Natalie W v. Acting Commissioner of Social Security

• Court: District Court, W.D. Washington
• Decided: April 20, 2026
• Docket: 2:25-cv-00716
• Status: Unknown

Opinion

1 2 3 4 UNITED STATES DISTRICT COURT WESTERN DISTRICT OF WASHINGTON 5 AT SEATTLE 6 NATALIE W, Case No. 2:25-cv-00716-TLF 7 Plaintiff, v. ORDER REVERSING AND 8 REMANDING DEFENDANT’S ACTING COMMISSIONER OF SOCIAL DECISION TO DENY BENEFITS 9 SECURITY, 10 Defendant. 11 12 Plaintiff filed this action pursuant to 42 U.S.C. § 405(g) for judicial review of 13 defendant’s denial of plaintiff’s application for supplemental security income (“SSI”) and 14 disability insurance benefits (“DIB”). Pursuant to 28 U.S.C. § 636(c), Federal Rule of 15 Civil Procedure 73, and Local Rule MJR 13, the parties have consented to the 16 jurisdiction of a Magistrate Judge. Dkt. 2. Plaintiff challenges the ALJ’s decision finding 17 that plaintiff was not disabled. Dkt. 5, Complaint. 18 FACTUAL AND PROCEDURAL BACKGROUND 19 Plaintiff filed a claim for SSI and DIB on April 16, 2018, alleging disability 20 beginning April 1, 2017. AR 310. Her applications were denied initially and upon 21 reconsideration. AR 308-59. ALJ Virginia Robinson held a hearing on December 5, 22 2019, and found plaintiff not disabled. AR 18-32. The Appeals Council denied plaintiff’s 23 request for review and plaintiff filed an action in this Court. AR 1-3, 2030-31. On 24 stipulation by the parties, this Court reversed and remanded the claim for further 1 proceedings. AR 2037-38. The ALJ again found plaintiff not disabled. AR 2087-2111. 2 Plaintiff filed written exceptions to that decision, and the Appeals Council remanded the 3 case for further proceedings before a new ALJ. AR 2123-24. ALJ Cecilia LaCara held a 4 hearing on December 8, 2023, and once more found plaintiff not disabled. AR 1910-36. 5 The ALJ found plaintiff had the following severe impairments: degenerative disc

6 disease; osteoarthritis of the right acromioclavicular joint; fibromyalgia; migraine 7 headaches; hypertension; ischemic heart disease; obesity; anxiety disorder; bipolar 8 disorder; post-traumatic stress disorder (PTSD); and chronic opioid use disorder. AR 9 1912. Plaintiff had the residual functional capacity (RFC) to perform light work as 10 defined in 20 C.F.R. §§ 404.1567(b) and 416.967(b) except she can: 11 frequently climb ramps or stairs, stoop, kneel, and crouch; never climb ladders, ropes or scaffolds; occasionally crawl; occasionally engage in 12 right overhead reaching; must avoid concentrated exposure to excessive industrial levels of noise, excessive industrial levels of vibration, and 13 respiratory irritants; work is limited to simple, routine tasks with occasional changes in the work setting and decision making; occasional interaction 14 with the public; and frequent superficial interaction with coworkers.

15 AR 1919. The ALJ found plaintiff could perform work existing in the national economy 16 and was accordingly not disabled. AR 1935. The Appeals Council denied plaintiff’s 17 request for review, making the ALJ’s decision the final decision of the Commissioner. 18 Plaintiff appealed to this Court. 19 DISCUSSION 20 Pursuant to 42 U.S.C. § 405(g), this Court may set aside the Commissioner's 21 denial of Social Security benefits if the ALJ's findings are based on legal error or not 22 supported by substantial evidence in the record as a whole. Revels v. Berryhill, 874 23 F.3d 648, 654 (9th Cir. 2017) (internal citations omitted). Substantial evidence is “‘such 24 1 relevant evidence as a reasonable mind might accept as adequate to support a 2 conclusion.’” Biestek v. Berryhill, 139 S. Ct. 1148, 1154 (2019) (internal citations 3 omitted). The Court must consider the administrative record as a whole. Garrison v. 4 Colvin, 759 F.3d 995, 1009 (9th Cir. 2014). The Court also must weigh both the 5 evidence that supports and evidence that does not support the ALJ’s conclusion. Id.

