April H. v. Frank Bisignano, Commissioner of Social Security

Opinion

1 EASTERUN. SD.I SDTIRSITCRTI COTF CWOAUSRHTI NGTON Jun 16, 2026 2 SEAN F. MCAVOY, CLERK

4 5 UNITED STATES DISTRICT COURT EASTERN DISTRICT OF WASHINGTON 6

7 APRIL H.,1 No. 1:25-cv-3226-EFS

8 Plaintiff, ORDER REVERSING THE 9 v. ALJ’S DENIAL OF BENEFITS, AND REMANDING FOR 10 FRANK BISIGNANO, MORE PROCEEDINGS Commissioner of Social Security, 11 Defendant. 12

13 Plaintiff April H. and the Commissioner of Social Security agree 14 that the Administrative Law Judge’s (ALJ) denial of disability benefits 15 should be remanded based on consequential errors, but they disagree 16 17

18 1 For privacy reasons, Plaintiff is referred to by first name and last 19 initial or as “Plaintiff.” See LCivR 5.2(c). 20 1 as to whether the decision should be remanded for further proceedings

2 or for an award of benefits. As is explained below, essential issues 3 remain for the ALJ to resolve based on conflicts in the evidence, so this 4 matter is remanded for further proceedings.

5 I. Background 6 Plaintiff filed her Title 2 and 16 applications for benefits in 2018, 7 alleging disability beginning January 1, 2016, due to several physical

8 and mental impairments.2 An ALJ issued an unfavorable decision, 9 which, on appeal to district court, the parties stipulated to remand for 10 further proceedings in November 2021.3 On remand, a different ALJ

11 issued an unfavorable decision, which the court remanded on appeal in 12 July 2024 for further proceedings based on consequential errors in the 13 ALJ’s evaluation of the mental health medical opinions.4

14 After conducting further proceedings following the second remand 15 in Plaintiff’s case, a different ALJ, Malcolm Ross, issued an 16

17 2 Administrative Record (AR) 190–97. 18 3 AR 12–28, 1158–61. See E.D. Wash. Case No. 1:20-cv-3239-MKD. 19 4 AR 1057–75, 2483–503. See E.D. Wash. Case No. 1:24-cv-3018-EFS. 20 1 unfavorable decision in October 2025.5 At step two of the five-step

2 sequential evaluation, the ALJ found that Plaintiff had the severe 3 impairments of obesity, polycystic ovarian syndrome, depressive 4 disorder, posttraumatic stress disorder, and social phobia.6 The ALJ

5 acknowledged the record evidence of headaches and other physical 6 impairments, but found those impairments non-severe.7 7 The ALJ found that Plaintiff had the residual functional capacity

8 (RFC) to perform a limited range of light work with certain physical 9 and mental limitations.8 In explaining the RFC finding, the ALJ 10 reasoned that Plaintiff’s alleged symptoms were inconsistent with the

11 medical evidence and other evidence.9 The ALJ discounted the severity 12 of Plaintiff’s alleged mental health symptoms based on the ALJ’s 13

14 5 AR 2398–415. Per 20 C.F.R. §§ 404.1520(a)–(g), 416.920(a)–(g), a five- 15 step evaluation determines whether a claimant is disabled. 16 6 AR 2404. 17 7 AR 2404. 18 8 AR 2406. 19 9 AR 2407. 20 1 findings that providers made normal mental health observations,

2 Plaintiff’s mental health improved with treatment, and she engaged in 3 a variety of daily activities.10 The ALJ also explained his RFC finding 4 based on the medical opinions, finding, as relevant, the reviewing

5 opinions of Lisa Hacker, PhD, and John Gilbert, PhD, persuasive; 6 examining opinions of R.A. Cline, PsyD, and Tasmyn Bowes, PsyD, 7 partly persuasive; and the treating opinions of Candy Joachims,

8 LMHC, Aubrie Duke, PhD, and Cara Kline, LMHC, not persuasive.11 9 Considering Plaintiff’s RFC, age, education, and work history, the ALJ 10 found that Plaintiff could perform work that existed in significant

11 numbers in the national economy, such as housekeeping-cleaner, 12 routing clerk, and office helper.12 13

