Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-casd-3_16-cv-00700/USCOURTS-casd-3_16-cv-00700-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:0405id Review of HHS Decision (SSID)

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MAY 1 5 2017

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CLERK US DISTRICT COURT

SOUTHERN DISTRICT/OF CALIFORNIA

KASC+-J DEPUTY

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BY

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8 UNITED STATES DISTRICT COURT

9 SOUTHERN DISTRICT OF CALIFORNIA

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11 CHRISTY ANNA POHLMANN, an Case No.: 3:16-CV-00700-MMA-KSC

individual, 12 REPORT AND

RECOMMENDATION RE CROSSMOTIONS FOR SUMMARY

JUDGMENT

Plaintiff,

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v. 14

CAROLYN W. COLVIN, Acting

Commissioner of Social Security, 15

[Doc. Nos. 16, 20] 16 Defendant.

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18 Pursuant to Title 42, United States Code, Section 405(g), ofthe Social Security Act

("SSA"), plaintiff filed a Complaint to obtain judicial review of a final decision by the

Commissioner of Social Security ("Commissioner") denying her disability insurance

benefits.1 Pursuant to Title 28, United States Code, Section 636(b)(1)(B), and Civil Local

Rules 72.1(c)(1)(c) and 72.2(a), this matter was assigned to the undersigned Magistrate

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1 Title 42, United States Code, Section 405(g), provides as follows: “Any individual, after any final

decision ofthe Commissioner of Social Security made after a hearing to which he was a party... may

obtain a review ofsuch decision by a civil action... brought in the district court ofthe United States....

The court shall have power to enter, upon the pleadings and transcript ofthe record, a judgment

affirming, modifying or reversing the decision ofthe Commissioner of Social Security, with or without

remanding the cause for a rehearing. The findings ofthe Commissioner ... as to any fact, ifsupported by

substantial evidence, shall be conclusive.”

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Judge for a Report and Recommendation.

Presently before the Court are: (1) plaintiffs Motion for Summary Judgment [Doc.

No. 16]; (2) defendant's Cross-Motion for Summary Judgment [Doc. No. 19];

(3) defendant's Response in Opposition to Plaintiffs Motion [Doc. No. 20]; (4) plaintiffs

Reply to defendant’s Opposition [Doc. No. 21]; and (5) the Administrative Record [Doc.

No. 9.]. After careful consideration of the moving and opposing papers, as well as the

Administrative Record and the applicable law, this Court RECOMMENDS that the

District Court remand the case for further consideration by the Commissioner pursuant to

the “fourth sentence” of Section 405(g) and enter a final judgment. Melkonyan v. Sullivan,

111 S.Ct. 2157 (1991); Sullivan v. Finkelstein, 110 S.Ct. 2658 (1990).

Background andProceduralHistory.

On March 24, 2014, plaintiff filed an application for a period of disability and

disability insurance benefits (“DIB”) alleging disability beginning January 1, 2011. [AR

155-156.] Plaintiffs application states that she was bom on July 29,1979. She said in her

application she was unable to work due to (1) severe migraines; (2) depression; (3) posttraumatic stress disorder (“PTSD”); (4) Unilateral Pars Defect in her spine; and (5) stress

incontinence. [AR 98.] On May 21,2014, the Commissioner denied plaintiffs application

for DIB. [AR 92-94.] Plaintiff requested reconsideration on July 14, 2014 [AR 95], but

her request was denied on October 20, 2014. [AR 98-102.] On October 31, 2014, she

requested a hearing before an administrative lawjudge (hereinafter “ALJ”). [AR 103-104.]

A hearing before an administrative law judge was held on May 27, 2015. [AR 35-64.]

