Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caed-1_06-cv-00527/USCOURTS-caed-1_06-cv-00527-0/pdf.json

Nature of Suit Code: 863
Nature of Suit: Social Security - DIWC/DIWW (405(g))
Cause of Action: 42:405 Review of HHS Decision (DIWC)

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 Michael J. Astrue is substituted for his predecessor, Jo Anne B. Barnhart, as Commissioner of the Social 1

Security Administration. 42 U.S.C. § 405(g); Fed. R. Civ. P. 25(d)(1). 

1

IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA

URBANO JIMENEZ, Case No. 06-cv-0527 LJO TAG

Plaintiff, FINDINGS AND RECOMMENDATIONS

ON PLAINTIFF’S APPEAL FROM A

vs. FINAL ADMINISTRATIVE DECISION

(Doc. 1)

MICHAEL J. ASTRUE,1

Commissioner of Social Security,

Defendant.

 /

Plaintiff Urbano Jimenez (“Plaintiff” or “Claimant”) seeks judicial review of an

administrative decision denying his claims for disability insurance benefits (“DIB”) under Title II of

the Social Security Act (“the Act”), 42 U.S.C. § 401 et seq., and for supplemental security income

(“SSI”) under Title XVI of the Act, 42 U.S.C. § 1381 et seq. (collectively “disability benefits”). 

(Doc. 1). Pending before the Court is Plaintiff’s appeal from the administrative decision of the

Commissioner. Plaintiff filed his complaint on April 29, 2006 (Doc. 1), and his opening brief on

January 13, 2007. (Doc. 17). The Commissioner filed his opposition on February 1, 2007. (Doc.

18). Plaintiff did not file a reply brief.

JURISDICTION

On November 1, 2002, Claimant filed applications for DIB and SSI alleging disability based

on neck pain following treatment for a December 8, 1999 work-related accident which resulted in

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28 Claimant protectively filed his SSI application on October 17, 2002. (AR 432). 2

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him suffering a broken back. Claimant’s alleged an onset date of December 8, 1999. 2

(Administrative Record (“AR”) 70-72, 76, 433-435). His DIB and SSI applications were considered

concurrently. (See, e.g., AR 55, 436). Claimant’s applications were denied initially and on

reconsideration. (AR 38, 49, 55-58, 60-64, 436-437). After timely requesting a hearing, Claimant,

his attorney, and an interpreter appeared before Administrative Law Judge (“ALJ”) James Ross on

September 3, 2004. (AR 65, 438-454). ALJ Ross found that Claimant was not disabled in a written

decision dated October 28, 2004. (AR 16-22). The Appeals Council denied Claimant’s request for

review on May 2, 2005. (AR 6-8). The ALJ’s decision, therefore, became the final decision of the

Commissioner, which is appealable to the district court pursuant to 42 U.S.C. § 405(g). The

initiation of an appeal in the district court must be commenced within sixty (60) days of the Appeal

Council’s decision. Id. On March 31, 2006, the Appeals Council granted Claimant’s request for an

extension of time to file his civil complaint. (AR 5). On March 29, 2006, Plaintiff timely filed this

action. (Doc. 1).

STATEMENT OF FACTS

The relevant facts have been presented in the administrative hearing transcript, the ALJ’s

decision, and the Plaintiff’s and the Commissioner’s briefs, and only will be summarized here. To

the extent necessary, additional facts will be addressed in this Court’s analysis.

As an initial matter, Claimant filed a prior application for DIB on January 18, 2001. (AR 32). 

After his claim was denied initially and on reconsideration, Claimant appeared for an administrative

hearing before ALJ Michael J. Haubner on June 13, 2002. (Id.). During that hearing, a vocational

expert testified in addition to Claimant, who testified with the assistance of an interpreter, and

Claimant’s attorney was present. (Id.). On June 28, 2002, ALJ Haubner issued a written decision in

which he found that, given his physical limitations, Claimant retained the residual functional

capacity (“RFC”) to perform light work with some restrictions. (See AR 32-37). After ascertaining

that there were jobs that were available in the national economy that Claimant could perform, ALJ

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Haubner concluded that Claimant was not entitled to disability benefits. (Id.). There is no indication

that Claimant appealed ALJ Haubner’s decision. (See generally AR). 

Plaintiff was born on November 9, 1960, making him almost 44 years old at the time of ALJ

Ross’s October 28, 2004 decision. (AR 70, 433, 442). At the hearing, Plaintiff testified that he

attended school in Mexico through the sixth grade. (AR 442). He denied being able to speak basic

English or that he previously testified that he spoke English 30% of the time when he worked,

claiming that he knew only a little English. (AR 447-448). Regarding his work history, Claimant

testified that he last worked in 1999, when he was involved in a work-related accident. (AR 442). 

Because he was receiving Workers’ Compensation from the accident, he was given the opportunity

to attend Vocational Rehabilitation, but the course he was sent to was for lawnmower repair, which

he physically could not do because it bothered his neck to lift the machines or use the pull-start. (AR

446-447). 

As to his daily life activities, Claimant testified that he lives with his wife and their four

children, whose ages range between three and nineteen years old. (AR 442). He added that his wife

takes their three-year-old son to daycare when she goes to her job working in the fields. (AR 442-

443). Claimant reported that he receives $637 every two weeks in disability payments from Workers

Compensation, which is more money than he earned in the past, but which, he stated, may end once

his case is closed. (AR 448-449, 451). Claimant added that the doctors he saw for his Workers

Compensation case did not think he would be able to work again. (AR 451). He also testified that,

during the majority of the day, he lies on the floor to avoid hurting his neck. (AR 443). According

to Claimant, he watches the news on the television, but does not read or listen to the radio. (AR

444). He testified that he has tried, but is unable to do housework or chores, providing as an

example that he attempted to do some light yard work but it bothered his neck. (AR 443-444). 

