Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_12-cv-04889/USCOURTS-cand-3_12-cv-04889-0/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)

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United States District Court 

Northern District of California 

UNITED STATES DISTRICT COURT 

NORTHERN DISTRICT OF CALIFORNIA 

RENEE MAINES, 

Plaintiff, 

v. 

COMMISSIONER OF SOCIAL 

SECURITY, 

Defendant. 

Case No. 12-cv-04889-JCS 

ORDER GRANTING IN PART AND 

DENYING IN PART MOTIONS FOR 

SUMMARY JUDGMENT; 

REMANDING FOR CALCULATION OF 

BENEFITS 

Dkt. Nos. 16, 28 

I. INTRODUCTION 

Plaintiff L.D.M., a minor, with the assistance of her mother, Renee Lucero-Maines, seeks 

review of the final decision of the Commissioner of the Social Security Administration (the 

“Commissioner”) denying her Application for Supplemental Security Income (“SSI”) benefits 

under Title XVI of the Social Security Act (“SSA”). Plaintiff asks the Court to reverse the 

Commissioner’s denial of benefits and remand with instructions to award benefits or, in the 

alternative, for additional administrative proceedings. The parties have filed Cross-Motions for 

Summary Judgment (“Motions”). For the reasons stated below, both Motions are GRANTED in 

part and DENIED in part.1

 

II. BACKGROUND 

A. Procedural Background 

On August 24, 2009, Plaintiff’s mother applied for SSI benefits on behalf of the claimant, 

her daughter, a child under the age of 18, with an alleged disability onset date of January 19, 2006. 

Administrative Record (“AR”) 63. In her application, Plaintiff’s mother claimed Plaintiff was 

disabled due to “[j]uvenile diabetes type 1 [and] severe food allergies.” AR 74. The claim was 

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 The parties have consented to the jurisdiction of the undersigned magistrate judge 

pursuant to 28 U.S.C. § 636(c). 

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initially denied on February 4, 2010, id. at 51, and denied upon reconsideration on July 15, 2010, 

id. at 56. On August 31, 2010, Plaintiff’s mother filed a written request for a hearing before an 

Administrative Law Judge (“ALJ”). Id. at 61. A video hearing was held before ALJ Mary L. 

Everstine on July 25, 2011. Id. at 34-48 (Hearing Transcript). Plaintiff appeared in person and 

was not represented. Id. at 36. Her mother was present as a witness. Id. On July 29, 2011, the 

ALJ issued a decision denying benefits, finding that the claimant was not disabled as defined in 

the SSA since August 24, 2009, the date the application was filed. Id. at 10-12 (Notice of 

Decision – Unfavorable); 13-19 (ALJ’s Decision). The ALJ’s decision became final when the 

Appeals Council declined review on February 21, 2012. Id. at 3-5. 

On September 18, 2012, Plaintiff filed this action pursuant to 42 U.S.C. § 405(g), which 

gives the Court jurisdiction to review the final decision of the Commissioner. Complaint 

(“Compl.”) ¶ 3. Plaintiff also submitted a brief entitled “Points and Authorities in Support of 

Complaint in Opposition to Denial of SSI Disability by Defendant” to supplement the Complaint. 

Dkt. No. 2 (“Plaintiff’s Brief”). On the same day, Plaintiff filed an Application to Proceed in 

forma pauperis, which was granted by the Court on October 7, 2012. Defendant filed an answer 

to the Complaint on January 24, 2013, along with a certified copy of the administrative record. 

Dkt. Nos. 13, 14. 

On February 11, 2013, Plaintiff filed a Motion for Summary Judgment. Dkt. No. 16 

(Plaintiff Motion for Summary Judgment, Remand and Reply) (“Plaintiff’s Motion”). On June 21, 

2013, Defendant filed a Cross-Motion for Summary Judgment. Dkt. No. 28 (Defendant’s Notice, 

Motion, and Memorandum in Support of Cross-Motion for Summary Judgment and in Opposition 

to Plaintiff’s Motion for Summary Judgment) (“Defendant’s Motion”). Plaintiff filed a reply brief 

on September 30, 2013. Dkt. No. 42 (Plaintiff Response to Defendant’s Cross-Motion for 

Summary Judgment) (“Plaintiff’s Reply”). 

B. Plaintiff’s Background 

Plaintiff was born on February 11, 2004. AR 70. She was twenty-three months old on the 

alleged onset date of her disability, January 19, 2006. Id. Plaintiff was five-years-old, a preschool 

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child,2 on August 24, 2009, the date Plaintiff’s mother filed an application for SSI. Id. at 79. 

When the hearing before the ALJ took place on July 25, 2011, as well as when the ALJ’s Decision 

was issued on July 29, 2011, Plaintiff was seven years old. Id. at 13, 34. She is currently a 

school-age child, age nine. Id. at 40. 

C. The Administrative Record 

On January 19, 2006, Plaintiff was admitted to the intensive care unit (“ICU”) at the Santa 

Barbara Cottage Hospital in Santa Barbara, California with evidence of “new-onset diabetes, 

including polyuria, polydipsia, weight loss, and hyperglycemia.” AR 118. Upon admission, 

Drake Paul, M.D., diagnosed Plaintiff with “[n]ew-onset diabetes mellitus and diabetic 

ketoacidosis.” Id. Dr. Paul commented in Plaintiff’s Discharge Summary that generally, Plaintiff 

“is in no acute distress. Is alert and is active. Is well-developed, well-nourished.” Id. The 

Discharge Summary also noted that Plaintiff’s “parents have been well educated and instructed on 

how to care for [Plaintiff’s] diabetes and continue to do the Accu-Cheks and insulin by themselves 

with nursing supervision here in the hospital and have shown proficiency in that regard.” Id. at 

119. Specifically, Plaintiff’s parents were to “continue their current regimen of 2 units of Lantus 

nightly,” “a Humalog carbohydrate count with meals only, of 1 unit for every 15 grams of 

carbohydrate after the meals,” and “Accu-Cheks q.a.c. and nightly as well an early morning, 2 to 3 

a.m., Accu-Chek.” Id. 

Between May 4, 2007 and April 21, 2010, Elena R. Regala, M.D., treated Plaintiff twelve 

times. AR 150-58. Dr. Regala’s notes show treatment for Plaintiff’s flu, runny nose, cough, ear 

ache, etc. Id. at 151-53. The records from September 2009 to December 2009 note that Plaintiff 

was to be administered insulin shots six to eight times per day. Id. at 154. 

On November 9, 2007, while on a family vacation in Lake Tahoe, California, Plaintiff 

developed a “mild pruritus” after she ate a muffin containing banana, coconut, and walnuts. AR 

122. Plaintiff subsequently had difficulty “eating . . . yogurt” and “clearing her throat.” Id. She 

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attainment of age 12) are terms of art under the Code of Federal Regulations. See 20 C.F.R. 

416.926a(k)(2)(iii) and (iv). 

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complained of a mild “lump in the throat” sensation. Id. Plaintiff’s parents discovered a few, 

scattered urticarial lesions on Plaintiff while they were bathing her, but did not observe any 

breathing problems. Id. The parents attempted to treat the lesions with Benadryl and a topical 

corticosteroid. Id. However, because the symptoms did not resolve, Plaintiff’s parents took 

Plaintiff to the emergency department. Id. There, she was treated with antihistamine and an 

aerosolized bronchodilator, but did not require injected epinephrine. Id. Plaintiff’s symptoms 

were completely resolved the next day. Id. 

On December 10, 2007, Randy P. Johnson, M.D., evaluated Plaintiff for food allergies. 

AR 122-24. Dr. Johnson placed a skin testing panel to food allergens, which showed “large 

positive reactions . . . to walnut and shrimp[,]” and “[s]maller positive reactions [that] may not 

correlate clinically . . . to egg, peanut, pecan, cashew, and hazelnut.” AR 123. Dr. Johnson 

diagnosed Plaintiff with “[f]ood allergy” and “[t]ype 1 diabetes,” and prescribed an EpiPen Jr. 

containing “epinephrine to be used as needed for any symptoms of anaphylaxis.” Id. Plaintiff’s 

“family was instructed to withhold tree nuts.” Id. 

On March 31, 2008, Plaintiff was treated at the Comprehensive Childhood Diabetes Center 

of Children’s Hospital Los Angeles (“CHLA”). AR 181-90. In his Diabetes Visit Form, Harry 

McCarthy, RN/CDE, noted that all of Plaintiff’s body systems and physical examination were 

“normal.” Id. at 182. RN McCarthy noted that Plaintiff’s hemoglobin A1c level measured 8.8%, 

a drop from the last count of 9.1% on December 3, 2007. Id. at 183; 188. He also noted that 

Plaintiff’s blood glucose levels were “high overnight.” Id. at 183. RN McCarthy recommended 

the treatment and monitoring of Plaintiff’s high blood glucose levels. Id. at 186. He also 

recommended adjusting Plaintiff’s Lantus (long-acting insulin) dosage and rotating insulin 

injection sites. Id. The 14-day summary covering from March 13, 2008 to March 26, 2008 shows 

that there were twelve episodes of hypoglycemia (low blood sugar), indicated by glucometer 

readings below the hypoglycemic threshold of 67 mg/dL. Id. at 189-90. There were 101 readings 

over this period. Id. at 189. The summary also indicates that only 38% of the blood sugar 

readings were within the personal target range. Id. Specifically, of the 101 readings, 49 readings 

exceeded the target range due to high blood sugar, while 2 readings were below the target due to 

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low blood sugar. Id. 

On October 9, 2008, Janet Leigh Phillips, FNP/CDE, evaluated Plaintiff for an initial 

consultation. AR 133-34. Ms. Phillips described Plaintiff as “a very sweet and sociable child,” 

and noted that since Plaintiff’s initial diagnosis, she had no further hospitalizations or serious 

illnesses. Id. at 133. Ms. Phillips noted that Plaintiff’s regiment of insulin is an “interesting” 1⁄4 

unit. Id. Further, the diabetes regiment consisted of two units of Lantus in the morning and 1 3⁄4 

units in the evening; correction of 1⁄4 unit for 50 points greater than 200, and 1⁄4 for night time 

correction for 100 points greater than 250, with no snacks. Id. Laboratory results showed that 

Plaintiff’s hemoglobin A1c level was 9.2%, up from the previous reading of 8.5%. Id. Ms. 

Phillips spent over an hour with Plaintiff’s mother “discussing general education, action of insulin, 

growth and the need for increased carbohydrates and protein, i.e., snacks.” Id. Ms. Phillips 

“congratulated and praised [Plaintiff’s mother] for a job well done under difficult circumstances.” 

Id. at 134. She also noted in her report that “[i]n California [Plaintiff] had medical insurance. 

[Mother] applied to Nevada Medicaid but was denied. [Ms. Phillips and Plaintiff’s mother] 

discussed the need to reapply which the norm is here [sic] and also provided other community 

resources.” Id. 

