3 UNITED STATES DISTRICT COURT 4 EASTERN DISTRICT OF WASHINGTON
5 RAUL F.,1 No. 1:24-cv-3198-EFS 6 Plaintiff, 7 ORDER REVERSING THE v. ALJ’S DENIAL OF BENEFITS, 8 AND REMANDING FOR FRANK BISIGNANO, MORE PROCEEDINGS 9 Commissioner of Social Security,2
10 Defendant.
11 Plaintiff Raul F. asks the Court to reverse the Administrative 12 Law Judge’s (ALJ) denial of Title 2 benefits. As is explained below, by 13 14
15 1 For privacy reasons, Plaintiff is referred to by first name and last 16 initial or as “Plaintiff.” See LCivR 5.2(c). 17 2 Frank Bisignano was confirmed as the Commissioner of Social 18 Security on May 6, 2025. Pursuant to Federal Rule of Civil Procedure 19 25(d) and 42 U.S.C. § 405(g), he is substituted as the Defendant. 20 1 not calling a medical expert, the ALJ erred when evaluating Plaintiff’s
2 symptom reports and the medical opinions. This matter is remanded 3 for further proceedings. 4 I. Background
5 In April 2017, Plaintiff applied for benefits, claiming disability 6 beginning March 15, 2017, because of right-sided numbness and pain, 7 injuries to the right hand, depression, and chronic headaches.3 The
8 agency denied benefits at the initial and reconsideration level.4 On 9 November 14, 2018, Plaintiff and his attorney attended a hearing 10 before ALJ Timothy Mangrum, at which Plaintiff and a vocational
11 expert testified.5 On January 18, 2019, ALJ Mangrum issued an 12 unfavorable decision, which denied benefits.6 Plaintiff filed a request 13
14 15
16 3 AR 356-362, 387. 17 4 AR 134, 146. 18 5 AR 42-60. 19 6 AR 103-123. 20 1 for review and on August 27, 2020, the Appeals Council remanded the
2 case for further proceedings.7 3 On July 21, 2021, Plaintiff and his attorney appeared for a second 4 hearing before ALJ Mangrum at which Plaintiff and a vocational
5 expert testified.8 On October 12, 2021, ALJ Mangrum issued a second 6 unfavorable decision denying benefits.9 On December 13, 2022, the 7 Appeals Council denied Plaintiff’s request for review.10 Plaintiff filed
8 suit in this Court and on June 26, 2023, the Court remanded the case 9 for further proceedings based upon a stipulation by the parties.11 The 10 Appeals Council remanded the case for a hearing before another ALJ
11 based upon the Court’s order.12 12 13
14 7 AR 124-131. 15 8 AR 61-81. 16 9 AR 15-41, 802-828. 17 10 AR 1-8, 829-836. 18 11 AR 841-2, 843. 19 12 AR 849-856. 20 1 On June 11, 2024, Plaintiff appeared with his attorney before
2 ALJ Deborah Van Vleck, but the hearing was rescheduled because it 3 started 45 minutes late and the ALJ did not think there was sufficient 4 time to take testimony.13 On August 13, 2024, Plaintiff again appeared
5 with his attorney for a hearing before ALJ Van Vleck at which Plaintiff 6 and a vocational expert testified.14 On September 9, 2024, ALJ Van 7 Vleck issued a partially favorable decision that found Plaintiff to be
8 disabled as of October 27, 2022.15 9 For the period prior to October 27, 2022, the ALJ found Plaintiff’s 10 alleged symptoms were “not fully supported prior to October 27,
11 2022.”16 As to the medical opinions, the ALJ found: 12 • the reviewing opinions of Deborah Baylor, MD, and the 13 treating opinions of Onel Martinez, DO, and Catherine Choi,
14 DO, to be not persuasive. 15
16 13 AR 762-768. 17 14 AR 769-801. 18 15 AR 728-761. 19 16 AR 742-744. 20 1 • the reviewing opinions of state agency consultants Dan
2 Donahue, MD, and Bruce Eather, PhD, to be not persuasive.17 3 As to the sequential disability analysis, the ALJ found: 4 • Plaintiff met the insured status requirements through
5 December 31, 2022. 6 • Step one: Plaintiff had not engaged in substantial gainful 7 activity since March 15, 2017, the alleged onset date.
