The opinion
1
2
3
4 UNITED STATES DISTRICT COURT
5 NORTHERN DISTRICT OF CALIFORNIA
6
7 M.J., Case No. 25-cv-07221-LJC
8 Plaintiff,
ORDER RESOLVING SOCIAL
9 v. SECURITY ACTION
10 SSA COMMISSIONER, et al., Re: Dkt. Nos. 20, 22
Defendants.
11
12 Plaintiff M.J.1 challenges the final decision of the Commissioner of Social Security (the
13 Commissioner) denying her applications for social security disability insurance benefits and
14 supplemental security income benefits. See ECF No. 1 (Compl.) ¶ 6. M.J. and the Commissioner
15 consented to magistrate judge jurisdiction and filed briefs on the merits in accordance with the
16 Federal Rules of Civil Procedure’s Supplemental Rules for Social Security Actions Under 42
17 U.S.C. § 405(g). ECF Nos. 20, 22. For the reasons discussed below, the Court finds in favor of
18 M.J. The matter is REMANDED for further administrative proceedings consistent with this
19 Order. The Clerk shall enter judgment in favor of M.J.
20 I. BACKGROUND
21 M.J. is a fifty-five-year-old woman who lives with her children in Hayward, California.
22 AR at 44, 103.2 She applied for disability benefits on November 17, 2022, claiming a disability
23 onset date of September 15, 2018. Id. at 226. She suffers from migraines, generalized anxiety
24
1 Because opinions by the Court are more widely available than other filings, and this Order
25
contains potentially sensitive medical information, this Order refers to the plaintiff only by her
initials. This Order does not alter the degree of public access to other filings in this action
26
provided by Rule 5.2(c) of the Federal Rules of Civil Procedure and Civil Local Rule 5-
1(c)(5)(B)(i).
27
2 This Order cites to the administrative record using the continuous page numbers applied by the
1 disorder, obesity, and hypertension, among other conditions, which she claims prevent her from
2 working. Id. at 254. M.J. previously worked as a home health aide and cook at an assisted living
3 facility but has not worked since her alleged disability onset date. Id. at 255; see id. at 45-49.
4 M.J.’s applications for benefits were denied initially on December 27, 2022 and on
5 reconsideration on October 26, 2023. Id. at 118, 127. She then requested a hearing in front of an
6 administrative law judge (ALJ). See id. at 156. The administrative hearing was held in front of
7 ALJ Debra Underwood on April 5, 2024. See id. at 35, 181. M.J., who was represented by
8 counsel, testified about her past work experience, medical conditions, and physical and mental
9 limitations. See id. at 44-59. Vocational expert Tavores Boyd testified about the types and
10 number of jobs available in the national economy for a hypothetical individual of M.J.’s age,
11 education, and work experience with varying types of limitations. Id. at 60-65. Following the
12 hearing, ALJ Underwood denied M.J.’s applications. Id. at 14-30. M.J.’s subsequent request for
13 review was denied, id. at 1-6, and she preceded to file the instant lawsuit claiming that the ALJ’s
14 decision was not based on substantial evidence and constituted legal error. See Compl. ¶ 8.
15 A. Medical History
16 This summary is not intended as a complete statement of the administrative record or of all
17 relevant evidence but rather summarizes the medical evidence most pertinent to the ALJ’s
18 decision, the briefs in this matter, and the Court’s analysis.
19 Among other conditions, M.J. suffers from migraines, hypertension, obesity, anxiety, and
20 depression. M.J.’s medical records indicate a history of headaches as early as January 2018. See
21 AR at 602, 655, 678. On October 14, 2019, she saw her doctor for, among other conditions, her
22 “[n]onintractable episodic headache, unspecified headache type.” Id. at 583. She was prescribed
23 amitriptyline and ordered to undergo a head computed tomography (CT) scan, which was normal.
24 Id. at 583, 430, 434. During a doctor’s visit on December 20, 2019, she reported having “frequent
25 headaches” lasting over two hours with photophobia and blurry vision. Id. at 430. At that point,
26 she had been taking ten milligrams of amitriptyline but had not “noticed a difference” in her
27 migraines. Id. Her doctor increased her amitriptyline dosage from ten milligrams to half of a
1 did not provide relief. Id. at 430, 582. (The medical records indicate that M.J. took a full fifty-
2 milligram tablet each night. See id. at 399.) By December 2019, M.J. was also taking citalopram
3 (CeleXA) for her migraines. Id. at 431. She stopped taking citalopram in October 2020 but
4 continued taking the higher dose of amitriptyline. Id. at 576. By December 2021, she was taking
5 sumatriptan (Imitrex) for her migraines in addition to amitriptyline. Id. at 417, 560. Her medical
6 records reflect the increased amitriptyline dosage improved her symptoms and caused her
7 migraines to decrease in frequency from occurring daily to once or twice per week. Id. at 415,
8 424, 426-27. She did not experience auras and her migraines did not last more than seventy-two
9 hours. See id. However, she reported experiencing “acute” and “[t]hrobbing” pain at the back of
10 her head, sensitivity to light, and, at least occasionally, vomiting and nosebleeds. Id. at 410, 416.
