Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_06-cv-02081/USCOURTS-casd-3_06-cv-02081-4/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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-1- 06cv2081-JLS (BLM) 

UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF CALIFORNIA

Constance MELKONIAN,

Plaintiff,

v.

Michael J. ASTRUE, Commissioner

of Social Security,

Defendant.

 

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Civil No. 06cv2081-JLS (BLM)

REPORT AND RECOMMENDATION FOR

ORDER DENYING PLAINTIFF’S

MOTION AND GRANTING

DEFENDANT’S CROSS-MOTION FOR

SUMMARY JUDGMENT

Constance Melkonian brought this action for judicial review

of the Social Security Commissioner’s (“Commissioner”) denial of her

claim for disability insurance benefits. Before the Court are

Plaintiff’s Motion for Summary Judgment (Doc. No. 35, “Pl. Mot.”),

and Defendant’s Cross-Motion for Summary Judgment (Doc. Nos. 57 &

57-2, “Def. Mot.”).

These motions were referred to the Honorable Barbara L. Major

for a Report and Recommendation pursuant to 28 U.S.C. § 636(b) and

Federal Rule of Civil Procedure 72(b). Doc. No. 49. For the

reasons set forth below, this Court RECOMMENDS that Plaintiff’s

motion be DENIED and Defendant’s cross-motion be GRANTED. 

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-2- 06cv2081-JLS (BLM) 

PROCEDURAL BACKGROUND

Plaintiff was born on May 28, 1986, with a heart defect that

caused oxygen-poor blood to circulate through her body.

Administrative Record (“AR”) at 112. Three years later, the Social

Security Administration (“SSA”) granted Plaintiff childhood

Supplemental Security Income (“SSI”) benefits, with a retroactive

onset date of her birthday. Id. at 116. In 1998, the SSA notified

Plaintiff that her case would be reconsidered pursuant to 20 C.F.R.

§ 416.994a(a), which requires periodic review to determine whether

disability benefits should continue. Id. at 1036. On June 10, 1999

the SSA informed Plaintiff that she no longer was eligible for SSI,

due to insufficient evidence to determine her disability status, and

Plaintiff’s failure to appear at a consultive examination with SSA

doctors. Id. at 117. Plaintiff’s parents made several requests for

reconsideration (id. at 122-30, 166-67, 170-76, 180-86), and

ultimately received a continuation of SSI benefits through September

1, 2003 (id. at 208). 

Plaintiff objected to the 2003 termination of her childhood

SSI benefits, and requested a hearing before an Administrative Law

Judge (“ALJ”). AR at 371-75. Because Plaintiff had turned eighteen

years old earlier that year, she also asked the ALJ to award her

adult SSI benefits. Id. ALJ Edward Steinman held the hearing on

February 1, 2005, and shortly thereafter issued separate orders

denying Plaintiff’s requests. Id. at 86-98, 102-111. The ALJ

determined that Plaintiff’s childhood benefits were properly

terminated because Plaintiff’s medical condition had improved

significantly. Id. at 86-98. The ALJ also rejected Plaintiff’s

request for adult benefits on several grounds relating to the

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-3- 06cv2081-JLS (BLM) 

conclusion that her medical problems did not prevent her from

working. Id. at 102-111. 

Plaintiff sought review of these holdings (id. at 81-82), and

submitted additional medical evidence in support of her arguments,

including reports from Dr. Mark Plunkett, written in March and July

of 2006 (id. at 8-61). On May 25, 2006, after considering the new

evidence, the Appeals Council upheld the ALJ’s holdings, thus

finalizing the SSA’s decisions. Id. at 73-80. 

Plaintiff filed a complaint in district court challenging,

inter alia, the ALJ’s decisions, and naming the U.S. Government as

the defendant. Doc. No. 1. After the district judge dismissed the

complaint for failure to name the proper defendant (Doc. No. 3),

Plaintiff filed the currently-operative first amended complaint

(Doc. No. 4, “FAC”). In the FAC, Plaintiff alleges wrongful conduct

by numerous actors, including the SSA and the ALJ, in violation of

the U.S. Constitution and several federal civil rights statutes.

Id. Plaintiff also argues that the ALJ erred in denying her

childhood and adult SSI benefits. Id. Pursuant to the above

claims, Plaintiff seeks (1) interim mandamus relief for all SSI

benefit claims, (2) injunctive, declaratory, and mandamus relief for

the payment of $3,000,000, and (3) reimbursement of all medical

costs and expenses rendered over her lifetime. Id.

Defendant moved to dismiss Plaintiff’s FAC. Doc. No. 11. In

June 2007, the district judge granted in part Defendant’s motion,

and dismissed Plaintiff’s constitutional and civil rights claims.

Doc. No. 22. Pursuant to this order, Plaintiff’s only remaining

claims are those for judicial review of the Commissioner’s final

decisions affirming the 2003 cessation of childhood SSI benefits and

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1 American Heart Association, Tetralogy of Fallot,

http://www.americanheart.org/presenter.jhtml?identifier=11071 (last visited July

17, 2008).

-4- 06cv2081-JLS (BLM) 

denying adult SSI benefits. Id. (stating that “Plaintiff’s

exclusive remedy for challenging the SSA’s denial of her SSI

benefits and cessation of her SSI benefits is the review procedure

set forth in 42 U.S.C. § 405(g)”). 

Plaintiff appealed the district court’s order (Doc. No. 33),

and the Ninth Circuit dismissed the appeal for lack of jurisdiction

(Doc. No. 48). Currently before the Court are the parties’ crossmotions for summary judgment and Plaintiff’s reply in opposition to

Defendant’s cross-motion for summary judgment. 

