Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_16-cv-01300/USCOURTS-casd-3_16-cv-01300-1/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:0405id Review of HHS Decision (SSID)

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UNITED STATES DISTRICT COURT 

SOUTHERN DISTRICT OF CALIFORNIA 

ARLENE ELIZABETH 

MASTERSON, 

 Plaintiff, 

v. 

CAROLYN W. COLVIN, 

 Defendant. 

Case No.: 16-CV-1300-GPC(WVG) 

REPORT AND 

RECOMMENDATION ON 

CROSS-MOTIONS FOR 

SUMMARY JUDGMENT 

[Doc. Nos. 13, 15.] 

This is an action for judicial review of a decision by the Acting Commissioner 

of Social Security, Carolyn W. Colvin (“the Commissioner,” or “Defendant”), 

denying Plaintiff Arlene Elizabeth Masterson supplemental security income (“SSI”) 

benefits under Title XVI of the Social Security Act. The parties have filed crossmotions for summary judgment, and the matter is before the undersigned Magistrate 

Judge for preparation of a Report and Recommendation. For the reasons stated 

below, the Court RECOMMENDS that Plaintiff’s motion for summary judgment 

be GRANTED, Defendant’s cross-motion for summary judgment be DENIED, and 

the matter be remanded for further proceedings.

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I. OVERVIEW OF SOCIAL SECURITY CLAIM PROCEEDINGS

Pursuant to the Act, the Social Security Administration (“SSA”) administers 

the SSI program. 42 U.S.C. § 901. The Social Security Act authorizes the SSA to 

create a system by which it determines who is entitled to benefits and by which 

unsuccessful claimants may obtain review of adverse determinations. Id. §§ 423 et 

seq. Defendant, as Acting Commissioner of the SSA, is responsible for the Act’s 

administration. Id. § 902(a)(4), (b)(4). 

A. SSA’s Sequential Five-Step Process 

The SSA employs a sequential five-step evaluation to determine whether a 

claimant is eligible for benefits. 20 C.F.R. §§ 416.920, 404.1520. To qualify for 

disability benefits under the Act, a claimant must show that (1) he or she suffers 

from a medically-determinable impairment1

 that can be expected to result in death 

or that has lasted or can be expected to last for a continuous period of twelve months 

or more and (2) the impairment renders the claimant incapable of performing the 

work that he or she previously performed or any other substantially gainful 

employment that exists in the national economy. See 42 U.S.C. §§ 423(d)(1)(A), 

(2)(A); 1382(c)(3)(A). 

A claimant must meet both of these requirements to qualify as “disabled” 

under the Act, id. § 423(d)(1)(A), (2)(A), and bears the burden of proving that he

or she “either was permanently disabled or subject to a condition which became so 

severe as to create a disability prior to the date upon which [his or] her disability 

insured status expired.” Johnson v. Shalala, 60 F.3d 1428, 1432 (9th Cir. 1995). 

An administrative law judge (“ALJ”) presides over the five-step process to 

 

1

 A medically-determinable physical or mental impairment “is an impairment that 

results from anatomical, physiological, or psychological abnormalities, which can 

be shown by medically acceptable clinical and laboratory diagnostic techniques.” 

42 U.S.C. § 423(d)(3). 

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determine disability. See Barnhart v. Thomas, 540 U.S. 20, 24-25 (2003) 

(summarizing the five-step process). If the Commissioner finds that a claimant is 

disabled or not disabled at any step in this process, the review process is terminated 

at that step. Corrao v. Shalala, 20 F.3d 943, 946 (9th Cir. 1994). 

 Step one in the sequential evaluation considers a claimant’s “work activity, 

if any.” 20 C.F.R. § 404.1520(a)(4)(i). An ALJ will deny a claimant disability 

benefits if the claimant is engaged in “substantial gainful activity.” Id. 

§§ 404.1520(b), 416.920(b). 

 If a claimant cannot provide proof of gainful work activity, the ALJ proceeds 

to step two to ascertain whether the claimant has a medically severe impairment or 

combination of impairments. The so-called “severity regulation” dictates the course 

of this analysis. Id. §§ 404.1520(c), 416.920(c); see also Bowen v. Yuckert, 482 

U.S. 137, 140-41 (1987). 

An ALJ will deny a claimant’s disability claim if the ALJ does not find that 

a claimant suffers from a severe impairment or combination of impairments which 

significantly limits the claimant’s physical or mental ability to do “basic work 

activities.” 20 C.F.R. § 404.1520(c). The ability to do “basic work activities” 

means “the abilities and aptitudes necessary to do most jobs.” Id. §§ 404.1521(b), 

416.921(b). 

However, if the impairment is severe, the evaluation proceeds to step three. 

At step three, the ALJ determines whether the impairment is equivalent to one of 

several listed impairments that the SSA acknowledges are so severe as to preclude 

substantial gainful activity. Id. §§ 404.1520(d), 416.920(d). An ALJ conclusively 

presumes a claimant is disabled so long as the impairment meets or equals one of 

the listed impairments. Id. §§ 404.1520(d). 

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If the ALJ has not yet deemed a claimant disabled, but before formally 

proceeding to step four, the ALJ must establish the claimant’s Residual Functional 

Capacity (“RFC”). Id. §§ 404.1520(e), 404.1545(a). An individual’s RFC is his or 

her ability to do physical and mental work activities on a sustained basis despite 

limitations from his or her impairments. Id. §§ 404.945(a)(1), 404.1545(a)(1). The 

RFC analysis considers “whether [the claimant’s] impairment(s), and any related 

symptoms, such as pain, may cause physical and mental limitations that affect what 

[the claimant] can do in a work setting.” Id. §§ 404.1545(a)(1), 416.945(a)(1). In 

establishing a claimant’s RFC, the ALJ must assess relevant medical and other 

evidence, as well as consider all of the claimant’s impairments, including 

impairments categorized as non-severe. Id. § 404.1545(a)(3), (e). If an ALJ does 

not conclusively determine a claimant’s impairment or combination of impairments 

is disabling at step three, the evaluation advances to step four. 

At step four, the ALJ uses the claimant’s RFC to determine whether the 

claimant has the RFC to perform the requirements of their past relevant work. Id.

§ 404.1520(f). So long as a claimant has the RFC to carry out his or her past relevant 

work, the claimant is not disabled. Id. §§ 404.1560(b)(3). Conversely, if the 

claimant either cannot perform or does not have any past relevant work, the analysis 

presses onward. 

 At the fifth and final step of the SSA’s evaluation, the ALJ must verify 

whether the claimant is able to do any other work in light of his or her RFC, age, 

education, and work experience. Id. § 404.1520(g). If the claimant is able to do 

other work, the claimant is not disabled. However, if the claimant is not able to do 

other work and meets the duration requirement, the claimant is disabled. Id. 

Although the claimant generally continues to have the burden of proving disability 

at step five, a limited burden of going forward with the evidence shifts to the SSA. 

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At this stage, the SSA must present evidence demonstrating that other work that the 

claimant can perform—allowing for his RFC, age, education, and work 

experience—exists in significant numbers in the national economy. Id. 

§§ 404.1520, 1560(c), 416.920, 404.1512(f). 

