Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-4_10-cv-00528/USCOURTS-azd-4_10-cv-00528-0/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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WO 

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Ramon Aguilar, 

Plaintiff, 

vs. 

Michael J. Astrue, Commissioner of Social 

Security, 

Defendant.

No. 10-0528-TUC-BPV 

ORDER 

Plaintiff, Ramon Aguilar, suffers from the impairments of right shoulder pain, 

knee pain, hand pain, carpal tunnel syndrome and diabetes mellitus type II. In addition, 

Plaintiff suffers from hypertension, asthma and depression. Plaintiff applied for Disability 

Insurance Benefits (DIB) and Supplemental Security Income (SSI) on September 4, 

2007, alleging disability since August 20, 2007. Tr. 118-29. The applications were denied 

initially, (Tr. 52-53), on reconsideration (Tr. 54-55), and after an administrative hearing 

before an Administrative Law Judge (ALJ) held on June 11, 2009 (Tr. 7-51). The ALJ 

issued a written decision on July 23, 2009, finding Plaintiff, age 53 at the time of 

decision, not disabled within the meaning of the Social Security Act. Tr. 15-25. This 

decision became the final decision for purposes of judicial review under 42 U.S.C. § 

405(g) when the Appeals Council denied review. Tr. 1-6. 

Plaintiff now brings this action for review of the final decision of the 

Commissioner for Social Security pursuant to 42 U.S.C. §§ 405(g). The United States 

Magistrate Judge has received the written consent of both parties, and, accordingly, 

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presides over this case pursuant to 28 U.S.C. § 636 (c) and Fed.R.Civ.P. 73. 

After considering the record before the Court and the parties’ briefing of the 

issues, the Court affirms Defendant’s decision. 

I. STANDARD OF REVIEW

The Court has the “power to enter, upon the pleadings and transcript of the record, 

a judgment affirming, modifying, or reversing the decision of the Commissioner of Social 

Security, with or without remanding the cause for a rehearing.” 42 U.S.C. § 405(g). The 

court will set aside a denial of benefits only if the Commissioner's findings are based on 

legal error or are not supported by substantial evidence in the record as a whole. Kail v. 

Heckler, 722 F.2d 1496, 1497 (9th Cir. 1984) (citing Sample v. Schweiker, 694 F.2d 639, 

642 (9th Cir.1982), Thompson v. Schweiker, 665 F.2d 936, 939 (9th Cir, 1982)); 42 U.S.C. 

§ 405(g)). In determining whether there is substantial evidence, the Court must consider 

the evidence as a whole, weighing both the evidence that supports and the evidence that 

detracts from the Commissioner's conclusion. Jones v. Heckler, 760 F.2d 993, 995 (9th

Cir. 1985). 

II. DISCUSSION

Whether a claimant is disabled is determined using a five-step evaluation process. 

To establish disability, the claimant must show (1) he has not worked since the alleged 

disability onset date, (2) he has a severe impairment, and (3) his impairment meets or 

equals a listed impairment or (4) his residual functional capacity (RFC) precludes him 

from performing his past work. At step five, the Commissioner must show that the 

claimant is able to perform other work. See 20 C.F.R. §§ 404.1520, 416.920. 

Plaintiff has met his burden. He has not worked since August 20, 2007. Tr. 17, ¶ 2. 

He has five severe impairments: right shoulder pain; knee pain; hand pain; carpal tunnel 

syndrome; and diabetes mellitus type II. Tr. 17, ¶ 3. While those impairments do not meet 

or equal a listed impairment (Tr. 19, ¶ 4), they do preclude Plaintiff from performing his 

past work as a construction laborer and as a mine mill supervisor (Tr. 23, ¶ 6). At step 

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five, the ALJ concluded that Plaintiff is not disabled because he has the RFC to perform a 

range of light work with some limitations in lifting, working above shoulder height, and 

exposure to dust fumes and gases, and, considering Plaintiff’s age, education, work 

experience and RFC, that there are jobs that exist in significant numbers in the national 

economy that Plaintiff can perform. Tr. 20-25, ¶¶ 5, 9[2]1

-10. 