11 She was prescribed naproxen for acute headaches. Id. at 416.
12 During this same timeframe, M.J.’s body mass index (BMI) ranged from 38 kg/m2 to 41
13 kg/m2. Id. at 393, 431. She is described as being obese. Id. at 393, 403, 412.
14 B. Administrative Hearing
15 During the administrative hearing, M.J. testified about her prior work experience and
16 current limitations caused by her medical conditions. She testified that she previously worked as
17 the head cook and a home health aide in a residential facility for disabled adults, and before that
18 worked as an in-home support services provider for her elderly father. AR at 45-48. She
19 explained that her jobs at the residential facility required her to be on her feet, climbing and
20 descending stairs, and regularly carrying heavy bags of food. Id. at 46-47.
21 She testified that she stopped working in 2018 because of her migraines and depression
22 caused by an abusive relationship. Id. at 50-51. She testified that she takes Lexapro to treat her
23 depression and amitriptyline for her migraines, id. at 51-52, and explained that she cannot drive
24 because her medications make her drowsy. Id. at 45. When the ALJ asked about her headaches,
25 M.J. explained that she needs to have the lights off and her eyes closed when she had a migraine,
26 because the light hurts her head and eyes. Id. at 53-54. Although she testified that she “rarely”
27 got migraines since starting amitriptyline, she clarified that she still had migraines “twice a week,
1 minutes and she would spend fifteen to twenty minutes in a dark room to protect against light or
2 “loud sounds.” Id. at 58-59. She explained that taking her migraine medication would “put [her]
3 to sleep.” Id. at 54.
4 When asked about her daily route, M.J. testified that after she wakes up each day, she takes
5 her medication and coffee. Id. at 56. Her older children take her youngest son to school and then
6 go to work, leaving her home alone. Id. She explained that she spent her days watching television
7 and doing household chores, such as doing dishes, cleaning the bathroom, and cooking simple
8 meals such as pasta or microwaveable food. Id. She testified that she “can’t stand very . . . long”
9 because her back ached, which she believed was caused by her weight or her feet, and so she
10 completed chores in five-minute increments. Id. at 57. She testified that she got out of breath
11 climbing up the stairs in her house and could walk comfortably for only ten to fifteen minutes. Id.
12 at 57-58.
13 The vocational expert, Tavores Boyd, testified that M.J.’s skills from her prior jobs could
14 transfer to jobs at the “light” exertional level (such as canteen operator, counter attendant, food
15 assembler), but no jobs at the “sedentary” exertional level. Id. at 60-61. The ALJ presented Mr.
16 Boyd with a number of hypotheticals. See id. at 61. First, she asked him if an individual of M.J.’s
17 same age, education, and work experience who had no limits on their ability to sit, stand, or walk;
18 who could carry up to fifty pounds, use stairs, and balance, stoop, kneel, crouch, or crawl
19 occasionally; but who could not use ladders, ropes, scaffolds, or work at unprotected heights could
20 perform M.J.’s prior jobs. Id. at 62. He testified that such an individual could work M.J.’s prior
21 jobs and would also be able to work a number of other jobs at the “medium” exertional level,
22 including packer hand, bagger, and poultry dresser. Id. The ALJ next asked Mr. Boyd if an
23 individual of M.J.’s same age, education, and work experience who could sit for six hours but only
24 walk or stand for two hours per day; who could carry twenty pounds, use ramps and stairs, and
25 balance, stoop, kneel, crouch or crawl occasionally; who could use both arms for fine
26 manipulation; but who could not use ladders, ropes or scaffolds could perform M.J.’s prior jobs.
27 Id. at 62-63. Mr. Boyd testified that such an individual could not work M.J.’s prior jobs, but could
1 then asked Mr. Boyd if work would be available if that hypothetical person “needed additional
2 breaks such that they were off task . . . 15 percent of the time” or absent two days a month. Id. at
3 64. Mr. Boyd testified that these limitations would be work-preclusive, as employees “[t]ypically”
4 tolerated employees being off-task only ten percent of the workday and absent “a maximum of one
5 day per month on a consecutive basis.” Id.
