Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-4_11-cv-00801/USCOURTS-azd-4_11-cv-00801-1/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 (SSID)

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IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Curtis Roberts, 

Plaintiff, 

vs.

Carolyn W. Colvin, Acting Commissioner

of the Social Security Administration, 

Defendant. 

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No. CV 11-801-TUC-HCE

ORDER

Plaintiff has filed the instant action seeking review of the final decision of the

Commissioner of Social Security pursuant to 42 U.S.C. § 405(g). The Magistrate Judge has

jurisdiction over this matter pursuant to the parties’ consent. See 28 U.S.C. § 636(c).

Pending before the Court are Plaintiff’s Opening Brief (Doc. 14) (hereinafter

“Plaintiff’s Brief”), Defendant’s Brief in Support of Motion to Remand for Further

Proceedings (Doc. 18) (hereinafter “Defendant’s Brief”), and Plaintiff’s Reply Brief (Doc.

20). The Court takes judicial notice that Michael J. Astrue is no longer Commissioner of the

Social Security Administration (“SSA”). Pursuant to Rule 25(d) of the Federal Rules of Civil

Procedure, the Court substitutes the new Acting Commissioner of the SSA, Carolyn W.

Colvin, as the named Defendant in this action. For the following reasons, the Court will: (1)

remand this action, in part, for an immediate award of benefits from January 1, 1998; and (2)

remand this action, in part, for further administrative proceedings.

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I. PROCEDURAL HISTORY

In August 2006, Plaintiff filed with the Social Security Administration (hereinafter

“SSA”) an application for disability insurance benefits and supplemental security income

under the Social Security Act. (TR. 53-57; see also Defendant’s Brief, p. 2). Plaintiff

alleges that as of October 1, 1995, he has been unable to work due to the following disabling

conditions: AIDS, hiatal hernia, wasting syndrome, AIDS related skin condition, and

arthritis. (TR. 95). Plaintiff’s application was denied initially and on reconsideration, after

which Plaintiff requested a hearing before an administrative law judge. (TR. 29-34, 42-48,

537-46). The matter came on for hearing on July 24, 2007 before Administrative Law Judge

(hereinafter “ALJ”) Norman R. Buls. (TR. 547-61). At the hearing, Plaintiff, who was

represented by counsel, testified. On December 17, 2007, the ALJ issued his decision

denying Plaintiff’s claim. (TR. 13-23). Thereafter, the Appeals Council denied Plaintiff’s

request for review thereby rendering the ALJ’s December 17, 2007 decision the final

decision of the Commission. (TR. 5-8). Plaintiff then initiated the instant action. 

II. INTRODUCTION

Plaintiff was born on December 2, 1967, was 27 years of age at the time of his alleged

disability onset date, and 33 years of age as of December 31, 2000, his date last insured. (See

Plaintiff’s Brief, p. 2). Plaintiff has a GED. (TR. 551). Plaintiff’s past work was as a

mechanic from October 1995 to June, 1996, and a truck driver from 1985 through October

1995. (TR. 63). 

On August 20, 1996, Plaintiff first saw J. Kevin Carmichael, M.D., who is Plaintiff’s

treating physician of record. (See TR. 342-43, 535). Plaintiff reported that he had tested

HIV positive in November or December 1995 by Dr. Leonard Fieber, with whom Plaintiff

later had a “falling out.” (TR. 342). Plaintiff did not have “confidence” in that test. (Id.).

Testing ordered by Dr. Carmichael confirmed that Plaintiff was HIV positive, and Dr.

Carmichael has treated Plaintiff ever since 1996. (TR. 535). 

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1

Listing 14.08(N) has been recodified to 14.08(K) and will be referred to hereinafter

as 14.08(K). 20 C.F.R. pt. 404, subpt. P, app. 1, §14.08.