B. SSA Hearings and Appeals Process 

 In accordance with Defendant’s delegation, the Office of Disability 

Adjudication and Review administers a nationwide hearings and appeals program. 

SSA regulations provide for a four-step process for administrative review of a 

claimant’s application for disability payments. See id. §§ 416.1400, 404.900. Once 

the SSA makes an initial determination, three more levels of appeal exist: 

(1) reconsideration, (2) hearing by an ALJ, and (3) review by the Appeals Council. 

See id. §§ 416.1400, 404.900. If the claimant is not satisfied with the decision at 

any step of the process, the claimant has sixty days to seek administrative review. 

See id. §§ 404.933, 416.1433. If the claimant does not request review, the decision 

becomes the SSA’s—and hence Defendant’s—binding and final decree. See id. 

§§ 404.905, 416.1405. 

 A network of SSA field offices and state disability determination services 

initially process applications for disability benefits. The processing begins when a 

claimant completes both an application and an adult disability report, and submits 

those documents to one of the SSA’s field offices. If the SSA denies the claim, the 

claimant is entitled to a hearing before an ALJ in the SSA’s Office of Disability 

Adjudication and Review. Id. §§ 404.929, 416.1429. A hearing before an ALJ is 

informal and non-adversarial. Id. § 404.900(b). 

 If the claimant receives an unfavorable decision by an ALJ, the claimant may 

request review by the Appeals Council. Id. §§ 404.967, 416.1467. The Appeals 

Council will grant, deny, dismiss, or remand a claimant’s request. Id. §§ 416.1479, 

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404.979. If a claimant disagrees with the Appeals Council’s decision or the Appeals 

Council declines to review the claim, the claimant may seek judicial review in a 

federal district court pursuant to 42 U.S.C. § 405(g) or § 1383(c). See id.

§§ 404.981, 416.1481. If a district court remands the claim, the claim is sent to the 

Appeals Council, which may either make a decision or refer the matter to another 

ALJ. Id. § 404.983. 

II. BACKGROUND

A. Administrative Proceedings 

In June 2012, Plaintiff protectively filed an application for SSI, alleging 

disability as of February 12, 2011. (AR 178-87.) Also in June 2012, the SSA denied 

Plaintiff’s initial application. (AR 61-87.) In December 2012, Plaintiff was again 

denied benefits upon reconsideration. (AR 88-101.) 

 On July 2, 2014, the ALJ held a hearing to review Plaintiff’s claim. (AR 35-

59.) Plaintiff and a vocational expert (“VE”) testified at the hearing. (AR 36.) The 

ALJ issued her written decision on September 9, 2014. (AR 16-29.) At step one of 

the sequential evaluation process described above, the ALJ found Plaintiff had not 

engaged in substantial gainful activity since her alleged onset date of February 12, 

2011. (AR 18.) 

At step two, the ALJ found Plaintiff had severe impairments of (1) a spine 

disorder, (2) right shoulder disorder, and (3) cystitis (an inflammation of the 

bladder), but found various other claimed impairments were either not severe or 

lacked medical support.2

 (AR 18-22.) 

 

2

 These included an episode of syncope (the temporary loss of consciousness caused 

by a fall in blood pressure), cardiac disorder, carpel tunnel, depressive disorder, pain 

disorder with psychological factors, and personality disorder with borderline 

features. 

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At step three, the ALJ concluded that Plaintiff did not have an impairment or 

combination of impairments that met or medically equaled one of the listed 

impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1. (AR 22.) 

Between steps three and four, in her RFC assessment, the ALJ found Plaintiff 

could perform light work, except that she was limited to lifting and carrying no 

more than 20 pounds occasionally and 10 pounds frequently; pushing and pulling 

within the same weight limits; standing and walking six out of eight hours with no 

prolonged walking for more than approximately 60 minutes at a time; sitting for six 

out of eight hours with the ability to stand and stretch for no more than 10 percent 

of the day; avoiding ladders, ropes, or scaffolds; no work hazards; occasional 

overhead reaching with the right extremity; unskilled work; and close proximity to 

a restroom facility. (Id.) 

At step four, the ALJ found Plaintiff was able to perform her past relevant 

work as a caregiver. (AR 27.) The ALJ concluded the caregiver work qualified as 

past relevant work because Plaintiff had performed it within the prior 15 years, had 

done so for a sufficient period of time to learn the position and to provide average 

performance, and she had performed it “at the level of substantial gainful activity.” 

(Id.) However, the ALJ did not explain the specific bases behind each of these 

findings. 

At step five, based on the VE’s testimony, the ALJ made an alternative 

finding that considering Plaintiff’s age, education, work experience, and RFC, there 

were jobs in significant numbers in the national economy that Plaintiff could 

perform. (AR 27-28.) These jobs were “mail clerk,” “small parts assembler,” and 

“garment folder.” (AR 28.) 

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Accordingly, the ALJ found that Plaintiff was not disabled from February 12, 

2011, her alleged onset of disability date, through the date of the decision. (AR 28-

29.) 

Plaintiff thereafter requested a review of the ALJ’s decision (AR 7-12), but 

the Appeals Council denied her request for review (AR 1-6). The ALJ’s decision 

thereafter became the SSA’s final and definitive determination in Plaintiff’s case. 

42 U.S.C. § 405(g). 

On February 18, 2016, Plaintiff commenced the instant action for judicial 

review. (Doc. No. 1.)3

 Plaintiff thereafter filed a motion for summary judgment 

(“MSJ”) (Doc. No. 14), and Defendant filed a cross-motion for summary judgment 

(“Cross-MSJ”) and opposition to Plaintiff’s MSJ (Doc. No. 16). Plaintiff did not 

file an opposition to Defendant’s Cross-MSJ or a reply to Defendant’s opposition 

to her MSJ. 

B. Summary of Medical Records Submitted to the ALJ for Review 

On January 23, 2009, more than two years before the date Plaintiff alleged 

she became disabled, Luis C. Maas, III, M.D., conducted an MRI on Plaintiff’s right 

shoulder. (AR 324-27.) The MRI indicated tears in her tendon, moderate 

degenerative change, and trace bursal fluid, but otherwise the findings were 

unremarkable. (AR 324.) Dr. Maas also investigated Plaintiff’s complaint of pain 

in her neck and arm, and diagnosed her with mild diffuse degenerative spondylosis 

(degeneration) of the cervical spine, mild central canal stenosis (narrowing), and 

mild to moderate bilateral neural foraminal narrowing at multiple levels. (AR 326-

27.) Later, on November 20, 2009, Plaintiff had an orthopedic evaluation of her 

 

3

 Unless otherwise noted, references to page numbers in documents filed on the 

Court’s CM/ECF system are to electronically-stamped page numbers created by the 

CM/ECF system, not to the document’s original pagination. 

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right shoulder with and was diagnosed with impingement syndrome and subcromial 

bursitis (inflammation). (AR 449.) 

On June 24, 2011, Diana Sandoval-Cortez, M.D., examined Plaintiff for 

chronic lower back pain and determined that Plaintiff had mild degenerative 

changes in her lower lumbar spine. (AR 383-84.) There was mild bilateral 

neuroforaminal narrowing, moderate left paravertebral bridging osteophyte (bony 

outgrowth), and mild disc space narrowing but no other abnormalities. (AR 383.) 