FACTUAL BACKGROUND

A. Plaintiff’s Medical History

Plaintiff, who is now twenty-two years old, was born in 1986

with Tetralogy of Fallot, a heart defect which results in oxygenpoor blood being pumped into the body. 1

 AR at 116. Plaintiff’s

condition was life-threatening at birth and, shortly after Plaintiff

was born, surgeons placed a prosthetic valve in her heart to

increase oxygen flow to her lungs. Id. at 247. Less than one year

later, Dr. John Lamberti installed another valve. Id. at 259. In

May 1989, Dr. Lamberti reported that though the post-operative

course was “quite stormy,” “complete repair of the Tetralogy of

Fallot was accomplished.” Id. at 267. The following month, the SSA

held that Plaintiff’s heart condition qualified her for childhood

SSI benefits, retroactive to her date of birth. Id. at 116. 

Because Plaintiff experienced tachycardia, an overly-rapid

///

///

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2 Mayo Clinic, Tachycardia,

http://www.mayoclinic.com/health/tachycardia/DS00929 (last visited July 17,

2008). 

-5- 06cv2081-JLS (BLM) 

heart rate,2 she visited Dr. John Perry, a pediatric cardiologist,

for assessment. Id. at 304. Dr. Perry determined that the

tachycardia could be eliminated with a minor procedure and, on March

4, 1997, he performed a right heart catheterization, with “excellent

result[s].” Id. at 304. Dr. Perry also reported that Plaintiff had

“done beautifully” since her previous surgeries. Id.

In 1996, Plaintiff developed scoliosis as a collateral effect

of her heart defect. Id. at 282. Dr. John Hall recommended a

corrective spinal fusion (id.), and performed the surgery on May 9,

1997 (id. at 278). Follow-up x-rays taken one year later showed

that Plaintiff’s condition “remained excellent” and that there was

“no longer any need to restrict her activity and she should be

allowed to do whatever she can.” Id. at 287.

On July 27, 1999, cardiologist Dr. Kathleen Maginot examined

Plaintiff, who was then thirteen years old. Id. at 328-30. Dr.

Maginot reported that Plaintiff “appear[ed] to be doing extremely

well clinically,” and noted that she was not taking any medications.

Id. at 330. Dr. Maginot reported that Plaintiff had “no specific

restrictions on her activity level,” and had attended summer camp on

Catalina Island and been snorkeling. Id. at 328-29. Plaintiff’s

parents also told Dr. Maginot that Plaintiff “had been entirely

asympotomatic with no history of chest pain, syncope [dizziness],

palpitations, or exercise intolerance.” Id. at 328. 

In July 1999, pediatrician Dr. Janna Cataldo informed

Plaintiff’s middle school that Plaintiff should follow a “modified

physical education program” which permitted her to run a maximum of

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3 A doctor described the incident as a “vasovagal event.” AR at 465. As

stated by the ALJ, “[i]n other words, the claimant fainted from the flu.” Id.

at 108; See also American Heart Association, Syncope,

http://www.americanheart.org/presenter.jhtml?identifier=4749 (last visited July

17, 2008) (defining a vasovagal event as a “benign” loss of blood pressure, and

the most frequent cause of fainting, particularly amongst children and young

adults).

-6- 06cv2081-JLS (BLM) 

400 yards a day, power walk, perform warm-up exercises, and

participate in “all other activities allowed, such as basketball,

racquetball, volleyball, soccer, et cetera, at her own pace.” Id.

at 300. In June 2003, Dr. Perry examined Plaintiff and reported

that she was doing great and reporting no symptoms. Id. at 468. 

Several months later, in December 2003, Plaintiff had a flulike illness and lost consciousness during the night. Id. at 465.

While Plaintiff’s father found her unconscious on the floor,

Plaintiff quickly recovered consciousness, and the whole episode

lasted “much less than a minute.” Id. Plaintiff was taken to the

emergency room and, after a cardiology consultation, blood chemistry

profile, and chest x-rays, a doctor diagnosed Plaintiff as having

fainted.3 Id. at 459. Plaintiff received a minor laceration on her

head as a result of the fall. Id. at 460. 

Dr. Perry examined Plaintiff six months later and reviewed

the fainting episode. Id. at 465-66. He characterized the postfaint emergency room assessment as “unremarkable,” stated that

Plaintiff was doing “very, very well,” and found that she had “no

worrisome [cardiac] rhythm abnormalities.” Id. Dr. Perry neither

stated nor implied that the fainting episode gave cause to limit

Plaintiff’s activity in any way. Id. Dr. Perry also opined that

Plaintiff would not need to replace the surgically-implanted shunt

in her heart for “many, many years.” Id. at 467. 

///

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-7- 06cv2081-JLS (BLM) 

B. The Administrative Hearing

The ALJ heard Plaintiff’s case on February 1, 2005. AR at

86. Because Plaintiff was a full-time university student in another

city, she was unable to appear at the hearing. Id. at 86, 1956.

The ALJ declared Plaintiff a non-essential witness and she was

represented by her father. Id. at 1954. Although, prior to the

hearing, the SSA requested a full history of Plaintiff’s medical

history for use at the hearing, Plaintiff did not submit any

documents pertinent to her condition after March 2000. Id. at 1957.

Plaintiff’s father did, however, submit additional evidence during

the hearing. Id. 1957-75. 

Plaintiff’s father testified regarding Plaintiff’s December

2003 faint. Id. at 1961. He stated that this was the third or

fourth such episode in her lifetime and opined that the fainting

spells resulted from tachycardia. Id. at 1961, 1966. Referring to

unspecified doctor’s reports, Plaintiff’s father also testified that

Plaintiff needed a replacement heart valve when she turned sixteen

or seventeen years old. Id. at 1971. 

After hearing Plaintiff’s father’s testimony, the ALJ

examined a vocational expert (“VE”) regarding the nature and

availability of employment that Plaintiff could perform. Id. at

1972-75. The VE testified that given Plaintiff’s age, lack of

employment history, education, and medical history, and assuming she

could perform light or medium work, there were approximately 3,000

jobs locally and almost one million nationally that Plaintiff could

perform. Id. 

