Smith v. Kijakazi
Filing
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ORDER by Judge Jacqueline Scott Corley granting 17 Plaintiff's Motion for Summary Judgment and denying 20 Defendant's Cross Motion for Summary Judgment. (ahm, COURT STAFF) (Filed on 7/29/2022)
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UNITED STATES DISTRICT COURT
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NORTHERN DISTRICT OF CALIFORNIA
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JACQLYN S.,
Plaintiff,
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United States District Court
Northern District of California
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Case No. 21-cv-04248-JSC
ORDER RE: CROSS-MOTIONS FOR
SUMMARY JUDGMENT
v.
KILOLO KIJAKAZI,
Re: Dkt. Nos. 17, 20
Defendant.
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Plaintiff seeks social security benefits for physical and mental impairments, including
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major depressive disorder, post-traumatic stress disorder, anxiety disorder, chronic fatigue
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syndrome, postural orthostatic tachycardia, obstructive sleep apnea, migraine headaches, short-
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term memory deficit, and Lyme disease. (Administrative Record (“AR”) 20, 2052, 2750.)
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Pursuant to 42 U.S.C. § 405(g), Plaintiff filed this lawsuit for judicial review of the Commissioner
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of Social Security’s determination of Plaintiff’s disability onset date. Plaintiff’s and Defendant’s
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motions for summary judgment are now pending before the Court. (Dkt. Nos. 17, 20.) After
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careful consideration, the Court concludes that oral argument is unnecessary. See N.D. Cal. Civ.
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L.R. 7-1(b). The Court GRANTS Plaintiff’s motion, DENIES Defendant’s cross-motion, and
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REMANDS for further proceedings. Because the ALJ’s evaluation of the medical evidence and
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consideration of Plaintiff’s subjective pain testimony is not supported by substantial evidence, and
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there are outstanding issues to be resolved before a disability determination can be made, remand
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for further proceedings is appropriate.
BACKGROUND
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A. Procedural History
Plaintiff applied for Disability Insurance Benefits under Title II of the Social Security Act
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(the “Act”) on April 30, 2015, alleging a disability onset date of July 1, 2011. (AR 396, 409.)
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Plaintiff filed a subsequent application associated with her Title II claim for Supplemental
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Security Income. (AR 396.) Plaintiff’s applications were denied both initially and upon
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reconsideration. (AR 189-193, 199-204.) Plaintiff then submitted a request for a hearing before an
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Administrative Law Judge (“ALJ”). (AR 206-207.) Her hearing was held on December 6, 2017.
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(AR 47.) The ALJ issued an unfavorable decision finding that Plaintiff is not disabled. (AR 177.)
United States District Court
Northern District of California
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Plaintiff then filed a request for a review of the ALJ’s decision. (AR 186.) The Appeals
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Council granted the request “under the error of law and broad policy or procedural issue provision
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of the Social Security Administration regulations (20 CFR 404.970),” and remanded the matter.
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(Id.) A different ALJ held a subsequent hearing on June 30, 2020. (AR 89.) The ALJ issued a
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partially favorable decision, finding that Plaintiff was disabled as of October 1, 2015, but not prior
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to that date. (AR 12, 30-34.) Therefore, Plaintiff was not under a disability within the meaning of
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the Act at any time through March 31, 2014, the date last insured. (Id.) Subsequently, Plaintiff
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sought review in this Court. (Dkt. No. 1.) In accordance with Civil Local Rule 16-5, the parties
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filed cross-motions for summary judgment. (Dkt. Nos. 17, 20.)
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B. Issues for Review
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1. Did the ALJ err in determining Plaintiff’s disability onset date under Social Security
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Ruling 18-1p?
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2. Did the ALJ err in evaluating the medical evidence?
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3. Did the ALJ err in evaluating Plaintiff’s subjective pain testimony?
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4. Did the ALJ err in evaluating lay witnesses?
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5. Should the Court remand for payment of benefits or further proceedings?