Then on January 17, 2012, Plaintiff saw Dr. Sandoval-Cortez again for back pain, 

and the doctor determined that Plaintiff had multi-level degenerative changes in her 

thoracic spine. (AR 381.) 

On March 6, 2012, Facika Tafara, M.D. completed a Supplemental 

Certification. (AR 556.) Dr. Tafara opined that the Plaintiff was disabled based on 

lumbar degenerative disc disease, cervical degenerative disc disease, and rotator 

cuff tear and that Plaintiff would be able to return to her regular or customary work 

on June 30, 2012. 

On July 9, 2012, Plaintiff was hospitalized for chest pains. (AR 329-35.) 

Plaintiff performed a treadmill test, where she essentially had normal results. (AR 

329.) Plaintiff did not have further chest pain after admission, and the doctor 

recommended that she exercise and cease tobacco use. Plaintiff was discharged in 

stable condition and diagnosed with chest pain, dyslipidemia, hypertension, and 

depression. The doctor prescribed Baclofen, Diphenhydramine, Prozac, Fluticasone 

nasal spray, Percocet, and Simvastatin, and advised her to take aspirin. (AR 330.) 

Also, on the same date, another doctor examined Plaintiff and found minimal 

atelectasis (collapsed lung) or scarring but found no abnormalities. (AR 376-77.) 

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Plaintiff was then referred to Alborz Hassankhani, M.D., on July 16, 2012, 

who found that Plaintiff had a negative (normal) exercise treadmill test, a slightly 

elevated level of LDL and total cholesterol, and palpitations. (AR 339.) 

On October 8, 2012, Jaga Glassman, M.D. performed a psychiatric

evaluation. (AR 385-91.) Dr. Glassman noted that Plaintiff was clean and welldressed, maintained good eye contact, and had a calm, cooperative, polite, and 

respectful attitude and demeanor, though she showed some mild depressed mood. 

(AR 388-89.) She exhibited average intellectual functioning, repeating and 

remembering three words; correctly solving a money-changing problem; 

appropriately interpreting a proverb; stating Sacramento as the current capital of 

California; knowing that the sun rose from the east; and naming the current and 

previous presidents. (AR 389.) Dr. Glassman diagnosed her with pain disorder 

with medical and psychological factors, probable personality disorder, and 

musculoskeletal/orthopedic problems. (AR 390.) Dr. Glassman assessed a Global 

Assessment of Functioning (GAF)4

 score of 60, and opined that Plaintiff was 

capable of behaving in a socially appropriate manner, getting along with others, 

adapting to changes and stresses in the workplace; maintaining concentration, 

persistence, and pace for simple and complex tasks; and managing her own funds. 

(AR 390-91.) 

The following day, Vicente R. Bernabe, D.O., conducted an orthopedic 

evaluation. (AR 392-96.) Dr. Bernabe did not observe any abnormal curvatures or 

scoliosis in Plaintiff’s spine or deformities, scars, or masses in her shoulders. (AR 

 

4

 A GAF score of 51-60 indicates moderate symptoms (e.g., flat affect and 

circumstantial speech, occasional panic attacks) or moderate difficulty in social, 

occupational, or school functioning (e.g., few friends, conflicts with peers or coworkers). Am. Psychiatry Assoc., Diagnostic and Statistical Manual of Mental 

Health Disorders, Fourth Ed. Text Revision (DSM-IV-TR), 34 (2000). 

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394.) The range of motion in her left shoulder was within normal limits, though 

she had a positive impingement sign and pain in her right shoulder. She was able 

to walk on her toes and heels without difficulty, and her alternating hand 

movements were normal. (AR 395.) Dr. Bernabe opined, among other things, that 

Plaintiff did not have any restrictions for fine and gross manipulative movements, 

but overhead motion was limited to an occasional basis due to her right upper 

extremity secondary to a rotator cuff tear and impingement syndrome. (AR 396.) 

On October 30, 2012, S. Lee, M.D., a State agency physician, reviewed the 

medical evidence of record, and found, among other things, that Plaintiff’s ability 

to reach to the right overhead was limited, but she could handle, finger, and feel 

without limitations. (AR 71.) 

On November 1, 2012, State agency physician Nicole Lazorwitz, Psy.D, 

found that Plaintiff had mild restrictions in activities of daily living, but had no 

difficulties in maintaining social functioning or concentration, persistence, or pace 

and no repeated episodes of decompensation of extended duration. (AR 81.) Dr. 

Lazorwitz noted that Plaintiff seemed frustrated but otherwise was independent and 

could engage in basic activities of daily living. (AR 82.) 

During the reconsideration phase, State agency physician R. Bitonte, M.D., 

reviewed the medical evidence on March 29, 2013. (AR 98-100.) His findings as 

to Plaintiff’s manipulative limitations mirrored those of Dr. Lee. (AR 98-99.) On 

April 8, 2013, Richard Kaspar, Ph.D., another State agency physician, also 

reviewed the medical evidence. (AR 95-97.) He confirmed Dr. Lazorwitz’s 

findings and the functional capacity assessed on October 30, 2012. (AR 95.) 

On October 2, 2014, after the ALJ’s decision, Plaintiff had an appointment 

with Akther Kotha, M.D. (AR 569-73.) Dr. Kotha found that Plaintiff had 

tenderness in the PIP and MCP joints, wrists, elbows, and ankles. (AR 572.) In a 

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section titled, “Discussion,” Dr. Kotha stated that Plaintiff had fibromyalgia and 

pain, swelling, and stiffness in her joints. (AR 573.) Dr. Kotha determined that 

Plaintiff possibly had rheumatoid arthritis and prescribed Lyrica.5

 (Id.) 

C. Plaintiff’s Testimony 

Plaintiff testified at the hearing before the ALJ that she suffered from a 

number of conditions. She confirmed her application for benefits was based on 

osteoarthritis, tendinitis, carpel tunnel syndrome, right shoulder impingement, 

sciatica, chronic obstructive pulmonary disease, migraines, depression, high blood 

pressure, and high cholesterol. (AR 40-41.) In addition to those ailments, she 

reported plaque buildup in her heart and carotid arteries and weight gain. (AR 40.) 

She reported difficulty sleeping, staying focused, and felt nervous. (AR 42.) She 

reported that her chronic pain was the most problematic physical ailment she 

suffered and that the pain spread from the top of her neck to the bottom of her spine. 

(AR 42.) Her right shoulder and arm also caused her significant problems with 

maintaining strength. (AR 45.) She wore a back brace every day and was required 

to elevate her feet periodically throughout the day to alleviate pain, which became 

worse by lifting and by general exertion. (AR 48-49.) She believed she could lift 

no more than 10 pounds. (AR 51.) She reported constant, periodic spasms in her 

neck, legs, feet, and even stated her feet were becoming numb during the hearing. 

(AR 49-50.) She took a variety of medications for her ailments, and her side effects 

included diarrhea, swelling, and problems with memory and concentration. (AR 

51.) 

