FINDINGS AND RECOMMENDATION

JOLIE A. RUSSO, Magistrate Judge.

Christopher S. Wesman ("plaintiff") seeks judicial review of the final decision of the Commissioner of the Social Security Administration ("Commissioner") denying Supplemental Security Income ("SSI") and disability insurance benefits ("DIB") under Titles II and XVI of the Social Security Act ("the Act"). For the reasons set forth below, the decision of the Commissioner should be REVERSED and REMANDED for an immediate payment of benefits.

BACKGROUND

Plaintiff was born in Coos Bay, Oregon, in May 1988. Tr. 324.1 He applied for SSI and DIB in July 2012, alleging disability with an amended onset date of October 1, 2011. Tr. 15, 43, 75, 90. Plaintiff has a Bachelor of Arts degree in English literature and film and no past relevant work as defined by the regulations, although he did work briefly as a barista and part-time as a custodian. Tr. 49-50, 58, 87, 106. At the time of his hearing, he was living with his grandparents. Tr. 41.

Plaintiff alleged disability based upon: fibromyalgia, depression/anxiety, recurrent syncope, asthma, irritable bowel syndrome ("IBS"), and chronic insomnia. Tr. 76, 91. His application was denied initially and upon reconsideration. Tr. 75-108. On September 22, 2014, an Administrative Law Judge ("ALJ") held a hearing, and on November 13, 2014, issued a decision finding plaintiff not disabled. Tr. 15-30; 35-72. On April 22, 2016, the Appeals Council denied review, making the ALJ's decision the final decision of the Commissioner. Tr. 1-6. This appeal followed.

THE ALJ'S FINDINGS

The ALJ performed the five step sequential analysis, for determining whether a person is disabled. Bowen v. Yuckert, 482 U.S. 137, 140 (1987); 20 C.F.R. §§ 404.1520, 416.920. At step one, the ALJ found plaintiff had not engaged in substantial gainful activity since his amended alleged onset date. Tr. 17. At step two, the ALJ determined the following impairments were medically determinable and severe: "fibromyalgia, asthma, anxiety/post-traumatic stress disorder ("PTSD"), and depression." Tr. 18. At step three, the ALJ determined plaintiff's impairments, neither individually nor in combination, met or equaled the requirements of a listed impairment. Tr. 19.

Because he did not establish presumptive disability at step three, the ALJ continued to evaluate how plaintiff's impairments affected his ability to work. The ALJ resolved plaintiff had the residual functional capacity ("RFC") to perform light work with the following limitations:

Tr. 20.

At step four, the ALJ determined plaintiff had no past relevant work as defined by the regulations. Tr. 28. At step five, the ALJ found, based on the RFC and the vocational expert ("VE") testimony, a significant number of jobs existed in the national and local economy such that plaintiff could sustain employment despite his impairments. Tr. 28-29. Specifically, the ALJ found plaintiff could perform the jobs of library helper, clerical checker, and address clerk. Tr. 29.

STANDARD OF REVIEW

A district court must affirm the Commissioner's decision if the decision is based on proper legal standards and the legal findings are supported by substantial evidence in the record. 42 U.S.C. § 405(g); Batson v. Comm'r, 359 F.3d 1190, 1193 (9th Cir. 2004). Substantial evidence "means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1971) (internal citation omitted). In reviewing the Commissioner's alleged errors, a court must weigh "both the evidence that supports and detracts from the [Commissioner's] conclusion." Martinez v. Heckler, 807 F.2d 771, 772 (9th Cir. 1986). Variable interpretations of the evidence are insignificant if the Commissioner's interpretation is rational. Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir. 2005).

When the evidence before the ALJ is subject to more than one rational interpretation, a court must defer to the ALJ's conclusion. Batson, 359 F.3d at 1198 (internal citation omitted). The reviewing court, however, cannot affirm the Commissioner's decision on grounds the agency did not invoke in making its decision. Stout v. Comm'r, 454 F.3d 1050, 1054 (9th Cir. 2006). Finally, the court may not reverse an ALJ's decision on account of an error that is harmless. Id. at 1055-56. "[T]he burden of showing that an error is harmful normally falls upon the party attacking the agency's determination." Shinseki v. Sanders, 556 U.S. 396, 409 (2009).

DISCUSSION

Plaintiff argues the ALJ erred by: (1) erroneously discounting his subjective symptom testimony; (2) failing to give adequate weight to the opinions of his treating physicians; and (3) failing to meet the Commissioner's burden at step five of the sequential evaluation.