8 • Step two: Since the alleged onset date of disability, March 15, 9 2017, through the established onset date of October 27, 2022, 10 Plaintiff has had the following severe impairments:
11 amputation of the distal phalanx of middle finger of right 12 hand, degenerative changes of fourth digit of right hand, 13 overuse syndrome affecting the intrinsic musculature of right
14 hand, and mild degenerative disc disease of the cervical, 15 thoracic, and lumbar areas of the spine. 16 • Step two: Beginning on the established onset date of disability,
17 October 27, 2022, Plaintiff has had the following severe 18
19 17 AR 744-745. 20 1 impairments: amputation of the distal phalanx of middle
2 finger of right hand, degenerative changes of fourth digit of 3 right hand, overuse syndrome affecting the intrinsic 4 musculature of right hand, and mild degenerative disc disease
5 of the cervical, thoracic, and lumbar areas of the spine as well 6 as degenerative joint disease of the right knee. 7 • Step three: Plaintiff did not have an impairment or
8 combination of impairments that met or medically equaled the 9 severity of one of the listed impairments. 10 • RFC: Prior to October 27, 2022, Plaintiff had the RFC to
11 perform light work except: 12 [he] was limited to frequent reaching, handling, and fingering with the right upper extremity. [Plaintiff] had 13 no limitations with the left upper extremity. [Plaintiff] was limited to occasional climbing of ladders, ropes, and 14 scaffolds.
15 • RFC: Since October 27, 2022, Plaintiff had the RFC to perform 16 sedentary work except: 17 [he] was limited to frequent reaching, handling, and fingering with the right upper extremity. [Plaintiff] had no limitations 18 with the left upper extremity. [Plaintiff] was limited to occasional climbing of ladders, ropes, or scaffolds. 19 • Step four: Plaintiff has no past relevant work. 20 1 • Step five: Prior to October 27, 2022, Plaintiff was capable of
2 performing work available in the general economy such as a 3 cleaner/housekeeper (DOT 323.687-014), cafeteria attendant 4 (DOT 311.677-010), and garment sorter (DOT 222.687-014).18
5 Plaintiff timely requested review of the ALJ’s decision by this 6 Court.19 7 II. Standard of Review
8 The ALJ’s decision is reversed “only if it is not supported by 9 substantial evidence or is based on legal error” and such error 10 impacted the nondisability determination.20 Substantial evidence is
12 18 AR 738-749. 13 19 ECF No. 1. 14 20 Hill v. Astrue, 698 F.3d 1153, 1158 (9th Cir. 2012). See 42 U.S.C. § 15 405(g); Molina v. Astrue, 674 F.3d 1104, 1115 (9th Cir. 2012) ), 16 superseded on other grounds by 20 C.F.R. § 416.920(a) (recognizing that 17 the court may not reverse an ALJ decision due to a harmless error— 18 one that “is inconsequential to the ultimate nondisability 19 determination”). 20 1 “more than a mere scintilla but less than a preponderance; it is such
2 relevant evidence as a reasonable mind might accept as adequate to 3 support a conclusion.”21 4 III. Analysis
5 Plaintiff argues the ALJ erred by rejecting Plaintiff’s symptom 6 testimony, by finding the opinions of the State agency medical 7 consultant and the treating sources unpersuasive and making her own
8 interpretation of the medical evidence, and by finding Plaintiff’s knee 9 impairment and chronic headaches not severe prior to October 27, 10 2022. In contrast, the Commissioner maintains that the ALJ’s findings
12 21 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 were supported by substantial evidence and that any possible error is
2 harmless. As is explained below, by not calling a medical expert to offer 3 testimony as to the progression of Plaintiff’s knee impairment and its 4 associated symptoms, the ALJ erred when evaluating Plaintiff’s
5 reported symptoms. 6 A. Symptom Reports: Plaintiff establishes consequential 7 error.
