United States District Court, N.D. California
ORDER GRANTING PLAINTIFF’S MOTION FOR SUMMARY
JUDGMENT, DENYING DEFENDANT’S MOTION FOR SUMMARY
JUDGMENT, REVERSING THE DECISION OF THE COMMISSIONER AND
REMANDING FOR AWARD OF BENEFITS RE: DKT. NO. 20
C. SPERO CHIEF MAGISTRATE JUDGE.
Antonia Antoinette Parker seeks review of the final decision
of Defendant Andrew M. Saul, Commissioner of Social Security
(“the Commissioner”), denying her applications
for disability insurance benefits and Supplemental Security
Income benefits under Titles II and XVI of the Social
Security Act. The parties have filed cross motions for
summary judgment pursuant to Civil Local Rule 16-5. For the
reasons stated below, the Court GRANTS Parker’s Motion
for Summary Judgment, DENIES the Commissioner’s Motion
for Summary Judgment, REVERSES the decision of the
Commissioner and REMANDS the case to the Social Security
Administration for award of benefits.
and Employment Background
was born on April 23, 1964. Administrative Record
(“AR”) at 1172. She graduated from high school in
1982 and then joined the Army, where she worked as a
secretary for two years. Id. at 1175. After she left
the Army, she worked in customer service. Id. Parker
completed cosmetology school in 1990. Id. at 380.
Parker received her cosmetology license in 2001 and held
various cosmetology jobs in New York. Id. at 1175.
In 2008, she worked twenty hours a week as a spa attendant
for six months. Id. at 381. In 2015, Parker worked
10 hours a week as a house monitor at Casa de Maria for a
month. See Id . at 73-74. Parker stopped working in
this position because she “was always tired” and
“did not have the energy” to do the work.
Id. at 74.
alleges that she is unable to work because of both physical
and mental impairments as well as side effects from
medication. See Id . at 77. She was diagnosed with
polycystic liver and kidney disease in 1998. Id. at
1404. In addition, she fell down a flight of stairs in 2008,
sustaining spinal injuries and fracturing her clavicle and
her “T5 and T6 spinous processes.” Id.
She began having “nerve blocks” every three
months after this accident. Id.
also has a history of physical and sexual abuse. Id.
at 945. When she was a child, her grandparents stripped her
naked and whipped her. Id. She was also raped in
2011, which she reported to the police. Id. Parker
is also a victim of domestic violence and suffered both
physical and emotional abuse when she lived with her
ex-husband. Id. As a result of her history of
trauma, Parker suffers from panic attacks and nightmares.
Id. at 1317. She also suffers from major depression
and anxiety disorder and experiences confusion and other side
effects of her medications. Id. at 77, 1089.
takes Morphine three times a day to manage her pain, which
she says makes her drowsy. Id. at 79, 1174. She also
takes Xanax for anxiety, Cymbalta for depression and to give
her energy, Seroquel “for [her] mood and sleeping,
” and Prozac for her mood as well. Id. at
1173-74. Parker sees multiple doctors for treatment of her
impairments. See Id . The Court summarizes
Parker’s relevant medical treatment below.
Parker’s Polycystic Kidney Disease
was diagnosed with polycystic kidney disease in 1998 after
feeling “excruciating pain” in her back and
stomach. Id. at 1404. Between 1998 and 2000, she had
four surgeries to drain cysts on her liver and kidneys.
2000 and 2009, Parker was treated for abdominal pain from her
kidney cysts at Alta Bates Summit Medical, in Oakland,
California. Id. at 1278-1308. Philip Rich, M.D.,
conducted a transabdominal ultrasound on August 14, 2000 and
found “[p]olycystic disease of the kidneys and
liver.” Id. at 1308. Parker went to the
Emergency Department at Alta Bates Summit on December 15,
2008 complaining of constant abdominal pain she had been
experiencing for approximately two weeks. Id. at
1286. She was treated by Ben Bonnes, M.D., who attributed
Parker’s pain to “ovarian cyst” and
“bacterial vaginitis.” Id. at 1290. On
January 22, 2009, Patrick Perkins, M.D., took a CT of
Parker’s abdomen and found that:
The liver exhibits multiple hypodensities which are all well
defined and of various size from moderate to tiny. These are
seen throughout the liver. The kidneys are enlarged by
multiple cysts of varying size with a degree of parenchymal
replacement less than usually seen with classic polycystic
Id. at 1278.