I. Subjective Symptom Testimony

Plaintiff assigns error to the ALJ's evaluation of his subjective symptom testimony. Pl.'s Br. at 12-14. When a claimant has medically documented impairments that could reasonably be expected to produce some degree of the symptoms complained of, and the record contains no affirmative evidence of malingering, "the ALJ can reject the claimant's testimony about the severity of . . . symptoms only by offering specific, clear and convincing reasons for doing so." Smolen v. Chater, 80 F.3d 1273, 1281 (9th Cir. 1996) (internal citation omitted). A general assertion the claimant is not credible is insufficient; the ALJ must "state which . . . testimony is not credible and what evidence suggests the complaints are not credible."2 Dodrill v. Shalala, 12 F.3d 915, 918 (9th Cir. 1993). The reasons proffered must be "sufficiently specific to permit the reviewing court to conclude that the ALJ did not arbitrarily discredit the claimant'stestimony." Orteza v. Shalala, 50 F.3d 748, 750 (9th Cir. 1995) (internal citation omitted). If the ALJ's finding regarding the claimant's subjective symptom testimony is "supported by substantial evidence in the record, [the court] may not engage in second-guessing." Thomas v. Barnhart, 278 F.3d 947, 959 (9th Cir. 2002) (internal citation omitted).

At the hearing, plaintiff testified his fibromyalgia was centered in his "lower back and it spreads from there when it is active." Tr. 58-59. He testified on "bad days," which he rated as seven or above on the pain scale, "even just breathing will hurt." Tr. 59. He testified his "bad days far outnumber" his good days. Tr. 59. Finally, he testified on his "worst days" he would "end up lying in bed unable to even pay attention to the people around [him]," and he could not "carry on a conversation when the pain is going on at its worst." Id.

The Commissioner responds that plaintiff "simply disagrees with the ALJ's rational assessment of" his subjective symptom testimony. Def.'s Br. at 5. According to the Commissioner, the ALJ provided three permissible rationales which undermined plaintiff's subjective complaints: (A) work activities; (B) activities of daily living; and (C) the objective medical evidence. The Court addresses each in turn.

A. Work Activities

The Commissioner argues plaintiff's ability to work part-time undermined his subjective symptom testimony relating to his fibromyalgia. Def.'s Br. at 6-7. Indeed, the regulations contemplate that "work done during any period in which [a claimant alleges disability may demonstrate the ability] to work at the substantial gainful activity level." 20 C.F.R. §§ 404.1571, 416.971. The Commissioner also cites Bray v. Comm'r of Soc. Sec. Admin., 554 F.3d 1219, 1228 (9th Cir. 2009), for the proposition that part-time work can undermine subjective complaints.

Bray, however, is distinguishable from this case. In reversing and remanding the ALJ's decision on an unrelated error, Bray upheld the ALJ's credibility determination based on "four . . . independent bases for discounting" the claimant's testimony, one being the claimant's prior work history. Bray, 554 F.3d at 27. That work history included part-time work as a "caregiver" for an ill friend, as well as "seeking out other employment" after the caregiver work concluded. Id. at 1221-27. Here, by contrast, the work activities relied on by the Commissioner are distinguishable in two important ways. First, unlike the claimant in Bray, after plaintiff was fired he did not seek other work. Compare Bray, 554 F.3d at 1227 (claimant "sought out other employment" after her part-time work concluded) with Tr. 48 (ALJ asking plaintiff if he had "looked for any other jobs" since being fired from his part-time work and plaintiff answering he had not).

Second, unlike the claimant in Bray, plaintiff struggled with and was ultimately unable to maintain his part-time employment. See Tr. 45 ("Originally, it was a five-day a week job . . . And I was able to do it in five days . . . Then as the [] fibromyalgia progressed, it became a six-day [a week] job, then a seven day [a week job] and then eventually I told them I could not do the entirety anymore, and I asked them to cut the job in half for me, which they agreed to."); Tr. 45-46 (explaining that plaintiff necessitated working additional days because "it was taking longer" to complete the same amount of work); Tr. 48 (explaining that plaintiff was "let go" when his work reached an unsatisfactory level).3 In Bray, there was no indication the claimant struggled with or was terminated from her "recent[] work[] as a personal caregiver[.]" Bray, 554 F.3d at 1227. In other words, Bray is inapposite because there the claimant was successful in her recent part-time work; and that fact coupled with seeking out other employment after that work concluded provided a permissible rationale to discount her testimony. Here, by contrast, plaintiff was unable to maintain part-time work; nor did plaintiff seek out other work after his employer fired him. Bray, therefore, does not control here.

The Commissioner's citation to Greger v. Barnhart, 464 F.3d 968, 972 (9th Cir. 2006), is similarly unpersuasive. There, the ALJ properly rejected the claimant's subjective symptom testimony because the claimant failed to report his alleged symptoms to his doctors, failed to participate in treatment, continued to work "under the table . . . well after his date of last insured," and continued to engage in "his past work activities as a contractor." Id. Here, by contrast, plaintiff consistently reported his symptoms to medical providers, diligently complied with treatment, and although plaintiff worked part-time during a portion of the relevant time period, the volume of work he performed progressively decreased as his fibromyalgia worsened. Furthermore, the record does not reflect plaintiff engaged in other work; nor is there evidence plaintiff continued his past work activities after being fired.

