Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_05-cv-02229/USCOURTS-cand-3_05-cv-02229-4/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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UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF CALIFORNIA

DOUG A. HALL,

Plaintiff,

v.

JOANNE B. BARNHART,

Commissioner of Social

Security

Defendant.

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No. C05-02229 BZ

ORDER GRANTING PLAINTIFF’S

MOTION FOR SUMMARY JUDGMENT

AND DENYING DEFENDANT’S

CROSS-MOTION FOR SUMMARY

JUDGMENT

Plaintiff Doug A. Hall appeals from a final decision by

the Commissioner of Social Security (Commissioner) denying his

claim for social security benefits. Hall applied for

disability benefits under Title II of the Social Security Act

on May 9, 2003, alleging a disability onset date of May 30,

2001. After his application was denied, a hearing was held

before the Administrative Law Judge (ALJ). Plaintiff was

represented at the hearing by counsel. The ALJ issued a

decision on January 20, 2005, finding that Hall was not

disabled and therefore not eligible for disability or

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disability insurance benefits under Sections 216(I) and 223 of

the Social Security Act. Tr. at 23. Hall appealed that

decision to the Social Security Administration Appeals

Council. The Appeals Council considered new evidence

submitted by Hall and denied a review of the ALJ’s decision. 

Tr. at 5. At that point, the ALJ’s decision became the final

decision of the Commissioner. 

Hall timely requested judicial review pursuant to 42

U.S.C § 405(g), and moved for summary judgment, requesting

that the case be remanded to the Commissioner for further

consideration of the new evidence provided to the Appeals

Council. In her reply, defendant made a cross-motion for

summary judgment.

In coming to its conclusion, the Appeals Council

considered a Headache Residual Functional Capacity

Questionnaire (RFC) from treating neurologist Dr. Ananth

Acharya, dated March 25, 2005, which states that Hall is

“incapable of even ‘low stress’ jobs” and includes a prognosis

showing that “migraines do sometimes remit spontaneously, but

I have tried essentially all currently used medications

without success.” Tr. at 168-169. Nevertheless, the Appeals

Council denied Hall’s appeal stating that “we considered . . .

the additional evidence from Ananth Acharya, M.D. [but] found

that this information does not provide a basis for changing

the [ALJ’s] decision.” Tr. at 5-6. There is no explanation

in the record as to how or why this conclusion was reached. 

In determining whether to remand a case in light of new

evidence, the court examines both whether the new evidence is

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material to a disability determination and whether a claimant

has shown good cause for having failed to present the new

evidence to the ALJ earlier. Mayes v. Massanari, 276 F.3d

453, 461 (9th Cir. 2001). 

For new evidence to be material under section 405(g), it

must bear “directly and substantially on the matter in

dispute.” Mayes, 276 F.3d at 462; Booz v. Secretary of Health

and Human Servs., 734 F.2d 1378 (9th Cir. 1984). Hall must

“additionally demonstrate that there is a ‘reasonable

possibility’ that the new evidence would have changed the

outcome of the administrative hearing.” Mayes, 276 F.3d at

462. I find that there is a reasonable possibility that Dr.

Acharya’s RFC would have changed the outcome of the present

case. 

In his decision denying Hall disability benefits, the ALJ

relied in large part on a neurological consultative

examination from Daniel R. Katzenberg, M.D., performed June 8,

2003, at the request of defendant. Tr. at 114-115. Dr.

Katzenberg diagnosed Hall with post-traumatic migraines which

“occur[] on a near daily basis and make it difficult for him

to function.” Tr. at 115. However, Dr. Katzenberg observed

that Hall was not on prophylactic or abortive medication at

that time, and wrote that he “suspect[ed] that with aggressive

medical care the headaches should be controllable. . . . [I]f

the headaches are controlled there would be no restrictions to

what Mr. Hall can do.” Tr. at 115. The ALJ relied upon this

opinion in his step 3 finding that Hall’s impairment did not

meet or equal a listing and his step 4 finding that Hall could

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1 Following the standard five step process for

evaluating Hall’s claim (see 20 C.F.R. § 416.920), the ALJ

found at step one that Hall had not performed substantially

gainful activity since May 20, 2001. Tr at 17-20. At step

two, the ALJ found that Hall suffered from post-traumatic

migraines which are “severe impairments” as defined by the

regulations. At step three, the ALJ found that Hall’s

migraines do not meet or equal a listed level impairment. Id.

At step four, the ALJ concluded that Hall could perform his

past relevant work as a sales representative and sales manager

and in the alternative, at step 5, Hall could perform other

jobs existing in significant numbers in the national economy. 