Specifically, the VE testified that Plaintiff could perform

medium work as a general laborer, with 1,500 positions available in

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4 As stated above, in 1999 Plaintiff was found to be no longer eligible for

childhood SSI benefits. AR at 117. Although the SSA ultimately continued

childhood benefits until 2003 (id. at 208), for the sake of consistency this

Court refers to the cessation of childhood benefits as the “1999 cessation.”

-8- 06cv2081-JLS (BLM) 

the county, and over 280,000 nationally. Id. at 1972; see also 20

C.F.R. §§ 404.1567 & 416.967 (defining grades of work in terms of

effort required of an employee, where “medium” work can require

lifting up to fifty pounds at a time, and frequent lifting and

carrying of objects up to twenty-five pounds). She also testified

that Plaintiff could perform light work as a production assembler,

with 1,000 positions available in the county, and over 680,000

nationally. AR at 1973. Finally, the VE testified that Plaintiff

could perform sedentary work as a production inspector, with 500

positions available in the county, and about 75,000 positions

nationally. Id. The VE’s testimony only referred to Plaintiff’s

ability to work as an adult, and did not bear on her childhood SSI

claim. Id. at 1978. 

On June 18, 2005, the ALJ issued two separate decisions. Id.

at 89-98, 102-111. The first upheld the 19994 cessation of childhood

SSI benefits (id. at 89-98), and the second held that Plaintiff was

not entitled to adult SSI benefits (id. at 102-11). 

STANDARD OF REVIEW

Section 405(g) of the Social Security Act allows unsuccessful

applicants to seek judicial review of the Social Security

Commissioner’s final decision. 42 U.S.C. § 405(g). The scope of

judicial review is limited. The Commissioner’s denial of benefits

will not be disturbed if it is supported by substantial evidence and

contains no legal error. Id.; Batson v. Comm’r Soc. Sec. Admin.,

359 F.3d 1190, 1193 (9th Cir. 2004). 

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-9- 06cv2081-JLS (BLM) 

Substantial evidence is “more than a mere scintilla but may

be less than a preponderance.” Lewis v. Apfel, 236 F.3d 503, 509

(9th Cir. 2001) (citation omitted). It is “relevant evidence that,

considering the entire record, a reasonable person might accept as

adequate to support a conclusion.” Id. (citation omitted); see

also Howard ex rel. Wolff v. Barnhart, 341 F.3d 1006, 1012 (9th Cir.

2003). Where the evidence can reasonably be construed to support

more than one rational interpretation, the court must uphold the

ALJ’s decision. Batson, 359 F.3d at 1193. This includes deferring

to the ALJ’s credibility determinations and resolutions of

evidentiary conflicts. See Lewis, 236 F.3d at 509. 

Even if the reviewing court finds that substantial evidence

supports the ALJ’s conclusions, the court must set aside the

decision if the ALJ failed to apply the proper legal standards in

weighing the evidence and reaching his or her decision. See Batson,

359 F.3d at 1193. When a federal court reviews the ALJ’s decisions,

the above standards apply equally whether those decisions concern

childhood or adult SSI benefits. Warre v. Commissioner of Social

Sec. Admin., 439 F.3d 1001, 1004-09 (9th Cir. 2006) (applying adult

SSI standards of review to consideration of childhood SSI denial).

Section 405(g) permits a court to enter a judgment affirming,

modifying, or reversing the Commissioner’s decision. 42 U.S.C. §

405(g). The reviewing court may also remand the matter to the SSA

for further proceedings. Id.

DISCUSSION

Plaintiff seeks reversal of the ALJ’s decisions, an immediate

award of SSI benefits, and damages. Pl. Mot; Reply at 24, 42-47.

She specifically requests that the case not be remanded to the ALJ.

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-10- 06cv2081-JLS (BLM) 

Id. at 24. Construing Plaintiff’s arguments broadly, she appears to

contend that the ALJ’s denials of benefits were improper because

(1) neither was based on “substantial evidence” (see Pl. Mot. at 1-

2; Reply at 3-4, 10, 12, 15-16, 25), (2) evidence submitted after

the 2005 administrative hearing undermined the ALJ’s holdings (Reply

at 14, 17-18, 22), and (3) the SSA lied about Plaintiff’s failure to

appear at a consultive exam (Pl. Mot. at 1-2; Reply at 5). 

Defendant argues that the Commissioner’s decisions were

supported by substantial evidence and were proper as a matter of

law. Def. Mot. Therefore, Defendant argues, Plaintiff’s remaining

claims should be dismissed. Id.

A. Substantial Evidence

Plaintiff contends that there was insufficient evidence

supporting either denial of benefits because a treating physician,

Dr. Mark Plunkett, determined in 2006 that Plaintiff had a lifethreatening condition that required surgery, and then performed the

requisite surgery. Reply at 14, 16-18. Plaintiff also argues that

the ALJ improperly relied on SSA officer Mary Murillo’s

determination that Plaintiff was not disabled. Pl. Mot. at 1-2;

Reply at 3-4, 15-16, 25. To address Plaintiff’s arguments, the

Court will evaluate the sufficiency of the evidence supporting both

of the ALJ’s decisions and the specific deficiencies asserted by

Plaintiff.

1. Childhood Disability

The ALJ held that Plaintiff was no longer under a

“disability” as defined in the Social Security Act, and that the

SSA’s 1999 cessation of her childhood disability benefits was

therefore proper. AR at 86-98. As required by 20 C.F.R. § 416.924,

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-11- 06cv2081-JLS (BLM) 

this determination was made after a three-step evaluation of

Plaintiff’s impairments and ability to work. 

a. Step One of the Childhood Disability Analysis

Under the first step of the evaluation, a claimant will be

determined not disabled if she has performed substantial gainful

work. 20 C.F.R. § 416.924(b). If she has, she is not disabled.

