Garcia v. Commissioner of Social Security Administration

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WO
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF ARIZONA
Valerie Antionette Garcia,
Plaintiff,
v.
Commissioner of Social Security
Administration,
Defendant.
No. CV-24-00579-TUC-SHR (JR)
ORDER
Plaintiff Valerie Antoinette Garcia (“Garcia”), pursuant to 42 U.S.C. §§ 405(g) and
1383(c)(3), seeks judicial review of a final decision by the Commissioner of the Social
Security Administration (the “Commissioner”). (Doc. 1.) This matter, on referral to the
undersigned United States Magistrate Judge for Report and Recommendation, is ripe for
decision. (Doc. 14, 18, 20, 21.) Garcia seeks remand for the immediate calculation and
award of benefits. (Doc. 18 at 23.) As more fully set forth below, the undersigned
recommends that the district court remand the matter to the agency for further proceedings.
BACKGROUND
Procedural Background
On September 20, 2021, Garcia filed an application for Supplemental Security
Income (“SSI”) and Social Security Disability Income (“SSDI”) benefits alleging disability
beginning on June 15, 2021. (AR 17.) Garcia’s application was denied for SSI and SSDI
benefits both initially and on reconsideration. (AR 102, 107 (initial denial); AR 124, 134
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(reconsideration denial).) On November 21, 2023, Administrative Law Judge (“ALJ”)
Larry E Johnson issued an unfavorable decision. (AR 17-29.) On October 9, 2024, Social
Security Administration Appeals Council denied Garcia’s request for review and adopted
the ALJ’s unfavorable decision as the agency’s final decision. (AR 1-3.)
Relevant Factual Background
Garcia was 27 at the time of her hearing. (Doc. 18 at 2.) She has a ninth-grade
education. (AR 260.) She was previously employed as a janitor, a medium, unskilled job.
(AR 27.) She was terminated from her janitor job on September 30, 2020. (AR 259.) She
has several severe impairments: schizoaffective disorder, bipolar type; borderline
personality disorder; trauma disorder; and substance abuse disorder including
amphetamine and cannabis use. (AR 20.)
Medical Record Summary1
During the relevant period, Garcia received mental health treatment with CODAC,
including with mental health care provider Nurse Practitioner Sharon Grant, BHMP,
FNPBC (“NP Grant”). On June 15, 2021, NP Grant completed a comprehensive psychiatric
evaluation with Garica. (AR 342-46.) During the evaluation, Garcia reported increased
depression and anxiety, and that she was getting angry and blacking out. (AR 346.) Her
symptoms also included irritability, racing thoughts, distractibility, actively refusing to
comply with adult requests, inappropriate or intense anger, excessively reactive mood,
social isolation, and hallucinations. (AR 342, 346.) Garcia reported that it was difficult for
her to keep a job because she was quick to anger and did not like crowds. (AR 344.) NP
Grant recorded that during the evaluation Garcia had an angry mood, an intense affect,
limited fund of knowledge, concrete thought processes, persecutory delusions, and poor
memory, insight, judgment, and concentration. (AR 345.) NP Grant diagnosed Garcia as
having: schizoaffective disorder, bipolar type; oppositional defiant disorder; borderline
personality disorder; amphetamine-induced psychotic disorder; moderate cannabis use
disorder; and unspecified neurodevelopmental and trauma disorders. (AR 345.) NP Grant
1 The medical records summary is primarily taken from Plaintiff’s opening brief to which
no objection has been made.
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prescribed carbamazepine (an anticonvulsant used to treat bipolar disorder), risperidone
(antipsychotic), and Trazodone (antidepressant and sedative). (AR 346.)
During a telehealth follow-up on August 17, 2021, NP Grant reported Garcia’s
mood as unstable and that she had increased auditory and visual hallucinations when she
was alone. (AR 367.) Garcia reported being clean from methamphetamine for 90 days. (AR
368.) NP Grant noted Garcia had an “empty” mood, flat affect, and limited insight,
concentration, and judgment. (AR 368.) NP Grant refilled Trazodone and risperidone and
added Depakote (anticonvulsant used to treat bipolar disorder) and clonidine (sedative).
(AR 368.)