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In July 2007, Dr. Carmichael opined that since “approximately 1997" Plaintiff met

Listing 14.08(N).1

 (TR. 535-36). Dr. Carmichael stated that since 1996, Plaintiff’s

“consistent symptoms were arthralgias, depression and anger, nausea and occasional

diarrhea, fatigue and vomiting”, and that Plaintiff also had “significant oral problems...with

severe gum recession and abscessed teeth.” (TR. 535). Dr. Carmichael also stated that

Plaintiff began counseling in 1997 for anger and depression, is susceptible to viral infections,

has had major weight changes during the past 10 years, and 

has repeated manifestations of HIV infection including diarrhea, wasting

syndrome, bronchitis, dermatitis resulting in fatigue fever, weight loss and

pain. Additionally, he has marked restriction in maintaining social functioning

and completing tasks. With regard to his social functioning, he has been angry

for a good portion of his life but exacerbated greatly by his HIV status. He

finds it difficult to control his temper and becomes verbally abusive. Further,

the onset of HIV related symptoms frequently interrupt his ability to maintain

any kind of regular schedule. He is unable to follow through with

appointments, projects and planned events in his personal life. His symptoms

are unpredictable including the diarrhea and vomiting. Sometimes they appear

for weeks and then resolve. Overall, it is difficult to imagine how Mr. Roberts

would be able to work given his poor condition.

(TR. 535-36).

III. THE ALJ’S FINDINGS

A. Claim Evaluation

SSA regulations require the ALJ to evaluate disability claims pursuant to a five-step

sequential process. 20 C.F.R. §§404.1520, 416.920. The first step requires a determination

of whether the claimant is engaged in substantial gainful activity. 20 C.F.R. §§ 404.1520(b),

416.920(b). If the claimant is not engaged in substantial gainful activity, then the ALJ

proceeds to step two which requires a determination of whether the claimant has a medically

severe impairment or combination of impairments. 20 C.F.R. §§ 404.1520(c), 416.920(c).

Id. If the ALJ makes a finding of severity, then the ALJ proceeds to step three which

requires a determination of whether the impairment meets or equals one of several listed

impairments that the Commissioner acknowledges are so severe as to preclude substantial

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2

RFC is defined as that which an individual can still do despite his or her limitations.

20 C.F.R. §§ 404.1545, 416.945.

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gainful activity. 20 C.F.R. §§ 404.1520(d), 416.920(d); 20 C.F.R. Pt. 404, Subpt. P, App.1.

If the claimant’s impairment meets or equals one of the listed impairments, then the claimant

is presumed to be disabled and no further inquiry is necessary. If a decision cannot be made

based on the claimant’s then current work activity or on medical facts alone because the

claimant’s impairment does not meet or equal a listed impairment, then evaluation proceeds

to the fourth step. The fourth step requires the ALJ to consider whether the claimant has

sufficient residual functional capacity (hereinafter “RFC”)2

 to perform past work. 20 C.F.R.

§§ 404.1520(e), 416.920(e). If the claimant cannot perform any past work due to a severe

impairment, then the ALJ must move to the fifth step, which requires consideration of the

claimant’s RFC to perform other substantial gainful work in the national economy in view

of claimant’s age, education, and work experience. 20 C.F.R. §§ 404.1520(f). 416.920(f).

B. The ALJ's Decision 

 The ALJ considered Plaintiff’s claim through Step 5 of the sequential evaluation

process. In pertinent part, the ALJ determined that Plaintiff met the insured status

requirements of the Social Security Act through December 31, 2000 and that Plaintiff had

the following severe impairments: HIV positive; cervical/lumbar spine degenerative disc

disease; and obesity. (TR. 18). The ALJ also found that Plaintiff had “adjustment disorder

with depression/anxious mood”, and that such condition was not severe. (TR. 19). The ALJ

concluded that Plaintiff did not have an impairment or combination of impairments that met

or was the medical equivalent of a listed impairment. (Id.). The ALJ further determined that

Plaintiff was capable of performing sedentary exertional work and could frequently climb,

balance, stoop, kneel, crouch, crawl and feel with bilateral hands. (Id.). Based on such an

RFC, the ALJ concluded that although Plaintiff was unable to perform past relevant work,

Plaintiff could perform other work that exists in significant numbers in the national economy.

