1 2 3 4 5 6 7 8 UNITED STATES DISTRICT COURT 9 FOR THE EASTERN DISTRICT OF CALIFORNIA 10 11 YIESA JONES, Case No. 1:21-cv-01414-JLT-BAM 12 Plaintiff, FINDINGS AND RECOMMENDATIONS 13 v. REGARDING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT 14 LELAND DUDEK, Acting Commissioner 15 of Social Security,1 (Docs. 17, 21, 22) 16 Defendant.
17 18
19 INTRODUCTION 20 Plaintiff Yiesa Jones (“Plaintiff”) seeks judicial review of a final decision of the 21 Commissioner of Social Security (“Commissioner”) denying her application for Disability Insurance 22 Benefits under Title II of the Social Security Act. The parties’ briefing on the motion was submitted, 23 without oral argument, to Magistrate Judge Barbara A. McAuliffe for findings and recommendations. 24 (Docs. 17, 21, 22.) Having considered the parties’ briefs, along with the entire record in this case, the 25 Court finds that the decision of the Administrative Law Judge (“ALJ”) was not supported by 26
27 1 Leland Dudek became the Acting Commissioner of Social Security in February 2025. Pursuant to Rule 25(d) of the Federal Rules of Civil Procedure, Leland Dudek is substituted for Kilolo Kijakazi as 28 Defendant in this suit. 1 substantial evidence in the record and was not based upon proper legal standards. Accordingly, this 2 Court will recommend reversing the agency’s determination to deny benefits. 3 FACTS AND PRIOR PROCEEDINGS 4 Plaintiff applied for Title II Disability Insurance Benefits on November 28, 2018, alleging that 5 she became disabled on September 15, 2018. AR 179-82.2 The claim was denied initially on January 6 3, 2020, and on reconsideration on April 29, 2020. AR 99-103, 107-112. Plaintiff requested a hearing 7 before an administrative law judge (“ALJ”) and ALJ Karen B. Kostol held a hearing on January 4, 8 2021. AR 34-67. ALJ Kostol issued an order denying benefits on the basis that Plaintiff was not 9 disabled on March 3, 2021. AR 12-33. Plaintiff sought review of the ALJ’s decision, which the 10 Appeals Council denied. AR 1-6. This appeal followed. 11 Medical Record 12 The relevant medical record was reviewed by the Court and will be referenced below as 13 necessary to this Court’s decision. 14 The ALJ’s Decision 15 Using the Social Security Administration’s five-step sequential evaluation process, the ALJ 16 determined that Plaintiff was not disabled under the Social Security Act. AR 12-33. Specifically, the 17 ALJ found that Plaintiff had not engaged in substantial gainful activity since the alleged onset date of 18 September 15, 2018. AR 18. The ALJ identified the following severe impairments: major depressive 19 disorder; anxiety disorder; post-traumatic stress disorder (PTSD); hypertension; mild intermittent 20 asthma; compression of median nerve; and ulnar neuritis. Id. The ALJ further determined that 21 Plaintiff did not have an impairment or combination of impairments that met or medically equaled any 22 of the listed impairments. AR 19. 23 Based on a review of the entire record, the ALJ found that Plaintiff retained the residual 24 functional capacity (“RFC”) to perform a full range of work at all exertional levels with the 25 nonexertional limitations that Plaintiff must avoid concentrated exposure to irritants such as fumes, 26 27 2 References to the Administrative Record will be designated as “AR,” followed by the appropriate 28 page number. 1 odors, dusts and gases; was capable of frequent fingering and handling with the bilateral upper 2 extremities; was capable of simple, routine and repetitive tasks in a low stress job, which is defined as 3 having only occasional decision making requirements and only occasional changes in the work setting; 4 was capable of performing jobs that require no fast paced production requirements such as fast paced 5 assembly line work or high volume piecemeal quotas; and was capable of no interaction with the 6 general public and only occasional interactions with co-workers and supervisors such that she is 7 capable of working with things rather than people. AR 21. The ALJ considered “all symptoms and 8 the extent to which these symptoms can reasonably be accepted as consistent with the objective 9 medical evidence and other evidence,” as well as “medical opinion(s) and prior administrative medical 10 finding(s).” AR 21-26. 