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LEGAL STANDARD
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A claimant is considered “disabled” under the Act if she meets two requirements. See 42
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U.S.C. § 423(d); Tackett v. Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999). First, the claimant must
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demonstrate “an inability to engage in any substantial gainful activity by reason of any medically
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determinable physical or mental impairment which can be expected to result in death or which has
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lasted or can be expected to last for a continuous period of not less than 12 months.” 42 U.S.C. §
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United States District Court
Northern District of California
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423(d)(1)(A). Second, the impairment(s) must be severe enough that she is unable to do her
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previous work and cannot, based on her age, education, and work experience “engage in any other
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kind of substantial gainful work which exists in the national economy.” Id. § 423(d)(2)(A). To
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determine whether a claimant is disabled, an ALJ is required to employ a five-step sequential
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analysis, examining: (1) whether the claimant is engaging in “substantial gainful activity”; (2)
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whether the claimant has a “severe medically determinable physical or mental impairment” or
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combination of impairments that has lasted for more than 12 months; (3) whether the impairment
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“meets or equals” one of the listings in the regulations; (4) whether, given the claimant’s RFC, the
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claimant can still do her “past relevant work”; and (5) whether the claimant “can make an
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adjustment to other work.” Molina v. Astrue, 674 F.3d 1104, 1110 (9th Cir. 2012), superseded by
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regulation on other grounds; see 20 C.F.R. § 404.1520(a).
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An ALJ’s “decision to deny benefits will only be disturbed if it is not supported by
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substantial evidence or it is based on legal error.” Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir.
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2005) (cleaned up). “Substantial evidence means such relevant evidence as a reasonable mind
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might accept as adequate to support a conclusion.” Id. (cleaned up). “Where evidence is
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susceptible to more than one rational interpretation, it is the ALJ's conclusion that must be
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upheld.” Id. In other words, if the record “can reasonably support either affirming or reversing,
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the reviewing court may not substitute its judgment for that of the Commissioner.” Gutierrez v.
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Comm'r of Soc. Sec., 740 F.3d 519, 523 (9th Cir. 2014) (cleaned up). However, “a decision
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supported by substantial evidence will still be set aside if the ALJ does not apply proper legal
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standards.” Id.
DISCUSSION
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Since the ALJ found Plaintiff disabled as of October 1, 2015, the sole issue is whether the
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ALJ erred by determining that Plaintiff was not disabled prior to that date. Plaintiff insists that she
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was disabled as of at least April 2013 and contends that the ALJ erred (1) as a matter of law in
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determining Plaintiff’s disability onset date; (2) in her consideration of the medical evidence; (3)
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in her consideration of Plaintiff’s subjective pain testimony; and (4) in her evaluation of lay
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witness testimony.
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United States District Court
Northern District of California
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A. Case Law Cited and Social Security Ruling 18-1p
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Plaintiff contends that the ALJ should have found her disabled no later than April 2013 and
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argues that Social Security Ruling 18-1p and case law support her proposition; however, in
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support of this argument Plaintiff block quotes portions of this Court’s opinion in Polavaa N. v.
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Saul, No. 19-CV-06366-JSC, 2021 WL 1118074 (N.D. Cal. Mar. 24, 2021), but does not explain
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what bearing the decision has on her case. (Dkt. No. 17-1 at 15-17.) Likewise, while Plaintiff
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block quotes from Social Security Ruling 18-1p and argues that “Social Security Ruling 18-1p
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describe the factors an ALJ should consider in determining an onset date of disability” and that the
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ALJ “failed to properly consider these factors in assessing the medical evidence,” Plaintiff does
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not specify which factors the ALJ failed to consider. (Dkt. No. 21 at 6.) Because Plaintiff has
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failed to raise a specific claim of legal error, the Court proceeds to consider her other arguments
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regarding the ALJ’s errors in determining the disability onset date.
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B. Consideration of the Medical Evidence
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In the Ninth Circuit, and under the rules in place at the time Plaintiff filed her
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application for disability benefits, courts must “distinguish among the opinions of three types
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of physicians: (1) those who treat the claimant (treating physicians); (2) those who examine
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but do not treat the claimant (examining physicians); and (3) those who neither examine nor
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treat the claimant (nonexamining physicians).” Lester v. Chater, 81 F.3d 821, 830 (9th Cir.
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1995) (as amended (Apr. 9, 1996)).1 A treating physician’s opinion is entitled to more weight
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than that of an examining physician, and an examining physician’s opinion is entitled to more
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weight than that of a non-examining physician. Orn v. Astrue, 495 F.3d 625, 631 (9th Cir.
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2007). If a treating doctor’s opinion is not contradicted by another doctor, it may be rejected
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only for “clear and convincing” reasons. Baxter v. Sullivan, 923 F.2d 1391, 1396 (9th Cir.
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1991) (internal citations omitted). And “[e]ven if the treating doctor’s opinion is contradicted
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by another doctor, the Commissioner may not reject this opinion without providing ‘specific
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and legitimate reasons’ supported by substantial evidence in the record for so doing.” Lester,
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Effective October 2, 2018, Social Security Ruling 83-20 was rescinded and replaced by Social
Security Ruling 18-1p.