Finally, the Commissioner's citation to Gregory v. Bowen, 844 F.2d 664, 667 (9th Cir. 1988), is equally unpersuasive. There, the claimant had back pain that remained "constant for a number of years," through which the claimant continued working. Id. Here, by contrast, although plaintiff initially worked part-time, plaintiff's impairments eventually progressed to the point he was fired from his highly accommodating part-time job. Tr. 48; Tr. 235 ("I feel that hiring [plaintiff] was like an accommodation for him. We told him we would work with him so we hired help."); see Denby v. Colvin, 2016 WL 917313, at *13 (D. Or. Mar. 8, 2016) ("The undisputed evidence is that Denby worked a reduced schedule, required extra breaks and trips to the women's room, had a benevolent employer, and was nevertheless terminated [due to her] impairments. . . Accordingly, the ALJ's conclusion that Denby's part-time work in 2010 was a basis to reject her testimony is not supported by substantial evidence in the record.").

As such, plaintiff's part-time work history was not a clear and convincing reason to discount plaintiff's subjective symptom testimony.

B. Activities of Daily Living

The ALJ found plaintiff's activities of daily living were "inconsistent with [his] allegations." Tr. 24. The Commissioner correctly asserts that an ALJ may discount a claimant's subjective symptom testimony where a claimant's daily activities are inconsistent with that testimony. Orn v. Astrue, 495 F.3d 625, 639 (9th Cir. 2007). Here, the Commissioner argues plaintiff's hobbies, which "included reading, video gaming, and practicing violin," undermined his testimony that his concentration was limited to "`several hours' on good days and `zero' time on bad days." Def.'s Br. at 7.

This argument fails for several reasons. First, the Commissioner failed to articulate how plaintiff's limited hobbies undermined his testimony. Second, a review of the record reveals the ALJ and the Commissioner mischaracterized plaintiff's engagement in such "hobbies." For example, plaintiff's testimony at the hearing confirms his lack of ability to concentrate and read on "bad days." See, e.g., Tr. 61 (ALJ's question: "[O]n bad days how long can you [read?] Plaintiff's answer: "On bad days . . . at worst of the worst, zero. [I] can't concentrate on anything except the pain . . . ."). Although the ALJ's decision mentions plaintiff's video game hobby in three separate sections, at the hearing the topic was only discussed in an isolated exchange. Compare Tr. 21 (noting plaintiff "indicated that he spends a lot of time . . . playing video games") with Tr. 55 (ALJ's question: "do you still [play video games as a distraction?]" Plaintiff's answer: "Yes, I do."). Finally, at the hearing, although plaintiff acknowledged he still owned his violin, he also testified he had not "used it for about a year." Tr. 55.

The Commissioner relies on a hobby plaintiff engages in when not suffering from debilitating pain, overstates the frequency with which plaintiff engages in another hobby, and relies on a hobby plaintiff had not engaged in for over a year. Those examples do not undermine plaintiff's hearing testimony that his concentration was limited to "several hours on good days and `zero' time on bad days." Def.'s Br. at 7. Claimants need not "vegetate in a dark room in order to be eligible for benefits." Molina v. Astrue, 674 F.3d 1104, 1112-13 (9th Cir. 2012) (citing Cooper v. Bowen, 815 F.2d 557, 561 (9th Cir. 1987)) (internal quotation marks omitted).

The Commissioner also mischaracterizes a "camping trip" plaintiff attended, noting that camping "seems an unusual activity for someone who could unexpectedly experience the highest level of pain imaginable." Def.'s Br. at 8. The Commissioner then directs the Court to a medical record from July 2014. The Court finds this argument unpersuasive for several reasons. First, a review of the record reveals the treatment note is from the month before the "camping trip." Compare Tr. 55 with Tr. 431. Second, the same hearing testimony also explains the activity the Commissioner characterizes as "camping" actually involved plaintiff's attendance at a "church family camp" where he stayed in a cabin, testifying he "could not have done it in a tent." Tr. 55. Third, the Court fails to see a relevant distinction between whether a person might "unexpectedly experience the highest level of pain imaginable" in a cabin or their normal living quarters. Cf. Poppa v. Comm'r of Soc. Sec. Admin., 202 F.3d 278 (9th Cir. 1999) ("Visits to family are not inconsistent with the need to rest for extended periods, nor with debilitating pain. Indeed, even the most severely limited individuals are able to undertake arduous travel to reach `home' and family, and may find it more restful to be with family members than in their own household."). The fact that plaintiff was capable of attending a "camping trip" does not undermine his subjective symptom testimony.

