Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_03-cv-00506/USCOURTS-cand-3_03-cv-00506-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:405 Review of HHS Decision (SSID)

---

United States District Court

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

United States District Court

For the Northern District of California

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

TWANIKA JOHNSON,

Plaintiff

v

JOANNE B BARNHART,

Commissioner of Social Security,

Defendant. /

No C-03-0506 VRW

ORDER

Plaintiff appeals from the decision of the Social

Security Administration (“SSA”) denying plaintiff social security

disability benefits. The parties have filed cross motions for

summary judgment. Pl Mot (Doc #13); Def Mot (Doc #15). Based on a

careful review of the administrative record and of the applicable

law, the court DENIES plaintiff’s motion and GRANTS defendant’s

motion.

\\

\\
United States District Court

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

2

I

A

Plaintiff alleges disability since birth due to limited

vision in the right eye. Administrative Record (“AR”) at 13. On

May 17, 1999, ophthalmologist Dr Leo Capocchi first examined

plaintiff’s vision. AR at 149. Dr Capocchi reported that

plaintiff had experienced ocular misalignment since shortly after

her birth on January 24, 1996. Id. Plaintiff had a large right

extropia, but her eyes otherwise appeared “grossly normal.” Id. 

Atropine refraction revealed -6.00 right myopia and +.50 left

hyperopia; plaintiff had “at least finger counting vision [in the]

right eye and apparently normal vision [in the] left eye.” Id. Dr

Capocchi recommended referral to a pediatric ophthalmologist. Id. 

Upon referral in summer 1999, Dr Creig Hoyt, director of

pediatric ophthalmology at UCSF Stanford Health Care, recommended

that plaintiff wear a patch over her left eye for eight hours a day

to improve vision in her right eye. AR at 159, 174. On January

20, 2000, Dr Hoyt wrote to Dr Capocchi that eye patching had

improved the visual acuity in the right eye to only 20/80ths. AR

at 159. Dr Hoyt expressed concern that the right eye might have

eccentric fixation. Plaintiff still suffered from anisometropic

refractive error, with the right eye significantly myopic. Id. Dr

Hoyt reported that he could not be certain whether there was “a

significant disc anomaly that accounts for some of the visual

problems.” Dr Hoyt concluded: “I think we at least need to renew

our efforts in trying to treat this patient over the next few

months. If visual acuity cannot be improved further, reassessment

of the underlying structural processes may be indicated.” Id. 
United States District Court

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

3

On April 18, 2000, Dr Hoyt reported that the patching had

proved unsuccessful. AR at 174. Although plaintiff had been

patched for eight hours per day for almost a year, there was little

evidence that the vision in the amblyopic eye was improving. Id. 

Dr Hoyt noted that he would perform an evaluation under anesthesia

to ensure that there was “no structural pathology that precludes

the ability to rehabilitate the anisometropic eye.” Id. 

After this evaluation under anesthesia, AR at 176,

plaintiff saw Dr Hoyt in November 2000. Dr Hoyt found that

plaintiff still had “dense amblyopia in the right eye with almost

eccentric fixation.” AR at 171. In addition, Dr Hoyt concluded

that patching therapy had been “only marginally effective.” Dr

Hoyt nevertheless continued the patching program over her left eye

through December 2001. AR at 166, 167. On December 7, 2001, Dr

Hoyt reported that “[v]isual acuity remains at 20/400 in the right

eye with eccentric viewing.” Dr Hoyt planned to maintain patching

of the left eye, though only on a thirty-minute-per-day basis and

to continue to see plaintiff periodically. Id. 

B

 In addition to plaintiff’s eye problems, plaintiff claims

that she also experienced behavioral and emotional problems. While

living with her grandmother until the age of two, plaintiff endured

beatings from her grandmother’s boyfriend. AR at 40-41. In May

1998, plaintiff’s great grandmother, Ruth Hamilton, took over

custody of plaintiff to prevent her from being sent to a foster

home. Id. 

\\
United States District Court

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

4

In the fall of 1998, Plaintiff enrolled in Valencia

Gardens pre-school. AR at 41. It took plaintiff three to four

months to get into pre-school because she required special care due

to her severe eye problem. Id. Evaluating plaintiff between

November 1998 and February 1999, Valencia Pediatrics reported that

plaintiff had a history of exotropia, mild dry skin, temper

tantrums and difficulty sleeping at night. AR at 130-35.