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81 F.3d at 830 (cleaned up). Likewise, “the opinion of an examining doctor, even if
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contradicted by another doctor, can only be rejected for specific and legitimate reasons that
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are supported by substantial evidence in the record.” Id. at 830-31 (cleaned up).
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United States District Court
Northern District of California
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Here, Plaintiff challenges the weight the ALJ gave to the opinions of treating physicians
Dr. Steven Harris and Dr. Charles Fenzi.
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1. Dr. Harris
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Plaintiff contends that the ALJ did not provide “clear and convincing” reasons for
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rejecting Dr. Harris’s opinion. Plaintiff was treated monthly by Dr. Harris beginning in 2016. (AR
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2052.) Dr. Harris completed a medical source statement regarding Plaintiff’s physical
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impairments in May 2017. (AR 2059.) Further, in May 2017, Dr. Harris opined that Plaintiff’s
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symptoms, such as severe fatigue and marked cognitive loss, and positive findings of co-incident
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infections were consistent with chronic Lyme disease. (AR 2060.) He also determined that
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Plaintiff exhibited 12 out of 16 objective medical signs listed on the medical source statement and
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all of the symptoms listed on the statement. (AR 2054.) Dr. Harris believed these symptoms and
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medical impairments would result in Plaintiff being absent for more than 4 days per month and he
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determined that Plaintiff would have to take breaks during work every 30 minutes for an average
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of one hour. (AR 2058.)
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Most important to this appeal, he also concluded that Plaintiff “had been experiencing a
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profound degree of symptoms for at least 18 to 24 months” before an April 2015 serological
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finding. (AR. 2061.) In reaching this conclusion, Dr. Harris relied on correlate testing of Lyme
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disease that occurred prior to when he became Plaintiff’s treating physician. (Id.) Thus, in
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evaluating those tests, Dr. Harris was arguably acting as an examining physician rather than a
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treating physician. Neither party addresses whether an examining physician’s or a treating
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physician’s legal standard should be applied to this portion of Dr. Harris’s opinion. The Court
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will apply the standard that applies to an examining physician, which requires the ALJ to give
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“specific and legitimate” reasons for rejecting the examining physician’s opinion. Lester, 81 F.3d
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at 830-831.
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Here, the ALJ gave Dr. Harris’s opinion little weight because it (1) was “not particularly
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United States District Court
Northern District of California
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well supported by his own treatment notes,” and (2) was inconsistent with the longitudinal
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evidence. (AR 27.) As a preliminary matter, although Plaintiff’s summary judgment motion
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challenges the ALJ’s rejection of Dr. Harris’s opinion, the Commissioner’s opposition does not
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address Dr. Harris’s opinion at all. (Compare Dkt. No. 17-1 at 22-24 with Dkt. No. 20.)
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Nonetheless, the Court has reviewed the ALJ’s decision and the controlling law to determine if the
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ALJ gave “specific and legitimate” reasons for giving little weight to Dr. Harris’s opinion. She
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did not.
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First, the ALJ’s finding that Dr. Harris’s treatment notes do not support his opinion is not
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sufficiently specific to support discounting Dr. Harris’s opinions. See McAllister v. Sullivan, 888
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F.2d 599, 602 (9th Cir. 1989) (internal citations omitted) (rejecting the ALJ’s reliance on “broad
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and vague” reasons for discounting treating physician’s opinion). The ALJ found that Dr. Harris’s
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notes reflected only minimal abnormalities and conservative treatment recommendations that
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failed to align with his opinion of Plaintiff’s severe limitations. (AR 27.) The ALJ cites to two
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2017 office visit notes from Dr. Harris in support of her conclusion. (Id.) In the first note, Dr.
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Harris reports that Plaintiff has “felt a little better than previous months,” but she is “still only
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45% improved” and continues to suffer from extreme fatigue and cognitive dysfunction. (AR
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1736.) In the second note, he reports “[g]etting ready to do stem cells, but really nervous of what
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is happening in the lower bowel,” and “[t]oday the pelvic pain is better, at it’s worse it’s an 8/10
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high pain.” (AR 2201.) The ALJ did not explain how these treatment notes and clinical findings
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did not support Dr. Harris’s opinions as to Plaintiff’s symptoms before October 2015 and it is not
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apparent from the notes themselves. (See AR 26-27.); see Reddick v. Chater, 157 F.3d 715, 725
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(9th Cir. 1998) (“The ALJ must do more than state conclusions. [Sh]e must set forth h[er] own
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interpretations and explain why they, rather than the doctors’, are correct.”).