11 The ALJ found that Plaintiff was unable to perform any past relevant work, that Plaintiff was a 12 younger individual on the alleged onset date, Plaintiff had a limited education, and that transferability 13 of job skills was not material to the disability determination. AR 26-27. Given Plaintiff’s age, 14 education, work experience, and residual functional capacity, the ALJ found that there were jobs that 15 existed in significant numbers in the national economy that Plaintiff could perform. AR 27. The ALJ 16 noted that examples of jobs consistent with Plaintiff’s age, education, work experience, and residual 17 functional capacity included: (1) Housekeeper (DOT No. 323.687-014, light exertional level, with 18 134,000 jobs in the national economy); (2) Janitor/Cleaner (DOT NO. 381.687-018, medium 19 exertional level, with two million jobs in the national economy); and (3) Garment Folder (DOT No. 20 789.687-066, light exertional level, with 230,000 jobs available in the national economy). AR 27-28. 21 The ALJ therefore concluded that Plaintiff had not been disabled from the alleged onset date of 22 September 15, 2018, through the date of the decision. Id. 23 SCOPE OF REVIEW 24 Congress has provided a limited scope of judicial review of the Commissioner’s decision to 25 deny benefits under the Act. In reviewing findings of fact with respect to such determinations, this 26 Court must determine whether the decision of the Commissioner is supported by substantial evidence. 27 42 U.S.C. § 405(g). Substantial evidence means “more than a mere scintilla,” Richardson v. Perales, 28 402 U.S. 389, 402 (1971), but less than a preponderance. Sorenson v. Weinberger, 514 F.2d 1112, 1 1119, n. 10 (9th Cir. 1975). It is “such relevant evidence as a reasonable mind might accept as 2 adequate to support a conclusion.” Richardson, 402 U.S. at 401. The record as a whole must be 3 considered, weighing both the evidence that supports and the evidence that detracts from the 4 Commissioner’s conclusion. Jones v. Heckler, 760 F.2d 993, 995 (9th Cir. 1985). In weighing the 5 evidence and making findings, the Commissioner must apply the proper legal standards. E.g., 6 Burkhart v. Bowen, 856 F.2d 1335, 1338 (9th Cir. 1988). This Court must uphold the Commissioner’s 7 determination that the claimant is not disabled if the Commissioner applied the proper legal standards, 8 and if the Commissioner’s findings are supported by substantial evidence. See Sanchez v. Sec’y of 9 Health and Human Servs., 812 F.2d 509, 510 (9th Cir. 1987). 10 REVIEW 11 In order to qualify for benefits, a claimant must establish that he or she is unable to engage in 12 substantial gainful activity due to a medically determinable physical or mental impairment which has 13 lasted or can be expected to last for a continuous period of not less than twelve months. 42 U.S.C. § 14 1382c(a)(3)(A). A claimant must show that he or she has a physical or mental impairment of such 15 severity that he or she is not only unable to do his or her previous work, but cannot, considering his or 16 her age, education, and work experience, engage in any other kind of substantial gainful work which 17 exists in the national economy. Quang Van Han v. Bowen, 882 F.2d 1453, 1456 (9th Cir. 1989). The 18 burden is on the claimant to establish disability. Terry v. Sullivan, 903 F.2d 1273, 1275 (9th Cir. 19 1990). 20 DISCUSSION3 21 Plaintiff argues that the ALJ erred as the jobs identified by the vocational expert at Step Five 22 had requirements that exceeded Plaintiff’s RFC. (Doc. 17 at 9-10, Doc. 22 at 1-2.) Plaintiff further 23 argues that the ALJ erred by failing to provide clear and convincing reasons for discounting Plaintiff’s 24 subjective symptoms. (Doc. 17 at 11-14, Doc. 22 at 2-3.) 25 A. Plaintiff’s Subjective Complaints 26
27 3 The parties are advised that this Court has carefully reviewed and considered all of the briefs, including arguments, points and authorities, declarations, and/or exhibits. Any omission of a reference to any specific 28 argument or brief is not to be construed that the Court did not consider the argument or brief. 1 Plaintiff contends that the ALJ committed harmful error by failing to provide clear and 2 convincing reasons for rejecting Plaintiff’s testimony. (Id.) In deciding whether to admit a claimant’s 3 subjective complaints, the ALJ must engage in a two-step analysis. Garrison v. Colvin, 759 F.3d 995, 4 1014 (9th Cir. 2014); Batson v. Comm’r, 359 F.3d 1190, 1196 (9th Cir. 2004). First, the claimant 5 must produce objective medical evidence of her impairment that could reasonably be expected to 6 produce some degree of the symptom or pain alleged. Garrison, 759 F.3d at 1014. If the claimant 7 satisfies the first step and there is no evidence of malingering, the ALJ may reject the claimant’s 8 testimony regarding the severity of her symptoms only by offering specific, clear and convincing 9 reasons for doing so. Id. at 1015. 