(TR. 21-22). Consequently, the ALJ found that Plaintiff “has not been under a disability, as

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Defendant states that: 

The State agency physician [whose opinion the ALJ credited over Dr.

Carmichael’s opinion (TR. 21)] purported to rely on a consultative

examination in assessing Plaintiff’s limitations (T[R]. 124). However, there

was no consultative examination in the record. Consequently, the State agency

physician’s opinion was unreliable. The ALJ credited the State agency

physician’s opinion over the treating physician’s opinion. (T[R]. 21). This

error warrants remand.

(Defendant’s Brief, p. 5). 

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defined in the Social Security Act, from October 1, 1995 through the date of...” of the ALJ’s

December 17, 2007 decision. (TR. 22). 

In reaching this determination, the ALJ rejected Dr. Carmichael’s opinion and,

instead, credited the opinion of a State agency physician. (TR. 21)

IV. DISCUSSION

A. Argument

Plaintiff asserts that the ALJ improperly rejected Dr. Carmichael’s opinion, and

improperly determined that Plaintiff did not suffer from a severe psychiatric impairment.

Plaintiff requests that the matter be remanded for an award of benefits.

Defendant “concedes that his final decision is not defensible.”3

 (Defendant’s Brief,

p. 5). Defendant argues that the proper remedy is remand for further proceedings instead of

an award of benefits. 

B. Analysis

Although the parties agree that the ALJ erred when crediting the State agency

physician’s opinion over Dr. Carmichael’s, the parties disagree as to how the Court should

resolve this action in light of that error. Plaintiff argues that the matter should be remanded

for an award of benefits. Defendant contends that the action should be remanded for further

administrative proceedings. 

"'[T]he decision whether to remand the case for additional evidence or to simply

award benefits is within the discretion of the court.'" Rodriguez v. Bowen, 876 F.2d 759, 763

(9th Cir. 1989) (quoting Stone v. Heckler, 761 F.2d 530, 533 (9th Cir. 1985)). "Remand for

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further administrative proceedings is appropriate if enhancement of the record would be

useful." Benecke v. Barnhart, 379 F.3d 587, 593 (9th Cir. 2004) (citing Harman v. Apfel, 211

F.3d 1172, 1178 (9th Cir. 2000)). Conversely, remand for an award of benefits is appropriate

where: 

(1) the ALJ failed to provide legally sufficient reasons for rejecting the

evidence; (2) there are no outstanding issues that must be resolved before a

determination of disability can be made; and (3) it is clear from the record that

the ALJ would be required to find the claimant disabled were such evidence

credited.

Id. (citations omitted). Where the test is met, "we will not remand solely to allow the ALJ

to make specific findings...Rather we take the relevant testimony to be established as true and

remand for an award of benefits." Benecke, 379 F.3d at 593 (citations omitted); see also

Lester v. Chater, 81 F.3d 821, 834 (1997) (same).

As to whether the ALJ "failed to provide legally sufficient reasons for rejecting the

[Plaintiff’s] evidence," Benecke, 379 F.3d at 593, Defendant concedes that it was erroneous

for the ALJ to credit the State agency physician’s opinion over Dr. Carmichael’s.

(Defendant's Brief, p. 5). However, Defendant “does not concede that the ALJ improperly

evaluated Dr. Carmichael’s opinion.” (Defendant’s Brief, p. 7). According to Defendant,

“the ALJ reasonably gave little weight to...” Dr. Carmichael’s opinion that Plaintiff met the

requirements of the listed impairments. (Id.). Defendant asserts that the ALJ “gave two

specific and legitimate reasons for discrediting...” treating Dr. Carmichael’s opinion, finding

that the opinion was not supported by the record and based on Plaintiff’s subjective

statements. (Id.).