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The ALJ also found that Dr. Harris’s opinion regarding Plaintiff’s functional limitations
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were inconsistent with his reports showing “poor to fair prognosis, infectious agents,
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neuropsychological testing, immune suppression, muscle twitching, spasms, tenderness, weakness,
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trigger tender points, abnormal neurological reflexes, skin rashes, cough, insomnia, swollen lymph
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nodes, and slowed or slurred speech.” (AR 27, referencing AR 2053-2061.) However, the ALJ
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did not explain which of Plaintiff’s limitations assessed by Dr. Harris were inconsistent with
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which portions of his treatment notes. (See AR 27.); see Garrison v. Colvin, 759 F.3d 995, 1012–
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1013 (9th Cir. 2014) (“[A]n ALJ errs when [s]he rejects a medical opinion or assigns it little
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weight while doing nothing more than ignoring it, asserting without explanation that another
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medical opinion is more persuasive, or criticizing it with boilerplate language that fails to offer a
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substantive basis for [her] conclusion.”). The ALJ also did not specify which treatment
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recommendations were regarded as “conservative.” (Id.) Therefore, the ALJ’s broad reference to
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the medical record does not provide “specific and legitimate reasons” to discount Dr. Harris’s
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opinion.
United States District Court
Northern District of California
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Moreover, the ALJ ignored that Dr. Harris’s limitations were based on positive laboratory
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findings and an evaluation of Plaintiff’s symptoms like profound fatigue, muscle and joint pains,
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and cognitive loss, which he found to be consistent with chronic Lyme disease. (AR 2052-2054,
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2061.) Based on correlate tests for Lyme disease, in particular the CD57 finding, Dr. Harris
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concluded that Plaintiff “had been experiencing a profound degree of symptoms for at least 18 to
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24 months” before an April 2015 serological finding. (AR. 2061.) According to this conclusion,
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Plaintiff’s symptoms could have begun as early as April 2013, which would support an earlier
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onset date. All of these clinical findings appear in the record, and Dr. Harris’s assessment of
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Plaintiff’s limitations such as standing for less than an hour, walking for less than an hour, sitting
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for up to 25 minutes, and limited repetitive reaching, handling, or fingering are logically tied to
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these symptoms. (AR 2052-2059.); see David D. v. Saul, No. 20-CV-02696-JSC, 2021 WL
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2476740, at *7 (N.D. Cal. June 17, 2021) (finding that Plaintiff’s “standing, walking, sitting,
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postural, and manipulative limitations” were “logically tied to “Plaintiff's pain level, diffuse
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tenderness all over Plaintiff’s body, numbness in Plaintiff's arms and legs, and reduced range of
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motion in Plaintiff's neck and back”). Thus, there are no obvious inconsistencies between the
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treatment notes and Dr. Harris’s medical opinion forms. See Nguyen v. Chater, 100 F.3d 1462,
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1465 (9th Cir.1996) (“Where the purported existence of an inconsistency is squarely contradicted
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by the record, it may not serve as a basis for the rejection of an examining physician’s
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conclusions.”).
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United States District Court
Northern District of California
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Second, the ALJ found that Dr. Harris’s opinions were inconsistent with “longitudinal
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evidence, given the intermittency of abnormalities and typically normal findings upon diagnostic
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testing and imaging.” (AR 27.) The ALJ relied on reports of diagnostic testing that contain varied
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findings depending on the area being tested. (See AR 24, 25, referencing, AR 619-631, 632-650,
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724-734, 761-805, 806-889, 925-937, 938-986, 1071-1270.) For example, a June 2014
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neuropsychological assessment noted that Plaintiff’s “[h]eart rate responses to deep breathing and
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the Valsalva maneuver were normal” and “QSWEAT responses were normal for all sites.” (AR
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1113.) The same report also noted that “protocol is abnormal. It suggests mild to moderate
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cognitive impairment. Neurologically-based cognitive compromise cannot be ruled out.” (AR
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1107.) Another report taken in March 2014 noted that Plaintiff’s cardiovascular results were
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normal, but also reported that Plaintiff had abnormal test results in other areas. (AR 768, 765.)