During her September 9, 2021 telehealth follow-up with NP Grant, Garica reported
her delusions and paranoia increased when her mother left the home to go to work. (AR
364.) NP Grant noted Garcia’s mood was anxious, and her insight, judgment, and
concentration were limited. (AR 365.) NP Grant refilled risperidone, Depakote, and
clonidine and added Seroquel (antipsychotic). (AR 365.)
At her October 15, 2021 telehealth follow-up, Garcia reported hypersomnia with the
new medication, but that her auditory hallucinations had improved. (AR 361-62.) NP Grant
noted Garcia’s mood was dysphoric and her affect was blunted. (AR 362.) NP Grant
decreased Seroquel and refilled clonidine, Depakote, and risperidone. (AR 362.)
On December 10, 2021, Garcia reported to NP Grant that her increased auditory
hallucinations caused her to get very angry and lash out against her mother. (AR 358-59.)
NP Grant noted Garcia was having anger and impulse control problems and had limited
insight. (AR 359.) NP Grant continued risperidone, Depakote, clonidine, and Seroquel and
added Lithium (mood stabilizer), trihexyphenidyl (antispasmodic drug), and naltrexone
(used to prevent drug relapses). (AR 359.)
At her February 11, 2022 telehealth follow-up with NP Grant, Garcia reported
having spells where she felt “out of it,” and that she was still experiencing auditory and
visual hallucinations. (AR 355-56.) Garcia reported having less angry outbursts. (AR 356.)
NP Grant noted Garcia had poor insight, judgment, and concentration. (AR 356.) NP Grant
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prescribed lithium, risperidone, Depakote, naltrexone, and hydroxyzine (antihistamine
used to treat anxiety). (AR 356.)
On March 15, 2022, Garcia did not want to speak with NP Grant, and Garcia’s
mother told NP Grant that Garcia was pacing around their home and was “very absent”
from time to time. (AR 351-52.) NP Grant noted that Garcia’s mood was anxious, she had
concrete thought processes, and she had limited insight, judgment, and concentration. (AR
352.) NP Grant prescribed risperidone and clonazepam (sedative). (AR 352.)
At her April 15, 2022 telehealth follow-up with NP Grant, Garcia’s anxiety
persisted, and she reported experiencing auditory and visual hallucinations. (AR 347-48.)
She slept a lot during the day and was restless at night. (AR 348.) NP Grant noted that
medication trials of clonazepam and risperidone had been ineffective. (AR 347-48.) NP
Grant noted Garcia’s mood was anxious and had fair insight, judgment, and concentration.
(AR 348.) NP Grant changed Garcia’s medications and prescribed olanzapine
(antipsychotic), fluoxetine (antidepressant), lithium, and clonazepam. (AR 348.)
On May 9, 2022, Garcia’s mood was more stable on new medications. (AR 396-
97.) NP Grant refilled clonazepam, fluoxetine, Lithium, and olanzapine. (AR 397.) At her
July 12, 2022 telehealth follow-up with NP Grant, Garcia’s mood was stable, and she still
used marijuana. (AR 394.) NP Grant noted Garcia had poor grooming and hygiene. (AR
394.) NP Grant refilled clonazepam, fluoxetine, Lithium, and olanzapine. (AR 394.)
At her December 2, 2022 telehealth follow-up with NP Grant, Garcia reported she
was depressed and still having auditory and visual hallucinations. (AR 390.) Risperidone
had to be stopped due to abnormal lab work. (AR 390.) NP Grant decreased olanzapine,
added a trial of Loxapine (another antipsychotic), and refilled fluoxetine, clonazepam, and
lithium. (AR 390.)
On January 27, 2023, Garica had hypersomnia on Loxapine and was still having
auditory and visual hallucinations. (AR 500.) She reported feeling like she slept all the time
and was sometimes irritable. (AR 501.) NP Grant noted Garcia had limited insight,
judgement, and concentration. (AR 501.) NP Grant refilled fluoxetine and clonazepam and
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added Caplyta (an atypical antipsychotic used to treat schizophrenia and depression related
to bipolar disorder). (AR 501.)
