Administrative Law
13
Judge’s (ALJ) denial of Title 2 benefits. Because the ALJ erred when
14
evaluating Plaintiff’s symptom claims and a treating provider’s
15
16
17
18
1 For privacy reasons, Plaintiff is referred to by first name and last
19
initial or as “Plaintiff.” See LCivR 5.2(c).
20
1 opinions, this matter is remanded for further proceedings, including a
2 consultative physical examination.
3 I. Background2
4 The medical records reflect that Plaintiff sought treatment for a
5 variety of issues prior to and during the alleged disability period,
6 beginning July 31, 2020, and that medication and other treatments
7 helped reduce inflammation but did not reduce all of Plaintiff’s
8 symptoms. One of the first treatment notes of record is from September
9 2019 when Plaintiff complained of chronic headaches, and the MRI
10 showed stable bilateral basal ganglia calcifications.3 In December 2019,
11 Plaintiff was referred to physical therapy by his treating provider PA-C
12 Zachary Stiles for his daily fatigue and malaise.4
13 The intake notes for physical therapy completed by the
14 naturopathic doctor, Chris Valley, ND, reflect the following history:
15
16
2 The Background’s summary of medical records focuses on Plaintiff’s
17
physical-health medical records.
18
3 AR 691–93, 753–54.
19
4 AR 424–34.
20
1 a 47-year-old male who comes in for evaluation and
treatment of myalgias and arthralgias. He was initially seen
2 in this clinic in April 2010 for migratory arthritis. His
presentation suggested palindromic rheumatism. The
3 symptoms began abruptly and would last for one to 3 days
before resolving spontaneously. Between the episodes, he
4 was free of joint pain. His serology showed elevated RF IgA
(319), RF IgM (197) and CCP antibody (+100). At that time,
5 he was started on hydroxychloroquine and colchicine, which
he discontinued within the first several weeks of taking. He
6 later restarted hydroxychloroquine and try to titrate up the
dose. In August 2018, he developed sharp pain in the biceps
7 and thighs. He noted burning discomfort in his extremities.
He had a sense of weakness. It was difficult for him to open
8 jars. Laboratory studies revealed a CK of 353. He
discontinued hydroxychloroquine. In October 2018, EMG
9 and nerve conduction studies were normal without evidence
of neuropathy or myopathy.
10
My first visit with this 47-year-old male referred to me by
11 Dr. [Jeffrey] Butler to discuss complementary evaluation in
the setting of inflammatory arthritis. Patient was last seen
12 with Dr. Butler on November 7. He was apparently not
tolerating methotrexate well noting significant fatigue.
13 Dr. Butler discontinued the drug in favor of leflunomide. He
then contacted the office shortly thereafter reporting
14 increased symptoms of tremor as well as increasing
headaches. Leflunomide was discontinued and he was
15 restarted on methotrexate 25 mg oral weekly with folic acid
1 mg. He states that he was previously on
16 hydroxychloroquine and per his report at full dosage 400 mg
noted increasing severe weakness of his extremities. As
17 stated above EMG studies were normal. Other biologic
agents have been discussed as alternatives in the future.
18
Patient describes a chronic deep aching and burning pain
19 diffusely in his neck and upper back. No focal
radiculopathy. He states that he has always noted trigger
20
1 points in his upper back. The patient often describes a sense
of “heat” in his back. He has tried some different
2 complementary treatment including working with another
naturopath in Spokane trying various dietary supplements
3 and “detox” methods.
4 He continues to struggle with daily fatigue and malaise.
The patient denies hypersomnia. Laboratory testing has not
5 shown any other causes of his fatigue, normal thyroid
studies.5
6
Plaintiff began physical therapy, which focused on his neck and
7
upper back; during which he was observed with generalized
8
hypomobility and weakness of cervical stabilizers.6 During May
9
through July 2020, he continued to report internal tremors in his neck
10
and torso and increased rheumatoid arthritis flairs, and he was
11
observed as depressed and frustrated with medical conditions.7
12
On July 9, 2020, Plaintiff returned to Dr. Valley. Plaintiff
13
reported that his arthritis symptoms were doing “quite well,” he
14
reported three-day improvement in tremor symptoms after taking a
15
16
17
5 AR 424.
18
6 AR 433–53.
19
7 AR 1214–17, 462–65, 666.
20
1 natural supplement.8 However, he reported that he still had muscle
2 pain, stiffness, and fatigue if he tried vigorous exercise, although he
3 was able to tolerate his work activities.9 Dr. Valley’s assessment was
4 that Plaintiff had no acute joint pain or swelling to suggest active
5 palindromic rheumatism and that he responded favorably to
6 methotrexate, but that Plaintiff “has had very vexing neurological
7 symptoms including dysesthesias and tremors” and that while Plaintiff
8 reported he responded well to a supplement Dr. Valley cautioned him
9 about the use of supplements.10
10 The next day Plaintiff saw PA-C Stiles for ongoing myalgias,
11 muscle weakness, and nerve pain.11 Plaintiff’s musculoskeletal findings
12 were normal other than decreased upper extremity strength on the left
13
14
15
16
8 AR 986.
17
9 AR 986–90.
18
10 AR 989.
19
11 AR 660–64.
20
1 side.12 PA-C Stiles referred him to neurology and began him on a
2 prednisone taper.
3 On July 18, 2020, Plaintiff sought emergency treatment for head
4 fog and pressure and reported that his arm muscles hurt and he had
5 weakness in his hands.13 He was observed with a very fine hand tremor
6 and very mild fine tongue tremor.14 His labs were normal except his
7 erythrocyte sedimentation rate (“sed rate” or “ESR”), was mildly
8 elevated, “suggesting a possible inflammatory response,” and his
9 thyroid-stimulating hormone (TSH) was low.15 It was assessed that
10 some of his symptoms were consistent with hyperthyroidism.
11
12
13
14
12 AR 664.
15
13 AR 684–86.
16
14 AR 686.
17
15 AR 688. Sed rate is a blood test that can show inflammatory activity
18
in the body. https://www.mayoclinic.org/tests-procedures/sed-
19
rate/about/pac-20384797 (last viewed January 26, 2026).