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The Court agrees that the reports display intermittent abnormal results, however the ALJ does not
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explain how these intermittent abnormal results are inconsistent with Dr. Harris’s opinion. (See
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AR 27.); see David D. v. Saul, No. 20-CV-02696-JSC, 2021 WL 2476740, at *7 (N.D. Cal. June
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17, 2021) (finding that the ALJ did not give a ‘specific and legitimate reason supported by
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substantial evidence’ to discount Plaintiff’s doctor’s opinion because the ALJ did not explain
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which treatment notes and clinical findings contradicted his opinion.). Additionally, the rest of the
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cited diagnostic testing that the ALJ relied on occurred in 2011 and 2012 but, evidence from that
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period does not contradict Dr. Harris’s opinion because he concluded that Plaintiff had been
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experiencing severe symptoms from around April 2013 to October 2014. (AR 20, 23, 2061.)
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Accordingly, the ALJ failed to provide “specific and legitimate reasons” for giving limited
weight to Dr. Harris’s medical opinion regarding Plaintiff’s limitations before October 2015.
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2. Dr. Fenzi
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Plaintiff also argues that the ALJ improperly rejected portions of Dr. Fenzi’s opinion
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showing that Plaintiff was disabled before October 2015. As Dr. Fenzi was one of Plaintiff’s
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treating doctors, the ALJ was required to provide “clear and convincing” reasons for rejecting his
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opinion. Baxter, 923 F.2d at 1396. The Court finds that the ALJ did not meet this standard in part.
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Dr. Fenzi provided his medical opinion in two separate forms in October 2015. (AR 23108
United States District Court
Northern District of California
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2318.) The ALJ relied on Dr. Fenzi’s findings to establish the October 2015 disability onset date.
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(AR 31-32.) In particular, the ALJ noted “[s]ince the established onset date, Dr. Fenzi’s opinion is
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supported by his clinical impressions, as he documented the claimant’s severe recurrent major
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depressive disorder with a significant delusional component starting in October 2015.” (AR 31
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(internal citations omitted).) However, the ALJ gave less weight to Dr. Fenzi’s opinions regarding
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limitations prior to October 2015 because she found his opinion was inconsistent with the
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evidence regarding Plaintiff’s “relatively intact activities of daily living.” (AR 28.)
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In particular, the ALJ highlighted Plaintiff’s ability to maintain a driver’s license and travel
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independently. (AR 26.) However, the ALJ ignored the significant hardship that performing these
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activities caused Plaintiff. (AR 68-69, 110-112.); see Gallant v. Heckler, 753 F.2d 1450, 1456 (9th
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Cir. 1984) (internal citations omitted) (The ALJ “cannot reach a conclusion first, and then attempt
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to justify it by ignoring competent evidence in the record that suggests an opposite result."). For
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example, while Plaintiff took one recreational solo out-of-state trip in 2014 to attend her best
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friend’s funeral (AR 110-111), the flight triggered a migraine and when she arrived at the funeral,
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she was not able to interact with others because of her fatigue. (AR 122-123.) Plaintiff did travel
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internationally to Costa Rica and Mexico without any travel illness, but those trips occurred in
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2006 and 2011, which is before the disability date alleged by Plaintiff. (AR 1754, 1498.)
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Additionally, Plaintiff would typically drive only about 10 minutes to get to school and was only
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able to drive for a total of 40 minutes before having to take a break. (AR 67, 68.) Thus, Plaintiff’s
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driving and purported travel are not clear and convincing” reasons for giving limited weight to Dr.
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Fenzi’s medical opinion regarding Plaintiff’s limitations before October 2015.
Plaintiff’s Subjective Pain Testimony
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C.
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The Ninth Circuit has “established a two-step analysis for determining the extent to which
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a claimant’s symptom testimony must be credited.” Trevizo v. Berryhill, 871 F.3d 664, 678 (9th
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Cir. 2017). “First, the ALJ must determine whether the claimant has presented objective medical
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evidence of an underlying impairment which could reasonably be expected to produce the pain or
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other symptoms alleged.” Lingenfelter v. Astrue, 504 F.3d 1028, 1036 (9th Cir. 2007) (cleaned
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up). “Second, if the claimant meets this first test, and there is no evidence of malingering, the ALJ
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can reject the claimant’s testimony about the severity of her symptoms only by offering specific,
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clear and convincing reasons for doing so.” Id. (cleaned up). If the ALJ’s assessment “is
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supported by substantial evidence in the record, [courts] may not engage in second-guessing.” See
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Thomas v. Barnhart, 278 F.3d 947, 959 (9th Cir. 2002) (cleaned up).