On January 15, 2009, Kathleen M. O’Connor, M.D., a pediatric endocrinologist, evaluated 

Plaintiff. AR 129-32. According to her Pediatric Diabetes Clinic Visit Report, Plaintiff’s 

hemoglobin A1c level was 9.3%, up from 9.2% on October 9, 2008. Id. at 129. Dr. O’Connor 

noted that Plaintiff experiences “some lows,” when she exhibits “yawn, dizzy.” Id. Also, Plaintiff 

had a new bike, and had ballet for one hour on Tuesdays. Id. Dr. O’Connor recommended that 

Plaintiff’s parents cut out snacks for the children, which had been recently added for afternoon 

exercise. Id. She noted “EpiPen Jr.,” “Lantus,” and “Humalog” as Plaintiff’s medication. Id. 

Plaintiff’s physical examination was “normal.” Id. at 130. Dr. O’Connor diagnosed Plaintiff with 

Type I Diabetes Mellitus, poor control. Id. According to the Onetouch Zoom Pro Logbook, over 

the period from December 17, 2008 to January 15, 2009, Plaintiff had further episodes3

 of 

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 Due to the poor visual quality of the Onetouch Zoom Logbook report, the Court could 

only discern four episodes. AR 131-32. Plaintiff’s mother contends that there were “ten episodes 

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hypoglycemia. Id. at 131-32. 

On April 23, 2009, Dr. O’Connor and Ms. Phillips assessed Plaintiff again. AR 125-26 

(Report of Ms. Janet Leigh Phillips); 127-28 (Report of Dr. Kathleen O’Connor). Ms. Phillips’s 

report from that date reveals that Plaintiff’s hemoglobin A1c level was “10.2%+,” up from 9.3% 

on January 15, 2009. Id. at 125. Both reports show that the physical examination of Plaintiff was 

“normal,” and indicate that Plaintiff was diagnosed with Type I Diabetes Mellitus, poor control. 

Id. at 126, 128. Dr. O’Connor prescribed Humalog (short acting insulin) and Lantus (long acting 

insulin) to be taken at specific time intervals and corrected as needed. Id. at 127. 

On May 5, 2009, Kevin Windisch, M.D.,4 of RL Sparks Pediatric and Adolescent 

Medicine, performed a “5 Year Well Child Exam” of Plaintiff. AR 139-42. Dr. Windisch’s 

Encounter Record and Progress Note states that Plaintiff was “slated to start kindergarten” in 

September 2009; had “multiple allergies” and “carried an epipen”; and “since diagnosis [of poorly 

controlled type I diabetes at the age of 2, Plaintiff’s] sugars have included high Hemoglobin 

A1c’s.” Id. at 139. Dr. O’Connor noted that Plaintiff had “not required admission since initial 

diagnosis.” Id. Plaintiff’s physical examination was “normal.” Id. at 141-42. Dr. O’Connor 

diagnosed Plaintiff with type 1 diabetes, poor control and “multiple food allergies.” Id. at 142. 

He opined: 

[Plaintiff] will require ongoing medical management for this illness 

for the rest of her life. If managed aggressively she will have a 

normal lifespan but if allowed to be uncontrolled, [Plaintiff] will be 

a grave risk for Myocardial Infarct, Cerebro Vascular Accident, 

Renal Failure, death from ketoacidosis and limb loss due to poor 

blood flow. She will need to be treated with multiple medications, 

follow with endocrinology and check her blood sugar frequently. 

Id. 

On May 6, 2009, April Henry, M.D.,5

 reviewed Plaintiff’s medical record and determined 

that Plaintiff’s “impairment or combination of impairments is severe, but does not meet, medically 

 

of hypoglycemia within the monthly period between December 17, 2008 and January 14, 2009” 

according to the same report. Plaintiff’s Brief at 3. 4

 According to Defendant’s Motion, Dr. Windisch is a pediatrician. Defendant’s Motion at 

7. 

5

 According to Defendant’s Motion, Dr. Henry is a State agency medical consultant. 

Defendant’s Motion at 8. 

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equal, or functionally equal the listings,” 20 C.F.R. § 404, Subpt. P, App. 1. AR 143-48. Dr. 

Henry further opined that Plaintiff had no limitations in four out of six functional equivalence 

domains: acquiring and using information; attending and completing tasks; moving about and 

manipulating objects; and in the ability to care for herself. Id. at 145-46. Dr. Henry appears to 

have no response to the domain “interacting and relating with others” in her Childhood Disability 

Form. Id. at 143-48. Dr. Henry opined that Plaintiff had less than marked limitation in the 

domain of health and physical well-being, based on her diabetes mellitus in poor control, food 

allergies, and normal growth curve. Id. at 146. 

On September 23, 2009, Cathy Baker, Plaintiff’s kindergarten teacher, completed a teacher 

questionnaire for child disability requested by the State Department of Social Services. AR 90-97. 

Ms. Baker indicated that she had observed no problems in any of the six domains of functioning.6 

Id. at 91-96. She did not know whether Plaintiff was prescribed medication, and indicated that 

Plaintiff did not frequently miss school due to illness. Id. at 96. 

On December 30, 2009, M. Nawar, M.D.,7 reviewed the medical evidence of record. AR 

159-65. Dr. Nawar concluded that Plaintiff’s impairments, while severe, did not meet, medically 

equal, or functionally equal the listings. Id. at 160. Specifically, Dr. Nawar opined that Plaintiff 

had no limitations in four out of the six functional domains: acquiring and using information, 

attending and completing tasks, interacting and relating with others, and moving about and 

manipulating objects. Id. at 163. Dr. Nawar noted that Plaintiff had a less than marked limitation 

in the domain for caring for herself and marked limitation in the domain of health and physical 

well-being based on her diabetes mellitus in poor control, normal growth, and “unlimited 

functioning.”8

 Id. 

On February 23, 2010, Plaintiff was treated at the Comprehensive Childhood Diabetes 

Center of the Children’s Hospital Los Angeles. AR 175-80. Dr. Kim’s review of Plaintiff’s 

 6

 As discussed below, the six domains of functioning are listed in section 416.926a(b)(1) of 

Title 20 of the Code of Federal Regulations. 7

 According to Defendant, Dr. Nawar is a State agency medical consultant. Defendant’s 

Motion at 9. 

8

 The definitions of “less than marked” and “marked” are discussed below. 

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systems and physical examination were normal. Id. at 176. She noted in her report that Plaintiff’s 

hemoglobin A1c level had decreased to 9.9% from the previous reading of 10.2% in April 2009. 

Id. at 177. Dr. Kim also noted that Plaintiff had no recorded incidents of severe hypoglycemia 

since her last visit. Id. L. Brancale, RN/CDE, noted in her report that Plaintiff was working on 

“improving control” by testing blood glucose levels a minimum of four times per day, rotating 

insulin injection sites, and logging blood glucose counts and calling Ms. Brancale in three days for 

a dose adjustment. Id. at 179. Ms. Brancale also noted in her Patient Education Documentation 

that Plaintiff’s mother, the “sole care-giver,” “requires ongoing support” and that she “needs help 

obtaining medical coverage . . . .” Id. at 180. 

On April 27, 2010, Dr. Kim and Ms. Brancale treated Plaintiff again. AR 167-71. On 

Plaintiff’s Diabetes Visit Form, Dr. Kim noted that Plaintiff was “really active on [her] bike.” Id.

at 167. Dr. Kim’s review of Plaintiff’s systems and physical examination were normal. Id. at 168. 

Plaintiff’s hemoglobin A1c level was 10.1% (reference range 3-6%), up from her previous reading 

of 9.9%. Id. at 169. Dr. Kim noted that Plaintiff’s “Mom does lunch [insulin] shot[s]” at noon. 

Id. Dr. Kim also reported that Plaintiff had not experienced severe hypoglycemia since her last 

visit. Id. Dr. Kim indicated that Plaintiff has “psychological issues,” specifically, “some chaos.” 

Id. at 170. According to Dr. Kim, Plaintiff had high blood sugar levels at lunchtime “if [she had a] 

big . . . snack,” and that Plaintiff needs either a snack or a shot in the mid-morning. Id. Dr. Kim 

and Ms. Brancale both recommended that Plaintiff’s blood sugar levels be tested more frequently, 

and that Plaintiff’s blood sugar levels be rechecked after treating a low level or correcting a high 

level. Id. at 170-71. Ms. Brancale indicated in Plaintiff’s Patient Education Documentation that 

“[Plaintiff’s mother] is overwhelmed but doing as best she can,” and that she “is a single parent 

caring for [two] children [with] diabetes.” Id. at 171. In a separate report submitted as the same 

exhibit, a health professional indicated that an obstacle to treatment compliance for Plaintiff was 

“forgetting shots.” Id. at 172. The report also noted that Plaintiff “attends [kindergarten] and is 

doing well academically. [Plaintiff] is physically active, [Plaintiff] likes to color and play with 

peers. [Plaintiff’s mother] involved and supportive.” Id. A fourteen-day summary covering the 

period between April 14, 2010 and April 27, 2010 showed that four out of forty-four glucometer 

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readings were below the hypoglycemic threshold of 67 mg/dL. Id. at 173-74. However, only 18% 

of the blood glucose readings were within the personal target for Plaintiff. Id. at 173. The 

majority of readings, 31 out of 44 readings, were above the Plaintiff’s personal target blood 

glucose level due to high blood sugar. Id. 

 On July 12, 2010, K. Quint, M.D.,9 reviewed all of the medical evidence and completed a 

Childhood Disability Evaluation Form. AR 191-95. Dr. Quint concluded in the report that 

Plaintiff had an impairment or combination of impairments that is severe, but it does not meet, 

medically equal, or functionally equal any of the listed impairments. Id. at 191. Specifically, Dr. 

Quint indicated that Plaintiff had no limitations in five out of six domains of functional 

equivalency. Id. at 193. Dr. Quint indicated that Plaintiff had a less than marked limitation in the 

domain of health and physical well-being because she “[h]as juvenile onset diabetes,” and had no 

limitation in the domains of moving about and manipulating objects and caring for oneself. Id. 

 On October 21, 2010, Kathleen M. O’Connor, M.D., treated Plaintiff’s diabetes and 

completed a Progress Note. AR 205-06. Plaintiff’s meter showed there were three to four blood 

glucose level readings being taken per day, with “[s]ome scattered lows associated with busy 

times.” Id. at 205. Dr. O’Connor noted that Plaintiff’s blood sugar levels “later in [the] day [were 

not] as good as” her morning levels. Id. She also noted that Plaintiff “[g]ets shots after meals.” 