Claimant added that he sometimes accompanies his wife when she goes grocery shopping, and he

tries to carry the light bags. (Id.). He further stated that he drives approximately thirty minutes over

an eight day span of time, but it scares him because he cannot turn his head to look at other moving

vehicles due to his pain. (AR 443). Claimant admitted that he had never had an activity that he

enjoyed except his job. (AR 445). 

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With respect to his limitations, Claimant stated that his neck pain is constant, with or without

medication, and it interferes with his ability to sit or stand. (AR 446). He added, however, that it

improves when he lies flat on the ground. (Id.). Claimant testified that the surgery he underwent on 

January 14, 2004, did not alleviate the pain and, when confronted with the surgeon’s follow-up

treatment notes, which reported that Claimant stated he had less pain with neck movement, the

improvement actually related to the removal of the lump such that he was able to move his neck

again, not any alleviation of the pain, which remained the same. (AR 449-450). Claimant further

testified he took pills and received monthly injections in his back for pain. (AR 452). In addition, he

started physical therapy in March 2004, which helps while he is undergoing treatment. (AR 453). 

Claimant also testified that he suffers from depression, for which he was referred to

Dr. Francisco Montalvo. (AR 445). According to Claimant, he takes the prescribed psychotropic

medication, which causes no adverse side effects, but he is not sure whether the medicine provides

any relief because he still has good and bad days. (Id.). In addition, he testified that he often cannot

sleep for more than four hours, if at all, and he does not sleep during the day. (AR 445-446). 

STANDARD OF REVIEW

Congress has provided a limited scope of judicial review of a Commissioner’s decision. See,

42 U.S.C. § 405(g). A court must uphold the Commissioner’s decision, made through an ALJ, when

the determination is not based on legal error and is supported by substantial evidence. See Ukolov v.

Barnhart, 420 F.3d 1002, 1004 (9th Cir. 2005)(quotations and citations omitted); Jones v. Heckler,

760 F.2d 993, 995 (9th Cir. 1985); 42 U.S.C. § 405(g). Substantial evidence is more than a mere

scintilla, Sorenson v. Weinberger, 514 F.2d 1112, 1119 n.10 (9th Cir. 1975), but less than a

preponderance. McAllister v. Sullivan, 888 F.2d 599, 601-602 (9th Cir. 1989); Desrosiers v. Sec’y

of Health and Human Servs., 846 F.2d 573, 576 (9th Cir. 1988). Substantial evidence “means such

evidence as a reasonable mind might accept as adequate to support a conclusion.” Richardson v.

Perales, 402 U.S. 389, 401, 91 S.Ct. 1420 (1971) (citations omitted). “[S]uch inferences and

conclusions as the [Commissioner] may reasonably draw from the evidence” will also be upheld. 

Mark v. Celebrezze, 348 F.2d 289, 293 (9th Cir. 1965). On review, the court considers the record as

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5

a whole, not just the evidence supporting the decision of the Commissioner. Weetman v. Sullivan,

877 F.2d 20, 22 (9th Cir. 1989) (citing Kornock v. Harris, 648 F.2d 525, 526 (9th Cir. 1980)).

It is the role of the trier of fact, not this Court, to resolve conflicts in evidence. Richardson,

402 U.S. at 400, 91 S. Ct. at 1426-1427. If evidence supports more than one rational interpretation,

the Court must uphold the decision of the ALJ. Allen v. Heckler, 749 F.2d 577, 579 (9th Cir. 1984). 

Moreover, if there is substantial evidence to support the administrative findings, or if there is

conflicting evidence that will support a finding of either disability or nondisability, the finding of the

Commissioner is conclusive. Sprague v. Bowen, 812 F.2d 1226, 1229-1230 (9th Cir. 1987). 

Nevertheless, a decision supported by substantial evidence will be set aside if the proper legal

standards were not applied in weighing the evidence and making the decision. Brawner v. Sec’y of

Health and Human Servs., 839 F.2d 432, 433 (9th Cir. 1987).

RELEVANT LEGAL FRAMEWORK

The Social Security Act defines “disability” as the “inability to engage in any substantial

gainful activity by reason of any medically determinable physical or mental impairment which can be

expected to result in death or which has lasted or can be expected to last for a continuous period of

not less than twelve months.” 42 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(A). The Act also provides

that a claimant shall be determined to be under a disability only if his impairments are of such

severity that he is not only unable to do his previous work but cannot, considering his age, education

and work experiences, engage in any other substantial gainful work which exists in the national

economy. 42 U.S.C. §§ 423(d)(2)(A), 1382c(a)(3)(B).

Sequential Evaluation Process

The Commissioner has established a five-step sequential evaluation process for determining

whether a person is disabled. 20 C.F.R. §§ 404.1520, 416.920. Step one determines if the claimant

is engaged in substantial gainful activities. If he is, benefits are denied. 20 C.F.R. §§ 404.1520(b),

416.920(b). If he is not, the decision maker proceeds to step two, which determines whether the

claimant has a medically severe impairment or combination of impairments. 20 C.F.R. §§

404.1520(c), 416.920(c).

