Delgado v. Kijakazi

FILED IN THE 2 EASTERU N. S D. I SD TI RS IT CR TI C OT F C WO AU SR HT I NGTON Feb 18, 2022 SEAN F. MCAVOY, CLERK UNITED STATES DISTRICT COURT EASTERN DISTRICT OF WASHINGTON

6 CRISELDA D.,1 No. 4:20-cv-5239-EFS Plaintiff, 8 ORDER RULING ON CROSS v. SUMMARY-JUDGMENT MOTIONS 9 AND DIRECTING ENTRY OF KILOLO KIJAKAZI, Acting JUDGMENT IN FAVOR OF 10 Commissioner of Social Security, PLAINTIFF Defendant.

12 Plaintiff Criselda D. appeals the denial of benefits by the Administrative 13 Law Judge (ALJ). Because the ALJ failed to adequately explain and support 14 several key findings, the Court grants summary judgment in favor of Plaintiff, 15 denies the Commissioner’s motion for summary judgment, reverses the decision of 16 the ALJ, and remands this case for further proceedings.

17 I. Five-Step Disability Determination 18 A five-step sequential evaluation process is used to determine whether an 19 adult claimant is disabled.2 Step one assesses whether the claimant is engaged in 21 1 For privacy reasons, the Court refers to every social security plaintiff by first 22 name and last initial or as “Plaintiff.” See LCivR 5.2(c).

23 2 20 C.F.R. §§ 404.1520(a), 416.920(a).

1 substantial gainful activity.3 If the claimant is engaged in substantial gainful 2 activity, benefits are denied.4 If not, the disability evaluation proceeds to step two.5 3 Step two assesses whether the claimant has a medically severe impairment 4 or combination of impairments that significantly limit the claimant’s physical or 5 mental ability to do basic work activities.6 If the claimant does not, benefits are 6 denied.7 If the claimant does, the disability evaluation proceeds to step three.8 7 Step three compares the claimant’s impairment or combination of 8 impairments to several recognized by the Commissioner as so severe as to preclude 9 substantial gainful activity.9 If an impairment or combination of impairments 10 meets or equals one of the listed impairments (a “listing”), the claimant is 11 conclusively presumed to be disabled.10 If not, the disability evaluation proceeds to 12 step four.

13 Step four assesses whether an impairment prevents the claimant from 14 performing work he performed in the past by determining the claimant’s residual 16 3 Id. §§ 404.1520(a)(4)(i), 416.920(a)(4)(i).

17 4 Id. §§ 404.1520(b), 416.920(b).

18 5 Id. §§ 404.1520(b), 416.920(b).

19 6 Id. §§ 404.1520(a)(4)(ii), 416.920(a)(4)(ii).

20 7 Id. §§ 404.1520(c), 416.920(c).

21 8 Id. §§ 404.1520(c), 416.920(c).

22 9 Id. §§ 404.1520(a)(4)(iii), 416.920(a)(4)(iii).

23 10 Id. §§ 404.1520(d), 416.920(d).

1 functional capacity (RFC).11 If the claimant can perform past work, benefits are 2 denied.12 If not, the disability evaluation proceeds to step five.

3 Step five, the final step, assesses whether the claimant can perform other 4 substantial gainful work—work that exists in significant numbers in the national 5 economy—considering the claimant’s RFC, age, education, and work experience.13 6 If so, benefits are denied. If not, benefits are granted.14 7 The claimant has the initial burden of establishing he is entitled to disability 8 benefits under steps one through four.15 At step five, the burden shifts to the 9 Commissioner to show the claimant is not entitled to benefits.16 10 II. Factual and Procedural Summary 11 In August 2016, Plaintiff filed Title II and Title XVI applications for a period 12 of disability and disability insurance benefits, alleging an onset date of 13 November 1, 2012.17 16 11 Id. §§ 404.1520(a)(4)(iv), 416.920(a)(4)(iv).

17 12 Id. §§ 404.1520(a)(4)(iv), 416.920(a)(4)(iv).

18 13 Id. §§ 404.1520(a)(4)(v), 416.920(a)(4)(v); Kail v. Heckler, 722 F.2d 1496, 1497–98 19 (9th Cir. 1984).

20 14 20 C.F.R. §§ 404.1520(g), 416.920(g).

21 15 Parra v. Astrue, 481 F.3d 742, 746 (9th Cir. 2007).

22 16 Id. 23 17 AR 22, 243.

1 A. Plaintiff’s Alleged Impairments & the Resulting Denials 2 Plaintiff initially asserted disability based on “bad knees,” bilateral carpal 3 tunnel syndrome (CTS), high blood pressure, and depression.18 By the time of the 4 administrative hearing, Plaintiff also asserted disability based on fibromyalgia.19 5 Plaintiff’s claims were denied initially and upon reconsideration.20 6 Administrative Law Judge Mark Kim presided over the requested administrative 7 hearing.21 At the hearing, Plaintiff and an independent vocational expert provided 8 testimony.

9 B. The ALJ’s Five-Step Findings 10 In the written decision denying Plaintiff’s disability claims, the ALJ found as 11 follows: 12  Insured Status—June 30, 2014, was Plaintiff’s date last insured.22 The 13 ALJ found the relevant periods to be “November 1, 2012 through June 30, 14 2014 and August 23, 2016 onward.”23 17 18 See AR 99, 282.

18 19 See, e.g., AR 48.

19 20 AR 22, 95–103, 118–133.

20 21 AR 32.

21 22 AR 22, 24.

22 23 AR 22. Neither party challenges the ALJ’s findings regarding the relevant 23 period.

1  Step One—Plaintiff had not engaged in substantial gainful activity since 2 November 1, 2012, the alleged onset date.24 3  Step Two—Between November 1, 2012, the alleged onset date, and the 4 date last insured, June 30, 2014, Plaintiff did not have any severe 5 impairments. After August 23, 2016, the date on which Plaintiff filed her 6 applications, she had the following medically determinable severe 7 impairments: “bilateral knee osteoarthritis; bilateral carpal tunnel 8 syndrome; fibromyalgia; and obesity.”25 9  Step Three—Plaintiff did not have an impairment or combination of 10 impairments that met or medically equaled the severity of one of the 11 listed impairments.26 12  RFC—Plaintiff had the RFC to perform light work with the following 13 limitations: 14 o She is “limited to standing and/or walking four hours in an eight-hour 15 workday.”

16 o She must be able to “alternate between sitting and standing on hourly 17 basis for five minutes.”

18 o “She can never crouch, crawl, or climb ladders or scaffolds.”

19 o She can “occasionally stoop and kneel.”

21 24 AR 25.

22 25 AR 25.

23 26 AR 27.

1 o She is limited to “less than occasionally climbing flights of stairs.”

2 o “She can frequently handle, finger, and feel objects with her hands 3 bilaterally.”