Id. As the record reflected no work history, the ALJ properly

determined that Plaintiff had never been gainfully employed. AR at

90. 

b. Step Two of the Childhood Disability Analysis

Under the second step of the evaluation, a child is not

disabled if she only suffers from minimal functional limitations

which do not rise to the level of severe impairments. 20 C.F.R.

§ 416.924(c). The ALJ determined that Plaintiff had scoliosis and

Tetralogy of Fallot, but that surgical repair of both reduced them

to the level of minimal functional limitations. AR at 91. 

In support of his conclusion that Plaintiff’s scoliosis was

a minimal impairment, the ALJ cited Dr. Hall, who had performed the

spinal fusion to correct the problem. Id. One month after the

surgery, Dr. Hall stated that Plaintiff’s fusion was “solid,” that

correction of her scoliosis remained “excellent,” and that “there is

no longer any need to restrict her activity and she should be

allowed [to] do whatever she can.” Id. at 287.

In support of his finding that Plaintiff’s Tetralogy of

Fallot was not a severe impairment, the ALJ cited the opinion of Dr.

Janna Cataldo. Id. at 91. In 1999, Dr. Cataldo sent a letter to

Plaintiff’s middle school, stating that Plaintiff could run 440

yards daily, power walk, and, at her own pace, participate in warmCase 3:06-cv-02081-JLS-BLM Document 64 Filed 07/25/08 Page 11 of 27
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5 After the hearing, Plaintiff submitted new evidence of arrhythmia to the

Appeals Council. As discussed infra at 20-26, this new evidence does not

undermine the ALJ’s holdings, such that reversal or remand is required.

-12- 06cv2081-JLS (BLM) 

up exercises and all other activities, such as basketball,

volleyball, and soccer. Id. 300. The ALJ also cited Dr. Maginot’s

1999 statements that Plaintiff had attended camp on Catalina island,

snorkeled, and participated in other activities (id. at 91, 328-29),

and Plaintiff’s eighth-grade teacher’s statement that Plaintiff had

no difficulty standing, walking or running. Id. at 91. 

c. Step 3 of the Childhood Disability Analysis

The third and final step of the childhood disability

evaluation requires the ALJ to assess whether the child’s

impairments meet a statutorily-listed impairment or, if not, whether

they “functionally equal” a listing. 20 C.F.R. § 416.924(d). If

not, the claimant is not disabled. Id. Plaintiff claimed that she

suffered from persistent tachycardia at rest, other recurrent

arrhythmias, and persistent chronic hypoxemia. The ALJ determined

that these claims were not supported by the record.5 AR at 92. 

For a claimant to be “disabled” by tachycardia (elevated

heart rate), the tachycardia must be “persistent ... such that a

pattern of continuing severity is established.” Disability

Evaluation Under Social Security (“Disability Evaluation”)

§ 104.00(A)(3)(b). In 1997, Dr. Perry stated that Plaintiff had

“rare” episodes of tachycardia, “perhaps once per year.” AR at 306.

Subsequently, Dr. Perry performed a right heart catheterization with

“excellent results,” thereby resolving the problem. Id. at 304; see

also id. at 465 (Dr. Perry’s 2004 statement that Plaintiff “has not

had any recurrent arrhythmia since her ablation in 1997"); id. at

332 (Dr. Maginot’s 1999 diagnosis that recurrence of tachycardia is

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-13- 06cv2081-JLS (BLM) 

“unlikely”). The ALJ held that Plaintiff’s “rare” episodes of

tachycardia, which were repaired by surgery eight years before the

administrative hearing, did not qualify as “persistent” or “severe.”

The ALJ also stated that Plaintiff did not suffer from

“recurrent arrhythmia” (arrhythmic heart beats). Id. at 88. To

qualify as a listed impairment, recurrent arrhythmia must result in

cardio-related syncopal (fainting) episodes at least three times

within a consecutive 12-month period. Disability Evaluation

§§ 104.00(A)(3)(c) & 104(E)(3)(a). Here, not only does the record

reflect only two syncopal episodes, one in 2001 and the other in

2003, but there is evidence that the latter event was not heartrelated, but, rather, a result of the flu. AR at 465. 

The ALJ also held that Plaintiff did not meet the listed

impairment of persistent chronic hypoxemia (low blood oxygen). This

holding is supported by reports from heart specialists stating,

among other things, that Plaintiff’s blood chemistry profile is

normal (id. at 459), that her health is “excellent” (id. at 287),

that she can exercise without restriction (id. at 328-29), and that

“she is doing well clinically” (id. at 912). 

Because Plaintiff’s conditions did not meet any of the listed

impairments, the ALJ was required to assess whether her impairments

“functionally equaled” the listings. 20 C.F.R. § 416.924. As

prescribed by statute, this is done by determining how the child

performs in six “domains of functioning.” Id. at § 416.926(a)(b).

A child must have “extreme” functional limitations in one domain or

“marked” limitations in at least two domains to be found disabled.

Id. These domains are: acquiring and using information, attending

and completing tasks, interacting and relating with others, moving

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-14- 06cv2081-JLS (BLM) 

about and manipulating objects, caring for yourself, and health and

physical well-being. See 20 C.F.R. § 416.926a(b)(1). 

After four pages of in-depth analysis, the ALJ concluded that

Plaintiff had no limitations in any of the domains. AR at 93-97.

The ALJ’s opinion was based on numerous citations to the opinions of

Plaintiff’s teachers and doctors, evidence that Plaintiff was

socially adept and performed well in school, and that she

participated in a full range of activities, such as snorkeling and

art classes. Id. 