10 Here, the ALJ found that Plaintiff’s medically determinable impairments could reasonably be 11 expected to cause the alleged symptoms. AR 22. However, the ALJ discounted Plaintiff’s statements 12 concerning the intensity, persistence, and limiting effects of those symptoms, noting that the 13 statements were not consistent with medical evidence and other evidence in the record. Id. The ALJ 14 was therefore required to provide specific, clear and convincing reasons for discounting Plaintiff’s 15 subjective complaints. 16 First, the ALJ found that Plaintiff’s allegations were not fully consistent with the medical 17 records. AR 22-25. Although lack of supporting medical evidence cannot form the sole basis for 18 discounting testimony, it is a factor that the ALJ can consider. See Burch v. Barnhart, 400 F.3d 676, 19 681 (9th Cir. 2005). 20 Here, the ALJ summarized Plaintiff’s allegations as follows: 21 [Plaintiff’s] claim for disability has two distinct components. The first part deals with the claimant's physical abilities to perform work-related 22 activities despite having multiple diagnoses. The second component is related to the claimant's overall mental health condition and how it 23 relates to her ability to mentally sustain work-related activities on a 24 regular and continuing basis
25 AR 22. Regarding Plaintiff’s physical abilities, the ALJ wrote: 26 The record shows that the claimant has a history of musculoskeletal pain, hypertension and asthma, but there is no evidence of any 27 significant and/or debilitating findings since the alleged onset date. For 28 example, on July 17, 2019, the claimant was examined due to 1 complaints of loss of sensation in the non-dermatomal distribution in the hands, exacerbated by repetitive activities of the hands (Exhibit 2F/9). 2 Examination findings documented "cutting" scars to the right wrist, and her Cozen test was positive in bilateral extremities (Exhibit 2F/10). Dr. 3 Cody assessed the claimant with medical arm pain, essential 4 hypertension, mild intermittent asthma, ulnar neuritis, compression of the median nerve at multiple levels, and GERD (Exhibit 2F/10-11). A 5 wrist brace for the bilateral extremities was prescribed and she was also provided prescriptions for Clonidine Gabapentin and Omeprazole 6 (Exhibit 2F/11). 7 Upon exam in August 2019, progress notes from St. Agnes Medical 8 Center indicated that the claimant was assessed with bilateral upper extremity neuropathy and chronic hand pain but she was advised to 9 merely continue taking her prescribed dosage of Gabapentin along with 10 Tylenol/Ibuprofen should symptoms persist (Exhibit 13F/1).
11 In January 2020, Dr. Thiesen, DO, noted the following claimant’s history of present illness: 12 33 y/o female presents c/o LUE pain and swelling x 4 days. She 13 describes the pain as throbbing/achy in nature. Pt reports that she was 14 referred from her PMD today to rule out blood clot. Pt denies hx of blood clots. Denies recent surgery. Denies blood thinner use. Additional 15 sx includes mild, intermittent chest pain, however denies chest pain at this time. Denies SOB (Exhibit 7F/2). 16
17 Physician notes revealed that the claimant’s oxygen saturation was at 100%. Her heart was of a regular rate and rhythm and her lungs were 18 clear to auscultation with non-labored respirations. The claimant also exhibited a normal speech and moved all extremities at baseline (Exhibit 19 7F/3). Furthermore, the claimant underwent a chest x-ray which was 20 unremarkable with no acute pulmonary disease witnessed. The claimant was, however, again assessed with hypertension (Exhibit 7F/7). 21 A Doppler ultrasound study of the left upper extremity (January 10, 22 2020) showed no evidence of venous thrombus. The veins demonstrated appropriate phasicity of flow, as did the left innominate and subclavian 23 vein(s) (Exhibit 7F/8). Objective signs and findings such as these, as 24 well as contained throughout the record, along with her conservative treatment, do not support the severity of the claimant’s allegations 25 regarding her physical impairments. There is simply no evidence of any recent treatment or significant complaints identifiable in the record with 26 respect to the severe physical impairments listed above. Furthermore, 27 while the undersigned does appreciate the claimant’s history of neuropathy and occasional hand pain, the record contains no recent 28 1 EMGs or other radiographic imaging and her physicians merely recommended that she continue with her prescribed medication. 2 Based on the medical evidence of record discussed above, the 3 undersigned finds that the claimant's allegations as to the intensity and 4 limiting effects of her physical impairments are not fully consistent with the medical evidence of record and certainly do not preclude her from 5 performing the limited range of work activity prescribed in the residual functional capacity. 6