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If a claimant does not have a severe impairment or combination of impairments, the disability

claim is denied. If the impairment is severe, the evaluation proceeds to the third step, which

necessitates that the claimant’s impairment be compared with a number of listed impairments

acknowledged by the Commissioner to be so severe as to preclude substantial gainful activity. 20

C.F.R. §§ 404.1520(d), 416.920(d); 20 C.F.R. Pt. 404, Subpt. P, App. 1. If the claimant’s

impairment meets or equals one of the listed impairments, the claimant is conclusively presumed to

be disabled. If the impairment is not one conclusively presumed to be disabling, the evaluation

proceeds to the fourth step, which determines whether the impairment prevents the claimant from

doing work performed in the past. If the claimant is able to perform his previous work, he is not

disabled. 20 C.F.R. §§ 404.1520(e), 416.920(e). If the claimant cannot perform this work, the fifth

and final step in the process determines whether he is able to perform other work in the national

economy in view of his age, education and work experience. 20 C.F.R. §§ 404.1520(f), 416.920(f). 

See Bowen v. Yuckert, 482 U.S. 137, 140-142, 107 S. Ct. 2287, 2291 (1987).

The initial burden of proof rests upon the claimant to establish a prima facie case of

entitlement to disability benefits. Rhinehart v. Finch, 438 F.2d 920, 921 (9th Cir. 1971). In terms of

the five step sequential evaluation process, the Ninth Circuit has held that “[t]he burden of proof is

on the claimant as to steps one to four,” while at the same time noting that an ALJ’s “affirmative

duty to assist a claimant to develop the record . . . complicates the allocation of burdens” such that

“the ALJ shares the burden at each step.” Tackett v. Apfel, 180 F.3d 1094, 1098 & n.3 (9th Cir.

1999)(italics in original). The initial burden is met once a claimant establishes that a physical or

mental impairment prevents him from engaging in his previous occupation. Kail v. Heckler, 722

F.2d 1496, 1498 (9th Cir. 1984). At step three, however, the claimant bears the burden to

demonstrate that his impairment(s) meet or equal one of the listings, rendering him presumptively

disabled. Benten ex rel. Benton v. Barnhart, 331 F.3d 1030, 1034 (9th Cir. 2003). The burden then

shifts to the Commissioner to show (1) that the claimant can perform other substantial gainful

activity and (2) that a “significant number of jobs exist in the national economy” which claimant can

perform. Kail, 722 F.2d at 1498. 

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 The ALJ determined that Plaintiff had worked the requisite period of time to gain insured status for eligibility 3

for DIB benefits at least through the October 28, 2004 date of his written decision. (AR 16). 

 AR 97-4(9) was adopted in response to Chavez v. Brown, 844 F.2d 691 (9th Cir. 1988), and explains how the 4

holding in Chavez is to be applied, noting that it is applicable only to 9th Circuit cases. See AR 97-4(9), 1997 WL

742748. Acquiescence Rulings “are binding on all components of the Social Security Administration,” and accorded

deference by a reviewing court. 20 C.F.R. § 402.35(b); McNabb v. Barnhart 340 F.3d 943, 944 (9th Cir. 2003).

7

ADMINISTRATIVE FINDINGS3

The ALJ indicated that claimant had filed a prior disability application which was denied on

June 28, 2002, with a finding that Claimant retained the RFC to perform light work with some

restrictions and, accordingly, he was not disabled. (AR 16). The ALJ noted that, under

Acquiescence Ruling (“AR”) 97-4(9), he was required to apply a presumption of continuing 4

nondisability from June 29, 2002 through the date of his decision unless that Claimant rebutted the

presumption with evidence of “changed circumstances.” (Id.). ALJ Ross concluded that Claimant

failed to demonstrate that his condition had worsened sufficiently to rebut the presumption of

continuing nondisability, as discussed further in this document. (Id.; see below). 

ALJ Ross found at step one that Plaintiff has not engaged in substantial gainful activity since

his alleged onset date of December 8, 1999. (AR 17, 21). At step two, the ALJ determined that

Claimant is “status post C5 crush injury and anterior fusion at C4-6,” which are severe impairments,

and also suffered from depression, which is well-controlled with medication and only minimally

affects his ability to work. (AR 17, 21). At step three, the ALJ found that Plaintiff “does not have

any impairment or combination of impairments meeting or equaling the criteria under any section of

Appendix 1, Subpart P, Regulations No. 4.” (AR 17, 21). The ALJ discussed in detail the medical

records, opinions, and assessments by Claimant’s treating and non-treating physical and mentalhealth professionals, noting the inconsistencies between them and the contradictions between the

records and Claimant’s testimony. (See AR 17-21). 

After determining that Claimant retained the residual functional capacity (“RFC”) to sit,

stand, and walk six hours in an eight hour day and to lift and carry ten pounds frequently and twenty

pounds occasionally, but that Claimant could not engage in repetitive neck rotations or extensions,

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 Plaintiff presents an issue, in one line, that ALJ Ross did not “properly consider reopening.” (Doc. 17, p. 4). 5

He does not further address this alleged error, nor is there any record evidence that Plaintiff asked that the previous ALJ

decision be reopened. (See Doc. 17; AR). The Social Security Administration may reopen an agency determination

within specified time limits after the date of the initial decision: twelve months as a matter of right and four years “upon a

finding of good cause,” which exists if new material evidence is provided or specific errors are discovered. 20 C.F.R. §§

404.987-404.989, 416.1487-416.1489. Moreover, this Court lacks jurisdiction to order a case reopened or to review the

denial of a request to reopen in the absence of a challenge based on constitutional grounds. Califano v. Sanders, 430

U.S. 99, 104-108 (1977). Accordingly, even had Plaintiff requested the agency to reopen the 2002 decision, this Court

likely would not have been able to review his argument, had he made one. 