On September 16, 2015, the ALJ issued a written opinion concluding that plaintiff

did not qualify for DIB under the SSA. [AR 21-30.] In reaching this decision, the ALJ

found that plaintiff has the severe impairments of “history of pars defect at L5-S1 ofthe

lumbar spine; history of migraine headaches; history of herniated disc thoracic spine;

alcohol dependence; and depression/mood disorder.” [AR 23.] However, the ALJ

concluded she did not have an impairment or combination ofimpairments that meet SSA

disability criteria and, as a result, would have the residual functional capacity to perform a

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full range oflight work with no sustained interaction with supervisors, coworkers and the

public. [AR 23-28.]

On November 13, 2015, plaintiff requested review of the ALJ’s decision by the

Appeals Council. [AR 15-17.] However, on January 27,2016, the Appeals Council denied

plaintiffs request for review. [AR 1-3.]

Standards ofReview.

The final decision of the Commissioner must be affirmed if it is supported by

substantial evidence and if the Commissioner has applied the correct legal standards.

Batson v. Comm'r ofthe Social Security Admin., 359 F.3d 1190, 1193 (9th Cir. 2004).

Under the substantial evidence standard, the Commissioner's findings are upheld if

supported by inferences reasonably drawn from the record. Id. Ifthere is evidence in the

record to support more than one rational interpretation, the District Court must defer to the

Commissioner's decision. Id. Substantial evidence means "such relevant evidence as a

reasonable mind might accept as adequate to support a conclusion." Osenbrock v. Apfel,

240 F.3d 1157,1162 (9th Cir. 2001). The Court must weigh both the evidence that supports

and detracts from the administrative ruling. Tackett v. Apfel, 180 F.3d 1094,1097 (9th Cir.

1999).

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Pursuant to Federal Rule ofCivil Procedure 56(a), "[t]he court shall grant summary

judgment ifthe movant shows that there is no genuine dispute as to any material fact and

the movant is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(a). "Summary

judgment motions, as defined by Fed.R.Civ.P. 56, contemplate the use of evidentiary

material in the form of affidavits, depositions, answers to interrogatories, and admissions.

In Social Security appeals, however, the Court may Took no further than the pleadings and

the transcript of the record before the agency,’ and may not admit additional evidence.

Morton v. Califano, 481 F.Supp. 908, 914 n. 2 (E.D.Tenn.1978); 42 U.S.C. § 405(g).

"[Although summary judgment motions are customarily used [in social security cases],

and even requested by the Court, such motions merely serve as vehicles for briefing the

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parties’ positions, and are not a prerequisite to the Court's reaching a decision on the

merits.” Kenney v. Heckler, 577 F.Supp. 214, 216 (D.C. Ohio 1983).

IIL MedicalEvidence?

Disability Determinations by the Department ofVeterans Affairs.

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4 A.

The record includes medical records from the Department of Veterans Affairs

indicating that plaintiffwas a veteran ofthe GulfWar Era and that she served in the Navy

from December 19,2000 to March 1,2006. [AR 153.] The record contains three disability

rating decisions from the Department of Veterans Affairs. [AR 484-497, 498-505,

506- 523.]

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In a decision dated April 19, 2013, from the Department of Veterans Affairs,

plaintiffs overall service connected disability rating was 100%. [AR 486.]

Department ofVeterans Affairs’ decision was based on an overall assessment ofplaintiffs

service connected conditions. [AR 485-486.] Plaintiffs service connected disability for

her sciatic nerve in her left and right legs with pars defect L5-S1 (sometimes also referred

to as a “unilateral pars defect L5-S1”) was increased from 10% to 20%, effective October

30, 2012. [AR 484-486, 491-92.] Plaintiffs service connected disability for her major

depressive disorder was increased from 50% to 70%, effective October 30, 2012. Id.

Plaintiffs service connected condition of migraine headaches was found to be 30%

disabling. [AR486.]