At each step of the childhood disability evaluation, the ALJ

provided “relevant evidence that, considering the entire record, a

reasonable person might accept as adequate” to support his

conclusion that Plaintiff’s childhood disability benefits were

properly terminated. Lewis, 236 F.3d at 509; Warre, 439 F.3d at

1004-00 (applying adult SSI standards of review to consideration of

childhood SSI denial). The ALJ “summarized the facts and [] medical

evidence in a detailed and thorough fashion, stating his

interpretation and making findings,” and his conclusions were

therefore based on substantial evidence. Magallanes v. Bowen, 881

F.2d 747, 755 (9th Cir. 1989). This Court’s independent review of

the record confirms the validity of the ALJ’s conclusions. 

2. Adult Disability

The ALJ also held that Plaintiff was not a “disabled” adult,

such that she was entitled to SSI benefits (AR at 102-11); a ruling

that Plaintiff contends was not based on substantial evidence (Pl.

Mot; Reply). Pursuant to the Social Security Regulations

(“Regulations”), the ALJ followed a five-step sequential evaluation

process for determining Plaintiff’s disability. Id.; 20 C.F.R.

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§ 416.920(a) (describing five-step evaluation). 

At the first step, the ALJ determined that Plaintiff had

never engaged in substantial gainful activity. AR at 103-04; 20

C.F.R. § 416.920(a)(4)(I) (first step of sequential disability

evaluation). This finding is not contested. 

At the second step, the ALJ was required to determine whether

Plaintiff had a medically determinable impairment, or combination of

impairments, considered “severe” under the Social Security Act. 20

C.F.R. § 416.920(a)(4)(ii). The ALJ found that Plaintiff’s

Tetralogy of Fallot and scoliosis were not “severe” because both

ailments had been surgically repaired. AR at 105. This finding was

thoroughly supported by the medical evidence already discussed

above, including records of Plaintiff’s successful corrective

surgeries, her excellent recoveries and ability to engage in a full

range of activity, and positive prognoses for the future. Id. at

104-05. 

Although the ALJ already had determined that Plaintiff did

not suffer from a severe impairment, and therefore was not disabled,

he continued the analysis to give Plaintiff “every benefit of the

doubt.” Id. at 105. At the third step of the disability

assessment, the ALJ asked whether Plaintiff’s impairments met or

equaled a listed impairment. 20 C.F.R. § 416.920(a)(4)(iii). For

the reasons discussed above, supra at 12-13, the ALJ found that the

record failed to support Plaintiff’s allegations of disabling

cyanosis, arrhythmia, syncope, or congenital heart disease. AR at

105. Based on Dr. Hall’s post-surgery conclusions that Plaintiff

had no restrictions on her activities, the ALJ also found that

Plaintiff’s corrected scoliosis did not constitute a listed

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prophylactic. AR at 468.

-16- 06cv2081-JLS (BLM) 

disability. Id. at 105, 107. 

At the fourth step of the disability assessment, the ALJ

determined that Plaintiff possessed the “residual functional

capacity” (“RFC”) to perform a significant range of medium work.

Id. at 106-10; 20 C.F.R. § 416.920(a)(4)(iv). In reaching this

conclusion, the ALJ cited evidence that Plaintiff’s heart defects

and scoliosis had been repaired by surgery, and doctors’ opinions

that she was “looking absolutely great” and “doing very, very well”.

Id. at 106. He noted that Plaintiff was not taking any cardiac

medications6, and cited Dr. Hall’s conclusion that there was no

reason to restrict her activities. Id. The ALJ also cited evidence

of Plaintiff’s participation in a normal range of activities,

including basketball and camping, and her status as a full-time

college student with a 3.325 grade point average. Id.

At the fifth and final step of the disability determination,

the ALJ assessed whether work existed in the national economy that,

given her RFC, Plaintiff could perform. 20 C.F.R.

§ 416.920(a)(4)(v). Based on the VE’s testimony, discussed supra at

7-8, the ALJ held that Plaintiff could work as a production

inspector, production assembler, or general laborer, and that

hundreds of thousands of such positions existed in the nation. AR

at 110. 

As thoroughly described by the ALJ, the overwhelming weight

of the evidence supports the conclusion that Plaintiff is not a

disabled adult. “The ALJ summarized the claimant’s background,

subjective complaints, and medical evaluations,” and, based on this

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-17- 06cv2081-JLS (BLM) 

information, properly found her to be not disabled. Seang Wang v.

Astrue, 252 Fed. Appx. 844, 846 (9th Cir. 2007). In reaching this

conclusion, the ALJ provided more than twenty-five citations to a

longitudinal cross-section of people who were most familiar with

Plaintiff and her abilities, including physicians, parents, and

teachers. AR at 102-11. These citations constitute “relevant

evidence that, considering the entire record, a reasonable person

might accept as adequate to support a conclusion.” Lewis, 236 F.3d

at 509; see also 20 C.F.R. § 416.920 (burden is on claimant to prove

disability). The ALJ’s opinion was thus supported by substantial

evidence. 

3. Plaintiff’s Argument That the ALJ Improperly Relied on

the 1999 Determination That Plaintiff Was Not Disabled

Plaintiff contends that the ALJ’s decision is improperly

founded on a 1999 determination that Plaintiff was not disabled.

Reply at 3-4, 15-16, 25; Pl. Mot. at 1-2. On June 10, 1999, the SSA

mailed Plaintiff a letter stating that her childhood disability

benefits would cease on August 1, 1999. AR at 121. Plaintiff’s

parents requested reconsideration of the cessation, and a

reconsideration hearing was held on March 14, 2000. Id. at 141.

The SSA hearing officer, Mary Murillo, subsequently issued a

decision affirming the cessation. Id. at 141-52. Citing more than

one dozen doctor’s reports, Ms. Murillo held that Plaintiff’s health

had improved such that she was no longer a “disabled child” by SSA

standards and that she was therefore no longer eligible for SSI

benefits. Id. at 141-52. 