At her February 23, 2023 telehealth follow-up, Garcia had some nausea and
vomiting and had stopped medications. (AR 495.) She had some mood swings and mild
auditory and visual hallucinations. (AR 495.) NP Grant prescribed Caplyta and
clonazepam. (AR 495.)
At her April 6, 2023 telehealth follow-up with NP Grant, Garcia was doing well on
Caplyta with a more stable mood and occasional auditory hallucinations. (AR 490.) NP
Grant prescribed benztropine mesylate (anti-tremor medication), clonazepam, and Caplyta.
(AR 490.)
NP Grant confirmed Garcia’s diagnoses on June 16, 2023 including schizoaffective
disorder, bipolar type, and unspecified personality disorder. (AR 504.)
Medical Opinion Evidence
During the initial review of Garcia’s medical records completed May 11, 2022, state
agency reviewers found that Garcia had sustained concentration, persistence, and social
interaction limitations but no understanding, memory, or adaptation limitations. (AR 69-
71.) The reviewers determined that Garcia can “perform 1-2 step tasks on a consistent,
productive basis across a routine work day and week, with limited social demand in the
workplace,” and that she is not disabled. (Id.)
Upon reconsideration on December 22, 2022, state agency reviewers found that
Garcia had understanding and memory, concentration and persistence, social interaction,
and adaptation limitations. (AR 89-90.) The reviewers determined that Garcia can “perform
1-2 step tasks on a consistent, productive basis across a routine work day and week, with
limited social demand in the workplace,” and that she is not disabled. (AR 90-91.)
NP Grant completed a check-box assessment of Garcia’s mental capacities on July
25, 2023. (AR 514-15.) NP Grant assessed that Garcia had a severe limitation defined as
“off task greater than 21% of an 8-hour workday,” in the abilities to understand, carry out,
and remember instructions and respond to customary work pressures. (AR 514.) NP Grant
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assessed moderately severe limitations defined as “off task 16-20% of an 8-hour workday,”
in Garcia’s ability to respond appropriately to supervision and coworkers. (AR 514.)
Ultimately, the ALJ found the State Agency reviewers’ opinions persuasive, and NP
Grant’s assessment unpersuasive. (AR 26.)
Summary of Hearing Testimony
Garcia testified she was fired from her last janitorial job because she got into a fight
with her manager, “well I don’t like for people to tell me what to do … and so I felt like
[the manager] was picking on me so I blew up on her.” (AR 43.) Garcia reported having
anxiety and that she angers easily, “really easy so if I feel like you’re picking on me I will
go off on you.” (AR 44.) When she worked as a cashier at Circle K, Garcia “got into it”
with the manager and had problems with her coworkers and the customers. (AR 44-45.)
When she worked as a cashier at Food City, Garcia had problems with the customers and
the manager, and “blew up” on the manager. (AR 45.) Garcia has a history of
methamphetamine use but last used in June 2021. (AR 45.) Once clean from
methamphetamine, Garcia testified to still having anxiety and anger issues, stating: “I like
to be home more of the time because I don’t get along with too many people and if they
say something or I feel like they’re staring at me I’ll say something and it causes problems.”
(AR 47.) Garcia testified she still experiences auditory and visual hallucinations. (AR 52.)
Garcia stated that anxiety causes her to pace around the house each day. (AR 54.) When
Garcia was depressed, she would not shower. (AR 55.)
At the ALJ’s prompting, the vocational expert, Susan Creighton-Clavel, answered
a hypothetical question that assumed an individual who could perform unskilled work
consisting of work that required one to three steps with occasional contact with the public
and coworkers, identifying Garcia’s past work as a janitor, and other jobs as an agricultural
packer, laundry laborer, and hand packager. (AR 57-58, 62.)
However, the vocational expert testified that an individual that had outbursts of
anger when dealing with supervisors and coworkers on more than an occasional basis that
would result in an interruption of work that lasted the remainder of the day, would be
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precluded from all work. (AR 60.) The vocational expert explained that “any type of
outburst no matter how long they are, they might have one and get a reprimand or two and
get a reprimand but after that … they’re not going to be able to continue the employment.”