4 o She “must avoid extreme cold temperatures and unprotected heights.”27 5  Step Four—Plaintiff was unable to perform any past relevant work.28 6  Step Five—Considering Plaintiff’s RFC, age, education, and work history, 7 Plaintiff could perform work that existed in significant numbers in the 8 national economy, such as cashier II, ticket seller, and marking clerk.29 9 The ALJ concluded Plaintiff had not been under a disability, as defined in 10 the Social Security Act (“the Act”), from November 1, 2012, through the date of the 11 ALJ’s decision: April 8, 2020.30 Plaintiff requested review of the ALJ’s decision by 12 the Appeals Council, which denied review.31 Plaintiff then timely appealed to this 13 Court, primarily asserting that several of the ALJ’s findings in the written decision 14 lacked sufficient analysis and explanation.

19 27 AR 28.

20 28 AR 31.

21 29 AR 32–33.

22 30 AR 31.

23 31 AR 1–7.

1 III. Standard of Review 2 A district court’s review of the Commissioner’s final decision is limited.32 3 The Commissioner’s decision is set aside “only if it is not supported by substantial 4 evidence or is based on legal error.”33 Substantial evidence is “more than a mere 5 scintilla but less than a preponderance; it is such relevant evidence as a reasonable 6 mind might accept as adequate to support a conclusion.”34 Moreover, because it is 7 the role of the ALJ and not the Court to weigh conflicting evidence, the Court 8 upholds the ALJ’s findings “if they are supported by inferences reasonably drawn 9 from the record.”35 The Court considers the entire record as a whole.36 10 Further, the Court may not reverse an ALJ decision due to a harmless 11 error.37 An error is harmless “where it is inconsequential to the ultimate 15 32 42 U.S.C. § 405(g).

16 33 Hill v. Astrue, 698 F.3d 1153, 1158 (9th Cir. 2012).

17 34 Id. at 1159 (quoting Sandgathe v. Chater, 108 F.3d 978, 980 (9th Cir. 1997)).

18 35 Molina v. Astrue, 674 F.3d 1104, 1111 (9th Cir. 2012).

19 36 Lingenfelter v. Astrue, 504 F.3d 1028, 1035 (9th Cir. 2007) (The court “must 20 consider the entire record as a whole, weighing both the evidence that supports and 21 the evidence that detracts from the Commissioner’s conclusion,” not simply the 22 evidence cited by the ALJ or the parties.) (cleaned up).

23 37 Molina, 674 F.3d at 1111.

1 nondisability determination.”38 The party appealing the ALJ’s decision generally 2 bears the burden of establishing harm.39 3 IV. Analysis 4 Plaintiff alleges the ALJ erred by (1) “improperly evaluating the medical 5 opinion evidence”; (2) “failing [at step three] to conduct an adequate analysis, 6 failing to even consider Listing 14.09D in accordance with SSR 12-2p for 7 fibromyalgia”; rejecting Plaintiff’s subjective complaints; and “failing to conduct an 8 adequate analysis at step five.”40 For the reasons discussed below, the Court finds 9 the ALJ reversibly erred by failing to adequately explain several of his findings.

10 Because these errors potentially affected nearly every aspect of the ALJ’s analysis, 11 the Court remands this case for renewed analysis starting at step three.

12 A. Medical Opinions: Plaintiff establishes consequential error as to her 13 knee and CTS impairments.

14 Plaintiff alleges that the ALJ “improperly rejected multiple medical opinions 15 limiting [Plaintiff] to sedentary work.”41 16 1. The Applicable Standard 17 For cases involving disability applications filed before March 27, 2017, the 18 role and status of a medical opinion’s author are important considerations when 20 38 Molina, 674 F.3d at 1115 (cleaned up).

21 39 Shinseki v. Sanders, 556 U.S. 396, 409–10 (2009).

22 40 See ECF No. 17 at 7.

23 41 ECF No. 17 at 2.

1 assigning weight to that opinion. The Court of Appeals for the Ninth Circuit laid 2 out the applicable standard in Garrison v. Colvin: 3 [Courts] distinguish among the opinions of three types of physicians: (1) those who treat the claimant (treating 4 physicians); (2) those who examine but do not treat the claimant (examining physicians); and (3) those who neither examine nor 5 treat the claimant (nonexamining physicians). As a general rule, more weight should be given to the opinion of a treating 6 source than to the opinion of doctors who do not treat the claimant.42 While the opinion of a treating physician is thus 7 entitled to greater weight than that of an examining physician, the opinion of an examining physician is entitled to greater 8 weight than that of a non-examining physician.43 9 If a treating or examining doctor's opinion is contradicted by another doctor's opinion, an ALJ may only reject it by providing 10 specific and legitimate reasons that are supported by substantial evidence. This is so because, even when contradicted, a treating 11 or examining physician's opinion is still owed deference and will often be entitled to the greatest weight even if it does not meet 13 42 See also 20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2) (“Generally, we give more 14 weight to medical opinions from your treating sources, since these sources . . . may 15 bring a unique perspective to the medical evidence that cannot be obtained from 16 the objective medical findings alone or from reports of individual examinations, 17 such as consultative examinations or brief hospitalizations. . . . We will always give 18 good reasons in our notice of determination or decision for the weight we give your 19 treating source's medical opinion.”).

20 43 See also 20 C.F.R. §§ 404.1527(c)(3), 416.927(c)(3) (“[B]ecause nonexamining 21 sources have no examining or treating relationship with you, the weight we will 22 give their medical opinions will depend on the degree to which they provide 23 supporting explanations for their medical opinions.”).

1 the test for controlling weight. An ALJ can satisfy the “substantial evidence” requirement by setting out a detailed and 2 thorough summary of the facts and conflicting clinical evidence, stating his interpretation thereof, and making findings. The 3 ALJ must do more than state conclusions. He must set forth his own interpretations and explain why they, rather than the 4 doctors', are correct.

5 Where an ALJ does not explicitly reject a medical opinion or set forth specific, legitimate reasons for crediting one medical 6 opinion over another, he errs. In other words, an ALJ errs when he rejects a medical opinion or assigns it little weight while 7 doing nothing more than ignoring it, asserting without explanation that another medical opinion is more persuasive, or 8 criticizing it with boilerplate language that fails to offer a substantive basis for his conclusion.44 Here, Plaintiff specifically challenges the weight assigned by the ALJ to two of Plaintiff’s treating physicians: Drs. Wagner and Opara.

2. Drs. Wagner & Opara’s Physical Functional Evaluations In August 2018, treating physician William Wagner, DO, completed a physical functional evaluation on a form supplied by the Department of Social and Health Services.45 About one year later, in July 2019, another treating physician, James Opara, MD, also conducted a physical functional evaluation and filled out the same form.46 When assessing how Plaintiff’s diagnosed physical impairments would affect basic work activities, Dr. Wagner opined that Plaintiff’s knee problems 20 44 Garrison v. Colvin, 759 F.3d 995, 1012–13 (9th Cir. 2014) (cleaned up) (internal 21 footnotes added).