6 C. The Five-Step Framework
7 The Social Security Administration uses a five-step process to determine whether
8 claimants are entitled to disability benefits:
9 Step 1. Is the claimant presently working in a substantially gainful
activity? If so, then the claimant is “not disabled ” within the meaning
10 of the Social Security Act and is not entitled to disability insurance
benefits. If the claimant is not working in a substantially gainful
11 activity, then the claimant’s case cannot be resolved at step one and
the evaluation proceeds to step two. See 20 C.F.R. § 404.1520(b).
12
Step 2. Is the claimant’s impairment severe? If not, then the claimant
13 is “not disabled” and is not entitled to disability insurance benefits. If
the claimant's impairment is severe, then the claimant’s case cannot
14 be resolved at step two and the evaluation proceeds to step three. See
20 C.F.R. § 404.1520(c).
15
Step 3. Does the impairment “meet or equal” one of a list of specific
16 impairments described in the regulations? If so, the claimant is
“disabled” and therefore entitled to disability insurance benefits. If
17 the claimant’s impairment neither meets nor equals one of the
impairments listed in the regulations, then the claimant’s case cannot
18 be resolved at step three and the evaluation proceeds to step four. See
20 C.F.R. § 404.1520(d).
19
Step 4. Is the claimant able to do any work that he or she has done in
20 the past? If so, then the claimant is “not disabled” and is not entitled
to disability insurance benefits. If the claimant cannot do any work he
21 or she did in the past, then the claimant’s case cannot be resolved at
step four and the evaluation proceeds to the fifth and final step. See
22 20 C.F.R. § 404.1520(e).
23 Step 5. Is the claimant able to do any other work? If not, then the
claimant is “disabled” and therefore entitled to disability insurance
24 benefits. See 20 C.F.R. § 404.1520(f)(1). If the claimant is able to do
other work, then the Commissioner must establish that there are a
25 significant number of jobs in the national economy that claimant can
do. There are two ways for the Commissioner to meet the burden of
26 showing that there is other work in “significant numbers” in the
national economy that claimant can do: (1) by the testimony of a
27 vocational expert, or (2) by reference to the Medical–Vocational
entitled to disability insurance benefits. See 20 C.F.R. §§ 404.1520(f),
1 404.1562. If the Commissioner cannot meet this burden, then the
claimant is “disabled” and therefore entitled to disability benefits. See
2 id.
3 Tackett v. Apfel, 180 F.3d 1094, 1098–99 (9th Cir. 1999) (footnote omitted); see also Maxwell v.
4 Saul, 971 F.3d 1128, 1130 n.2 (9th Cir. 2020). “Between the third and fourth steps, an ALJ
5 determines a claimant’s residual functional capacity, i.e., the extent of mental and physical
6 activities a claimant can perform in a work setting despite their limitations.” Nadon v. Bisignano,
7 145 F.4th 1133, 1135–36 (9th Cir. 2025).
8 “At steps one through four, the claimant retains the burden of proof; at step five, the
9 burden shifts to the Commissioner.” Maxwell, 971 F.3d at 1130 n.2. “At step five of the
10 sequential process, the agency may meet its burden either ‘(1) by the testimony of a vocational
11 expert, or (2) by reference to the Medical–Vocational Guidelines,’” known as “the grids,” which
12 are a “short-hand method for determining the availability and numbers of suitable jobs for a
13 claimant.” Id. at 1130 (quoting Tacket, 180 F.3d at 1099, 1101). If the Commissioner
14 conclusively finds the claimant “disabled” or “not disabled” at any point in the five-step process,
15 they do not proceed to the next step. 20 C.F.R. § 404.1520(a)(4).
16 D. The ALJ’s Decision
17 The ALJ issued her decision denying M.J.’s applications for disability benefits on August
18 1, 2024. AR at 14. The decision followed the five-step process outlined above. At step one, the
19 ALJ determined that M.J. did not engage in any substantial gainful activity since September 5,
20 2018, M.J.’s alleged disability onset date. Id. at 19. At step two, the ALJ determined that M.J.
21 suffered from the following severe medically determinable impairments: migraine headaches and
22 obesity. Id. She determined that M.J.’s hypertension and hyperlipidemia were “relevantly
23 asymptomatic” and non-severe, and that her anxiety and depression did “not cause more than
24 minimal limitation in [M.J.’s] ability to perform basic mental work activities and are therefore
25 non-severe.” Id. at 20. At step three, the ALJ determined that M.J.’s impairments did not meet or
26 equal one of the specific impairments listed at 20 C.F.R. §§ 404.1520(d), 404.1525, 414.1526,
27 416.920(d), 416.925, or 416.926. Id. at 23.
1 most” a claimant “can still do despite [their] limitations.” 20 C.F.R. § 416.945(a); see AR at 24.