 

5

 Generically known as “pregabalin,” Lyrica “is a prescription medicine approved . . . 

to treat fibromyalgia, diabetic nerve pain, spinal cord injury nerve pain and pain after 

shingles. [It] is also indicated to treat partial onset seizures in adults with epilepsy 

who take 1 or more drugs for seizures.” https://www.lyrica.com/ about-lyrica (last 

visited July 5, 2017). 

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Plaintiff reported she lived alone in an apartment, washed dishes but did so 

with difficulty and while taking frequent breaks, did laundry, possessed a driver’s 

license, and drove herself to the hearing. (AR 45-47.) 

As for her employment history, Plaintiff confirmed she had worked as a 

caregiver for the prior 15 years. (AR 52.) In that capacity, she cooked for a client, 

assisted with hygienic needs, cleaned the house, and attended to other necessities. 

(Id.) 

D. Vocational Expert’s Testimony 

A vocational expert also testified at the hearing. (AR 52-58.) The VE 

classified Plaintiff’s caregiver position as light work that involved lifting up to 10 

pounds and standing and walking for four hours. (AR 54.) 

The ALJ presented the VE a hypothetical where the worker was limited to 

lifting and carrying no more than 20 pounds occasionally and 10 pounds frequently; 

pushing and pulling within those same limits; standing and walking for six hours 

out of an eight-hour workday, with no prolonged walking for more than about an 

hour at a time; sitting six out of eight hours with the ability to stand and stretch for 

no more than 10 percent of the day; no work hazards; and a restroom facility in 

close proximity. (AR 54-55.) This hypothetical, based on Plaintiff’s RFC, also 

limited her overhead reaching with her right extremity to occasional reaching. (AR 

55.) 

In response, the VE testified that there would be past work as actually 

performed but not as generally performed. (AR 55.) As for other unskilled light 

jobs in the national economy, the VE testified that other available jobs would 

include a mail clerk, a small parts assembler, and a garment folder. (AR 56.) 

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III. STANDARD OF REVIEW

A district court will not disturb the Commissioner’s decision unless it is based 

on legal error or not supported by substantial evidence. Smolen v. Chater, 80 F.3d 

1273, 1279 (9th Cir. 1996). Substantial evidence means more than a scintilla, but 

less than a preponderance. Id. Substantial evidence is evidence that a reasonable 

mind would consider adequate to support a conclusion. Id. The ALJ is responsible 

for determining credibility, resolving conflicts in medical testimony, and resolving 

ambiguities. Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir. 1995). If the 

evidence is subject to more than one rational interpretation, the ALJ’s conclusion 

must be upheld. Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir. 2005). 

The district court may enter a judgment affirming, modifying, or reversing 

the Commissioner’s decision. 42 U.S.C. § 405(g). The Court may also remand the 

matter to the Social Security Administration for further proceedings. Id.

IV. DISCUSSION

 Plaintiff challenges the ALJ’s adverse decision on two grounds. First, she 

contends a new medical examination that occurred after the ALJ’s decision issued 

explains why objective medical evidence did not exist to support many of her 

claimed impairments. Although, the ALJ did not have the opportunity to consider 

this post-decision medical evidence, Plaintiff contends this new medical evidence 

establishes that the ALJ’s RFC assessment was not based on substantial evidence. 

Second, she claims the ALJ erred when she concluded Plaintiff’s past work was 

“past relevant work” because she performed it at “substantial gainful activity” 

(“SGA”) levels. She claims her work never met minimum earnings thresholds for 

the relevant years and thus could not have qualified. The Court addresses the SGA 

issue first and recommends remand for further proceedings by the ALJ. As part of 

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that remand, the ALJ should also consider the new medical evidence and develop 

the record. 

A. Substantial Evidence Does Not Support the ALJ’s Finding that

Plaintiff’s Past Work Was Performed at a Substantial Gainful Activity 

Level; the Error Was Not Harmless; and the Matter Should be 

Remanded 

So long as a claimant has the RFC to carry out her past relevant work, she is 

not disabled. 20 C.F.R. § 404.1560(b)(3). In order for prior jobs to qualify as “past 

relevant work,” they must have been “substantial gainful activity.” Lewis v. Apfel, 

236 F.3d 503, 515 (9th Cir. 2001). Substantial gainful activity is defined as “work 

activity that involves doing significant physical or mental activities . . . that [a 

claimant does] for pay or profit.” 20 C.F.R. §§ 404.1572, 416.972. “Earnings can 

be a presumptive, but not conclusive, sign of whether a job is substantial gainful 

activity.” Lewis, 236 F.3d at 515. A presumption that a person engaged in 

substantial gainful activity is made if that person’s average monthly income 

attributable to that activity exceeds a certain average amount that is designated for 

each applicable calendar year and which vary depending on the year. 20 C.F.R. 

§§ 404.1574, 416.974; Keyes v. Sullivan, 894 F.2d 1053, 1056 (9th Cir. 1990). 

In her decision, the ALJ found Plaintiff’s past work as a caregiver qualified 

as “past relevant work” in part because she performed it “at the level of substantial 

gainful activity.”6

 (AR 27.) Plaintiff petitioned the Appeals Council to review the 

ALJ’s SGA finding, contending that her past work did not meet the minimum 

 

6

 The ALJ found: “Based on the evidence of record, the undersigned finds . . . 

[Plaintiff’s work as a caregiver] is past relevant work because the claimant 

performed it within 15 years of the date of this decision, for a sufficient length of 

time to learn and provide average performance, and at the level of substantial gainful 

activity.” (AR 27 (emphasis added).) 

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monthly earnings thresholds to qualify as such.7

 (AR 8.) The Appeals Council 

denied her request for review, and Plaintiff now again contends the ALJ erred in 

finding her past work was performed at SGA levels. 

Defendant contends Plaintiff waived this issue because she failed to raise it 

before the ALJ. In the alternative, Defendant contends the ALJ did not err and, in 

any event, error, if any, was harmless because the ALJ made an alternative finding 

at step five that Plaintiff could perform three jobs that are available in the national 

economy. Plaintiff preemptively addressed this harmless error argument in her 

MSJ, arguing that the ALJ’s step five findings were not based on substantial 

evidence and thus do not save the ALJ’s error at step four. Plaintiff is correct 

This Court first finds that Plaintiff did not waive the SGA issue. Second, 

substantial evidence does not support the ALJ’s conclusory finding that Plaintiff 

performed the caregiver work at SGA levels. Third, this error was not harmless. 

Finally, the Court recommends remand for further proceedings rather than ordering 

that disability benefits be granted. 

/ / / 

/ / / 

/ / / 

/ / / 

/ / / 

 

7

 Between 2001 and 2011, Plaintiff had earnings as a caregiver in nine years out of 

eleven years. (AR 8.) The minimum average monthly earnings thresholds for each 

year are as follows (with Plaintiff’s corresponding average monthly earnings in 

parentheses): 2001 $740 ($353.87); 2002 $780 ($765.61); 2004 $810 ($595.50); 

2005 $830 ($520.55); 2006 $860 ($616.58); 2008 $940 ($408.85); 2009 $980 

($591.15); 2010 $1,000 ($961.84); and 2011 $1,000 ($537.66). (Id.) Plaintiff 

duplicated the earnings comparison chart she provided to the Appeals Council in the 

MSJ now pending before the Court. (Doc. No. 13-1 at 8.) 

