Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_18-cv-02541/USCOURTS-casd-3_18-cv-02541-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:0423 Social Security Act (Disability Insurance Benefit Payments)

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UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF CALIFORNIA

BRIAN G.,

Plaintiff,

v.

Andrew M. SAUL, Commissioner of 

Social Security,

Defendant.

Case No.: 18-cv-2541-BAS-AGS

REPORT AND RECOMMENDATION 

ON SUMMARY JUDGMENT 

MOTIONS

The Social Security Administration ruled that claimant was not disabled from about 

2014 to 2017. And it discounted a surgeon’s letter supporting disability, believing that the 

surgeon didn’t treat claimant during the relevant time frame. But the SSA was wrong. The 

surgeon’s care took place during the exact period at issue. Given the importance of that

treating doctor’s opinion, this case should be remanded to consider it.

BACKGROUND

Claimant Brian G. was adjudicated disabled starting in 2004 due to “advanced 

degenerative disc disease of the lumbar spine” and “morbid obesity.” (AR 16; see also

AR 272.) After his 2007 gastric-bypass surgery, however, Brian “lost 250 pounds.” 

(AR 36.) Because his back condition then improved, the SSA concluded that he was no 

longer disabled as of May 2014. (AR 68.)

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Brian disagreed, so an Administrative Law Judge heard his case. The ALJ 

determined that Brian had indeed seen “medical improvement” and was not disabled from 

May 1, 2014, through the date of the ALJ’s decision, September 29, 2017. (AR 22, 24; see 

also AR 18.) The ALJ considered the opinions of four doctors with differing views on the 

exertional level that Brian could tolerate, as summarized below:

Doctor Role Exertional Level AR

T. Sabourin, M.D. Orthopedic Consultative Examiner Light 21-22

R. Masters, M.D. State Agency Consultant Light 21-22

R. Jacobs, M.D. State Agency Consultant Medium 21

P. Kirz, M.D. Orthopedic Consultative Examiner Heavy (full range) 22

The ALJ afforded the “most weight” to the opinion of Dr. Jacobs, adopting his “medium 

exertional level” assessment. (AR 21, 23.) Also, the ALJ noted that both orthopedic 

consultative examiners observed “exaggeration of symptoms.” (AR 19, 285, 329.)

The ALJ’s decision never mentions orthopedic surgeon William Tontz, Jr., who 

treated Brian for years and had a more pessimistic view of his prognosis. (See AR 8, 14-

25, 72, 255-56.) At the disability hearing, Brian testified that his “surgeon” said Brian

“couldn’t do any meaningful work,” that he would need future surgery, and “not to do 

anything too strenuous or lifting,” or else his “spine could collapse.” (AR 44-45.) The 

administrative record contains similar statements from Dr. Tontz or attributed to him. 

(AR 255-56; see also AR 76, 86.) Yet none of this evidence appears in the ALJ’s ruling.

Brian zeroed in on this omission while seeking review before the SSA’s Appeals

Council. He submitted a new letter from Dr. Tontz, which concluded that Brian had 

“severe” back problems causing “trouble with standing, sitting, twisting, stooping, and 

lifting.” (AR 8.) According to Dr. Tontz, Brian required “spinal fusion” surgery, and his 

“back injury” and “complex treatments” would render him “unable to work indefin[i]tely.” 

(Id.)

Although the first line of Dr. Tontz’s letter states that Brian “has been under my care 

since 2014” (and the letter was dated 2018) (AR 8), the Appeals Council discounted this

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evidence, arguing that it did “not relate to the period at issue [May 1, 2014, to 

September 29, 2017].” (AR 2.) For this reason alone, the Council rejected Dr. Tontz’s 

letter, and the ALJ’s decision became final. (AR 1-2.)

DISCUSSION

The only relevant issue is whether the SSA adequately considered Dr. Tontz’s

opinion, which was belatedly submitted to the Appeals Council.

A. Late-Filed Evidence Before the Appeals Council

As a threshold matter, Dr. Tontz’s letter is properly before this Court. “[W]hen a 

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

evidence in denying review of the ALJ’s decision, the new evidence is part of the 

administrative record, which the district court must consider . . . .” Brewes v. Comm’r of 

Soc. Sec. Admin., 682 F.3d 1157, 1159-60 (9th Cir. 2012).

B. Treating-Doctor Rule in Cessation-of-Benefits Cases

To revoke previously awarded benefits, the SSA must conclude that the recipient 

has made “medical improvement” and can return to work. See Attmore v. Colvin, 827 F.3d 

872, 873 (9th Cir. 2016). For that medical-improvement determination, the SSA must 

correctly account for a treating physician’s opinion. See Trevizo v. Berryhill, 871 F.3d 664, 

675 (9th Cir. 2017) (explaining treating-doctor rule); 20 C.F.R. § 404.1594(b)(6) 

(incorporating same standards for cessation-of-benefits cases as original applications).

Under the relevant regulation,

1 a treating doctor’s opinion is given “controlling 

weight” so long as it “is well-supported by medically acceptable clinical and laboratory 

diagnostic techniques and is not inconsistent with the other substantial evidence in the 

claimant’s case record.” Trevizo, 871 F.3d at 675 (alterations omitted). Even if a treating 

 

1 After Brian filed his continuing-benefits claim, the SSA substantially changed the 

way it treats medical opinions. Compare 20 C.F.R. § 404.1527 (claims filed before 

March 27, 2017) with 20 C.F.R. § 404.1520c (claims filed on or after March 27, 2017).

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physician’s opinion is contradicted by another doctor, the SSA can only reject it after 

“providing specific and legitimate reasons that are supported by substantial evidence.” Id.