In a decision dated November 26, 2013, from the Department of Veterans Affairs,

plaintiffreceived a determination that her “stress incontinence” was 60% disabling. [AR

498-503.] The “reasons for decision” were as follows: (1) plaintiff was required to wear

“absorbent materials which must be changed more than four times per day;” (2) plaintiff

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25 2 The instant dispute concerns only whether the ALJ properly evaluated and/or addressed plaintiffs

overall service connected disability rating from the Department ofVeterans Affairs. [Doc. No. 16, at pp.

6-17; Doc. No. 20-1, at pp. 6-16; Doc. No. 21, at p. 3.] Accordingly, a summary ofplaintiffs disability

determinations by the Department ofVeterans Affairs are summarized herein. The Court refers to

specific evidence from the record where pertinent to the Court’s analysis in the Discussion section of

this Order.

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was waking up “to void five or more times per night;” and (3) plaintiffs “daytime voiding

interval [was] less than one hour.” [AR 503.]

In a decision dated March 3, 2014, from the Department of Veterans Affairs,

plaintiffs overall service connected disability rating remained at 100%. [AR 148.]

However, her disability rating for her evaluation ofmigraine headaches was increased from

30 percent disabling to 50 percent disabling, effective October 30,2012. [AR 153-154.] In

its determination, the Veterans Administration states:

Evaluation of migration headaches, which is currently 30 percent

disabling, is increased to 50 percent effective October 30,2012, the date

we received your claim based on continuous prosecution. The overall

disability picture demonstrates a level of functional impairment that

more approximates that which is contemplated in the 50 percent

evaluation criteria. An evaluation of 50 percent is assigned for very

frequent, completely prostrating, and prolonged attacks productive of

severe economic inadaptability.

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At the VA exam, you reported migraines 3-5 times per week with nausea,

vomiting, changes in vision, and photo and phone sensitivity. The

examiner noted there is evidence of very frequent prostrating and

prolonged attacks ofmigraine headache pain, [sic] You reported missing

48 days from school in the past 12 months due to migraine headaches.

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18 [AR 154.]

19 B. May 27, 2014 Hearing Before the ALJ.

20 1. Plaintiffs Testimony.

21 At the hearing, plaintifftestified that she was 35 years old, and had completed some

college. [AR 38.] She testified that she had three children, two ofwhom lived with her. Id.

Plaintiff testified that regarding her history with drug or alcohol problems, she had one

“DUI” in 2013 but “since then [she hasn’t] used alcohol.” [AR 38; AR 48.] She also

testified that she was using medical marijuana, but she had abstained from using it for the

last month. [AR 38; AR 48.]

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At the hearing, the ALJ noted as follows: “You’re 100 percent VA disability, and

you’ve got SSDI here. What is that?” [AR 39.] Plaintiff explained that she was originally

approved for Social Security Disability, but then she filed an appeal regarding the date of

onset. Id. Plaintiffsaid that she was currently receiving disability benefits, but understood

that she may have to repay them. Id.

Plaintifftestified that she earned a pharmacy technician certification in 2013. [AR

39-40.] She said that in obtaining the certification, she “had many absences due to [her]

illnesses,” but the school worked with her to help her graduate. Id. Plaintifftestified that

she was in the Navy for six years. During that time, she was stationed in Camp Pendleton

as a hospital corpsman, and she also did many field operations with the Marines. [AR 40-

41.] She testified that left the Navy on a pregnancy discharge because she was “going

through [her] divorce and pregnant with [her] third child.” [AR 40.]

The ALJ asked plaintiff about what medications she took on a daily basis, noting

that she had “quite a few pain meds” listed on her medical records. [AR 40.] Plaintiff

testified that she took them “all every day for [her] back and/or [her] migraines.” Id. The

ALJ asked plaintiffwhen she started having physical problems. Id. Plaintifftestified that

she “was first diagnosed with the migraines when [she] was in boot camp which was in

March of 2001.” [AR 41.] She further testified that she injured her back in approximately

2002, and then it just progressively became worse after that when they eventually

discovered she had a fracture referred to as pars defect. Id. The ALJ asked plaintiff about

how she fractured her back, and plaintiff said that she was not sure. Id. Plaintiff further

explained that she is “pretty petite, and [she] was having to carry pretty heavy packs,” so

it may have been the stress on her back from that. Id. She also noted that she has a herniated

disc in her back. Id. The ALJ asked plaintiff how she got the herniated disc, and plaintiff

said that she was not sure. Id. She explained generally that “[t]he military was pretty rough

on [her] body.” Id.