Next, the Commissioner argues plaintiff's ability to perform "self-care (i.e., hygiene), fix [] meals, and car[e] for his dog" undermined his testimony "that on bad days his pain was 7 to 10 out of 10." Def.'s Br. at 8. The Ninth Circuit has explained, however, that a claimant need not be utterly incapacitated to receive disability benefits, and sporadic completion of minimal activities is insufficient to support a negative credibility finding. Vertigan v. Halter, 260 F.3d 1044, 1050 (9th Cir. 2001). Although the Commissioner cites plaintiff's ability to perform "selfcare" tasks, plaintiff indicated that when "in pain it becomes increasingly difficult to perform" such activities. Tr. 217 ("There have been many times when I have not been able to dress or shave due to pain . . . ."); see also Tr. 237 ("Sometimes while doing these activities the pain level increases so rapidly and severely [plaintiff] has had to call out for help to get back to bed, stopping these activities."). Although a third party function report indicated plaintiff "fixed meals," the same report also indicated plaintiff was limited to fixing "pre-prepared" or "easy to fix single dish meals," adding the caveat he could only do so "pain permitting." Tr. 238. Finally, although plaintiff testified he owns a "small Lhasa Apso dog," he explained the dog had been prescribed to him by his primary care physician to help with his "severe night terrors." Tr. 56. As such, although plaintiff performs "self-care" and "fixes meals" on a limited basis, he can only do so when pain permits; and although he "cares" for a small dog, he does so at the direction of his primary care physician. This minimal level of activity does not undermine plaintiff's symptom testimony.4 Vertigan, 260 F.3d at 1050 ("This court has repeatedly asserted that the mere fact that a plaintiff has carried on certain daily activities, such as grocery shopping, driving a car, or limited walking for exercise, does not in any way detract from her credibility as to her overall disability.").

As such, plaintiff's activities of daily living were not a clear and convincing reason to discount plaintiff's subjective symptom testimony.

C. Lack of Objective Medical Evidence

In response to plaintiff's assignment of error regarding the ALJ's evaluation of fibromyalgia, the Commissioner contends the objective medical evidence undermines plaintiff's symptom testimony. Def.'s Br. at 9-11. As discussed below, the medical record corroborates plaintiff's testimony. Moreover, because the ALJ's other reasons for discrediting plaintiff's testimony fail to meet the clear and convincing standard, a lack of objective medical evidence could not independently sustain the ALJ's assessment. Reddick v. Charter, 157 F.3d 715, 722-23 (9th Cir. 1998) ("[T]he Commissioner may not discredit the claimant's testimony as to the severity of symptoms merely because they are unsupported by objective medical evidence."); see also Burch, 400 F.3d at 681 (explaining a lack of medical evidence can support an adverse credibility finding only if there are additional grounds for discrediting the claimant's testimony) (emphasis added). As such, the Court declines to address this argument.

In sum, the Court should find the ALJ did not provide clear and convincing reasons for discrediting plaintiff's testimony. The ALJ's evaluation of plaintiff's subjective symptom testimony should be reversed.

II. Medical Evidence

Plaintiff next asserts the ALJ erred by assigning little weight to the medical opinion of Basil Pittenger, M.D., plaintiff's treating physician, and Clay McCord, M.D., plaintiff's treating rheumatologist. Pl.'s Br. at 15-17. The Commissioner responds the ALJ properly weighed the medical opinions of record. Def.'s Br. at 11-18.

The ALJ is responsible for resolving conflicts in the medical record. Carmickle v. Comm'r Soc. Sec. Admin., 533 F.3d 1155, 1164 (9th Cir. 2008). "As a general rule, more weight should be given to the opinion of a treating source than to the opinion of doctors who do not treat the claimant[.]" Turner v. Comm'r, 613 F.3d 1217, 1222 (9th Cir. 2010) (internal quotation and citation omitted). An ALJ may reject the uncontradicted medical opinion of a treating or examining physician only for "clear and convincing" reasons supported by substantial evidence in the record. Bayliss v. Barnhart, 427 F.3d 1211, 1216 (9th Cir. 2005). An ALJ may reject the contradicted opinion of a treating or examining doctor by providing "specific and legitimate reasons that are supported by substantial evidence." Id. "[An] ALJ can satisfy the substantial evidence requirement by setting out a detailed and thorough summary of the facts and conflicting clinical evidence, stating his interpretation thereof, and making findings." Garrison v. Colvin, 759 F.3d 995, 1012 (9th Cir. 2014) (citation and quotation marks omitted). "The ALJ must do more than state conclusions. He must set forth his own interpretations and explain why they, rather than the doctors' are correct." Id. (citation omitted).

The Commissioner asserts the opinions of Drs. Pittenger and McCord were contradicted by the opinions of the state agency consultants. Accordingly, the ALJ was required to provide specific and legitimate reasons for discounting the opinions of Drs. Pittenger and McCord.

A. Dr. Pittenger

Dr. Pittenger was plaintiff's treating physician from October 2009 through at least March 2015. Tr. 338-67, 385-418, 453. Dr. Pittenger diagnosed plaintiff with fibromyalgia and severe anxiety disorder, asthma, seasonal allergies, IBS, and recurrent syncope. Id. Dr. Pittenger's treatment notes reveal plaintiff was regularly prescribed pain medication, including narcotics, to reduce the pain from fibromyalgia. See, e.g., Tr. 339, 343-44, 349, 351. In June 2012, Dr. Pittenger wrote a letter in which he opined plaintiff was "unable to hold any kind of permanent employment" due to his fibromyalgia and severe anxiety. Tr. 338. In March 2015, Dr. Pittenger opined that plaintiff's "impairments [were] severe enough to preclude his ability to maintain fulltime competitive work," and that he expected plaintiff's impairments to cause him to miss work "[f]our or more days a month."5 Tr. 453. Because Dr. Pittenger's opinion was contradicted, the ALJ was required to provide specific and legitimate reasons for rejecting it.

