C.D. v. Commissioner

Background

Plaintiff C.D. applied on October 7, 2022, for a period of disability, disability insurance benefits, and Supplemental Security Income (SSI) under Titles II and XVI of the Social Security Act, alleging she stopped working on June 2, 2022, due to hearing loss, anxiety, and depression. Her claims were initially denied on February 27, 2023, and again on reconsideration on February 6, 2024. C.D. requested a hearing, alleged increased mental health symptoms in Winter 2023–2024, and amended her alleged disability onset date to October 7, 2022. A hearing was held on August 7, 2024.

On October 8, 2024, the ALJ issued an unfavorable decision covering the period October 7, 2022, through October 8, 2024. The ALJ found C.D. had severe impairments — PTSD, major depressive disorder (MDD), gender dysphoria, generalized anxiety disorder (GAD), and degenerative joint disease of the right knee — but concluded that C.D.'s impairments did not meet a listed level of severity and that she retained the residual functional capacity (RFC — the most work a claimant can do despite her limitations) to perform light work with certain restrictions. The ALJ found C.D. unable to perform past relevant work but determined that jobs exist in significant numbers in the national economy that she could perform, and therefore found her not disabled.

C.D. sought judicial review, arguing the ALJ erred in: (1) rejecting medical opinions, (2) rejecting her subjective symptom testimony, (3) assessing her RFC, and (4) relying on vocational expert (VE) testimony. All parties consented to magistrate judge jurisdiction.

Legal Standard

A court may disturb the Commissioner's decision only if it is not supported by substantial evidence or rests on legal error. Substantial evidence is more than a mere scintilla but less than a preponderance — evidence a reasonable mind would accept as adequate to support the conclusion. Legal errors are harmless if they do not affect the outcome, but a reviewing court may not independently determine harmlessness based on the evidence before the ALJ.

Analysis

A. ALJ Errors in Weighing Medical Opinions

For claims filed after March 27, 2017, an ALJ must explain how she considered the supportability and consistency of each medical opinion when determining its persuasiveness. Supportability refers to how well the source's own findings back up the opinion; consistency refers to how well the opinion aligns with other medical and non-medical evidence in the record.

Dr. Katherine Wiebe, Ph.D. The ALJ discounted Dr. Wiebe's opinion because C.D. was referred by her own representative, the opinion was based on a single examination, and the assessed limitations were inconsistent with the record as a whole. The court found these reasons legally insufficient. The referral source and single-examination basis go to the length and purpose of the treatment relationship — a factor that cannot, by itself, justify discounting an opinion. The ALJ also failed entirely to address supportability. As to inconsistency, the ALJ pointed to: (1) C.D.'s intent to co-parent and induce lactation — but did not explain how this contradicted disability; (2) "generally unremarkable" mental status examinations (MSEs) — but the court found the ALJ cherry-picked results from physical exams while ignoring MSEs showing dysthymic mood, hopelessness, anxiety, agitation, and depression; (3) Dr. Wiebe's own finding that C.D. could manage her own funds — but the ALJ gave no explanation why fund management contradicted cognitive and concentration limitations; and (4) lack of therapy and psychiatric medication until 2024 — but the Ninth Circuit has specifically criticized penalizing mental health claimants for not seeking treatment, particularly when the ALJ had already found severe mental illnesses such as PTSD, MDD, and GAD.

Dr. Michelanne Baker, Psy.D., and APCC Cadence McCracken. The ALJ rejected their Mental Impairment Questionnaire (MIQ) as overly restrictive and inconsistent with the record, noting: the MIQ was submitted only two months after therapy began; APCC McCracken appeared to rely heavily on C.D.'s subjective allegations; there was minimal prior therapy and no prior psychiatric medication; and MSEs were generally unremarkable. The court found each basis flawed. The short treatment relationship cannot alone discount an opinion. Reliance on a patient's self-report is inherent in psychiatry and is not a valid basis for rejection — especially here, where the ALJ had not properly discounted C.D.'s own testimony. The ALJ also failed to address that the MIQ was based on psychological evaluations and reports, not just self-report. Regarding inconsistency, the ALJ again improperly used lack of prior treatment and cherry-picked the same MSEs the court had already found to be mischaracterized.