2 She determined that M.J. had the capacity to perform a limited range of work at “medium”
3 exertional level, as she had “no limitations on sit[t]ing, standing, or walking[;]” could lift and
4 carry fifty pounds occasionally and twenty-five pounds frequently; could occasionally use steps,
5 stairs, and occasionally balance, stoop, kneel, crouch, or crawl; and could never use ladders, ropes,
6 scaffolds, or work at unprotected heights. AR at 24. The ALJ explained that she made this
7 finding after considering “all symptoms and the extent to which these symptoms can reasonably
8 be accepted as consistent with the objective medical evidence and other evidence,” as well as
9 medical opinions and prior administrative medical findings. Id. The ALJ determined that M.J.’s
10 “medically determinable impairments could reasonably be expected to cause some of the alleged
11 symptoms” but that her statements “concerning the intensity, persistence and limiting effects of
12 these symptoms are not entirely consistent with the medical evidence and other evidence in the
13 record.” Id.
14 Addressing M.J.’s migraines, the ALJ determined that “the record is insufficient to support
15 the extent of limitations alleged” or to preclude M.J. from working at the “medium” exertional
16 level. Id. at 25. She explained that the record demonstrated that M.J.’s migraines were
17 “responsive to and/or improved with symptomatic treatments,” that M.J. did not undergo
18 diagnostic brain imaging or EEGs, and did not require “urgent or emergent medical attention” or
19 overnight or inpatient hospital admission related to her migraines. Id. Addressing M.J.’s obesity,
20 the ALJ noted that although M.J. “may have appeared ‘off-balance’ and ‘unsteady’ with
21 ‘abnormal’ rapid alternating movements of the hands and toes” during her consultative physical
22 examination, the record was insufficient to support additional limitations that would preclude M.J.
23 from working at the “medium” exertional level because the record did not include other
24 documentation of “abnormal musculoskeletal or neurological examination findings” or particular
25 physical symptoms, such as chest pain, palpitations, or impaired respiratory or cardiovascular
26 functioning. Id. (quoting AR at 692-93).
27 The ALJ explained that the RFC accounted for M.J.’s limitations caused by her migraines
1 by, among other things, not requiring her to use ladders or scaffolds or working at unprotected
2 heights and limiting her to “occasionally” using stairs, lifting fifty pounds, and stooping,
3 balancing, kneeling, or crawling. Id. at 26.
4 At step four, the ALJ determined that M.J. was unable to perform any relevant work that
5 she had done in the past. The ALJ determined that M.J. did not have “past relevant work,” as
6 defined by 20 C.F.R. §§ 404.1565 and 416.965, as M.J. had not performed substantial and gainful
7 work in the last five years. Id. at 28. However, at step five, the ALJ determined that, based on the
8 vocational expert’s testimony, M.J. would be able to make “a successful adjustment to other work
9 that exists in significant numbers in the national economy,” and thus was not disabled. Id. at 29-
10 30.
11 II. STANDARD OF REVIEW
12 Pursuant to 42 U.S.C. § 405(g), a district court has authority to review a Commissioner’s
13 decision to deny disability benefits to a claimant. “The ALJ is responsible for determining
14 credibility, resolving conflicts in medical testimony, and for resolving ambiguities.” Ahearn v.
15 Saul, 988 F.3d 1111, 1115 (9th Cir. 2021) (quoting Andrews v. Shalala, 53 F.3d 1035, 1039 (9th
16 Cir. 1995)). The district court’s role is “to ensure that the [ALJ’s] decision was supported by
17 substantial evidence and a correct application of the law.” Ludwig v. Astrue, 681 F.3d 1047, 1051
18 (9th Cir. 2012) (quoting Valentine v. Comm’r Soc. Sec. Admin., 574 F.3d 685, 690 (9th Cir.
19 2009)). “‘Substantial evidence’ means more than a mere scintilla, but less than a preponderance,
20 i.e., such relevant evidence as a reasonable mind might accept as adequate to support a
21 conclusion.” Robbins v. Social Sec. Admin., 466 F.3d 880, 882 (9th Cir. 2006). The Court must
22 “consider the entire record as a whole, ‘weighing both the evidence that supports and the evidence
23 that detracts from the Commissioner’s conclusion.’” Lingenfelter v. Astrue, 504 F.3d 1028, 1035
24 (9th Cir. 2007) (quoting Reddick v. Chater, 157 F.3d 715, 720 (9th Cir. 1998)). “Where the
25 evidence can reasonably support either affirming or reversing the decision, [the Court] may not
26 substitute [its] judgment for that of the Commissioner.” Parra v. Astrue, 481 F.3d 742, 746 (9th
27 Cir. 2007). Courts “review only the reasons provided by the ALJ in the disability determination
1 F.3d 995, 1010 (9th Cir. 2014).
2 III. ANALYSIS
3 M.J. argues that the ALJ’s RFC determination, made between the third and fourth steps of
4 the process to determine benefit eligibility, was improper because she rejected M.J.’s symptom
5 testimony without a sufficient basis for doing so. ECF No. 20 at 7. “In determining a claimant’s
6 RFC, an ALJ must consider all relevant evidence in the record, including, inter alia, medical
7 records, lay evidence, and the effects of symptoms, including pain, that are reasonably attributed
8 to a medically determinable impairment.” Robbins, 466 F.3d at 883 (internal quotations omitted).