7 AR 23-24. Regarding Plaintiff’s mental health conditions, the ALJ wrote: 8 Turning more specifically to the claimant’s mental impairments, examination findings from physicians and other treating sources have 9 essentially shown normal mental functioning with no significant restrictions from a mental health standpoint since the alleged onset date. 10 More specifically, the record shows that in August 2017, the claimant 11 was examined at Exodus Recovery Crisis Stabilization Center after calling 911 stating that she was suicidal. The claimant reported suicidal 12 thoughts due to recent stressors of being homeless, her husband working nights, and due to the passing of her mother. The claimant was initially 13 verbally aggressive but quickly de-escalated as she calmed down. Upon exam, the claimant was fully oriented with a normal speech and thought 14 process. Her insight and judgment were intact and her affect was 15 appropriate. The claimant also denied perceptual disturbances/hallucinations. Upon discharge, the claimant was calm and 16 cooperative and stated that she was no longer suicidal, just overwhelmed. She stressed a desire to go home so that she could spend 17 time with her family (Exhibit 10F/1-4). 18 Upon a follow up visit in September 2018, the claimant stated, “I finally 19 found medication that worked for me, they work wonders and I am sleeping better, no anxiety attacks.” The claimant reported that her 20 auditory and visual hallucinations were gone and that her appetite, 21 energy and ability to focus were improving. Dr. Gill noted that the claimant was fully oriented and cooperative and that her mood and 22 affect were in the average range. The claimant’s cognition, speech, insight and judgment were also within normal limits as she evidenced an 23 organized thought process throughout the examination (Exhibit 1F/22).
24 In January 2020, medical records indicated that the claimant was again 25 cooperative with an appropriate mood and affect (Exhibit 7F). Also, upon a psychiatric evaluation in January 2020, the claimant was noted to 26 be well groomed, alert, and oriented x4. Her motor activity was normal, as was her cognition, speech (goal directed), sensorium and thought 27 processes. She denied any homicidal/suicidal ideations but did endorse 28 worrying about her health and finances. The claimant was assessed with 1 a history of PTSD, depression, major, recurrent, in partial remission, and anxiety. The claimant was noted to be in stable condition and her 2 prescribed medication was adjusted accordingly (Exhibit 5F/1-5).
3 More recently, in October 2020, the claimant reported that she was 4 doing better with her psychotropic medication, but still endorsed occasional panic attacks. She added that she routinely stays at home and 5 helps her children with their homework. She stated that she was “smoking less,” and sleeping better (approximately 8 hours/night). The 6 claimant also reported that she was willing to cut her Klonopin in halves 7 and to try Buspirone before leaving the house to combat her anxiety. She again denied any AVH or homicidal/suicidal ideations (Exhibit 6F/2). 8 There is no evidence of any further documented mental health treatment present in the record since October 2020. 9 10 In addition, although medication compliance and counseling appear to attenuate the claimant’s condition, her symptoms continue to wax and 11 wane. The evidence indicates strong psychological underpinnings to her physical condition and her somatic focus serves to magnify mental 12 health symptoms, thereby impinging upon sustainability/stress tolerance. However, due a lack of significant treatment/complaints, there are no 13 documented findings that support a finding of disability. 14 AR 24-25. 15 Here, the ALJ appropriately contrasted the relatively normal examination findings with 16 Plaintiff’s more extreme allegations regarding her mental health conditions. See AR 336 (September 17 2018 medication progress note noting normal findings related to appearance, behavior, motor activity, 18 sensorium, cognition, speech, orientation, thought processes, mood, affective range, intelligence, and 19 insight and judgment); 563 (January 2020 physician note noting psychiatric findings as “Cooperative, 20 appropriate mood & affect”); 615 (August 2017 crisis stabilization center inter-disciplinary 21 intake/screening form noting that Plaintiff had reported being suicidal and that she was “initially 22 verbally aggressive but quickly was deescalated by the… team and is calm & tearful at this time” and 23 checking