Id. Dr. O’Connor opined that aside from a “bump on [Plaintiff’s] buttock that needs [to be] 

checked,” she was “normal” and “healthy looking.” Id. Dr. O’Connor assessed Plaintiff with 

“[d]iabetes mellitus without mention of complication, type I (juvenile type), uncontrolled – 250.03 

(Primary),” and “cellulitis of injection site.” Id. Dr. O’Connor’s treatment consisted of the 

continuation of Lantus Solution and Humalog KwikPen Solution. Id. Plaintiff’s hemoglobin A1c 

reading was 9.5%, down from her previous reading of 10.2% on April 23, 2010. Id. 

 On January 20, 2011, Plaintiff returned to Dr. O’Connor for follow-up treatment of her 

diabetes. AR 203-04. Plaintiff’s meter showed there were three to six glucose blood glucose level 

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 According to Defendant, Dr. Quint is a State agency medical consultant. Defendant’s 

Motion at 10. 

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readings being taken per day. Id. at 203. Dr. O’Connor noted that Plaintiff’s “[n]umbers” were 

“erratic,” and that there was “[n]o pattern.” Id. Plaintiff appeared to continue to “[t]ake shots 

after she eats.” Id. Dr. O’Connor noted that Plaintiff was taking ballet once per week and was 

participating in Girl Scouts twice per month. Id. Dr. O’Connor concluded from a general 

examination of Plaintiff that her general appearance was “normal” and “healthy looking.” Id. Dr. 

O’Connor assessed Plaintiff with “[d]iabetes mellitus without mention of complication, type I 

(juvenile type), uncontrolled – 250.03 (Primary).” Id. Dr. O’Connor’s treatment consisted of the 

continuation of Lantus Solution and Humalog KwikPen Solution. Id. Plaintiff’s hemoglobin A1c 

reading was 9.1%, down from the previous reading of 9.5% on October 21, 2010. Id. 

 On February 4, 2011, Dr. O’Connor completed a Functional Assessment for Children 

Form, in which she assessed Plaintiff’s functionality within each of the six domains. AR 198-200. 

In the domain of acquiring and using information, Dr. O’Connor concluded that Plaintiff had a 

moderate limitation. Id. at 198. She commented that Plaintiff’s “self-management is limited by 

her age. She is not old enough yet to count carbohydrates, decide on insulin dose, and give 

injections independently. Her mother must provide/supervise all care of her Type 1 Diabetes.” Id. 

In the domain of attending and completing tasks, Dr. O’Connor indicated that Plaintiff had a 

moderate limitation. Id. at 199. Specifically, Dr. O’Connor commented that “[a]ttention is 

appropriate for her age; but not yet well-developed enough for self-management of diabetes.” Id. 

In the domain of health and physical well-being, Dr. O’Connor opined that Plaintiff had a 

moderate limitation. Id. at 200. To explain her opinion, Dr. O’Connor noted in her form that 

Plaintiff “must monitor blood sugar and take insulin injections before each meal and/or snack. 

During exercise [and] heavy activity she must monitor for lows [and] as necessary.” Id. In three 

of the six domains, interacting and relating with others, moving about and manipulating objects, 

and personal care, Dr. O’Connor concluded that there was no evidence of limitation. Id. at 199. 

 On April 27, 2011, Dr. O’Connor continued to treat Plaintiff’s diabetes. AR 201-02. 

Plaintiff’s meter showed that there were three to five glucose blood glucose level readings being 

taken per day. Id. at 201. Dr. O’Connor noted that there were “some lows,” specifically, about 

four times every two weeks but with “no pattern.” Id. In half the mornings, the readings were 

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high, while in the other half of the mornings, the readings were “low normal, 2 lows.” Id. Dr. 

O’Connor indicated that Plaintiff’s “numbers [were] highly variable.” Id. She also noted that 

Plaintiff “sometimes snacks without telling,” but that it is “getting better now that they know they 

won’t get in trouble.” Id. Following a general examination of Plaintiff, Dr. O’Connor concluded 

that Plaintiff’s general appearance was “normal” and “healthy looking,” despite a “bad rash in 

[the] panty area” and “some discomfort” as a result. Id. Dr. O’Connor assessed Plaintiff with 

“[d]iabetes mellitus without mention of complication, type I (juvenile type), uncontrolled – 250.03 

(Primary),” and “[c]andidiasis of vulva and vagina.” Id. Dr. O’Connor’s treatment consisted of 

the continuation of Lantus SoloStar Solution and Apidra SoloStar Solution, and start of Diflucan 

Suspension Recontinued and EMLA Cream. Id. Plaintiff’s hemoglobin A1c reading was 10.3%, 

up from the previous reading of 9.1% on January 20, 2011. Id. 

 After the ALJ’s decision on July 29, 2011 denying Plaintiff SSI benefits, Dr. O’Connor 

drafted a letter on September 9, 2011, “support[ing] [Plaintiff’s] application for disability.” AR 

207. She noted that: 

At her age [Plaintiff] is unable to provide most of her own Diabetes 

care. Her care includes counting carbohydrates every time she eats, 

determining the dose of Insulin required for that amount of food, 

injecting insulin with meals and a longer acting insulin at bedtime, 

monitoring for low and high blood sugars and treating each. . . . 

Younger children aren’t as aware as older kids and adults and often 

need assistance to detect and treat low blood sugars. . . . Children on 

average learn to give injections around age 8 [years] old, but 

counting carbohydrates is a skill that takes many years to learn. 

Further still is the fact that children are very concrete thinkers; they 

are unable to think of long term consequences and the daily 

management of Diabetes must be monitored by an adult through 

high school or compliance and quality of care will suffer. 

Id. Dr. O’Connor also opined that “a child with Diabetes can do almost anything a child with no 

medical problems can do,” but “the disability coverage helps pay for the supervision required for 

her healthcare in a single parent household.” Id. Dr. O’Connor noted that Plaintiff’s “mom is 

usually required to miss work because there are few sitters capable of managing [Plaintiff’s] 

diabetes.” Id. 

 Twenty-four weeks into the 2011-2012 school year, Plaintiff’s first grade teacher, Ms. 

Sandi Jensen at G. L. Scarselli Elementary School, completed a Competency Progress Report. AR 

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116. Plaintiff’s attendance record shows that Plaintiff was present on 144 days, absent on nine 

days, and tardy on six days. Id. Her report card demonstrates that Plaintiff’s “characteristics of a 

successful student” were “strong always,” in all eleven categories. Id. Academically, with the 

exception of two standards in mathematics during the first twelve weeks of school and some 

standards that were not assessed, Plaintiff was either approaching or met the academic standards.10 

Id. Plaintiff’s first grade teacher commented that she “is a pleasure to have in class. She plays 

school well and with continued effort will continue to reach all the goals that have been set for 

her!” Id. 

D. The Administrative Hearing 

The ALJ held an administrative hearing by video teleconferencing on July 25, 2011. AR 

34-48 (Hearing Transcript). Plaintiff and her mother were present in the San Luis Obispo, 

California hearing office, and the ALJ heard the case from Santa Barbara, California. Id. at 36. 

The ALJ advised Plaintiff and her mother of the right to representation and the ability to continue 

the hearing to a later date. Id. Plaintiff’s mother elected to proceed on Plaintiff’s behalf. Id. 

Because Plaintiff was only seven years old, she did not testify during the hearing. Id. at 38. 

Plaintiff’s mother testified that Plaintiff was scheduled to start second grade in two weeks. 

AR 39. Through the ALJ’s questioning and the testimony of Plaintiff’s mother, it was confirmed 

that Plaintiff has insulin-dependent diabetes, and allergies to walnuts, shrimp, and cephalexin. Id. 

Plaintiff’s mother testified that all three allergies are severe and that she carries an EpiPen for that 

reason. Id. She also testified that Plaintiff’s brother, three years old, was also diabetic and that 

she had a case pending on him “right behind [Plaintiff]” in the Social Security process. Id. at 40. 

 The ALJ questioned Plaintiff’s mother about Plaintiff’s performance in school. AR 40-41. 

Plaintiff’s mother testified that in first grade, Plaintiff was behind in reading. Id. at 40. She 

continued to testify that Plaintiff is still behind for second grade, but she was approaching grade 

level. Id. Plaintiff was not in any special programs and was entirely in a mainstream classroom. 

 10 Specifically, in most academic standards, Plaintiff was awarded either a “3” 

(Approaching Standard) or “4” (Meets Standard) on a 5-point scale, where “5” is Exceeds 

Standard. 

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Id. at 41. Plaintiff got along well with her peers and adults, and was polite. Id. Through the 

ALJ’s questioning, Plaintiff’s mother confirmed that Plaintiff is “sweet and social.” Id. The ALJ 

questioned Plaintiff’s mother about whether Plaintiff was expected to help around the house. Id.

at 43. Plaintiff’s mother testified that Plaintiff assisted with chores, such as feeding the dogs, 

emptying the wastebaskets, and making her bed. Id. at 43-44. 

 On Plaintiff’s diabetes, Plaintiff’s mother testified that “when [Plaintiff’s] sugars are off, 

she gets kind of sleepy or she gets moody.” AR 41. Plaintiff’s mother had provided Plaintiff’s 

teacher with a list of symptoms because “not many people know too much about type 1 diabetes.” 

Id. at 42. Plaintiff’s mother testified that every morning, she tests Plaintiff’s sugar levels when 

Plaintiff wakes up. Id. at 43. After breakfast, Plaintiff’s mother gives Plaintiff a shot and counts 

her carbohydrates before taking Plaintiff to school. Id. If a problem arises prior to the school 

lunch hour, Plaintiff’s mother would go to the school, and test and treat as needed. Id. Plaintiff’s 

mother testified that typically, she goes to Plaintiff’s school every day during the lunch hour to do 

her testing, counting of carbohydrates, and shots. Id. at 42-43. Two hours later, Plaintiff’s mother 

would pick Plaintiff up when school ended. Id. at 43. Plaintiff wears a wristband and necklace to 

alert others of her diabetes. Id. at 42. Whenever Plaintiff felt she had a problem during the school 

day, she would go to the nurse’s office. Id. at 42-43. Plaintiff’s mother explained that the nurse at 

school is “just a nurse aide,” and thus could not legally test or apply shots to Plaintiff. Id. at 43. 

Accordingly, the nurse calls Plaintiff’s mother when Plaintiff was not feeling well. Id. at 42-43. 

 Plaintiff’s mother testified that the most limiting aspect of Plaintiff’s diabetes was the 

administration of tests and insulin shots throughout the day. AR 44. According to Plaintiff’s 

mother, Plaintiff’s hemoglobin A1c level should ideally be 7%, but it is currently 10.5%. Id. 

Plaintiff’s mother also testified that following a recent “little minor ear infection . . . [Plaintiffs] 

sugars aren’t going down.” Id. Plaintiff’s mother testified that “the medication spiked 

[Plaintiff’s] sugars even more.” Id. She also confirmed that Plaintiff had not been hospitalized 

since the initial hospitalization on January 19, 2006, when she was first diagnosed of diabetes. Id. 