15 10 AR 2407–08. 16 11 AR 2410–12. 17 12 AR 2413–14. See AR 2444–47 (vocational expert testifying that a 18 hypothetical individual of Plaintiff’s age, education, and work history, 19 with RFC as found in ALJ’s decision, could perform those three jobs). 20 1 Plaintiff did not file written exceptions to the ALJ’s decision with

2 the Appeals Council and the Appeals Council did not assume 3 jurisdiction on its own, so the ALJ’s decision became the 4 Commissioner’s final decision.13 Plaintiff now appeals to district

5 court.14 6 II. Standard of Review 7 The ALJ’s decision is reversed “only if it is not supported by

8 substantial evidence or is based on legal error”15 and such error 9 impacted the nondisability determination.16 Substantial evidence is 10 “more than a mere scintilla but less than a preponderance; it is such

12 13 See AR 2398–400; 20 C.F.R. §§ 404.984, 416.1484. 13 14 ECF No. 1. 14 15 Hill v. Astrue, 698 F.3d 1153, 1158 (9th Cir. 2012). See 42 U.S.C. 15 § 405(g). 16 16 Molina v. Astrue, 674 F.3d 1104, 1115 (9th Cir. 2012), superseded on 17 other grounds by 20 C.F.R. § 416.920(a) (recognizing that the court may 18 not reverse an ALJ decision due to a harmless error—one that “is 19 inconsequential to the ultimate nondisability determination”). 20 1 relevant evidence as a reasonable mind might accept as adequate to

2 support a conclusion.”17 3 III. Analysis 4 Plaintiff argues the ALJ erred by not providing specific, clear,

5 and convincing reasons to discount her allegations of the severity of her 6 mental health symptoms; not properly assessing the psychological 7 medical opinions; and not sufficiently considering the evidence of her

8 headaches. She contends that the first error requires remand for an 9 award of benefits because her improperly rejected testimony must be 10 credited as a matter of law. She contends that the second error requires

12 17 Hill, 698 F.3d at 1159 (quoting Sandgathe v. Chater, 108 F.3d 978, 13 980 (9th Cir. 1997)). See also Lingenfelter v. Astrue, 504 F.3d 1028, 14 1035 (9th Cir. 2007) (The court “must consider the entire record as a 15 whole, weighing both the evidence that supports and the evidence that 16 detracts from the Commissioner's conclusion,” not simply the evidence 17 cited by the ALJ or the parties.) (cleaned up); Black v. Apfel, 143 F.3d 18 383, 386 (8th Cir. 1998) (“An ALJ’s failure to cite specific evidence does 19 not indicate that such evidence was not considered[.]”). 20 1 remand for an award of benefits because the record has been fully

2 developed, the ALJ did not give legally sufficient reasons to reject the 3 challenged medical opinions, and those opinions compel a finding of 4 disability. She contends that the third error would, at minimum,

5 require remand for the ALJ to properly assess the headaches evidence, 6 but, combined with the other errors, supports remand for an award of 7 benefits.

8 The Commissioner agrees that the ALJ reversibly erred but 9 disagrees as to the appropriate remedy. The Commissioner contends 10 that this Court should remand this case for further administrative

11 proceedings to resolve outstanding evidentiary conflicts, reevaluate 12 Plaintiff’s headaches, reevaluate the medical evidence, reevaluate the 13 subjective allegations, reevaluate the RFC, further develop the record,

14 and issue a new decision. The Commissioner asserts that remand for 15 an award of benefits is improper because the ALJ must resolve 16 conflicts among the medical evidence, the substance and credibility of

17 Plaintiff’s testimony, and the medical opinions. 18 19

20 1 When a harmful error occurs in the administrative proceeding,

2 remand for further administrative proceedings is the usual course.18 3 However, in “rare circumstances where no useful purpose would be 4 served by further administrative proceedings and the record has been

5 thoroughly developed,” the court may remand for an award of 6 benefits.19 The Ninth Circuit has distilled the “credit-as-true” rule, 7 where remand for an award of benefit is appropriate, into three steps.20

8 First, the court asks “whether the ALJ has failed to provide legally 9 sufficient reasons for rejecting evidence, whether claimant testimony or 10 medical opinion.”21 Second, if the ALJ erred, the court determines

