Stephanie Rule v. Andrew Saul
859 F. App’x 754
| 9th Cir. | 2021Background
- Stephanie Rule appealed the district court’s order affirming the ALJ’s denial of disability insurance benefits and SSI under Titles II and XVI.
- The ALJ discounted multiple treating/examining and other-source opinions: Dr. N.K. Marks, Dr. Rachel Carstens, Dr. Manuel Gomes, and nurse practitioner Daniel Pitts.
- ALJ reasons for discounting included: asserted inconsistency between Dr. Marks’s exam findings and her conclusions; opinions obtained for DHS/self-report; checkbox form entries; inconsistency with non‑examining reviewer Dr. Lace and with treatment notes showing punctual, calm presentations.
- The record contained repeated findings of anxiety, depression, distractibility, missed appointments, and multiple hospitalizations after February 2015 (contradicting Dr. Lace’s testimony).
- The Ninth Circuit held the ALJ failed to give specific and legitimate reasons for rejecting examining psychiatrists and germane reasons for rejecting the NP’s opinion; these errors affected step three (listings) and step five (RFC/ability to work).
- Court reversed and remanded to the district court with instructions to remand to the Social Security Administration for further proceedings to reassess the listings and mental RFC.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether ALJ permissibly rejected Dr. N.K. Marks’s (and Dr. Carstens’s) examining psychiatric opinions | Marks’s findings and conclusions are internally consistent and supported by exams and records; ALJ failed to give specific and legitimate reasons to reject them | ALJ argued inconsistency between exam findings and functional conclusions, purpose of exam (DHS), and checkbox form format | Rejected ALJ: reasons were not specific and legitimate; opinions should not have been discounted for those bases |
| Whether ALJ permissibly rejected Dr. Manuel Gomes’s opinion | Gomes’s opinion aligns with his exam and other examiners (Marks); ALJ lacked substantial evidence to reject it | ALJ relied on conflict with Dr. Lace (non‑examiner) and Lace’s purported review of the longitudinal record | Rejected ALJ: Dr. Lace’s testimony contradicted record (missed hospitalizations) and did not furnish a valid basis to discount Gomes |
| Whether ALJ permissibly rejected NP Daniel Pitts’s “other‑source” opinion | Pitts’s notes, read in full, support his opinion about attendance/task limits; ALJ’s contrary reading cherry‑picked calm/punctual visits | ALJ pointed to many notes showing calm/prompt presentation and used that to discount severe attendance limitations | Rejected ALJ: ALJ did not give germane reasons; full context of notes supports Pitts’s opinion |
| Whether ALJ’s errors were harmless or prejudicial to step three/step five determinations | Improperly discounting these opinions affected listing analysis and mental RFC; errors prejudicial and require further proceedings | ALJ may contend RFC/listing could be upheld despite some opinions | Ninth Circuit: errors were prejudicial; remand for further administrative proceedings to reassess listings and RFC |
Key Cases Cited
- Smolen v. Chater, 80 F.3d 1273 (9th Cir. 1996) (standard for evaluating medical opinions and substantial evidence review)
- Lester v. Chater, 81 F.3d 821 (9th Cir. 1995) (examining physician opinions require specific and legitimate reasons if contradicted)
- Orn v. Astrue, 495 F.3d 625 (9th Cir. 2007) (examining opinion consistency with record)
- Buck v. Berryhill, 869 F.3d 1040 (9th Cir. 2017) (psychiatric opinions necessarily rely in part on claimant self‑report)
- Burrell v. Colvin, 775 F.3d 1133 (9th Cir. 2014) (checkbox form does not alone justify rejection if supported by exam/records)
- Trevizo v. Berryhill, 871 F.3d 664 (9th Cir. 2017) (proper evaluation of medical opinion evidence)
- Popa v. Berryhill, 872 F.3d 901 (9th Cir. 2017) (germane reasons required to discount other‑source opinions)
- Holohan v. Massanari, 246 F.3d 1195 (9th Cir. 2001) (treatment notes must be read in full and in context)
- Garrison v. Colvin, 759 F.3d 995 (9th Cir. 2014) (assessing evidence consistency and credibility across the record)
- Brown‑Hunter v. Colvin, 806 F.3d 487 (9th Cir. 2015) (prejudicial error standard when ALJ fails to properly weigh opinion evidence)
- Dominguez v. Colvin, 808 F.3d 403 (9th Cir. 2015) (remand for further proceedings when record contains ambiguities/questions requiring development)