22 45 AR 690–93.

23 46 AR 696–701.

1 caused severe limitations in sitting, standing, walking, lifting, stooping, and 2 crouching.47 Dr. Opara later opined that Plaintiff’s knee problems caused only a 3 marked limitation in standing and walking.48 But Dr. Opara also found that 4 Plaintiff’s bilateral carpal tunnel syndrome caused marked limitations in carrying, 5 lifting, and pushing.49 Both doctors indicated that Plaintiff could sustain work at 6 only a sedentary level.50 7 Both doctors’ opinions were separately reviewed by one or more independent 8 physicians. In each case, the reviewing physician concurred with the treating 9 physicians’ evaluations, confirming that the listed diagnoses were “supported by 10 available objective medical evidence” and that “the severity and functional 11 limitations [were] supported by available medical evidence.”51 But the record also 13 47 AR 692. Dr. Wagner noted that Plaintiff had “difficulty walking, standing, 14 bending,” that x-rays from June 2018 showed “severe osteoarthritis of both knees,” 15 and that Plaintiff was awaiting knee surgery. AR 692–93.

16 48 AR 697.

17 49 AR 697.

18 50 AR 693, 698. See also id. (defining sedentary work as being able to walk or stand 19 only for brief periods and able to lift 10 pounds maximum and frequently lift or 20 carry lightweight articles).

21 51 AR 694 (Sept. 2018: Arild Lein, MD, reviewing and agreeing with Dr. Wagner’s 22 Aug. 2018 evaluation); 702 (Aug. 2019: Derek J. Leinenbach, MD, reviewing and 23 agreeing with Dr. Wagner’s Aug. 2018 evaluation, Dr. Lein’s Sept. 2018 review, 1 contains contradictory medical opinions.52 Thus, to reject medical opinions of 2 Plaintiff’s treating physicians, the ALJ was required to set forth specific and 3 legitimate reasons supported by substantial evidence.53 4 3. Weight Assigned to the Medical Opinions 5 In conducting the disability analysis, the ALJ assigned little weight to each 6 of Drs. Wagner and Opara’s medical opinions, as well as the concurring opinions of 7 the reviewing physicians.54 And although not included in the ALJ’s explanation for 8 rejecting either Dr. Wagner or Dr. Opara’s medical opinions, the ALJ assigned 9 “significant weight” to the two opinions that were rendered by the State agency’s 10 reviewing physicians in April 2017 and February 2018.55 To the extent this 12 and Dr. Opara’s July 2019 evaluation). But see AR 702 (Aug. 2019: Dr. Leinenbach 13 stating in regard to Dr. Opara’s evaluation, “Physical exam lists bilateral carpal 14 tunnel syndrome, fibromyalgia, anxiety, and depression but nothing to 15 substantiate so didn't list.”).

16 52 See also AR 112–13, 146–47 (State agency’s reviewing physicians, in Apr. 2017 17 and Feb. 2018, finding exertional and postural limitations to a lesser degree than 18 those found by Drs. Wagner and Opara); AR 115, 149 (same reviewing physicians 19 each finding Plaintiff could engage in work at a light—rather than sedentary— 20 exertional level).

21 53 See Garrison, 759 F.3d at 1012–13.

22 54 AR 30.

23 55 AR 30–31.

1 assignment of weight could be considered a reason for rejecting Drs. Wagner and 2 Opara’s opinions, the Court finds the ALJ failed to adequately explain his decision 3 to prioritize these reviewing physicians’ opinions over those of Plaintiff’s treating 4 physicians.56 The April 2017 and February 2018 reviewing opinions not only 5 predate Drs. Wagner and Opara’s opinions, they also lack the benefit of an in- 6 person examination, they do not reflect—and are largely inconsistent with— 7 Plaintiff’s subsequent treatment and diagnostic history, and they contain a lesser 8 degree of supporting explanations than the opinions of Drs. Wagner and Opara, 9 especially when considering each treating physician’s treatment notes in the 10 aggregate.57 11 4. Rejection of Drs. Wagner and Opara’s Knee-Related Opinions 12 In giving little weight to Dr. Wagner’s opinions—all of which related to 13 Plaintiff’s diagnosis of bilateral knee osteoarthritis—the ALJ provided the 14 following reasoning: 16 56 “Where an ALJ does not explicitly reject a medical opinion or set forth specific, 17 legitimate reasons for crediting one medical opinion over another, he errs.”

18 Garrison, 759 F.3d at 13.

19 57 See 20 C.F.R. §§ 404.1527(c), 416.927(c) (each, in the context of assigning weight 20 to medical opinions, discussing the importance of considerations such as the 21 opportunity for the medical source to conduct an examination, the treatment 22 relationship, to supportability of the opinion, and its consistency with other 23 evidence).

1 [T]he evaluation from December 2018 only revealed that the claimant had an antalgic gait and mildly limited range of motion 2 in the left leg. Likewise, the following year, in August 2019, the claimant had slightly diminished strength in the bilateral knees.

3 The imaging has consistently shown severe degenerative changes, but no evidence of significant worsening. Given her 4 activities, I find that a limitation to work at the light exertional level, with additional limitations, is more consistent with the 5 longitudinal record.58 6 Similarly, in rejecting Dr. Opara’s opinions relating to Plaintiff’s knees, the 7 ALJ stated as follows: 8 [T]he contemporaneous treatment notes indicate that the claimant had moderate tenderness in the knees . . . but there 9 were no other findings. Similar findings were noted in May and June 2019 as well. While the imaging of the bilateral knees has 10 shown severe degenerative changes, the claimant has noted good control of her pain with medication.59 a. The ALJ failed to provide specific and legitimate reasons for rejecting the medical opinions relating to Plaintiff’s knee impairment.

The ALJ’s analysis as to both Dr. Wagner and Dr. Opara is flawed for several reasons. First, the ALJ failed to explain how the findings he cites in any way contradict or otherwise detract from the treating physicians’ opinions; rather, the findings he lists appear consistent with the opinions he rejects.60 21 58 AR 30 (citing AR 620).

22 59 AR 30 (cleaned up).

23 60 See Garrison, 759 F.3d at 1012–13.

1 Second, by skipping over the plethora of supportive findings in the record 2 and suggesting “there were no other findings,” the ALJ wrongfully implied the 3 record contained only sparse, minimal medical findings regarding Plaintiff’s knee 4 problems.61 But, as illustrated further below, the bulk of the medical findings of 5 record are at least consistent with, if not supportive of, Drs. Wagner and Opara’s 6 opinions.62 7 Third—setting aside that the ALJ failed to explain why a showing of 8 “significant worsening” was needed in the first place—evidence of “severe 9 degenerative changes” necessarily qualifies as evidence of “significant 10 worsening.”63 Looking to the most applicable entries, the Merriam-Webster 11 Dictionary defines “degenerative” as “of, relating to, involving, or tending to cause 12 degeneration”; it in turn defines “degeneration” to include “progressive 14 61 AR 30 (emphasis added). See Garrison, 759 F.3d at 1018 (rejecting the ALJ’s use 15 of a few “singled out” reports to discredit a claimant under the clear-and-convincing 16 standard, stating that the data points the ALJ chooses “must in fact constitute 17 examples of a broader [pattern]”).