March 27, 2013, Clifford Wong, M.D., evaluated Parker for
renal insufficiency at St. Rose Hospital. Id. at
944. Dr. Wong diagnosed her with renal insufficiency with
reported polycystic kidney disease, given a “very
strong family history” and “suspect[ed] autosomal
dominant polycystic kidney disease.” Id. at
was also referred by her primary care physician to Varun
Chawla, M.D., a nephrologist at Chabot Nephrology Medical
Group. Id. at 741. Her first appointment with Dr.
Chawla was on October 24, 2013. Id. Parker continued
to see him through September 2015. Id. at
1194–1240. Parker reported to Dr. Chawla that she had
flank pain, “mostly right side, severe.”
Id. at 741. Dr. Chawla confirmed Parker’s
diagnosis of polycystic kidney disease when he examined her
on October 24, 2013. Id. at 745. He further added
that she suffers from “excruciating flank pain, ”
the cause of which he suspected was a “cyst bleed
causing acute pain.” Id. at 746. Dr. Chawla
also diagnosed Parker with chronic atrial fibrillation,
anxiety and hypertension. Id. He recommended Vicodin
for severe pain and Tylenol for mild to moderate pain.
Id. However, he also noted that “no specific
treatment has been proven to prevent or delay progression of
autosomal dominant polycystic kidney disease.”
Id. Parker saw Dr. Chawla for a follow-up on
November 14, 2013. Id. at 738. Dr. Chawla confirmed
the same diagnoses, adding anemia and hypertension, and asked
Parker to follow up in three to four months. Id. at
739. Parker saw Dr. Chawla again on March 28, 2014 for flank
pain. Id. at 1205–07. He prescribed Percocet
for severe pain. Id. at 1207. Dr. Chawla saw Parker
again on July 1, 2014 and noted the same diagnoses.
Id. at 1210. However, when he treated her on
February 18, 2015, Dr. Chawla also diagnosed Parker with
“[a]cute renal failure syndrome, ” based on lab
results showing that her creatinine had “jumped from
baseline 1.0-1.2 to 1.6” and noted that “this
could be [acute kidney injury] versus progression of
[polycystic kidney disease].” Id. at 1212. He
ordered a re-check in one to two weeks. Id. At a
follow-up appointment on March 18, 2015, Dr. Chawla again
diagnosed Parker with acute renal failure syndrome noting
that on recheck her creatinine remained high at 1.5.
Id. at 1228. He also diagnosed Parker with
polycystic kidney disease and “chronic kidney disease,
stage three.” Id. At Parker’s follow-up
appointment on June 12, 2015, Dr. Chawla listed
Parker’s diagnoses as “[p]olycystic kidney
disease, adult type, ” “[c]hronic kidney disease,
stage 3, ” “[e]ssential hypertension, ”
“[a]nxiety, ” “[a]nemia, ” and
“[a]cute renal failure syndrome.” Id. at
1230. He prescribed Venofer by IV weekly for three weeks in
his care plan to address Parker’s anemia. Id.
Parker returned on July 17, 2015 and Dr. Chawla listed the
same diagnoses as the previous visit. Id. at 1234.
He referred Parker to a pain management specialist. He also
prescribed Percocet for “severe pain.”
Id. Dr. Chawla saw Parker again on September 1,
2015, and confirmed all previous diagnoses except for acute
renal failure syndrome, which was no longer listed.
Id. at 1239.