8 The ALJ found Plaintiff’s statements about the intensity, 9 persistence, and limiting effect of his symptoms were not fully 10 supported by the record for the time period prior to October 27, 2022.22
11 Plaintiff argues that the ALJ erred by arbitrarily concluding that 12 Plaintiff’s knee impairment became severe on the date that he fell 13 because subsequent surgery established that he was suffering from
14 advanced Grade 3 to 4 chondromalacia and that because this condition 15 was gradual, not sudden, expert testimony was needed to determine 16 when it became disabling. As is discussed below, the ALJ’s date-of-
17 disability finding is not supported by substantial evidence given the 18
19 22 AR 742-744. 20 1 ALJ’s failure to call a medical examiner to offer an opinion based on
2 the complete record, as to the date that Plaintiff’s chondromalacia 3 would reasonably have been expected to limit him to sedentary rather 4 than light exertional activities.
5 1. Standard 6 The ALJ must identify what symptom claims are being 7 discounted and clearly and convincingly explain the rationale for
8 discounting the symptoms with supporting citation to evidence.23 This 9 requires the ALJ to “show his work” and provide a “rationale . . . clear 10 enough that it has the power to convince” the reviewing court.24 Factors
11 the ALJ may consider when evaluating the intensity, persistence, and 12 limiting effects of a claimant’s symptoms include: 1) objective medical 13 evidence, 2) daily activities; 3) the location, duration, frequency, and
14 intensity of pain or other symptoms; 4) factors that precipitate and 15 aggravate the symptoms; 5) the type, dosage, effectiveness, and side 16 effects of any medication the claimant takes or has taken to alleviate
18 23 Smartt v. Kijakazi, 53 F.4th 489, 499 (9th Cir. 2022). 19 24 Id. at 499. 20 1 pain or other symptoms; 6) treatment, other than medication, the
2 claimant receives or has received for relief of pain or other symptoms; 3 and 7) any non-treatment measures the claimant uses or has used to 4 relieve pain or other symptoms.25
5 2. Plaintiff’s Reported Symptoms 6 Plaintiff testified that he was having knee problems at the time 7 that he filed his application in 2017 and was not able to stand on his
8 feet for very long.26 9 The medical records reflect that Plaintiff reported chronic pain in 10 his right knee from October 2017 through the date of the decision. On
11 October 30, 2017, Plaintiff was seen at Central Washington Family 12 Medicine by Patrick Vigil, MD.27 Dr. Vigil noted: “Patient words: He is 13 here to discuss several issues right knee and leg pain, started about a
14 month ago, bending makes it worse as does prolonged physical activity. 15
16 25 20 C.F.R. §§ 404.1529(c)(2), (3), 416.929(c). See also 3 Soc. Sec. Law 17 & Prac. § 36:26, Consideration of objective medical evidence (2019). 18 26 AR 798. 19 27 AR 599-600. 20 1 Felt in the back of the thigh, no knee swelling. Also discussed chronic
2 headaches, without aura, treated with short acting analgesics but does 3 not remember ever having a prophylactic medication. Occurs once a 4 week or more, stable course, moderate severity and interference with
5 daily activities.”28 6 At an office visit with Margaret Russell, MD, of Central 7 Washington Family Medicine, on January 16, 2020, Dr. Russell noted a
8 history of varicose veins of legs, lateral epicondylitis, obesity, knee 9 pain, chronic pain of right upper extremity, prediabetes, chronic 10 tension headaches, and fatigue.29
11 At a visit on November 7, 2021, Dr. Vigil noted that there was no 12 swelling, minimal crepitus, and limited extension bilaterally.30 13 Dr. Vigil noted chronic knee pain and diagnosed bilateral chronic knee
14 pain likely secondary to osteoarthritis.31 15
16 28 AR 600. 17 29 AR 713. 18 30 AR 600-601. 19 31 AR 601. 20 1 On October 28, 2022, Plaintiff presented to Joan Knight, MD, of
2 the Yakima Medical Center ER with complaints that he had fallen the 3 day prior and landed on his right knee.32 Plaintiff reported that prior to 4 the fall he had been given a brace to wear on his knee and had been