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1. Plaintiff Did Not Waive the SGA Issue 

 Although Defendant is correct that Plaintiff failed to raise the SGA issue 

before the ALJ, Plaintiff nonetheless did not waive it because she presented it to the 

Appeals Council when she sought review of the ALJ’s decision.8

Defendant contends that under Meanel v. Apfel, 172 F.3d 1111 (9th Cir. 

1999), Plaintiff waived the SGA issue because she did not raise it at the 

administrative hearing. In Meanel, the plaintiff argued that, contrary to the 

vocational expert’s testimony, the jobs the vocational expert identified did not exist 

in sufficient numbers in the local economy. 172 F.3d at 1115. In support, the 

plaintiff relied on new statistical evidence not provided to the ALJ at the hearing or 

to the Appeals Council. Id. The Ninth Circuit held that the plaintiff had not 

preserved this argument, explaining that “when claimants are represented by 

counsel, they must raise all issues and evidence at their administrative hearings in 

order to preserve them on appeal.” Id.

However, district courts in the Ninth Circuit have distinguished and declined 

to apply Meanel where the claimant failed to present an argument or issue to the 

ALJ but presented it to the Appeals Council in a subsequent request for review of 

 

8

 It appears Plaintiff may have implicitly agreed or at least assumed that the caregiver 

position was past relevant work and later ambushed the ALJ in her review request 

to the Appeals Council. Although she later protested to the Appeals Council that the 

work did not qualify (AR 8), in her initial letter-brief to the ALJ, she identified her 

prior work under the heading, “Past Relevant Work,” and simply contended she 

could “no longer perform past relevant work” due to her then-RFC. (AR 308.) This 

statement to the ALJ necessarily acknowledged or assumed that her past work was

“past relevant work” in the first place, and she never argued otherwise to the ALJ. 

Indeed, at the hearing, her attorney sat silently as the ALJ told the vocational expert 

that Plaintiff “worked as a caregiver. That’s the only occupation she’s had at SGA 

level . . . ,” and she never challenged this statement at any point in the hearing. (AR 

53-54 (emphasis added).) Nonetheless, there was no waiver here due to Plaintiff’s 

post-hearing letter-brief to the Appeals Council. 

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the ALJ’s decision. See, e.g., Gomez v. Berryhill, 2017 U.S. Dist. LEXIS 95882, at 

*5-6 (C.D. Cal. June 21, 2017); Ruiloba v. Colvin, 2016 U.S. Dist. LEXIS 70846, 

at *13-15 (C.D. Cal. May 31, 2016); Chin v. Colvin, 2015 U.S. Dist. LEXIS 43876, 

at *18-19 (D. Haw. Apr. 2, 2015). When district courts have applied Meneal, the 

claimant had failed to present the issue to both the ALJ and Appeals Council. See, 

e.g., Guerrero v. Colvin, 2017 U.S. Dist. LEXIS 64248, at *18-19 (S.D. Cal. Apr. 

26, 2017); Simpson v. Colvin, 2016 U.S. Dist. LEXIS 71648, at *3-4 (C.D. Cal. 

May 31, 2016); Harhaw v. Colvin, 2014 U.S. Dist. LEXIS 32256, at *13 (E.D. Cal. 

Mar. 10, 2014). Here, although Plaintiff failed to raise the SGA issue both in her 

letter-brief to the ALJ and during the hearing, she did raise it in her letter-brief to 

the Appeals Council. (AR 8.) Accordingly, the SGA issue is not waived. 

2. Substantial Evidence Does Not Support the ALJ’s Conclusory 

Finding that Plaintiff’s Past Work Was Performed at SGA Levels 

Without in-depth analysis or explanation, and in a conclusory fashion, the 

ALJ found Plaintiff’s past work as a caregiver qualified as “past relevant work” in 

part because she performed it “at the level of substantial gainful activity.” (AR 27; 

see also AR 53.) But she did not explain the specific bases behind this conclusion. 

Then for the first time, and after the ALJ had issued her decision, Plaintiff argued 

she did not perform her past work as the SGA level because her average monthly 

pay fell well below the presumptive minimum thresholds. (See Doc. No. 13-1 at 8 

(chart depicting SGA levels and shortfalls).) Defendant does not directly dispute 

that Plaintiff’s average monthly income fell below the average amounts for any of 

the nine years Plaintiff identified in her MSJ. See Doc. No. 15-1 at 17-18 (arguing 

that earnings are not presumptive proof of SGA but not challenging Plaintiff’s 

chart); see also Tables of SGA Earnings Guidelines and Effective Dates Based on

Year of Work Activity, Social Security Administration Program Operations Manual 

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System (“POMS”) § DI 10501.015(B), available at https://secure.ssa.gov/ 

poms.nsf/lnx/0410501015 (last visited July 11, 2017) (listing threshold earnings 

levels for years listed in Plaintiff’s chart). Instead, Defendant argues other factors—

the Lewis factors below—qualify the caregiver work as SGA. However, the ALJ 

did not address these factors—indeed, Defendant does not contend she did so—and 

the Court cannot affirm an ALJ’s decision based on reasons the ALJ did not cite. 

Stout v. Comm’r, SSA, 454 F.3d 1050, 1054 (9th Cir. 2006) (“[W]e cannot affirm 

the decision of an agency on a ground that the agency did not invoke in making its 

decision”); see also Steele v. Barnhart, 290 F.3d 936, 941 (7th Cir. 2002) 

(“[R]egardless whether there is enough evidence in the record to support the ALJ’s 

decision, principles of administrative law require the ALJ to rationally articulate the 

grounds for her decision and [courts] confine [their] review to the reasons supplied 

by the ALJ.”) (citing SEC v. Chenery Corp., 318 U.S. 80, 93-95 (1943) (other 

citations omitted)). 

Although it indeed appears Plaintiff did not meet the minimum average 

monthly income, see supra footnote 7, the ALJ stated that she had past relevant 

work as a caregiver without developing the record on, or even addressing, the SGA 

issue.9

 The ALJ could not have done so because the presumption that the position 

was SGA was no triggered by sufficient earnings. This was error. However, the 

SGA earnings consideration is merely one factor in the overall determination 

whether past work qualifies as past relevant work that a claimant may continue to 

 

9

 To be fair, Plaintiff provided the ALJ no reason to believe she contested this issue. 

She assumed her past work was “past relevant work” in her letter-brief to the ALJ 

and simply stated she could no longer perform that work. And she never contested 

the ALJ’s representation to the VE that the caregiver work was “the only occupation 

she’s had at SGA level.” (AR 53.) Plaintiff essentially allowed the ALJ to proceed 

down the path of error and then sprung the issue upon the Appeals Council after the 

ALJ’s decision issued. 

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perform—it is not the sole factor. As the Ninth Circuit has explained, when a 

claimant’s earnings fall below the presumptive SGA thresholds, 

The presumption that arises from low earnings shifts the stepfour burden of proof from the claimant to the Commissioner. Without 

the presumption, the claimant must produce evidence that he or she has 

not engaged in substantial gainful activity; if there is no such evidence, 

the ALJ may find that the claimant has engaged in such work. With the 

presumption, the claimant has carried his or her burden unless the ALJ 

points to substantial evidence, aside from earnings, that the claimant 

has engaged in substantial gainful activity. The regulations list five 

factors: the nature of the claimant’s work, how well the claimant does 

the work, if the work is done under special conditions, if the claimant 

is self-employed, and the amount of time the claimant spends at work. 