normal initial mental status findings for orientation, speech, motor, thought process, insight, 24 judgment, affect, behavioral, thought content, perceptual, and ideation). The ALJ also similarly 25 contrasted the examination findings with Plaintiff’s physical impairment allegations. See AR 26 562 (January 2020 physician note regarding complaints of “throbbing/achy” left upper extremity 27 stating that Plaintiff denied history of blood clots, denied recent surgery, denied blood thinner use, and 28 though Plaintiff reported mild intermittent chest pain she denied chest pain or shortness of breath at 1 the time of the examination); 568 (January 2020 Doppler ultrasound report noting normal 2 compressibility of veins and appropriate augmentation of flow within left upper extremity veins). The 3 ALJ therefore appropriately examined the medical evidence as one factor in discounting Plaintiff’s 4 symptoms testimony. 5 Second, the ALJ wrote that given Plaintiff’s “reported activities of daily living (basic 6 household chores, recent work activity at a dine-in restaurant, occasional grocery shopping, etc.) 7 (Exhibit 7E and Hearing Testimony), the undersigned has more than accommodated for her physical 8 impairments with the previously mentioned additional nonexertional limitations.” AR 24. The ALJ 9 also later noted that “claimant's reported activities of daily living and detailed testimony demonstrates 10 her ability to concentrate and to appropriately interact with others.” AR 25. An ALJ may properly 11 discount a claimant's subjective complaints when the daily activities demonstrate an inconsistency 12 between what the claimant can do and the degree that disability is alleged. Molina v. Astrue, 674 F.3d 13 1104, 1112–13 (9th Cir. 2012) (an ALJ may consider “whether the claimant engages in daily activities 14 inconsistent with the alleged symptoms”), superseded by regulation on other grounds. Even where a 15 plaintiff's activities suggest some difficulty functioning, they may be grounds for discrediting the 16 claimant's testimony to the extent that they contradict claims of a totally debilitating impairment. Id. 17 at 1113. 18 However, the Ninth Circuit has cautioned that a claimant's ability to complete minimal daily 19 activities does not detract from the claimant's credibility. See Cooper v. Bowen, 815 F.2d 557, 561 20 (9th Cir. 1987) (“evidence that [claimant] could assist with some household chores was not 21 determinative of disability. ‘Disability does not mean that a claimant must vegetate in a dark room 22 excluded from all forms of human and social activity.’”) (quoting Smith v. Califano, 637 F.2d 968, 23 971 (3d Cir. 1981)); Vertigan v. Halter, 260 F.3d 1044, 1050 (9th Cir. 2001) (“This court has 24 repeatedly asserted that the mere fact that a plaintiff has carried on certain daily activities, such as 25 grocery shopping, driving a car, or limited walking for exercise, does not in any way detract from her 26 credibility as to her overall disability.”). 27 Here, some of Plaintiff’s daily activities – basic household chores and occasional grocery 28 shopping – are the same as those the Ninth Circuit has cautioned against using to discredit symptoms 1 testimony. Id. Moreover, an examination of the evidence cited by the ALJ indicates that Plaintiff’s 2 activities were more limited than the ALJ suggested. In testifying regarding her past restaurant job, 3 Plaintiff’s testimony suggested that she could not cope with her anxiety and panic attacks at work and 4 took regular additional breaks to attempt to deal with those conditions. See AR 51 (in testifying 5 regarding past restaurant job, Plaintiff stated that she needed additional breaks because of her 6 condition and said that her manager would allow her “those extra breaks and I would sit out back in 7 the alley and I would cry until I got myself together, and I'd get back in there”); 52 (in testifying 8 regarding past restaurant job, Plaintiff said that she “I constantly have to call in and I was constantly 9 required to bring in doctors' notes so that I would not be terminated.”); 52-53 (“The job was simple. I 10 was to wash dishes and I was to bus tables. It was the being around people. I stay home every single 11 day. I cannot be around people, but I wanted to try, and I, I gave it all I could. And the hustle and 12 bustle and all of the customers and all the coworkers on top of everything… And during the day 13 working around so many people it just made my anxiety worse and that's why I develop paranoia.”). 