 The ALJ questioned Plaintiff’s mother about whether Plaintiff misses school because of 

her diabetes. AR 45. Plaintiff’s mother answered in the affirmative, and added that Plaintiff “had 

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a lot of sick days last year” and that “last year was the first year [Plaintiff] was there all day long . 

. . .” Id. She also added that last “January, February, March [were] just brutal, with the flu bug 

and . . . stuff going around.” Id. According to Plaintiff’s mother, when Plaintiff has a sick day, 

Plaintiff’s mother must test Plaintiff “every hour on the hour, around the clock, until [Plaintiff’s 

mother] can bring [Plaintiff’s] sugars down.” Id. 

 The ALJ asked Plaintiff’s mother if there was anything else that was not in the records that 

she should know prior to making a decision. AR 46. In response, Plaintiff’s mother testified that 

she was a “single parent taking care of not only [Plaintiff] but [her] son, too,” who could not rely 

on anyone else to care for them. Id. She further testified that she was thus “not able to go to 

work.” Id. 

E. The SSA’s Three-Step Analysis to Determine Whether a Minor is Disabled 

Supplemental Security Income (“SSI”) is available under Title XVI of the Social Security 

Act (the “Act”) for an individual under the age of 18 when she is “disabled.” 42 U.S.C. § 

1382c(a)(3)(C)(i); see also 42 U.S.C. § 1381a. A child is “disabled” if she “has a medically 

determinable physical or mental impairment, which results in marked and severe 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.” Id.; Merrill v. Apfel, 224 F.3d 1083, 1085 (9th Cir. 

2000). “The claimant bears the burden of establishing a prima facie case of disability.” Roberts v. 

Shalala, 66 F.3d 179, 182 (9th Cir. 1995) (citing Drouin v. Sullivan, 966 F.2d 1255, 1257 (9th Cir. 

1992)), cert. denied, 517 U.S. 1122 (1996); Smolen v. Chater, 80 F.3d 1273, 1289 (9th Cir. 1996) 

(citation omitted). 

The Commissioner has established a three-step sequential evaluation process for the ALJ 

to follow when considering the disability application of a minor claimant. 20 C.F.R. § 416.924; 

see, e.g., Augustine ex rel. Ramirez v. Astrue, 536 F. Supp. 2d 1147, 1150 (C.D. Cal. 2008) 

(applying the three-step sequential evaluation process in a child disability case); Smith ex rel. Enge 

v. Massanari, 139 F. Supp. 2d 1128, 1132 (C.D. Cal. 2001) (same). 

At Step One, the ALJ must determine whether the claimant is engaged in “substantial 

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gainful activity.” Id. § 416.924(a). If the claimant engages in substantial gainful activity, she is 

not disabled regardless of her medical condition, age, education, or work experience. Id. § 

416.924(a)-(b). 

If the claimant is not engaged in substantial gainful activity, at Step Two, the ALJ must 

determine whether the claimant has a “severe” medically determinable impairment or combination 

of impairments. 20 C.F.R. § 416.924(a). For a child, a medically determinable impairment or 

combination of impairments is not severe if it is a “slight abnormality or a combination of slight 

abnormalities that causes no more than minimal functional limitations . . . .” Id. § 416.924(c). If 

the claimant’s impairment(s) is not severe, the child is not disabled, and SSI is denied at this step. 

Id. § 416.924(a), (c). 

If it is determined that one or more impairments are severe, at Step Three, the ALJ must 

determine whether the claimant’s impairments meets, medically equals, or functionally equals an 

impairment in the Listing of Impairments (the “Listing”), 20 C.F.R. § 404, Subpart P, Appendix 1. 

If the claimant’s impairment(s) meets or equals an impairment in the Listing, and meets the 

durational requirement, disability is presumed and benefits are awarded. Id. § 416.924(a), (d). 

Step three encompasses two analytical steps. First, it must be determined whether the 

claimant’s impairments meets or medically equals a Listing. The mere diagnosis of an impairment 

in the Listing is insufficient, in itself, to sustain a finding of disability. Young v. Sullivan, 911 

F.2d 180, 183 (9th Cir. 1990); Key v. Heckler, 754 F.2d 1545, 1549 (9th Cir. 1985). The 

impairment must also satisfy all of the criteria of the listing. 20 C.F.R. § 416.925(d). The Listing 

for diabetes mellitus is discussed in further detail in the next section. 

If the claimant does not meet or medically equal a Listing, she may still be considered 

disabled if an impairment results in limitations that “functionally equal the listings.” 20 C.F.R. § 

416.926a(a). In determining whether the severe impairment(s) functionally equals the listings, the 

ALJ must assess the claimant’s functioning in the following six domains: (1) acquiring and using 

information; (2) attending and completing tasks; (3) interacting and relating with others; (4) 

moving about and manipulating objects; (5) caring for yourself; and (6) health and physical wellbeing. 20 C.F.R. § 416.926a(b)(1). To “functionally equal” the listings, the impairment(s) must 

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result in “marked” limitations in two domains of functioning or an “extreme” limitation in one 

domain. Id. § 416.926a(a), (d). In making this assessment, the ALJ must look at “how 

appropriately, effectively, and independently [the claimant] preform[s] [her] activities compared to 

the performance of other children [the claimant’s] age who do not have impairments.” Id. § 

416.926a(b). 

A child has a “marked” limitation in a domain when her impairment(s) “interferes 

seriously” with her “ability to independently initiate, sustain, or complete activities.” 20 C.F.R. § 

416.926a(e)(2)(i). The regulations also provide that “marked” limitations means a limitation that 

is “more than moderate” but “less than extreme.” Id. For the sixth domain of functioning, health 

and well-being, a child has a “marked” limitation if she is frequently ill because of the 

impairment(s) or has frequent exacerbations of impairment(s) that result in “significant, 

documented symptoms or signs.” Id. § 416.926a(e)(2)(iv). “Frequent” is defined as (1) “episodes 

of illness or exacerbations that occur on an average of 3 times a year, or once every 4 months, 

each lasting 2 weeks or more,” or (2) “episodes that occur more often than 3 times in a year or 

once every 4 months but do not last for 2 weeks, or occur less often than an average of 3 times a 

year or once every 4 months but last longer than 2 weeks, if the overall effect (based on the length 

of the episode(s) or its frequency) is equivalent in severity.” Id. 

A child has an “extreme” limitation in a domain when her impairment(s) “interferes very 

seriously” with her “ability to independently initiate, sustain, or complete activities.” 20 C.F.R. § 

416.926a(e)(3)(i). The regulations also provide that an “extreme” limitation also means a 

limitation that is “more than marked.” Id. However, “extreme” limitation does not mean a “total 

lack or loss of ability to function.” Id. For the sixth domain of functioning, health and well-being, 

a child has an “extreme” limitation if she is frequently ill because of the impairment(s) or has 

frequent exacerbations of the impairment(s) that result in “significant, documented symptoms or 

signs substantially in excess of the requirements for showing a ‘marked’ limitation . . . .” Id. § 

416.926a(e)(3)(iv). In fact, for an impairment(s) to be “extreme,” in most cases, they should 

“meet or medically equal the requirements of a listing . . . .” Id. 

F. Listing of Impairments 

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Effective June 7, 2011, Listing 109.08 for juvenile diabetes mellitus was amended to apply 

only to children under the age of six (“New Listing”). The New Listing states: “Any type of 

diabetes mellitus in a child who requires daily insulin and has not attained age 6. Consider under a 

disability until the attainment of age 6. Thereafter, evaluate the diabetes mellitus according to the 

rules in 109.00B5 and C.” 20 C.F.R. § 404, Subpt. P, App. 1, Pt. B, § 109.08 (2013). The SSA 

Regulation clarifies that it “is only for children with [diabetes mellitus] who have not attained age 

6 and who require daily insulin.” Id. For children over six, or for children who do not require 

daily insulin, the SSA considers whether the diabetes mellitus “is severe, alone or in combination 

with another impairment, whether it meets or medically equals the criteria of a listing in another 

body system, or functionally equals the listings under the criteria in § 416.926a, considering the 

factors in § 416.924a.” Id. 

In contrast, the Listing that was effective until June 6, 2011 (“Old Listing”) was not limited 

to children under the age of six. It also required that further criteria be satisfied in addition to 

requiring daily insulin: 

Juvenile diabetes mellitus (as documented in 109.00C) requiring 

parental insulin. And one of the following, despite prescribed 

therapy: 

A. Recent, recurrent hospitalizations with acidosis; or 

B. Recent, recurrent episodes of hypoglycemia; or 

C. Growth retardation as described under the criteria in 100.02 A or 

B; or 

D. Impaired renal function as described under the criteria in 

106.00ff.” 

20 C.F.R. § 404, Subpt. P, App. 1, Pt. B, § 109.08 (2011). The documentation requirement of 

109.00C for Old Listing stated: 

Description of characteristic history, physical findings, and 

diagnostic laboratory data must be included. Results of laboratory 

tests will be considered abnormal if outside the normal range or 

greater than two standard deviations from the mean of the testing 

laboratory. Reports in the file should contain the information 

provided by testing laboratory as to their normal values for that test. 

Id. 

// 

G. The ALJ’s Findings of Fact and Conclusions of Law 

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 The ALJ’s found that Plaintiff had never engaged in substantial gainful activity and that 

Plaintiff’s insulin-dependent diabetes and allergies are “severe” impairments. AR 16. The ALJ’s 

most important findings were at Step Three. At Step Three, the ALJ found that Plaintiff does not 

have an impairment or combination of impairments that meets, medically equals, or functionally 

equals one of the one of the impairments in the Listing. AR 17. 

 First, the ALJ held that Plaintiff does not meet or medically equal a Listing. The ALJ 

arrived at this conclusion without explaining her analysis. The ALJ did not discuss whether she 

applied the New Listing or the Old Listing. The ALJ only wrote that that “[t]he medical record 

fails to show listing level severity.” Id. 

 Next, the ALJ found that Plaintiff does not have an impairment or combination of 

impairments that functionally equals an impairment in the Listing because her impairment(s) did 

not result in either “marked” limitations in two domains of functioning or an “extreme” limitation 

in one domain. AR 18-19. The ALJ found that Plaintiff had a “marked” limitation in the domain 

of health and physical well-being, but no limitation in the other five domains. Id. at 19. 

 In reaching this conclusion, the ALJ considered “all of the relevant evidence” and the 

“whole child.” Id. at 18. The ALJ followed a two-step process in considering Plaintiff’s 

symptoms. Id. First, the ALJ “determined whether there is an underlying medically determinable 

physical or mental impairment.” Id. Second, the ALJ evaluated “the intensity, persistence, and 

limiting effects of the claimant’s symptoms to determine the extent to which they limit the 

claimant’s functioning.” Id. When considering the evidence, the ALJ placed “significant weight” 

on the medical records from Children’s Hospital Los Angeles from February and April 2010 

(“Exhibit 12F”), id., although she “carefully reviewed and considered” the opinions of all medical 

consultants, id. at 19. The ALJ found that those records were “fully credible, based on the length, 

nature and/or extent of the treating physicians’ relationships with the claimant; supportability with 

medical signs and laboratory findings; consistency with the record; and areas of specialization.” 