Parker’s Chronic Back Pain
went to Alta Bates Summit Medical Center emergency department
on July 1, 2009 after she was hit by a car. Id. at
555. Stephan D. Chin, M.D., treated Parker and took x-rays of
her spine. Id. at 556–558. Dr. Chin concluded
that Parker fractured her “distal right clavicle”
but did not fracture her spine. Id. at 558. He
instructed her to ice her clavicle and wear a sling until
better. Id. at 559. Dr. Chin prescribed Ibuprofen,
Vicodin, and Flexeril. Id. Parker went back to the
emergency room on July 11, 2009, complaining of persistent
back pain, and the attending doctor, Dr. Klemenson-Chau,
ordered a CT of Parker’s spine. Id. at 546.
Based on the CT and a reevaluation of Parker’s back
x-ray, Dr. Klemenson-Chau concluded that Parker did have a
fracture of “T5 involving the spinous process, ”
and “[f]racture of T6 involving the spinous
process.” Id. at 546. Dr. Klemenson-Chau
instructed Parker to wear a fiberglass splint. Id.
at 547. Khalil Zahra, M.D., also consulted and confirmed
“[a]cute fracture of the spinous process of T5, T6, and
possibly T7.” Id. at 543.
Washington Hospital and Dr. Banh
sought treatment for chronic back pain exacerbated by a fall
on July 16, 2009 at the Washington Hospital emergency room.
Id. at 670. Mohamed Nazari, M.D., her attending
physician, diagnosed Parker with a back sprain but also noted
“pain syndrome: chronic” and prescribed Vicodin.
Id. at 674. On August 19, 2009, Parker returned to
the Alta Bates emergency department and was evaluated by Ronn
Berrol, M.D., who noted, “[r]eview of old records show
a CT that did indeed show a spinus [sic] process [fracture]
last month, [i]t appears well healed.” Id. at
540. Parker went back to the Washington Hospital emergency
department on August 29, 2009, seeking treatment for thoracic
back pain, reporting that the symptoms began two months
earlier. Id. at 658. David Orenburg, M.D., the
attending physician, prescribed Norco for “acute back
pain.” Id. On September 22, 2009, Dr. Banh at
Mission Peaks Orthopedics to whom Parker was referred by her
primary care physician, evaluated Parker’s back pain.
Id. at 565. Parker reported that the pain in her
back increased to nine out of ten. Id. Dr. Banh
noted under assessments, “thoracic spine fracture,
” “right distal clavicle fracture, ”
“right radial head fracture” and “right
thoracic strain.” Id. at 566. Dr. Banh
recommended “conservative” treatment of the
thoracic fracture and referred Parker to a surgeon to
consider surgery regarding her elbow fracture. Id.
January 9, 2011, Parker returned to Washington Hospital
emergency department seeking treatment for back pain,
“right flank” and vomiting. Id. at 627.
Leonard Popky, M.D., the attending physician, prescribed
Vicodin and gave Parker “a lot of Zofran by IV.”
Id. Parker returned to Washington Hospital emergency
department two weeks later on January 22, 2011, again seeking
treatment for chronic back pain and vomiting. Id.
Dr. Nazari, the attending physician, prescribed Vicodin and
set up a Zofran IV again. Id. at 615. Parker went to
the Washington Hospital emergency department on February 22,
2011 after suffering an assault which exacerbated her back
pain. Id. at 579. However, Dr. Halimi, the attending
physician, found no “evidence of spine trauma.”
Id. at 580. He prescribed Flexitril. Id. at
July and November 2013, Parker went to St. Rose emergency
department multiple times for treatment of her chronic back
pain. Id. at 791–932. On August 17, 2013,
Parker went to the St. Rose emergency department after
falling down a flight of concrete stairs. Id. at
931. Tan Nguyen, M.D., noted her back pain but found no
fracture of Parker’s thoracic spine. Id. at
932. Dr. Nguyen administered Morphine and Zofran
intravenously and gave Parker Vicodin and Clonidine.
Id. at 933. Parker returned a week later, with
continuing back pain. Id. at 911. Attending
physician, Dimpi Kalira, M.D., noted no fracture of the
thoracic spine, but ordered Morphine and Zofran and
prescribed Norco for treatment of severe pain. Id.
at 920. On November 4, 2013, Parker went back to St. Rose
emergency department, complaining of constant right flank
pain that had lasted more than four months and had worsened
in the last few days, reaching a level of eight out of ten.