14 Additionally, the ALJ cited Plaintiff’s self-reports as demonstrating Plaintiff’s abilities, but the 15 evidence instead indicates that Plaintiff’s capacities are minimal. AR 260 (Plaintiff wrote that she 16 needed reminders to take care of personal needs and to take her medication, that she would only 17 prepare a meal of toast or a sandwich one to two times per week and that “My spouse and children do 18 all of the laundry and cleaning… I don’t do any chores”); 261 (Plaintiff wrote that she would shop 19 “once every 2-3 months… I’m only able to withstand being in a store full of people for maybe 20-30 20 minutes”). As Plaintiff’s reported daily activities appear to be minimal, they are not a proper basis for 21 discounting Plaintiff’s symptoms testimony. Vertigan, 260 F.3d at 1050. 22 Third, the ALJ noted that, “for her mental impairments, the claimant received minimal and 23 sporadic mental health treatment throughout the relevant period, with records reflecting little more 24 than a conservative regimen of psychotropic medication with no evidence of any significant 25 psychotherapy” and that there was “little evidence to suggest that the claimant had any significant 26 complications associated with said conditions that were intractable in nature, precluding all work 27 activity.” AR 22-23. The ALJ further wrote that “While the claimant has been diagnosed with several 28 physical impairments, she has received the proper conservative treatment with signs of 1 improvement…” AR 24. The ALJ also cited Exhibit 6F in demonstrating that “while the claimant has 2 experienced symptoms associated with depression, PTSD and anxiety, recent findings indicate that she 3 had shown improvement via prescribed medication.” AR 25. 4 An ALJ is permitted to consider evidence of conservative treatment in evaluating a claimant's 5 subjective complaints. See Parra v. Astrue, 481 F.3d 742, 750-51 (9th Cir. 2007) (finding evidence of 6 conservative treatment sufficient to discount claimant's testimony regarding severity of impairment); 7 Warre v. Comm'r of Soc. Sec. Admin., 439 F.3d 1001, 1006 (9th Cir. 2006) (“Impairments that can be 8 controlled effectively with medication are not disabling.”); see also 20 C.F.R. § 404.1529(c)(3)(iv), 9 (v) (medication effectiveness and treatment history are relevant factors for evaluating a claimant's 10 symptom testimony). Yet, “the fact that treatment may be routine or conservative is not a basis for 11 finding subjective symptom testimony unreliable absent discussion of the additional, more aggressive 12 treatment options the ALJ believes are available.” Block v. Berryhill, No. 2:16-cv-2230-EFB, 2018 13 WL 1567814 at *5 (E.D. Cal. Mar. 31, 2018), quoting Moon v. Colvin, 139 F.Supp.3d 1211, 1220 (D. 14 Or. 2015); see also Wheeler v. Kijakazi, No. 1:21-cv-1225 JLT-BAM, 2023 WL 4146215, at *4 (E.D. 15 Cal. June 23, 2023). 16 Furthermore, in evaluating social security claims involving mental health issues, courts have 17 found that medication prescriptions may indicate that the treatment was not conservative. For 18 instance, the Ninth Circuit held that an “ALJ improperly characterized [a claimant’s] treatment as 19 ‘limited and conservative’ given that she was prescribed a number of psychiatric medications.” 20 Drawn v. Berryhill, 728 F. App’x 637, 642 (9th Cir. 2018). While courts have differed on what 21 medications constituted conservative treatment, they have clarified that some prescription medications 22 and the adjustment of those prescriptions indicated that the treatment was not conservative. See 23 Armando R. E. v. Kijakazi, No. 2:22-CV-02907-GJS, 2023 WL 3292855, at *5 (C.D. Cal. May 5, 24 2023) (holding that the ALJ improperly relied on conservative treatment to discount Plaintiff’s 25 symptoms testimony where the record reflected multiple psychiatric prescriptions including Klonopin 26 and modifications of said prescriptions); Saltzman v. Comm'r of Soc. Sec., No. 2:18-CV-2215-DMC, 27 2019 WL 6683130, at *14 (E.D. Cal. Dec. 6, 2019) (finding that plaintiff’s treatment “has not been 28 conservative” where plaintiff’s “mental health treatment involves powerful prescription medications 1 [such as bupropion, Abilify, and Klonopin], which doctors continually adjust due to side effects and 2 varying effectiveness”). 3 Here, the ALJ does not address which additional, more aggressive treatment options would be 4 available to Plaintiff. AR 21-25. While the ALJ noted that Plaintiff’s treatment reflected “little more 5 than a conservative regimen of psychotropic medication with no evidence of any significant 6 psychotherapy,” it is unclear why the ALJ believes that psychotherapy would be a more aggressive 7 treatment option than psychotropic medication. AR 22-23. The ALJ therefore improperly relied on 8 conservative treatment as a basis for discounting Plaintiff’s testimony. Block, 2018 WL 1567814 at 9 *5. 