8

the ALJ found that Plaintiff’s allegations regarding the limitations of his impairments were not

wholly credible when assessed in accordance with Social Security Ruling (“SSR”) 96-7p. (AR 21). 

At step four, the ALJ determined that Plaintiff could not return to his past relevant work, as defined

in 20 C.F.R. §§ 404.1565 and 416.965. (AR 21). At step five, the ALJ noted Plaintiff’s age,

minimal education, and inability to communicate in English, and, using Rule 202.18 of the MedicalVocational Guidelines as a framework, he concluded that there were a significant number of jobs in

the national economy that Plaintiff could perform and, thus, Claimant was not disabled. (AR 21-22). 

Accordingly, the ALJ determined that Plaintiff was not eligible for DIB or SSI payments. (AR 22). 

ISSUES

In his opening brief, Plaintiff raises the following alleged errors for consideration:

A. The ALJ erroneously applied the law regarding a presumption of continuing

nondisability;5

B. The ALJ failed to fully consider the mental health record and erroneously applied

Workers Compensation assessments to determine Claimant’s Residual Functional Capacity; 

C. The ALJ ignored the opinion of treating psychiatrist Dr. Montalvo without providing an

adequate explanation; and

D. The ALJ erroneously found Plaintiff’s testimony less then credible. 

This Court must uphold the Commissioner’s determination that a claimant is not disabled if

the Commissioner applied the proper legal standards and there is substantial evidence in the record

as a whole to support the decision.

DISCUSSION

A. Presumption of Continuing Nondisability

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1. Improper consideration of new evidence

Plaintiff first contends that the ALJ ignored the new evidence proving that he suffered from

an additional ailment – depression – as well as documentation evidencing that his physical condition 

had worsened. (Doc. 17, pp. 5-6). According to Plaintiff, these records, especially those regarding

his mental health, constitute new and material evidence because they were not considered by ALJ

Haubner, but ALJ Ross did not recognize their importance because he had not view them in relation

to ALJ Haubner’s 2002 decision. (Id.). Plaintiff, therefore, asserts that these records were sufficient

to rebut the presumption of continuing nondisability, rendering ALJ Ross’ application of said

presumption erroneous. (Id.). 

An administrative decision denying disability benefits that the claimant does not appeal

operates as res judicata as to the finding of nondisability through the date of the prior decision. 

Although applied less rigidly to administrative than to judicial proceedings, the principles of res

judicata apply to administrative decisions. Chavez v. Bowen, 844 F.2d 691, 693 (9th Cir. 1988);

Gregory v. Bowen, 844 F.2d 664, 666 (9th Cir. 1988). 

This binding determination of nondisability also creates a presumption of continuing

nondisability with respect to the period after the date of the prior decision. See Lester v. Chater, 81

F.3d 821, 827 (9th Cir. 1995); Miller v. Heckler,770 F.2d 845, 848 (9th Cir. 1985); Lyle v. Secretary

of Health & Human Servs., 700 F.2d 566, 568-569 (9th Cir. 1983). The presumption does not apply,

however, if there are “changed circumstances.” Taylor v. Heckler, 765 F.2d 872, 875 (9th Cir.

1985). Thus, the presumption may be overcome by a showing of “changed circumstances,” such as

new and material changes to the claimant’s residual functional capacity (“RFC”), age, education, or

work experience. Lester, 81 F.3d at 827-828 (9th Cir. 1995); Chavez, 844 F.2d at 693; Lyle, 700

F.2d at 568 n. 2. Accordingly, res judicata does not apply when the claimant raises an issue not

considered in the previous decision, such as the existence of a new impairment, or demonstrates an

increase in the severity of an impairment, either one of which adversely affects his RFC. Lester, 81

F.3d at 827 (citations omitted). Nor is it applicable when a change in the claimant’s circumstances

constitutes a categorical change under the Grids, such as a change in claimant’s age category. Id.,

citing Chavez, 844 F.3d at 693. 

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Claimant’s assertion that his depression is a new impairment arguably is faulty as a matter of

fact given that, in the prior decision, the ALJ discussed a June 25, 2001 report prepared by

examining psychiatric consultant Dr. Kenneth Gottlieb, who opined that any psychological

disturbances suffered by Plaintiff were a component of his general pain disorder as opposed to

disabling psychiatric problems. (See AR 34). In addition, Claimant fails to explain why treating

psychiatrist Francisco E. Montalvo’s April 2002 mental health evaluation, in which Dr. Montalvo

reported that Claimant suffered from depression, or the March 2002 diagnostic test results, which

similarly indicated symptoms of depression, anxiety, or schizoid personality disorders, apparently

had not been submitted to ALJ Haubner for consideration. (See AR 230-246). To the extent that

Claimant contends that both his depression and physical condition had worsened since the prior

decision, however, ALJ Ross properly considered whether the alleged increase in the severity of

Claimant’s impairments constituted “changed circumstances” that would negate his obligation to

apply res judicata to the prior decision. Lester, 81 F.3d at 827.