20
1 At a follow-up two days later with PA-C Cody Solders, Plaintiff
2 continued to be frustrated with his internal tremors and myalgia.16 In
3 August 2020, Plaintiff began acupuncture treatments and he reported
4 that his internal tremors and burning became less intense, however,
5 insurance stopped acupuncture coverage.17 Labs continued to show a
6 high sed rate.18
7 Plaintiff saw rheumatologist Dr. Butler again, who referred him
8 to several specialists, including to cardiology, which revealed a normal
9 EKG; to endocrinology, which assessed Plaintiff with hyperthyroidism;
10 and to audiology, which revealed bilateral normal to moderate
11 sensorineural hearing loss and age-related bilateral cataracts.19 When
12 Plaintiff saw PA-C Stiles in October 2020, he was “distraught,” tearful,
13 and reported that he felt “like he is falling part” and “has burning all
14
15
16
16 AR 654–67.
17
17 AR 472–77.
18
18 AR 919.
19
19 AR 675–84, 821–29, 1119–22, 1165–69.
20
1 throughout his body.20 PA-C Stiles wrote, “I had a very frank
2 discussion with him that I think his symptoms could all be explained
3 by his autoimmune process,” as Plaintiff “has a known autoimmune
4 disease with a very high titer for double-stranded DNA.”21 The labs
5 taken the week prior revealed that Plaintiff’s ANA-A, ANA-B, SS-DNA,
6 DS-DNA, RF IgA, RF IgM, RF IgG, and sed rate were all high.22
7 In October 2020, based on a referral by PA-C Stiles, Plaintiff was
8 seen at UW Neurology Clinic for his reported muscle weakness and
9 tremor.23 His observed muscle strength and tone were normal, he had
10 sharp-dull discrimination decreased below the knee but intact
11 sensation at the toes on the pinprick, decreased temperature below the
12 knee but intact at the feet, a slight postural tremor with outstretched
13 hands, and normal gait. The doctor stated:
14 [u]nfortunately, we are not able to put together his
[history], [physical examination] and testing to come up
15
16
20 AR 633–34.
17
21 AR 633.
18
22 AR 959–60.
19
23 AR 493–97.
20
1 with a neurological issue. Temporally, his symptoms started
after increasing the hydroxychloroquine. But not clear if
2 cause and effect. Consider stopping. We would not
recommend further neurological testing or work-up at this
3 time and defer further treatment to the primary care and
rheumatologist.24
4
In November 2020, Plaintiff returned to PA-C Stiles.25 Plaintiff
5
was “very tearful in the office,” and while he reported that the
6
prednisone taper helped with his pain, he advised that he still was not
7
able to work due to his pain.26 Prior to this, Plaintiff had worked in
8
environmental cleanup services for many years.27 PA-C Stiles referred
9
Plaintiff to a new rheumatology clinic to help address his polyarthritis
10
flare-up.28 Although Plaintiff’s musculoskeletal physical exam was
11
normal, PA-C Stiles wrote, “I think he would need to have some sort of
12
permanent treatment on board [before he returns back to work],
13
14
15
24 AR 497.
16
25 AR 627–29.
17
26 AR 627.
18
27 AR 248–54, 402, 520.
19
28 AR 628.
20
1 whether that is some sort of other [disease-modifying antirheumatic
2 drug] or something else.”29
3 At the appointment the next week, PA-C Stiles assessed that
4 Plaintiff’s reports for internal shaking may be due to being on
5 prednisone for an extended time and emphasized the need for him to
6 get into rheumatology as “I feel pretty confident that this is most likely
7 due to his rheumatological disorder and possibly due to being on the
8 [p]rednisone for an extended period of time.”30 Hyporeflexia was
9 present on the physical examination.31
10 In December 2020, he was restarted on Propranolol and
11 Plaquenil, and re-met with PA-C Stiles to discuss sleep study results,
12 which showed moderate sleep apnea.32 PA-C Stiles wrote, “He is feeling
13
14
15
16
29 AR 628.
17
30 AR 622.
18
31 AR 622.
19
32 AR 605–08.
20
1 very run down and at the end of his rope. He is very frustrated by his
2 illness and not being able to get it under control.”33
3 In February 2021, Plaintiff returned to Dr. Butler, continuing to
4 report morning stiffness of variable duration, widespread arthralgias,
5 pain in his wrist predominantly on the right side, and diffuse soft
6 tissue pain as well as forearm discomfort.34 Dr. Butler wrote,
7 The patient has serologies highly suggestive of rheumatoid
arthritis with high titer positive rheumatoid factor and anti-
8 CCP antibodies. He has had some arthralgias with
migratory symptoms suggestive of palindromic rheumatism.
9 He does have somewhat poorly defined symptoms with
neurological qualities. He has noted some benefit from the
10 combination of methotrexate and hydroxychloroquine but he
remains symptomatic. His primary concerns are symptoms
11 which do not correlate with active rheumatoid arthritis. We
discussed that we do have other treatment options that he
12 may consider.
13 I would be hesitant to recommend a TNF inhibitor. The
patient does show serologies suggesting a possible
14 overlapping connective tissue disease. He has had high titer
positive ANA with borderline positive double-stranded DNA
15 antibodies. I am concerned that a TNF inhibitor potentially
could aggravate symptoms of connective tissue disease. We
16 discussed the option of B-cell depleting therapy such as
rituximab. The patient does plan to pursue COVID-19
17
18
33 AR 606.
19
34 AR 924.
20
1 vaccination. Rituximab could interfere with his ability to
mount an appropriate immune response to the vaccination.
2 Therefore, I would recommend deferring treatment with
rituximab.35
3
Dr. Butler also considered that “a mood disorder could be contributing
4
somewhat to his [depressed] presentation.”36
5
At his follow-up sleep apnea visit in February 2021, Plaintiff
6
appeared tired, with mildly dysphoric mood and blunted affect; was
7
frustrated with medical concerns and weakness, with slight wasting of
8
wrist extensors and hands with weakness bilaterally for wrist
9
extension worse on right; and reported pain with wrist movement. 37
10
He had a mild intention tremor bilaterally with finger to nose.