Valencia Gardens teacher Eva White also assessed

plaintiff’s social behavior between June and September 1999. AR at

126-29. In June 1999, plaintiff had difficulty completing

activities, and her attention span was short. AR at 126. She

walked always looking down and had trouble climbing stairs and

peddling a tricycle. She was very distant at times, choosing not

to communicate with adults. Id. In addition, she did not share or

get along well with other children. Id. 

By August 1999, plaintiff’s behavior had significantly

improved. White reported in August that “[plaintiff] comes on her

own now to listen to stories being read” and that “[plaintiff’s]

confidence in climbing and getting down from high places has

improved tremendously.” AR at 126-27. Plaintiff was more excited

about participating in activities, was “gradually asking for help

and talking to adults,” and was “learning to share and get along

well with other children.” AR at 126-29. In her concluding

comments, White stated that while plaintiff experienced

difficulties at the start of the program, by August 1999 she was

“doing very well in the center. This was definitely a need for

her. She is a happy child [who] loves to come to school, [and]

loves her playmates and teachers.” AR at 129. 
United States District Court

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

5

 At the April 11, 2000, hearing, Ms Hamilton testified that

she had observed plaintiff experiencing emotional and behavioral

difficulties at Valencia Gardens. AR at 43-60. Ms Hamilton

testified that plaintiff: pushed and shoved her playmates; cried

about having to wear an eye patch for eight hours per day because

of her difficulty seeing; had difficulty climbing monkey bars and

riding her tricycle; and had sleep problems, refusing to take a nap

at school. AR at 46, 48, 51, 53-54. 

Ms Hamilton testified that plaintiff experienced similar

problems at home. AR at 54-60. Ms Hamilton stated that plaintiff

had difficulty falling asleep and needed to be accompanied to the

bathroom at 3:00am. AR at 54. Ms Hamilton testified further that

plaintiff: had difficulty distinguishing colors and needed help

with getting dressed, washed or bathed; cried sometimes, wanting to

see her mother; threw daily temper tantrums “when she c[ouldn’t]

get her way”; and was a “very picky eater” with poor eating habits. 

AR at 56, 114, 57, 57-58.

C

On March 30, 1999, plaintiff filed an application with

the SSA for Supplemental Security Income (“SSI”) payments alleging

disability since birth due to limited vision in the right eye. AR

at 13. Non-examining State Agency physicians Dr Darnell Richey and

Dr Phillip Suster conducted SSA Childhood Disability Evaluations of

plaintiff. AR at 136-46. In June 1999, both doctors concluded

that although the impairment was “severe,” it did not “meet,

medically equal, or functionally equal the severity of a listing.” 

\\
United States District Court

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

6

AR at 136. Accordingly, on June 30, 1999, the SSA denied

plaintiff’s application for SSI. AR at 65, 68-70. 

After plaintiff requested reconsideration in August 1999,

AR at 71, non-examining State Agency physician Dr SD Battis

confirmed Dr Richey’s and Dr Suster’s findings that plaintiff’s

impairment was insufficient to warrant receiving SSI. AR at 150-

58. Plaintiff’s request for reconsideration was denied in

September 1999. AR at 72-75. In November 1999, plaintiff filed a

request for a hearing before an Administrative Law Judge (“ALJ”). 

AR at 76. 

The ALJ held a hearing on April 11, 2000, at which Ms

Hamilton and medical expert Dr Moses Grossman testified. AR at 33-

64. Dr Grossman belonged to the American Board of Pediatrics and

practiced at San Francisco General Hospital. AR at 89. 

To determine whether plaintiff was disabled, and thus

entitled to SSI benefits, the ALJ considered two specific issues as

required by section 1614(a)(3)(C) of the Social Security Act (“the

Act”): (1) whether plaintiff was engaging in “substantial gainful

activity” and (2) “whether she has a medically determinable

physical or mental impairment which results in marked and severe

functional limitations, and 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 12 months.” AR at 13. 