(AR 60.) In addition, the vocational expert testified that an individual that had interruptions
from auditory or visual hallucinations or other issues that exceeded 15% of the workday,
congruent with NP Grant’s assessment and Garcia’s symptom testimony, would be
precluded from all work. (AR 60.) Last, the vocational expert concluded that an individual
that suffered from anxiety that required walking and leaving the workstation in excess of
15% of a workday would be precluded from all work. (AR 61.)
Summary of the ALJ’s Decision
At step one, the ALJ determined that Garcia has not engaged in substantial gainful
activity since June 15, 2021. (AR 20.) At step two, the ALJ determined that Garcia suffers
from the severe impairments of schizoaffective disorder, bipolar disorder, oppositional
defiant disorder, borderline personality disorder, trauma disorder, and substance abuse
disorder including amphetamine and cannabis use. (Id.) At step three, the ALJ determined
Garcia does not suffer from an impairment or combination of impairments that met or
equaled a listed impairment. (AR 21.) After step three but before step four, the ALJ
determined Garcia’s residual functional capacity (“RFC”) as follows:
[T]he claimant has the residual functional capacity to perform
a full range of work at all exertional levels but with the
following non-exertional limitations: she can perform work
that consists of 1-3 step tasks. She can have occasional contact
with the public that is infrequent, superficial, and not a primary
component of the job. She can have occasional interaction with
co-workers and can do no work that requires teamwork or
responsibility for the safety of others. The claimant will
function best where she is dealing with objects rather than
people. She will function best where work is routine with few
changes.
(AR 22.) At step four, the ALJ determined that Garcia has past relevant work as a janitor.
(AR 27.) At step five, the ALJ found that Garcia is able to perform her past relevant work
as a janitor and that such work does not require the performance of work-related activities
precluded by Garcia’s RFC. (Id.) Also at step five, the ALJ alternatively determined that
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Garcia is able to perform other jobs that exist in significant numbers in the national
economy. (Id.)
STANDARD OF REVIEW
This Court reviews only those issues raised by the party challenging the ALJ's
decision. See Lewis v. Apfel, 236 F.3d 503, 517 n.13 (9th Cir. 2001). In reviewing the
decision of the ALJ, the Court will not overturn the ALJ's decision “unless it is either not
supported by substantial evidence or is based upon legal error.” Luther v. Berryhill, 891
F.3d 872, 875 (9th Cir. 2018). “Substantial” evidence means “more than a mere scintilla,”
but it is “less than a preponderance.” Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007)
(internal citation omitted). That is, “substantial evidence” is “such relevant evidence as a
reasonable mind might accept as adequate to support a conclusion.” Burch v. Barnhart,
400 F.3d 676, 679 (9th Cir. 2005) (internal citation omitted). In determining whether
substantial evidence supports the ALJ's decision, the Court considers “the administrative
record as a whole, weighing both the evidence that supports and the evidence that detracts
from the” ALJ's conclusions. Reddick v. Chater, 157 F.3d 715, 720 (9th Cir. 1998). “If the
evidence can reasonably support either affirming or reversing the Secretary's conclusion,
the court may not substitute its judgment for that of the Secretary.” Id. at 720-21. The
“court must consider the entire record as a whole and may not affirm simply by isolating a
specific quantum of supporting evidence.” Orn, 495 F.3d at 630 (internal quotations and
citations omitted). The Court reviews “only the reasons provided by the ALJ in the
disability determination and may not affirm the ALJ on a ground upon which he did not
rely.” Id.
ISSUES ON REVIEW
Garcia raises two (2) issues for review. (Doc. 18 at 1-2.) First, Garcia claims the
ALJ committed materially harmful error by rejecting NP Grant’s medical opinion without
providing sufficient explanation supported by substantial evidence. Second, Garcia claims
the ALJ committed materially harmful error by rejecting her symptom testimony in the
absence of specific, clear, and convincing reasons supported by substantial evidence.
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ANALYSIS
1. The ALJ did not commit materially harmful error when discounting NP
Grant’s medical opinion.
The ALJ’s determination discounting NP Grant’s July 2023 medical opinion
evidence states in part:
In July 2023, treatment provider Susan Grant, FNP-BC,
BHMP, PHHNP, opined the claimant has moderate limitations
in the following: relating to other people; restriction of daily
activities, such as attending meetings; deterioration of personal
habits; constriction of interests; and performing simple tasks.