Here, ALJ Ross initially noted that, since June 29, 2002 – the day after the first decision was

issued – the record was devoid of “any new or material evidence warranting a change in” Claimant’s

RFC and, accordingly, he would apply the presumption of continuing nondisability. (AR 16). With

respect to Claimant’s allegations of depression as a new ailment that limited his ability to work, ALJ

Ross noted that treating psychiatrist Dr. Francisco Montalvo’s April 2002 evaluation indicated that

Claimant’s moderate-to-severe depression resulted from his financial problems and worsening

physical problems, adding that Claimant reported that psychotropic medications helped alleviate his

symptoms. (AR 17; see AR 228-34). The ALJ also relied on the October 2003 and June 2004

evaluations by psychiatrist Dr. Bruce Kaldor, which were agreed to by the parties. Dr. Kaldor 

diagnosed Claimant with a depressive disorder not otherwise specified (“nos”) and a pain disorder

with both psychological factors and a general medical condition. (AR 17; see AR 416, 428-29). 

ALJ Ross noted that, during the June 2004 evaluation, Claimant reported that the only mental-health

problem that Claimant believed would interfere with his ability to return to work was the anger

induced by his physical pain. (AR 17, see AR 414). Based on Dr. Kaldor’s findings that Claimant

had only slight work-related limitations and, from a psychological standpoint, could return to his

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usual employment, the ALJ concluded that Claimant’s depression was not severe that his

nonexertional impairments did not preclude him from performing a limited range of light work. (AR

18, 22). Assuming, without deciding, that Claimant provided sufficient evidence of a new or

worsening mental-health impairment that would overcome the presumption of nondisability, ALJ

Ross provided a detailed discussion of the records based upon which he concluded that Claimant’s

nonexertional impairment would not affect his RFC to the extent that he could not work at the level

found in the prior decision. (AR 22). 

With respect to Claimant’s allegation that his physical ailments had become more severe over

the years, as correctly found by ALJ Ross, the medical records indicated that Claimant’s pain and

range of motion had improved. (AR 18-20). The ALJ cited Claimant’s reported alleviation of pain

and muscle spasms following myobloc injections, the excision of mass that Claimant stated provided

great relief and enabled him to move his neck, and noted that his treating physician released

Claimant to work. (Id.). Based on the records, ALJ Ross again found, as had ALJ Haubner, that

Claimant was able to perform a wide range of light work, limited by the inability to engage in

repeated neck extensions or rotations. (AR 21). ALJ Ross, therefore, considered the new medical

records but ultimately applied res judicata to the prior decision. (Compare AR 16-22 with AR 32-

37). 

2. Incorrect RFC assessment

Plaintiff further asserts that, because he is illiterate, unable to communicate in English, and a

younger individual between 45-49 years old, who, contrary to the ALJ’s determination, was limited

to sedentary work, Rule 201.17 of the Medical-Vocational Guidelines (“Grids”) dictates a finding of

disability. (Doc. 17, pp. 5-6). The change in Plaintiff’s age classification purported precludes the

application of the presumption of nondisability set forth in Chavez, 844 F.2d 691. Alternatively,

Plaintiff contends that a remand is required because ALJ Ross failed to consider Plaintiff’s age

change and illiteracy, and determined that the RFC assessment did not allow him to engage in the

full range of light work. (Id.). 

Pursuant to 20 C.F.R. Pt. 404, Subpt. P, App. 2, Rule 201.00(h)(i), an individual who is

between the ages of 45 and 49, is restricted to sedentary work, cannot return to his past relevant

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 The essence of Plaintiff’s argument is that ALJ Ross did not properly consider and apply the mental health 6

records evidencing his depression. (Doc. 17, pp. 6-7). It is not clear why Plaintiff mentioned Dr. Sharma, who treated

him solely for his physical ailments and, to the extent he dealt with Plaintiff’s psychological problems, referred him to

Dr. Montalvo for what he summarily diagnosed as depression. (See AR 314-33). 

12

work, and cannot communicate in English, should be deemed disabled. This is set forth as Rule

201.17 in Table No. 1, which, again, is limited to persons limited to sedentary work. In the instant

case, ALJ Haubner’s finding Claimant retained the RFC to perform light work with some restrictions

was binding on ALJ Ross because there were no changed circumstances that adversely affected

Claimant’s RFC, as discussed above. 20 C.F.R. Pt. 404, Subpt. P, App. 2, Rule 201.00(h)(i), 201.17;

Lester, 81 F.3d at 827-28; Chavez, 844 F.2d at 693; Lyle, 700 F.2d at 568 n. 2. Moreover, Claimant

was only 43 years old when ALJ Ross issued his October 28, 2004, decision, and aged 44 by the time

the Appeals Council denied review in May 2005. (AR 6-8, 16-22, 70, 433, 442). Contrary to

Plaintiff’s assertion, he had not reached age 45 at the time of the final administrative decision. (Doc.

17, pp. 5-6). It is, therefore, recommended that this claim be denied. 

B. Improper Review and Application of the Mental Health Records

Plaintiff next asserts that ALJ Ross relied on the records of Claimant’s treating physician, 

Dr. Dinesh Sharma, as well as his treating psychiatrist, Dr. Francisco Montalvo, only when their 6

records reported that Claimant appeared to be improving, despite the doctors’ numerous reports that

Claimant’s mental health was deteriorating. (Doc. 17, p. 6). Thus, the ALJ failed to comply with his

obligation to consider the record as a whole, including the combined impact of all of Claimant’s

ailments. (Doc. 17, pp. 6-7). Plaintiff further contends that the ALJ only spent seven lines

addressing treatment records that had not been considered by ALJ Haubner, and erroneously relied

on opinions in which the consultant utilized Workers Compensation schedules, which schedules do

not coincide with the criteria for disability under the Act. (Doc. 27, p. 7). By not calling a mental

health expert or otherwise further developing the record, Claimant argues that the ALJ failed to

comply with his obligation to develop the mental health record, necessitating a remand. (Id.). 