Id. at 836. Dr. Nguyen administered Morphine and
Zofran and prescribed Norco. Id. at 838, 843.
Further, she notes “you have back pain, which is likely
related to your polycystic kidney disease.” Parker
returned to the St. Rose emergency department two weeks
later, on November 18, 2013, complaining of continued
abdominal and back pain, and attending physician, Alia Kim,
M.D., gave her Morphine again. Id. at 817, 821.
went to the St. Rose emergency department on December 2, 2013
for lightheadedness “[a]ssociated with chest pain,
[a]ssociated with tremors, dizziness.” Id. at
806. Parker’s triage notes indicate “patient here
for chest pain and severe headache . . . was doing errands
when chest pain happened with diaphoresis.”
Id. at 810. Parker was inpatient from December 2,
2013 to December 6, 2013 and her attending physician is
listed as Prasad Ghimire, M.D. Id. at 747. When
Parker was first admitted on December 2, 2013, Zarah Napuli,
RN, noted that Parker’s speech was slurred, and she was
“complaining of severe headache.” Id. at
811. David Wei, M.D., ordered a CT scan “[without]
[c]ontrast” and Michael Faer, M.D., a radiation
oncologist, read the results, noting “[n]o acute
findings” and “[n]o signs of intracranial
hemorrhage, hematoma, hydrocephalus, acute infarct, large
mass, mass effect, or fracture.” Id. at 784,
808–809. Dr. Wei also ordered a chest x-ray using a
portable x-ray machine to determine the cause of
Parker’s chest pain. Id. at 808. Dr. Faer
conducted the exam and found “[r]educed lung volumes
with elevation of the hemidiaphragms compressing the lung
bases, accentuating the cardiovascular mediastinal size and
producing bibasilar decreased acration.” Id.
at 780. Dr. Faer also found “vascular crowing and
compressional atelectasis.” Id. Dr. Faer
recommended “repeat[ing] evaluation in full inspiration
for clarification” as to what was causing the basilar
areas of decreased aeration. Id. Dr. Wei performed
an EKG and found “[heart rate] 52, ” “sinus
[bradycardic].” Id. at 808. Dr. Wei ordered a
CT of Parker’s chest, abdomen and pelvis as well.
Id. at 782. Dr. Faer read the results and found
“[n]o evidence for aortic aneurysm nor
dissection” and “[n]o signs of central pulmonary
embolism.” Id. at 783. Dr. Faer also noted
“[b]ilateral layering pleural effusions/compressional
atelectasis, small.” Id. At the end of the
day, Dr. Ghimire, Parker’s attending physician,
summarized the results from her tests. Id. at 750.
In addition to the above findings, Dr. Ghimire included
“[h]ypertension, ” “[a]nemia, ”
“[h]ypokalemia, ” and “[g]astrointestinal
bleeding by history.” Id. He made a further
note to “[c]heck occult blood and GI workup.”
Id. Dr. Ghimire noted “[r]ecent CT is negative
for any bleeding and headache improved at the moment.”
December 3, 2013, Dr. Ghimire requested a consultation by
Bhupinder Bhandari, M.D., for Parker’s [a]nemia,
anterior abdominal discomfort, nausea and vomiting.”
Id. at 751. Based on his evaluation of Parker, Dr.
Bhandari recommended “[u]pper GI endoscopy” and
“colonoscopy” if endoscopy is
“nonrevealing.” Id. at 752.
December 4, 2013, Dr. Bhandari performed the upper GI
endoscopy “with biopsy.” Id. at 761. The
test revealed “mild gastritis, ” but otherwise
findings were normal. Id. On the same day, Dr. Kumar
assessed Parker for chest pain at the request of Dr. Ghimire.