18 62 Indeed, in the very records the ALJ cited to support his rejection of Dr. Opara’s 19 opinion, the doctor had also found Plaintiff’s range of motion “limited by painful 20 motion” for both knees. AR 701, 705, 723, 735.

21 63 See Degenerative and Degeneration, Merriam-WebsterDictionary.com, Medical 22 Definition entries, https://www.merriam-webster.com/dictionary/ (last visited Feb.

23 7, 2022).

1 deterioration of physical characters from a level representing the norm of earlier 2 generations or forms” as well as “deterioration of a tissue or an organ in which its 3 vitality is diminished or its structure impaired.” Under their natural meanings, 4 any degenerative change is a change for the worse, and anything considered severe 5 is at least significant. Nothing in Plaintiff’s medical records suggests the 6 authoring physicians meant differently.

7 Fourth, the ALJ failed to articulate which of Plaintiff’s activities were at 8 issue or how they were inconsistent with the doctors’ opinions.64 Just as is true 9 with a party’s unsupported assertion, the Court may not “comb the administrative 10 record to find specific conflicts” for the purpose of upholding an ALJ’s general 11 statement or finding concerning an alleged inconsistency.65 12 Fifth and finally, the ALJ erred by asserting, falsely, that Plaintiff had 13 “noted good control of her pain with medication” in relation to her knee pain.66 In 14 support of this statement, the ALJ cited to Dr. Opara’s entries from August and 17 64 See Garrison, 759 F.3d at 1012–13.

18 65 Cf. Burrell v. Colvin, 775 F.3d 1133, 1138 (9th Cir. 2014) (noting, in the context 19 of assessing claimant credibility, that courts are constrained to review the reasons 20 the ALJ asserts); Fair v. Bowen, 885 F.2d 597, 603 (9th Cir. 1989) (“[M]any home 21 activities are not easily transferable to what may be the more grueling 22 environment of the workplace.”).

23 66 AR 30.

1 September 2019.67 But neither of those entries indicate that Plaintiff’s knee pain 2 (or CTS) were well controlled by medication. Instead, both entries arise in the 3 context of Plaintiff following up on her fibromyalgia, with the notes stating she 4 reported her fibromyalgia was well controlled by medication.68 In the September 5 2019 note, Dr. Opara even observed that “the bilateral knee osteoarthritis is 6 getting worse with the cold weather,” and he indicated that Plaintiff “will have 7 surgery done in both knees when she quits smoking.”69 8 b. The record contained ample medical findings supporting the 9 doctors’ medical opinions regarding Plaintiff’s knee problems.

10 Because the ALJ’s primary justification for rejecting Drs. Wagner and 11 Opara’s opinions was an alleged lack of supportive medical findings,70 to illustrate 15 67 AR 30 (citing to AR 731 & AR 734).

16 68 AR 731 (Aug. 2019: noting in the context of discussing her referral for 17 fibromyalgia, Plaintiff reported “the Gabapentin is helping her nerve pain but 18 makes her drowsy”); AR 734 (Sept. 2019: noting that, in relation to Plaintiff’s 19 fibromyalgia, diabetes mellitus, and depression, “She is taking her medications as 20 prescribed and doing well. . . . She is no longer having frequent exacerbation of her 21 musculoskeletal pain since she started taking the Lyrica.”).

22 69 AR 734 (emphasis added) (cleaned up).

23 70 See AR 30–31.

1 how the record belies the ALJ’s proffered reasoning, the Court sets forth below 2 several examples of knee-related medical findings.71 3  July 2015: “Noted crepitus on flexion and extension of both knees.”72 Imaging showing “[s]evere left tricompartment osteoarthritis with varus” and 4 “[m]oderate right tricompartment arthritis with joint effusion.”73  Aug. 2015: “There is moderate patellofemoral crepitation bilaterally and pain 5 with patellar grind, right greater than left.”74 6  July 2016: “Severe tricompartment osteoarthritis with varus. Large right effusion.”75 7  Oct. 2017: Positive findings for crepitus, joint pain, joint swelling, joint tenderness, and popping.76  Jan. 2018: Plaintiff “walked with a wide-based gait and notable bowing of her knees.”77  June 2018: “There is severe bilateral medial femorotibial joint space 10 narrowing, subchondral sclerosis and marked marginal spurring. There is bilateral moderate lateral femorotibial joint space narrowing with marginal 11 spurring. . . . There is severe lateral and moderate left knee medial 14 71 The examples of supportive findings are only to highlight deficiencies in the 15 ALJ’s proffered reasons. The record also contains several medical findings—many 16 of which were not mentioned by the ALJ—that could reasonably be interpreted as 17 cutting against Plaintiff’s claims.

18 72 AR 420.

19 73 AR 459.

20 74 AR 435.

21 75 AR 581.

22 76 AR 541.

23 77 AR 569.

1 patellofemoral osteoarthritis.”78 “Radiographs obtained today show bone-on- bone medial compartment arthrosis of both knees. There is moderately 2 advanced patellofemoral arthrosis on the right and fairly severe patellofemoral arthrosis on the left.”79 3  Dec. 2018: “Severe degenerative changes of the left knee.”80 4  Mar. 2019: “Patient does have severe osteoarthritis of the knee . . . but she reports the surgery is on hold until patient is in a more stable situation.”81 5  Apr. 2019: Impressions including “[s]evere bilateral medial femorotibial and lateral left knee patellofemoral osteoarthritis,” as well as “[b]ilateral moderate 6 lateral femorotibial and left knee medial patellofemoral osteoarthritis.”82  Aug. 2019: Both knees demonstrating “severe medial compartment joint space loss with near bone-on-bone contact,” mild and moderate “lateral patellofemoral compartment joint space loss,” and moderate and large “osteophytes are noted of all compartments.”83 9  Sept. 2019: Physical therapist noting during initial assessment, “Objective exam reveals impairments with pain, muscle spasm, reduced ROM, difficulty 10 walking and standing. These impairments are causing functional limitations with standing, walking, bending, lifting, pushing and pulling, which are 11 restricting this patient's ability to participate in ADL's and gainful employment.”84 13 /// 14 // 15 / 17 78 AR 578–79.

18 79 AR 655.

19 80 AR 620.

20 81 AR 590.

21 82 AR 579.

22 83 AR 685.

23 84 AR 773–74.

1 c. Remand is required for the ALJ to reevaluate the medical 2 opinions concerning Plaintiff’s knee impairment.

