Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-cand-3_06-cv-04607/USCOURTS-cand-3_06-cv-04607-2/pdf.json

Nature of Suit Code: 863
Nature of Suit: Social Security - DIWC/DIWW (405(g))
Cause of Action: 42:405 Review of HHS Decision (DIWC)

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United States District Court

For the Northern District of California

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IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF CALIFORNIA

GLORIA COSTA, Parent on behalf of

F.R.A., a minor child,

Plaintiff,

 v.

JO ANNE B BARNHARD, Commissioner,

Social Security Administration,

Defendant. /

No. C 06-04607 WHA

ORDER (1) GRANTING IN PART

PLAINTIFF’S MOTION FOR

SUMMARY JUDGMENT;

(2) DENYING DEFENDANT’S

MOTION FOR SUMMARY

JUDGMENT; AND

(3) REMANDING FOR

FURTHER PROCEEDINGS

INTRODUCTION

In this social security appeal, this order holds that the administrative law judge erred

in failing to make a specific finding on the limitations imposed by the side effects of the

medications used to ameliorate the applicant’s Tourette’s Syndrome and ADHD. 

Accordingly, plaintiff’s motion for summary judgment is GRANTED IN PART and defendant’s

motion for summary judgment is DENIED. This case is REMANDED for further proceedings

consistent with this order. This order, however, does not compel any particular outcome. 

Rather, this order remands for a more specific finding and then re-consideration by the ALJ

in light of that finding.

Case 3:06-cv-04607-WHA Document 21 Filed 04/24/07 Page 1 of 7
United States District Court

For the Northern District of California

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 At the hearing, Gloria Acosta testified under the name of Gloria Banales.

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 A 504-plan accommodates students with special needs by granting modified workloads as compared

to mainstream academic expectations. F.R.A.’s plan called for “weekly progress report, extended day/help

classes, allow extra time to complete assignments as needed except for sketchbook, [and] modified homework

quantity” (AR 126, 352–53).

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STATEMENT

1. PROCEDURAL HISTORY.

On June 7, 2004, F.R.A., age 13, applied for supplemental security income, alleging

she became disabled on April 1, 2004, due to ADHD and a tic disorder. Her application was

denied both initially and upon reconsideration. An administrative hearing was timely requested

(AR 41, 48, 53, 63–66, 68).

On February 21, 2006, plaintiff had a hearing before ALJ Brenton Rogozen. The ALJ

rendered a decision on March 29, 2006, finding that plaintiff was not disabled. The Appeals

Council denied plaintiff’s request for review (AR 5, 14, 22). Plaintiff filed an action in this

Court on July 27, 2006, seeking judicial review pursuant to 42 U.S.C. 405(g). The parties now

make motions for summary judgment. At issue is the ALJ’s consideration of testimony and

evidence documenting the physical effects of plaintiff’s medications in his determination of a

less than marked limitation in the health and physical well-being domain.

2. TESTIMONY AT THE ADMINISTRATIVE HEARING.

At the hearing before the ALJ, plaintiff’s mother, Gloria Acosta, testified on her behalf.1

Ms. Acosta testified that F.R.A. was in the eighth grade and attended conventional classes under

a 504-plan except for math which was an English as a Second Language class.2

 Plaintiff had

been home-schooled for the last three months of the seventh grade. Ms. Acosta stated that

Dr. Michelle Banducci, the treating psychiatrist, recommended home-schooling based on

conversations about plaintiff’s inability to do the work in school because “the medication

[plaintiff] was taking made her real tired and sleepy, and she couldn’t concentrate, and also

because of the ticks [sic] . . . [which] would disturb her” (AR 335–37). Ms. Acosta testified

that plaintiff’s medications were Prozac, Haldol, Cogentin, and Tenex and that the medications

kept the Tourette’s Syndrome under control but that stress triggered the tics. Ms. Acosta

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 Throughout the record ADHD and ADD were used interchangeably to describe F.R.A.’s impairment. 

Her impairment was diagnosed as Attention-Deficit/ Hyperactivity Disorder, Predominately Inattentive Type

(AR 255). 

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reported that plaintiff had a short attention span and difficulty completing tasks at home. 