Id. at 759. He noted that “[c]hest pain
appears atypical” and planned to “check an
echocardiogram” and “check stress thallium test
for coronary ischemia.” Id. at 760. On the
same day, December 4, 2013, Qi Che, M.D., ordered an MR
Angiogram of Parker’s head “without
contrast.” Id. at 790. Dr. Faer read the test
and noted “[n]o acutely significant MRA abnormality
detected. Specifically, no signs of intracranial aneurysm or
stenosis seen.” Id. Later that night, Vasiliki
Economou, M.D., performed an EEG and found “[n]ormal
electroencephalogram without evidence of any epileptiform
abnormalities.” Id. at 805. Dr. Ghimire
addressed the negative findings in his discharge notes,
commenting that Parker’s severe headache was likely a
“tension headache or possible migraine.”
Id. at 748. On December 5, 2013, Dr. Khetrapal
ordered an MRI of Parker’s brain and brain stem, which
Dr. Faer read, finding “[n]o signs of intracranial
hemorrhage, hematoma, hydrocephalus, acute infarct, large
mass, mass effect, or fracture.” Id. at 793.
On the same day, Shankar Prasad Ghimire, M.D., also ordered
an MRI of Parker’s lumbar spine. Id. at 791.
Dr. Faer performed the MRI and noted “[n]o acutely
significant MRI abnormality detected.” Id. at
December 6, 2013, Dr. Bhandari performed a colonoscopy on
Parker. Id. at 763. He diagnosed her with
“[c]olonic diverticulosis” and “internal
hemorrhoids.” Id. Dr. Bhandari recommended
“consideration for small bowel capsule endoscopy as an
was discharged on December 6, 2013. In his discharge notes,
Dr. Ghimire described the tests that had been performed while
Parker was inpatient, and their results, and stated that
Parker’s “[m]edication has been adjusted and
[she] needs to follow up closely with [her] primary care
doctor.” AR at 748. He further stated:
[P]atient discharged home with following medications;
clonidine 0.3mg one table p.o. three times a day, hydralazine
25 mg p.o three times a day, Protonix 40mg twice a day,
sucralfate 1 gram twice a day, Colace 250 mg once a day,
aspirin 162 mg once a day, Zocor 20mg once a day, and
continue Seroquel, Prozac as before and Xanax 1mg three times
a day as needed, Percocet 5/325 mg one tablet every four
hours as needed for moderate-to-severe pain and Dilaudid 2 mg
p.o. every six hours as needed for severe pain and advised to
follow up with primary care doctor and will be referred to
pain specialist for further management of chronic pain
including headache and all these plan[s] explained to the
Id. at 748.
Rabin Khetrapal, of Fremont Primary Care, treated Parker from
November 27, 2013 to May 7, 2014. Id. at 1107, 1110.
Progress notes have been provided for examinations on
November 27, 2013, December 11, 2013, February 7, 2014, April
23, 2014 and May 7, 2014. Id. at 1101-1106. In
addition, Dr. Khetrapal completed a Medical Opinion re:
Ability to do Work- Related Activities (Physical) form on May
7, 2014. Id. at 1107-1110. In that form, he states
that Parker can lift or carry no more than 10 pounds
occasionally and can stand and walk less than two hours in an
eight-hour day due to pain. Id. at 1108. He opines
that Parker must alternate between, sitting, standing and
walking frequently to alleviate her discomfort, stating that
she can sit no more than 10 minutes without changing
position, stand no more than 5 minutes without changing
position, and must walk around every ten minutes for at least
5 minutes. Id. He states that Parker must be able to
shift at will and needs to lie down at unpredictable
intervals. Id. He states that she can never stoop,
kneel or climb stairs or ladders and can rarely crouch or
crawl. Id. at 1109. He states that Parker’s
pain and other symptoms interferes with her attention and
concentration constantly and that she would need to be absent
more than three times a month due to her symptoms.
Id. at 1109-1110.
was referred for pain treatment to Kishore Narra, M.D., a
physiatrist, by her primary care physician, Dr. Khetrapal.
Id. at 1143. Dr. Narra treated Parker between
December 2013 and June 2014. Id. at 1143–71.
Parker first saw Dr. Narra on December 10, 2013 for a pain
evaluation. Id. at 1166. Dr. Narra diagnosed Parker
with “chronic pain syndrome, lumbago, and polycystic
kidney disease.” Id. at 1168. Dr. Narra
recommended obtaining an x-ray of Parker’s spine.