It is well-settled in the Ninth Circuit that to reject the opinion of a treating physician

that is not contradicted by another doctor, the ALJ must provide “clear and convincing”

reasons. Hiler v. Astrue, 687 F.3d 1208, 1212 (9th Cir. 2012) (citing Lester, 81 F.3d at 830);

Magallanes v. Bowen, 881 F.2d 747, 751 (9th Cir. 1989) (citing Rodriguez, 876 F.2d 761-62;

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4

In contrast, to reject a treating physician’s opinion that is contradicted, the ALJ need

only state specific and legitimate reasons. See Magallanes, 881 F.2d at 751. Defendant

relies on Molina v. Astrue, 674 F.3d 1104, 1111 (9th Cir. 2012), for the premise that the ALJ

need only state specific and legitimate reason to reject the uncontroverted opinion of a

treating physician. (Defendant’s Brief, p. 7). Molina is inapposite in that the physician’s

assistant whose opinion was at issue in that case was not considered to be a medically

acceptable treating source. Id. Further, the physician’s assistant’s opinion, unlike Dr.

Carmichael’s, was contradicted by a doctor’s opinion. Id. Moreover, Molina was not an en

banc decision and, thus, cannot overrule the well-established rule in this Circuit requiring the

ALJ to state clear and convincing reasons to reject an uncontradicted treating doctor’s

opinion. See United States v. Mandel, 914 F.2d 1215, 1221 (9th Cir. 1990) (en banc panel

required to overrule binding precedent where there is no intervening Supreme Court case law

requiring reconsideration of issue). Nor does Defendant argue otherwise. 

5

Claimants are conclusively disabled if their condition either meets or equals a listed

impairment. 20 C.F.R. §§404.1520(d), 416.920(d).

6

Listing 14.08K reads:

Repeated (as defined in 14.00I3) manifestations of HIV infection, including

those listed in 14.08A–J, but without the requisite findings for those listings

(for example, carcinoma of the cervix not meeting the criteria in 14.08E,

diarrhea not meeting the criteria in 14.08I), or other manifestations (for

example, oral hairy leukoplakia, myositis, pancreatitis, hepatitis, peripheral

neuropathy, glucose intolerance, muscle weakness, cognitive or other mental

limitation) resulting in significant, documented symptoms or signs (for

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Montijo v. Secretary of Health & Human Servs., 729 F.2d 599 (9th Cir. 1983)).4

 Here,

Defendant does not argue that the ALJ met that standard. "Where the Commissioner fails

to provide adequate reasons for rejecting the opinion of a treating or examining physician,

we credit that opinion as a matter of law." Lester, 81 F.3d at 834 (internal quotation marks

and citation omitted). 

Defendant argues that Dr. Carmichael’s opinion that Plaintiff meets the listings5

 is not

a medical opinion that can be credited as true. (Defendant’s Brief, p. 11 (citing 20 C.F.R.

§§404.1513, 404.1527(e), SSR 96-5p)). Defendant is correct that the ALJ is not bound to

accept the treating physicians' conclusions that Plaintiff is disabled. See Batson v.

Commissioner of Social Security, 359 F.3d 1190, 1195 (9th Cir.2004). However, Dr.

Carmichael did not merely state that Plaintiff met Listing 14.08(K).6

 Dr. Carmichael, who

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example, severe fatigue, fever, malaise, involuntary weight loss, pain, night

sweats, nausea, vomiting, headaches, or insomnia) and one of the following at

the marked level: 1. Limitation of activities of daily living. 2. Limitation in

maintaining social functioning. 3. Limitation in completing tasks in a timely

manner due to deficiencies in concentration, persistence, or pace.

20 C.F.R. Part 404, Subpart P, Appendix 1 §14.08(K).

7

The regulations provide:

Social functioning includes the capacity to interact independently,

appropriately, effectively, and on a sustained basis with others. It includes the

ability to communicate effectively with others. We will find that you have a

“marked” limitation in maintaining social functioning if you have a serious

limitation in social interaction on a sustained basis because of symptoms, such

as pain, severe fatigue, anxiety, or difficulty concentrating, or a pattern of

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has been Plaintiff’s treating physician for over 10 years, also set forth his medical findings

and observations to support his conclusions. (See TR. 535-36); see also 20 C.F.R.