She opined the claimant has a severe limitation in
understanding, remembering, and carrying out instructions,
and in responding to customary work pressure; and a
moderately severe limitation in responding appropriately to
supervision and coworkers (Exhibit 6F). The opinion is not
persuasive as Ms. Grant provided no support in the form of
objective findings or rationale. The opinion is not persuasive
as it is inconsistent with the medical evidence of record,
particularly with Ms. Grant’s treatment notes. For example,
Ms. Grant opined the claimant has a severe limitation in
understanding, remembering, and carrying out instructions,
though she always noted the claimant’s memory was intact
(Exhibits 3F/8, 11, 14, 18, 21, 27, 30 & 4F/3, 4, 11, 14). Ms.
Grant opined the claimant has a deterioration of personal habits
though she noted poor grooming/hygiene only once (Exhibit
3F/8). She opined the claimant has a moderately severe
limitation in responding appropriately to supervision and
coworkers but regularly noted the claimant to be cooperative
(Exhibits 3F/8, 11, 14, 18, 21, 27, 30 & 4F/3, 4, 11, 14). Lastly,
Ms. Grant opined the claimant has a severe limitation in
responding to customary work pressure though she often noted
fair or improving – and at times good – insight and judgment
and did not note severity commensurate with a severe
limitation (Exhibits 3F/8, 11, 14, 18, 21, 24, 27, 30 & 4F/3, 4,
11, 14).
(AR 26-27.)
An ALJ does not “give any specific evidentiary weight, including controlling
weight, to any medical opinion(s).” 20 C.F.R. § 404.1520c(a). Instead, the ALJ must weigh
several factors, particularly the medical opinion's supportability and consistency. Woods v.
Kijakazi, 32 F.4th 785, 791–92 (9th Cir. 2022) (quoting 20 C.F.R. § 404.1520c(c)(a)).
“Supportability means the extent to which a medical source supports the medical opinion
by explaining the ‘relevant...objective medical evidence.’” Id. at 791–92 (quoting 20
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C.F.R. § 404.1520c(c)(1)). “Consistency means the extent to which a medical opinion is
‘consistent ... with the evidence from other medical sources and nonmedical sources in the
claim.’” Id. (quoting 20 C.F.R. § 404.1520c(c)(2)). Further, medical evidence is
inconsistent “when it conflicts with other evidence, contains an internal conflict, is
ambiguous, or when the medical evidence does not appear to be based on medically
acceptable clinical or laboratory diagnostic techniques.” 20 C.F.R. § 404.1520b(b). When
rejecting a medical source's opinion, the ALJ must provide “an explanation supported by
substantial evidence.” Woods, 32 F.4th at 792.
Here, the ALJ’s decision to discount the medical opinion evidence of NP Grant
addresses both the supportability and consistency factors required under the regulations
and is supported by substantial evidence. First, the ALJ determined that the medical
opinion evidence was unsupported because NP Grant provided no support in the form of
objective findings or rationale on the form submitted for review. (AR 26 (“The opinion is
not persuasive as Ms. Grant provided no support in the form of objective findings or
rationale.”).) NP Grant’s medical opinion evidence was submitted as a check-box form.
(See AR 514-16.) It contains no explanations or attachments to support its indicated
assertions but ends with a handwritten note which simply directs “Please see previously
supplied responses.” (AR 515.) An ALJ may discount a medical opinion set forth in a
check-box form, as here, with little to no explanation. Kitchen v. Kijakazi, 82 F.4th 732,
740-41 (9th Cir. 2023.) Accordingly, the ALJ did not commit harmful error in determining
NP Grant’s medical opinion evidence was unsupported.