Plaintiff contends that the ALJ erred by failing to give controlling weight to the 

treating physician’s RFC assessment; failing to find Plaintiff disabled under Rule 202.01 

of the Medical Vocational Guidelines (Grids); and failing to remand the claim for 

consideration of new and material evidence in the form of an award of benefits in a 

subsequently filed claim. (Doc. 17) Defendant contends that the ALJ did not err and that 

the ALJ’s decision is supported by substantial evidence. (Doc. 18) 

The medical evidence of record indicates Plaintiff was treated at El Rio Health 

Center by primary care physicians Dr. Lisa Soltani from August 2006 to October 2008, 

and Dr. Rama Dasari from January to April, 2009. Tr. 266-299, 388-394, 420-456. 

Dr. Dasari completed an RFC opining that Plaintiff could lift and carry less than 

10 pounds, sit and walk for less than one hour each at a time (for less than a total of two 

hours each in an eight-hour day), and sit for more than two hours at a time (for less than 

six hours total in an eight-hour day). Tr. 417. Dr. Dasari also indicated that Plaintiff’s 

limitations included the requirement that he lie down during the day and alternate sitting 

and standing. Id. The ALJ considered the treating source opinion, but gave limited weight 

to the opinion, finding it “too restrictive in light of the medical evidence and not well 

supported by treating records and other clinical reports.” Id. 

In support of his argument, Plaintiff relies on new evidence submitted to the 

Appeals Council consisting of a letter written by Plaintiff’s attorney (Tr. 458); medical 

records from the emergency department at University Physicians Hospital from 

 

1

 The ALJ’s memorandum decision contains two paragraphs numbered 9. The Court will refer to them as paragraphs 9[1] and 9[2] sequentially. 

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December 1, 2009, describing admission of Plaintiff for chest pain, a subsequent cardiac 

catheterization, and diagnosis of coronary artery disease, unstable angina, right-sided 

pectoral chest pain, diabetes mellitus 2, and hypertension (Tr. 460-66). Plaintiff further 

relies on the additional treatment records from December, 2009, consisting of a physical 

therapy order for lower back pain and peripheral neuropathy (Tr. 471); a prescription for 

Fenofibrate to reduce blood cholesterol (Tr. 468); and a third party letter from Plaintiff’s 

daughter indicating that, in addition to his other diagnoses, she has been told that her 

father has second stage dementia. (Tr. 475). Plaintiff maintains that “his current 

conditions were a direct result of his diabetes mellitus, which is now affecting his heart 

and brain.” (Doc. 17, at 7.) 

The Government responds, first, that additional evidence submitted to the Appeals 

Council after the ALJ’s decision should be considered only under sentence six of 42 

U.S.C. § 405(g), citing Mayes v. Massanari, 276 F.3d 453 (9th Cir. 2001). Mayes, 

however, addressed a Plaintiff’s request to remand a case to the ALJ for consideration of 

new evidence, and did not address the distinction between a sentence four claim of 

substantive error based on new evidence and a sentence six request for consideration of 

new evidence. Section 405(g) “authorizes district courts to review administrative 

decisions in Social Security benefit cases.” Akopyan v. Barnhart, 296 F.3d 852, 854 (9th

Cir. 2002). If a claimant is not asking for a substantive ruling, but only for a remand to 

consider new evidence, it is a sentence six remand and good cause must be shown. If 

claimant is seeking a substantive ruling on alleged errors in the decision, it is under 

sentence four of section 405(g). As to Plaintiff’s first argument, that the ALJ improperly 

weighed Dr. Dasari’s opinion, Plaintiff is seeking a substantive ruling on an alleged error 

in the decision, and this issue is reviewed under sentence four of section 405(g). 

Plaintiff’s brief requesting a sentence four reversal and award of benefits supports this 

interpretation. See Doc. 17, at 11. 

Applicable regulations provide that, if “new and material evidence is submitted,” 

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the Appeals Council “shall evaluate the entire record including the new and material 

evidence submitted if it relates to the period on or before the date of the administrative 

law judge hearing decision. It will then review the case if it finds that the administrative 

law judge’s action, findings, or conclusion is contrary to the weight of the evidence 

currently of record.” 20 C.F.R. § § 404.970(b), 416.1470(b). 