Workers Compensation v. Social Security

In general, workers compensation disability ratings are not controlling in disability cases

decided under the Social Security Act, and the terms of art used in the California workers

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compensation guidelines are not equivalent to Social Security disability terminology. See Macri v.

Chater, 93 F.3d 540, 544 (9th Cir.1996); Desrosiers v. Secretary of Health & Human Servs., 846

F.2d 573, 576 (9th Cir.1988); 20 C.F.R. §§ 404.1504, 416.904. The differences between the tools

for measuring disability under these schemes appears to be relevant only with respect to the physical

capacity of the claimant. For example, under the California system, if one could lift 100 pounds preinjury, but is restricted to “no heavy work” post-injury, then it is assumed that one retains 50% of

prior lifting capacity or, in this example, 50 pounds. In other words, and in most cases, the postinjury lifting capacity is proportionately relative to the pre-injury capacity. See Administrative

Director, State of California, “California Schedule for Rating Permanent Disabilities (April

1997)(the “California Schedule for Rating Permanent Disabilities”). In contrast, Social Security

exertional levels are measured in absolute values, such that if the claimant can lift no more than 20

pounds, he is limited to light work. See 20 C.F.R. §§ 404.1567(b), 416.967(b). 

In the instant case, examining psychiatric consultant Bruce Kaldor, M.D., evaluated

nonexertional/non-physical impairments to ascertain the effect Claimant’s depression might have on

his ability to work, and determined that, from a mental-health standpoint, Claimant could return to

his “usual and customary” job. (AR 417). The ALJ considered Dr. Kaldor’s narrative in its entirety,

not just the one page of conclusions that listed Claimant’s slight and non-existent psychological

impairments set forth in Workers Compensation parlance. (AR 17-18). The ALJ noted Dr. Kaldor’s

statement that Claimant could return to his past job and had no impairments that would preclude him

from performing repetitive, simple tasks, as well as Claimant’s statements that pain angered him and

he wanted to work. (Id., see AR 411-30). Because ALJ Ross did not base Claimant’s RFC on a

report prepared for benefits under Workers Compensation, and relied on more than a few “check the

box” statements when considering his nonexertional psychological impairments, there was no error. 

Evaluate and Develop the Record

In a Social Security case, an ALJ is obligated to fully and fairly develop the record even if the

claimant is represented by counsel. Celaya v. Halter, 332 F.3d 1177, 1183 (9th Cir. 2003). This duty

may require that the ALJ obtain additional information by, inter alia, contacting treating physicians,

scheduling consultative examinations, or calling a medical expert. 20 C.F.R. §§ 416.912(e)-(f),

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416.919a; Armstrong v. Commissioner , 160 F.3d 587, 590 (9th Cir. 1998). The ALJ is not

obligated to develop the record further, however, unless the evidence is ambiguous or “the record is

inadequate to allow for proper evaluation of the evidence.” Mayes v. Massanari, 276 F.3d 453, 459-

460 (9th Cir. 2001). 

In the instant case, the ALJ was not obligated to further develop the record with respect to

Plaintiff’s depression given that there were sufficient, unambiguous records to enable him to

evaluate the evidence and render a proper decision. The administrative record includes records from

Claimant’s treating psychiatrist, Dr. Montalvo, which indicate that Claimant’s had good and bad

days, often dependant upon his pain and financial worries, but that he responded well to psychotropic

medicine. (See AR 225-234, 392-411). Also included were diagnostic tests evidencing Claimant’s

tendency to magnify his ailments and either a refusal to cooperate or his misunderstanding of the

exam questions. (AR 235-236). The record also contained opinions and evaluations from state

physicians, treating physicians, and an agreed-upon independent psychiatrist. (AR 230-234, 265,

268, 405-409, 411-430). The ALJ reviewed the various records, including Claimant’s disability

forms, third party questionnaires, and statements he made to treating and consulting doctors, and

found that Dr. Montalvo’s assessment did not coincide with the treatment notes and, therefore, he did

not accord the assessment a great deal of weight. (AR 17). Instead, ALJ Ross primarily relied on

Dr. Kaldor’s evaluations, which he found were consistent with Dr. Montalvo’s progress reports, to

conclude that Claimant’s depression imposed, at the most, minimal effects on his ability to work. 

(AR 17-18, 22). Given the plethora of straightforward documentation regarding Claimant’s

depression, the ALJ did not commit legal error when he failed to further develop Claimant’s mental

health record. Mayes, 276 F.3d at 459-460; 

C. Treating Psychiatrist’s Opinion

Plaintiff further alleges that ALJ Ross did not provide “specific and legitimate” reasons,

based on substantial evidence, for disregarding the opinion of treating psychiatrist Dr. Montalvo,

although it was supported by the chart records. (Doc. 17, pp. 8-9). He further contends that the

opinions of consultant Dr. Kaldor support Dr. Montalvo’s opinion when considered in light of the

treating records and after the Workers Compensation terms are translated to the equivalent Social

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 This assertion is moot given the discussion of Workers’ Compensation and Social Security terminology in 7

Section B and, thus, will not be addressed. Moreover, Claimant provides no support for this argument

15

Security phrases. (Doc. 17, p. 9). 7

The opinions of treating doctors should be given more weight than the opinions of doctors

who do not treat the claimant. Reddick v. Chater, 157 F.3d 715, 725 (9th Cir.1998); Lester v.