9 “Careful consideration” must “be given to any evidence about symptoms because subjective
10 descriptions may indicate more severe limitations or restrictions than can be shown by medical
11 evidence alone.” Id. (internal quotations omitted). “An RFC that fails to take into account a
12 claimant’s limitations is defective.” Valentine, 574 F.3d at 690. “[S]ubstantial evidence does not
13 support an ALJ’s RFC assessment if ‘the ALJ improperly rejected [the claimant’s] testimony as to
14 the severity of his pain and symptoms.’” Ferguson v. O’Malley, 95 F.4th 1194, 1199 (9th Cir.
15 2024) (quoting Lingenfelter, 504 F.3d at 1035).
16 A. Legal Standard for Evaluating Symptom Testimony
17 The Ninth Circuit has “established a two-step analysis for determining the extent to which
18 a claimant’s symptom testimony must be credited.” Trevizo v. Berryhill, 871 F.3d 664, 678 (9th
19 Cir. 2017). “First, the ALJ must determine whether the claimant has presented objective medical
20 evidence of an underlying impairment which could reasonably be expected to produce the pain or
21 other symptoms alleged.” Id. (quoting Garrison, 759 F.3d at 1014). “In this analysis, the
22 claimant is not required to show ‘that her impairment could reasonably be expected to cause the
23 severity of the symptom she has alleged; she need only show that it could reasonably have caused
24 some degree of the symptom.’” Garrison, 759 F.3d at 1014 (quoting Smolen v. Chater, 80 F.3d
25 1273, 1282 (9th Cir. 1991)). If the claimant meets this requirement and there is no evidence of
26 malingering, “the ALJ can reject the claimant’s testimony about the severity of her symptoms only
27 by offering specific, clear and convincing reasons for doing so.” Id. at 1014-15 (quoting Smolen,
1 requirement to meet: ‘The clear and convincing standard is the most demanding required in Social
2 Security cases.’” Garrison, 759 F.3d at 1015 (quoting Moore v. Comm’r of Soc. Sec. Admin., 278
3 F.3d 920, 924 (9th Cir. 2002)). To satisfy the “clear and convincing reasons” requirement,
4 “[g]eneral findings are insufficient; rather, the ALJ must identify what testimony is not credible
5 and what evidence undermines the claimant’s complaints.” Brown-Hunter v. Colvin, 806 F.3d
6 487, 493 (9th Cir. 2015) (quoting Reddick, 157 F.3d at 722). The ALJ may “only find an
7 applicant not credible by making specific findings as to credibility and stating clear and
8 convincing reasons for each” finding. Robbins, 466 F.3d at 883. In weighing the claimant’s
9 credibility, the ALJ may consider many factors, including:
10 (1) ordinary techniques of credibility evaluation, such as the
claimant’s reputation for lying, prior inconsistent statements
11 concerning the symptoms, and other testimony by the claimant that
appears less than candid; (2) unexplained or inadequately explained
12 failure to seek treatment or to follow a prescribed course of treatment;
and (3) the claimant’s daily activities.
13
Tommasetti v. Astrue, 533 F.3d 1035, 1039 (9th Cir. 2008) (quoting Smolen, 80 F.3d at 1284).
14
The ALJ may also include observations of treating physicians and “other third parties regarding,
15
among other matters, the nature, onset, duration, and frequency of the claimant’s symptom;
16
precipitating and aggravating factors; [and] functional restrictions caused by the symptoms.”
17
Smolen, 80 F.3d at 1284. The ALJ’s reasons must be “supported by substantial evidence in the
18
record.” Thomas v. Barnhart, 278 F.3d 947, 959 (9th Cir. 2002). An ALJ may not discredit a
19
claimant’s subjective symptom testimony “solely because” their symptoms “are not substantiated
20
by objective medical evidence.” SSR 96-7p, 1996 WL 374186, at *1.
21
B. Analysis
22
There is no dispute that the ALJ determined that M.J. presented medical evidence of her
23
underlying impairments “which could reasonably be expected to produce the pain or other
24
symptoms alleged.” Trevizo, 871 F.3d at 678 (internal quotations omitted); see ECF Nos. 20 at 8,
25
22 at 3; AR at 24 (“I find that the claimant’s medically determinable impairments could
26
reasonably be expected to cause some of the alleged symptoms . . . .”). The ALJ did not cite to
27
any evidence of malingering. See AR at 24. Thus, the ALJ could only discount M.J.’s testimony
1 regarding the severity of her symptoms “by offering specific, clear and convincing reasons for
2 doing so.” Treviso, 871 F.3d at 678.