The ALJ found that: (1) plaintiff’s lack of vision in

the right eye was a severe impairment, 20 CFR § 416.924(c), and (2)

the statements made by the plaintiff’s guardian, Ms Hamilton, were

credible. AR at 16. The ALJ held, however, that (3) the

limitations, resulting from the effects of the plaintiff’s
United States District Court

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

7

impairment, do not meet, medically equal or functionally equal the

criteria of any of the listed impairments in Appendix 1, Subpart P,

Part 404. Id; 20 CFR § 416.924(d). Finally, the ALJ concluded

that (4) plaintiff does not have a medically determinable physical

or mental impairment that results in marked or severe functional

limitations and (5) plaintiff has not been under a “disability” as

defined in the Act, at any time through the date of this decision. 

AR at 16. On April 24, 2000, the ALJ denied benefits to plaintiff. 

Id.

In reaching this decision, the ALJ considered Ms

Hamilton’s and Dr Grossman’s testimony in determining that

plaintiff’s impairment(s) did not meet or medically equal the

listings. AR at 14. The ALJ wrote: “The medical expert, Dr Moses

Grossman[,] stated that the claimant has no vision in her right eye. 

Because she has a good eye, however, she does not meet the Listings. 

The undersigned finds the claimant[‘s] impairment (or impairments)

does not meet or medically equal the criteria of any of the listed

impairments * * *.” Id. Next, the ALJ stated the appropriate law

for determining functional limitation and cited the medical reports

of Drs Capocchi and Hoyt and the Childhood Disability Evaluation

Form in determining that plaintiff’s impairment(s) did not

functionally equal the listings. AR at 15-16.

Plaintiff appealed the ALJ’s decision to the SSA’s

Appeals Council (“Appeals Council”) on June 22, 2000. AR at 8-9. 

The Appeals Council considered: (1) “the applicable statutes,

regulations, and rulings in effect as of the date of this action”;

(2) the final regulations, effective January 2, 2001, implementing

the childhood disability provisions of Public Law 104-193; (3) the
United States District Court

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

8

contentions raised in plaintiff’s August 21, 2002, brief; and (4)

the additional evidence identified on the attached Order of the

Appeals Council. AR at 4. The Appeals Council found that none of

these provided a basis for changing the ALJ’s decision. Id. On

December 6, 2002, the Appeals Council declined to review the ALJ’s

decision, and the ALJ’s decision became final. AR at 4-5. 

On February 5, 2003, plaintiff timely filed the instant

action for judicial review of the final decision. Compl (Doc #1). 

II

The court’s jurisdiction is limited to determining

whether the SSA’s denial of benefits is supported by substantial

evidence in the administrative record. 42 USC § 405(g). A

district court may overturn a decision to deny benefits only if the

decision is not supported by substantial evidence or if the

decision is based on legal error. See Andrews v Shalala, 53 F3d

1035, 1039 (9th Cir 1995); Magallanes v Bowen, 881 F2d 747, 750

(9th Cir 1989). The Ninth Circuit defines “substantial evidence”

as “more than a mere scintilla but less than a preponderance; it is

such relevant evidence as a reasonable mind might accept as

adequate to support a conclusion.” Andrews, 53 F3d at 1039. 

Determinations of credibility, resolution of conflicts in medical

testimony and all other ambiguities are to be resolved by the ALJ. 

See id; Magallanes, 881 F2d at 750. The decision of the ALJ will

be upheld if the evidence is “susceptible to more than one rational

interpretation.” Andrews, 53 F3d at 1040.

\\

\\
United States District Court

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

9

III

A

Section 1614(a)(3)(C)(I) of the Act defines a child as

“disabled” if she “has a medically determinable physical or mental

impairment, which results in marked or severe functional

limitations, and 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 USC § 1382c(a)(3)(C)(I). The SSA

“consider[s] all relevant evidence in your case record when we make

a determination or decision whether you are disabled * * *. Thus,

we will consider the combined effects of all your impairments upon

your overall health and functioning.” 20 CFR § 416.924(a). 

When a child plaintiff files an application for benefits,

the SSA conducts a three-step evaluation process to determine

whether the child is disabled. Id. For a child to be determined

disabled, (1) she must not be involved in “substantial gainful

activity,” (2) she “must have a medically determinable impairment

that is severe,” and (3) her “impairment(s) must meet, medically

equal or functionally equal the listings.” 20 CFR § 416.924(b)-(d). 