11
In late February 2021, Plaintiff presented to rheumatologist Yan
12
Li, MD, for a consultation for his migratory joint pain, morning
13
stiffness, persistent burning sensation in extremities, muscle shaking,
14
15
16
17
35 AR 926.
18
36 AR 928.
19
37 AR 500–03.
20
1 fatigue, and frequent cough.38 He presented with grossly intact upper
2 and lower extremity strength, with swelling and tenderness in right
3 4th MTP, 4th PIP, left 2nd and 3rd PIP joints, and bilateral wrists.39
4 The labs from that month showed a positive ANA, SS-DNA, chromatin,
5 and RF, and high sed rate levels.40 Dr. Li determined that Plaintiff’s
6 “clinical presentations are suggestive [of] inflammatory arthritis, likely
7 early onset rheumatoid arthritis. Given the inadequate response to
8 methotrexate and Plaquenil, biologic agent is suggested at this time.”41
9 Dr. Li recommended a chest x-ray for Plaintiff’s frequent cough.42 The
10 ordered CT imaging of the chest revealed bilateral lower lobe
11 predominant ground-glass opacities with likely NSIP pattern,
12 suggesting connective tissue disease-related disease.43 It was
13
14
38 AR 526–29.
15
39 AR 528.
16
40 AR 528, 913–18, 1012.
17
41 AR 528.
18
42 AR 529.
19
43 AR 522.
20
1 recommended that his immunosuppression therapy be increased, with
2 rituximab as an option.44 Imaging of the spine showed moderate
3 degenerative disc disease of the spine at C6–7.45
4 In March 2021, Plaintiff sought a formal evaluation via a televisit
5 with a Mayo Clinic neurologist.46 The neurologist stated:
6 It is difficult to attribute these symptoms [of generalized
muscle weakness, intermittent burning/crawling sensations
7 throughout the body but primarily bilateral lower
extremities and internal tremor] to a neurologic cause or
8 localizable to one location . . . [I]t is unlikely we will find
any pathology as patient’s symptoms do not fit a neurologic
9 pattern at this time. Another possibility on the differential
is a side effects from the Plaquenil which has shown to
10 cause a sensorimotor neuromyopathy.47
11 Plaintiff began Rituxan (rituximab) infusion therapy to help reduce
12 inflammation, which assisted greatly with reducing his cough and
13 increasing his exercise capacity.48
14
15
44 AR 522.
16
45 AR 567.
17
46 AR 519–21.
18
47 AR 521.
19
48 AR 518, 791, 809, 79–79.
20
1 In April 2021, Plaintiff was evaluated in person by the same
2 Mayo Clinic neurologist.49 The neurological exam was normal. The
3 neurologist concluded there were no neurological causes for the
4 reported symptoms and opined that they could be attributed to
5 anxiety/stress.50
6 Plaintiff returned to PA-C Stiles in May 2021.51 PA-C Stiles
7 commented that a CT scan showed severe pulmonary fibrosis and so a
8 referral to pulmonology was made; in addition, a referral for physical
9 therapy was done due to Plaintiff’s “pretty severe deconditioning with
10 muscle weakness,” although Plaintiff exhibited normal strength during
11 the physical examination.52
12 During the physical-therapy evaluation, Plaintiff was observed
13 with 4/5 lower extremity strength with bilateral hip flexion, 4+/5
14 bilateral hip extensions and abductions, 4+5/5 bilateral knee flexors,
15
16
49 AR 515–17.
17
50 AR 517.
18
51 AR 596–601.
19
52 AR 600.
20
1 and a slight tremor when lifting and holding objects with bilateral
2 upper extremities.53 Based on testing performed, the physical therapist
3 assessed fatigue, impaired balance, and nerve pain.54
4 Two days after this evaluation in June 2021, Plaintiff applied for
5 benefits under Title 2, claiming disability beginning July 31, 2020, at
6 the age of 48, based on physical and mental impairments.55
7 At an appointment in July 2021, Plaintiff advised that he had
8 done some strenuous hiking and swimming the day prior and now felt
9 fatigued and was observed with slightly tender joints.56 Dr. Butler
10 encouraged continued rituximab infusions to treat Plaintiff’s
11 rheumatoid arthritis and rheumatoid lung disease.57 He reduced
12
13
14
15
53 AR 1061–62, 794–97.
16
54 AR 797.
17
55 AR 250–54.
18
56 AR 900–04.
19
57 AR 893, 885, 902–03.
20
1 Plaintiff’s methotrexate in hopes of reducing Plaintiff’s nausea and
2 malaise.58 Plaintiff’s sed rate was in the mid-high range of normal.59
3 At a pulmonary appointment later that month, Plaintiff
4 performed a 6-minute walk test, which he was able to walk 1525 feet
5 (or 464 meters).60 Plaintiff continued physical therapy through August
6 2021 during which he demonstrated quick fatigue of scapular
7 retraction with some moves, shaking in his back muscles during other
8 exercises, and balance impairments which were significantly amplified
9 when vision and somatosensory systems were deprived.61
10 Plaintiff’s labs in September 2021 revealed a high sed rate.62 In
11 November 2021, Plaintiff told Dr. Butler that his pain had improved
12
13
58 AR 903–04.
14
59 AR 1141.
15
60 AR 793. Compare with https://www.neuropt.org/docs/default-
16
source/cpgs/core-outcome-measures/6mwt-pocket-guide-
17
proof9.pdf?sfvrsn=9ee25043_0 (last viewed Jan. 26, 2026).
18
61 AR 779–90, 814–19, 1078–86, 1092–96.
19
62 AR 888, 1139.
20
1 although he still had daily fatigue and chronic sinus congestion, and he
2 was concerned about the black mold in his residence.63 Dr. Butler noted
3 that Plaintiff was no longer taking methotrexate due to the side effects
4 of nausea and malaise.64 Plaintiff was observed with full muscle
5 strength and no tenderness or swelling in all extremities and his sed
6 rates were at the high end of the normal range.65
7 In December 2021, Plaintiff sought emergency room treatment for
8 lower extremity burning, constant fatigue, light sensitivity, and
9 abdominal pain.66 Based on the benign physical examination, the
10 provider recommended he follow-up with an allergist/immunologist.