3 1. Migraines
4 The ALJ determined that M.J.’s claimed symptoms of her migraines were “not entirely
5 consistent with the medical evidence and other evidence in the record.” AR at 24. The ALJ
6 explained that M.J. described experiencing migraines up to two to three times per week, with
7 “accompanying sensitivity to light and loud noise and ‘blurry’ vision,” and that her migraines
8 interfered with her day-to-day activities. Id. at 25. The ALJ determined that the record was
9 insufficient to support the extent of the symptoms alleged, based on the following:
10 For example, the evidence of record demonstrates that the claimant’s
migraine headaches and associated symptoms have been responsive
11 to and/or improved with symptomatic treatments ([Exhibits 5E/5;
1F/15-18, 46, 47-51 & 2F/2], see also Exhibit 1F/38, 43). In addition,
12 the claimant was not referred for additional workup and/or repeat
diagnostic imaging scans of the brain or head, or ambulatory digital
13 electroencephalogram (EEG), to determine the correct headache
diagnosis or exclude secondary causes of these headache episodes,
14 e.g., acute intracranial hemorrhage, cerebral infarct, cortical and
subcortical dysfunction, mass-lesion, vascular malformations,
15 epileptiform discharges, infection, or trauma or injury to the head or
neck (See Exhibit 1F/50). Moreover, the claimant did not require
16 urgent or emergent medical attention with the administering of fluids
and/or “migraine cocktail” on a frequent basis nor did she require
17 overnight observation or inpatient admission for any tension-type
and/or migraine headache attacks lasting more than 72 hours during
18 this period.
19 Id.
20 As explained below, these are not valid reasons to discount M.J.’s symptom testimony
21 regarding the severity of her migraines. First, the medical records are generally consistent with
22 M.J.’s symptom testimony, not inconsistent as the ALJ claims. Second, that M.J.’s symptoms
23 improved with treatment does not mean that her symptoms are not severe or disabling. Third,
24 without evidence that more aggressive treatment was available or would be useful, that M.J. was
25 “not referred for additional” screening or received emergency treatment does not undermine M.J.’s
26 symptom testimony. Id. Lastly, lack of objective medical records showing that she received
27 urgent medical care for her migraines is not a legitimate reason for rejecting M.J.’s symptom
1 Although the ALJ claims that M.J.’s “statements concerning the intensity, persistence and
2 limiting effects of [her] symptoms are not entirely consistent with the medical evidence and other
3 evidence in the record,” the records she cites to in her decision are generally consistent with M.J.’s
4 symptom testimony. Id. at 24. In relevant part, M.J. testified that she used to get daily migraines,
5 but since starting amitriptyline, her migraines decreased in frequency to once or twice per week.
6 Id. at 53. She testified that when she got a migraine, she had to rest in a dark room with the door
7 closed as she was sensitive to light and loud noise. Id. at 58-59. She testified that after she took
8 her medication, it would take twenty to thirty minutes for the medication to take effect and would
9 cause her to fall asleep. Id. at 54. The medical records are generally consistent with this
10 testimony. A progress note from December 20, 2019 reflects that M.J. experienced “frequent
11 headaches” with photophobia and blurry vision that lasted over two hours. Id. at 430. At that
12 point, she took ten milligrams of amitriptyline nightly but did not notice “a difference.” Id. Her
13 dose was increased to half of a fifty-milligram tablet per night, with instructions to increase the
14 dose to the full tablet if the lower dose was not effective. Id. at 433. A progress note from
15 September 2, 2020, indicated that the increased amitriptyline dose was “helping her migraines.”
16 Id. at 429. A progress note from October 21, 2020 described M.J. as not having “that much”
17 headaches, but—consistent with her testimony—noted that she experienced migraines twice per
18 week rather than daily. Id. at 426. Subsequent progress notes confirmed that M.J.’s migraines
19 “[i]mproved with amitriptyline” and she continued to get migraines approximately two times per
20 week rather than every day. Id. at 398, 407, 421. The progress notes consistently indicate that