An impairment is medically equivalent to a listed

impairment in Appendix 1, Subpart P, Part 404 “if the medical

findings are at least equal in severity and duration to the listed

findings.” 20 CFR 416.926(a). If they are not, the SSA “will

nevertheless find that your impairment is medically equivalent to

that listing if you have other medical findings related to your

impairment that are at least of equal medical significance.” 20 CFR

416.926(a)(1)(ii).

\\
United States District Court

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

10

20 CFR § 416.926a sets forth the regulations determining

functional equivalence for children. Because these regulations

changed effective January 2, 2001, the ALJ — who made his decision

in April 2000 — and the Appeals Council — which made its decision in

December 2002 — were required to consider different regulations when

coming to their decisions. 

Prior to January 2, 2001, the regulations prescribed four

methods that the SSA may use to decide whether an impairment is

functionally equivalent in severity to a listing: (1) limitation of

specific function; (2) broad areas of development or function; (3)

episodic impairments; and (4) limitations related to the effects of

treatment or medication. 20 CFR § 416.926a(b). 

Under the second method, the SSA evaluated children

between the ages of three and eighteen in terms of five areas of

development: cognitive and communicative development; motor

development; social development; personal development; and

concentration, persistence and pace. 20 CFR 416.926a(c)(5)(iii). 

Disability was established if the child had an extreme degree of

restriction in one area of functioning or marked limitation in two

areas of function. 20 CFR § 416.926a(b)(2). An extreme restriction

was present if there was “no meaningful function in a given area,”

and a marked limitation arose when the “degree of limitation is such

as to interfere seriously with the child’s functioning.” 20 CFR §

416.926a(c)(3). 

As of January 2, 2001, the regulations instruct the SSA to

determine functional equivalence by considering how the child

functions in six types of activities: (1) acquiring and using

information, (2) attending and completing tasks, (3) interacting and
United States District Court

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

11

relating to others, (4) moving about and manipulating objects, (5)

caring for [her]self and (6) health and physical well-being. 20 CFR

§ 416.926a(b)(1). Similar to the superceded regulation, the SSA

decides that a child’s impairment functionally equals the listings

if it is of “listing-level severity[:] if [the child has] ‘marked’

limitations in two of the domains in paragraph (b)(1) of this

section, or an ‘extreme’ limitation in one domain.” 20 CFR §

416.926a(d). The definitions of “marked” and “extreme” remain the

same. 20 CFR § 416.926a(e)(2)-(3). 

B

Plaintiff offers three arguments why the ALJ’s decision

should be reversed and the case remanded for rehearing. First,

plaintiff contends that the Appeals Council “failed to apply the

final rules” effective January 2, 2001, in denying plaintiff’s

request for review. Pl Mot at 10. Second, plaintiff asserts that

the ALJ failed to “discuss or articulate any rationale for finding

that [p]laintiff’s impairments did not medically equal or

functionally equal a listed impairment.” Id at 11-12. Finally,

plaintiff argues that the ALJ did not make a reasonable effort to

obtain a “case evaluation” from a pediatrician or appropriate

specialist. Id at 15. The court examines each argument in turn. 

1

SSA regulations provide that the Council will grant a

request for review where: (1) there appears to be an abuse of

discretion by the ALJ; (2) there is an error of law; (3) the ALJ’s

action, findings or conclusions are not supported by substantial
United States District Court

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

12

evidence; or (4) there is a broad policy or procedural issue that

may affect the general public interest. The regulations also

provide that where new and material evidence is submitted with the

request for review, the entire record will be evaluated and review

will be granted if the Council finds that the ALJ’s actions,

findings or conclusions are contrary to the weight of the evidence

currently of record. 20 CFR 416.1470(a)-(b).

As to the change in rules effective January 2, 2001, the

SSA stated: “When the final rules become effective, we will apply

them to new applications filed on or after the effective date of the

rules. We will also apply them to the entire period at issue for

claims that are pending at any stage of our administrative review

process * * *.” 65 FR 54747 (9/11/01). 

The Council followed the above rules in coming to its

decision. In denying request for review, the Council wrote that it

had “considered the contentions raised in [plaintiff]’s brief dated

August 21, 2002, as well as the additional evidence also identified

on the attached Order of the Appeals Council.” AR at 4. The

Council also “considered the final regulations, effective January 2,

2001, implementing the childhood disability provisions of Public Law

104-193.” Id. The Council held that neither the additional

evidence nor the new regulations “provide[d] a basis to change the

Administrative Law Judge’s decision.” Id. 