11 In early January 2022, labs showed high levels of ANA, SS-A,
12 AbIgM, AbIgG, and Rh factor.67 Later that month, Plaintiff had a
13 consultation with Dr. Valley. Dr. Valley wondered whether Plaintiff’s
14
15
63 AR 1312–20.
16
64 AR 1313.
17
65 AR 1316–17, 1138.
18
66 AR 1282–87.
19
67 AR 1199.
20
1 tremors were caused by small fiber polyneuropathy or a somatoform
2 disorder.68
3 During an epilepsy consultation in February 2022, the doctor
4 observed slightly slowed foot tapping with no decrement, very mild
5 tremor on the right hand, a trace deep tendon reflex at the biceps and
6 triceps, decreased left great toe pinprick sensation, and mild difficulty
7 standing on heels and toes.69 The doctor advised Plaintiff that his
8 muscle strength was normal, and his sed rate was normal at 6, and
9 therefore the doctor doubted that there was an underlying myopathy
10 but instead wondered whether the Plaquenil medication used to treat
11 Plaintiff’s autoimmune diseases was causing the experienced
12 myalgias.70
13 Biopsies taken during a dermatology appointment in March 2022
14 were consistent with small fiber neuropathy.71 The dermatologist
15
16
68 AR 1361.
17
69 AR 1409–10.
18
70 AR 1410, 1520–23.
19
71 AR 1489–90, 1560–61.
20
1 advised that the condition could be treated with selective serotonin
2 reuptake inhibiters (SSRIs).72 Imaging that month confirmed mild
3 diffuse lung disease.73
4 In April 2022, Plaintiff saw both PA-C Stiles and Dr. Butler.
5 Although the physical examination was normal, PA-C Stiles diagnosed
6 Plaintiff with small fiber neuropathy, mixed connective tissue disease,
7 and rheumatoid arthritis with rheumatoid factor of multiple sites
8 without organ or system involvement, and wrote:
9 Certainly, with the incredibly extensive workup that he has
had in regards to his rheumatological condition and his
10 fatigue and disability, I think he is more than qualified to
be considered disabled and unable to work at this time. He
11 will continue to follow up with all his specialists. I filled out
his note for him and he will follow up with us as needed.74
12
Three days later, Dr. Butler observed Plaintiff with mild macular
13
erythema over the cheeks and noted that labs from February showed
14
positive SS-A antibodies at 83 units but negative SS-B antibodies and
15
16
17
72 AR 1489.
18
73 AR 1558–59.
19
74 AR 1621.
20
1 negative double-stranded DNA antibodies.75 Plaintiff’s sed rate from
2 his early April 2022 specimen was in the mid-high range of normal,
3 and his sed rate from a late April 2022 specimen was at the high end of
4 normal.76
5 A week later, Plaintiff visited neurologist Steven Pugh, MD, who
6 concluded that Plaintiff may have a somatoform disorder causing his
7 symptoms of pain, paresthesia, burning, and vibration.77 Dr. Pugh
8 wrote that in his “experience with this type of disorder . . . [it] is very
9 difficult for these patients to have any closure with their ongoing
10 symptoms.”78 Plaintiff again saw Dr. Pugh in July 2022, at which time
11 Plaintiff was “very dysphoric, very anxious.”79 Dr. Pugh wrote, “[b]ased
12 on what I am seeing the degree of his anxiety surrounding his
13 condition is so extreme that I do not see how he could ever possibly
14
15
75 AR 1651–55.
16
76 AR 1644–45.
17
77 AR 1633.
18
78 AR 1633.
19
79 AR 1635.
20
1 work and that may be a primary disorder of his as well.”80 He
2 reiterated to Plaintiff that his central nervous system was intact.81
3 A couple days later, Plaintiff saw PA-C Stiles and they discussed
4 his current medications.82 Plaintiff reported about three good days per
5 week when he did not have muscle fatigability and internal tremors.