5 taking ibuprofen and Tylenol, and that he was feeling pain and tingling 6 in his knee.33 On examination, Plaintiff had no effusion and full range 7 of motion of the knee, but it was point tender and X-Rays showed small
8 effusion without fracture or dislocation.34 Dr. Knight diagnosed a 9 medial collateral ligament sprain.35 10 An MRI of the right knee performed on December 30, 2022,
11 indicated mild arthritic changes with thinning of the cartilage and 12 moderate joint effusion, with an impression of a radial tear involving 13 the posterior horn of the medial meniscus, a subtle radial tear
14 involving the apex posterior horn of the lateral meniscus versus chronic 15
16 32 AR 1095. 17 33 Id. 18 34 Id. 19 35 AR 1096. 20 1 degeneration, and some increased signal in the region of the posterior
2 horn lateral meniscus inferior fascicle which may represent fascicle 3 injury, localized joint fluid.36 4 On July 3, 2023, Dr. Griffiths performed a diagnostic arthroscopy
5 with partial medial meniscectomy and partial chondroplasty of medial 6 femoral condyle, right knee.37 The preoperative diagnosis was a 7 symptomatic medial meniscus tear of the right knee and the post-
8 surgical diagnosis was minor mid medial meniscus tear to the leading 9 edge, small radial flap tear with extensive grade 3, possibly small areas 10 of grade 4, near full-thickness chondromalacia involving almost the
11 entire medial femoral condyle with relatively normal pristine lateral 12 compartment, intact ACL and some thinning grade 2-3 at the trochlear 13 groove.38In his operative report, Dr. Griffiths noted extensive grade 3
14 chondromalacia to the medial femoral condyle.39 15
16 36 AR 1102-1103. 17 37 AR 1098. 18 38 AR 1098. 19 39 AR 1100. 20 1 On September 6, 2023, Orthopedist Gene Griffiths, MD, ordered
2 physical therapy for the right knee as well as Synvisc injections with a 3 notation that Plaintiff was status post right knee meniscectomy.40 4 On September 9, 2023, Catherine Choi, DO, completed a medical
5 report form for Plaintiff.41 She said she treated Plaintiff from 6 2016/2017 to present.42 She said that he had right hand and shoulder 7 pain; right knee pain, status-post meniscectomy; chronic back pain;
8 minimal degenerative spondylosis; and primary osteoarthritis of the 9 right knee.43 Dr. Choi said that Plaintiff’s symptoms were decreased 10 right hand grip strength, and inability to stand too long due to back
11 pain; and that he had been treated with osteopathic manipulation, 12 ibuprofen/Tylenol, physical therapy, and Synvisc injections in the right 13 knee.44
15 40 AR 1087. 16 41 AR 1089-1091. 17 42 AR 1089. 18 43 Id. 19 44 Id. 20 1 3. ALJ’s Reasons and Analysis
2 The ALJ gave very little reasoning regarding Plaintiff’s 3 complaints of right knee pain and limitation prior to October 27, 2022, 4 and never actually used the word knee but rather discussed Plaintiff’s
5 gait in general. She noted as follows: 6 Examinations from October 2018 showed the claimant had mild tenderness to palpation of the thoracic and lumbar 7 areas of the spine, slow and antalgic gait, limited range of motion to the cervical and lumbar areas of the spine, and 8 positive lumbar compression and distraction testing on the right (Exhibit 13F/18-19 & 30). One examination from 9 October 2018 showed the claimant had grossly intact lower extremity motor and sensory function as well as normal grip 10 strength bilaterally (Id./30). Imaging of the spine revealed mild degenerative changes in the thoracic and lumbar areas 11 of the spine (Exhibit 12F).45
12 She additionally noted:
13 Physical therapy notes from November 2018 showed the claimant reported improvement in walking because his 14 walking increased from 15 minutes to 1 hour (Exhibits 13F/6 and 14F/2). The physical therapist indicated the 15 claimant was progressing well and had improvement in range of motion of the trunk (Id.).46 16 17
18 45 AR 743. 19 46 AR 744. 20 1 As to the period after October 27, 2022, the ALJ articulated the