Id. On December 31, 2013, Robert Huberman, M.D.,
took x-rays of Parker’s thoracolumbar spine, finding
“[s]pine alignment is unremarkable” and
“minimal scoliosis.” Id. at 1170. Parker
saw Dr. Narra on the same day because she felt increased pain
in her feet and hips. Id. at 1164. She reported that
the Norco was not helping and that she could not walk because
of the pain. Id. Dr. Narra diagnosed Parker with
lumbago, chronic pain syndrome, and lesion of ulnar nerve,
for which he prescribed methadone. Id. at 1165. On
January 9, 2014, Parker saw Dr. Narra again because the night
before she had “swelling in [her] whole body” and
difficulty walking. Id. at 1161–63. Dr. Narra
added diagnoses of “hypertension” and
“hyperlipidemia” but kept the treatment the same.
Id. When Parker saw Dr. Narra for a follow-up on
February 28th, 2014, she said it “feels like someone is
stabbing [me] in the legs.” Id. at 1158. Dr.
Narra continued treatment with methadone. Id. at
1159. At an appointment on March 27, 2014, Dr. Narra
diagnosed chronic pain syndrome and paresthesia of the feet.
Id. at 1156. He discontinued the methadone because
Parker told him it was “making her sleepy all the
time” and instead prescribed Percocet. Id. at
1155–57. On April 23, 2014, Dr. Narra conducted a nerve
conduction study and EMG, which showed “prolonged
distal onset latency” of the left tibial motor nerve,
but “all remaining nerves within normal limits.”
Id. at 1149–54. On May 23, 2014, when Parker
saw Dr. Narra for a one month follow-up, he prescribed 30 mg.
MS Contin once daily for her chronic pain. Id. at
1147. At an appointment on July 18, 2014, Dr. Narra adjusted
Parker’s MS Contin prescription to 15 mg. twice a day.
Id. at 1143, 1145.
saw Sabiha Rasheed, M.D., at Tricity Rheumatology between
March 11, 2014 and November 5, 2015. Id. at
1259–65. Parker first sought treatment from Dr. Rasheed
for low back, hip, knee and foot pain on March 11, 2014.
Id. at 1265. Dr. Rasheed noted that Parker had a
history of back pain due to osteoarthritis. Id. Dr.
Rasheed also diagnosed Parker with trochantric bursitis and
recommended application of ice and Tylenol for pain.
Id. In addition, treatment records from Dr. Rasheed
reflect diagnoses of lumbosacral spondylosis and thoracic
spondylosis without myelopathy. Id. at 1261,
notes from March 11, 2014 reflect that Dr. Rasheed ordered
x-rays to evaluate Parker for osteoarthritis. Id. at
12654. On April 2, 2014, Dr. Robert Huberman at NorCal
Imaging took x-rays of Parker’s hips, thoracic spine,
knees, hands, wrists, and feet. Id. at 1267-72. Dr.
Huberman reported “mild midthoracic disc changes,
” “mild scoliosis, ” but “no other
findings evident.” Id. at 1268. Each of the
other x-rays showed “[n]o significant joint related
abnormality” and normal “bone architecture
findings.” Id. at 1267, 1269–72. Parker
saw Dr. Rasheed again on April 2, 2014 for a follow-up.
Id. at 1264. Dr. Rasheed diagnosed Parker with
osteoarthritis of the thoracic and lumbar spine but noted
“x-rays of the hands, knees, feet and hips:
normal.” Id. She changed nothing in her
treatment plan. Id. Dr. Rasheed saw Parker again on
May 8, 2014, September 9, 2014, September 28, 2015, November
5, 2015, July 26, 2016 and October 25, 2016. Id. at
notes from July 26, 2016 reflect that Dr. Rasheed ordered an
MRI of Parker’s lumbar spine because Parker was
experiencing “radicular pain in the lower
extremities.” Id. at 1415. She also ordered
x-rays of Parker’s bilateral hips and noted,
“consider steroid injection if [hip] pain
persists.” Id. On October 25, 2016, an MRI of
Parker’s lumber spine was performed. Id. at
1416. According to the report, the alignment of the lumbar
spine was normal and there was no abnormal bone marrow edema,
though the MRI showed polycystic kidney disease. Id.