6 The Court may not affirm the decision of the ALJ for a reason upon which the ALJ did 7 not rely. Id. Rather, only the reasons identified by the ALJ are considered in the scope 8 of the Court’s review. Id. 9 Plaintiff argues that the ALJ failed to explain why she rejected opinions from the 10 state agency psychological consultants and failed to give legally sufficient reasons for 11 rejecting the opinions of Margaret Cunningham, Ph.D., and Gilberto Fernandez, MSW. 12 Dkt. 12 at 1. 13 1. Medical Evidence 14 Under the applicable regulations the ALJ was required to articulate how

15 persuasive she found each medical opinion or prior administrative medical finding and 16 explain how she considered supportability and consistency in her analysis. 20 C.F.R. §§ 17 404.1520c(b)(2), 416.920c(b)(2). Supportability means the extent to which a medical 18 source supports their opinion by explaining the relevant medical evidence. Woods v. 19 Kijakazi, 32 F.4th 785, 791-92 (9th Cir. 2022). Consistency means the extent to which 20 an opinion is consistent with the evidence from other medical and non-medical sources 21 in the claim. Id. at 792. An ALJ cannot reject an opinion as unsupported or inconsistent 22 without providing an explanation supported by substantial evidence. Id. 23 a. State Agency Psychological Consultants 24 1 Plaintiff argues that the ALJ erred in finding the state agency psychological 2 consultants’ opinions persuasive but failing to adopt all the limitations in those findings 3 when crafting the RFC. Dkt. 12 at 5. 4 State agency psychological consultant Matthew Comrie, PsyD., reviewed 5 plaintiff’s claim at the initial level and found that she was moderately limited in the

6 abilities to maintain attention and concentration for extended periods and to complete a 7 normal workday or workweek without interruptions from psychologically based 8 symptoms and perform at a consistent pace without an unreasonable number and 9 length of rest periods. AR 335. He noted that plaintiff would be expected to have 10 occasional breaks in concentration, persistence, and pace (CPP) due to her mental 11 health symptoms, but such breaks would not interfere with her ability to complete a 12 normal workday and workweek. Id. On reconsideration, Michael Regets, Ph.D., affirmed 13 these findings. AR 353-54. 14 Plaintiff filed a new application in 2020 which has been consolidated with her

15 prior applications. Dr. Beth Fitterer reviewed this claim at the initial level and found 16 plaintiff moderately limited in her ability to carry out detailed instructions and work in 17 coordination with or in proximity to others without being distracted by them. AR 2047. 18 She stated that plaintiff could carry out simple routine tasks with occasional distractibility 19 secondary to PTSD. Id. 20 The ALJ found the findings of Dr. Comrie, Dr. Regets, and Dr. Fitterer generally 21 persuasive. AR 1928. Plaintiff argues that because the RFC did not address the 22 occasional breaks in CPP opined by Dr. Comrie & Dr. Regets or the occasional 23 distractibility opined by Dr. Fitterer, the ALJ rejected these limitations without 24 1 explanation.1 Dkt. 12 at 5. The Commissioner argues that the ALJ reasonably 2 incorporated these limitations in the RFC. Dkt. 14 at 4-5. 3 The ALJ is responsible for “translating and incorporating clinical findings into a 4 succinct RFC.” Rounds v. Comm’r Soc. Sec. Admin., 807 F.3d 996, 1006 (9th Cir. 5 2015). The RFC need not directly correspond to a specific medical opinion, but if the

6 RFC conflicts with an opinion from a medical source, the ALJ must explain why the 7 opinion was not adopted. SSR 96-8p, available at 1996 WL 374184, at *7 (July 2, 8 1996). An ALJ’s RFC assessment adequately captures restrictions related to 9 concentration, persistence, or pace where the assessment is “consistent with 10 restrictions identified in the medical testimony.” Stubbs-Danielson v. Astrue, 539 F.3d 11 1169, 1174 (9th Cir. 2008) (finding a limitation to simple, routine, repetitive work was 12 consistent with opinion that a claimant could carry out “very short simple instructions”). 13 Relying on Stubbs-Danielson, the Ninth Circuit has found restrictions to simple 14 repetitive tasks accounted for moderate difficulties in concentration, persistence, or