10 Additionally, the evidence cited by the ALJ to demonstrate that Plaintiff’s conditions were 11 effectively controlled through medication is undermined by the record. For instance, the ALJ cites a 12 September 2018 report in which Plaintiff reported that she had “finally found medication, that worked 13 for me, they worked wonders, I am sleeping better no anxiety attacks.” AR 24, 336 (also noting past 14 history of “suicide attempts/SIB hx of one suicide attempt in 2017 by overdose” and that previous 15 medications included Prozac, Buspar, Paxil, Zoloft, Trazodone, and Abilify). In that September 2018 16 visit, Plaintiff reported that she rated her anxiety as “2/10,” denied any panic attacks in the past month, 17 and that her focus was “awesome.” Id. However, the record also includes a subsequent visit report 18 from December 2018 in which Plaintiff reported that her “anxiety has come back, I think the 19 medication is not working again, I am back in bed, I don't feel like cooking, not walking my kids to 20 school” and reported “that she is not able to do ‘normal things’ as her anxiety is worse again for no 21 identifiable reason.” AR 331 (Plaintiff also reported: “my chest gets tight, I start to have shakes, it is 22 hard to breathe, my heart is beating hard, sometimes I feel like I am about to pass out.”). Given the 23 adjustments to Plaintiff’s prescriptions and indication that Plaintiff’s panic attacks and anxiety had 24 increased just three months after Plaintiff had apparently found the correct prescription, it is difficult 25 to conclude that her conditions were effectively or conservatively controlled. Armando R.E., 2023 26 WL 3292855, at *5; Saltzman, 2019 WL 6683130, at *14. 27 The ALJ also cites an October 2020 report in which Plaintiff informed the physician that she 28 was “doing better with the medications,” but the ALJ omits the remainder of the finding, in which 1 Plaintiff reported “I am doing better with the medications but I still have panics, anxiety and I isolate 2 at home and don’t go out much…” and the report notes that Plaintiff “Still has anxiety and is willing 3 to cut the Klonopin in halves and try buspirone before leaving the house.” AR 492. While Plaintiff 4 denied “any AVH… SI or HI,” the report noted that Plaintiff had paranoia. Id. Considering that 5 Plaintiff was still experiencing panic attacks, anxiety, refrained from going out and interacting with 6 others, and her medications were adjusted at various points, the evidence cited by the ALJ does not 7 demonstrate that Plaintiff’s conditions were effectively controlled by conservative treatment. 8 Armando R.E., 2023 WL 3292855, at *5; Saltzman, 2019 WL 6683130, at *14. The ALJ therefore 9 erred in relying on conservative treatment or effective treatment by medication as a basis for 10 discounting Plaintiff’s symptoms testimony. 11 Fourth, the ALJ notes that “As for her mental impairments, the claimant received minimal and 12 sporadic mental health treatment throughout the relevant period, with records reflecting little more 13 than a conservative regimen of psychotropic medication with no evidence of any significant 14 psychotherapy.” AR 22-23. An ALJ may consider “unexplained or inadequately explained failure to 15 seek treatment or to follow a prescribed course of treatment” in credibility evaluations. Tommasetti v. 16 Astrue, 533 F.3d 1035, 1039 (9th Cir. 2008). However, the record includes many reports from 2017 17 through 2020 in which Plaintiff sought mental health treatment and relevant medications. See AR 18 315-349 (approximately ten mental health visit reports from March 30, 2017 through November 15, 19 2019 related to Plaintiff’s mental health concerns); 412-438 (2019 prescription refill requests and visit 20 reports); 481 (January 2020 visit report noting Plaintiff was there for medication refills and to update 21 her psych evaluation and stating “Last suicidal attempt was 2 weeks ago by overdose but escaped 22 harm.”); 492 (October 2020 visit report in which Plaintiff reported still experiencing anxiety and panic 23 attacks). This history does not indicate a failure to seek treatment or failure to follow a prescribed 24 course of treatment, but instead suggests Plaintiff was attempting to better manage her conditions and 25 medication. Failure to seek treatment was therefore not an appropriate basis for discounting Plaintiff’s 26 symptoms testimony. 