Chater, 81 F.3d at 830. Where the treating doctor's opinion is not contradicted by another doctor, it

may be rejected only for “clear and convincing” reasons supported by substantial evidence in the

record. Id. Even if the treating doctor’s opinion is contradicted by another doctor, the ALJ may not

reject this opinion without providing “specific and legitimate reasons” supported by substantial

evidence in the record. Id. (quoting Murray v. Heckler, 722 F.2d 499, 502 (9th Cir.1983)). This can

be done by the ALJ setting out a detailed and thorough summary of the facts and conflicting clinical

evidence, stating his interpretation thereof, and making findings. Magallanes v. Bowen, 881 F.2d

747, 751 (9th Cir.1989). The ALJ must do more than offer his conclusions. He must set forth his

own interpretations and explain why they, rather than the doctor’s, are correct. Embrey v. Bowen,

849 F.2d 418, 421-422 (9th Cir.1988).

In Orn v. Astrue, 495 F.3d 625 (9th Cir. 2007), the Ninth Circuit reiterated and expounded

upon its position regarding the ALJ’s acceptance of the opinion of an examining physician over that

of a treating physician. “When an examining physician relies on the same clinical findings as a

treating physician, but differs only in his or her conclusions, the conclusions of the examining

physician are not substantial evidence.” Orn, 495 F.3d at 632 (citation and quotation omitted). “By

contrast, when an examining physician provides independent clinical findings that differ from the

findings of the treating physician, such findings are substantial evidence.” Id. (citation omitted). 

“Independent clinical findings can be either (1) diagnoses that differ from those offered by another

physician and are supported by substantial evidence . . . or (2) findings based on objective medical

tests that the treating physician has not herself considered.” Id. (citations omitted).

If there is “substantial evidence” in the record contradicting the opinion of the treating

physician, the opinion of the treating physician is no longer entitled to “controlling weight.” 20

C.F.R. §§ 404.1527(d)(2), 416.927(d)(2). In that event, the ALJ is instructed by §§ 404.1527(d)(2)

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and 416.927(d)(2) to consider the factors listed in §§ 404.1527(d)(2)-(6) and 416.927(d)(2)-(6) in

determining what weight to accord the opinion of the treating physician. Those factors include the

“[l]ength of the treatment relationship and the frequency of examination” by the treating physician;

and the “nature and extent of the treatment relationship” between the patient and the treating

physician. 20 C.F.R. §§ 404.1527(d)(2)(i)-(ii), 416.927(d)(2)(i)-(ii). Even when contradicted by an

opinion of an examining physician that constitutes substantial evidence, the treating physician’s

opinion is “still entitled to deference.” SSR 96-2p; Orn, 495 F.3d at 633. “In many cases, a treating

source’s medical opinion will be entitled to the greatest weight and should be adopted, even if it does

not meet the test for controlling weight.” Orn, 495 F.3d at 633.

In the instant case, the ALJ determined that Claimant’s depression was not severe, but only a

slight impairment that did not have more than a minimal effect, if any, on his ability to engage in

light work with restricted neck movements. (AR 17, 22). ALJ Ross based this decision on an April

2002 evaluation by Claimant’s treating psychiatrist, Dr. Francisco Montalvo, Dr. Montalvo’s

progress reports through September 2002, and the October 2003 and June 2004 consultant’s opinions

provided by an agreed-upon psychiatrist, Dr. Bruce Kaldor. (AR 17-18). The ALJ did not reference

Dr. Montalvo’s notes for Claimant’s visits from October 2002 through July 2004, and does not

mention or explain any reason for rejecting Dr. Montalvo’s 2004 assessment. (See AR 17-22, 225-

27, 392-409). Because the ALJ does not discuss Dr. Montalvo’s later evaluation, much less provide

any reason for rejecting this treating doctor’s opinion, it is recommended that the action be remanded

for further consideration of Dr. Montalvo’s 2004 opinion and otherwise to ensure that the ALJ

comply with the requirements of Orn and the applicable administrate rules when evaluation the

opinions of treating physicians. Orn, 495 F.3d at 633.

D. Credibility of Testimony

Plaintiff contends that ALJ Ross failed to provide specific and convincing reasons for

discounting his testimony. (Doc. 17, pp. 8-9). He further asserts that the ALJ misrepresented and

misconstrued the record evidence in finding his testimony not wholly credible. (Id.). 

A two step analysis applies at the administrative level when considering a claimant’s

subjective credibility. Smolen v. Chater, 80 F.3d 1273, 1281 (9th Cir. 1996). First, the claimant

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SSR 96-7p directs the ALJ to consider not only objective medical evidence, but also the following factors: (1) 8

the claimant’s daily activities; (2) the location, duration, frequency, and intensity of her pain or other symptoms;

(3) factors that precipitate or aggravate the symptoms; (4) the effectiveness and adverse side effects of prescribed

medications; (5) other treatments for the relief pain and symptoms; (6) any other measures used by the individual to

relieve the pain and symptoms; and (7) any other factors concerning the claimant’s functional limitations and restrictions

resulting from pain or other symptoms. SSR 96-7p.