Id. at 18. The ALJ cited the findings of the treating physicians in Exhibit 12F, that Plaintiff 

“performed well academically, was physically active, enjoyed riding her bike, and was well-liked 

by her peers.” Id. at 19. Further, the ALJ found that the Childhood Disability Evaluation Forms 

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completed by Dr. Nawar (“Exhibit 10F”) in December 2009 and Dr. Quint (“Exhibit 13F”) in July 

201011 to be “persuasive in establishing marked limitation in only one domain, in health and 

physical well-being.” Id. The ALJ also found that the medical records put together by Dr. 

O’Connor were persuasive to a certain extent. Id. The ALJ acknowledged Dr. O’Connor’s 

finding regarding no complications in Plaintiff’s diabetes, although uncontrolled, and Dr. 

O’Connor’s conclusion that Plaintiff was “normal and healthy looking.” Id. While 

acknowledging that Dr. O’Connor opined Plaintiff had moderate limitations in acquiring and using 

information, attending and completing tasks, and in health and well-being, the ALJ did not credit 

this finding because “it appears the majority of [Plaintiff’s limitations] were related to her young 

age.” Id. The ALJ concluded that the assessment by Dr. O’Connor in Exhibit 15F was “partially 

credible, but not to the extent of establishing disability.” Id. 

 In sum, the ALJ found that Plaintiff had a “marked” limitation in the domain of health and 

physical well-being, but no limitations in the remaining five domains. AR 19. Because Plaintiff 

did not have an impairment or combination of impairments that result in either “marked” 

limitations in two domains of functioning or “extreme” limitation in one domain of functioning, 

the ALJ concluded that Plaintiff’s impairment(s) did not “functionally equal” an impairment in the 

Listing. Id. The ALJ held that Plaintiff had not been disabled, as defined in the Social Security 

Act, since August 24, 2009, the date the application was filed, and denied Plaintiff benefits. Id. 

H. Letters Submitted Following the Appeals Council Decision 

 On September 18, 2012, Plaintiff submitted two letters—one from Kathleen M. O’Connor, 

M.D. and Kathryn Eckert, M.D., and another from Dr. O’Connor only, as exhibits to Plaintiff’s 

Brief.12 Plaintiff’s Brief, Exs. E, F. The first letter is from Drs. O’Connor and Eckert, and is 

dated April 24, 2012, after the hearing before the ALJ (July 25, 2011) and the ALJ’s Decision 

(July 29, 2011). In this letter, the doctors note that Plaintiff is too young to fully care for all of her 

needs given her impairment, that Plaintiff’s mother struggles to provide all of Plaintiff’s need and 

 11 The ALJ also found “persuasive” the medical record in Exhibit 6F, but no such record 

exists in the Administrative Record. AR 19. 

12 The letter is not attached as an exhibit to a declaration, but rather, as an exhibit to 

Plaintiff’s Brief. 

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requires financial help, and notes the cost of various medical supplies required for Plaintiff’s 

condition. Plaintiff’s Brief, Ex. F. 

 The second letter from Dr. O’Connor, and is dated September 14, 2012, which is also after 

the hearing and the ALJ’s Decision. The letter states: 

I am the health care provider for [Plaintiff]. She has been a patient 

in our practice in Reno, NV for several years. [Plaintiff] has Type 1 

Diabetes and throughout her association with me I have witnessed . . 

. recurrent bouts of hypoglycemia, frequent episodes of 

hyperglycemia, and ongoing difficulty with high A1c levels. 

Plaintiff’s Brief, Ex. E. 

I. The Summary Judgment Motions 

1. Plaintiff’s Contentions 

Plaintiff contends that the ALJ committed reversible error by: (1) determining that she had 

not met or medically equaled the criteria for Listing 109.08B for juvenile diabetes mellitus, 

Plaintiff’s Brief at 2-4; (2) finding that Plaintiff did not functionally equal the listings, id. at 4-7; 

and (3) by not considering a case evaluation from a qualified medical professional who specializes 

in pediatric endocrinology, id. at 9-12. Plaintiff therefore argues that the ALJ’s decision should be 

reversed and the case remanded to the Commissioner for award of benefits, or, in the alternative, 

further proceedings. 

First, Plaintiff challenges the ALJ’s conclusion at Step Three that Plaintiff’s impairments 

did not meet or medically equal any of the impairments in the Listing. Plaintiff’s Brief at 2-4. 

Specifically, Plaintiff argues that her impairment (1) meets or medically equals Listing 109.08B 

for juvenile diabetes mellitus requiring parental insulin and recent or recurrent episodes of 

hypoglycemia, and (2) satisfies the documentation requirement set forth in 109.00C. Id. To 

demonstrate her juvenile diabetes mellitus and recent or recurrent episodes of hypoglycemia, 

Plaintiff cites glucometer readings from March 2008, December 2008, and April 2010. Id. at 3. 

Plaintiff argues that the ALJ’s failure to credit these readings constitutes legal error. Id. Further, 

Plaintiff presents a letter, dated September 14, 2012, from Dr. O’Connor that was not considered 

by the ALJ nor the Appeals Council that “supports the fact Plaintiff suffered from recurring 

episodes of hypoglycemia during the subject evaluation timeframe and still experiences recurring 

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episodes today.” Id. Plaintiff argues she satisfied the documentation requirement with “medical 

records [that] document the conditions of her life-long disease, as substantiated with periodic lab 

reports, medical examinations, and other certifiable testing data.” Id. 

Second, Plaintiff contends that the ALJ committed legal error when she concluded at Step 

Three that Plaintiff’s impairments did not functionally equal any of the impairments in the Listing. 

Plaintiff’s Brief at 4-7. Specifically, Plaintiff argues that although the ALJ correctly found that 

Plaintiff had a “marked” limitation in the domain of health and physical well-being, the ALJ 

should have reached the same conclusion for the domain of caring for yourself.13 Id. at 4-5, 7. 

Plaintiff contends that the ALJ should have found that Plaintiff has a “marked” limitation in the 

domain of caring for yourself because she cannot: 

(a) [A]dminister . . . medications, including but not limited to giving 

herself one or more insulin injections; (b) make a quick and accurate 

determination, as necessary, of the quantity and quality of sugar or 

other carbohydrates she needs to eat or drink; and (c) perform one or 

more repeated tests of her blood sugar levels to ascertain the need 

for either more insulin shots or more food intake in response to how 

her body has just reacted to the shot(s) and/or ingested food. 

Id. at 5. Plaintiff argues that Drs. Eckert and O’Connor’s observations and reports support the 

conclusion that Plaintiff has a “marked” limitation under the age group descriptor for school age 

children (age 6 to attainment of age 12) in the domain of caring for yourself. Id. at 6 (citing 20 

C.F.R. § 416.926a(k)(2)(iv)). Plaintiff thus contends that the ALJ committed legal error in finding 

that Plaintiff’s impairments did not functionally equal any of the impairments in the Listing. 

 Third, Plaintiff challenges the ALJ’s decision because the only medical records that were 

considered were from “DDS professionals that are neither Pediatricians nor Diabetes specialists.” 

Plaintiff’s Brief at 9-12. Plaintiff argues that the ALJ’s failure to consider evidence from a 

 13 In addition to arguing that the ALJ erred, Plaintiff also appears to contend that the 

evaluators of the Disability Determination Service (“DDS”) and Children’s Hospital Los Angeles 

(“CHLA”) erred in concluding that Plaintiff had no limitation in the domain of caring for yourself. 

Plaintiff’s Brief at 4. That is because Plaintiff cannot take care of her own health, give herself 

insulin injections, or test her blood glucose levels. Id. Plaintiff also contends that “[d]espite three 

separate declarations by DDS evaluators that Plaintiff had no limitations in caring for yourself, 

[the evaluators have] failed to cite in the record a single incident wherein Plaintiff was either 

tested, observed, or reported to have independently performed any of the specific tasks” in the 

domain of caring for yourself. Id. at 6. 

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qualified pediatrician in a child disability case constitutes a violation of the Ninth Circuit’s ruling 

in Howard ex rel. Wolff v. Barnhart, 341 F.3d 1006 (9th Cir. 2003) and 42 U.S.C. § 

1382c(a)(3)(I). Plaintiff’s Brief at 10. 

2. Defendant’s Contentions 

Defendant counters each of Plaintiff’s contentions. First, Defendant contends that the ALJ 

did not err at Step Three by concluding that Plaintiff did not meet or equal any of the impairments 

in the Listing. Defendant’s Motion at 9-13. Defendant contends that the Old Listing applies to 

Plaintiff’s claim for the time period prior to the enactment date of June 7, 2011, and that the New 

Listing applies to the time period thereafter. Defendant argues that Plaintiff does not meet the 

criteria of the New Listing because for the time period in which the New Listing applies (starting 

on June 7, 2011), Plaintiff was older than six. Defendant also contends that Plaintiff does not 

meet the criteria of the Old Listing for the time period in which it applies because Plaintiff did not 

have evidence that she experienced recent, recurrent episodes of hypoglycemic and because the 

evidence does not meet the documentation requirement. Id. at 11-12. 

Second, Defendant contends that the ALJ did not err at Step Three by concluding that 

Plaintiff’s impairments did not functionally equal any of the impairments in the Listing. 

Defendant’s Motion at 13-17. Specifically, Defendant rejects Plaintiff’s argument that the ALJ 

should have found that Plaintiff had a “marked” limitation in the domain of “caring for yourself” 

in addition to the domain of “health and well-being.” Id. at 13. In doing so, Defendant cites 

provisions of the Code of Federal Regulations and Plaintiff’s medical records that suggest 

Plaintiff’s limitations, if any, are due to her young age, rather than any disabling medical 

condition. Id. at 15. 

Third, Defendant claims that the ALJ followed the requirements set forth by the Ninth 

Circuit in Howard and 42 U.S.C. § 1382c(a)(3)(I) because the ALJ considered evidence from Dr. 

Windisch, a pediatrician, who performed “a comprehensive medical evaluation and assessment of 

Plaintiff’s complaints of diabetes type 1 and food allergies for purposes of assessing Social 

Security disability.” Defendant’s Motion at 17-19. Defendant also contends that “[s]hould this 

Court disagree, however, any resulting error would be harmless. Id. at 18 (citing Molina v. Astrue, 

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674 F.3d 1104, 1111 (9th Cir. 2012)). With respect to Dr. O’Connor’s functional assessment 

report for Plaintiff that found no more than a moderate limitation in any of the six domains of 

functioning, Defendant contends that the “ALJ properly concluded that Dr. O’Connor’s opinion 

was partially credible, but not to the extent of establishing disability.” Id. at 18-19. 