§404.1527(c)(2) (recognizing that treating doctors “are likely to be the medical professionals

most able to provide a detailed, longitudinal picture of [the claimant’s] medical

impairment(s) and may bring a unique perspective to the medical evidence that cannot be

obtained from the objective medical findings alone or from reports of individual

examinations, such as consultative examinations or brief hospitalizations.”); 20 C.F.R.

§416.927(c)(2) (same).

Defendant asserts that Dr. Carmichael’s letter setting forth his opinion implies that

Plaintiff met Listing 14.08(H). (Defendant’s Brief, p. 9). Defendant contends that the

information set forth in Dr. Carmichael’s letter fails to support such a finding. (Id. at pp. 9-

10). Plaintiff does not argue that Plaintiff satisfies the precise requirements of Listing

14.08(H). Instead, Plaintiff argues that Dr. Carmichael’s opinion establishes that Plaintiff

meets Listing 14.08(K). Defendant counters that the Listing 

requires that a claimant show marked limitations in activities of daily living,

social functioning, or completing tasks in a timely manner due to deficiencies

in concentration, persistence, and pace. With respect to social functioning,[7]

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exacerbation and remission, caused by your immune system disorder

(including manifestations of the disorder) or its treatment, even if you are able

to communicate with close friends or relatives.

20 C.F.R. pt. 404, Subpt. P., App. 1 §14.00(I)(7). 

The regulations also provide:

When “marked” is used as a standard for measuring the degree of functional

limitation, it means more than moderate but less than extreme. We do not

define “marked” by a specific number of different activities of daily living in

which your functioning is impaired, different behaviors in which your social

functioning is impaired, or tasks that you are able to complete, but by the

nature and overall degree of interference with your functioning. You may have

a marked limitation when several activities or functions are impaired, or even

when only one is impaired. Also, you need not be totally precluded from

performing an activity to have a marked limitation, as long as the degree of

limitation seriously interferes with your ability to function independently,

appropriately, and effectively. The term “marked” does not imply that you

must be confined to bed, hospitalized, or in a nursing home.

Id. at §14.00(I)(5).

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Dr. Carmichael simply states that Plaintiff has ‘been angry for a good portion

of his life.’ (T[R]. 535). But being angry does not necessarily result in

marked limitations in social functioning. With respect to completing tasks,

[Dr.] Carmichael states that Plaintiff’s impairment is limiting, but he does not

state that the limitations relate to deficiencies in concentration, persistence, and

pace.

(Defendant’s Brief, p. 10). 

In his letter, Dr. Carmichael states that since 1996, Plaintiff’s consistent symptoms

included anger and that Plaintiff started counseling “around 1997 for anger and depression

issues revolving around his HIV+ status. I referred him again on 9/5/00 for counseling due

to anger outbursts and depression. His counselor documents ongoing difficulties with

extreme anger and acting out.” (TR. 535). Dr. Carmichael also opined that Plaintiff has

marked restriction in maintaining social functioning and completing tasks.

With regard to his social functioning, he has been angry for a good portion of

his life but exacerbated greatly by his HIV status. He finds it difficult to

control his temper and becomes verbally abusive. Further, the onset of HIV

related symptoms frequently interrupt his ability to maintain any kind of

regular schedule. He is unable to follow through with appointments, projects

and planned events in his personal life. His symptoms are unpredictable

including the diarrhea and vomiting. Sometimes they appear for weeks and

then resolve. Overall, it is difficult to imagine how Mr. Roberts would be able

to work given his poor condition.