6 Even though the physical exam findings were unremarkable that day,
7 PA-C Stiles wrote:
8 I discussed that with all of his laboratory findings showing
significant autoimmune processes that I would certainly
9 support any disability claim that he may have. He typically
always presents as a healthy individual but his laboratory
10 workup would seem to show otherwise and some of his
medications that he is on certainly could lend themselves to
11 very easy fatigability.83
12 Later in July 2022, Plaintiff was observed with occasional
13 expiratory wheeze, decreased range of motion with tenderness along
14
15
16
80 AR 1635.
17
81 AR 1635.
18
82 AR 1605–10.
19
83 AR 1608.
20
1 the C2-S1 areas, and positive joint tenderness with swelling.84 His sed
2 rate was in the normal range.85 In September 2022, Dr. Pugh observed
3 that Plaintiff’s anxiety levels seemed lower with Lyrica.86 An
4 examination in October 2022 indicated moderate bilateral
5 sensorineural loss.87 Plaintiff’s labs in October 2022 were in the normal
6 range for IgA, IgG, IgM, and sed rate.88
7 In April 2023, Plaintiff returned to PA-C Stiles.89 Plaintiff
8 reported continued fatigue, he discontinued Lyrica because it increased
9 his GERD, and he continued to be very frustrated that he did not have
10 a clear answer or treatment for his autoimmune disorder.90 They
11 discussed Plaintiff’s lab results, which showed he had a positive
12
13
84 AR 1694–1702.
14
85 AR 1642.
15
86 AR 1704.
16
87 AR 1709.
17
88 AR 1716.
18
89 AR 1947–53.
19
90 AR 1947–53.
20
1 Sjogren’s antibody test.91 PA-C Stiles restarted Plaintiff on Duloxetine
2 and more labs were ordered.92
3 A week later Plaintiff saw PA-C Cox for his internal shakiness,
4 myalgias, and arthralgia.93 PA-C Cox wrote that Plaintiff’s rheumatoid
5 arthritis seems to be responding well to the current medications and he
6 did not have joint swelling or warmth, but that Plaintiff continued to
7 “endorse abnormal vibratory sensations, decreased strength in his
8 calves and forearms, and abnormal temperature sensations” as well as
9 fatigue.94
10 May 2023 imaging revealed fairly stable patchy bibasal opacities
11 with nodular component in Plaintiff’s lungs, which were “likely from
12 chronic inflammatory process.”95 In September 2023, Plaintiff sought
13 treatment from PA-C Stiles for reported difficulty breathing due to
14
15
91 AR 1951.
16
92 AR 1951–52.
17
93 AR 1742–48.
18
94 AR 1747.
19
95 AR 1832.
20
1 recent smoke in the air.96 PA-C Stiles assessed interstitial lung disease
2 with progressive fibrotic phenotype and recommended nebulizer
3 treatments.97 Plaintiff’s lab specimen collected in October 2023 showed
4 high sed rate levels.98
5 In January 2024, ALJ Marie Palachuk held a telephone hearing
6 at Plaintiff’s request, following the initial denial of Plaintiff’s disability
7 claim.99 Plaintiff testified that he had difficulty sleeping, internal
8 shaking, severe fatigue, intermittent shortness of breath, balance
9 issues, and pain in his joints, particularly in his wrists, and he can
10 start shaking or experience muscle paralysis if he performs repetitive
11 motions.100 Plaintiff stated that during his last years working he
12 missed quite a bit of work due to his symptoms.101 He stated that the
13
14
96 AR 1924–29.
15
97 AR 1927–28.
16
98 AR 1977–78.
17
99 AR 40–69.
18
100 AR 48–49.
19
101 AR 48–49.
20
1 infusion treatments and immune suppressants have helped
2 significantly with his pain, ability to walk, and coughing but that he
3 still has issues with repetitive motion and extreme fatigue.102 He
4 testified that he still has muscle strength but that repetitive muscle
5 movement causes his muscles to shake and then he is unable to lift.103
6 He stated that he has good days when he is able to do things and then
7 he has bad days about 2–3 times a week during which he is so fatigued
8 that he may have difficulty getting out of bed, is unable to walk far, has
9 to use the toilet several times, and usually sits and reads or watches
10 TV.104 He stated that regardless of whether it’s a good day or a bad day
11 he must usually nap.105 Plaintiff shared that it takes him longer to
12 accomplish household and yard chores because he needs to take
13 breaks.106 He stated that after he initially started rheumatological
14
15
102 AR 50–51.
16
103 AR 51.
17
104 AR 51, 57–58.
18
105 AR 57–58.
19
106 AR 52.
20
1 infusions he was able to do more physically, including walking 4–5
2 miles; however, after the second infusion, he began experiencing
3 injuries if he exercised and he was forced to do less.107 He stated that
4 he can stand about an hour a day and then he gets dizzy.108 He testified
5 that after an infusion he will experience nerve pain throughout his
6 entire body and he must be careful about what he eats.109 He stated
7 that through treatment and an anti-inflammatory diet he has been
8 able to get his inflammatory numbers down but his disease activity
9 numbers are still high.110
10 The vocational expert testified the following limitations would be
11 work preclusive: needing to take a break every 30 minutes, being off
12 task more than 10 percent of the workday, and being absent 2 or more
13 days a month for 3 months in a row.111
14
15
107 AR 53–54.
16
108 AR 54.
17
109 AR 54–55.
18
110 AR 55.
19
111 AR 65–66.
20
1 After the hearing, the ALJ issued a decision denying benefits.112
2 The ALJ found Plaintiff’s alleged symptoms were “not entirely
3 consistent with the medical evidence and other evidence,113 and found:
4 • the psychiatric consultative opinion of Patrick Metoyer, PhD,
5 and the administrative findings of Mark Magdaleno, MD,
6 Dennis Pacl, MD, and Beth Fitterer, MD, persuasive; and
7 • the administrative findings of Patricia Kraft, PhD, the treating
8 opinions of Zachary Stiles, PA-C, and the psychological
9 consultative opinion of Melvin Watt, PhD, not persuasive.114
10 As to the sequential disability analysis, the ALJ found:
11 • Plaintiff met the insured status requirements through
12 December 31, 2025.
13 • Step one: Plaintiff had not engaged in substantial gainful
14 activity since July 31, 2020, the alleged onset date.
15
16
112 AR 14–39. Per 20 C.F.R. § 404.1520(a)–(g), a five-step evaluation
17
determines whether a claimant is disabled.
18
113 AR 23.
19
114 AR 17–29. The ALJ referred to Dr. Pacl as Dr. Paci.
20
1 • Step two: Plaintiff had the following medically determinable
2 severe impairments: systemic lupus erythematous, small fiber
3 neuropathy, rheumatoid arthritis with no organ or system
4 involvement, hearing loss, anxiety, depression, and post-
5 traumatic stress disorder.
6 • Step three: Plaintiff did not have an impairment or
7 combination of impairments that met or medically equaled the
8 severity of one of the listed impairments.
9 • RFC: Plaintiff had the RFC to perform light work except:
10 he can never climb ladders, ropes, or scaffolds, but
occasionally perform all other postural activities,
11 should avoid concentrated exposure to extreme
temperatures, noise, and vibration, and all exposure to
12 hazards such as unprotected heights and dangerous,
moving machinery. He is able to understand,
13 remember, and carry out simple, routine, and detailed
tasks and able to maintain concentration, persistence,
14 and pace for 2-hour intervals between regularly
scheduled breaks. He is limited to no assembly line
15 pace or similarly fast-paced work, and superficial
interaction with the public.
16
• Step four: Plaintiff is unable to perform past relevant work.
17
• Step five: considering Plaintiff’s RFC, age, education, and work
18
history, Plaintiff could perform work that existed in significant
19
20
1 numbers in the national economy, such as telephone directory
2 distribution driver, lab sample carrier, and car driver.115
3 Plaintiff timely requested review of the ALJ’s decision by the
4 Appeals Council and now this Court.116
5 II. Standard of Review
6 The ALJ’s decision is reversed “only if it is not supported by
7 substantial evidence or is based on legal error” and such error
8 impacted the nondisability determination.117 Substantial evidence is
9 “more than a mere scintilla but less than a preponderance; it is such
10 relevant evidence as a reasonable mind might accept as adequate to
11
12
13
14
15
115 AR 17–30.
16
116 AR 1–6; ECF No. 1.
17
117 Hill v. Astrue, 698 F.3d 1153, 1158 (9th Cir. 2012). See 42 U.S.C. §
18
405(g); Molina v. Astrue, 674 F.3d 1104, 1115 (9th Cir. 2012),
19
superseded on other grounds by 20 C.F.R. § 416.920(a).
20
1 support a conclusion.”118 The court looks to the entire record to
2 determine if substantial evidence supports the ALJ’s findings.119
3 III. Analysis
4 Plaintiff argues the ALJ erred by rejecting the work-preclusive
5 assessment from treating provider PA-C Stiles and by discounting
6 Plaintiff’s symptom testimony. The Commissioner argues no error
7 occurred, as the ALJ’s findings are supported by substantial evidence.