III. LEGAL STANDARD 

When asked to review the Commissioner’s decision, the Court takes as conclusive any 

findings of the Commissioner which are free from legal error and supported by “substantial 

evidence.” 42 U.S.C. § 405(g). Substantial evidence is “such evidence as a reasonable mind 

might accept as adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 401 

(1971) (quoting Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229 (1938)). Substantial 

evidence means “more than a mere scintilla[,]” id., but “less than a preponderance,” Desrosiers v. 

Sec’y of Health and Human Servs., 846 F.2d 573, 576 (9th Cir. 1988) (quoting Sorenson v. 

Weinberger, 514 F.2d 1112, 1119 n. 10 (9th Cir. 1975)). Even if the Commissioner’s findings are 

supported by substantial evidence, they should be set aside if proper legal standards were not 

applied when weighing the evidence and reaching a decision. Benitez v. Califano, 573 F.2d 653, 

655 (9th Cir. 1978) (citing Flake v. Gardner, 399 F.2d 532, 540 (9th Cir. 1968)). In reviewing the 

record, the Court must consider both the evidence that supports and detracts from the 

Commissioner’s decision. Smolen v. Chater, 80 F.3d 1273, 1279 (9th Cir. 1996) (citing Jones v. 

Heckler, 760 F.2d 993, 995 (9th Cir. 1985)). 

IV. ANALYSIS 

The Court separately considers whether the ALJ’s decision was correct at Step Three in 

finding that: (1) Plaintiff’s impairments did not meet or medically equal the Listing, and (2) 

Plaintiff’s impairments did not functionally equal the Listing. The Court also considers whether 

the ALJ erred by not considering a comprehensive pediatric examination in reaching her decision. 

A. Whether the ALJ Erred at Step Three in Finding Plaintiff’s Impairments Did 

Not Meet or Medically Equal Listing 109.08 

The parties dispute whether the ALJ erred at Step Three in finding Plaintiff’s impairments 

did not meet or medically equal Listing 109.08 for diabetes mellitus. For the reasons stated below, 

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the Court finds that Plaintiff met Listing 109.08 for diabetes mellitus from the date the application 

for SSI benefits was filed to the date Plaintiff turned six-years-old. Accordingly, Plaintiff is 

entitled to benefits for that limited period. 

1. Which Listing Applies 

As discussed above, effective June 7, 2011, Listing 109.08 was amended to apply only to 

children under the age of six. Under the “New Listing,” children over the age of six must either 

meet another listing or functionally equal the listings under the criteria in 20 C.F.R. § 416.926a. 

Under the “Old Listing,” there was no age restriction precluding the application of the listing to 

children six and older, but the Old Listing did have additional criteria, requiring the claimant to 

prove: 

A. Recent, recurrent hospitalizations with acidosis; or 

B. Recent, recurrent episodes of hypoglycemia; or 

C. Growth retardation as described under the criteria in 100.02 A or 

B; or 

D. Impaired renal function as described under the criteria in 

106.00ff. 

20 C.F.R. § 404, Subpt. P, App. 1, Pt. B, § 109.08 (2011). The ALJ decided Plaintiff’s claim on 

July 29, 2011, and the Appeals Council affirmed that decision on February 21, 2012. Both the 

ALJ’s and the Appeals Council’s decisions took place after the New Listing went into effect on 

June 7, 2011. 

Plaintiff contends that only the Old Listing applies. Plaintiff’s Reply at 20 (“Plaintiff 

contends the new requirements are not binding at any time in this case, including the timeframe 

inclusive of the Court’s findings and disposition.”). Defendant contends that both the Old Listing 

and the New Listing apply to Plaintiff’s claim, and that the New Listing only governs Plaintiff’s 

claim from the date in which it was in effect. See Defendant’s Motion at 11−12. The Court 

disagrees with both Plaintiff and Defendant, and holds that the New Listing applies to the entire 

period relevant to Plaintiff’s claim for benefits. 

Defendant does not cite any authority for the proposition that the two versions of Listing 

109.08 may apply to Plaintiff’s claim. Indeed, the SSA has instructed courts to take a different 

approach. When the SSA published “Final Rules” containing the New Listing, the SSA included a 

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section entitled “When will we use these final rules?” That section provides: 

We will use these final rules beginning on their effective date. We 

will continue to use the current listings until the date these final 

rules become effective. We will apply the final rules to . . . claims 

that are pending on . . . the effective date. 

76 Fed. Reg. 19692-01, 19692 (emphasis added). A footnote to this section provides: 

This means that we will use these final rules on and after their 

effective date in any case in which we make a determination or 

decision. We expect that Federal courts will review our final 

decisions using the rules that were in effect at the time we issued the 

decisions.

Id. at 19692 n. 3 (emphasis added).14 The SSA’s rule suggests that New Listing for diabetes 

mellitus will apply to Plaintiff’s claim because the New Listing became effective on June 7, 2011, 

before the ALJ’s and the Appeals Council’s decisions. The application of the New Listing is also 

consistent with the general “rule that ‘a court is to apply the law in effect at the time it renders its 

decision.’” Landgraf v. USI Film Products, 511 U.S. 244, 264 (1994) (quoting Bradley v. Sch. Bd. 

of City of Richmond, 416 U.S. 696, 716 (1974)). 

In Landgraf, the Supreme Court discussed the “apparent tension” between the general rule 

that courts are to apply the law in effect at the time the decision is rendered, and the “axiom that 

‘[r]etroactivity is not favored in the law.’” Id. (quoting Bowen v. Georgetown Univ. Hosp., 488 

U.S. 204, 208 (1988). The issue in Landgraf was whether § 102 of the Civil Rights Act of 1991, 

which permits a party to seek compensatory and punitive damages under Title VII for intentional 

discrimination, applied to an employment discrimination case that was pending on appeal when 

the 1991 Act was enacted. The Court articulated the following three-part test to determine 

whether a statute should be applied to conduct prior to its enactment: 

When a case implicates a federal statute enacted after the events in 

suit, the court’s first task is to determine whether Congress has 

expressly prescribed the statute’s proper reach. If Congress has 

done so, of course, there is no need to resort to judicial default rules. 

 14 The words “determination” and “decision” are terms of art defined by the SSA’s 

regulations. “Decision means the decision made by an administrative law judge or the Appeals 

Council.” 20 C.F.R. § 416.1401. “Determination means the initial determination or the 

reconsidered determination.” Id. 

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When, however, the statute contains no such express command, the 

court must determine whether the new statute would have 

retroactive effect, i.e., whether it would impair rights a party 

possessed when he acted, increase a party’s liability for past 

conduct, or impose new duties with respect to transactions already 

completed. If the statute would operate retroactively, our traditional 

presumption teaches that it does not govern absent clear 

congressional intent favoring such a result. 

Landgraf, 511 U.S. at 280. Applying this test, the Court held that (1) Congress had not expressly 

prescribed the reach of § 102 of the Civil Rights Act of 1991, (2) the statute had a retroactive 

effect because it exposed employers to monetary liability for acts which predated the statute’s 

enactment, and (3) the presumption against retroactively applied because there was no clear 

congressional intent to apply the statute retroactively. Landgraf, 511 U.S. at 280-86. 

Applying Landgraf to the case at bar, the first question is whether “Congress has expressly 

prescribed the statute’s proper reach.” Id. (emphasis added). In this case, there is no indication 

that Congress has spoken at all. Unlike in Landgraf, where a statute passed by Congress was at 

issue, this case concerns a regulation promulgated by the SSA. This distinction is important 

because while Congress may expressly provide that a statute applies retoractively so long as it is 

consistent with constitutional restraints, see Landgraf, 511 U.S. at 267, “[i]t is axiomatic that an 

administrative agency’s power to promulgate legislative regulations is limited to the authority 

delegated by Congress.” Bowen v. Georgetown Univ. Hosp., 488 U.S. 204, 208 (1988). Indeed, 

a statutory grant of legislative rulemaking authority will not, as a 

general matter, be understood to encompass the power to 

promulgate retroactive rules unless that power is conveyed by 

Congress in express terms.... Even where some substantial 

justification for retroactive rulemaking is presented, courts should be 

reluctant to find such authority absent an express statutory grant. 

Id. at 208-09 (noting that the statutory provisions authorizing the Secretary of Health and Human 

Services to promulgate regulations implementing Medicare “contain no express authorization of 

retroactive rulemaking”). 

While the SSA promulgated a rule that requires the application of the New Listing to 

Plaintiff’s claim, there is no indication that Congress has authorized the SSA to promulgate 

retroactive regulations. The authorizing statute grants the Commissioner of Social Security “full 

power and authority to make rules and regulations and to establish procedures,” but lacks any 

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express authorization for retroactive rulemaking. 42 U.S.C. § 405(a); see also Combs v. 

Commissioner of Social Security, 459 F.3d 640, 645 (6th Cir. 2006) (citing Bowen, 488 U.S. at 

214 n. 3) (“While Congress has the power to permit the SSA to promulgate retroactive regulations, 

Congress generally has not done so.”). Therefore, the Court must proceed to the next step in the 

Landgraf analysis and consider whether applying the New Listing to Plaintiff’s claim has a 

retroactive effect. 

 To consider whether the application of the New Listing has a retroactive effect, the Court 

must consider “whether it would impair rights a party possessed when he acted, increase a party’s 

liability for past conduct, or impose new duties with respect to transactions already completed.” 

Landgraf, 511 U.S. at 280. “A statute does not operate ‘retrospectively’ merely because it is 

applied in a case arising from conduct antedating the statute’s enactment, ... or upsets 

expectations based in prior law.” Id. at 269 (citations omitted). Rather, the question is “whether 

the new provision attaches new legal consequences to events completed before its enactment.” Id. 

at 270. This is because “[e]lementary considerations of fairness dictate that individuals should 

have an opportunity to know what the law is and to conform their conduct accordingly.” 

Landgraf, 511 U.S. at 265. Thus, the presumption is most often applied to “provisions affecting 

contractual or property rights, matters in which predictability and stability are of prime 

importance.” Id. at 271. On the other hand, there are “diminished reliance interests in matters of 

procedure ... [b]ecause rules of procedure regulate secondary rather than primary conduct.” Id. at 

275. 