United States District Court
Northern District of California
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Here, applying the two-step analysis, the ALJ first determined that Plaintiff’s subjective
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pain testimony “could reasonably be expected to produce the alleged symptoms.” (AR 22.) Since
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Plaintiff met the first part of the test, the ALJ had to find evidence of malingering or provide
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“specific, clear and convincing reasons” for rejecting Plaintiff’s testimony regarding the severity
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of her symptoms. Lingenfelter, 504 F.3d at 1036. The ALJ found no evidence of malingering, but
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found that Plaintiff’s “statements concerning the intensity, persistence and limiting effects of these
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symptoms are not entirely consistent with the medical evidence and other evidence in the record.”
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(AR 22.) The ALJ provided three reasons for her conclusion: (1) Plaintiff’s symptom testimony
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of her “impairments and functional limitations prior to October 2015” were not supported by the
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objective medical evidence in the record; (2) Plaintiff’s treatment received before October 2015
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was limited and conservative; and (3) Plaintiff’s activities before October 2015 were inconsistent
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with a finding of severe impairment. (AR 23, 28.)
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1. Plaintiff’s Symptom Testimony is Consistent with the Medical Evidence
First, the ALJ found that Plaintiff’s limitations prior to October 2015 were inconsistent
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with the medical evidence in the record. (AR 23.) A lack of objective medical evidence to fully
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corroborate the severity of a claimant’s symptoms is insufficient on its own, to reject the
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claimant’s testimony. Bunnell v. Sullivan, 947 F.2d 341, 345 (9th Cir. 1991) (en banc) (internal
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citations omitted). Here, although the ALJ listed several physical and mental examinations that
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she found undermined Plaintiff’s testimony, she did not explain which of these findings
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contradicted Plaintiff’s specific statements regarding her limitations. (AR 23-25); Brown-Hunter
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v. Colvin, 806 F.3d 487, 489 (9th Cir. 2015) (holding that ALJ is required to “specify which
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testimony she finds not credible and then provide clear and convincing reasons . . . to support that
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credibility determination”).
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The ALJ’s finding that Plaintiff was not consistently disabled prior to October 1, 2015,
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United States District Court
Northern District of California
1
rests on a few examples of temporary small improvements and overlooks other examples of
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temporary worsening and the overall severity of Plaintiff’s decreased functionality. (Compare AR
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2264 (On a February 2014 visit, Plaintiff “reports that she is better physically and mentally.”), AR
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2278 (On a report signed March 2014, “She [plaintiff] feels she is doing well without
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medication.”), AR 24 (“[S]ome abnormalities were seen at a January 2018 neuropsychological
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evaluation in (52F/18-24), but the validity of test results were challenged due to variability and the
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claimant’s inconsistent performance”), with AR 529 (From August 2010 to June 2011, Plaintiff
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sought chiropractic care from providers, who noted that Plaintiff’s “symptoms of pain, fatigue,
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anxiety, and cognitive decline.”), AR 65 (In 2012, Plaintiff had to stop attending classes regularly
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due to her fatigue.), AR 126-128 (Since 2014, Plaintiff experienced cognitive issues, including
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significant memory loss and nearly daily migraines that could sometimes last up to a week.), AR
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2751 (Since 2014, the “variety and severity” of Plaintiff’s symptoms made her entire day “have to
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revolve around managing them”)). The ALJ also ignored the opinions of Dr. Harris and Dr. Fenzi,
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which corroborated Plaintiff’s symptom testimony. (See AR 2749 (noting Plaintiff’s fatigue began
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sixteen years before October 13, 2016), AR 2060 (finding that as of April 2015, Plaintiff’s
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symptoms were “highly correlated with persistent Lyme infection of long duration”), Id. (finding
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that before August 2014 “neuropsychological testing showed cognitive impairments in areas of the
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brain associated with Lyme infection”).
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The ALJ’s reliance on “cherry-picked” evidence of some functional improvements at
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certain times does not rise to the level of a specific, clear, and convincing reason to discount any
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part of Plaintiff’s testimony. See Williams v. Colvin, No. ED CV 14-2146-PLA, 2015 WL
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4507174, at *6 (C.D. Cal. July 23, 2015) (cleaned up) (“An ALJ may not cherry-pick evidence to
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support the conclusion that a claimant is not disabled, but must consider the evidence as a whole
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in making a reasoned disability determination.”).
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2. Lack of Consistent Treatment Prior to October 2015
Second, the ALJ found that the treatment Plaintiff received before October 2015 was
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limited and conservative and, therefore, did not support her functional limitations for that period.