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must produce objective medical evidence of an impairment and show that the impairment could

reasonably be expected to produce some degree of symptom. Id. at 1281-1282. If claimant satisfies

this test – and if there is no evidence of malingering – the ALJ can reject the claimant’s testimony

about the severity of his or her symptoms “only by offering specific, clear and convincing reasons for

doing so.” Id. at 1281. Such specificity is crucial so as to enable effective judicial review. See

Mersman v. Halter, 161 F. Supp. 2d 1078, 1086 (N.D. Cal. 2001)(“The lack of specific, clear, and

convincing reasons why Plaintiff’s testimony is not credible renders it impossible for [the] Court to

determine whether the ALJ’s conclusion is supported by substantial evidence”); SSR 96-7p (the

ALJ’s decision “must be sufficiently specific to make clear to the individual and to any subsequent

reviewers the weight the adjudicator gave to the individual’s statements and reasons for that

weight”). Thus, an ALJ’s decision “must identify what testimony is not credible and what evidence

undermines the claimant’s complaints.” Lester v. Chater, 81 F.3d at 835. Grounds for an adverse

credibility finding include, but are not limited to, inconsistencies either in the claimant’s testimony

or between the claimant’s testimony and conduct, the claimant’s daily activities and work record, the

location, duration, frequency, and intensity of the claimant’s pain or other symptoms, testimony from

physicians and third parties concerning the nature, severity, and effect of the symptoms of which the

claimant complains, and the lack of adequate explanation for a claimant’s failure to follow a

prescribed course of treatment. See Light v. Social Sec. Admin., 119 F.3d 789, 792 (9th Cir. 1997);

SSR 96-7p. 

Here, ALJ Ross discussed Plaintiff’s physical and mental impairments and noted that he was

required to consider “all symptoms, including pain, and the extent to which these symptoms can

reasonably be accepted as consistent with the objective medical evidence and other evidence based

on the requirements of 20 CFR §§ 404.1529 and 416.929, and Social Security Ruling 96-7p.”8

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(AR 19). The ALJ proceeded to discuss the record evidence, noting that Claimant reported that he

felt better in February 2000 and had tried to return to work, but his limited range of motion and neck

pain prevented him from doing his past job and the company had no other work for him. (AR 19-

20). The ALJ gave credence to the results of Claimant’s diagnostic psychological tests, which

indicated that Claimant either failed to cooperate or misunderstood the directions, that he

exaggerated his symptoms, and that his responses were so inconsistent that they rendered his profile

invalid. (AR 19-20; see AR 235-36). In addition, ALJ Ross noted that, despite the alleged intensity,

severity, and frequency of Claimant’s pain, he had not been referred for treatment generally used to

alleviate chronic pain syndrome, citing as examples biofeedback and use of a TENS unit. (AR 19). 

Moreover, although Claimant told one of his treating physicians that he was able to move his neck

back and forth, he had fewer headaches, and he felt better after he underwent surgery in January 2004

to remove a soft-tissue mass, during the administrative hearing Claimant denied saying or meaning it

to be understood as the doctor noted it in his progress reports. (AR 20, AR 349-52, 357-58, 449-

50). The ALJ referenced several additional inconsistencies between Claimant’s testimony and the

administrative record. (AR 17-21). 

It is sufficiently clear from the record that the ALJ’s decision to discount Plaintiff’s testimony

was based on, inter alia, discrepancies between his testimony and the medical records, medical

opinions, statements he made to physicians, his Social Security disability forms, and his reported

daily activities, which were confirmed by third parties. See Light, 119 F.3d at 792; SSR 96-7p. The 

ALJ, therefore, provided clear and convincing reasons for discounting Plaintiff’s subjective

complaints of pain and limitations to the extent alleged, and these reasons were supported by

substantial evidence in the record and were sufficiently specific to enable a reviewing court to

conclude that the ALJ rejected Plaintiff’s testimony on permissible grounds and did not arbitrarily

discredit Plaintiff’s testimony. 

CONCLUSION AND RECOMMENDATIONS

For the reasons discussed above, this Court finds error only with respect to the ALJ’s failure

to consider or otherwise evaluate the opinion of Claimant’s treating psychiatrist. Otherwise, the ALJ 

///

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properly concluded that Claimant is not disabled, which decision is supported by substantial

evidence in the record as a whole and based on proper legal standards. 

Accordingly, this Court RECOMMENDS:

1. Plaintiff’s Social Security complaint, (Doc. 1), BE GRANTED, 

2. Judgment BE ENTERED for Plaintiff Urbano Jimenez and against Defendant Michael J.

Astrue; and

 3. This matter BE REMANDED to Defendant, Michael J. Astrue, pursuant to Sentence Four

of 42 U.S.C. § 405(g), for further consideration of the weight and deference to be accorded

Plaintiff’s treating psychiatrist, in accordance with Orn v. Astrue, 495 F.3d 625 (9th Cir. 2007).

These Findings and Recommendations are submitted to the United States District Judge

assigned to this action, pursuant to 28 U.S.C. § 636(b)(1)(B) and this Court’s Local Rule 72-304. No

later than fifteen (15) days after service of these Findings and Recommendations, any party may file

written objections to these Findings and Recommendations with the Court and serve a copy on all

parties and otherwise in compliance with this Court’s Local Rule 72-304(b). Such a document

should be captioned “Objections to Magistrate Judge’s Findings and Recommendations.” Responses

to objections shall be filed and served no later than ten (10) court days after service of the objections

and otherwise in compliance with this Court’s Local Rule 72-304(d). The District Judge will review

the Magistrate Judge’s Findings and Recommendations, pursuant to 28 U.S.C. § 636(b)(1)(C). The

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

appeal the District Judge’s order. Martinez v. Ylst, 951 F.2d 1153 (9th Cir. 1991).

IT IS SO ORDERED.

Dated: January 25, 2008 /s/ Theresa A. Goldner 

j6eb3d UNITED STATES MAGISTRATE JUDGE 

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