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(TR. 536). Dr. Carmichael is clear that, in his opinion, Plaintiff’s anger, including angry

outbursts and difficulty controlling his temper, rendered Plaintiff markedly limited in the area

of social functioning. Contrary to Defendant’s position, there is no basis on the instant

circumstances where an ALJ, when crediting Dr. Carmichael’s medical opinion and findings,

could conclude that Plaintiff did not satisfy Listing 14.08(K)’s requirement that the claimant

have a marked limitation in areas of social functioning. Thus, the ALJ would be required to

find Plaintiff disabled and entitled to benefits. See Benecke, 379 F.3d at 593-595

(remanding for an award of benefits where no outstanding issues remain and ALJ would be

required to find claimant disabled if evidence is credited); Ramirez v. Shalala, 8 F.3d 1449,

(9th Cir. 1993) (remanding for payment of benefits where ALJ improperly discredited treating

doctor’s opinion showing that the plaintiff met the Listings). 

Defendant also argues that whether Plaintiff was disabled prior to the expiration of

his date last insured remains unresolved. (Defendant’s Brief, pp.5-6). To be entitled to

disability benefits, Plaintiff must show that: (1) he was entitled to benefits 12 months prior

to his application; (2) he had been disabled on the date his insured status expired; and (3) he

had been disabled for the entire period between the date his insured status expired and the

date he became eligible for benefits. See 20 C.F.R. §404.315(a); see also 20 C.F.R. §§

416.202(g) (Plaintiff became eligible for supplemental security income on the date he applied

for benefits); see also Flaten v. Secretary of Health & Human Servs., 44 F.3d 1453, 1463 (9th

Cir. 1995). Failure to meet any one of these requirements is fatal to Plaintiff claim. (Id.). 

The parties do not dispute the ALJ’s finding that Plaintiff met the insured status

through December 31, 2000. (TR. 18). Nor do they dispute that Plaintiff applied for

disability benefits and supplemental security income in August 2006. (See Defendant’s

Brief, p.2). However, according to Defendant, Plaintiff must show he was entitled to benefits

in August 2005 (one year before he applied for disability benefits), he was disabled on

December 31, 2000 (when his insured status expired), and he has been disabled for the entire

period between December 31, 2000 and August 21, 2005. (See Defendant’s Brief, p.6). 

Defendant contends that the ALJ considered Dr. Carmichael’s opinion “going back one year

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According to Defendant:

Although the ALJ found that Plaintiff had “not been under a disability, as

defined by the Social Security Act from October 1, 1995 through the date of

this decision” (T[R]. 22), that does not mean he actually considered Plaintiff’s

medical condition through the entire period. Instead, as discussed above, it

means that Plaintiff was not eligible for benefits for the entire time, i.e., he did

not meet all three of the Flaten requirements. In this case, the Flaten

requirement Plaintiff did not meet was the requirement that he show he was

disabled beginning in August 2005 (one year before he filed his application for

disability insurance benefits).

(Defendant’s Brief, pp. 6-7 n.7).

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from the [August 2006] filing dates...” (TR. 21) to reach his determination that Plaintiff “has

not been under a disability, as defined in the Social Security Act, from October 1, 1995

through the [December 17, 2007] date of this decision.” (TR. 22). Therefore, according to

Defendant, “even if the Court finds that Plaintiff is disabled after crediting evidence as true,

there are facts that the ALJ did not consider, i.e., whether Plaintiff was disabled at the time

his insured status elapsed and whether Plaintiff was continuously disabled from that time

until he became eligible for benefits.”8

 (Defendant’s Brief, p. 6). 

When the ALJ addressed Dr. Carmichael’s opinion, he indicated that he was

discussing “the opinion evidence, going back one year from the filing dates....” (TR. 21).

However, as Plaintiff points out, elsewhere in his opinion the ALJ was also clear that upon

“careful consideration of all the evidence, the undersigned Administrative Law Judge

concludes the claimant has not been under a disability within the meaning of the Social

Security Act from October 1, 1995 through the date of this decision.” (TR. 16; see also TR.