The report also revealed a “[s]mall posterior disc
protrusion at ¶ 5-S1 with no significant neural
impingement.” Id. In treatment notes from
Parker’s October 25, 2016 visit to Dr. Rasheed, Dr.
Rasheed observed that Parker was experiencing hip pain and
lower back pain. Id. at 1417. She wrote that Parker
had tenderness at the “trochanter of the right hip,
” that her thoracic spine was “tender with
paraspinal muscle spasm” and that the lumber spine was
“tender at ¶ 5S1, SLRT at 60 degrees, no
sensory/motor deficit.” Id.
October 25, 2016, Dr. Rasheed completed a Residual Functional
Capacity Questionnaire (“RFC Questionnaire”) and
on October 26, 2016 she completed a form entitled Medical
Opinion re: Ability to do Work-Related Activities (Physical)
(“Medical Opinion form”). AR 40-46. In the RFC
Questionnaire, Dr. Rasheed lists the following diagnoses: 1)
“osteoarthritis of lumbar and thoracic spine”; 2)
“Myalgia – lower back sciatica”; and 3)
“Hip bursitis.” AR 40. She found that Parker had
the following physical limitations: lifting and carrying less
than 10 pounds; standing less than 2 hours in an 8 hour
workday; walking less than 2 hours in an 8 hour workday;
sitting less than 2 hours in an 8 hour workday; limited
ability to push or pull as to both upper and lower
extremities; and no climbing, balancing, stooping, kneeling,
crouching or crawling. AR 40-41. In the Medical Opinion form,
Dr. Rasheed wrote that Parker was “unable to walk at
this time due to pain in midback, low back and hips.”
Id. at 45.
February of 2014, Parker was referred to Prabhjot Khalsa,
M.D., at Fremont Neurology Medical Associates, by her primary
care physician, Dr. Khetrapal. Id. at 999. Dr.
Khalsa examined Parker on February 11, 2014 for “lower
extremity pain and weakness.” Id. In his
assessment, he listed “[p]ain in limb, ”
“[g]ait impairment “[paresthesias and numbness,
” “[w]eakness of muscles, ” and
“[f]amily history of cerebral aneurysm.”
Id. at 1000. Dr. Khalsa ordered an MRI of
Parker’s lumbosacral and cervical spine. Id.
At a subsequent appointment on February 20, 2014, Dr. Khalsa
summarized the results of the MRI as follows:
MRI of the cervical spine revealed C3-4, C4-5, C5-6, and C6-7
disc desiccation with mild canal stenosis and some
right-sided neural foraminal stenosis at C5-6. MRI scan of
the thoracic spine has revealed mild wedging along the
superior end plate of T5, along with T6-7 left posterior
lateral disc protrusion. Additionally, there was evidence of
bilateral pleural effusions and extensive lesions identified
within the right lung and/or within the hepatic parenchyma.
MRI scan of the lumbar spine reveals L1-2 and L3-4, L5-S1
disc desiccation, L4-5 disc bulge, with moderate foraminal
narrowing. Extensive bilateral renal cysts were demonstrated.
Id. at 1004. Dr. Khalsa recommended that Parker
follow up with her primary care physician for “further
evaluation and management of pleural effusions, lung/hepatic
lesions, and bilateral renal cysts.” Id. At
the February 20, 2014 appointment Dr. Khalsa also conducted
electrodiagnostic studies to attempt to determine the
“underlying neuropathology” of her “ongoing
pain syndrome.” Id. at 1002-1003. He was
unable to find “evidence of radiculopathy, plexopathy,
or other peripheral neuropathic process” and
recommended that Parker obtain a rheumatology evaluation.
Id. at 1004.