Second, the ALJ provided numerous reasons supported by substantial evidence why
the NP Grant’s medical opinion evidence was inconsistent with the record. (See AR 26-
27.) The ALJ identified the four limitations which NP Grant indicated were “severe” or
“moderately severe” on the check-box form and determined they were inconsistent with
NP Grant’s own medical treatment notes. (Id.) The ALJ determined that the severe
limitation in “understanding, remembering, and carrying out instructions” was inconsistent
with NP Grant’s notes reporting Garcia’s memory was intact. (AR 26 (citing eleven
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examples in the record).) Next, the ALJ determined that NP Grant’s opinion that Garcia
has “a deterioration of personal habits” was inconsistent when NP Grant only once noted
Garcia had poor grooming and hygiene. (Id. (citing NP Grant’s single note in the record
indicating Garcia had “poor grooming/hygiene”).) The ALJ determined the moderately
severe limitation “in responding appropriately to supervision and coworkers” was
inconsistent with NP Grant’s notes which indicated that Garcia was cooperative. (Id. (citing
eleven examples in the record).) Finally, the ALJ determined that the severe limitation “in
responding to customary work pressure” was inconsistent where NP Grant’s notes often
reported that Garcia had “fair or improving – and at times good – insight and judgement
and did not note a severity commensurate with a severe limitation.” (AR 26-27 (citing
twelve example in the record).) Accordingly, the ALJ’s decision to discount NP Grant’s
medical opinion evidence was properly explained in his opinion and supported by
substantial evidence in the record.
Garcia argues that the ALJ committed materially harmful error as a matter of law
because she asserts the ALJ only considered the supportability factor, and not the
consistency factor, as required by 20 C.F.R. § 404.1520c(c)(1)-(2). See Woods, 32 F.4th
785, 791 (“The agency must…‘explain how [it] considered the supportability and
consistency factors’ in reaching these findings.”) Plaintiff asserts that the ALJ’s
consistency determination was actually a supportability determination because he found
NP Grant’s own medical notes inconsistent with her medical opinion evidence. (Doc. 18
at 11.) Plaintiff premises this assertion on a single word in 20 C.F.R. § 404.1520c(c)(2):
“the regulations confirm that the consistency evaluation relates to how consistent a medical
opinion ‘is with the evidence from other medical sources and nonmedical sources in the
claim.’” (Doc. 18 at 11 (emphasis in original).) Plaintiff points to no other legal authority
to support the assertion.
This argument fails as a matter of law for two reasons. First, the regulation defining
what makes medical evidence inconsistent explicitly allows for an ALJ to determine
evidence is inconsistent when the evidence, as here, “contains an internal conflict.” 20
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C.F.R. § 404.1520b(b). Accordingly, the ALJ’s determination that the medical opinion
evidence was inconsistent with itself is permissible under the regulations. Second,
controlling Ninth Circuit precedent provides that incongruities between medical opinion
questionnaire responses and the underlying medical records provide for a “specific and
legitimate reason for rejecting” medical opinions of treating physicians. Tommasetti v.
Astrue, 533 F.3d 1035, 1041 (9th Cir. 2008).
Next, Plaintiff challenges the ALJ’s decision to discount NP Grant’s medical
opinion evidence based solely on an adverse supportability determination where the
medical opinion evidence consists of a check-box form. (Doc. 18 at 12.) As discussed
above, the ALJ did not only reject the medical opinion evidence because the check-box
form “provided no support in the form of objective findings or rationale,” but also because
he determined the limitations on the checkbox form were inconsistent with the objective
medical evidence in the record.
Plaintiff further challenges the ALJ’s inconsistency determination arguing that it is
legal error for the ALJ to rely on normal observations of cognitive function to discount
medical opinion evidence of Garcia’s mood disorder—schizoaffective disorder, bipolar
type. (Doc. 18 at 14-15.) However, the authority cited by Plaintiff makes clear that it is a
legal error for an ALJ to fail to explain why normal cognitive health observations
undermine medical opinion evidence, not simply that the reliance on such observations is
itself a legal error. See Nielsen v. Colvin, 2024 WL 5200174, *1 (9th Cir. Dec. 23, 2024)
(“The ALJ failed to explain why normal cognitive health indications undermine Nielsen’s
testimony about her behavioral health issues.”) (emphasis added); Bonger v. Comm’r of
Soc. Sec. Admin., 2023 WL 4734120, *5 (D. Ariz. July 25, 2023) (“[T]he ALJ did not
explain, nor is it apparent, how these observations of cognitive functioning negated [the]
opined limitations.”) (emphasis added); Ghanim v. Colvin, 763 F.3d 1154, 1164 (9th Cir.