Plaintiff argues that Ms. Murillo’s conclusion is a “lie,”

and contends that because the ALJ relied on Ms. Murillo’s report,

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-18- 06cv2081-JLS (BLM) 

his opinion was not based on “substantial evidence.” Reply at 15;

see also id. at 3-4, 16, 25; Pl. Mot. at 1-2. Plaintiff argues that

Ms. Murillo’s finding of not disabled was false because Plaintiff

was “in desperate need of a life saving open heart surgery with her

designated Surgeon, Denton A. Cooley scheduled for October 1, 1999.”

Pl. Mot. at 2; Reply at 5. In support, Plaintiff provided an

October 1, 1999 letter from Dr. Cooley. Pl. Mot. at 2; Reply at 15.

Plaintiff’s argument is unavailing for a number of reasons.

First, although the ALJ supported his holdings with citations to

numerous sources, he never once cited Ms. Murillo’s report as a

foundation for his opinions. In fact, part of Plaintiff’s purpose

in bringing the case before the ALJ was to appeal Ms. Murillo’s

holding. AR at 86 (ALJ’s statement that “[t]his case is before the

Administrative Law Judge upon a request for hearing filed ... by

Garo Melkonian, the claimant’s father, who is dissatisfied with the

April 20, 2000 Notice of Reconsideration”). Because he was

reviewing Ms. Murillo’s decision, the ALJ quite properly did not

rely on Ms. Murillo’s statements in reaching his conclusion that

Plaintiff’s childhood medical condition had improved. Id. at 86-98.

Although the ALJ ultimately reached the same conclusion as Ms.

Murillo, he did so without support from her opinion. Plaintiff’s

statements to the contrary find no support in the record and

therefore are unpersuasive. 

Second, the letter from Dr. Cooley that Plaintiff cites in

support of her allegation that Ms. Murillo lied is insufficient to

support Plaintiff’s arguments. Dr. Cooley’s letter merely states:

Constance V. Melkonian is a 13 year old girl from La

Jolla, California with congenital heart disease who

has undergone several surgeries for this condition.

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Our office was contacted by her parents about her

condition, and she has an appointment to see Dr.

Denton Cooley ... and Dr. Roberto Luischanowski ...

at the Texas Heart Institute, on December 20, 1999,

2:00 p.m. 

AR at 892. This letter establishes nothing more than the fact that

Plaintiff had an appointment to see Dr. Cooley, and in no way

indicates that she was on the cusp of a medical emergency, in need

of a life-saving operation, or that such an operation was scheduled

for October 1, 1999. Id.

Third, the record as a whole does not support Plaintiff’s

contentions that Ms. Murillo “lied” in her report, or offered

“perjured evidence and willful misrepresentation[s].” Pl. Mot. at

1-2. Ms. Murillo’s conclusion that Plaintiff’s medical condition

had improved was well supported by citation to several medical

reports written by Plaintiff’s treating doctors. AR at 145-47.

These reports include statements that Plaintiff’s condition was

“stable,” that “she appears to be doing extremely well clinically,”

and that both her heart and spinal surgeries were successful. Id.

For the above reasons, Plaintiff’s arguments that the ALJ’s

disability finding was false, improperly based on Ms. Murillo’s

report, or compromised by Dr. Cooley’s letter are not persuasive.

Because they fail to show that the ALJ’s opinion was not based on

substantial evidence, or that he applied an improper legal standard,

this Court sees no reason to disturb the ALJ’s holding on these

grounds. See Batson, 359 F.3d at 1193 (ALJ’s opinion will only be

disturbed when not founded on substantial evidence, or when based on

legal error).

///

///

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7 Although Plaintiff argues that the ALJ failed to give proper weight to

Plaintiff’s treating physicians in general, she cites only the opinions of Dr.

Plunkett when making this argument. Reply at 14, 16-18. Therefore, in this

section of the discussion, the Court only addresses Plaintiff’s argument in

regards to Dr. Plunkett. See Carmen v. San Francisco Unified School Dist., 237

F.3d 1026, 1029 (9th Cir. 2001) (when considering motion for summary judgment,

court need not consider evidence not “specifically referred to” in motion

papers). However, the Court notes that, as emphasized throughout this Report and

Recommendation, and contrary to Plaintiff’s allegations, the record as a whole

indicates that the ALJ did in fact give sufficient weight to Plaintiff’s treating

physicians. 

-20- 06cv2081-JLS (BLM) 

4. Arguments Based on Evidence Acquired After the 2005

Administrative Hearing

Plaintiff also argues that she is entitled to SSI benefits

because in 2006 she experienced an episode of cardiac arrhythmia and

because she required surgery in 2006 to replace her prosthetic heart

valve. Reply at 14, 16-18 (surgery) and id. at 4, 18-19, 22

(arrhythmia). These arguments are based on thirty-four pages of

newly-submitted medical evidence. AR at 8-61; Pl. Mtn. at 33-67

(duplicating evidence submitted in record). All of this evidence

was created after the February 1, 2005 disability hearing, and was

therefore not presented to the ALJ. Id. However, the Appeals

Council considered this information (AR at 8-61), and the evidence

is thus properly before this Court. See Bates v. Sullivan, 894 F.2d

1059, 1064 (new evidence presented to Appeals Council incorporated

into record); 20 C.F.R. § 404.970 (applicant may present new

evidence to appeals council). 

a. Dr. Plunkett’s Opinions and Plaintiff’s Need for

Surgery in 2006

Plaintiff argues that the Commissioner failed to give

sufficient weight to the opinions of Plaintiff’s treating physicians

and, specifically, to the statements of Dr. Mark Plunkett. Reply at

14, 16-18.7

 Plaintiff states that Dr. Plunkett found Plaintiff’s

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-21- 06cv2081-JLS (BLM) 

heart condition to be “severe, gross, compelling and potentially

life threatening,” and that because Dr. Plunkett is a “treating

surgeon”, “a finding of disability is mandatory without additional

inquiry.” Id. at 14. 