22; Plaintiff’s Reply, pp. 2-3). As Plaintiff persuasively argues, Defendant’s “argument that

the ALJ did not consider whether Plaintiff was disabled as of 12/31/00 is contradicted by the

ALJ’s own words.” (Plaintiff’s Brief, p. 3). Regardless, Dr. Carmichael was clear that his

opinion dates back to “approximately 1997.” (TR. 535). Consequently, when Dr.

Carmichael’s opinion is credited as true, the record is clear that Plaintiff will have satisfied

all three of the Flaten requirements. Under such circumstances, there is no need to remand

the matter for determination of whether Plaintiff was disabled prior to the date last insured.

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However, resolution of whether Plaintiff was disabled prior to the date last insured

does not end the analysis. Also at issue, is determination of the disability onset date. (See

Plaintiff’s Brief, pp. 11-13). Plaintiff claims a disability onset date of October 1, 1995. Yet,

Dr. Carmichael, who began treating Plaintiff in 1996, opines that Plaintiff did not meet the

Listing until “approximately 1997". (TR. 535). Even crediting Dr. Carmichael’s opinion

as true as this Court is required to do under the instant circumstances, it is not clear precisely

when in 1997 Plaintiff became disabled. At best, Dr. Carmichael’s opinion supports the

conclusion that as of January 1, 1998, Plaintiff met the listing and thus was presumptively

disabled. Plaintiff stresses that he “has been waiting almost six years for his benefits.”

(Plaintiff’s Reply, p. 1). The Ninth Circuit has recognized that "[r]emanding a disability

claim for further proceedings can delay much needed income for claimants who are unable

to work and are entitled to benefits, often subjecting them to 'tremendous financial

difficulties while awaiting the outcome of their appeals and proceedings on remand.'"

Benecke, 379 F.3d at 595 (quoting Varney v. Secretary of Health and Human Services, 859

F.2d 1396, 1398 (9th Cir. 1988)); see also Terry v. Sullivan, 903 F.2d 1273 (9th Cir. 1990)

(remanding for an award of benefits where the plaintiff applied almost four years prior);

Erickson v. Shalala, 9 F.3d 813 (9th Cir. 1993) (remanding for an award of benefits where

the plaintiff, who was disabled under the Act, "has been waiting for well over four years for

his disability benefits"). On the instant record, Plaintiff has satisfied all three factors in favor

of remand for benefits for the period post 1997. Where the ALJ failed to provide adequate

reason for rejecting the opinion of Plaintiff's treating physician and where Plaintiff has

satisfied all three factors in favor of a remand for an award of benefits, "[r]emanding for

further administrative proceedings would serve no useful purpose and would unnecessarily

extend...[Plaintiff's] long wait for benefits." Benecke, 379 F.3d at 595. See also. Regennitter

v. Commissioner, 166 F.3d 1294, 1300 (9th Cir. 1999) (citations omitted) (where the court

"conclude[s] that...a doctor's opinion should have been credited and, if credited, would have

led to a finding of eligibility, we may order the payment of benefits."); Ramirez, 8 F.3d at

1449 (remanding for payment of benefits where ALJ improperly discredited treating doctor’s

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opinion showing that the plaintiff had a listed impairment); Pitzer v. Sullivan, 908 F.2d 502,

506 (9th Cir.1990) (remanding for payment of benefits where the Secretary did not provide

adequate reasons for disregarding examining physician’s opinion); Winans v. Bowen, 853

F.2d 643, 647 (9th Cir. 1987) (same). Therefore, this matter is remanded for an immediate

award of benefits from January 1, 1998.

As to whether Plaintiff was entitled to benefits beginning on his alleged onset date of

October 1, 1995, Plaintiff urges the Court to presume that the onset date shown on the

application is the onset date of disability because, according to Plaintiff, such date is

consistent with all the other evidence of record. (See Plaintiff’s Brief, p. 11 (citing Swanson

v. Heckler,763 F.2d. 1061, 1066 n. 2 (1985)). "The significant date for disability

compensation is the date of onset of the disability rather than the date of diagnosis." Morgan

v. Sullivan, 945 F.2d 1079, 1081 (9th Cir. 1991). 