The ALJ found Dr. Pittenger's opinion: (1) relied on plaintiff's subjective complaints; (2) conflicted with plaintiff's daily activities; and (3) inconsistent with mental status exam findings and plaintiff's testimony. Tr. 26.

The Commissioner argues the ALJ discounted Dr. Pittenger's opinion because he found the opinion "was based on [plaintiff's] subjective complaints." Def.'s Br. at 15. Although an ALJ may reject a treating physician's opinion where the opinion is based on a claimant's subjective complaints, which the ALJ properly discredits, as discussed supra at 4-12, the ALJ erroneously rejected plaintiff's subjective symptom testimony. See Fair v. Bowen, 885 F.2d 597, 605 (9th Cir. 1989). Therefore, this was not a specific and legitimate reason to reject Dr. Pittenger's opinion.6

The Commissioner next argues the ALJ permissibly discounted Dr. Pittenger's opinion because it conflicted with plaintiff's daily activities. Def.'s Br. at 16. Specifically, the Commissioner asserts that Dr. Pittenger's opinion that plaintiff "could not perform `any kind of permanent employment'" conflicted with plaintiff's part-time work as a janitor for a local church. Id. Although plaintiff was working part-time when Dr. Pittenger opined that plaintiff could not sustain "permanent employment," the fact plaintiff was engaged in part-time work is not inconsistent with Dr. Pittenger's assessment that full-time permanent employment was not possible given plaintiff's fibromyalgia and severe anxiety. Notably, the Commissioner's own rulings recognize that permanent full-time employment involves the ability to engage in work "[eight] hours a day, for [five] days a week . . . ." SSR 96-8p, available at 1996 WL 374184. Moreover, as discussed above, plaintiff's testimony concerning the decline of his part-time work as his conditions worsened, ultimately culminating in his dismissal, supports Dr. Pittenger's opinion that plaintiff was incapable of sustaining full-time permanent employment. See Tr. 45-48; see also Tr. 234-35.

Finally, the Commissioner contends the ALJ permissibly discounted Dr. Pittenger's opinion regarding plaintiff's anxiety disorder because it was inconsistent with mental status exams and plaintiff's testimony. Def.'s Br. at 16-17. This argument lacks merit. Although the Commissioner relies on medical records showing plaintiff's memory and mood was described as "normal," and plaintiff's testimony that "he was `doing okay' with his anxiety," assuming without deciding that such records would support the conclusion that plaintiff's severe anxiety and depression symptoms were not "significant," the Ninth Circuit has cautioned against drawing inferences based upon reports of improvements during mental health treatment. Garrison, 759 F.3d at 1017. In other words, "such observations must be read in context of the overall diagnostic picture," and the fact that a person suffering from mental health impairments "makes some improvement does not mean that the person's impairment [] no longer seriously affect[s his] ability to function in a workplace." Ghanim v. Colvin, 763 F.3d 1154, 1162 (9th Cir. 2014) (internal quotation omitted) (bracketing in original). Here, Dr. Pittenger frequently noted plaintiff's anxiety, see, e.g., Tr. 340 ("mood and affect: anxious); Tr. 348 ("He appears chronically ill and very anxious. He is rubbing his pant leg repetitively."); Tr. 350 (presenting "somewhat anxious"); Tr. 355 (presenting withdrawn affect and increasing Zoloft dosage), as did other treating providers, see, e.g., Tr. 388 (assessing generalized anxiety disorder); Tr. 391 (same); Tr. 394 (General appearance: Abnormal. (JITTERY, SHAKING LEGS)) (capitalization in original).

As such, this was not a specific and legitimate reason to discount Dr. Pittenger's opinion.

B. Dr. McCord

Dr. McCord was plaintiff's treating rheumatologist from October 2012 through at least January 2014. Tr. 320-37, 372, 440-51. Dr. McCord treated plaintiff for musculoskeletal pain, and diagnosed plaintiff with fibromyalgia, IBS, generalized anxiety disorder, obsessive compulsive disorder ("OCD"), and PTSD. Tr. 324, 330, 331-32, 334-35, 440-41, 443, 446, 449. In July 2013, Dr. McCord also wrote a letter in support of plaintiff's disability claim. Tr. 372. In terms of functional limitations, Dr. McCord opined that plaintiff could sit less than two hours at any one time, stand less than fifteen minutes at any one time, and lift only ten pounds or less occasionally. Id. Dr. McCord further opined plaintiff could not work a full eight hours and found plaintiff's condition was permanent. Id. Because Dr. McCord's opinion was contradicted, the ALJ was required to provide specific and legitimate reasons for rejecting it.