Dr. Ryan Gorton, M.D. The ALJ found Dr. Gorton's opinion unpersuasive as not supported by treatment notes and inconsistent with C.D.'s treatment history and testimony. As to supportability, the ALJ made only conclusory statements without citing specific treatment notes, and failed to address that Dr. Gorton's opinion was grounded in findings including hearing loss requiring hearing aids, MRI evidence of an old ACL tear and meniscal injury, psycho-emotional elements, and IBS. The ALJ also conclusorily stated that Dr. Gorton's assessment relied heavily on an August 5, 2024, conversation, citing an exhibit spanning over 100 pages without further identification. As to consistency, the ALJ mischaracterized the IBS record (which showed consistent diagnoses, ongoing symptoms, medication use, and a dietary accommodation letter), mischaracterized the knee record (ignoring ACL tears, meniscal injuries, multiple positive clinical findings, gait problems, and testimony about knee locking), and failed to adequately identify where C.D. denied tremors while ignoring extensive records of tremor complaints and diagnoses dating to 2022. The court did find one valid inconsistency — that C.D.'s demonstrated ability to hear and understand during the hearing was inconsistent with Dr. Gorton's opinion that she needed hearing aids — but held that a single discrepancy cannot justify rejecting Dr. Gorton's entire opinion.

B. ALJ Errors in Weighing C.D.'s Symptom Testimony

When a claimant presents objective medical evidence of an impairment that could reasonably produce the alleged symptoms and there is no evidence of malingering, an ALJ may reject the claimant's testimony about symptom severity only by providing specific, clear, and convincing reasons supported by substantial evidence. There was no dispute that C.D. met the threshold showing and that there was no malingering allegation.

The ALJ discounted C.D.'s testimony on four grounds, each of which the court found erroneous:

1. Inconsistency with the medical evidence. The ALJ cited C.D.'s prioritization of gender-affirming care and "doing well" after breast augmentation as inconsistent with her mental health disability claims — but did not explain how gender-affirming care is inconsistent with PTSD, MDD, or GAD, and "doing well" in a treatment program has no necessary relation to work-related functional capacity. The ALJ also cherry-picked isolated notes of hope and reduced suicidality while ignoring extensive records of passive suicidal ideation, dysphoric mood, and ongoing psychological impairment. The MSE references were too vague (citing hundreds of pages without identifying specific testimony) and continued to mischaracterize the results. The ALJ also relied improperly on lack of mental health treatment without considering documented reasons for the gap, as required by SSR 16-3p.

2. Conservative and routine treatment. The ALJ faulted C.D. for gaps in knee treatment and late disclosure of possible surgery needs, without considering reasons C.D. did not seek more aggressive care — including that her physical therapist reportedly did not recommend repair and she declined surgery for reasons related to her recovery situation. Under controlling law, conservative treatment can undermine allegations of debilitating pain only if there is no good reason for not seeking more aggressive care.

3. Brief work activity. The ALJ speculated, without evidentiary support, that C.D.'s brief bike-repair job required kneeling and crouching. The ALJ also failed to address that C.D. testified the job lasted only a couple of months and "didn't work out." A brief, unsuccessful work attempt is not a clear and convincing reason to discredit symptom testimony.

4. Grooming observations. The ALJ relied on C.D.'s appearance at the hearing and occasional treatment notes of appropriate grooming to discount her testimony about hygiene difficulties. The court found the ALJ failed to explain how occasional good grooming — including when C.D. was out of her apartment for a hearing — contradicted C.D.'s account that she must mentally force herself to shower and may go weeks without doing so.

C. RFC and VE Testimony Not Reached

Because the ALJ must reassess her RFC determination — which was based in part on the improperly discounted medical opinions and symptom testimony — and must therefore present a new hypothetical to a new vocational expert, the court declined to reach those remaining arguments.

D. Remand for Further Proceedings, Not for Award of Benefits

C.D. argued for an immediate award of benefits. The court declined, finding that additional proceedings are needed for the ALJ to consider all relevant factors regarding the medical opinions and symptom testimony, reassess the RFC, and obtain new VE testimony. On remand, the ALJ is directed to reassess Dr. Wiebe's opinion, Dr. Baker/APCC McCracken's opinion, Dr. Gorton's opinion, C.D.'s symptom testimony, and the RFC determination.

Disposition

The court REMANDED the case for further administrative proceedings consistent with the order and directed the Clerk to enter judgment and close the file.