3 In rejecting all of Dr. Wagner’s medical opinions and those of Dr. Opara’s 4 opinions concerning Plaintiff’s knee impairment, the ALJ failed to provide specific 5 and legitimate reasons, much less “a detailed and thorough summary of the facts 6 and conflicting clinical evidence” along with explanations as to why his own 7 interpretations, rather than those of a treating physician, were correct.85 It is 8 unclear whether Plaintiff would still be employable if the additional knee-related 9 limitations, by themselves, were included in the RFC determination.86 10 Accordingly, remand is appropriate, and the ALJ is instructed on remand to 11 reevaluate the medical opinions relating to Plaintiff’s knee and CTS impairments.

12 5. Rejection of Dr. Opara’s Opinions Relating to CTS 13 In rejecting Dr. Opara’s marked limitations from Plaintiff’s CTS, the ALJ 14 again relied on an asserted lack of supporting medical findings, saying, “the 15 contemporaneous treatment notes indicate that the claimant had . . . positive 17 85 See Garrison, 759 F.3d at 1012–13; Lambert v. Saul, 980 F.3d 1266, 1277 (9th 18 Cir. 2020).

19 86 See AR 88–92 (vocational expert opining that being limited to sedentary work 20 and only occasionally handling, fingering, and feeling objects with both hands 21 would bar competitive employment, saying, “I am not aware of any jobs to offer at 22 the sedentary level that would only require occasional handling, fingering, and 23 feeling.”).

1 Tinel’s signs bilaterally, but there were no other findings.”87 Yet, in the very 2 records the ALJ cites, in addition to the Tinel’s signs, Dr. Opara also found positive 3 Phalen signs.88 Further, contrary to what the ALJ implied, the medical record does 4 contain other medical findings supportive of the opined CTS-related limitations.89 5 Indeed, soon after Dr. Opara conducted his evaluation of Plaintiff, a nerve- 6 conduction study confirmed that she had “moderate median neuropathy at both 7 wrists, consistent with bilateral carpal tunnel syndrome”—a finding which 8 provided the specialist with sufficient objective medical evidence to recommend the 9 more aggressive treatment of sequential bilateral carpal tunnel release surgery.90 10 The ALJ also erred in stating that Plaintiff “underwent right carpal tunnel 11 release surgery” prior to the administrative hearing.91 The ALJ’s confusion is 12 perhaps understandable,92 but close examination of the record reveals that 14 87 AR 30.

15 88 AR 701, 705, 723, 735.

16 89 See, e.g., AR 488, 490 (June 2015: “Decreased sensation in her right hand 17 especially greater than the left exacerbated by wrist flexion.”); AR 679 (Aug. 2019: 18 “Positive for tingling and weakness.”).

19 90 AR 796.

20 91 AR 29–30.

21 92 See AR 48 (counsel representing that “she had the carpal tunnel release finally 22 just January 24, 2020”); AR 50 (counsel stating that “they did the carpal tunnel 23 release on the right”); AR 57 (Plaintiff answering “yes” when asked if she “had the 1 although Plaintiff was scheduled for carpal tunnel release surgery in January 2 2020, as of the date of the administrative hearing, she had never undergone the 3 procedure.93 Importantly, by that point, the medical record contained far more 4 detailed medical findings supporting Dr. Opara’s CTS-related opinion, many of 5 which went unaddressed by the ALJ.94 Therefore, and because it is unclear to 8 release here last month, correct, on your right?”). But see AR 57 (When asked, “You 9 already had it, right, on your right?”, Plaintiff responding, “No. I went to the 10 hospital and I checked in and stuff but something was like not okay with me and 11 . . . we had a discussion and he was explaining some stuff to me and so we had to 12 cancel it.”).

13 93 See AR 848 (Jan. 23, 2020: Plaintiff “presents to our clinic today for a preop 14 examination. [She is] scheduled for a right carpal tunnel release on 1/24/2020.”); 15 AR 847–48 (Jan. 24, 2020: “Endorsed coffee w/ cream at 0400; marijuana 16 yesterday, and methamphetamines 5 days ago. Reinforced importance of 17 aspiration avoidance . . . . Ultimately, patient elected to cancel herself because she 18 had plans later in the day and was unwilling to endure the delay for safety . . . .”); 19 cf. also AR 28 (ALJ noting, “She also testified that she was not able to undergo 20 right carpal tunnel release due to high blood pressure.”).

21 94 See, e.g., AR 756 (Dec. 2019: “clinical presentation is consistent with carpal 22 tunnel syndrome, which was confirmed by nerve study.”); AR 866 (“She has 23 decreased grip strength bilaterally. She has a degree of thenar eminence atrophy 1 what extent the ALJ’s mistaken belief influenced his analysis,95 the ALJ is 2 instructed on remand to reevaluate Plaintiff’s carpal tunnel syndrome and its 3 effects at each step of the disability analysis, including while assessing how much 4 weight to assign to Dr. Opara’s related medical opinions.

5 6. Rejection of Dr. Opara’s Opinions Relating to Fibromyalgia, Anxiety, and 6 Depression 7 In addition to the physical limitations already discussed above, Dr. Opara 8 opined in his July 2019 evaluation of Plaintiff that her fibromyalgia would cause 9 marked limitations in lifting, carrying, and pushing.96 Dr. Opara further asserted 10 that her anxiety and depression would each cause severe limitations in “obeying 11 instructions” and “working with others.”97 The ALJ adequately explained why he 12 assigned little weight to these opinions.

14 present bilaterally. She has a positive Phalen's test bilaterally at less than 10 15 seconds.”).

16 95 If not for this fundamental misunderstanding, the ALJ’s other errors in 17 assessing the CTS-related medical opinions might have been considered harmless.

18 Unlike with her knee problems, the Plaintiff did indeed report that her CTS was 19 well controlled by medication, and the ALJ cited to this finding elsewhere in his 20 decision. See AR 27, 29; see also AR 661 (June 2018: “She has been taking 21 Gabapentin for her carpal tunnel syndrome and reports it has been effective.”).

22 96 AR 697.

23 97 AR 697.

1 Impairments are not disabling if they “can be controlled effectively with 2 medication.”98 The ALJ correctly noted that Plaintiff reported control of her 3 fibromyalgia through medication.99 The repeated reports of well-controlled 4 symptoms provide the requisite substantial evidence supporting the ALJ’s rejection 5 of Dr. Opara’s asserted limitations relating to fibromyalgia, especially when 6 considering the general lack of remarkable findings as well as the fact that 7 Plaintiff complained about, and sought treatment for, her fibromyalgia far less 8 frequently and to a lesser degree than she did in relation to her knee problems and 9 CTS.

10 As to Plaintiff’s anxiety and depression, the ALJ accurately pointed out that 11 “regarding [Plaintiff’s] mental impairments, the observations of her by Dr. Opara 12 were generally unremarkable other than the appointment in July 2019,” and that 17 98 Warre v. Comm'r of Soc. Sec. Admin., 439 F.3d 1001, 1006 (9th Cir. 2006).