Generally, an ALJ should not consider activities like taking care of 

oneself, household tasks, hobbies, school attendance, club activities, or 

social programs to be substantial gainful activities. 

Lewis v. Apfel, 236 F.3d 503, 515-16 (9th Cir. 2001) (citations omitted). Because 

Plaintiff’s earnings did not exceed the minimum thresholds in the regulations, the 

presumption that the past work was SGA did not arise. It simply meant that the 

ALJ could not properly have concluded that the caregiver position was done at SGA 

levels and that she had the duty to inquire further and develop the record. At that 

point, the burden shifted to the ALJ to further inquire about Plaintiff’s past work, 

develop the record, and provide other reasons to explain how the past work was 

SGA despite the low earnings. The ALJ did not do so here and thus could not have 

found that the factors above favored an SGA determination despite insufficient 

earnings. Accordingly, substantial evidence does not support the ALJ’s finding that 

the caregiver position was “past relevant work” based, in part, on Plaintiff 

performing it at SGA levels. 

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 3. The Error Was Not Harmless 

 Defendant contends that any error at step four was harmless because the ALJ 

made alternative findings at step five that Plaintiff could perform three other jobs 

that are available in the national economy. (Doc. No. 15-1 at 18-19.) Thus, even if 

the ALJ erred at step four, the error was inconsequential to her ultimate finding that 

Plaintiff was not disabled. Plaintiff argues the ALJ relied on suspect testimony 

because the VE (1) stated there was no conflict between Plaintiff’s RFC and the 

Dictionary of Occupational Titles’ (“DOT”) description of these three jobs when 

(2) such a conflict in fact existed and was never resolved. (Doc. No. 13-1 at 10-

13.) As a result, she argues, the VE’s testimony is not substantial evidence for the 

ALJ’s step five findings. (Id.) Plaintiff is correct. Although the ALJ made 

alternative findings at step five, those findings do not find support in substantial 

evidence. As a result, the ALJ’s error at step four was not harmless because the 

ALJ also erred at step 5. 

 Harmless error principles apply in the context of the Social Security Act. 

Marsh v. Colvin, 792 F.3d 1170, 1172 (9th Cir. 2015). Error is harmless “where 

the mistake was nonprejudicial to the claimant or irrelevant to the ALJ’s ultimate 

disability conclusion,” Stout, 454 F.3d at 1055, or where it is “clear from the record 

that ‘the ALJ’s error was inconsequential to the ultimate nondisability 

determination.’” Tommasetti v. Astrue, 533 F.3d 1035, 1038 (9th Cir. 2008); see 

Parra v. Astrue, 481 F.3d 742, 747 (9th Cir. 2007); see also Batson v. Comm’r of 

SSA, 359 F.3d 1190, 1197 (9th Cir. 2004) (finding an error harmless where it did 

not negate the validity of the ALJ’s ultimate conclusion). Specifically relevant to 

the SGA issue in this case, if an ALJ errs at step four, the error is harmless when 

the ALJ makes alternative findings based on substantial evidence at step 5. 

Tommasetti, 533 F.3d at 1042-43. 

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At step five of the disability analysis, the burden shifts to the Commissioner 

to show the existence of other work in the national economy that a claimant can 

perform. See Pinto v. Massanari, 249 F.3d 840, 844 (9th Cir. 2001) (citing 20 

C.F.R. §§ 404.1520(f), 416.920(f)). To meet this burden, the Commissioner “must 

‘identify specific jobs existing in substantial numbers in the national economy that 

[the claimant] can perform despite [her] identified limitations.’” Zavalin v. Colvin, 

778 F.3d 842, 845 (9th Cir. 2015) (quoting Johnson v. Shalala, 60 F.3d 1428, 1432 

(9th Cir. 1995)). In making this determination, the ALJ relies on the DOT, which 

is the SSA’s “primary source of reliable . . . information” about jobs that exist in 

the national economy. Id. at 845-46 (citations omitted). In addition to the DOT, 

the ALJ relies on the testimony of vocational experts with respect to specific 

occupations that a claimant can perform in light of her RFC. Id. at 846 (citations 

omitted). The ALJ then determines “whether, given the claimant’s [RFC], age, 

education, and work experience, [the claimant] actually can find some work in the 

national economy.” Id. at 846 (citations omitted). Before relying on the testimony 

of a VE, an ALJ has an “affirmative responsibility to ask about any possible conflict 

between [the VE’s testimony] and information provided in the DOT.” Social 

Security Ruling (“SSR”) 00-4p, 2000 SSR LEXIS 8, at *8. 

The ALJ in this case considered at step five whether there were other jobs in 

the national economy that Plaintiff could perform. At the outset, the ALJ asked the 

VE to explain any conflict between her testimony and the DOT, and she agreed to 

do so. (AR 53.) The VE then testified—that taking Plaintiff’s RFC into account—

Plaintiff could perform the jobs of a “mail clerk” (DOT 209.687-026), a “small parts 

assembler” (DOT 929.587-010), and a garment folder (DOT 789.687-066). (AR 

56.) Based on the VE’s testimony, the ALJ found Plaintiff could perform these 

three jobs, that they existed in the national economy in sufficient numbers, and 

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accordingly found Plaintiff was not disabled. However, the three occupations the 

VE identified all had a key physical demand that plainly exceeded the RFC 

determined by the ALJ and given in the hypothetical questions propounded to the 

VE. (AR 54-55, 57-58.) 

Plaintiff’s RFC explicitly limited her to “reaching overhead with the right 

extremity” on only an occasional basis. (AR 55.) Reaching “occasionally” means 

the activity is done only “up to 1/3 of the day.” See SSR 83-10, 1983 SSR LEXIS 

30, at *13. However, all three jobs the VE identified exceeded Plaintiff’s RFC 

limitations. DOT 209.687-026 (mail clerk; frequent reaching, where “[a]ctivity or 

condition exists from 1/3 to 2/3 of the time”), DOT 929.587-010 (same for small 

parts assembler), DOT 789.687-066 (garment folder; constant reaching, where 

“[a]ctivity or condition exists 2/3 of the time or more”). Additionally, since Social 

Security Ruling 85-15 notes that “reaching” is “extending the hands and arms in 

any direction,” 1985 SSR LEXIS 20, at *18-19 (emphasis added), the necessary

implication is that all three jobs required frequent or constant reaching in all 

directions—a requirement Plaintiff cannot fulfill with her right arm. Thus, the 

reaching requirements of the three jobs the VE identified plainly conflicted with the 

reaching limitation in Plaintiff’s RFC.10 Additionally, the requirement that Plaintiff 

 

10 Numerous other district courts in this Circuit have found an apparent conflict 

existed where the ALJ limited a claimant to “occasional reaching” but a VE testified 

a worker with the limitation was able to perform work the DOT indicated required 

constant or frequent reaching. See, e.g., Murry v. Colvin, 2016 U.S. Dist. LEXIS 

12345, at *20-21 (E.D. Cal. Feb. 1, 2016); Lang v. Comm’r of Soc. Sec., 2014 U.S. 