Ms. Acosta asserted that side effects of the medications included weight gain, lack of a

menstrual cycle, and tiredness. She stated that plaintiff took three-to four-hour naps after

school (AR 338–43).

3. MEDICAL EVIDENCE.

The medical evidence was summarized in the ALJ’s decision (AR 16–22). In brief,

Dr. Banducci stated in her declaration that F.R.A.’s reported side effects included tiredness,

weight gain, and a change in blood pressure. But the effect on plaintiff’s blood pressure was

favorable as she was prone to borderline high blood pressure. Dr. Banducci opined that

plaintiff’s impairments were marked in the following domains: acquiring and using

information, attending to and completing tasks, and interacting and relating with others. 

She did not conclude as to the other domains (AR 317–330). 

Dr. Daniel Seffinger, plaintiff’s treating psychologist, noted that “Haldol

caused . . . severe side effects” and that plaintiff was “very sensitive to meds” (AR 187). 

The medical expert, Dr. Moses Grossman, testified that plaintiff had three problems: attention

deficit disorder, Tourette’s Syndrome and side effects of the medications, but that the

combination did not equal a listing.3 He gave a health and physical well-being score of

“less than marked because of Tourette’s Syndrome” (AR 355–56, 358). 

ANALYSIS

1. LEGAL STANDARD.

A decision denying disability benefits must be upheld if it is supported by substantial

evidence and free of legal error. 

Substantial evidence means more than a mere scintilla but less

than a preponderance; it is such relevant evidence as a reasonable

mind might accept as adequate to support a conclusion. 

To determine whether substantial evidence supports the ALJ's

decision, [the court] review[s] the administrative record as a

whole, weighing both the evidence that supports and that which

detracts from the ALJ's conclusion. The ALJ is responsible for

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determining credibility, resolving conflicts in medical testimony,

and for resolving ambiguities. The court must uphold the ALJ’s

decision where the evidence is susceptible to more than one

rational interpretation.

Andrews v. Shalala, 53 F.3d 1035, 1039–40 (9th Cir. 1995) (internal citations omitted). 

The claimant has the burden of proving disability. Id. at 1040. The court may only look to

the administrative record when reviewing an ALJ’s decision. 42 U.S.C. 405(g).

To be considered disabled and eligible for SSI under the Social Security Act, a child

under the age of eighteen must have a “medically determinable physical or mental impairment,

which results in marked and severe functional limitations, and which can be expected to result

in death or which has lasted or can be expected to last for a continuous period of not less than

12 months.” 42 U.S.C. 1382c(a)(3)(C)(i). The regulations delineate a three-step sequential

evaluation process to determine if a child is disabled. A child will be found to be disabled

(1) if he or she is not working or engaged in substantial gainful activity; (2) if he or she has a

medically determinable impairment or combination of impairments that is severe; and (3) if the

impairment(s) meets, medically equals, or functionally equals the severity of impairments

listed in 20 C.F.R. 404, subpt. P, app. 1. 20 C.F.R. 416.924. For functional equivalence, a

child must show “marked” limitations in two domains of functioning or “extreme” limitation in

one domain. 20 C.F.R. 416.926(a). The six domains include: (1) acquiring and using

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

(4) moving about and manipulating objects; (5) caring for oneself; and (6) health and physical

well-being. 20 C.F.R. 416.926a(b)(1)(i)-(vi). A marked limitation means the “impairment(s)

interferes seriously with [claimant’s] ability to independently initiate, sustain, or complete

activities.” 20 C.F.R. 416.926a(e)(2)(i). An extreme limitation means the “impairment(s)

interferes very seriously with [claimant’s] ability to independently initiate, sustain, or complete

activities.” 20 C.F.R. 416.926a(e)(3)(i). 

2. THE ALJ’S THREE-STEP ANALYSIS.

In his decision, the ALJ found at steps one and two of the sequential evaluation process

that the plaintiff was not engaged in substantial gainful activity and that her impairments,

ADHD and Tourette’s Syndrome, were severe (AR 16). At step three, the ALJ found that

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plaintiff’s impairments neither met nor medically equaled any of the listed impairments under

20 C.F.R. 404, subpt. P, app. 1 (AR 17). The ALJ found that plaintiff had a marked impairment

in the attending and completing tasks domain, less than marked impairments in the acquiring

and using information, caring for oneself, and health and physical well-being domains, and no

marked impairment in the remainder of the domains. Thus, plaintiff’s impairments did not

functionally equal the listings (AR 17–22). For the health and well-being domain, the ALJ

found that plaintiff’s “functional impairment . . . [did] not constitute a significant impediment to

her continued growth and maturation” (AR 22). The ALJ did not make a specific finding as to

the severity of the side effects of plaintiff’s medications or their impact on her health and

physical well-being. 