Plaintiff argues that the ALJ “did not even evaluate

Plaintiff’s case using the six domains of functioning.” Pl Mot at

11. Plaintiff also contends that the Council’s “conclusory

assertion that it had considered the final rules fails to rise to

the level of articulation required by circuit precedent.” Id. 
United States District Court

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

13

Plaintiff, however, fails to provide support — in the form of a

regulation or judicial authority — for either of these contentions. 

In contrast, defendant cites a Seventh Circuit case

holding that the Council properly denied a child plaintiff’s request

for review based on final rules for evaluating child disability. 

Def Mot at 6 (citing Keys v Barnhart, 347 F3d 990, 994 (7th Cir

2003)). In denying request for review, the Council in Keys stated

that it “ha[d] considered the final regulations * * * implementing

the childhood disability provisions * * * [and found that the] new

regulations do not provide a basis to change the [ALJ]’s decision.” 

Id at 992. In affirming the Commissioner’s final decision, the

Seventh Circuit held:

Had the Council just said we’re denying review

because we’re too busy, then the only decision

for the courts to review would be that of the

[ALJ]. But that was not the character of the

Council’s reason for denying review; its reason

was that the new regulations would make no

difference to the outcome. That was a

reasonable substantive judgment to which we

would defer even if we did not independently

believe that the changes brought about by the

new regulations do not help Keys. 

Id at 995 (emphasis added). 

The Keys court stated further that “the differences

between the old and new regulations are not great” and “the report

accompanying the final regulations confirms that the purpose of the

revision was ‘largely to clarify’ the earlier categories and to

‘rename, and to some extent to reorganize, the prior areas of

functioning.’” Keys, 347 F3d at 994 (quoting 65 Fed Reg 54756

(9/11/00)).

In its decision denying review, the Appeals Council

specifically stated that it had considered the new regulations and
United States District Court

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

14

found that they did not provide a basis to change the ALJ’s

decision. AR at 4. The Council also noted that it had considered

the additional evidence submitted with the appeal (see AR at 6). AR

at 4. It found no abuse of discretion by the ALJ, no error of law,

no evidence and no policy concern that warranted overturning the

ALJ’s decision. Id. Applying the rationale of Keys, the court

concludes that the Council’s decision was a “reasonable substantive

judgment” and therefore rejects plaintiff’s first argument. 

2

Plaintiff contends that the ALJ’s decision should be

reversed and the case remanded for rehearing because the ALJ failed

to “discuss or articulate any rationale for finding that Plaintiff’s

impairments did not medically equal or functionally equal a listed

impairment.” Pl Mot at 11-12. Plaintiff cites Ninth Circuit

precedent as support: “[I]n determining whether a claimant equals a

listing under step three of the Secretary’s disability evaluation

process [medical and functional equivalence tests], the ALJ must

explain adequately his evaluation of alternative tests and the

combined effects of the impairments.” Marcia v Sullivan, 900 F2d

172, 176 (9th Cir 1990).

In the instant case, the court holds that the ALJ did

adequately explain his evaluation of plaintiff’s record and based

his findings on substantial evidence.

a

The ALJ found first that plaintiff’s impairment(s) did not

meet the criteria of any of the SSA’s listed impairments. AR at 14. 
United States District Court

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

15

The ALJ considered both Ms Hamilton’s and Dr Grossman’s testimony in

reaching this decision. Id. After recounting in detail Ms

Hamilton’s testimony about plaintiff’s emotional and behavioral

problems, the ALJ quoted Dr Grossman: “[Plaintiff] has no vision in

her right eye. Because [plaintiff] has one good eye, however, she

does not meet the Listings.” Id. Specifically, plaintiff did not

meet listing 20 CFR Pt 404, Subpt P App 1, § 2.02 (impairment of

visual acuity requires that vision in the better eye after best

correction be 20/200 or less).

b

The ALJ’s consideration of Ms Hamilton’s and Dr Grossman’s

testimony was also sufficient for the ALJ to determine that

plaintiff’s impairment(s) did not medically equal a listed

impairment. An impairment is medically equivalent to a listed

impairment “if the medical findings are at least equal in severity

and duration to the listed findings” or “if you have other medical

findings related to your impairment that are at least of equal

medical significance.” 20 CFR 416.926(a). 