8 As is explained below, the ALJ consequentially erred when evaluating
9 PA-C Stiles’ opinion and therefore remand for further proceedings is
10 needed.
11
12
118 Hill, 698 F.3d at 1159 (quoting Sandgathe v. Chater, 108 F.3d 978,
13
980 (9th Cir. 1997)).
14
119 Kaufmann v. Kijakazi, 32 F4th 843, 851 (9th Cir. 2022). See also
15
Lingenfelter v. Astrue, 504 F.3d 1028, 1035 (9th Cir. 2007) (requiring
16
the court to consider the entire record, not simply the evidence cited by
17
the ALJ or the parties) (cleaned up); Black v. Apfel, 143 F.3d 383, 386
18
(8th Cir. 1998) (“An ALJ’s failure to cite specific evidence does not
19
indicate that such evidence was not considered[.]”).
20
1 A. Medical Opinions: Plaintiff establishes consequential
2 error.
3 Plaintiff argues the ALJ’s supportability and consistency
4 evaluation of PA-C Stiles was flawed. The Court agrees.
5 1. Standard
6 The ALJ must consider and articulate how persuasive she found
7 each medical opinion and prior administrative medical finding,
8 including whether the medical opinion or finding was consistent with
9 and supported by the record.120 This persuasiveness evaluation
10 requires require the ALJ to explain the supportability and consistency
11 of each medical opinion.121 The regulations define these two required
12 factors as follows:
13 (1) Supportability. The more relevant the objective medical
evidence and supporting explanations presented by a
14 medical source are to support his or her medical opinion(s)
or prior administrative medical finding(s), the more
15 persuasive the medical opinions or prior administrative
medical finding(s) will be.
16
17
120 20 C.F.R. § 404.1520c(a)–(c); Woods v. Kijakazi, 32 F.4th 785, 792
18
(9th Cir. 2022).
19
121 20 C.F.R. § 404.1520c(b)(2).
20
1
(2) Consistency. The more consistent a medical opinion(s) or
2 prior administrative medical finding(s) is with the evidence
from other medical sources and nonmedical sources in the
3 claim, the more persuasive the medical opinion(s) or prior
administrative medical finding(s) will be.122
4
The ALJ may, but is not required to, explain how the other listed
5
factors were considered, including relationship with the claimant and
6
specialization.123
7
When considering the ALJ’s findings, the Court is constrained to
8
the reasons and supporting explanation offered by the ALJ.124
9
2. PA-C Stiles
10
As mentioned above, PA-C Stiles began treating Plaintiff before
11
the alleged onset date and continued to treat him. PA-C Stiles issued
12
three “opinions” that the ALJ evaluated. First, in April 2022, PA-
13
C Stiles certified for purposes of obtaining a county property tax
14
exemption for Plaintiff that Plaintiff became disabled on January 7,
15
16
17
122 Id. § 404.1520c(c)(1)–(2).
18
123 Id. § 404.1520c(b)(2), (3), (c)(1)–(5).
19
124 See Burrell v. Colvin, 775 F.3d 1133, 1138 (9th Cir. 2014).
20
1 2020, and would continue to be disabled through at least January 7,
2 2025.125
3 Second, in September 2023, PA-C Stiles completed a Physical
4 Medical Source Statement, listing Plaintiff’s diagnoses as rheumatoid
5 arthritis, mixed connective tissue disorder, neuropathy, Sjogren’s,
6 small fiber neuropathy, and interstitial lung disease.126 He wrote that
7 Plaintiff has muscle weakness, easy fatiguability, stiffness, shortness
8 of breath, poor memory, and tremors, and it is easy to exacerbate the
9 global pain that affects Plaintiff’s joints and muscles.127 He stated that
10 he based his findings on labs, physical examination findings,
11 consultations, and imaging studies.128 He also noted that
12 immunosuppressant medications can cause Plaintiff to be more prone
13 to infections and increased fatigue.129 He opined that emotional factors,
14
15
125 AR 1580.
16
126 AR 1962–65.
17
127 AR 1962.
18
128 AR 1962.
19
129 AR 1962.
20
1 including depression and anxiety, contribute to Plaintiff’s symptoms
2 and functional limitations.130 He also opined that Plaintiff can walk 1–
3 2 city blocks, sit for 30 minutes at one time for a total of less than 2
4 hours each workday, and stand for 15 minutes at one time for a total of
5 less than 2 hours each workday.131 He listed that Plaintiff needs a job
6 that allows him to shift positions at will and have unscheduled 5-
7 minute breaks every 30 minutes due to his muscle weakness, chronic
8 fatigue, pain/paresthesia, and numbness.132 He further opined that
9 Plaintiff should rarely be required to lift/carry, crouch/squat, and climb
10 ladders and only occasionally twist and stoop.133 He recommended that
11 Plaintiff be limited to grasping, manipulating, and reaching for only
12 10% of the workday.134 He opined that Plaintiff would be off task more
13 than 25% of the workday, was incapable of even low-stress work
14
15
130 AR 1962–63.
16
131 AR 1963.
17
132 AR 1963.
18
133 AR 1964.
19
134 AR 1964.
20
1 because of his fatigue, that he would have good days and bad days, and
2 that he would be absent more than 4 days a month.135 Finally, he wrote
3 that Plaintiff was unable to tolerate cold conditions and he was very
4 sensitive to irritants in the air due to his lung disease.136
5 Third, on the treatment note the same day that PA-C Stiles
6 completed the Physical Medical Source Statement discussed above, PA-
7 C Stiles wrote:
8 He really is only able to sit in one position for about 30
minutes before he starts getting muscle aches and pains
9 that are pretty severe. He can stand for about 20 to 30
minutes. He feels very wiped out after he goes to the grocery
10 store. He sleeps for about 4 hours before he has to change
positions and adjust because he is too uncomfortable. He
11 can walk maybe 1 to 2 city blocks before he has to sit down
and rest. He has very very little stamina. He is able to lift
12 weights but he pretty much goes into muscle exhaustion
after lifting only one or 2 reps. In my opinion, based on his
13 history, I think he is disabled. I think this has worsened his
depression as well which is causing some of his memory
14 issues. I did discuss with him that I will go ahead and follow
his Social Security paperwork for his attorney and leave it
15 at the front desk for him to pick up. I also wrote a letter for
necessity stating that he really should relocate to a warmer
16 climate during the winter months as his symptoms do seem
to get significantly worse when he is exposed to cold
17
18
135 AR 1965.
19
136 AR 1965.
20
1 weather which would certainly be in line with his
autoimmune disorder.137
2
The ALJ evaluated these three statements from PA-C Stiles.