18 99 AR 60; see also, e.g., AR 731 (Aug. 2019: reporting at follow-up appointment for 19 fibromyalgia that she was “doing well” and that “the Gabapentin is helping her 20 nerve pain but makes her drowsy”); AR 733 (Aug. 2019: Dr. Opara noting, “Her 21 fibromyalgia is stable now . . . .”); AR 734 (Sept. 2019: “She is taking her 22 medications as prescribed and doing well. . . . She is no longer having frequent 23 exacerbation of her musculoskeletal pain since she started taking the Lyrica.”).

1 Plaintiff “reported good control of her depression.”100 Additionally, the ALJ 2 reasonably gave greater weight to the mental-health findings provided by 3 Dr. Bartell, who was board certified in psychiatry and had conducted a 4 comprehensive psychiatric evaluation of Plaintiff in January 2018.101 In contrast 5 to the severe limitations later suggested by Dr. Opara, Dr. Bartell had opined that 6 Plaintiff’s depression and irritability only mildly impaired her ability to “accept 7 instructions from supervisors” and “to interact with coworkers, and the public.”102 8 Given this, substantial evidence supports the ALJ’s rejection of Dr. Opara’s 9 opinions, instead finding that Plaintiff’s anxiety and depression did not 10 significantly limit her ability to perform basic work activities.103 13 100 AR 25–26, 30. See also, e.g., AR 661 (“[S]he is taking Sertraline for depression 14 and states it has been effective.”); AR 734 (Aug. 2019: “She is taking her 15 medications as prescribed and doing well.”).

16 101 AR 26. See 20 C.F.R. §§ 404.1527(c)(5), 416.927(c)(5) (An ALJ should “generally 17 give more weight to the medical opinion of a specialist about medical issues related 18 to his or her area of specialty than to the medical opinion of a source who is not a 19 specialist.”).

20 102 AR 572. Dr. Bartell also opined that Plaintiff’s “ability to deal with the usual 21 stress of the workplace” was “moderately impaired by her depression and 22 irritability.” Id. 23 103 AR 26, 30.

1 B. Step Three: Plaintiff establishes consequential error as to her knee 2 and CTS impairments and Listings 1.02A and 1.02B.

3 Plaintiff challenges several of the ALJ’s findings at step three. For purposes 4 of step three, the listings describe the characteristics of each impairment. Each 5 description includes the “symptoms, signs and laboratory findings” that make up 6 the characteristics of that listed impairment.104 If a medically determinable 7 impairment is found severe at step two but is not among those listed, the ALJ must 8 determine whether the claimant’s impairments—separately or in combination— 9 medically equal a listing.

10 To meet a listed impairment, a claimant must establish that he or she meets each characteristic of a listed impairment relevant 11 to his or her claim. To equal a listed impairment, a claimant must establish symptoms, signs and laboratory findings “at least 12 equal in severity and duration” to the characteristics of a relevant listed impairment, or, if a claimant's impairment is not 13 listed, then to the listed impairment “most like” the claimant's impairment.

14 If a claimant suffers from multiple impairments and none of them individually meets or equals a listed impairment, the 15 collective symptoms, signs and laboratory findings of all of the claimant's impairments will be evaluated to determine whether 16 they meet or equal the characteristics of any relevant listed impairment.105 21 104 20 C.F.R. §§ 404.1525, 416.925.

22 105 Tackett v. Apfel, 180 F.3d 1094, 1099 (9th Cir. 1999) (cleaned up) (emphasis in 23 original); 20 C.F.R. §§ 404.1526, 416.926.

1 1. Plaintiff’s Knee Impairment and Listing 1.02A 2 The ALJ found that Plaintiff’s “bilateral knee impairments do not meet or 3 medically equal Listing 1.02A (major dysfunction of a joint) because there is no 4 indication in the record that the claimant is unable to ambulate effectively.”106 5 Plaintiff challenges this finding, arguing that the ALJ erred by not providing 6 sufficient analysis.107 The Court agrees.

7 As relevant here, Listing 1.02A requires evidence of major joint dysfunction 8 that is characterized by “gross anatomical deformity (e.g., subluxation, contracture, 9 bony or fibrous ankylosis, instability) and chronic joint pain and stiffness with 10 signs of limitation of motion or other abnormal motion of the affected joint(s), and 11 findings on appropriate medically acceptable imaging of joint space narrowing, 12 bony destruction, or ankylosis of the affected joint(s),” which—with the knees— 13 must result in the “inability to ambulate effectively, as defined in 1.00B2b.”108 The 14 relevant portions defining and explaining the phrase “inability to ambulate 15 effectively” state as follows: 16 Inability to ambulate effectively means an extreme limitation of the ability to walk; i.e., an impairment(s) that interferes very 17 seriously with the individual's ability to independently initiate, sustain, or complete activities. Ineffective ambulation is defined 18 generally as having insufficient lower extremity functioning to permit independent ambulation without the use of a hand-held 19 assistive device(s) that limits the functioning of both upper extremities. . . .

21 106 AR 27.

22 107 ECF No. 17 at 15–16.

23 108 Listing 1.02A.

1 To ambulate effectively, individuals must be capable of sustaining a reasonable walking pace over a sufficient distance 2 to be able to carry out activities of daily living. They must have the ability to travel without companion assistance to and from a 3 place of employment or school. Therefore, examples of ineffective ambulation include, but are not limited to, the inability to walk 4 without the use of a walker, two crutches or two canes, the inability to walk a block at a reasonable pace on rough or uneven 5 surfaces, the inability to use standard public transportation, the inability to carry out routine ambulatory activities, such as 6 shopping and banking, and the inability to climb a few steps at a reasonable pace with the use of a single hand rail. The ability to 7 walk independently about one's home without the use of assistive devices does not, in and of itself, constitute effective 8 ambulation.109 9 Contrary to the ALJ’s assertion, the record contains at least some 10 indications—beyond the reasonable inferences drawn from various medical 11 opinions—suggesting that Plaintiff cannot ambulate effectively.110 Although a 12 reasonable ALJ might have rejected such evidence after addressing it and 13 explaining why other competing evidence was more compelling, the ALJ provided 14 no such analysis here, and the record could be reasonably interpreted either way.

15 Because the Court is left without an adequate explanation supported by 17 109 Listing 1.00B2b (cleaned up) (emphasis added).

18 110 See, e.g., AR 332 (Sept. 2017: Plaintiff’s daughter writing that Plaintiff “isn't 19 able to do the things she enjoys most like walk, clean, cook, work even exercise.”); 20 AR 569 (Jan. 2018: Dr. Bartell noting that Plaintiff “walked with a wide-based gait 21 and notable bowing of her knees.”); AR 768 (Sept. 2019: physical therapist finding 22 “[a]ntalgic gait with reduced knee flexion and significant trendelenberg gait on the 23 right more than the left.”).