The record contains three documents written by Dr. Plunkett.

The first, dated March 17, 2006, is a report evaluating Plaintiff’s

need for surgical replacement of the artificial heart valve

implanted when she was a child. AR at 42-44. In this report, Dr.

Plunkett concluded that surgery was necessary in the “near future”

because Plaintiff was at “significant risk for rupture or dissection

of her aortic root and ascending aorta,” which would be a “sudden

and likely fatal event.” Id. at 44. Dr. Plunkett’s second report

is a brief letter dated July 2, 2006, that reiterates Plaintiff’s

need for surgery. Id. at 41. Dr. Plunkett’s third report, written

July 16, 2006, describes the valve replacement surgery he performed,

and concludes that Plaintiff “tolerated the procedure well” and

there were “no complications.” Id. at 38-39. The following month,

Dr. Neil Siecke noted the presence of Plaintiff’s new prosthetic

valve and stated that it “appear[ed] to be well seated with normal

leaflet/disc motion.” Id. at 32. At no point does the new evidence

from Dr. Plunkett state that Plaintiff is limited in her physical

activity or ability to work. Id. at 38-39, 41-44.

Plaintiff argues that the fact that she had to have this

surgery in 2006 proves that she continued to be disabled as a child

and establishes that she is a disabled adult. Reply at 14, 16-18.

However, a required surgery does not automatically establish

disability. Here, Plaintiff’s doctors had long anticipated the need

for this operation, and none of them opined or implied that the

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-22- 06cv2081-JLS (BLM) 

pending surgery would disable Plaintiff or otherwise prevent her

from working. See AR at 331 (Dr. Maginot’s 1999 statement that the

time at which Plaintiff will need the valve replaced “cannot be

determined exactly”); id. at 467 (Dr. Perry’s 2004 statement that

Plaintiff will not need valve replacement for “many, many years,”

maybe when Plaintiff was “well into her 30's”). The ALJ considered

these statements when making his decision, and found that “while the

evidence does indicate that the claimant will require surgery [to

replace her valve] some time in the future causing justifiable

concern for the claimant, the need for surgery in the future does

not mean that her ability to work is currently restricted.” Id. at

107. 

Moreover, Plaintiff’s surgeon, Dr. Plunkett, did not opine

that either the surgery or the need for the surgery limited

Plaintiff’s ability to work or her ability to engage in other

activities. Furthermore, six months before the operation, Dr. Child

stated that Plaintiff “is doing very well and denies cardiac

symptometology [sic], specifically no palpitations, dizziness or

syncope. She ... is not limited in her ability to climb stairs,

bicycle around the city, and walk long distances to class.” Id. at

45. 

Although Dr. Plunkett’s reports indicate that Plaintiff was

at significant risk of danger, a risk of which the ALJ was unaware,

they also state that replacement of Plaintiff’s heart valve would

prevent that danger. Id. at 42 & 50. Now that the surgery has been

performed, the risk of aortic rupture or dissection to which Dr.

Plunkett referred is no longer present. Id. at 42 & 50; see also

id. at 32 (Dr. Siecke’s statement that Plaintiff’s replacement heart

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8 Though Plaintiff does not make this argument, the Court notes that

Plaintiff is not entitled to disability benefits for the period between Dr.

Plunkett’s statement that Plaintiff needed surgery, and the time the surgery was

performed. A “disability” is an “inability to engage in any substantial gainful

activity by reason of any medically determinable physical or mental impairment

which can be expected to result in death or which has lasted or can be expected

to last for a continuous period of not less than 12 months ... ” 42 U.S.C.S.

§ 1382c(a)(3)(A). Dr. Plunkett’s statements do not indicate that Plaintiff’s

need for surgery impaired her ability to work. AR at 38-39, 41-44. Furthermore,

Plaintiff attended college around this time, and was “not limited in her ability

to climb stairs, bicycle around the city, and walk long distances to class.” Id.

at 45 (February 2006 report by Dr. Child); see also Matthews, 10 F.3d 678, 680

(9th Cir. 1993) (claimant’s ability to attend classes three times a week is “an

activity which is inconsistent with an alleged inability to perform all work”).

 

 

-23- 06cv2081-JLS (BLM) 

valve is “well seated with normal [] motion”). Dr. Plunkett’s presurgery risk assessments are thus moot, and Plaintiff’s reliance on

these statements is therefore unconvincing.8 The question of whether

Dr. Plunkett is, as Plaintiff argues, a “treating surgeon” (Reply at

18) is therefore moot as well. 

Additionally, the Appeals Council considered Plaintiff’s new

evidence, including the statements of Drs. Plunkett and Child, and

upheld the ALJ’s denials of benefits. AR at 77 (“While there is new

evidence concerning the claimant’s cardiovascular condition ... this

evidence does not present persuasive reasons to find significant

limitations for the period up to May 2004, when she attained age

18). For the reasons already stated, this Court agrees with the

Appeals Council, and does not believe that the AJL’s holdings should

be disturbed. 

Furthermore, Plaintiff requests the district court to reverse

the ALJ and award her childhood and adult SSI benefits. Reply at

24. She explicitly states that she does not seek remand. Id. An

award of benefits without remand is only appropriate when “it is

clear from the record that the ALJ would be required to find the

claimant disabled if he considered the claimant’s evidence.”

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-24- 06cv2081-JLS (BLM) 

McCartey v. Massanari, 298 F.3d 1072, 1076-77 (9th Cir. 2002)

(questioning whether award without remand appropriate when Appeals

Council stated that newly-submitted evidence was “not material;”

other elements of test omitted) (citing Smolen v. Chater, 80 F.3d

1273, 1292 (9th Cir. 1996)). 