 In Combs v. Commissioner of Social Security, the Sixth Circuit, sitting en banc, applied the 

principles in Landgraf to determine the retroactive effect of a change in the Social Security listing 

for obesity. 459 F.3d 640 (6th Cir. 2006) (en banc). Prior to 1999, claimants who met certain 

criteria of the obesity listing were presumed disabled. In 1999, however, the Social Security 

Administration deleted the obesity listing, and thereby increased the burden of proof for 

individuals claiming disability based on obesity. The claimant in Combs filed her claim for 

disability in 1996, and had two hearings before an ALJ to determine her disability: first in 1999 

when the obesity listing was still in effect, and again in 2003 (upon remand from the Appeals 

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Council) after the obesity listing had been deleted. The Sixth Circuit considered whether the ALJ 

that adjudicated the claimant’s claim in 2003 erred by declining to apply the obesity listing that 

had been deleted in 1999. 

The court was split. The lead opinion held that applying the rules in effect in 2003 did not 

mean that those rules operated retroactively: 

The factors articulated in Landgraf—fair notice, reasonable reliance, 

and settled expectations—weigh against finding a retroactive 

effect.... It can hardly be argued that claimants become obese or 

otherwise become impaired in reliance on the availability of the 

presumption in the listing. Nor is there any indication that they file 

their claims, or decide what to put in their claims, based on how the 

agency determines whether they meet the statutory requirements for 

disability eligibility. Similarly, claimants have no settled 

expectation that the agency will use one as opposed to another 

algorithm for determining whether the statutory requirements are 

met. Finally, there is no basis for claimants to argue that they need 

“fair notice” of a change in the step three presumptions. 

Combs, 459 F.3d at 646. The lead opinion believed the changed listing was procedural rather than 

substantive, writing that the difference lies in “whether there is a change in substantive obligation 

as opposed to a change in the way in which the same obligation is adjudicated.” Id. The lead 

opinion held that the elimination of the obesity listing did not change “[t]he substantive 

requirements for disability,” but “only the way in which the agency goes about determining 

whether they are present.” Id. at 647. 

The five dissenting judges in Combs criticized the lead opinion, writing that it “seriously 

misapprehends and oversimplifies the Supreme Court’s retroactivity jurisprudence.” Combs, 459 

F.3d at 661 (Clay, J., dissenting). The dissent noted that “[a]t the first hearing, had the ALJ 

correctly analyzed Plaintiff’s impairments, he most likely would have found Plaintiff to be 

disabled.” Combs, 459 F.3d at 662 (Clay, J., dissenting). The dissent argued the change in the 

listing caused the claimant to lose an irrebuttable presumption that she was disabled, and thereby 

increased her burden of proof, which caused a substantive change in the law. Id. at 667. The 

dissent believed that there was an impermissible retroactive effect because “the new obesity rules 

adversely affected Plaintiff’s prospects for success on the merits” of her claim. Id. at 669. While 

the dissent agreed with the majority that the claimant did not rely on the obesity listing when 

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becoming disabled, this fact was not relevant. Instead, it was important that the claimant “planned

for the possibility of becoming disabled in reliance on the disability benefits scheme available at 

that time.” Id. at 673 (emphasis added). 

The Combs dissent found support in a case from this district. See id. at 669 (citing Kokal 

v. Massanari, 163 F.Supp.2d 1122, 1130 n. 6 (N.D. Cal. 2001) (Laporte, J.). Similar facts were at 

issue in Kokal: the obesity listing was deleted after the claimant’s hearing before the ALJ but 

before the Appeals Council considered the claimant’s appeal. The court wrote that “Plaintiff’s 

rights would be substantively altered if the revision [to the listings] was deemed applicable to 

pending claims, because the revised regulation would raise the bar on proof of disability based on 

obesity.” Id. at 1131. The court also noted that “Plaintiff likely satisfied the requirements of 

Listing 9.09, automatically qualifying her for disability benefits.” Id. The court further wrote that 

the unfairness to Plaintiff is that she made her claim at a time when 

Listing 9.09 was in effect and, without the aid of an attorney, 

presented extensive evidence to the ALJ of obesity combined with 

other impairments that may well have qualified her as disabled 

under that Listing. Through no fault of her own but through the 

ALJ’s error in not considering whether she met Listing 9.09, she 

was found not disabled. Subsequently, while pursuing her 

administrative appeal to the Appeals Council, the Listing was 

repealed and replaced with new, less favorable regulations regarding 

obesity. The Appeals Council then erroneously failed to consider 

either the new or the old regulations in rejecting her appeal. 

Id. at 1132. 

The facts in this case are materially different from the facts in both Combs and Kokal. 

Here, the New Listing was in effect by the time Plaintiff’s claim was decided by the ALJ. That 

distinguishes this case from both Comb and Kokal, because when the claimants in those cases 

were before the ALJ (for the first time, at least, for the Combs claimant), the obesity listing was 

still in effect. Both courts noted that if the ALJ had correctly applied the obesity listing in the first 

instance, then the claimant would have been entitled to benefits. See Kokal, 163 F.Supp.2d at 

1132; Combs, 459 F.3d at 662 (Clay, J., dissenting). It was because the ALJ erred that the 

claimants were consequently subject to new rules due to the lapse in time. In this case, however, 

the New Listing was in effect when Plaintiff’s case was before the ALJ. While this does not 

preclude the possibility that applying the New Listing will have a retroactive effect, it does 

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eliminate the unfairness factor of applying a change in the listings solely because the ALJ erred in 

the first instance. 

More importantly, however, is the fact that, in both Combs and Kokal, the claimants 

planned on the disability scheme in effect at the time they filed their applications, and would likely 

have satisfied the obesity listing criteria. The Kokal court wrote that “Plaintiff’s rights would be 

substantively altered ... because the revised regulation would raise the bar on proof of disability 

based on obesity,” id. at 1131, and noted that the plaintiff “likely satisfied the requirements of 

Listing 9.09....” Kokal, 163 F.Supp.2d at 1131. Similarly, the Combs dissent believed that there 

was an impermissible retroactive effect because the new obesity rules adversely affected 

“Plaintiff’s prospects for success on the merits,” id. at 669, and noted that the claimant “planned

for the possibility of becoming disabled in reliance on the disability benefits scheme available at 

that time.” Id. at 673 (emphasis added). In this case, however, even if Plaintiff had planned her 

case in expectation that the Old Listing applied, there is no evidence to suggest that she would 

have prevailed on her claim because the evidence presented does not meet the criteria of the Old 

Listing. 

Plaintiff argues that she met the Old Listing because she had “[r]ecent, recurrent episodes 

of hypoglycemia.” 20 C.F.R. § 404, Subpt. P, App. 1, Pt. B, § 109.08 (2011). The documentation 

requirement to prove this condition requires the following: 

Description of characteristic history, physical findings, and 

diagnostic laboratory data must be included. Results of laboratory 

tests will be considered abnormal if outside the normal range or 

greater than two standard deviations from the mean of the testing 

laboratory. Reports in the file should contain the information 

provided by testing laboratory as to their normal values for that test. 

Id. To show that she met the documentation requirement, Plaintiff cites the following evidence: 

(1) a 14-day summary covering March 13, 2008 to March 26, 2008, showing that 12 out of 101 

glucometer readings were below the hypoglycemic threshold of 67 mg/dL (AR 189-90); (2) a 14-

day summary covering April 14, 2010 to April 27, 2010, showing that four out of 44 glucometer 

readings were below the hypoglycemic threshold of 67 mg/dL (AR 173-43); and (3) the 

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which states that Dr. O’Connor has “witnessed [Plaintiff’s] problems with recurrent bouts of 

hypoglycemia, frequent episodes of hyperglycemia, and ongoing difficulty with A1c levels,” 

(Plaintiff’s Brief, Ex. E). 

 The evidence cited by Plaintiff does not show that Plaintiff had recent, recurrent episodes 

of hypoglycemia. First, the 14-day summary covering March 13, 2008 to March 26, 2008 does 

not show “recent” episodes of hypoglycemia because Plaintiff’s claim was not filed until over a 

year later on August 24, 2009. Second, the 14-day summary covering April 14, 2010 to April 27, 

2010, showing that four out of 44 glucometer readings were below the hypoglycemic threshold, 

does not show that Plaintiff met the documentation requirement for the Old Listing. Specifically, 

it does not show that Plaintiff’s readings were “two standard deviations from the mean of the 

testing laboratory.” In any event, on April 27, 2010, Plaintiff’s treating physician noted that 

Plaintiff had not experienced any “severe hypoglycemia” since Plaintiff’s last visit. AR 169. In 

May of 2009, Plaintiff’s mother told the consultative examiner that Plaintiff had “intermittent 

highs” and “occasional lows.” AR 139. 

Dr. O’Connor’s September 24th letter does not change this result. The letter was never 

submitted to the ALJ or the Appeals Council, and therefore, is not part of the administrative 

record. See Brewes v. Comm'r of Soc. Sec. Admin., 682 F.3d 1157, 1162 (9th Cir. 2012). While 

the Court may remand this case to consider additional evidence, the Court may only do so “upon a 

showing that there is new evidence which is material and that there is good cause for the failure to 

incorporate such evidence into the record in a prior proceeding.” 42 U.S.C. § 405(g). Dr. 

O’Conner’s letter is not “material” because it does not meet the documentation requirement for the 

Old Listing. 

Accordingly, the Court finds that Plaintiff does not meet the criteria of the Old Listing. 

There are no “new legal consequences” when the New Listing is applied to Plaintiff’s claim, and, 

consequently, there is no “retroactive effect.” Therefore, the Court will apply the New Listing to 

Plaintiff’s claim. In doing so, the Court follows the SSA’s rule to apply the listing in effect at the 

time of the ALJ’s decision, which is also consistent with the general “rule that ‘a court is to apply 

the law in effect at the time it renders its decision.’” Landgraf, 511 U.S. at 264 (quoting Bradley, 

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416 U.S. at 716). 

2. Whether Plaintiff’s Impairment Meets or Medically Equals the New 

Listing 

The New Listing includes “[a]ny type of diabetes mellitus in a child who requires daily 

insulin and has not attained age 6 [will be] consider[ed] under a disability until the attainment of 

age 6.” 20 C.F.R. § 404, Subpt. P, App. 1, Pt. B, § 109.08. The only requirements to meet the 

New Listing are that a child be under the age of six, be diagnosed with diabetes mellitus, and meet 

the durational requirement that the impairment last for twelve months. See id.; 20 C.F.R. § 

416.924(a), (d). 

Plaintiff’s mother filed the claim for SSI benefits on Plaintiff’s behalf on August 24, 2009. 

At the time, Plaintiff was only five years old, and had been diagnosed with diabetes mellitus since 

January 1, 2006. Between the date in which the application was filed (August 24, 2009) and the 

date in which Plaintiff turned six-years-old (February 11, 2010), Plaintiff satisfied all the criteria 

of the New Listing. Therefore, Plaintiff is entitled to receive SSI benefits for this time period. 