The ALJ found the opinion: (1) conflicted with plaintiff's daily activities; (2) inconsistent with objective findings and treatment notes; and (3) inconsistent with the record as a whole. Id.

The Commissioner contends Dr. McCord's opinion conflicted with plaintiff's daily activities, specifically his part-time work. Def.'s Br. at 12-13. When viewed in context, however, the evidence the Commissioner relies on does not conflict with Dr. McCord's opinion. The Commissioner argues a conflict exists because Dr. McCord's July 29, 2013, opinion letter that plaintiff could not "work a full [eight] hours [and] the condition [was] permanent" was written while plaintiff was still employed. Id. (citing Tr. 372). First, no actual conflict exists because plaintiff's work was part-time — not a full eight hours. Second, as discussed above, plaintiff's work hours had already sharply declined by July 2013, with his employer ultimately firing him in August 2013 for unsatisfactory work after previously reducing his workload. See supra at 4-12; Tr. 45-48; see also Tr. 234 (former employer noting the "change did appear gradual but over a short period"). Thus, Dr. McCord's opinion was consistent with both plaintiff's testimony and the evidence solicited from his employer that plaintiff was incapable of working "a full [eight] hours." Compare Tr. 372 with Tr. 45-48 and Tr. 234-35.7

The Commissioner also asserts "that Dr. McCord's opinion conflicted with his own treatment notes," and argues this case is analogous to Bayliss, 427 F.3d at 1211. In Bayliss, the Ninth Circuit upheld an ALJ's rejection of a treating physician who opined the claimant "could stand or walk for only fifteen minutes at a time." Id. at 1216. The court reasoned the treating physician's "notes [composed] on the same day" contradicted his opinion "assessing [the claimant's] ability to stand or walk," although the court did not identify the specific contemporaneous discrepancy. Id. The Commissioner argues that plaintiff's presentation at prior appointments with a "normal gait and no atrophy" contradicts Dr. McCord's fifteen minute walking restriction. Plaintiff's impairments, however, manifest in the form of pain and fatigue and it is unclear how plaintiff's lack of muscle degradation and ability to ambulate contradicts Dr. McCord's walking limitation.8 See e.g., Tr. 440 (describing fatigue); Tr. 443 (as a result of plaintiff's fibromyalgia he is "still quite [limited] in what he can do physically"). As the Commissioner's own rulings acknowledge, fibromyalgia symptoms often manifest in fatigue. See SSR 12-2p, available at 2012 WL 3104869, at *6 ("Widespread pain and other symptoms associated with [fibromyalgia], such as fatigue, may result in exertional limitations . . . ."). Thus, Bayliss is distinguishable because there is no discrepancy between Dr. McCord's limitation and his treatment notes.

The Commissioner also relies on the ALJ's observation that although Dr. McCord diagnosed plaintiff with "classic hyperalgesia," he only demonstrated tender points "periodically," seemingly arguing those two observations creates a conflict. Def.'s Br. at 13 (citing Tr. 26). The Commissioner, post hoc, then directs the Court to examples in the record that document plaintiff reporting "no tenderness." Id. at 14. An independent review of those treatment notes arguably supports the Commissioner's assertion to a degree. See, e.g., Tr. 332 (no joint or spine tenderness); Tr. 447 (same). Hyperalgesia is defined as "[e]xtreme sensitivity to painful stimuli." Guillen v. Owens, 2010 WL 4977575, at *4 (D. Ariz. Dec. 2, 2010) (quoting Stedman's Medical Dictionary, 190850 (27th ed.2000)). The Court, however, fails to see a relevant contradiction between Dr. McCord's assessment of hyperalgesia and plaintiff's periodic presentation of tenderness. To the extent the ALJ attempted to identify an inconsistency, periodically demonstrating tender points is not unequivocally inconsistent with Dr. McCord assessing hyperalgesia.9 Moreover, there is no correlation between Dr. McCord's assessment of hyperalgesia and the limitations he opined. Accordingly, this was not a specific and legitimate rationale to discount Dr. McCord's opinion.

Finally, the Commissioner's additional arguments that Dr. McCord's opinion conflicts with other evidence also fails. First, the Commissioner's assertion that plaintiff "generally denied pain symptoms to Dr. Pittenger" and that Dr. Pittenger described plaintiff's fibromyalgia as "stable" mischaracterizes the record. Def.'s Br. at 14. Although Dr. Pittenger's treatment notes did contain negative musculoskeletal findings, plaintiff's chief complaint at one of the appointments cited by the Commissioner was his mental health. Tr. 387. Moreover, the treatment notes from the exams the Commissioner relies on also reveal Dr. Pittenger's repeated assessments of fibromyalgia and noted plaintiff's narcotic pain prescription as well as a cocktail of other drugs for his pain. Furthermore, plaintiff regularly reported his pain levels between three and four out of five on the Wong Baker Pain Scale. Tr. 331, 334, 441, 443, 447, 450. Second, for the reasons explained supra at 10, plaintiff's "camping" activities fail to undermine his subjective symptom testimony or Dr. McCord's opinion.