2 following reasoning: 3 The record showed that on October 28, 2022 the claimant sought treatment for right knee pain (Exhibit 23F/4). At 4 that visit, the claimant reported the knee pain started after he fell on October 27 (Id.). The examination showed the 5 claimant had full range of motion of both lower extremities but point tenderness to the medial collateral aspect of the 6 right knee (Id.). Initially, the claimant was diagnosed with a medial collateral ligament sprain of the knee (Id./5). 7 However, the claimant continued to complain of knee pain and December 2022 MRI of the right knee revealed findings 8 that suggested a radial tear involving the posterior horn of the medial meniscus (Exhibit 23F/11-12). The claimant had 9 a partial medial meniscectomy with partial chondroplasty of the medial femoral condyle of the right knee in July 2023 10 (Id./7). The claimant was diagnosed with osteoarthritis of the right knee (Exhibit 21F). Despite surgery, the claimant 11 continued to complain of right knee pain and 2024 x-ray showed the claimant had grade 2-3/4 early mild 12 degenerative change to the knee (Exhibit 26F/2).47
13 4. The ALJ’s Consideration of the Medical Opinions 14 The ALJ considered each of the three medical opinions regarding 15 Plaintiff’s physical limitations and found all three unpersuasive. 16 On September 7, 2017, State agency consultant Debra Baylor, 17 MD, reviewed Plaintiff’s file and opined that Plaintiff would have the 18
19 47 AR 746. 20 1 ability to occasionally lift and carry up to 50 pounds, to frequently lift
2 and carry up to 25 pounds, to stand or walk for up to 6 hours in an 3 eight-hour day, and to sit for up to 6 hours in an eight-hour day.48 The 4 records reviewed by Dr. Baylor did not include records commencing in
5 October 2017 regarding right knee pain.49 6 As noted above, on September 9, 2023, Catherine Choi, DO, 7 completed a medical report form for Plaintiff.50 She opined that as a
8 result of his right hand and shoulder pain; right knee pain, status-post 9 meniscectomy; chronic back pain; minimal degenerative spondylosis; 10 and primary osteoarthritis of the right knee, Plaintiff would be limited
11 to performing work at the sedentary level.51 12 5. Analysis 13 The ALJ did not properly articulate her consideration of
14 Plaintiff’s allegations of knee pain from October 2017 to October 2022. 15
16 48 AR 98-100. 17 49 AR 96-97. 18 50 AR 1089-1091. 19 51 Id. 20 1 As noted above, the ALJ focused her analysis of Plaintiff’s complaints
2 regarding his right knee to the period after October 27, 2022. Her 3 consideration of that issue was crucial to her decision, as it was a 4 finding that Plaintiff was limited by his knee injury that rendered him
5 to be able to perform only sedentary work and thereby disabled 6 pursuant to the medical-vocational guidelines.52 The ALJ stated: 7 The combination of the claimant’s severe impairments with the abnormal examination findings as well as the claimant’s 8 need for surgery to the right knee supports limiting the claimant to sedentary work instead of light work.53 9 With regard to the period prior to October 27, 2022, the ALJ 10 found that Dr. Baylor’s findings were not persuasive, noting the 11 following: 12 The prior administrative findings from the State agency, 13 Debra Baylor, M.D., are not persuasive (Exhibit 4A). Dr. Baylor supported their findings by discussing the claimant’s 14 allegations and examination findings (Id.). However, the imaging studies showing the claimant had degenerative 15 changes to the lumbar and thoracic spine and examinations showing tenderness to palpation of the thoracic and lumbar 16 spine and limited range of motion to the lumbar spine supports limiting the claimant to light work as well as 17
18 52 AR 746-747. 19 53 AR 746. 20 1 supports limiting the claimant to occasional climbing of ladders, ropes, and scaffolds (Exhibits 9F/2; 12F; 13F/18-19 2 & 30; 15F/5; and 20/29). Furthermore, the periodic examinations showing normal strength to the right upper 3 extremity contradicts limiting the claimant to occasional fingering (Exhibits 11F/15 and 13F/30).54 4 In discussing Dr. Baylor’s opinions, the ALJ failed to consider 5 that Dr. Baylor’s review of the record was performed approximately 6 one month prior to Plaintiff’s first reported symptoms of right knee 7 pain.55 8 Similarly, the ALJ failed to consider that Dr. Choi’s medical 9 report was rendered in September 2023, after it was determined that 10 Plaintiff suffered from grade 3-4 chondromalacia in his right knee.56 11 When addressing the period after October 27, 2022, the ALJ 12 stated the following: 13 The record showed that on October 28, 2022 [Plaintiff] 14 sought treatment for right knee pain (Exhibit 23F/4). At that visit, [Plaintiff] reported the knee pain started after he 15 fell on October 27 (Id.). The examination showed [Plaintiff] had full range of motion of both lower extremities but point 16