The record reflects no medical evidence contemporaneous with Plaintiff's alleged

onset date. Although retrospective diagnoses may be considered when determining an onset

date, see Flaten, 44 F.3d at 1461 n.5; Smith v. Bowen, 849 F.2d 1222 (9th Cir. 1998), Dr.

Carmichael, who began treating Plaintiff in 1996, does not opine that Plaintiff was disabled

as far back as October 1, 1995. Where the date of onset is unclear, the Ninth Circuit has

cited to Social Security Ruling 83-20 ("SSR 83-20") addressing "Onset of Disability." See

Armstrong v. Commissioner of the Social Security Admin., 160 F.3d 587, 589-590 (9th Cir.

1998). SSR 83-20 states in pertinent part:

[i]n determining the date of onset of disability, the date alleged by the

individual should be used if it is consistent with all the evidence available....

[T]he established onset date must be fixed based on the facts and can never be

inconsistent with the medical evidence of record. .... In some cases, it may be possible, based on the medical evidence to reasonably

infer that the onset of a disabling impairment(s) occurred some time prior to

the date of the first recorded medical examination, e.g., the date the claimant

stopped working. How long the disease may be determined to have existed at

a disabling level of severity depends on an informed judgment of the facts in

the particular case. This judgment, however, must have a legitimate medical

basis. At the hearing, the administrative law judge (ALJ) should call on the

services of a medical advisor when onset must be inferred. If there is

information in the file indicating that additional medical evidence concerning

onset is available, such evidence should be secured before inferences are made.

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Id. (quoting SSR 83-20) Further, "[i]f the 'medical evidence is not definite concerning the

onset date and medical inferences need to be made, SSR 83-20 requires the administrative

law judge to call upon the services of a medical advisor and to obtain all evidence which is

available to make the determination.'" Id. at 590 (remanding case "to the ALJ with instruction

to call a medical expert to determine when [plaintiff] became disabled" where the record was

"unclear" as to onset date) (quoting DeLorme v. Sullivan, 924 F.2d 841, 849 (9th Cir. 1991);

see also Morgan, 945 F.2d 1079 (reversing in part an ALJ's determination of the onset date

of mental disorders without the assistance of a medical expert). Additionally, “where

medical testimony is unhelpful...”, the ALJ should “explor[e] lay evidence including the

testimony of family, friends or former employers to determine the onset date." Armstrong,

160 F.3d at 590. 

Because the ALJ determined that Plaintiff was not disabled, he never explored the

issue of a disability onset date. Consequently, the issue of the disability onset date remains

unresolved. This determination is more appropriately left, in the first instance, to

consideration by the ALJ. See Armstrong, 160 F.3d at 591-92 (remanding for ALJ to hold

further proceedings to determine when the plaintiff became disabled). Accordingly, this

matter is remanded for further proceedings to determine the onset date of Plaintiff’s

disability. On remand the ALJ may develop the record and take such further evidence as is

necessary, including testimony from a medical advisor, as is required to determine whether

Plaintiff’s disability onset date occurred prior to January 1, 1998. 

V. CONCLUSION

For the foregoing reasons, IT IS ORDERED that the Commissioner’s final decision

in this matter is:

(1) REMANDED, in part, for an immediate award of benefits commencing January

1, 1998; and

(2) REMANDED, in part, for further proceedings to determine whether Plaintiff’s

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disability onset date occurred prior to January 1, 1998, as discussed within the body of this

Order.

The Clerk of Court is DIRECTED to:

(1) amend the docket to reflect that Carolyn W Colvin, Acting Commissioner of

the Social Security Administration, has been substituted as the named

Defendant in this action pursuant to Fed.R.Civ.P. 25(d); and

(2) enter judgment and close this case.

DATED this 22nd day of March, 2013.

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