 The Appeals Council considered the additional material submitted, which 

concerns medical treatment and additional diagnoses and third party statements received 

after July 23, 2009, the date of the ALJ’s decision denying benefits in this case, and 

concluded the “additional evidence ... does not provide a basis for changing the 

Administrative Law Judge's decision.” Tr. 2. Where the claimant submits evidence after 

the ALJ's decision and the Appeals Council specifically considers that evidence, Awe 

consider the rulings of both the ALJ and the Appeals Council,@ and the record for review 

includes the new evidence. Ramirez v. Shalala, 8 F.3d 1449, 1451-52 (9th Cir.1993); 20 

C.F.R. ' 404.970(b) (providing that the Appeals Council shall evaluate the entire record, 

including new relevant evidence); see also Vasquez v. Astrue, 572 F.3d 586, 595 n.7 (9th

Cir. 2009)(“Because this evidence was submitted to and considered by the Appeals 

Council, and is part of the administrative record, this Court may consider it in reaching its 

final decision even though the ALJ did not have the benefit of this information during the 

initial hearing.”); Lingenfelter v. Astrue, 504 F.3d 1028, 1030 n.2 (9th Cir. 2007) (quoting 

Ramirez, court considers new evidence presented to the Appeals Council); Harman v. 

Apfel, 211 F.3d 1172, 1180 (9th Cir. 2000)(“We properly may consider the additional 

material because the Appeals Council addressed them in the context of denying 

appellant’s request for review.”); Gomez v. Chater, 74 F.3d 967, 971 (9th Cir. 

1996)(“Although the Appeals Council affirmed the decision of the ALJ denying benefits 

to Gomez, this evidence is part of the record on review to this court.”). If the new 

evidence is material, then we must remand the case to the ALJ for reconsideration. Booz 

v. Secretary of Health and Human Serv., 734 F.2d 1378, 1380 (9th Cir.1984). The new 

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evidence is material if there is a Areasonable possibility@ that it would have changed the 

outcome of the administrative proceedings. Id. 

Here, Plaintiff has not met his burden of showing that the additional evidence is 

material to the question of whether he was disabled on or before July 23, 2009. The 

additional evidence concerns medical diagnoses and treatment received after July 23, 

2009. Plaintiff maintains that his current condition was a direct result of his diabetes and 

argues that the new evidence shows 30 years of a history of “not particularly wellcontrolled” diabetes, diabetic polyneuropathy, and, in December, 2009, a recent diagnosis 

of dementia. As the Ninth Circuit instructed in Mayes, however, where there is no 

evidence in the record supporting a conclusion that a condition has developed into a 

disabling condition, the Court should not speculate to reach such a conclusion. See 

Mayes, 276 F.3d at 462, n.4. The burden is on the Plaintiff to show that the two 

conditions are related. Id. Plaintiff’s heart condition and dementia (which even now has 

not been demonstrated by any medical evidence) was not at issue in the ALJ hearing. 

Furthermore, because the new evidence did not relate to the relevant period, it is not 

material to this determination. 

As Plaintiff’s treating physician, Dr. Dasari’s opinion is entitled to “special 

weight,” and if the ALJ chooses to disregard it, he must, at a minimum, “‘set forth 

specific, legitimate reasons for doing so, and this decision must itself be based on 

substantial evidence.’” Embrey v. Bowen, 849 F.2d 418, 421 (9th Cir. 1988)) (quoting 

Cotton v. Bowen, 799 F.2d 1403, 1408 (1986)). However, “[t]he ALJ need not accept the 

opinion of any physician, including a treating physician, if that opinion is brief, 

conclusory, and inadequately supported by clinical findings.” Thomas v. Barnhart, 278 

F.3d 947, 957 (9th Cir.2002). 

The ALJ's interpretation of the conflicting medical evidence is supported by 

substantial evidence included in his factual findings. Although Dr. Dasari opined in the 

RFC that Plaintiff was substantially limited, both Dr. Dasari’s treatment notes and the 

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treatment notes from Plaintiff’s other treating physicians of record at El Rio Health 

Center, Drs. Soltani and Short, contradict Dr Dasari’s opinions. Dr. Short, a podiatrist, in 

Plaintiff’s last examination of record found “[n]o activity modifications or restrictions 

recommended at this time.” Tr. 443. Dr. Dasari’s treatment notes, contemporaneous with 

her RFC assessment, indicates right shoulder pain, with reduced range of motion and 

moderately severe pain, but no other musculoskeletal complaints or observations that 

would explain the restrictions in Dr. Dasari’s RFC limiting Plaintiff in his ability to stand, 

sit or the need to lie down during the day. Tr. 420-22. The pain and limitations caused by 

the shoulder problems as noted by Dr. Dasari in her treatment notes were incorporated 

into the ALJ’s RFC assessment. Tr. 20, ¶ 5. Accordingly, because it was not adequately 

supported by clinical findings, the ALJ did not err by rejecting Dr. Dasari’s conclusory 

opinion. 