In sum, the Court should find the ALJ did not provide specific and legitimate reasons for discrediting the opinions of plaintiff's treating physicians. The ALJ's evaluation of the medical evidence should be reversed.

III. Step Five Finding

Finally, plaintiff contends the ALJ erred at step five of the sequential evaluation because his hypothetical to the VE failed to include all of plaintiff's limitations. Pl.'s Br. at 17-18 (citing DeLorme v. Sullivan, 924 F.2d 841, 850 (9th Cir.1991)). The RFC reflects the most an individual can do. 20 C.F.R. §§ 404.1545, 416.945. In formulating an RFC, the ALJ must consider all medically determinable impairments, including those that are not "severe," and evaluate "all of the relevant medical and other evidence," including the claimant's testimony. Id.; SSR 96-8p, available at 1996 WL 374184. An ALJ may rely on the testimony of a VE to determine whether a claimant retains the ability to perform past relevant work at step four, or other work in the national or regional economy at step five. Osenbrock v. Apfel, 240 F.3d 1157, 1162 (9th Cir. 2001). The ALJ is required to include only those limitations which are supported by substantial evidence in the hypothetical posed to a VE. See id. at 1163-65. "Conversely, an ALJ is not free to disregard properly supported limitations." Robbins v. Soc. Sec. Admin., 466 F.3d 880, 886 (9th Cir. 2006). In other words, limitations supported by substantial evidence must be incorporated into the RFC and, by extension, the dispositive hypothetical question posed to the VE. Osenbrock, 240 F.3d at 1163-65.

Here, the ALJ improperly discredited plaintiff's testimony and the opinions of plaintiff's treating physicians. By failing to incorporate all of plaintiff's limitations supported by substantial evidence into the RFC and, by extension, the dispositive hypothetical question posed to the VE, the ALJ's conclusion lacked evidentiary value. Id. at 886. Thus, the ALJ's finding was not supported by substantial evidence and is therefore erroneous. Id.; see also Matthews v. Shalala, 10 F.3d 678, 681 (9th Cir. 1993) ("If a vocational expert's hypothetical does not reflect all the claimant's limitations, then the expert's testimony has no evidentiary value to support a finding that the claimant can perform jobs in the national economy.") (internal citation omitted).

As such, the ALJ failed to craft an RFC accounting for all of plaintiff's limitations supported by substantial evidence in the record and this case should be remanded.

IV. Remand

The decision whether to remand for further proceedings or for the immediate payment of benefits lies with the discretion of the court. Harman v. Apfel, 211 F.3d 1172, 1176-78 (9th Cir. 2000), cert. denied, 531 U.S. 1038 (2000). The court may not award benefits punitively and must conduct a "credit-as-true" analysis on evidence that has been improperly rejected by the ALJ to determine if a claimant is disabled under the Act. Strauss v. Comm'r of the Soc. Sec. Admin., 635 F.3d 1135, 1138 (9th Cir. 2011).

The Ninth Circuit's "credit-as-true" doctrine is settled and binding on this Court. Garrison, 759 F.3d at 999. In conducting the "credit-as-true" analysis, the court considers whether: (1) the ALJ has failed to provide legally sufficient reasons for rejecting evidence; (2) the record has been fully developed and further proceedings would serve no useful purpose; and (3) if the improperly discredited evidence were credited as true, the ALJ would be required to find the plaintiff disabled on remand. Dominguez v. Colvin, 808 F.3d 403, 407 (9th Cir. 2015). Even if all of the requisites are met, however, the court may still remand for further proceedings "when the record as a whole creates serious doubt as to whether the claimant is, in fact, disabled[.]" Id. at 1021. "Serious doubt" can arise when there are "inconsistencies between the claimant's testimony and the medical evidence," or if the Commissioner "has pointed to evidence in the record the ALJ overlooked and explained how that evidence casts serious doubt" on whether the claimant is disabled under the Act. Dominguez, 808 F.3d at 407 (citing Burrell v. Colvin, 775 F.3d 1133, 1141 (9th Cir. 2014) (internal quotation marks omitted)).

Here, the first requisite is met based on the ALJ's harmful legal errors. As discussed above, the ALJ failed to provide legally sufficient reasons for discrediting plaintiff's subjective symptom testimony and for discounting the opinions of plaintiff's treating physicians.

As to the second requisite, the Ninth Circuit has held that remanding for proceedings rather than for an immediate payment of benefits serves a useful purpose where "the record has [not] been fully developed [and] there is a need to resolve conflicts and ambiguities." Treichler v. Comm'r of Soc. Sec. Admin., 775 F.3d 1090, 1101 (9th Cir. 2014) (internal quotations and citations omitted). In Treichler, the court pointed to "significant factual conflicts in the record between [the claimant's] testimony and objective medical evidence." Id. at 1105 (emphasis added). Specifically, the claimant testified that he would lose control of his bladder during the day, though treatment notes indicated that the urinary incontinence issue occurred only at night. Id. He also testified that he experienced fecal incontinence, but the single medical report on the issue stated that the claimant complained of constipation and denied problems with fecal incontinence. Id. The claimant further testified that he had debilitating pain twice a week, though he reported to a physician that his pain medication made life tolerable and stated, during the hearing, that the medication alleviates a lot of the pain. Id. Based on these conflicts in the medical evidence, the court concluded that a remand for further proceedings, rather than payment of benefits, was the appropriate remedy. Id. at 1107.