2014) (“These observations of cognitive functioning during therapy sessions do not
contradict Ghanim’s reported symptoms of depression and social anxiety.”) (emphasis
added).
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Here, the ALJ’s ruling explains, with substantial citations to the record, why the
certain and specific limitations included on NP Grant’s check-box medical opinion
evidence form are inconsistent with the medical record. (See AR 26-27.) As discussed
above, incongruities between medical opinion questionnaire responses and the underlying
medical records provide for a “specific and legitimate reason for rejecting” medical
opinions of treating physicians. Tommasetti, 533 F.3d at 1041.
Finally, Plaintiff argues that the ALJ’s adverse determination cannot rely on
cognitive exams to discount mood or behavioral symptoms. (Doc. 18 at 14-16.) Because
there is no indication in the record that the ALJ relied on any such cognitive exams, and
instead relied primarily on treatment notes from NP Grant, such argument is inapposite.
B. The ALJ committed error when discounting Garcia’s symptom
testimony.
Garcia argues the ALJ committed materially harmful error by rejecting Garcia’s
symptom testimony without specific, clear, and convincing reasons supported by
substantial evidence. (Doc. 18 at 17.) The Commissioner defends the ALJ’s determination,
asserting that the ALJ provided specific, clear and convincing reasons why the Plaintiff’s
testimony regarding the intensity, persistence, and limiting effects of her symptoms was
discounted. (Doc. 20 at 3.) As explained below, this Court finds that the ALJ failed to
provide specific, clear, and convincing reasons supported by substantial evidence when
discounting Garcia’s symptom testimony.
Legal Standard
Disability benefits cannot be granted based solely on a claimant’s subjective
complaints. See 42 U.S.C. § 423(d)(5)(A) (“[a]n individual’s statement as to pain or other
symptoms shall not alone be conclusive evidence of disability”); 20 C.F.R. pt. 404.1529(a)
(statements about pain or other symptoms will not alone establish disability). Where a
claimant has provided objective medical evidence of an impairment that could reasonably
produce the alleged symptoms, the ALJ evaluates the intensity and persistence of the
symptoms. See SSR 16-3p, 2016 WL 1119029. The ALJ is required to evaluate whether a
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claimant’s statements about her symptoms are consistent with the objective medical
evidence and the other evidence in the record. See 20 C.F.R. pt. 404.1529(c)(2), (3); SSR
16-3p, 2016 WL 1119029. The ALJ must make specific findings about a claimant’s
allegations, properly supported by the record and sufficiently specific to ensure a reviewing
court that the claimant’s subjective testimony was not arbitrarily discredited. See Thomas
v. Barnhart, 278 F.3d 947, 958 (9th Cir. 2002) (citing Bunnell v. Sullivan, 947 F.2d 341,
345-46 (9th Cir. 1991) (en banc)). Unless there is affirmative evidence that a claimant is
malingering, an ALJ’s reasons for discounting the claimant’s testimony regarding the
severity of his symptoms must be “clear and convincing.” Reddick v. Chater, 157 F.3d 715,
722 (9th Cir. 1998). “If the ALJ's . . . finding is supported by substantial evidence, [a court]
may not engage in second-guessing.” Kelly L. K. v. Saul, 2021 WL 3269981, at *6 (C.D.
Cal. July 30, 2021) (citation omitted).
Analysis
Here, the ALJ discounted Garcia’s testimony to the extent that her statements
concerning the intensity, persistence, and limiting effects were “not entirely consistent”
with the medical evidence. (See AR 24-26.) The ALJ found generally that the medical
record shows that many of Plaintiff’s limitations improved over the course of treatment.
(AR 24-25.) Upon review of the medical evidence the ALJ discussed NP Grant’s treatment
notes which indicated that Garcia is not at risk for self-harm, reported no suicidal ideations,
and that she had logical thought process with appropriate content. (Id.) The ALJ then
discussed how NP Grant’s treatment notes from 2021 indicated that Garcia was
“improving” in the areas of insight, judgment, and concentration. (AR 25.) The ALJ
further discussed that the treatment records continued to indicate that Garcia was
improving, noting that Garcia reported no hallucinations for most of her treatment, and that
speech, thought process, and memory remained normal throughout treatment. (Id.) The
ALJ noted that while Garcia did report hallucinations, that treatment providers did not note
any preclusive clinical findings, such as responses to internal stimuli, and that Garcia’s
logical and linear thought processes and appropriate content remained. (Id.)