27 Defendant argues that Plaintiff’s mental health treatment and psychiatric medication use was 28 intermittent and lacked a history of psychiatric hospitalization or residential psychiatric treatment, 1 citing Meanel v. Apfel. (Doc. 21 at 8.) However, Defendant does not cite to authority demonstrating 2 that a claimant must be hospitalized or more regularly seek medical intervention. Indeed, in the case 3 cited, the Ninth Circuit only held that the ALJ was entitled to reject testimony that a claimant 4 “constantly experienced pain comparable to ‘being burned’” where the claimant’s doctor failed to 5 prescribe, and the claimant failed to request, “any serious medical treatment for this supposedly 6 excruciating pain.” Meanel v. Apfel, 172 F.3d 1111, 1114 (9th Cir. 1999), as amended (June 22, 7 1999). In contrast to the Meanael claimant’s failure to request any serious medical treatment, Plaintiff 8 here continually requested medication refills and sought medication modifications. See AR 315-49; 9 412-38; 481; 492. Defendant’s argument that the ALJ properly used a failure to seek treatment as a 10 basis for discounting Plaintiff’s testimony is therefore unavailing. 11 As the ALJ failed to utilize or articulate proper bases for evaluating Plaintiff's symptoms 12 testimony beyond the lack of supporting medical evidence, the ALJ erred in assessing Plaintiff's 13 symptoms. Burch, 400 F.3d at 681. 14 B. Remedy 15 The decision whether to remand for further proceedings or order an immediate award of 16 benefits is within the Court's discretion. See Harman v. Apfel, 211 F.3d 1172, 1175-78 (9th Cir. 17 2000). Unless “the record has been fully developed and further administrative proceedings would 18 serve no useful purpose,” remand for further proceedings is warranted. Garrison v. Colvin, 759 F.3d 19 995, 1020 (9th Cir. 2014). As it is not clear that “further administrative proceedings would serve no 20 useful purpose,” remand for further proceedings is appropriate. Id.; see also Dominguez v. Colvin, 808 21 F.3d 403, 407 (9th Cir. 2015) (“A district court may reverse the decision of the Commissioner of 22 Social Security, with or without remanding the cause for a rehearing, but the proper course, except in 23 rare circumstances, is to remand to the agency for additional investigation or explanation.”) (internal 24 quotes and citations omitted). On remand, the ALJ should specifically address Plaintiff’s symptoms 25 testimony. 26 Having found that remand is warranted, the Court declines to address Plaintiff’s remaining 27 argument that the ALJ erred at Step Five. See Hiler v. Astrue, 687 F.3d 1208, 1212 (9th Cir. 2012) 28 (“Because we remand the case to the ALJ for the reasons stated, we decline to reach [plaintiff's] 1 alternative ground for remand.”); see also Augustine ex rel. Ramirez v. Astrue, 536 F.Supp.2d 1147, 2 1153 n.7 (C.D. Cal. 2008) (“[The] Court need not address the other claims plaintiff raises, none of 3 which would provide plaintiff with any further relief than granted, and all of which can be addressed 4 on remand.”); Marcia v. Sullivan, 900 F.2d 172, 177 n.6 (9th Cir. 1990) (“Because we remand for 5 reconsideration of step three, we do not reach the other arguments raised.”). 6 CONCLUSION AND RECOMMENDATION 7 Based on the foregoing, the Court finds that the ALJ’s decision is not supported by substantial 8 evidence in the record as a whole and is not based on proper legal standards. Accordingly, IT IS 9 HEREBY RECOMMENDED as follows: 10 1. Plaintiff’s appeal from the administrative decision of the Commissioner of Social 11 Security be GRANTED; 12 2. The agency’s determination to deny benefits be REVERSED; and 13 3. The Clerk of this Court be directed to enter judgment in favor of Plaintiff Yiesa Jones 14 and against Defendant Leland Dudek, Acting Commissioner of Social Security. 15 These Findings and Recommendations will be submitted to the United States District Judge 16 assigned to the case, as required by 28 U.S.C. § 636(b)(l). Within fourteen (14) days after being 17 served with these findings and recommendations, the parties may file written objections with the 18 Court. The document should be captioned “Objections to Magistrate Judge’s Findings and 19 Recommendations.” Objections, if any, shall not exceed fifteen (15) pages or include exhibits. 20 Exhibits may be referenced by document and page number if already in the record before the 21 Court. Any pages filed in excess of the 15-page limit may not be considered. The parties are 22 advised that the failure to file objections within the specified time may result in the waiver of the 23 “right to challenge the magistrate’s factual findings” on appeal. Wilkerson v. Wheeler, 772 F.3d 834, 24 839 (9th Cir. 2014) (citing Baxter v. Sullivan, 923 F.2d 1391, 1394 (9th Cir. 1991)). 25 IT IS SO ORDERED.
26 Dated: May 27, 2025 /s/ Barbara A. McAuliffe _ 27 UNITED STATES MAGISTRATE JUDGE