Tr. at 21 Although a vocational expert was present at the

administrative hearing, neither side, nor the ALJ, questioned

the expert.

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perform his past relevant work.1 Tr. at 18-21. Dr. Acharya’s

March 2005 RFC directly conflicts with and calls into question

Dr. Katzenberg’s findings. Dr. Acharya’s RFC indicates that

he had seen Hall “about every four months for [his]

migraine[s]” and that his prognosis is “poor” as he has tried

“essentially all currently used medications without success.” 

Tr. at 166, 168. Dr. Acharya further indicates that Hall is

“incapable of even ‘low stress’ jobs [and] is not reliably

able to work most days because of [his] migraines.” Tr. at

169. Hall began seeing Dr. Acharya, a neurologist, about his

post-traumatic migraines in February 2004, two months prior to

the ALJ hearing. The ALJ considered the post-traumatic

migraine diagnosis from Dr. Acharya’s February 25, 2004

initial consultation with Hall and was aware that Hall was

continuing to see Dr. Acharya at the time of the hearing. Tr.

at 194-195. Clearly the new evidence bears “directly and

substantially on the matter in dispute” as it deals

specifically with the post-traumatic migraines suffered by

Hall prior to the ALJ hearing. Further, since Dr. Acharya’s

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2 Since I must defer to the fact finder’s credibility

determination, Acharya’s RFC may not alter the ALJ’s step 3

analysis. This new evidence may affect the step 4 and 5

determinations. Since no vocational expert was called to

testify at the ALJ hearing, I cannot surmise what jobs, if any,

would be possible for Hall to perform in light of this new

evidence. Remand to the ALJ is therefore necessary. 

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determinations directly conflict with Dr. Katzenberg's

conclusion, relied upon by the ALJ, there is a “reasonable

possibility” that this new evidence would change the outcome

of the present case.2

 

 In addition to the materiality requirement, a claimant

seeking remand must demonstrate that “there is good cause for

the failure to incorporate [the new] evidence into the record

in a prior proceeding.” 42 U.S.C. § 405(g); Clem v. Sullivan,

894 F.2d 328 (9th Cir. 1990). A claimant does not meet the

good cause requirement by merely obtaining a more favorable

report once his or her claim has been denied. Mayes, 276 F.3d

at 463. To demonstrate good cause, the claimant must

demonstrate that the new evidence was unavailable earlier. 

Key v. Heckler, 754 F.2d 1545, 1551 (9th Cir. 1985)(“If new

information surfaces after the Secretary’s final decision and

the claimant could not have obtained that evidence at the time

of the administrative proceeding, the good cause requirement

is satisfied.”) The claimant must also establish good cause

for not having sought the expert’s opinion earlier. Clem, 894

F.2d at 332. 

The March 25, 2005 RFC, in which Dr. Acharya concluded

that Hall is “incapable of even ‘low stress’ jobs,” resulted

from the fact that over the course of the prior year, he had

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3 Notably, however, the ALJ could have requested

additional information from Dr. Acharya before a decision was

reached since the ALJ was aware that Hall was seeing Dr.

Acharya at the time of the hearing. 

4 The RFC is dated March 25, 2005. The ALJ hearing

took place on April 12, 2004 and the ALJ’s decision was reached

on January 26, 2005. 

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seen Hall regularly and tried a variety of treatment options. 

Since Hall began seeing Dr. Acharya only two months prior to

the ALJ’s hearing, the neurologist could not, at the time of

the hearing, have concluded that these drugs would be

ineffective on Hall’s migraines.3 It is undisputed that Dr.

Acharya's RFC was created after the ALJ hearing, and even

after the ALJ’s decision was issued.4 Since the RFC was not

in existence at the time of the hearing and the diagnosis and

prognosis contained within it relate back to the period before

the ALJ’s decision, I find that the claimant had good cause

for not presenting the evidence to the ALJ. 

Since I find that Hall has demonstrated that Dr.

Acharya’s report is new and material to the assessment of his

claimed disability and that there was good cause for Hall’s

not having produced the RFC to the ALJ at the time of the

administrative hearing, I need not reach Hall’s other

arguments. 

Accordingly, IT IS ORDERED that plaintiff’s motion for

summary judgment is GRANTED, the defendant’s cross-motion for 

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summary judgment is DENIED, and the case is remanded to the

Commissioner for consideration of the new evidence.

Dated: March 13, 2006

 Bernard Zimmerman 

 United States Magistrate Judge

G:\BZALL\-BZCASES\HALL II\SUM.JUDG.ORDER.wpd

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