The only reason the Appeals Council gave for rejecting Dr. Tontz’s opinion was that 

it did “not relate to the period at issue”—May 1, 2014, to September 29, 2017. (AR 2.) But 

Dr. Tontz wrote that Brian “has been under my care since 2014” and “was last examined” 

on October 5, 2017. (AR 8; see AR 34, 72, 255-56.) In other words, Dr. Tontz’s opinion 

appears to be based on years of treatment within the relevant period. Yet, even if 

Dr. Tontz’s opinion were based entirely on Brian’s last examination on October 5, 2017—

six days after the period ended—it would still “relate” to the period at issue. “Medical 

evaluations made after the expiration of a claimant’s insured status are relevant to an 

evaluation of the preexpiration condition.” Taylor v. Comm’r of Soc. Sec. Admin., 659 F.3d 

1228, 1232 (9th Cir. 2011); see also Smith v. Bowen, 849 F.2d 1222, 1224-25 (9th Cir. 

1988) (holding that three doctors’ medical evaluations, occurring some three to nine years 

after the expiration of the insured status, were “relevant to an evaluation of the 

pre-expiration condition”). So the SSA’s sole reason for rejecting Dr. Tontz’s opinion was 

wrong.

C. Harmless-Error Analysis

“Even when the ALJ commits legal error, we uphold the decision where that error is 

harmless.” Treichler v. Comm’r of Soc. Sec. Admin., 775 F.3d 1090, 1099 (9th Cir. 2014). 

An error is harmless when it is “inconsequential to the ultimate nondisability 

determination,” or when “the agency’s path may reasonably be discerned, even if the 

agency explains its decision with less than ideal clarity.” Id. (alterations and citations 

omitted). The Court must “look at the record as a whole to determine whether the error 

alters the outcome of the case.” Molina v. Astrue, 674 F.3d 1104, 1115 (9th Cir. 2012).

Despite a range of medical opinions on the seriousness of Brian’s back issues (see

AR 21-22), the ALJ decided that Brian was fit for “medium” work—lifting up to 

50 pounds—and that he could “frequently . . . stoop.” (AR 18); see 20 CFR § 404.1567(c).

This brings into sharp relief the importance of Dr. Tontz’s opinion that Brian “has trouble

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with . . . stooping[] and lifting.” (AR 8.) Also, Dr. Tontz noted Brian’s “trouble with 

standing, sitting, [and] twisting,” whereas the ALJ set no limitations whatsoever on these 

activities. (AR 8, 18.) Of course, the ALJ relied on the mistaken assumption that Brian was 

“referred for only conservative, nonsurgical treatment.” (AR 19.) But Dr. Tontz’s letter 

confirmed the opposite: Brian “will require a complex anterior lumbar spinal fusion,” and 

he “was referred to a vascular surgeon in October of 2017[] for medical clearance” for that 

surgery. (AR 8.)

Given these stark facts and the traditional deference paid to treating physician’s 

opinions, the error here cannot be deemed harmless. See, e.g., Taylor, 659 F.3d at 1232

(“[I]f the Appeals Council rejected [the treating physician’s] opinion because it 

[incorrectly] believed it to concern a time after Taylor’s insurance expired, its rejection 

was improper” and required remand.); Edgecomb v. Berryhill, 741 F. App’x 390, 393 

(9th Cir. 2018) (remanding to the ALJ because “the Appeals Council failed to consider” a 

treating doctor’s new letter “on the mistaken belief that it did not relate to the period before 

the date of the ALJ’s decision”).

One final matter bears on the harmless-error analysis: As of January 17, 2017, the 

Appeals Council will only consider new evidence if the claimant “show[s] good cause for 

not informing [the SSA] about or submitting the evidence” sooner. 20 C.F.R. § 404.970(b). 

This new regulation applied when Brian submitted Dr. Tontz’s letter to the Appeals 

Council. (See AR 2.) But this Court need not wrestle with whether Brian had “good cause”

for the late submission, because the Appeals Council never argued otherwise. “We review 

only the reasons provided by the [SSA] in the disability determination and may not affirm 

the [SSA] on a ground upon which [it] did not rely.” Revels v. Berryhill, 874 F.3d 648, 654 

(9th Cir. 2017). The Council’s sole rationale for rejecting Dr. Tontz’s opinion was that it 

did “not relate to the period at issue.” (AR 2.) That reason was faulty; no other ones matter.

D. Remand Type

When the Appeals Council erroneously rejects new treating-physician evidence, a 

“remand to the ALJ for further consideration is in order,” rather than a remand for award 

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of benefits. Taylor, 659 F.3d at 1235; see also Harman v. Apfel, 211 F.3d 1172, 1180 

(9th Cir. 2000) (same). This case cries out for further fact-finding, as it appears the SSA 

never received Dr. Tontz’s full medical records. A consultant who reviewed Brian’s file 

noted that Dr. Tontz was sent a “source letter.” (AR 340.) But, unlike other doctors whose 

documents are missing, the administrative record does not include a medical-recordsrequest letter to Dr. Tontz. (See AR 381-83, 385-87.)

CONCLUSION

The Court recommends that Brian’s summary judgment motion (ECF No. 22)2 be 

GRANTED, defendant’s cross-motion for summary judgment (ECF No. 24) be DENIED, 

and the case be REMANDED for further proceedings and factual development. The parties 

must file any objections to this report by May 15, 2020. See 28 U.S.C. § 636(b)(1). A party 

may respond to any objection within 14 days of receiving it. Fed. R. Civ. P. 72(b)(2).

Dated: May 1, 2020

 

2 The Court interprets Brian’s brief (ECF No. 22) as a summary judgment motion.

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