11 “whether the record has been fully developed, whether there are 12 outstanding issues that must be resolved before a determination of 13 disability can be made, and whether further administrative

15 18 Treichler v. Comm’r of Social Sec. Admin., 775 F.3d 1090, 1099 (9th 16 Cir. 2014). 17 19 Id. at 1100 (citation modified). 18 20 Id. 19 21 Id. at 1100–01 (citation modified). 20 1 proceedings would be useful.”22 Third, if no issues remain and further

2 proceedings would not be useful, then the court will find “the relevant 3 testimony credible as a matter of law, and then determine whether the 4 record, taken as a whole, leaves not the slightest uncertainty as to the

5 outcome of the proceeding.”23 When these three elements are satisfied, 6 the decision whether to remand for benefits or further proceedings is 7 within the court’s discretion, as it “is a fact-bound determination that

8 arises in an infinite variety of contexts.”24 9 Here, the second element is not met. Further administrative 10 proceedings are “generally useful where the record has not been fully

11 developed, there is a need to resolve conflicts and ambiguities, or the 12 presentation of further evidence may well prove enlightening in light of 13 the passage of time.”25 “Where there is conflicting evidence, and not all

14 essential factual issues have been resolved, a remand for an award of 15

16 22 Id. at 1101 (citation modified). 17 23 Id. (citation modified). 18 24 Id. at 1100 (citation modified). 19 25 Id. at 1101 (citation modified). 20 1 benefits is inappropriate.”26 The ALJ must resolve, at minimum, the

2 following essential issues before disability may be determined on this 3 remand: 4 1. Whether Plaintiff’s sometimes normal presentation to treating

5 providers is inconsistent with the alleged severity of her mental 6 health symptoms in the context of her ability to sustain full-time 7 work considering the episodic, waxing-and-waning nature of her

8 mental health impairments and the controlled, clinical setting in 9 which the providers’ observations were made.27 10

11 12 13

14 26 Id. 15 27 The ALJ did not discuss this issue. See Garrison v. Colvin, 759 F.3d 16 995, 1017 (9th Cir. 2014) (Mental health observations must be 17 “interpreted with an awareness that improved functioning while being 18 treated and while limiting environmental stressors does not always 19 mean that a claimant can function effectively in a workplace.”). 20 1 2. Whether the record as a whole supports improvement of mental

2 health symptoms with treatment such that Plaintiff would be 3 capable of full-time employment.28 4

5 28 The ALJ cited only two isolated reports of marginal improvement. 6 See AR 2408. Especially for mental health impairments, where “[c]ycles 7 of improvement and debilitating symptoms are a common occurrence,” 8 the ALJ must not “pick out a few isolated instances of improvement 9 over a period of months or years” and “treat them as a basis for 10 concluding a claimant is capable of working.” Garrison, 759 F.3d at 11 1017. See Holohan v. Massanari, 246 F.3d 1195, 1205 (9th Cir. 2001) 12 (“That a person who suffers from severe panic attacks, anxiety, and 13 depression makes some improvement does not mean that the person’s 14 impairments no longer seriously affect her ability to function in a 15 workplace.”); Taylor v. Comm’r of Soc. Sec. Admin., 659 F.3d 1228, 16 1234 (9th Cir. 2011) (finding error where, “while recognizing that 17 Taylor’s physical symptoms ‘may wax and wane,’ the ALJ held against 18 Taylor two instances where he was able to function, even though his 19 alleged disability involves [physical symptoms] that come and go”). 20 1 3. Whether Plaintiff’s activities of daily living are specifically

2 relevant to her abilities at work to understand, remember, and 3 carry out instructions; maintain pace without interruption from 4 psychological symptoms; not require work-preclusive breaks or

5 absences; and work around or interact with others.29 6 4. Whether, even if not a severe medically determinable 7 impairment, Plaintiff’s headaches cause RFC limitations based