17 54 AR 744. 18 55 Id. 19 56 AR 744-745. 20 1 tenderness to the medial collateral aspect of the right knee (Id.). Initially, [Plaintiff] was diagnosed with a medial 2 collateral ligament sprain of the knee (Id./5). However, [Plaintiff] continued to complain of knee pain and December 3 2022 MRI of the right knee revealed findings that suggested a radial tear involving the posterior horn of the medial 4 meniscus (Exhibit 23F/11-12). [Plaintiff] had a partial medial meniscectomy with partial chondroplasty of the 5 medial femoral condyle of the right knee in July 2023 (Id./7). [Plaintiff] was diagnosed with osteoarthritis of the 6 right knee (Exhibit 21F). Despite surgery, [Plaintiff] continued to complain of right knee pain and 2024 x-ray 7 showed the claimant had grade 2-3/4 early mild degenerative change to the knee (Exhibit 26F/2).57 8 The ALJ erred by failing to consider the treatment sought by 9 Plaintiff prior to October 28, 2022, as well as the consistent complaints 10 made by Plaintiff of pain in his right knee. The ALJ did not consider 11 that the treatment notes from the period prior to October 27, 2022, 12 were consistent with those of October 28, 2022. When examined on 13 October 28, 2022, Plaintiff reported pain and tingling in the knee and 14 had no bruising or effusion swelling but was tender at the medial 15 collateral aspect.58 When Plaintiff first reported symptoms of knee pain 16 17
18 57 AR 746. 19 58 AR 1095. 20 1 in October 2017 there was no swelling but there was limited range of
2 motion.59 When Plaintiff was seen by Dr. Vigil in November 2021, he 3 continued to report knee pain and had crepitus and limited extension.60 4 The ALJ additionally erred in stating that Plaintiff’s diagnosis of
5 advanced chondromalacia was based upon a March 2024 X-ray.61 The 6 diagnosis of grade 3-4 chondromalacia was made on July 3, 2023, based 7 upon the results of arthroscopic surgery.62 Moreover, an MRI of the
8 knee in December 2022 indicated arthritic changes, thinning of the 9 cartilage, radial tears, and chronic degeneration.63 The ALJ’s 10 impression that advanced chondromalacia was not identified until 2024
11 is error, as it was identified as early as 2022. 12 13
15 59 AR 600. 16 60 AR 601. 17 61 AR 746. 18 62 AR 1100. 19 63 AR 1102-1103. 20 1 There is no dispute that as of December 2022 to July 2023
2 Plaintiff was diagnosed with a degenerative condition and that he was 3 diagnosed with severe degenerative changes. 4 “Social Security proceedings are inquisitorial rather than
5 adversarial. It is the ALJ's duty to investigate the facts and develop the 6 arguments both for and against granting benefits[.]”64 The ALJ has an 7 affirmative duty to assist the claimant in developing the record “when
8 there is ambiguous evidence or when the record is inadequate to allow 9 for proper evaluation of the evidence.”65 10
11 64 Sims v. Apfel, 530 U.S. 103, 110-11 (2000). 12 65 Mayes v. Massanari, 276 F.3d 453, 459-60 (9th Cir. 2001); see 13 also Brown v. Heckler, 713 F.2d 441, 443 (9th Cir. 1983) (per curiam) 14 (“In Social Security cases the ALJ has a special duty to fully and fairly 15 develop the record and to assure that the claimant's interests are 16 considered. This duty exists even when the claimant is represented by 17 counsel.”) (citation omitted). At the same time, “the ALJ is the final 18 arbiter with respect to resolving ambiguities in the medical evidence.” 19
20 1 The record indicates that by October 2022 Plaintiff was suffering
2 from advanced degenerative changes in his right knee. The record is 3 unclear to an untrained individual, however, at what point Plaintiff’s 4 degenerative conditions would have been expected to have impacted his