Dist. LEXIS 48558, at *19-20 (E.D. Cal. Apr. 8, 2014); Giles v. Colvin, 2013 U.S. 

Dist. LEXIS 132188, at *9-11 (C.D. Cal. Sep. 10, 2013); Ricker v. Colvin, 2013 U.S. 

Dist. LEXIS 107372, at *17-19 (D. Or. May 24, 2013); Richardson v. Astrue, 2012 

U.S. Dist. LEXIS 138633, at *17-19 (N.D. Cal. Sept. 25, 2012); Duff v. Astrue, 2012 

U.S. Dist. LEXIS 122442, at *10-13 (C.D. Cal. Aug. 28, 2012); Bentley v. Astrue, 

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be able to reach in all directions conflicted with her inability to do so with her right 

arm. 

Given the above conflicts, the ALJ had a duty to ask follow-up questions to 

resolve the conflicts. The ALJ did not fulfill this duty. Cf. Lidster v. Astrue, 2012 

U.S. Dist. LEXIS 555, at *8-9 (S.D. Cal. Jan. 3, 2012) (Sabraw, J.) (“In her RFC 

determination, the ALJ had found that Plaintiff was limited by ‘no reaching above 

the shoulder level on the right.’ The ALJ questioned [the VE] about the reaching 

requirement, and determined that the reaching was not repetitive and could be done 

with either hand. Plaintiff had no limitations on reaching with his left hand. [¶] 

[T]he ALJ fulfilled her duty of questioning the vocational expert regarding any 

conflict between the DOT definition and Plaintiff’s limitations.”) (emphasis added). 

Neither the ALJ nor the VE discussed the evident inconsistencies between the 

reaching requirements listed in the DOT and the reaching limitation imposed in the 

RFC. The ALJ’s failure to do so meant that her findings at step five were not based 

on substantial evidence, and, as a result, her SGA error in step four was not 

harmless.11

 

2011 U.S. Dist. LEXIS 77042, at *9-11 (C.D. Cal. July 14, 2011); Hernandez v. 

Astrue, 2011 U.S. Dist. LEXIS 6377, at *4-6 (C.D. Cal. Jan. 21, 2011). 

11 The Court acknowledges that under some circumstances, the Court may rely on 

its common experience and find that no apparent conflict exists between a DOT 

occupation and a claimant’s limitation. See, e.g., Gutierrez v. Colvin, 844 F.3d 804, 

808-09 (9th Cir. 2016). In Gutierrez, the court relied on common experience with 

the “familiar” occupation of cashiering to find that the occupation did not require 

overhead reaching. Id. at 808. As a result, the court reasoned that the ALJ did not 

have an obligation to ask follow-up questions where the “frequency or necessity of 

a task is unlikely and unforeseeable” as it was “with cashiers having to reach 

overhead.” Id. Here, the Court cannot do the same with the occupations the VE 

identified because they are not readily familiar occupations. 

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Defendant contends that no conflict exists here because the VE agreed to 

identify any conflicts at the beginning of her testimony and then did not identify 

any conflicts, the implication being that a conflict must not have existed since the 

VE did not identify one. This is unpersuasive given that a conflict is plainly evident 

from the text of the DOT and Social Security Ruling 85-15. The VE not identifying 

a conflict either means that no conflict existed or she failed to recognize and identify 

one. The latter is a much more reasonable interpretation under the circumstances 

of this case. Even if no conflict existed in the view of the VE, one certainly seems 

apparent given the DOT requirements for the three jobs, Plaintiff’s RFC, and the 

ALJ’s hypothetical. It was therefore incumbent upon either the ALJ or the VE to 

affirmatively identify the conflict and address it rather than leave the record 

uncertain about what the VE actually believed about the conflict and whether 

Plaintiff could perform the jobs she identified despite the apparent conflict. 

Defendant also notes that the ALJ’s RFC assessment “did not endorse a 

limitation to frequent or constant reaching in general, but only to overhead reaching 

with the right extremity.” (Doc. No. 15-1 at 14-15 (emphasis in general).) This 

simply underscores the fact that the VE should have identified and then been asked 

about the conflict between the reaching requirements in the DOT and Plaintiff’s 

reaching limitation given that the ALJ specifically informed the VE about Plaintiff’s 

overhead reaching limitation. The VE indeed may have excluded all jobs that 

required significant overhead reaching, but that is not at all evident from the record. 

The ALJ did not expressly instruct the VE to exclude such jobs, and the VE did not 

state she had done so. 

4. Remand for Further ALJ Proceedings 

In social security cases, remand may be for additional proceedings or for an 

award of benefits. Garrison v. Colvin, 759 F.3d 995, 1019 (9th Cir. 2014) 

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(explaining that if “additional proceedings can remedy defects in the original 

administrative proceeding, a social security case should be remanded[,]” but “in 

appropriate circumstances courts are free to reverse and remand a determination by 

the Commissioner with instructions to calculate and award benefits”) (internal 

quotation marks omitted). “Courts have generally exercised this power [to grant 

benefits] when it is clear from the record that a claimant is entitled to benefits, 

observing on occasion that inequitable conduct on the part of the Commissioner can 

strengthen, though not control, the case for such a remand.” Id.

To determine which type of remand is appropriate, the Ninth Circuit uses a 

three-part test. Id. at 1020. First, the record must be fully developed and further 

administrative proceedings would serve no useful purpose. Garrison, 759 F.3d at 

1020. Second, the ALJ must fail to provide legally sufficient reasons for rejecting 

evidence, whether claimant testimony or medical opinion. Id. Third, if the case is 

remanded and the improperly discredited evidence is credited as true, the ALJ 

would be required to find the claimant disabled. Id. To remand for an award of 

benefits, each part of this test must be satisfied. Id. If the record is “uncertain and 

ambiguous,” the matter is properly remanded for further proceedings. Treichler v. 

Comm’r of SSA, 775 F.3d 1090, 1105 (9th Cir. 2014). 

As explained above, the mere fact that Plaintiff’s earnings appear to be below 

the SGA thresholds is not dispositive of whether her caregiver work qualifies as 

past relevant work. The pertinent error in this case is the ALJ’s step four finding 

that Plaintiff’s caregiver work was performed at the SGA level and the subsequent 

failure to inquire into various relevant SGA factors. See Lewis v. Apfel, 236 F.3d 

503, 515-16 (9th Cir. 2001) (identifying factors). Although the ALJ erred when she 

did not develop the record and consider the factors in Lewis, the error does not 

conclusively favor Plaintiff or compel the automatic grant of benefits. Moreover, 

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the apparent conflict between the VE’s opinion and the DOT also merit further 

exploration and clarification. It is not clear from such an undeveloped record that 

Plaintiff is entitled to benefits. Accordingly, the Court cannot proceed past the first 

step of the test in Garrison because the record is uncertain, not fully developed, and 

additional administrative proceedings are required. This Court recommends 

remand for further proceedings and findings by the ALJ on the SGA issue. 

