Trevizo v. Berryhill

A treating physician's opinion receives controlling weight when it is well supported by medically acceptable techniques and is not inconsistent with other substantial evidence. Even when it is not controlling, the ALJ must weigh the treatment relationship's length, frequency, nature, and extent, along with supportability, consistency, and specialization. The ALJ acknowledged that Dr. Galhotra was Trevizo's primary physician but did not meaningfully apply these factors despite his extensive four-year treatment relationship with her.

The ALJ's reliance on Trevizo's childcare activities was unsupported because the record did not establish what those activities actually required. It contained no meaningful evidence about how often Trevizo lifted, bathed, chased, or otherwise physically cared for the children, or how much help family members provided. One-time events such as attending hearings or taking a child to a doctor could not substantially contradict her physician's work-related limitations.

Trevizo's reported ability to walk for about 30 minutes and grocery shop once a week for an hour and a half was consistent with, rather than contrary to, Dr. Galhotra's assessment that she could stand or walk fewer than two hours and sit no more than three hours in a workday. Limited, intermittent activities do not establish an ability to sustain full-time employment.

The ALJ also failed to identify actual conflicts between Dr. Galhotra's treatment notes and his opinion. His notes repeatedly documented back pain, chronic lumbago, joint pain, positive straight-leg testing, prescribed pain medications, and weight-management counseling. Further, psoriatic arthritis independently supported her back and joint pain. The absence of more aggressive treatment, without more, was not a legitimate reason to discount the later medical assessment.

Because the vocational expert testified that a person with the limitations Dr. Galhotra described could not perform full-time work, properly crediting that opinion established disability. The district court could not supply new rationales, such as criticism of the check-box form, that the ALJ itself had not given.

Trevizo produced medical evidence of impairments that could reasonably cause her claimed symptoms, and the ALJ made no malingering finding. The ALJ therefore could reject her testimony only by identifying specific, clear, and convincing reasons. The boilerplate statement that her testimony was inconsistent with the RFC did not itself satisfy that demanding requirement.

The record did not support the ALJ's conclusion that Trevizo's psoriasis, foot pain, and related walking limits were less severe than alleged. A few notes stating that her feet appeared normal or lacked ulcers did not show that her psoriasis never affected her feet, particularly where the record documented severe flare-ups and substantial body-surface-area involvement. Symptom-free periods are not inconsistent with disability, and testimony cannot be rejected solely for lack of continuous objective confirmation.

The ALJ improperly used Trevizo's decision not to take prescribed oxycodone against her. Trevizo explained that she feared addiction and that hydroxyzine controlled her pain, but the ALJ neither evaluated nor rejected those explanations. A claimant is not required to take potentially addictive narcotics merely to substantiate pain allegations.

The ALJ also lacked a sound basis to reject Trevizo's testimony about weak grip and hand numbness. Dr. House, an examining psychologist, observed only that she held a pencil normally; he did not assess grip strength or fine and gross manipulation. That observation could not outweigh the treating physician's limitations and Trevizo's history of bilateral carpal-tunnel surgery.

The treatment record, viewed as a whole, supported rather than undermined Trevizo's accounts of fatigue and uncontrolled diabetes. Some periods of medication noncompliance could be considered, but the ALJ failed to evaluate her explanation that she feared a medication caused her rash and wrongly assumed that insurance coverage and doctor visits meant she could afford expensive prescriptions. Benefits cannot be denied because a claimant cannot obtain treatment for lack of funds.

Trevizo's earlier work history did not undermine her claim that pain, itching, and fatigue later impaired concentration, because the severe psoriasis and related symptoms arose after that work. Nor were her statements that she stopped working because of psoriasis inconsistent with telling Dr. House that she quit. The ALJ itself recognized that her confusing answers could stem from borderline intellectual functioning, yet inconsistently used those answers to discredit her.

Childcare likewise did not clearly conflict with Trevizo's symptom testimony. The record lacked detail about her role and assistance from others, and home childcare allowed her to rest, nap, and shower repeatedly during the day—accommodations generally unavailable in a full-time workplace. The remaining unexplained instances of diabetes-medication noncompliance, standing alone, could not substantially support rejection of her testimony.

Under the Ninth Circuit's credit-as-true rule, a court ordinarily directs an award of benefits when the record is fully developed, the ALJ lacked legally sufficient reasons to reject medical or symptom evidence, and crediting that evidence would require a disability finding. Those conditions were met here.

The record was extensive, including hundreds of pages, more than 50 medical visits, Trevizo's testimony and reports, third-party corroboration, the longitudinal opinion of her treating physician, and vocational-expert testimony directly addressing her limitations. Further proceedings would not serve a useful purpose.

Crediting Dr. Galhotra's improperly rejected opinion required a finding that Trevizo could not sustain full-time work. The court also found no serious doubt that she was disabled when considering her severe diabetes and psoriasis, psoriatic arthritis, obesity, borderline intellectual functioning, advanced age, and the length of time she had awaited a decision. Immediate benefits were especially appropriate because she was 65 years old, had sought benefits more than seven years earlier, and had significant unmet medical needs.