1 substantial evidence, and because a different finding would have likely led to a 2 different outcome, the Court finds the ALJ reversibly erred.111 3 2. Plaintiff’s CTS Impairment and Listing 1.02B 4 For the ALJ’s step-three analysis of Plaintiff’s CTS, he stated as follows: 5 With regard to the claimant’s carpal tunnel syndrome, while there is no specific listing, it is considered to be a neurological 6 impairment and it has been evaluated under the criteria of Section 11.00. As there is no evidence of disorganization of 7 motor function, as defined by the regulations, the claimant’s symptoms of carpal tunnel do not medically equal any listed 8 impairment. I have also considered the claimant’s symptoms under listing 1.02B (major dysfunction of a joint); however, it 9 appears from the record that the claimant is able to perform fine and gross movements effectively. For example, she reported 10 that she is able to feed herself, she is able to do household chores, and she is able to drive a car.112 Plaintiff argues that the ALJ erred by not providing sufficient analysis regarding her ability to perform gross and fine movements effectively with her upper extremities.113 And, unlike with fibromyalgia and Listing 14.09D, Plaintiff did specifically raise and push for disability based on her CTS and Listing 1.02.114 18 111 Garrison, 759 F.3d at 1010 (“[Courts] review only the reasons provided by the 19 ALJ in the disability determination and may not affirm the ALJ on a ground upon 20 which he did not rely.”); see Marsh v. Colvin, 792 F.3d 1170, 1173 (9th Cir. 2015).

21 112 AR 27.

22 113 ECF No. 17 at 15.

23 114 AR 50.

1 The definition for the “inability to perform fine and gross movements 2 effectively” speaks to an impairment that “interferes very seriously with the 3 individual's ability to independently initiate, sustain, or complete activities,” noting 4 the term applies only if the claimant is incapable of “sustaining such functions as 5 reaching, pushing, pulling, grasping, and fingering to be able to carry out activities 6 of daily living.”115 Among the nonexclusive list of examples of evidence of an 7 inability to perform fine and gross movements effectively, the definition includes 8 “the inability to sort and handle papers or files” and “the inability to place files in a 9 file cabinet at or above waist level.”116 10 Reconsideration of the related medical opinions and Plaintiff’s symptom 11 testimony may impact the ALJ’s analysis; therefore, the Court need not assess the 12 sufficiency of the ALJ’s stated reasons here. The Court notes, however, that the 13 ALJ provided scant analysis regarding the extent to which Plaintiff’s CTS 14 impairment affected functional abilities such as reaching, pushing, pulling, 15 grasping, and fingering—particularly on a sustained basis in a work-like setting.

16 The ALJ is instructed on remand to reevaluate Plaintiff’s CTS at step three.

17 3. Plaintiff’s Fibromyalgia Impairment and Listing 14.09D 18 In his step-three analysis, the ALJ stated, “Although there is no specific 19 medical listing regarding the claimant’s fibromyalgia symptoms, I have 20 nonetheless considered its effects on each body system included in the listings, and 22 115 Listing 1.00B2c (emphasis added).

23 116 Listing 1.00B2c.

1 [find] that the evidence does not show that the claimant’s fibromyalgia symptoms 2 are of listing level severity (SSR 12-2p).”117 Plaintiff argues that “the ALJ’s failure 3 to even consider Listing 14.09D in accordance with SSR 12-2p regarding 4 [Plaintiff]’s fibromyalgia constitutes harmful legal error on its own.”118 The Court 5 disagrees.

6 Fibromyalgia is not a condition that generally presents with extensive 7 objective findings and as such it is a challenging condition for not only the medical 8 community to diagnosis but also for an ALJ to assess when considering 9 applications for disability based on this condition.119 To provide guidance, Social 10 Security Ruling 12-2p provides diagnostic criteria for fibromyalgia, and, because 11 fibromyalgia is not a listed impairment, the Ruling directs the ALJ at step three to 12 “determine whether [fibromyalgia] medically equals a listing (for example, listing 13 14.09D in the listing for inflammatory arthritis), or whether it medically equals a 14 listing in combination with at least one other medically determinable 15 impairment.”120 16 Here, though the ALJ’s analysis of Plaintiff’s fibromyalgia was certainly 17 thin, Plaintiff has not established harmful error. Importantly, Plaintiff bears the 19 117 AR 27.

20 118 ECF No. 17 at 16.

21 119 See Soc. Sec. Ruling (SSR) 12-2p; see generally Revels v. Berryhill, 874 F.3d 648 22 (9th Cir. 2017); Benecke v. Barnhart, 379 F.3d 587 (9th Cir. 2004).

23 120 SSR 12-2p.

1 burden of proof at step three, and a mere diagnosis does not suffice to establish 2 disability.121 An “ALJ is not required to discuss the combined effects of a 3 claimant's impairments or compare them to any listing in an equivalency 4 determination, unless the claimant presents evidence in an effort to establish 5 equivalence.”122 Social Security Ruling 12-2p does not alter this, and merely sets 6 forth one of many potential listings which might apply to a claimant with 7 fibromyalgia.

8 Plaintiff did not press the ALJ at the administrative hearing regarding 9 Listing 14.09D nor did she present specific evidence at the hearing to demonstrate 10 equivalence. Even now, Plaintiff fails to demonstrate how her impairments 11 medically meet or equal Listing 14.09D.123 Consequently, the ALJ's failure to 12 discuss Listing 14.09D was not erroneous.

15 121 Bowen v. Yuckert, 482 U.S. 137, 146 n.5 (1987); Key v. Heckler, 754 F.2d 1545, 16 1549-50 (9th Cir. 1985); 20 C.F.R. §§ 404.1525(d), 416.925(d).

17 122 Ford v. Saul, 950 F.3d 1141, 1157 (9th Cir. 2020).

18 123 Plaintiff—not the Court—must flesh out and support her arguments with law 19 and facts. See Indep. Towers of Wash. v. Washington, 350 F.3d 925, 930 (9th Cir. 20 2003) (“We require contentions to be accompanied by reasons.”); McPherson v. 21 Kelsey, 125 F.3d 989, 995–96 (6th Cir. 1997) (“It is not sufficient for a party to 22 mention a possible argument in a most skeletal way, leaving the court to . . . put 23 flesh on its bones.”).

1 C. Plaintiff’s Symptom Reports: Reconsideration is warranted as to 2 reports regarding Plaintiff’s knee and CTS impairments.