While Plaintiff also satisfied the criteria of the New Listing prior to the date in which the 

application was filed, she did not become eligible to receive SSI benefits until she filed the 

application. “Under title XVI, there is no retroactivity of payment.” Social Security Rule 

(“SSR”) 83–20; see also 20 C.F.R. § 416.202 (requiring a claimant to file an application for SSI 

benefits to become eligible for SSI). Rather, SSI payments “are prorated for the first month for 

which eligibility is established after application and after a period of ineligibility.” SSR 83-20; 

see also 20 C.F.R. § 416.501 (“Payment of SSI benefits will be made for the month after the 

month of initial eligibility and for each subsequent month provided all requirements for eligibility 

(see § 416.202) and payment (see § 415.420) are met.”); Van Hoosen v. Astrue, No. 09-6314, 2011 

WL 3299845 (D. Or. July 8, 2011) report and recommendation adopted, No. 09-6314, 2011 WL 

3322515 (D. Or. Aug. 2, 2011) (“The filing date of a claimant's application determines the earliest 

date for which benefits can be paid under Title XVI, because supplemental security income 

payments cannot be made retroactively.”); Lara v. Astrue, No. 11-0129, 2012 WL 4442255, at *1 

(N.D. Tex. Sept. 25, 2012) (affirming the ALJ’s finding that “supplemental security income was 

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not payable prior to the application date . . . .”); Hayes v. Sec’y of Health & Human Servs., 653 F. 

Supp. 551, 552 (W.D. Penn. 1987) (finding the plaintiff to be disabled and directing the 

Commissioner to pay the plaintiff benefits from the date of the application). 

 After Plaintiff turned six-years-old, she no longer satisfied the criteria to meet the New 

Listing. If the child is above the age of six, the Court must “follow [the] rules for determining 

whether the [diabetes mellitus] is severe, alone or in combination with another impairment, 

whether it meets or medically equals the criteria of a listing in another body system, or 

functionally equals the listings under the criteria in § 416.926a, considering the factors in § 

416.924a.” 20 C.F.R. § 404, Subpt. P, App. 1, Pt. B, § 109.00C. Plaintiff does not argue that she 

meets any other listing than the listing for diabetes mellitus. Therefore, the Court finds that 

Plaintiff does not meet any listing starting with the day she turned six-years-old. 

B. Whether the ALJ Erred at Step Three in Finding Plaintiff’s Impairments Did 

Not Functionally Equal the Listing 

As explained in further detail above, even if the claimant does not meet a listing, she may 

still be considered disabled if an impairment results in limitations that “functionally equal the 

listings.” 20 C.F.R. § 416.926a(a). Because Plaintiff does not meet the New Listing after the day 

in which she turned six-years-old, the Court must consider whether the ALJ erred in finding that 

Plaintiff did not “functionally equal” the listings by assessing the claimant’s functioning in six 

domains: (1) acquiring and using information; (2) attending and completing tasks; (3) interacting 

and relating with others; (4) moving about and manipulating objects; (5) caring for yourself; and 

(6) health and physical well-being. 20 C.F.R. § 416.926a(b)(1). To “functionally equal” a listing, 

the impairment(s) must result in “marked” limitations in two domains of functioning or an 

“extreme” limitation in one domain. Id. § 416.926a(a), (d). 

The ALJ found that Plaintiff had a “marked” limitation in the domain of “health and wellbeing,” but no limitation in the other five domains. AR 18-19. Plaintiff argues that the ALJ erred 

in not finding that she also has a “marked” limitation in the domain of “caring for yourself.” 

Plaintiff contends she has a “marked” limitation in that domain because she cannot administer 

insulin injections on herself, count carbohydrates and sugars, and perform blood sugar tests. The 

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Court finds that Plaintiff’s inability to perform such tasks is normal for a child of her age, and 

therefore affirms the ALJ’s finding that there is no marked limitation in this domain. 

To determine a child’s functional equivalency to the Listing for the purpose of determining 

eligibility for SSI benefits, the ALJ must examine “how appropriately, effectively, and 

independently [Plaintiff] perform[s] [her] activities compared to other children [Plaintiff’s] age 

who do not have impairments.” 20 C.F.R. § 416.926a(b) (emphasis added). In other words, for 

Plaintiff to have a “marked” limitation in the domain of caring for herself, Plaintiff must be 

limited in her ability to care for herself as compared to other children of Plaintiff’s age. The 

SSA’s regulations provide specific, age-appropriate examples of what activities are expected of 

school-age children to care for themselves: 

You should be independent in most day-to-to activities (e.g., 

dressing yourself, bathing yourself), although you may still need to 

be reminded sometimes to do these routinely. You should begin to 

recognize that you are competent in doing some activities and that 

you have difficulty doing others. You should be able to identify 

those circumstances when you feel good about yourself and when 

you feel bad. You should begin to develop understanding of what is 

right and what is wrong, and what is acceptable and unacceptable 

behavior. You should begin to demonstrate consistent control over 

your behavior, and you should be able to avoid behaviors that are 

unsafe or otherwise not good for you. You should begin to imitate 

more of the behavior of adults you know. 

Id. § 416.926a(k)(2)(iv). Notably, the regulations do not suggest that school-aged children should 

be able to administer insulin shots, count carbohydrates and sugars, and perform blood sugar tests. 

The average school-aged child cannot perform these tasks. Thus, the fact that Plaintiff cannot 

perform these tasks does not equate to a marked limitation in the domain of caring for oneself. 20 

C.F.R. § 416.926a(b). Rather, the question is whether Plaintiff can care for herself by performing 

tasks expected of children her age. 

The Court finds that the ALJ’s decision that Plaintiff does not have a marked limitation in 

this domain was based on “substantial evidence.” 42 U.S.C. § 405(g). Plaintiff’s mother testified 

that Plaintiff was “really active,” liked to ride her bicycle, and assisted with chores around the 

house such as feeding the dogs and making her bed. AR 17, 43, 167. Both Dr. Henry (on May 6, 

2009) and Dr. Quint (on July 12, 2010) concluded that Plaintiff had no limitation in the domain of 

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caring for oneself. Id. at 146, 193. On December 30, 2009, Dr. Nawar found that Plaintiff had a 

“less than marked” limitation in the domain of caring for oneself. Id. at 163. Moreover, on 

February 4, 2011, Dr. O’Connor noted in her report that Plaintiff “is not old enough yet to count 

carbohydrates, decide on insulin dose, and give injections independently.” AR 198. Thus, the 

ALJ correctly found that Plaintiff’s inability to perform the tasks above “appear to be related 

primarily to the claimant’s young age, rather than to any disabling medical condition.” Id. at 17. 

Accordingly, the ALJ properly concluded that Plaintiff’s impairments did not functionally equal 

the Listing. 

C. Whether the ALJ Erred by Not Considering a Comprehensive Pediatric 

Examination in Reaching Her Decision 

Plaintiff also contends that the ALJ committed legal error by not making a reasonable 

effort “to ensure that a qualified pediatrician or other individual who specializes in a field of 

medicine appropriate to the disability of the individual (as determined by the Commissioner of 

Social Security) evaluates the case of such individual.” 42 U.S.C. § 1382c(a)(3)(I). In Howard ex 

rel. Wolff v. Barnhart, the Ninth Circuit interpreted § 1382c, and held that it was insufficient for 

an ALJ to rely on individual evaluations and separate reports. 341 F.3d 1006, 1014 (9th Cir. 

2003). The Howard court wrote that an “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.” Id. (emphasis added). 

In response to Howard, the SSA issued the Acquiescence Ruling 04-1(9) to explain how 

the SSA’s interpretation of § 1382c(a)(3)(I) differs from the Ninth Circuit’s interpretation in 

Howard. See SSAR 04-1(9), 69 Fed. Reg. 22578-03 (Apr. 26, 2004). Acquiescence Rulings are a 

subset of Social Security Rulings, which do not carry the “force of law,” but are binding on ALJ’s. 

Bray v. Comm'r of Soc. Sec. Admin., 554 F.3d 1219, 1224 (9th Cir. 2009). They “reflect the 

official interpretation of the [SSA] and are entitled to ‘some deference’ as long as they are 

consistent with the Social Security Act and regulations.” Avenetti v. Barnhart, 456 F.3d 1122, 

1124 (9th Cir. 2006) (quoting Ukolov v. Barnhart, 420 F.3d 1002, 1005 n. 2 (9th Cir. 2005)). 

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In the Acquiescence Ruling 04-1(9), the SSA disagreed with the Ninth Circuit’s “broad” 

interpretation of § 1382c(a)(3)(I), which expressly applies to the “Commissioner of Social 

Security” when making a “determination.” 42 U.S.C. § 1382c(a)(3)(I). The SSA wrote that “[t]he 

words ‘determination’ and ‘decision’ are terms of art ... the word ‘determination’ means the initial 

determination or reconsidered determination, while the term ‘decision’ means the decision made 

by the ALJ or Appeals Council. Therefore, the SSA interprets § 1382c(a)(3)(I) to apply “only to 

determinations made by a State agency and not to decisions made by ALJs or AAJs (when the 

Appeals Council makes a decision).” SSAR 04-1(9), 69 Fed. Reg. 22578-03 (Apr. 26, 2004). The 

SSA explained how it would apply the Howard decision within the Ninth Circuit: 

For cases that are subject to this Ruling, ALJs and AAJs (when the 

Appeals Council makes a decision) must make reasonable efforts to 

ensure that a qualified pediatrician or other individual who 

specializes in a field of medicine appropriate to the disability of the 

individual (as identified by the ALJ or AAJ) evaluates the case of 

the individual. To satisfy this requirement, the ALJ or AAJ may 

rely on a case evaluation made by a State agency medical or 

psychological consultant that is already in the record, or the ALJ or 

AAJ may rely on the testimony of a medical expert. When the ALJ 

relies on the case evaluation made by a State agency medical or 

psychological consultant, the record must include the evidence of 

the qualifications of the State agency medical or psychological 

consultant. In any case, the ALJ or AAJ must ensure that the 

decision explains how the State agency medical or psychological 

consultant’s evaluation was considered. 

SSAR 04-1(9), 69 Fed. Reg. 22578-03 (Apr. 26, 2004). 

Therefore, to satisfy the requirements of § 1382c(a)(3)(I), as interpreted by Howard and 

the Acquiescence Ruling 04-1(9), the ALJ was required to “make reasonable efforts to ensure that 

a qualified pediatrician or other individual who specializes in a field of medicine appropriate to the 

disability of the individual ... evaluates the case of the individual,” and was entitled “to rely on a 

case evaluation made by a State agency medical ... consultant that is already in the record.” Id. 

The Commissioner contends that the ALJ satisfied this requirement with Dr. Windish, who is a 

pediatrician and performed a 5-year Well Child Exam on Plaintiff, the results of which are in the 

Administrative Record. Dr. Windish did not, however, perform a case evaluation for Plaintiff, and 

the ALJ did not mention Dr. Windish in her opinion. In addition, while the ALJ relied on case 

evaluations made by State agency medical consultants (Drs. Henry, Nawar, and Quint), there is no 

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