Plaintiff argues that the ALJ should have found him disabled under Rule 202.012

of the Medical Vocational Guidelines (Grids). Under the Grids, a claimant who is closely 

approaching advanced age (i.e. 50 to 54) and is found to have a residual functional 

capacity which is limited to light work will generally not be considered to be disabled 

when they cannot return to their past relevant work unless they are illiterate and have had 

only unskilled or no previous work experience. See 20 C.F.R. Pt. 404, Subpt. P, App. 2, 

Table No. 2, Rules 202.09. 

The ALJ determined that Plaintiff has a limited education but is able to 

communicate in English. Tr. 23, ¶ 8. Though Plaintiff requested to testify at the hearing 

through an interpreter (Tr. 26, 190), and testified that he spoke “no” or “very little” 

 

2

 Plaintiff argues that according to Grid Rule 202.01 a claimant must be 

determined disabled if he is approaching advanced age, can perform only light duty activities, and is illiterate or unable to communicate in English. (Doc. 17, at 3.) Grid Rule 

202.01, however, applies to claimants of “advanced age,” but does not apply to claimants such as Plaintiff, who are only “approaching advanced age.” Accordingly, Grid Rule 202.01 does not apply to Plaintiff. Presumably, Plaintiff intended to cite Grid Rule 

202.09, which applies to claimants “approaching advanced age” and the Court will analyze the argument accordingly. 

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English (Tr. 30), Plaintiff’s Disability Report states that Plaintiff can speak, understand, 

and read English. (Tr. 140) Plaintiff did not assert that the Disability Report, which is 

completed in a field office through a face-to-face interview process (see Tr. 137), was 

completed incorrectly. Furthermore, Plaintiff completed handwritten responses in English 

to the English language “Exertional Daily Activities Questionnaire,” suggesting that 

Plaintiff is literate to some degree. (Tr. 148) Finally, Plaintiff completed a consultative 

examination with a psychologist, Francisco Sanchez, Ph.D., and Dr. Sanchez’s report 

indicates that Plaintiff undertook the exam in Plaintiff’s primary language, which Dr. 

Sanchez indicated was “English.” Tr. 347. 

The Commissioner, not the court, is charged with the duty to weigh the evidence, 

resolve material conflicts in the evidence and determine the case accordingly. Reviewing 

courts must consider the evidence that supports as well as detracts from the examiner's 

conclusion. Day v. Weinberger, 522 F.2d 1154, 1156 (9th Cir. 1975). AWhen the 

evidence before the ALJ is subject to more than one rational interpretation, we must defer 

to the ALJ's conclusion.@ Batson v. Comm'r of Soc. Sec. Admin., 359 F.3d 1190, 1198 

(9th Cir. 2004). This is so because A[t]he [ALJ] and not the reviewing court must resolve 

conflicts in the evidence, moreover, "if the evidence can support either outcome, the 

court may not substitute its judgment for that of the ALJ." Matney v. Sullivan, 981 F.2d 

1016,1019 (9th Cir. 1992)(citations omitted). At the same time, the Court "must consider 

the entire record as a whole and may not affirm simply by isolating a 'specific quantum of 

supporting evidence.'" Batson, 359 F.3d at 1198 (citing Hammock v. Bowen, 879 F.2d 

498, 501 (9th Cir.1989)). 

The ALJ did not err in finding that Plaintiff was able to communicate in English. 

Plaintiff did not, in fact, claim an inability to speak English in his first field interview 

Disability Report, and no interpreter was requested. Tr. 136. This was consistent with the 

medical evidence of record overall, which, though not conclusive, does not indicate any 

need for interpretation during medical appointments, and does indicate that interviews 

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were not conducted in English, and does indicate that English was Plaintiff’s primary 

language, and that despite Plaintiff’s self-serving testimony that he was unable to speak 

any English at all, or only very little (Tr. 30), he was able to read and fill in written 

answers to an English language form of daily activities questionnaire. Tr. 148. 

Finally, Grid Rule 202.09 applies to an individual with unskilled, or no work 

experience. In this case, Plaintiff had semi-skilled work experience (Tr. 41-42), thus, 

Grid Rule 202.09 does not apply, and the ALJ did not err in finding that Plaintiff did not 

meet a grid rule. 