21 M.J.’s migraines did not last more than seventy-two hours. See id. at 439.
22 Both the medical records and M.J.’s testimony indicate that after M.J. began taking her
23 increased dose of amitriptyline, her migraines decreased in frequency from daily to twice per week
24 and did not last multiple days. Although “inconsistent objective medical evidence in the record”
25 can be used to discount symptom testimony, given the consistency between the medical records
26 and M.J.’s testimony about her symptoms, the ALJ’s decision to discount M.J.’s symptom
27 testimony based on purported inconsistencies with the medical record was erroneous. Ferguson,
1 As described above, both the medical records and M.J.’s testimony reflect that the
2 frequency and severity of M.J.’s migraines decreased when M.J. began taking a high dose of
3 amitriptyline. See AR at 58 (“[S]ince I’m on this medication, it’s twice [a week]”); 407
4 (“Migraine headache frequency is less than before now. Used to have daily. Now 2 times a
5 week.”). The ALJ discounted M.J.’s testimony, in part, because her headaches and associated
6 symptoms had improved with medication, and the Commissioner argues that this is a viable reason
7 for rejecting M.J.’s symptom testimony. Id. at 25; ECF No. 22 at 5. But improvement is relative:
8 the fact that M.J.’s symptoms improved shows that they were not as bad as they once were, not
9 that they improved to a point that they were nondisabling. Garrison, 759 F.3d at 1017 (quoting
10 Holohan v. Massanari, 246 F.3d 1195, 1205 (9th Cir. 2001)) (explaining that medical notes
11 indicating “some improvement does not mean that the person’s impairments no longer seriously
12 affect her ability to function in a workplace”). The ALJ’s evaluation that M.J. improved with
13 treatment, without regard to M.J.’s actual functional abilities, was not a clear and convincing
14 reason to discredit M.J.’s testimony.
15 The ALJ also explained that M.J.’s failure to obtain diagnostic imaging scans or receive
16 “urgent or emergent” medical attention undercut her symptom testimony. AR at 25. The
17 Commissioner contends this is a viable reason for discounting M.J.’s symptom testimony. See
18 ECF No. 22 at 5-6. “[E]vidence of ‘conservative treatment” is a legitimate basis for discounting a
19 claimant’s testimony regarding the severity of an impairment. Parra, 481 F.3d at 751 (quoting
20 Johnson v. Shalala, 60 F.3d 1428, 1434 (9th Cir. 1995)). But what constitutes “conservative
21 treatment” necessarily turns on what treatment is available and “whether a claimant experiencing
22 the symptoms testified to would be expected to seek further treatment.” Remi S. v. Comm’r of
23 Soc. Sec., No. 25-cv-1373, 2025 WL 3653716, at *2 (W.D. Wash. Dec. 17, 2025). M.J.
24 underwent a head CT, which had normal findings, and consistently sought treatment and took
25 prescription medication for her migraines. See AR at 406-07, 426, 430. The ALJ cites to no
26 evidence in the record showing that the “more aggressive treatment options” she describes in her
27 decision “were appropriate or available” to M.J. Lapeirre-Gutt v. Astrue, 382 F. App’x 662, 664
1 treatment options where none exist” or where none would effectively address her symptoms. Id.;
2 see Annette P. v. Comm'r of Soc. Sec. Admin., 578 F. Supp. 3d 1179, 1184 (D. Or. 2022) (finding
3 “plaintiff’s failure to seek” more aggressive treatment when there was “no reference in the record
4 to any additional, available care that plaintiff failed to obtain” not sufficient reason to discount
5 symptom testimony). Absent such evidence, or evidence that M.J. refused treatment that was
6 offered to her, the ALJ’s decision to discount M.J.’s symptom testimony due to an absence of
7 more aggressive treatment or diagnostics was improper.
8 Moreover, to the extent that the ALJ rejected M.J.’s symptom testimony based on a “lack
9 of medical evidence,” such as a lack of medical records showing that M.J. sought emergency
10 treatment, “to fully corroborate the alleged severity of pain,” doing so was improper. Burch v.
11 Barnhart, 400 F.3d 676, 680 (9th Cir. 2005); see Ferguson, 95 F.4th at 1200 (explaining that the
12 “absence of positive medical evidence” did not indicate claimant could not “experience severe and
13 frequent headaches” and thus was not proper basis for discrediting symptom testimony) .
14 The Court accordingly concludes that the ALJ failed to provide clear and convincing
15 reasons, supported by substantial evidence, for discounting M.J.’s symptom testimony regarding
16 her migraines.
17 2. Obesity
18 The ALJ also considered M.J.’s obesity when determining her RFC. See AR at 24-25. In
19 the context of M.J.’s migraines and obesity, the ALJ generically explained that M.J.’s “statements
20 concerning the intensity, persistence and limiting effects of these symptoms are not entirely
21 consistent with the medical evidence and other evidence in the record.” Id. at 24. However, she
22 does not identify what specific testimony or statements M.J. made regarding the symptoms of her
23 obesity are inconsistent with the medical record. See id. at 24-26. This is error. As described
24 above, and ALJ may reject a claimant’s symptom testimony “only by providing specific, clear,
25 and convincing reasons for doing so.” Brown-Hunter, 806 F.3d at 488-89. “This requires the ALJ
26 to specifically identify the testimony [from a claimant] she or he finds not to be credible and .