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Here, Plaintiff asserts that the ALJ “failed to connect anything specific in the
medical record to a specific inconsistency with any particular portion of Garcia’s symptom
testimony.” (Doc. 18 at 18.) The Court agrees. A finding that a claimant's testimony is not
credible “must be sufficiently specific to allow a reviewing court to conclude the
adjudicator rejected the claimant's testimony on permissible grounds and did not arbitrarily
discredit a claimant's testimony[.]” Bunnell, 947 F.2d at 345–46 (citation and internal
quotation marks omitted). “General findings are insufficient; rather, the ALJ must identify
what testimony is not credible and what evidence undermines the claimant's complaints.”
Reddick v. Chater, 157 F.3d 715, 722 (9th Cir.1998) (citation and internal quotation marks
omitted); see also Holohan v. Massanari, 246 F.3d 1195, 1208 (9th Cir.2001) (“the ALJ
must specifically identify the testimony she or he finds not to be credible and must explain
what evidence undermines the testimony” (emphasis added)).
Here, the ALJ specifically addressed Garcia’s reports of hallucinations and
determined that although the medical notes corroborated that Garcia had hallucinations,
the record did not support her hallucinations having a work preclusive effect. (See AR 25.)
However, the ALJ failed to discuss at any extent Garcia’s reports of anxiety, depression,
or anger issues, and in turn also failed to connect anything in the medical record to a
specific inconsistency with those portions of her testimony. (See AR 24-25.) The ALJ relies
on general observations of the medical record that Garcia was improving through
treatment, and that Garcia was not a risk for self-harm but does not explain how such
normal findings, nor how Garcia’s reported hallucinations, contradict Garcia’s testimony
as to the work-preclusive effect of her anxiety, depression, or anger symptoms. See Brown-
Huner v. Colvin, 806 F.3d 487, 494 (9th Cir. 2015) (“Because the ALJ failed to identify
the testimony she found not credible, she did not link that testimony to the particular parts
of the record supporting her non-credibility determination. This was legal error.”)
Accordingly, this Court finds that the ALJ erred in discounting Garcia’s symptom
testimony by not providing clear and convincing reasons supported by substantial
evidence.
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C. Remand for Immediate Reward Inappropriate
Here remand for immediate reward is inappropriate where the ALJ properly
discounted the medical opinion evidence but erred in discounting the Plaintiff’s symptom
testimony. Under the “credit-as-true” doctrine, remand for immediate reward is appropriate
where “(1) the record has been fully developed and further administrative proceedings
would serve no useful purpose; (2) the ALJ has failed to provide legally sufficient reasons
for rejecting evidence, whether claimant testimony or medical opinion; and (3) if the
improperly discredited evidence were credited as true, the ALJ would be required to find
the claimant disabled on remand.” Garrison, 759 F.3d at 1020. Here, because benefits
cannot be granted based solely on a claimant’s subjective complaints, even if her testimony
is credited as true, Plaintiff would not be entitled to remand for immediate award of benefits
on the sole basis of such testimony. See 42 U.S.C. § 423(d)(5)(A) (“[a]n individual’s
statement as to pain or other symptoms shall not alone be conclusive evidence of
disability”); 20 C.F.R. pt. 404.1529(a) (statements about pain or other symptoms will not
alone establish disability). Accordingly, the undersigned does not recommend remand for
immediate calculation and payment of benefits.
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RECOMMENDATION
For the foregoing reasons, it is RECOMMENDED that the district court
REVERSE the decision of the Administrative Law Judge and REMAND the matter to the
Commissioner for further proceedings. Pursuant to Federal Rule of Civil Procedure
72(b)(2), any party may serve and file written objections within fourteen days of being
served with a copy of the Report and Recommendation. A party may respond to the other
party’s objections within fourteen days. No reply brief shall be filed on objections unless
leave is granted by the district court. If objections are not timely filed, they may be deemed
waived. If objections are filed, the parties should use the following case number: 4:24-cv-
579-SHR.
Dated this 17th day of November, 2025.
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