Neither Dr. Plunkett’s reports nor the record as a whole

demonstrate that, had the ALJ seen Dr. Plunkett’s reports, he would

have been “required” to find Plaintiff disabled. To the contrary,

Dr. Plunkett’s reports and other newly-acquired evidence show that

Plaintiff is no longer in danger of aortic rupture or dissection.

AR at 32, 38-39, 41-44. Plaintiff’s arguments that she is entitled

to summary judgment on these grounds are therefore unavailing. The

Court is not persuaded that “the ALJ would be required to find the

claimant disabled [had] he considered the claimant’s evidence,”

McCartey, 298 F.3d at 1076-77, and remand is therefore not

appropriate on these grounds. 

b. Plaintiff’s 2006 Episode of Cardiac Arrhythmia

Plaintiff states that she suffered an episode of tachycardia

on July 21, 2006, and argues that, in combination with previous

episodes of tachycarida, she is thus disabled by “recurring

arrhythmia.” Reply at 18-19; see also id. at 22, 24. Therefore,

she argues, she is entitled to an award of benefits and reversal of

the ALJ without remand. Id. at 18-19, 22 (describing arrhythmia),

24 (requesting award of benefits and reversal). Because this

arrhythmic episode occurred after the 2005 administrative hearing,

the ALJ did not consider the event when finding Plaintiff not

disabled; the Appeals Council, however, did and found that it did

not compromise the ALJ’s decision. AR at 73-80. 

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-25- 06cv2081-JLS (BLM) 

 Plaintiff’s argument is not persuasive. For an adult

claimant to be “disabled” by tachycardia, the tachycardia must be

“recurrent,” such that “within a consecutive 12-month period, the

finding(s) occurs at least three times.” Disability Evaluation

§§ 4.05 (describing requirements for disabling

tachycardia); 4.00(A)(3)(c) (defining “recurrent”). As described

supra, in 1997, Dr. Perry stated that Plaintiff had “rare” episodes

of tachycardia, “perhaps once per year.” AR at 306. Subsequently,

Dr. Perry performed a surgical procedure with “excellent results,”

thereby resolving the problem. Id. at 304; see also id. at 465 (Dr.

Perry’s 2004 statement that Plaintiff “has not had any recurrent

arrhythmia since her ablation in 1997"); id. at 332 (Dr. Maginot’s

1999 diagnosis that recurrence of tachycardia is “unlikely”).

Although the ALJ was not privy to the 2006 episode of

tachycardia, the previous episode occurred in 1997. Id. at 304.

Two documented episodes of tachycardia within nine years do not meet

the SSA’s definition of “persistent” (three episodes within one

year), and Plaintiff’s arguments to the contrary are not persuasive.

B. The SSA Did Not Appear to Lie About Plaintiff’s Absence at

the 1998 Consultive Examination

Plaintiff contends that the SSA lied when it stated in 1999

that she failed to appear at a 1998 consultive medical examination

with SSA doctors. Pl. Mot. at 1-2; Reply at 5. She does not,

however, explain why this alleged fabrication leads to the

conclusion that the ALJ erred in denying her benefits. Nonetheless,

this Court addresses the argument. 

Plaintiff’s only proof that she attended the consultive

examination is a letter from the SSA informing her of the

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9 Although Plaintiff makes additional arguments concerning alleged

violations of the U.S. Constitution and federal civil rights statutes (Pl. Mot.;

Reply), Judge Moskowitz dismissed these claims in his order granting in part and

denying in part Defendant’s motion to dismiss (Doc. No. 22). As stated in that

order, Plaintiff’s only surviving claims are those arising under 42 U.S.C.

§ 405(g) for review of the Commissioner’s decisions. Doc. No. 22; 42 U.S.C.

§ 405(g) (defining scope of federal review). This Court thus limits its

conclusions to those claims. 

-26- 06cv2081-JLS (BLM) 

appointment. Pl. Mot. at 1-2 (citing AR at 1036-38). This document

merely shows that an appointment was scheduled, not that she

appeared at the exam. 

Furthermore, although the failure to appear was cited as one

reason among several for the 1999 denial of childhood benefits (AR

at 117), Plaintiff’s parents subsequently met with an SSA officer to

discuss the confusion regarding Plaintiff’s failure to appear. Id.

at 128-30. After this meeting, the SSA gave Plaintiff another

opportunity to file for reconsideration of the denial of benefits,

and, upon such filing, extended her benefits until 2003. Id.

Therefore, not only does Plaintiff fail to show that the SSA “lied”

by stating that she failed to appear at the appointment, the

extension of benefits shows that, even if SSA thought Plaintiff

failed to appear, it negated the issue. Moreover, there is no

evidence that this alleged failure to appear affected in any way the

ALJ’s decisions currently under review. Plaintiff’s argument is

thus unpersuasive.

CONCLUSION

For the foregoing reasons, this Court finds that the ALJ’s

conclusion that Plaintiff is not entitled to either adult or

childhood disability benefits is supported by substantial evidence

and free from legal error.9

 

In light of these findings, IT IS HEREBY RECOMMENDED that the

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District Court issue an Order DENYING Plaintiff’s motion for summary

judgment and GRANTING Defendant’s cross-motion for summary judgment.

IT IS ORDERED that any written objections to this Report must

be filed with the Court and served on all parties no later than

August 15, 2008. The document should be captioned “Objections to

Report and Recommendation.”

IT IS FURTHER ORDERED that any reply to the objections shall

be filed with the Court and served on all parties no later than

September 5, 2008 . The parties are advised that failure to file

objections within the specified time may waive the right to raise

those objections on appeal of the Court’s order. Martinez v. Ylst,

951 F.2d 1153 (9th Cir. 1991).

IT IS SO ORDERED.

DATED: July 25, 2008

BARBARA L. MAJOR

United States Magistrate Judge

COPY TO:

HONORABLE JANIS L. SAMMARTINO

U.S. DISTRICT JUDGE

ALL COUNSEL AND UNREPRESENTED PARTIES

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