Here, by contrast, the medical evidence of record is consistent with plaintiff's testimony. The record is extensive and provides a detailed and complete longitudinal picture of plaintiff's impairments over time, and is consistent with the opinions of plaintiff's two treating physicians, who both endorsed his disability claim. See Trevizo v. Berryhill, 871 F.3d 664, 683 (9th Cir. 2017). Indeed, the only physicians of record who opined plaintiff was capable of full-time employment never treated or examined him. Although plaintiff testified that his medication allows him to no longer be "bound to a couch or bed," he testified that his "bad days far outnumber" his good days. Tr. 49, 59-60; see also Tr. 346 (primary care physician noting "less than 50% of his days are good days"). Moreover, when his fibromyalgia is at its worst he continues to be relegated to his bed. Tr. 59-60. Although the Commissioner asserts the record contains conflicts that preclude an award of benefits, she failed to direct the Court to specific examples beyond "the evidence supporting the ALJ's decision." Def.'s Br. at 20. Upon review the Court finds no significant conflicts. Furthermore, allowing the ALJ to revisit plaintiff's testimony and medical opinions he rejected for legally insufficient reasons does not qualify as a remand for a "useful purpose." See Garrison, 759 F.3d at 1021 (citing Benecke v. Barnhart, 379 F.3d 587, 595 (9th Cir. 2004)) ("Allowing the Commissioner to decide the issue again would create an unfair `heads we win; tails, let's play again' system of disability benefits adjudication."). Finally, the post hoc rationales raised by the Commissioner similarly fail to raise "significant factual conflicts in the record between [plaintiff's] testimony and objective medical evidence." Treichler, 775 F.3d at 1104 (emphasis added).10

As to the third requisite, if the discredited evidence were credited as true, the ALJ would be required to find plaintiff disabled on remand. Crediting the limitations of plaintiff's treating physicians as true compels a finding of disability based on the VE testimony. Compare Tr. 372 (Dr. McCord limiting plaintiff to: sitting less than two hours at any one time; standing less than fifteen minutes at any one time; and lifting only ten pounds or less occasionally) with Tr. 69-70 (VE testimony that added Dr. McCord's limitations to the ALJ's hypothetical posed to the VE would "rule out" sedentary work) and Tr. 453 (Dr. Pittenger opining plaintiff's impairments would cause him to miss four or more days of work per month) with Tr. 68-69 (VE testimony: "[I]f a person is missing one to two days a month . . . [t]hey will not sustain work with absence at that level."); see Trevizo, 871 F.3d at 683 (crediting plaintiff's testimony and medical opinions as true combined with VE testimony established disability, making remand for immediate payment of benefits proper).

If a court concludes, as in this case, that a plaintiff meets the three criteria of the creditas-true standard, the improperly discredited evidence is credited as true and remand for an award of benefits is appropriate unless "the record as a whole creates serious doubt as to whether the claimant is, in fact, disabled with the meaning of the Social Security Act." Garrison, 759 F.3d at 1020-21 (citations omitted). Considering the record as a whole, the Court should conclude that there is no reason for serious doubt as to whether plaintiff is disabled. See Id. at 1021; see also Revels v. Berryhill, 874 F.3d 648, 668 n.8 (9th Cir. 2017) (explaining that where each of the credit as true factors is met, only in "rare instances" does the record as a whole leave "serious doubt as to whether the claimant is actually disabled") (citing Garrison, 759 F.3d at 1021). Moreover, the Commissioner has not "pointed to evidence in the record the ALJ overlooked and explained how that evidence casts serious doubt" on whether the plaintiff is disabled under the Act. Dominguez, 808 F.3d at 407. As such, the Court should credit the erroneously discredited testimony as true and remand this case for immediate calculation and payment of benefits.

RECOMMENDATION

Pursuant to sentence four of 42 U.S.C. § 405(g), the decision of the Commissioner should be REVERSED and REMANDED for an immediate payment of benefits.

This recommendation is not an order that is immediately appealable to the Ninth Circuit Court of Appeals. Any notice of appeal pursuant to Rule 4(a)(1), Federal Rules of Appellate Procedure, should not be filed until entry of the district court's judgment or appealable order. The parties shall have fourteen (14) days from the date of service of a copy of this recommendation within which to file specific written objections with the court. Thereafter, the parties shall have fourteen (14) days within which to file a response to the objections. Failure to timely file objections to any factual determination of the Magistrate Judge will be considered as a waiver of a party's right to de novo consideration of the factual issues and will constitute a waiver of a party's right to appellate review of the findings of fact in an order or judgment entered pursuant to this recommendation.