3. THE ALJ ERRED IN FAILING TO MAKE SPECIFIC FINDINGS 

ON THE IMPACT OF SIDE EFFECTS.

The health and well-being domain considers “the cumulative physical effects of the

physical or mental impairments and their associated treatments or therapies” that were not

considered under the moving about and manipulating objects domain. 20 C.F.R. 416.926(a)(l). 

Under this domain, the ALJ must consider whether “the medication [taken] or treatments

[received] have physical effects of medication that also limit [the] performance of activities.” 

20 C.F.R. 416.926(a)(l)(2). “If the [ALJ] chooses to disregard a claimant’s testimony as to the

subjective limitations of side effects, he must support that decision with specific findings . . . .” 

Varney v. Sec’y of Health and Human Servs, 846 F.2d 581, 585 (9th Cir. 1988). 

Since “medications can create [] side effects that cause or contribute to [claimant’s]

functional limitations,” a showing of a disabling side effect could result in a marked limitation

in the health and physical well-being domain. 20 C.F.R. 416.924a(9)(i)(A). Given that the ALJ

determined that plaintiff had a marked limitation in the attending to and completing tasks

domain, an additional finding of a marked limitation would result in a determination that F.R.A.

was disabled and eligible for SSI. Thus, a finding as to the impact of the medications’ side

effects is required. It will be of assistance both to this Court and the Ninth Circuit on any

subsequent appeal.

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When Ms. Acosta stated the medication made F.R.A. very tired and caused her to sleep

“a lot,” the ALJ asked for additional details. Ms. Acosta related that F.R.A. took three-tofour-hour naps after school. The record shows in addition to Ms. Acosta’s testimony on the

medications’ side effects, Dr. Seffinger noted that they were severe and Dr. Banducci stated that

the medication was sedating. The transcript also shows that the ALJ asked the medical expert if

the combination met or equaled the listings in his opinion (AR 355). Subsequently, plaintiff’s

counsel asked the medical expert “specifically . . . why in combination the cumulative impact or

effect [of the impairments and medication side effects] would not be marked.” The expert

responded, “she is able to lead a normal life, she is able to take care of herself with some help,

and she is able to be in school . . . ” (AR 358). Nothing in the ALJ’s decision indicates that he

specifically adopted Dr. Grossman’s opinion. Nothing indicates that he considered or

disregarded Ms. Acosta’s testimony on the side effects. The ALJ erred by failing to address this

testimony in his decision. In light of above evidence, the ALJ had an obligation to make a

specific finding on the limiting nature of the side effects. Varney, 846 F.2d at 585.

4. FURTHER ADMINISTRATIVE PROCEEDINGS ARE NECESSARY.

“The decision whether to remand a case for additional evidence or simply to

award benefits is within the discretion of the court.” Reddick v. Chater, 157 F.3d 715, 728

(9th Cir. 1998). The general rule is that remand for further administrative proceedings

“is appropriate if enhancement of the record would be useful.” Harmon v. Apfel, 211 F.3d 1172,

1178 (9th Cir. 2000). Here, this order finds that the ALJ may wish to hear additional evidence

on the impact the medications’ side effects have on plaintiff’s functioning. Accordingly,

remanding the case for additional evidence, or at least for the ALJ to elaborate his analysis of the

foregoing issues, is the most appropriate course of action. 

CONCLUSION

For the foregoing reasons, plaintiff’s motion for summary judgment is GRANTED to the

extent stated and defendant’s motion for summary judgment is DENIED. The case is REMANDED

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for further proceedings consistent with this order. The Court shall retain jurisdiction over any

subsequent appeal. Meanwhile, the Clerk shall close the file.

IT IS SO ORDERED.

Dated: April 24, 2007. WILLIAM ALSUP

UNITED STATES DISTRICT JUDGE

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