3
First, as to the property-tax statement, the ALJ found this statement
4
not persuasive because it was a conclusion of disability—a
5
determination reserved for the Commissioner—rather than a
6
functional assessment.138
7
Second, as to PA-C Stiles’ Physical Medical Source Statement, the
8
ALJ found it unsupported by his “treatment notes where he states
9
claimant typically presented as a healthy individual (Exhibit
10
33F/4).”139 The ALJ also found the opinion “not supported by or
11
consistent with the overall medical evidence of record noting claimant
12
with lots of subjective complaints but generally normal to benign
13
physical exam findings (see e.g. 41F).”140
14
15
16
137 AR 1984.
17
138 AR 27.
18
139 AR 27.
19
140 AR 27.
20
1 Third, the ALJ found PA-C Stiles’ opinions expressed in his
2 September 2023 treatment note unpersuasive.141 The ALJ found the
3 lifting and walking limitations were based simply on Plaintiff’s reports
4 rather than PA-C Stiles’ observations and therefore were not truly a
5 medical opinion. In addition, the ALJ found PA-C Stiles’ statement, “In
6 my opinion, based on his history, I think he is disabled” unpersuasive
7 because it was speculative and was not a functional assessment but
8 again a conclusion of disability.142 Finally, the ALJ found them
9 inconsistent with PA-C Stiles’ treatment notes indicating that Plaintiff
10 typically presented as a healthy individual.143
11 3. Administrative findings as to Plaintiff’s exertional abilities
12 No other treating or examining source offered an opinion as to
13 Plaintiff’s exertional abilities. However, the record contains the prior
14 administrative medical findings from Mark Magdaleno, MD, and
15 Dennis Pacl, MD, dated October 21, 2021, and November 4, 2022,
16
17
141 AR 27.
18
142 AR 28.
19
143 AR 28.
20
1 respectively. Dr. Magdaleno opined that Plaintiff could occasionally lift
2 and/or carry 20 pounds, frequently lift and/or carry 10 pounds, sit for
3 about 6 hours in an 8-hour workday, stand and/or walk about 6 hours
4 in an 8-hour workday, had no postural limitations, no manipulative
5 limitations, no visual limitations, no communicative limitations, and no
6 environmental limitations other than avoiding concentrated exposure
7 to noise due to his hearing loss.144 Dr. Magdaleno wrote that although
8 Plaintiff has palindromic rheumatoid arthritis, which may cause the
9 reported chronic migratory myalgias, and interstitial lung disease the
10 “objective findings consistently show good strength, gait, and station . .
11 . .”145
12 Dr. Pacl agreed with Dr. Magdaleno’s lifting/carrying, sitting, and
13 standing opinions.146 However, Dr. Pacl opined that Plaintiff was
14 limited in each of the posturals: frequent balancing and occasional
15 climbing ramps/stairs, climbing ladders/ropes/scaffolds, stooping,
16
17
144 AR 70–77.
18
145 AR 75.
19
146 AR 91.
20
1 kneeling, crouching, and crawling.147 He also opined that Plaintiff
2 should avoid concentrated exposure to both noise and hazards.148
3 Dr. Pacl noted that Plaintiffs inflammatory markers were in the
4 normal range.149
5 The ALJ found both Dr. Magdaleno’s and Dr. Pacl’s opinions
6 persuasive because 1) they supported their opinions by fully reviewing
7 the then-available medical evidence and citing to the relevant
8 supporting evidence, and 2) their opinions were generally consistent
9 with the longitudinal medical evidence including treatment notes with
10 benign exam findings, no hospitalizations, and extensive range of
11 activities of daily living including consistent regular exercise.150
12 In evaluating Dr. Magdaleno’s and Dr. Pacl’s opinions the ALJ
13 did not highlight that they reached different opinions as to Plaintiff’s
14 postural abilities. In addition, the ALJ did not discuss why he found
15
16
147 AR 91.
17
148 AR 92.
18
149 AR 95.
19
150 AR 26.
20
1 Dr. Magdaleno’s and Dr. Pacl’s opinions persuasive while also crafting
2 an RFC that was more restrictive as to postural activities than either
3 Dr. Magdaleno or Dr. Pacl opined: restricting any climbing of ladders,
4 ropes, and scaffolds, and occasional performance of all other postural
5 activities.151
6 4. Analysis as to PA-C Stiles’ opinion on property-tax form
7 The ALJ appropriately found that PA-C Stiles’ conclusion of
8 disability on this form is not persuasive by itself, as the finding of
9 disability is reserved for the Commissioner. However, considering that
10 PA-C Stiles treated Plaintiff for the entirety of the relevant period and
11 reviewed the reports and imaging obtained from referrals to specialists,
12 PA-C Stiles’ opinion in April 2022 that Plaintiff was unable to engage
13 in substantial gainful activity, even if it is conclusory, is useful to
14 consider the consistency of PA-C Stiles’ subsequent opinions.152
15 Moreover, the ALJ failed to consider that the treatment note
16 accompanying this property-tax form states, “Certainly, with the
17
18
151 AR 22, 26.
19
152 20 C.F.R. § 404.1527(d).
20
1 incredibly extensive workup that he has had in regard to his
2 rheumatological condition and his fatigue and disability, I think he is
3 more than qualified to be considered disabled and unable to work at
4 this time.”153 The ALJ failed to fairly and fully consider that
5 PA-C Stiles believed that Plaintiff’s rheumatological condition and
6 fatigue severely impacted his ability to work—an opinion consistent
7 with the more detailed findings contained in his other two statements
8 discussed below.