To equal a listed impairment, plaintiff “must establish

symptoms, signs and laboratory findings ‘at least equal in severity

and duration’ to the characteristics of the relevant listed

impairment * * *.” Tacket v Apfel, 180 F3d 1094, 1099 (9th Cir

1999) (quoting 20 CFR § 404.1526). Furthermore, under Ninth Circuit

precedent, “the opinions of non-treating or non-examining physicians

may also serve as substantial evidence when the opinions are

consistent with independent clinical findings or other evidence in

the record.” Thomas v Barnhart, 278 F3d 947, 957 (9th Cir 2002). 
United States District Court

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

16

Both Ms Hamilton’s and Dr Grossman’s testimony demonstrate

that plaintiff’s emotional and behavioral problems were not medical

equivalents. The ALJ thoroughly recounted Ms Hamilton’s testimony,

discussing plaintiff’s physical problems, such as vision, movement

and sleep, and social troubles, such as temper, shyness and

loneliness. AR at 14. The ALJ and Dr Grossman reasonably concluded

that these were not medical problems of the same “severity” or

“duration” as the listed impairments. AR at 4, 60-61. Dr Grossman

stated that plaintiff was “going through some difficulties, now,

obviously, because what Dr Hoyt is trying to do is improve the

vision in the right eye by patching the left eye, and that’s causing

her problems, obviously.” AR at 60. Dr Grossman reasonably

concluded that “[t]he other things we talked about [non-eye related

problems], I think, are pretty normal behavior for a child, under

her circumstances. And unfortunately, I do not think it either

meets or equals the listings * * *.” AR at 60-61 (emphasis added). 

Dr Grossman’s conclusions were uncontradicted by

plaintiff’s prior medical reports. AR at 136-46, 147-59.

Accordingly, as a pediatrician who had reviewed the record, Dr

Grossman’s opinions represented substantial evidence. See Thomas,

278 F3d at 957. Moreover, plaintiff introduced no “symptoms, signs

and laboratory findings” that established severity or duration equal

to the listed impairment. See Tacket, 180 F3d at 1099. For the

foregoing reasons, the ALJ’s finding that plaintiff’s impairment did

not medically equal the listed impairments was supported by

substantial evidence.

\\

\\
United States District Court

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

17

c 

The ALJ’s determination that plaintiff’s impairment(s) did

not functionally equal a listed impairment found support not only in

Ms Hamilton’s and Dr Grossman’s testimony, but also in the medical

reports of Drs Capocchi and Hoyt and in the SSA’s Childhood

Disability Evaluation Form. AR at 15; AR at 147-59. Both Dr

Capocchi and Dr Hoyt reported that plaintiff only suffered problems

in her right eye. AR at 147-49, 159. Dr Capocchi stated further

that plaintiff “appear[ed] to be otherwise normal during the office

examination of eyes.” AR at 148. 

The Childhood Disability Evaluation Form directly dealt

with the issue of functional equivalence. The State Agency

physicians concluded that plaintiff’s degree of limitation in four

of five “areas of development or functioning” was “less than marked”

(cognitive and communicative, motor, social and personal). AR at

138, 152. They found “no evidence of limitation” in the final

category (concentration, persistence, or pace). Id. Accordingly,

plaintiff’s impairment(s) fell short of the requirement for

functional equivalence: “extreme limitation” in at least one

category or “marked limitation” in at least two. 20 CFR §

416.926a(b)(2).

By contrast, plaintiff has offered no theory based on

evidence in the record that supports a finding of functional

equivalence. In Lewis v Apfel, the Ninth Circuit held that

plaintiff is responsible for pointing to evidence that shows that

his combined impairments equal a listed impairment. 236 F3d 503,

514 (9th Cir 2001). In the instant case, plaintiff has similarly

introduced no evidence that the lack of vision in her right eye
United States District Court

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

18

combined with her behavioral problems functionally equals a listing. 

 Considering all the evidence, the ALJ reasonably concluded

that both plaintiff’s physical and emotional problems were

insufficient to warrant SSI payments: “The limitations, resulting

from the effects of the claimant’s impairment, do not meet,

medically equal, or functionally equal the criteria of any listed

impairments * * *.” AR at 16. Accordingly, the court concludes

that the ALJ adequately explained his evaluation of the combined

effects of the impairment. 