15 pace. Lee v. Berryhill, 721 F. App’x 604, 608 (9th Cir. 2017); Turner v. Berryhill, 705 F. 16 App’x 495, 498-99 (9th Cir. 2017). Here, the ALJ limited plaintiff to simple, routine tasks 17 with occasional changes in the work setting and decision making. AR 1919. Thus, the 18 RFC adequately incorporates the moderate limitations opined by the state agency 19 psychological consultants. 20 b. Margaret Cunningham, Ph.D. 21

22 1 Plaintiff also contends that “occasional” in the social security context means up to one-third of a workday and implies that the state agency consultants intended that her breaks in CPP and distractibility would 23 occur up to one-third of the workday. Dkt. 12 at 5. As all three doctors concluded that plaintiff was capable of unskilled work despite her functional limitations, the Court may infer that they implemented this 24 definition of “occasional” when forming their opinions. 1 Dr. Cunningham evaluated plaintiff in November 2017 and found her markedly 2 limited in her ability to sustain the following basic work activities: adapt to changes in a 3 routine work setting; communicate and perform effectively in a work setting; maintain 4 appropriate behavior in a work setting; and complete a normal workday and work week 5 without interruptions from psychologically based symptoms. AR 751. She found plaintiff

6 moderately limited in nine other basic work activities. Id. The ALJ found the opinion 7 unpersuasive on supportability and consistency grounds. AR 1932. 8 i. Supportability 9 The ALJ found Dr. Cunningham’s opinion unpersuasive because it was not well 10 supported by her relatively unremarkable mental status examination (MSE). AR 1932. 11 Plaintiff argues the ALJ did not actually review Dr. Cunningham’s findings or provide 12 any reasoning to support her conclusion. Dkt. 12 at 9. 13 The ALJ’s supportability findings are not supported by substantial evidence. First, 14 “[t]o say that medical opinions are not supported by sufficient objective findings or are

15 contrary to the preponderant conclusions mandated by the objective findings does not 16 achieve the level of specificity our prior cases have required.” Embrey v. Bowen, 849 17 F.2d 418, 421-22 (9th Cir. 1988). The ALJ also mischaracterizes Dr. Cunningham’s 18 findings as unremarkable when the MSE actually contains several abnormal findings. 19 Plaintiff’s mood was anxious and depressed, and her affect was anxious and worried. 20 AR 753. Dr. Cunningham found plaintiff’s thought process and content were not within 21 normal limits because she hears her name called, misperceives things, and has 22 generalized paranoia and thoughts of suicide. Id. Plaintiff’s orientation, fund of 23 knowledge, and concentration also were not within normal limits, as plaintiff did not 24 1 know the season or day, did not know the name of the governor, and could not count 2 backward by seven. Id. Beyond the MSE, plaintiff scored in the severe range for 3 generalized anxiety and major depression on the Beck Anxiety Inventory and Beck 4 Depression Inventory-II, respectively. AR 754. These findings support Dr. 5 Cunningham’s opinion that plaintiff would have a number of marked functional

6 limitations. Accordingly, the ALJ’s supportability findings are not supported by 7 substantial evidence. 8 ii. Consistency 9 The ALJ found Dr. Cunningham’s opinion of marked limitations inconsistent with 10 the record, including relatively normal findings on mental status examination, evidence 11 of improvement with treatment, and plaintiff’s activities such as caring for children and 12 driving. AR 1932-33. 13 While ALJs must rely on examples to support their findings, the data points they 14 choose must constitute examples of a broader development. Garrison, 759 F.3d at

15 1018. An ALJ “cannot reach a conclusion first, and then attempt to justify it by ignoring 16 competent evidence in the record that suggests an opposite result.” Gallant v. Heckler, 17 753 F.2d 1450, 1456 (9th Cir. 1984). Considered in full, the record shows repeated 18 instances of mania and hypomania, visual, and auditory hallucinations, paranoia, sleep 19 disturbances, severe anxiety, and episodes of self-injury. See, e.g., 632, 644, 647, 20 1077, 1143, 2497, 2512, 2527, 2542, 2671, 2680. The ALJ has erroneously cherry- 21 picked normal MSE findings which do not accurately reflect the record as a whole. 22 Holohan v. Massanari, 246 F.3d 1195, 1207-08 (9th Cir. 2001) (finding error where the 23 ALJ cherry-picked certain entries in records while ignoring others). 24 1 The ALJ also found Dr. Cunningham’s opinion inconsistent with plaintiff’s 2 improvement with treatment. AR 1932. Evidence that a claimant has improved with 3 treatment can undermine a claim for disability, but “some improvement” in a person’s 4 symptoms “does not mean that the person’s impairments no longer seriously affect her 5 ability to function in a workplace.” Holohan, 246 F.3d at 1205. In the context of mental