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(AR 28.) The ALJ stated that although there “are notes of prescribed medications for mental
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health such as Clonazepam once a day for short periods such as in early 2014, such use was
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intermittent and there is no history of psychiatric hospitalization, thoughts of self-harm, or
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residential psychiatric treatment.” (AR 24.) However, before the ALJ can discount Plaintiff’s
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symptom testimony based on treatments not pursued by Plaintiff, the ALJ is required to analyze
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the reasons Plaintiff gave for not pursuing the treatments. See Orn, 495 F.3d at 638 (cleaned up)
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(“[A]n adjudicator must not draw any inferences about an individual’s symptoms and their
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functional effects from a failure to seek or pursue regular medical treatment without first
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considering any explanations that the individual may provide, or other information in the case
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record, that may explain infrequent or irregular medical visits or failure to seek medical
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United States District Court
Northern District of California
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treatment.”).
Here, Plaintiff offered explanations for her intermittent health treatment and decline of
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psychiatric medication. She testified that in 2014 treatments such as IV antibiotics helped
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alleviate her symptoms, but she had to discontinue the process because she was not able to afford
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them. (AR 77.) She also testified that she tried several mental health medications, but they
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resulted in side effects, such as nightmares and weight gain. (AR 22, 117.) Additionally, starting
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around 2012, she would drive herself once a week to the acupuncturist to alleviate her pain, but
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often had to cancel appointments because of her health. (AR 121, 739.) The ALJ did not discuss
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whether these reasons justified Plaintiff’s decision to pursue “conservative” treatment. (See AR
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24.) Moreover, Plaintiff was not insured and “failure to receive medical treatment during the
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period that [s]he had no medical insurance cannot support an adverse credibility finding.” Orn,
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495 F.3d at 638.
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Having failed to address the reasons Plaintiff gave for her intermittent health treatment
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and declining medication, the ALJ erred by relying on those treatment decisions to discount
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Plaintiff’s testimony.
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3. Plaintiff’s Activities of Daily Living
Third, the ALJ found that Plaintiff’s activities before October 2015 were inconsistent with
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the severity of the limitations alleged. (AR 23, 25.) “[T]he ALJ may use ordinary techniques of
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credibility evaluation, including assessing inconsistencies either in the claimant's testimony or
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between the testimony and the claimant's conduct . . . and whether the claimant engages in daily
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activities inconsistent with the alleged symptoms.” Molina v. Astrue, 674 F.3d 1104, 1112 (9th
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Cir. 2012). If the ALJ makes a “specific finding” that the plaintiff “is able to spend a substantial
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part of [her] day engaged in pursuits involving the performance of physical functions that are
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transferable to a work setting,” that “may be sufficient to discredit a claimant’s [symptom]
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allegations.” Vertigan v. Halter, 260 F.3d 1044, 1049 (9th Cir. 2001) (citation omitted).
United States District Court
Northern District of California
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The ALJ found that Plaintiff’s activities prior to October 2015, such as household chores,
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driving, living with a roommate, attending classes, shopping, and her single solo cross-country trip
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in 2014, suggested fewer limitations than alleged by Plaintiff. (AR 23, 27-28, 63-71, 105, 108-09,
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111-12). Plaintiff did engage in daily living activities such as attending school part-time, driving
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for up to 40 minutes, living with a roommate, and taking monthly grocery trips. (AR 65-67.)
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However, her ability to perform these activities is not a specific, clear, and convincing basis on
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which to discredit her symptom testimony. See Garrison, 759 F.3d at 1016 (finding that “the
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ability to talk on the phone, prepare meals once or twice a day, occasionally clean one’s room,
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and, with significant assistance, care for one’s daughter, all while taking frequent hours-long rests,
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avoiding any heavy lifting, and lying in bed most of the day” . . . did not “satisfy the requirement
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of a clear, convincing, and specific reason to discredit” a plaintiff’s testimony.). Moreover, these
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activities are not inconsistent with her inability to perform activities that would be expected of her
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in a work setting. See Fair v. Bowen, 885 F.2d 597, 603 (9th Cir.1989) (“[M]any home activities
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are not easily transferable to what may be the more grueling environment of the workplace, where
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it might be impossible to periodically rest or take medication.”).