3 The ALJ found that Plaintiff’s medically determinable impairments could 4 “reasonably be expected to cause some of the alleged symptoms.”124 But the ALJ 5 found that Plaintiff’s statements concerning the intensity, persistence, and limiting 6 effects of the reported symptoms were “not entirely consistent with the medical 7 evidence and other evidence in the record.”125 Again, the Court need not consider 8 the sufficiency of the ALJ’s asserted reasons regarding Plaintiff’s knee problems 9 and CTS, because reconsideration of the medical opinions may impact the ALJ’s 10 analysis regarding Plaintiff’s symptom reports. As such, the ALJ is instructed on 11 remand to reevaluate Plaintiff’s symptom reports relating to her knee and CTS 12 impairments.

13 As to Plaintiff’s fibromyalgia, however, for the reasons discussed above, the 14 Court affirms the ALJ’s decision to discount Plaintiff’s symptom reports related to 15 her fibromyalgia. The ALJ reasonably relied on the evidence of the control with 16 medication to find her symptom allegations not supported. This is a specific, clear, 17 and convincing reason to discount her symptom testimony as to her fibromyalgia 18 symptoms.126 20 124 AR 29.

21 125 AR 29.

22 126 Tommasetti v. Astrue, 533 F.3d 1035, 1039–40 (9th Cir. 2008) (stating that ALJ 23 may discredit symptom testimony where there is evidence of improvement with 1 D. RFC Determination: Reconsideration is warranted.

2 For the same reasons discussed above, the ALJ is instructed on remand to 3 reevaluate Plaintiff’s RFC, particularly in regard to her knee and CTS 4 impairments. To provide further direction and clarity on remand, the Court lists 5 below additional considerations and instructions for remand.

6 1. Medication Side Effects 7 As Plaintiff correctly pointed out, “the ALJ never considered the side effects 8 of prescription medication, as required.”127 Among other things, an ALJ is required 9 to consider the “type, dosage, effectiveness, and side effects of any medication an 10 individual takes or has taken to alleviate pain or other symptoms.”128 Here, 11 Plaintiff testified at the trial that her medications caused drowsiness, and this 12 testimony is supported by other reports and treatment notes interspersed 13 throughout the record.129 Thus, the ALJ should have addressed the reported 14 medication side effect, and the ALJ is instructed to do so on remand.

16 treatment); Fair, 885 F.2d at 603 (explaining that “an unexplained, or inadequately 17 explained, failure to seek treatment or follow a prescribed course of treatment” 18 may be a sufficient reason to discredit a claimant's symptom testimony).

19 127 ECF No. 17 at 20.

20 128 SSR 16-3p; see 20 C.F.R. §§ 404.1529(c), 416.929(c).

21 129 See, e.g., AR 66 (Plaintiff testifying her medication makes her “feel really super 22 tired.”); AR 313 (Apr. 2017: reporting cyclobenzaprine makes her feel very sleepy 23 the next day). Notably, however, the treatment notes—including those during 1 2. Plaintiff’s Need to Ice and/or Elevate Her Legs 2 Though the ALJ noted that Plaintiff reported needing to elevate her knees 3 “at least one hour two times a day,” he did not directly address this potential 4 limitation, implicitly rejecting it in assessing Plaintiff’s RFC.130 Similar to 5 medication side effects, an ALJ is required to consider other measures “used to 6 relieve [the claimant’s] pain or other symptoms (e.g., lying flat on [her] back, 7 standing for 15 to 20 minutes every hour, sleeping on a board, etc.).”131 8 Here, not only did Plaintiff report needing to elevate and ice her knees, but 9 the medical records also confirm that one of her physicians recommended that she 10 engage in “[c]old therapy for 20 mins three times a day.”132 Accordingly, the ALJ is 11 instructed on remand to expressly address to what extent, if any, measures taken 12 to relieve Plaintiff’s knee pain and other symptoms affect her ability to engage in 13 competitive employment.

17 periods in which she was taking those medications consistently—do not include 18 observations of drowsiness or any similar medication-related impairment, instead 19 consistently noting that Plaintiff was “alert, cooperative, pleasant.” See, e.g., 20 AR 592.

21 130 See AR 28.

22 131 SSR 16-3p; see 20 C.F.R. §§ 404.1529(c), 416.929(c).

23 132 AR 543.

1 V. CONCLUSION 2 The Court reverses the decision of the ALJ because it was based at least in 3 part on legal error and, in many instances, lacked sufficient explanation for the 4 Court to meaningfully review the ALJ’s findings. Still, an immediate award of 5 benefits would be inappropriate, as the Court finds that “the record as a whole 6 creates serious doubt as to whether [Plaintiff] is, in fact, disabled within the 7 meaning of the Social Security Act.”133 Therefore, the Court remands this case for 8 further proceedings and a redetermination beginning at step three of the disability 9 analysis. As part of the redetermination, the ALJ is instructed to, at a minimum, 10 provide detailed and supported analysis regarding the following: 11  The weight assigned to the medical opinions relating to Plaintiff’s knee 12 and CTS impairments, specifically including Drs. Wagner and Opara’s 13 opinions regarding Plaintiff’s knee and CTS impairments. When 14 rejecting any such medical opinion, the ALJ shall expressly note any 15 relied upon inconsistencies between the doctor’s findings and the other 16 evidence of record—specifically identifying and analyzing any of 17 Plaintiff’s reported activities that are perceived as inconsistent—as well.

18 The ALJ shall also specify how each such opinion was considered when 19 assessing Plaintiff’s RFC.

20  Plaintiff’s credibility and the significance of her symptom reports, 21 specifically regarding her knee and CTS impairments.

23 133 Garrison, 759 F.3d at 1021.

1  Whether Plaintiff’s impairments, whether separately or in combination, 2 meet or equal any listing at step three. In doing so, the ALJ shall 3 expressly analyze Plaintiff’s knee impairment under Listing 1.02A as 4 well as Plaintiff’s CTS impairment under Listing 1.02B.

5  Reported side effects of Plaintiff’s medications, specifically including 6 drowsiness.

7  Measures taken to relieve Plaintiff’s impairment-related pain and other 8 symptoms, specifically including elevating and/or icing her knees.

9  Plaintiff’s RFC, including any limitations arising from Plaintiff’s knee 10 and CTS impairments.

11 Accordingly, IT IS HEREBY ORDERED: 12 1. The decision of the ALJ is REVERSED and this matter is 13 REMANDED to the Commissioner of Social Security pursuant to 14 sentence four of 42 U.S.C. § 405(g) for further proceedings as set forth 15 above.

16 2. Plaintiff’s Motion for Summary Judgment, ECF No. 17, is 17 GRANTED.

18 3. The Commissioner’s Motion for Summary Judgment, ECF No. 19, is 19 DENIED.

20 //// 21 /// 22 // 23 / 1 4. The Clerk’s Office shall enter JUDGMENT in favor of Plaintiff.

2 5. The case shall be CLOSED.

3 IT IS SO ORDERED. The Clerk’s Office is directed to file this Order and 4 provide copies to all counsel.

5 DATED this 18th day of February 2022. s/Edward F. Shea 7 EDWARD F. SHEA Senior United States District Judge