6 health issues, the Ninth Circuit has cautioned that reports of improvement “must be 7 interpreted with an understanding of the patient’s overall well-being and the nature of 8 her symptoms.” Garrison, 759 F.3d at 1017. This is particularly relevant here, where 9 plaintiff is diagnosed with bipolar disorder, a condition that waxes and wanes. Attmore v. 10 Colvin, 827 F.3d 872, 878 (9th Cir. 2016); see also Buck v. Colvin, 540 F. App’x 772, 11 773 (9th Cir. 2013) (“Given the episodic nature of bipolar disorder, short-lived 12 improvements in functioning are consistent with the diagnosis[.]”). 13 The ALJ erroneously isolated notations of improvement from the records in which 14 they appear, which – when considered in context -- indicate ongoing symptoms such as

15 auditory hallucinations, racing thoughts, high energy, grandiose presentation, and 16 nightmares. See, e.g, AR 1477, 2550, 2557, 3222, 3245. The ALJ also selectively 17 focused on visits where plaintiff is noted as stable on her psychiatric medications but the 18 ALJ failed to acknowledge the context -- counseling records from around the same time 19 that indicate ongoing symptoms. Compare AR 1660 (August 22, 2019 visit with PCP, 20 stable on medication) and AR 2557 (August 15, 2019 therapy note, high manic mood, 21 experiencing sudden changes in mood and energy, presents as grandiose); compare 22 AR 2586 (April 22, 2020 medication management visit, stable and at baseline) and AR 23 2611 (April 23, 2020 therapy note, having problems with sleep, high levels of anxiety, 24 1 and increased mania). The ALJ has thus committed the same error as that in Garrison, 2 where “[r]ather than describe [plaintiff’s] symptoms, course of treatment, and bouts of 3 remission, and thereby chart a course of improvement, the ALJ improperly singled out a 4 few periods of temporary well-being from a sustained period of impairment[.]” 759 F.3d 5 at 1018.

6 The ALJ also found Dr. Cunningham’s opinion inconsistent with evidence of 7 plaintiff’s activities, such as caring for her children and driving. AR 1932-33. An ALJ may 8 reject an opinion when the physician sets restrictions that “appear to be inconsistent 9 with the level of activity that [the claimant] engaged in.” Rollins v. Massanari, 261 F.3d 10 853, 856 (9th Cir. 2001). The ability to care for others without help has been considered 11 an activity that may undermine claims of disability. Id. at 857 (restrictions inconsistent 12 with ability to raise two young children without significant assistance from ex-husband). 13 But “[a]bsent specific details about [claimant’s] childcare responsibilities, those tasks 14 cannot constitute “substantial evidence” inconsistent with [the physician’s] opinion[.]”

15 Trevizo v. Berryhill, 871 F.3d 664, 676 (9th Cir. 2017). 16 Plaintiff’s childcare responsibilities are not inconsistent with Dr. Cunningham’s 17 opinion. At her first hearing plaintiff described her children (13 and 17 years old at the 18 time) as “rather self-sufficient.” AR 281, 284. On another occasion she stated her kids 19 “can mostly take care of themselves.” AR 2978-79. She also receives assistance from 20 her boyfriend in caring for her children. AR 517, 1991, 3185. 21 Despite their self-sufficiency and help from her boyfriend, plaintiff has stated at 22 numerous therapy appointments that caring for her family is stressful and 23 overwhelming. AR 2550, 2557, 2575, 3185. Thus, plaintiff’s parenting responsibilities, at 24 1 least as they are reflected in the record before the Court, are not inconsistent with Dr. 2 Cunningham’s opinion. Nor is her ability to drive. Dr. Cunningham did not restrict 3 plaintiff from driving, and the ALJ fails to explain why driving is inherently inconsistent 4 with the limitations opined by Dr. Cunningham. 5 In sum, the ALJ’s consistency findings are not supported by substantial evidence.