B. On Remand the ALJ Should Also Consider Dr. Kotha’s Assessment 

 Plaintiff’s challenge to the ALJ’s RFC assessment is very narrow and based 

solely on a single medical report generated after the hearing and submitted to the 

Appeals Council after the ALJ’s decision had already issued.12 (See AR 569-73.) 

Rather than argue that the ALJ erred in finding that many of her claimed 

impairments were non-severe, she appears to acknowledge that this finding was 

correct at the time the ALJ made her findings, but argues that the new medical 

assessment by Dr. Akther Kotha explains why no objective medical evidence 

existed to support those impairments. (See Doc. No. 13-1 at 5 (“The ALJ found 

many of the impairments non[-]severe because of [the] lack of objective medical 

evidence. The diagnosis of Fibromyalgia a month after the unfavorable decision[] 

reasonably answers the question . . . why no objective evidence exists.”) (emphasis 

added).) She contends that this new evidence renders the ALJ’s RFC assessment 

unsupported by substantial evidence and asks the Court to remand the matter to 

allow the ALJ to consider Dr. Kotha’s assessment as part of her RFC analysis. This 

is an appropriate course of action. 

 

12 Plaintiff also does not challenge the ALJ’s RFC assessment based on the evidence 

the ALJ actually had before her and was able to consider. Her challenge of the ALJ’s 

RFC finding is limited to reliance on post-hearing medical evidence that she claims 

undermines the RFC finding. 

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 Although Dr. Kotha did not generate her assessment until after the ALJ’s 

decision issued, that evidence is part of the record in this case because the Appeals 

Council considered it in its decision to deny Plaintiff’s request for review. Brewes 

v. Comm’r of SSA, 682 F.3d 1157, 1160-61, 1163 (9th Cir. 2012) (holding that when 

a claimant submits evidence for the first time to the Appeals Council, which 

considers that evidence in denying review of the ALJ’s decision, the new evidence 

is part of the administrative record, which the district court must consider in 

determining whether the Commissioner’s decision is supported by substantial 

evidence.”).13 Defendant contends that the record as a whole supports the ALJ’s 

findings even when Dr. Kotha’s assessment is considered. That, however, is not 

readily apparent to this Court given the nature of Fibromyalgia and Plaintiff’s 

claimed impairments. See generally Benecke v. Barnhart, 379 F.3d 587, 589-90 

(9th Cir. 2004) (“fibromyalgia . . . [is] a rheumatic disease that causes inflammation 

of the fibrous connective tissue components of muscles, tendons, ligaments, and 

other tissue. Common symptoms . . . include chronic pain throughout the body, 

multiple tender points, fatigue, stiffness, and a pattern of sleep disturbance that can 

exacerbate the cycle of pain and fatigue associated with this disease.”). Although 

Plaintiff appears to experience some of the symptoms of Fibromyalgia, Dr. Kotha’s 

report is ambiguous and is not conclusive. For example, it is unclear whether Dr. 

 

13 Defendant contends the Court lacks jurisdiction to review the Appeals Council’s 

decision denying review of the ALJ’s decision because the Council’s decision is an 

unreviewable non-final agency action. (Doc. No. 15-1 at 12.) However, the Court 

is not reviewing the Appeals Council’s decision and acknowledges that the ALJ’s 

decision is the only agency action being reviewed in this matter. Yet, that doesn’t 

place Dr. Kotha’s report out of this Court’s reach. As Defendant acknowledges, 

Brewes clearly requires the Court to consider Dr. Kotha’s report as part of its review 

of the ALJ’s decision—Dr. Kotha’s report is part of the administrative record under 

the circumstances of this case. 

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Kotha’s report is actually a Fibromyalgia diagnosis. While it appears she concludes 

that Plaintiff has this condition (see AR 573), it also appears she may have believed 

Plaintiff had been diagnosed with the condition in the past (see AR 569 

(summarizing that Plaintiff “was dx [or diagnosed] with Fibro as well” and had been 

taking Lyrica)). But the record does not reflect Plaintiff being diagnosed with 

Fibromyalgia before Dr. Kotha’s assessment.14 Given these observations, the Court 

is reluctant to fully credit Dr. Kotha’s report on a cold record. There may be factors 

or circumstances that affect the report’s reliability or credibility. However, the 

Court is not in the best position to evaluate these concerns and determine this 

report’s ultimate import. The ALJ, who made the initial RFC decision after a full 

hearing and based on the medical record, is in the best position to consider the 

ultimate impact of Dr. Kotha’s assessment on the ALJ’s own RFC findings. See 

Allen v. Sec’y of Health & Human Servs., 726 F.2d 1470, 1473 (9th Cir. 1984) (“It 

is the ALJ’s role to resolve evidentiary conflicts.”). Not having had the benefit of 

Dr. Kotha’s assessment, the ALJ should be afforded the opportunity to consider it 

given the recommendation above that the matter be remanded for further 

proceedings. 

Ultimately, although Dr. Kotha’s report may support Plaintiff’s claimed 

impairments, there may be qualitative issues with the report itself. This Court 

should not be the first to resolve these issues. That initial analysis should be left to 

the ALJ, who will have the benefit of being able to further explore Dr. Kotha’s 

 

14 Even assuming that Dr. Kotha’s assessment was a formal Fibromyalgia diagnosis, 

a diagnosis alone is not dispositive. See Matthews v. Shalala, 10 F.3d 678, 680 (9th 

Cir. 1993) (mere existence of impairment is insufficient proof of a disability; 

claimant bears the burden of proving that an impairment is disabling). The mere 

existence of this report does not necessarily mean that Plaintiff is disabled, and the 

Court is not persuaded that this report conclusively has the meaning Plaintiff assigns 

it. 

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report and possibly seek medical expert testimony at the remand hearing if 

necessary. Remand is therefore appropriate because the record is not fully 

developed with respect to Dr. Kotha’s report, any Fibromyalgia diagnosis, and their 

impact on the ALJ’s assessment. Additional administrative proceedings would 

therefore be helpful both to the proceedings below and an eventual second judicial 

review, if any, by this Court. 

C. Defendant is Not Entitled to Summary Judgment

Based on the foregoing recommendation that Plaintiff’s MSJ be granted and 

this matter be remanded for further proceedings, this Court necessarily recommends 

that Defendant’s Cross-MSJ be DENIED. 

VI. CONCLUSION

 This Court RECOMMENDS that Plaintiff’s MSJ be GRANTED, that 

Defendant’s Cross-MSJ be DENIED, and the matter be REMANDED for further 

proceedings by the ALJ. 

This Report and Recommendation is submitted to the United States District 

Judge assigned to this case, pursuant to the provisions of 28 U.S.C § 636(b)(1) and 

Federal Rule of Civil Procedure 72(b). 

IT IS ORDERED that no later than July 25, 2017, any party to this action 

may file written objection with the Court and serve a copy on all parties. The 

document shall be captioned “Objections to Report and Recommendation.” The 

parties are advised that failure to file objections within the specific time may waive 

the right to raise those objections on the appeal. 

/ / / 

/ / / 

/ / / 

/ / / 

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IT IS FURTHER ORDERED that, in consultation with the District Judge 

assigned to this matter, no reply briefs will be accepted. 

IT IS SO ORDERED.

DATED: July 11, 2017 

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