Mental Health Treatment
Kumar, M.D., a psychiatrist at Pathways to Wellness, treated
Parker from November 2013 to April 2014. Id. at
1078-93. In his initial evaluation on November 20, 2013, he
described Parker’s history as follows:
This 49-year-old Afro-American female who is treated for
depression and anxiety while at primary care for years. She
was on Prozac 40 mg a day for four years, Wellbutrin 150 mg
for four years and Xanax 0.25 mg three times a day. The
patient felt current medication is not working because she
has no motivation in her life. Her symptoms include chronic
fatigue, depression, anhedonia, paranoid thought. People are
watching her or they are doing something wrong and messing
her life. She is also complaining about confusion, irritable
mood, poor sleep, fatigue for few years. The patient denies
auditory or visual hallucinations. Denies obsessive thoughts.
Id. at 1089. In the comments from Dr. Kumar’s
mental status examination for the same visit, on November 20,
2013, Dr. Kumar writes that Parker was “very well
dressed, ” “cooperative, ” that her speech
was “normal rate and rhythm, ” that she had
“good eye contact” and no suicidal ideation,
movement disorder or hallucination” and that her mood
was “irritable and depressed, ” her affect was
“restrictive” and that she has “delusions,
” namely, that she is “very paranoid about the
people around her.” Id. at 1091. He rated
Parker’s functional limitations as follows: mild
restrictions of activities of daily living; moderate
difficulties in maintaining social functioning/relationships;
moderate difficulties in maintaining concentration,
persistence of place; and moderate “episodes of
decomposition and increased symptoms, each of extended
duration.” Id. at 1092. In his supporting
comments he wrote, “patient has significant irritable
mood. She is fatigue[d] most of the time, unable to
concentrate, unable to finish her job.” Id. He
diagnosed Parker with Major Depressive Disorder, severe, and
Generalized Anxiety Disorder. Id. Dr. Kumar
increased Parker’s Prozac dose to 60 mg. a day,
discontinued her Wellbutrin prescription, prescribed 100mg.
of Seroquel at night, and increased her Xanax prescription
from .25mg. three times a day to .50 mg. three times a day.
Id. at 1092.
Parker returned for a follow-up on December 18, 2013, Dr.
Kumar noted “[t]he patient states she is doing very
well on current medications, ” and that Parker
“is sleeping well after many, many months.”
Id. at 1086. The following month, on January 22,
2014, however, Parker still felt depressed and anxious, and
reported that she was having difficulty concentrating.
Id. at 1084–85. Dr. Kumar did not change
Parker’s prescriptions of Xanax, Prozac, and Seroquel
at this appointment. Id. At Parker’s next
visit, on February 19, 2014, Parker complained of “more
anxiety. . . depression” and “poor
concentration.” Id. at 1002. Dr. Kumar doubled
her Seroquel dose “to decrease her depression and
anxiety” but did not change her Xanax and Prozac
prescriptions. Id. at 1082. Parker returned for a
follow-up visit on March 19, 2014, complaining that she was
having significant concentration and focus problems.
Id. at 1080. Dr. Kumar added “possible
ADHD” to her diagnoses and prescribed Strattera.
Id. at 1081. On April 21, 2014, Parker told Dr.
Kumar that her concentration had improved but that she was
“still feeling depressed.” Id. at 1072.
He noted that Parker had “significant anhedonia,
” had “no motivation, ” and was
“feeling fatigue[d].” Id. at 1078.
Harris, M.D., another psychiatrist at Pathways to Wellness,
treated Parker in 2015. Id. at 1245–57. Dr.
Harris evaluated Parker on July 21, 2015 and diagnosed her
with Bipolar Affective Disorder and General Anxiety Disorder.
Id. at 1249. Dr. Harris noted that Parker was
“trying to go back to school.” Id. at
1249. On August 13, 2015, Dr. Harris saw Parker again and
confirmed the same diagnoses. Id. at 1247. Parker
told Dr. Harris, “I’m not doing good
today.” Id. Dr. Harris prescribed Abilify,
Cymbalta, Hydroxyzine, Alprazolam and Venlafaxine.
Id. at 1244. On September 15, 2015, ...