Last, Plaintiff argues that remand is appropriate in light of a subsequent favorable 

decision granting benefits as of July 24, 2009. 

In this instance, Plaintiff seeks remand to consider new evidence, and thus, is 

requesting relief pursuant to 42 U.S.C. § 405(g), sentence six. Remand for 

reconsideration under sentence six of 42 U.S.C. ¶ 405(g) is appropriate only where a 

plaintiff submits new evidence and further shows that: (1) the new evidence is material to 

his disability; and (2) he had good cause for failing to submit the evidence earlier. See 

Mayes, 276 F.3d at 462; see also 42 U.S.C. ¶ 405(g) (sentence six: a court may “order 

additional evidence to be taken before the Commissioner of Social Security, but only 

upon a showing that there is new evidence which is material and that there is good cause 

for the failure to incorporate such evidence into the record”). To be material, the new 

evidence must bear “directly and substantially on the matter in dispute,” and the plaintiff 

must show a “reasonable probability” that the new evidence would have changed the 

outcome of the administrative hearing. See Mayes, 276 F.3d at 462. 

Plaintiff asserts that the agency’s subsequent decision in February 2010, finding 

disability and awarding benefits as of July 24, 2009, which Plaintiff submitted to the 

Appeals Council, was new and material evidence warranting remand in this case. 

Plaintiff, citing a district court case out of the Southern District of West Virginia, argues 

that remand is warranted when an award is based on an onset date coming in immediate 

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proximity to an earlier denial of benefits. Bradley v. Barnhart, 463 F.Supp.2d 577, 581 

(S.D.W.Va. 2006). The District Court in Bradley, however, distinguished that case from a 

Ninth Circuit case which controls the outcome in this case, and which Plaintiff did not 

cite, which states: 

Under 42 U.S.C. § 405(g), remand is warranted only if there is new 

evidence that is material and good cause for the late submission of the 

evidence. New evidence is material if it “bear[s] directly and substantially 

on the matter in dispute,” and if there is a “reasonabl[e] possibility that the 

new evidence would have changed the outcome of the ... determination.” 

Booz v. Sec'y of Health & Human Servs., 734 F.2d 1378, 1380 (9th 

Cir.1984) (internal quotation marks and citations omitted) (emphasis 

omitted). 

In this case, Bruton's second application involved different medical 

evidence, a different time period, and a different age classification. For 

these reasons, the second ALJ's subsequent decision to award benefits [] is 

not inconsistent with the first ALJ's denial of Bruton's initial application. 

We therefore hold that the district court did not err in denying Bruton's 

motion to remand. 

Bruton v. Massanari, 268 F.3d 824, 827 (9th Cir. 2001). 

 Here, the subsequent decision is not material because it concerns a different time 

period and different medical evidence. The ALJ decision under review in this case is 

dated July 23, 2009, and concerns the period from August 20, 2007 through July 23, 2009 

(Tr. 25). By contrast, the subsequent decision finds disability between July 24, 2009, and 

February 1, 2010. Tr. 482-83. The subsequent decision specifically states that Plaintiff 

became eligible for Social Security benefits after the date of the first ALJ’s decision. Tr. 

482. Thus, the two periods do not overlap and there is nothing inconsistent about the two 

decisions. Further, though this Court is not definitively aware of what evidence supported 

the agency’s decision to award benefits, as discussed above, the medical evidence 

submitted concerning Plaintiff’s condition at least as of December 2009, indicated the 

development of heart conditions and possible dementia, two conditions which were not at 

issue prior to the ALJ’s decision. Thus, Plaintiff has not met the burden of showing 

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materiality. 

III. CONCLUSION

Because the Court finds that the ALJ’s interpretation of the medical opinions is a 

rational one supported by the evidence, and because the ALJ did not err in failing to find 

Plaintiff disabled under the Grids, and because Plaintiff did not meet his burden in 

demonstrating the materiality of either the new evidence or the subsequent award of 

benefits in order to demonstrate cause for remand, the Court will not reverse the agency’s 

denial of benefits. 

IT IS ORDERED: 

1. Defendant’s administrative decision denying benefits is affirmed. 

2. The Clerk is directed to terminate this action. 

 Dated this 6th day of March, 2012. 

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