8 on her headache symptom reports and the medical evidence.30 9

10 29 The ALJ acknowledged that daily activities are generally more 11 flexible and varied than work activities without logically connecting 12 specific activities to any specific part of the mental RFC. See AR 2408; 13 Molina v. Astrue, 674 F.3d 1104, 1113 (9th Cir. 2012) (“[T]he ALJ may 14 discredit a claimant’s testimony when the claimant reports 15 participation in everyday activities indicating capacities that are 16 transferable to a work setting.”). 17 30 The ALJ did not explain whether the subjective reports or treatment 18 records of headaches supported RFC limitations. See 20 C.F.R. 19 §§ 404.1545(a)(1)–(3), 416.945(a)(1)–(3). 20 1 The Court makes this finding that further proceedings are

2 necessary reluctantly because it results in the third remand in this 3 case. Courts must avoid creating “an unfair ‘heads we win; tails, let’s 4 play again’ system of disability benefits adjudication.”31 But neither the

5 first remand, based upon the parties’ stipulation, nor the second 6 remand, based upon the erroneous evaluation of the mental health 7 medical opinions, identified the outstanding issues the Court identified

8 above. The Court is hopeful that such specific instructions will aid the 9 ALJ in making a complete decision that follows all correct legal 10 standards and is supported by substantial evidence. If this third

11 remand results in an appealed non-disability determination that does 12 not address all the specified remaining issues, such may reflect that 13 further administrative proceedings are not useful.

14 IV. Conclusion 15 As the parties agree, the ALJ erred. The Court finds that remand 16 for reevaluation is the appropriate remedy. The ALJ is to develop the

17 record and reevaluate—with meaningful articulation and evidentiary 18

19 31 Benecke v. Barnhart, 379 F.3d 587, 595 (9th Cir. 2004). 20 1 support—the sequential process. On remand, the ALJ’s RFC analysis

2 must, at minimum, address the essential remaining issues identified 3 herein. For clarity, the Court repeats that those issues are: 4 1. Whether Plaintiff’s sometimes normal presentation to treating

5 providers is inconsistent with the alleged severity of her mental 6 health symptoms in the context of her ability to sustain full-time 7 work considering the episodic, waxing-and-waning nature of her

8 mental health impairments and the controlled, clinical setting in 9 which the providers’ observations were made. 10 2. Whether the record as a whole supports improvement of mental

11 health symptoms with treatment such that Plaintiff would be 12 capable of full-time employment. 13 3. Whether Plaintiff’s activities of daily living are specifically

14 relevant to her abilities at work to understand, remember, and 15 carry out instructions; maintain pace without interruption from 16 psychological symptoms; not require work-preclusive breaks or

17 absences; and work around or interact with others. 18 19

20 1 4. Whether, even if not a severe medically determinable

2 impairment, Plaintiff’s headaches cause RFC limitations based on 3 her headache symptom reports and the medical evidence. 4 When engaging in the five-step disability evaluation on remand, the

5 ALJ must meaningfully articulate the supportability and consistency of 6 each medical opinion. If the ALJ discounts a medical opinion based on 7 a perceived inconsistency with the evidence, the ALJ should include

8 sufficient explanation and citations to show that an inconsistency truly 9 exists and why the inconsistency tends to undermine the medical 10 opinion in question. Similarly, if the ALJ discounts Plaintiff’s reported

11 symptoms, the ALJ must articulate clear and convincing reasons for 12 discounting the identified symptoms and cite the evidence that 13 undermines the symptoms. The ALJ must ensure that the examples he

14 relies on fairly represent the record as a whole. Finally, the ALJ must 15 offer Plaintiff the opportunity for a new hearing and update the record 16 as necessary.

17 Accordingly, IT IS HEREBY ORDERED: 18 1. The ALJ’s nondisability decision is REVERSED, and this 19 matter is REMANDED to the Commissioner of Social

20 1 Security for further proceedings pursuant to

2 sentence four of 42 U.S.C. § 405(g). 3 2. The Clerk’s Office shall TERM the parties’ briefs, ECF

4 Nos. 11 and 14, enter JUDGMENT in favor of Plaintiff, 5 and CLOSE the case.

6 IT IS SO ORDERED. The Clerk’s Office is directed to file this

7 ||order and provide copies to all counsel.

8 DATED this 16 day of June 2026. deed Fhe 10 EDWARD F. SHEA Senior United States District Judge 11 12 13 14 15 16 17 18 19 20 DISPOSITIVE ORDER - 16