27 . . explain what evidence undermines that testimony.” Lambert, 980 F.3d at 1277 (internal
1 clear, and convincing reasons for rejecting” a claimant’s symptom testimony where the ALJ does
2 not identify “which testimony she found not credible” and explains “which evidence” contradicts
3 that testimony. Brown-Hunter, 806 F.3d at 494 (emphasis in original). Because the ALJ failed to
4 identify the specific testimony she found not to be credible, the Court is unable to determine
5 whether she made her credibility determination based on clear and convincing reasons supported
6 by substantial evidence. See id.; AR at 24-26.
7 The Court accordingly concludes that the ALJ failed to provide clear and convincing
8 reasons, supported by substantial evidence, for determining that C.P.’s “statements concerning the
9 intensity, persistence and limiting effects of [her] symptoms are not entirely consistent with the
10 medical evidence and other evidence in the record.” AR at 24-25; see Ferguson, 95 F.4th at 1199.
11 The Court also concludes that the ALJ’s errors were not harmless and that remand is
12 warranted. “An error is harmless only if it is ‘inconsequential to the ultimate nondisability
13 determination.’” Lambert, 980 F.3d at 1278 (quoting Brown-Hunter, 806 F.3d at 494). Although
14 the ALJ stated that she “considered the chronicity and intensity of the claimant’s migraine
15 headaches, ongoing efforts to manage them[,] . . . and associated sensitivity to light” as well as the
16 “added effects of [M.J.’s] obesity” when formulating the RFC, the RFC does not account for the
17 severity of M.J.’s symptoms as testified to. AR at 26. For example, M.J. testified that “due to
18 [her] weight” she could only stand comfortably for five minutes and walk for “around” five to
19 fifteen minutes. Id. at 57, 62. The RFC did not limit M.J. to walking or standing for short
20 intervals. See id. at 26. Similarly, although the ALJ states that she “considered” M.J.’s migraine
21 symptoms when formulating the RFC, the RFC does not for M.J.’s testimony regarding the
22 limitations caused by her frequent headaches and sensitivity to light. Thus, while the ALJ may
23 have “considered” M.J.’s symptom testimony, the ALJ clearly discounted M.J.’s symptom
24 testimony when formulating the RFC. Id. This is not to say that, on remand, the ALJ must fully
25 credit M.J’s symptom testimony, but rather there shall be a proper evaluation of M.J.’s symptom
26 testimony, and the formulation of an accurate RFC depends, in part, on the proper evaluation of a
27 claimant’s testimony.. See Lambert, 980 F.3d at 1278. As the ALJ failed to provide specific,
1 was improper. See Ferguson, 95 F 4th at 1199. Remand is thus warranted.
2 M.J. briefly argues that the vocational expert testified that there would be no work
3 available for someone with her described limitations. ECF No. 20 at 15-16. The vocational expert
4 || did not go that far. He testified that someone of M.J.’s age, education, and work experience who
5 could sit for six hours of an eight-hour day (that is, who could perform sedentary work),
6 || occasionally lift twenty pounds and use ramps and stairs, and never use ladders, ropes, or scaffolds
7 || could find work in the national economy. AR at 62-63. He later confirmed that someone with
8 || these same qualifications who needed “additional breaks such that they were off task” fifteen
9 || percent of the time, or were absent two days per month, could not find employment. /d. at 64. He
10 || did not address whether someone with M.J.’s additional claimed limitations—including, among
11 other things, being unable to walk or stand for more than five to fifteen minutes at a time and
12 || needing to retreat to a dark room up to twice each week—would be able to find work. The Court
13 anticipates that on remand, additional testimony from the vocational expert will be necessary so
14 || that the ALJ may make a proper determination as to whether M.J.’s conditions preclude work.
15 | Iv. CONCLUSION
B 16 For the reasons discussed above, the Court REVERSES the Commissioner’s decision
17 || finding M.J. not disabled and denying her application for benefits, and REMANDS the matter for
Zz 18 further administrative proceedings consistent with this Order, including directing the
19 || Commissioner to reevaluate M.J.’s credibility as to the severity of her symptoms and what
20 || limitations to assess based on her symptoms. This may require (but is not limited to) obtaining
21 additional medical records or testimony from M.J. regarding the severity of her symptoms and the
22 || availability and utility of more aggressive courses of treatment. Further testimony from the
23 || vocational expert may also be necessary to permit the ALJ to evaluate whether someone with
24 || M.J.’s limitations could find work in the national economy.
25 IT IS SO ORDERED.
26 || Dated: July 29, 2026
J. CISNEROS
28 ited States Magistrate Judge