6 Having failed to articulate valid supportability or consistency findings, the ALJ 7 erroneously rejected Dr. Cunningham’s opinion. As Dr. Cunningham opined limitations 8 more restrictive than those included in the RFC, the error was not “inconsequential to 9 the nondisability determination,” and was therefore harmful. Molina v. Astrue, 674 F.3d 10 1104, 1115 (9th Cir. 2012). 11 c. Gilberto Fernandez, MSW 12 Mr. Fernandez, plaintiff’s therapist of several years, opined plaintiff had marked 13 limitations in the following categories: remember locations and work-like procedures; 14 understand and remember very short and simple instructions; maintain attention and

15 concentration for extended periods; complete a normal workday and workweek without 16 interruptions from psychologically based symptoms; and deal with normal work stress. 17 AR 1891. He also opined a number of mild and moderate limitations. Id. The ALJ found 18 his opinion unpersuasive on supportability and consistency grounds. AR 1933 19 i. Supportability 20 The ALJ found Mr. Fernandez’s opinion was not well supported by his treatment 21 notes because the treatment notes indicate plaintiff’s mental health has been generally 22 stable. AR 1933. 23 24 1 The ALJ’s s The ALJ’s supportability findings are not supported by 2 substantial evidence and are erroneous in two respects. First, the fact that a person’s 3 condition is stable has little bearing on whether a condition is disabling. “Stable” is 4 defined as steady, not varying, and resistant to change. Stedmans Medical Dictionary 5 842460. Many courts in this circuit have held the fact that a plaintiff’s condition is stable

6 does not, without more, indicate that a plaintiff’s condition is not disabling. See, e.g., 7 Petty v. Astrue, 550 F. Supp. 2d 1089, 1099 (D. Ariz. 2008) (“The Court initially notes 8 that a condition can be stable but disabling.”); Gomez v. Kijakazi, 2023 WL 6811993, at 9 *7 (E.D. Cal. Oct. 16, 2023); Debra D. B. v. Comm’r, Soc. Sec. Admin., 202 WL 118255, 10 at *6 (D. Or. Jan. 9, 2020). 11 Further, as with the other mental health medical opinions discussed above, the 12 decision shows the ALJ cherry-picked normal findings that do not reflect the context of 13 plaintiff’s overall challenges, and consequently mischaracterized Mr. Fernandez’s 14 treatment notes as showing stability. The Court is required to consider the whole

15 medical record; Mr. Fernandez’s treatment notes reveal that, consistent with the 16 diagnosis of bipolar disorder, plaintiff experienced many ups and downs in her condition 17 over the course of their four-year treatment relationship. See, e.g., AR 631-719 18 (significant manic symptoms consistently between June and October 2017); AR 2559- 19 79 (documented stability between June and August 2019); AR 2524 (November 2019, 20 plaintiff rates mania 8/10, noted as thoughts moving too fast, abnormally upbeat, and 21 talkative); AR 3218-46 (stable and doing well between April and August 2021). 22 ii. Consistency 23 24 1 The ALJ’s consistency analysis for Mr. Fernandez’s opinion is identical to that 2 used for Dr. Cunningham’s opinion. See AR 1932-33. This analysis is not supported by 3 substantial evidence for the same reasons already discussed above. Having failed to 4 articulate valid supportability or consistency findings, the ALJ erroneously rejected Mr. 5 Fernandez’s opinion. As Mr. Fernandez opined limitations more restrictive than those

6 included in the RFC, the error was not “inconsequential to the ultimate nondisability 7 determination,” and was therefore harmful. Molina, 674 F.3d at 1115. 8 CONCLUSION 9 For those reasons, the Court concludes the ALJ improperly determined plaintiff to 10 be not disabled. Therefore, the ALJ’s decision is reversed and remanded for further 11 administrative proceedings. On remand, the ALJ shall conduct a de novo hearing, allow 12 plaintiff to present additional evidence, reevaluate the medical evidence, and proceed 13 with the sequential analysis as necessary. 14

15 Dated this 20th day of April, 2026. 16 A Theresa L. Fricke 17 United States Magistrate Judge

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