9 5. Analysis as to PA-C Stiles’ medical source statement
10 The ALJ’s finding that PA-C Stiles’ September 2023 medical
11 source statement was not supported was based solely on that
12 PA-C Stiles’ July 19, 2022 treatment note mentioned that Plaintiff
13 typically presented as a healthy individual. However, the ALJ failed to
14 consider the full context of this statement, which was:
15 Polyarthritis inflammatory; Systemic lupus – We discussed
continued follow up with Arthritis Northwest for
16 maintenance of his new medications. Physical exam
findings were unremarkable today but he does report
17 subjective muscle fatigability. I discussed that with all of
his laboratory findings showing significant autoimmune
18
19
153 AR 1621.
20
1 processes that I would certainly support any disability claim
that he may have. He typically always presents as a healthy
2 individual but his laboratory workup would seem to show
otherwise and some of his medications that he is on certainly
3 could lend themselves to very easy fatigability. I discussed
that continued follow up with Arthritis Northwest though
4 would hopefully yield good results.154
5 PA-C Stiles recognized that given Plaintiff’s autoimmune disorders it
6 was not unexpected that Plaintiff could appear healthy. PA-C Stiles
7 further recognized that Plaintiff’s labs showed that he had
8 inflammatory activity in his body and that the medications that he
9 took to address his autoimmune disorders could cause fatigue.
10 Therefore, the ALJ’s failure to consider the full context of the
11 PA-C Stiles’ comment about Plaintiff’s “healthy” presentation
12 consequently impacted the ALJ’s supportability finding.
13 Likewise, the ALJ’s consistency analysis failed to consider that
14 Plaintiff’s symptoms related to his autoimmune conditions may not be
15 readily observed during an appointment. Even if he presented as
16 “healthy” or with full strength, normal gait, and no joint swelling or
17 tenderness, Plaintiff’s labs often reflected inflammatory activity in the
18
19
154 AR 1608 (emphasis added).
20
1 body, and as PA-C Stiles recognized even if medication reduced the
2 inflammatory activity, those medications could themselves cause
3 fatigue.155
4 In addition, the treatment records reflect that during physical
5 therapy, Plaintiff was observed with quick fatigue of scapular
6 retraction with exercises, balance issues during physical therapy, and
7 slight tremors in the lower extremities, or fatigue when lifting and
8 holding objects156; and Dr. Butler found that Plaintiff had “developed a
9 component of ataxia.”157
10 On this record, the ALJ’s consistency analysis—and overall
11 analysis of the medical evidence—reflects a failure to fairly and fully
12 consider the nature of Plaintiff’s conditions, cause for his symptoms,
13 and the side effects of the medications taken to treat them.
14
15
155 See Soc. Sec. Rlg. 16-3p (allowing the medical source to consider
16
medication side-effects and requiring the ALJ to consider medication
17
side-effects when assessing the claimant’s symptom reports).
18
156 AR 783, 802, 1062.
19
157 AR 1973.
20
1 6. Analysis as to PA-C Stiles’ opinions in the September 2023
2 treatment note
3 The ALJ found PA-C Stiles’ lifting and walking opinions in the
4 treatment note unsupported because they were based on Plaintiff’s self-
5 reports rather than any observed limitations in these areas by
6 PA-C Stiles. However, again, the ALJ failed to consider that PA-C
7 Stiles met with and evaluated Plaintiff over several years and had
8 reviewed labs showing positive inflammatory processes, biopsies
9 consistent with small fiber neuropathy, physical therapy records
10 showing observed tremors and muscle fatigue, and imaging showing
11 bilateral basal ganglial and caudate head calcifications and interstitial
12 lung disease. Instead of discussing these findings or that PA-C Stiles
13 believed that Plaintiff’s autoimmune-disorder medications caused
14 fatigue, the ALJ focused on that PA-C Stiles had not observed lifting or
15 walking limitations himself. Given the overall treatment record, the
16 ALJ failed to meaningfully explain why PA-C Stiles’ lifting and
17 walking limitations are not supported by the medical evidence.
18
19
20
1 Finally, although the ALJ reasonably did not adopt PA-C Stiles’s
2 conclusory statements that Plaintiff is disabled, the ALJ’s evaluation of
3 the medical evidence and opinions should have considered that
4 PA-C Stiles found Plaintiff’s overall conditions to be extremely limiting.
5 Moreover, the ALJ failed to mention that treating neurologist Dr. Pugh
6 stated: “Based on what I am seeing the degree of his anxiety
7 surrounding his condition is so extreme that I do not see how he could
8 ever possibly work and that may be a primary disorder of his as
9 well.”158
10 B. Other Steps: The ALJ must reevaluate on remand.
11 The ALJ’s errors when evaluating PA-C Stiles’ medical opinions
12 impacted her sequential analysis, including her evaluation of Plaintiff’s
13 reports of internal shaking, severe fatigue, intermittent shortness of
14 breath, balance issues, wrist pain, and muscle paralysis with repetitive
15 movements. Remand is required. Furthermore, development of the
16 record requires an extended functionality capacity evaluation be
17 performed to test Plaintiff’s functional abilities with repeated
18
19
158 AR 1635.
20
1 activity.159 Such an evaluation is needed on this record given Plaintiff’s
2 observed muscle intolerance and balance issues during physical
3 therapy and the comments by treating providers that his autoimmune-
4 disorder medication can cause fatigue.
5 IV. Conclusion
6 Plaintiff establishes the ALJ erred. The ALJ is to develop the
7 record and reevaluate—with meaningful articulation and evidentiary
8 support—the sequential process.
9 Accordingly, IT IS HEREBY ORDERED:
10 1. Plaintiff’s Motion for Summary Judgment, ECF No. 10, is
11 GRANTED.
12 2. The ALJ’s nondisability decision is REVERSED, and this
13 matter is REMANDED to the Commissioner of Social
14
15
159 20 C.F.R. §§ 404.1519a, 404.1517. See Celaya v. Halter, 332 F.3d
16
1177, 1183 (9th Cir. 2003) (“The ALJ always has a special duty to fully
17
and fairly develop the record” to make a fair determination as to
18
disability, even where, as here, “the claimant is represented by
19
counsel.” (cleaned up)).
20
1 Security for further proceedings pursuant to
2 sentence four of 42 U.S.C. § 405(g).
3 3. The Clerk’s Office shall TERM the Commissioner’s brief,
4 ECF No. 12, enter JUDGMENT in favor of Plaintiff, and
5 CLOSE the case.
6 IT IS SO ORDERED. The Clerk’s Office is directed to file this
7 ||order and provide copies to all counsel.
8 DATED this 27 day of January 2026.
□□□ | Lhew.
10 EDWARD F. SHEA
Senior United States District Judge
11
12
13
14
15
16
17
18
19
DISPOSITIVE ORDER - 48