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Further, the ALJ did not make a “specific finding” that Plaintiff “is able to spend a
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substantial part of [her] day” engaged in these activities. Vertigan, 260 F.3d at 1049. And, to the
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contrary, Plaintiff testified that since March 2014, her chronic fatigue has been increasingly
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severe, with only a few “good days here and there.” (AR 125.) Plaintiff categorized a good day as
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a day where she could get out of bed, brush her teeth, and bathe on her own. (Id.) The ALJ
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nevertheless found that Plaintiff’s “ability to learn, recall, or use information to perform work
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activities independently, appropriately” was not effectively limited because she was able to
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maintain a driver’s license and drive independently. (AR 25.) However, the ALJ failed to consider
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that Plaintiff was only able to drive for a total of 40 minutes before having to take a break. (AR
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68.) Additionally, from 2011 to 2014, Plaintiff lived with boyfriends that would help her
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complete all her tasks, including household chores and cooking. (AR 63-65.) Moreover, while she
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was in school, she would take resting breaks in between classes and classmates would assist her
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when she had postural orthostatic tachycardia syndrome episodes. (AR 70, 75.) She had special
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accommodations from professors to allow her to lay down during class. (AR 120.) Eventually,
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Plaintiff ceased attending classes completely because she felt “too sick.” (AR 67.)
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Northern District of California
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Thus, the record does not support a specific finding that Plaintiff was able to spend a
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substantial part of the day performing these activities. See Diedrich v. Berryhill, 874 F.3d 634,
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642–43 (9th Cir. 2017) (“The ALJ took note of certain daily activities that [plaintiff] could
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perform, such as bathing, cooking, taking care of her cat, chores around the house, shopping,
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paying bills, and using a checkbook. But the ALJ ignored other evidence showing the difficulties
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[plaintiff] faced in everyday life.”).
***
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In sum, none of the reasons given by the ALJ rise to the level of a “specific, clear and
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convincing” reason to discount Plaintiff’s testimony and the ALJ’s rejection of Plaintiff’s
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testimony was in error.
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C. Harmless Error
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Because the ALJ’s consideration of the medical evidence and subjective pain testimony are
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not supported by substantial evidence, the ALJ’s decision cannot stand. Given this, the Court
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need not consider Plaintiff’s additional arguments regarding the ALJ’s errors with respect to the
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lay witness testimony. Since the ALJ’s errors here collectively go to the center of the disability
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determination, they are not harmless. See Treichler v. Comm’r of Soc. Sec. Admin., 775 F.3d 1090,
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1099 (9th Cir. 2014) (cleaned up) (“An error is harmless if it is inconsequential to the ultimate
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nondisability determination, or if the agency’s path may reasonably be discerned.”); See also Stout
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v. Comm’r, Soc. Sec. Admin., 454 F.3d 1050, 1056 (9th Cir. 2006) (“[A] reviewing court cannot
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consider the error harmless unless it can confidently conclude that no reasonable ALJ, when fully
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United States District Court
Northern District of California
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crediting the testimony, could have reached a different disability determination.”).
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D. Remand for Benefits or Further Proceedings.
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Plaintiff asks the Court to remand the case for the payment of benefits or, alternatively, for
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further proceedings. When courts reverse an ALJ’s decision, “the proper course, except in rare
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circumstances, is to remand to the agency for additional investigation or explanation.” Benecke v.
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Barnhart, 379 F.3d 587, 595 (9th Cir. 2004) (cleaned up). A remand for an award of benefits is
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proper, however, “where (1) the record has been fully developed and further administrative
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proceedings would serve no useful purpose, (2) the ALJ has failed to provide legally sufficient
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reasons for rejecting evidence, whether claimant testimony or medical opinion; and (3) if the
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improperly discredited evidence were credited as true, the ALJ would be required to find the
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claimant disabled on remand.” Revels v. Berryhill, 874 F.3d 648, 668 (9th Cir. 2017) (cleaned up).
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Here, the first prong of the test is not satisfied because the record has not been fully
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developed. There are outstanding issues that must be resolved before a final determination can be
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made given the Court’s conclusion that the ALJ erred concerning (1) her weighing of the medical
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evidence; and (2) her weighing of Plaintiff’s subjective pain testimony. Next, as discussed above,
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the second prong of the test has been satisfied because the ALJ gave legally insufficient reasons
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for discounting Plaintiff’s symptom testimony and Dr. Harris’s and portions of Dr. Fenzi’s
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medical opinions relating to her limitations prior to October 2015. However, the third prong is not
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satisfied because it is unclear from the record that the ALJ would be required to find Plaintiff
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disabled prior to October 2015 were the evidence properly evaluated.
CONCLUSION
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For the reasons set forth above, the Court GRANTS Plaintiff’s motion, DENIES
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Defendant’s cross-motion, and REMANDS for further proceedings consistent with this Order.
This Order disposes of Dkt. Nos. 17 and 20.
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//
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//
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IT IS SO ORDERED.
Dated: July 29, 2022
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JACQUELINE SCOTT CORLEY
United States District Judge
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United States District Court
Northern District of California
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