3

Plaintiff finally contends that the ALJ did not make a

reasonable effort to obtain a “case evaluation, based on the record

in its entirety.” Pl Mot at 15. Plaintiff cites Howard v Barnhart,

which held that “the ALJ ‘shall make reasonable efforts’ to ensure

that a qualified individual ‘evaluates the case’ of the claimant.” 

341 F3d 1006, 1014 (9th Cir 2003); 42 USC § 1382c(a)(3)(I). Howard

held further that “the ALJ is required to make a reasonable effort

to obtain a case evaluation, based on the record in its entirety,

from a pediatrician or other appropriate specialist, rather than

simply constructing his own case evaluation from the evidence in the

record.” 341 F3d at 1014. The Howard court concluded that the ALJ

failed to rely on a “case” evaluation: “[r]ather, he only relied on

the individual evaluations and reports of each separate specialist,

which pertained to each of their individual specialities. The ALJ

made no effort to have [the] case evaluated in its entirety.” Id.

The instant case is clearly distinguishable from Howard. 

First, while the ALJ in Howard denied plaintiff’s request for a
United States District Court

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

19

pediatrician to provide an expert evaluation, the ALJ in the present

case ensured that a “qualified individual” evaluated plaintiff’s

entire case. The ALJ in the present case obtained the medical

expert testimony of pediatrician Dr Grossman. AR at 60-64, 87-88. 

Dr Grossman belonged to the American Board of Pediatrics and

practiced at San Francisco General Hospital. AR at 89. Plaintiff’s

counsel had no objection to Dr Grossman serving as a medical expert

at the April 11, 2000, hearing. AR at 58. Moreover, the ALJ sent

copies of all relevant medical exhibits to Grossman and informed him

that he would be asked to testify “as an expert medical witness on

the basis of the enclosed material as well as any additional

evidence that may be ordered at the hearing.” AR at 87-88.

Most importantly, substantial evidence indicates that both

Dr Grossman and the ALJ examined the record in its entirety before

coming to a decision. Dr Grossman was present during the entire

hearing. AR 33-64. Dr Grossman heard Ms Hamilton’s testimony about

plaintiff’s medical and functional limitations; he asked his own

questions of Ms Hamilton; and he answered questions from the ALJ and

the plaintiff’s attorney. Id. Dr Grossman asked Ms Hamilton about

both plaintiff’s vision and sleeping problems, AR at 59-60, and

answered questions about Dr Hoyt’s eye-patching treatment and the

childhood disability evaluation form. AR at 60-63. Considering

this breadth of evidence, Dr Grossman concluded that “normal [child]

behavior” and the temporary eye patching were the primary causes of

plaintiff’s functional limitations. Id.

Furthermore, Dr Grossman’s conclusion and the ALJ’s

finding are supported by substantial evidence. Plaintiff argues

that neither Dr Grossman nor the ALJ addressed the Valencia
United States District Court

For the Northern District of California

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

20

Pediatrics report (AR at 130-35), the statements of Valencia teacher

Eva White (AR at 126-29) or Ms Hamilton’s testimony (AR at 35-63) in

reaching their decisions. This statement is only accurate in

regards to the Valencia records. These records, however, actually

support, rather than contradict, Dr Grossman’s and the ALJ’s

conclusions. The Valencia records document plaintiff’s significant

improvement between November 1998 and August 1999, suggesting even

further that plaintiff’s functional limitations were not primarily

caused by her vision impairment. AR at 126-35.

Accordingly, the court holds that the ALJ did make a

reasonable effort to obtain a case evaluation based on the record in

its entirety, and Dr Grossman competently provided such an

evaluation.

 

IV

In sum, the court affirms the ALJ’s decision to deny

benefits. Because substantial evidence supported the ALJ’s decision

and there was no legal error on the part of the Appeals Council or

the ALJ, the court DENIES plaintiff’s motion for summary judgment

(Doc #13) and GRANTS defendant’s motion summary judgment (Doc #15).

The clerk is directed to enter judgment in favor of the

defendant and to close the file. 

IT IS SO ORDERED.

 

VAUGHN R WALKER

United States District Chief Judge