5 ability to perform work above the sedentary exertional level. As noted 6 above, the only medical opinion rendered that considered the issue is 7 Dr. Choi’s opinion which limited Plaintiff to sedentary work, but even
8 that opinion is unclear as to the date on which the restriction to 9 sedentary work would apply. 10 It has been held in this Circuit that an ALJ may not substitute
11 her lay interpretation of raw medical data in making an RFC 12 assessment in lieu of a qualified expert's medical opinion.66 13 The Court concludes that given the lack of medical opinion
14 evidence regarding the progression of Plaintiff’s degenerative condition 15 16
17 18
19 66 Penny v. Sullivan, 2 F.3d 953, 958 (9th Cir. 1993) 20 1 the ALJ erred in failing to either order an updated consultative
2 examination67 or call medical expert to testify at the hearing.68 3 The ALJ’s finding that Plaintiff’s symptom reports were “not 4 entirely consistent” with the record is not supported by substantial
5 evidence. The ALJ’s decision not to call a medical expert to testify at 6 the hearing and offer an opinion based on the more recent medical 7 records, before discounting Plaintiff’s symptom reports contributed to
8 this error.69 While an ALJ is given the discretion to determine whether 9 to call a medical expert to “clarify and explain the evidence or help 10 resolve a conflict because the medical evidence is contradictory,
11 inconsistent, or confusing” or there are ”question(s) about the etiology 12 or course of a disease and how it may affect the claimant’s ability to 13 engage in work activities at pertinent points in time,” the ALJ
14 consequentially erred by not exercising this discretion to call a medical 15
16 67 20 C.F.R. § 404.1517, 17 68 20 C.F.R. §§ 404.1519, 404.1519a. 18
19 69 Program Operations Manual System, HA 01250.034. 20 1 expert to resolve these conflicts/questions and instead proceeded
2 herself to interpret the medical record. 3 B. Medical Opinions: the ALJ must reconsider on remand. 4 Because this matter is being remanded due to the ALJ’s errors
5 when evaluating Plaintiff’s symptom reports, the ALJ is to reevaluate 6 the medical opinions on remand. The ALJ is to be mindful that 7 Dr. Baylor’s opinion was rendered in 2017, just prior to Plaintiff’s
8 initial treatment for right knee pain. 9 C. Other Issues: these are rendered moot. 10 Because the Court has remanded the case for further development
11 of the record, the other issues raised are rendered moot. 12 D. Remand: further proceedings 13 Plaintiff seeks a remand for payment of benefits. However,
14 further development is necessary for a proper disability determination, 15 including both the development of the medical record and either 16 ordering a new consultative examination by a qualified medical
17 provider, who is to be given a copy of sufficient longitudinal medical 18 records to aid that examiner in reaching an opinion as to the 19 progression of Plaintiff’s degenerative condition, and/or calling a
20 1 medical expert qualified to testify as to the expected progression of
2 such condition.70 The ALJ is to then reconsider the medical evidence, 3 Plaintiff’s symptom reports, and reevaluate the sequential process. 4 IV. Conclusion
5 Plaintiff establishes the ALJ erred. The ALJ is to develop the 6 record and reevaluate—with meaningful articulation and evidentiary 7 support—the sequential process.
8 Accordingly, IT IS HEREBY ORDERED: 9 1. The ALJ’s nondisability decision is REVERSED, and this 10 matter is REMANDED to the Commissioner of Social
11 Security for further proceedings pursuant to 12 sentence four of 42 U.S.C. § 405(g). 13 2. The Clerk’s Office shall TERM the parties’ briefs, ECF
14 Nos. 8 and 12, enter JUDGMENT in favor of Plaintiff, 15 and CLOSE the case. 16
18 70 See Leon v. Berryhill, 880 F.3d 1041, 1045 (9th Cir. 2018); Garrison 19 v. Colvin, 759 F.3d 995, 1020 (9th Cir. 2014). 20 1 IT IS SO ORDERED. The Clerk’s Office is directed to file this
2 ||order and provide copies to all counsel.
3 DATED this 12 day of June 2025.
wed I law 5 EDWARD F.SHEA Senior United States District Judge 6 7 8 9 10 11
12 13 14 15 16 17 18 19
DISPOSITIVE ORDER - 28