The ALJ asked plaintiff how she cares for her two children, and plaintiff explained

that she “get[s] help a lot ofthe time.” [AR 41.] Plaintifftestified that she receives help

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with her children from the following people: (1) a caregiver/friend named Shanna Dodson;

(2) a neighbor, Steve Millot; (3) plaintiffs mother; and (4) her children’s sports coaches

with transporting them to activities. [AR 41.] Plaintiff explained that she “spends many

days in bed so it’s tough.” Id. Regarding her migraines, plaintifftestified that at the time

of the hearing, she was experiencing them daily. Id. Plaintiff said that she used to get

migraines about three to five times a week, but then approximately six or seven months

ago, she started experiencing them daily. Id. Plaintiff further testified that her migraines

began around the time of her enlistment with the Navy and that she had to miss a lot of

duty. [AR 43.] She said that her migraine medications generally prevent her from driving

because it causes her photosensitivity, and it can also make her irritable, constipated, and

nauseous. Id. When the ALJ asked plaintiffwhether the migraines were the most serious

issue she has, she said that “it’s a tie between that and [her] back.” Id.

Regarding her back pain, plaintiff testified that she had not had an MRI since she

was on active duty when they discovered her herniated disc. [AR 44.] She testified that she

had asked her doctor for it, but they denied it. Id. However, she explained that she had an

appointment with neurology one month after the hearing “to explore the option of getting

an MRI and also some type of pain injections in her back.” Id. Regarding medical issues

that affect plaintiffs ability to work other than migraines and back problems, plaintiff

testified thatshe had PTSD, depression, anxiety, and stress incontinence. [AR 44.] Plaintiff

explained that the medication that she takes for depression “helps a small bit” and that she

would “rather take it than not take it.” [AR 46.]

When the ALJ asked plaintiffwhat she does during the day, she said that she spends

almost every day in bed. Id. The ALJ asked her whether she did that every day, and

plaintiffsaid yes, “some days it’s hard to even shower.” Id. When the ALJ asked plaintiff

whether she does any physical exercise, she said “very seldomly.” [AR 47.] She said that

she sometimes tries to go for a walk, but then she ends up in more pain. Id. Plaintiff

testified that in the past she has belonged to a gym, in order to walk on the treadmill, and

for the tanning and massage services. Id. The ALJ asked plaintiff how recently she went

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to the gym. Id. Plaintiffsaid that she went to the gym “last weekjust to get on the treadmill

and try to get a little exercise because the doctors have said that ifI can try to get a little

movement it’s better than nothing.... But I’m usually not getting more than few minutes

on the treadmill before it starts to really bother my lower back.” Id. at 47-48.

After the ALJ finished his initial examination of plaintiff, plaintiffs attorney

questioned her. Plaintiffs attorney asked her about the disability rating(s) she received

from the Department of Veterans Affairs. [AR 49.] Plaintiff testified that her disability

rating was for her sciatica, headaches, tinnitus, stress incontinence (which she believed was

listed as chronic cystitis), depression, and her back issues. [AR 49-50.] Plaintiffs attorney

asked her how long her disability rating from the Department ofVeterans Affairs has been

at 100 percent. [AR 50.] Plaintifftestified that she has been at 100 percent disability rating

since 2012. Id. Plaintiffs attorney asked her about whether she has experienced difficulty

with fainting episodes. Id. Plaintifftestified that she has had several fainting episodes and

that they happen every four to six months. Id. She testified that she does not know what

causes the fainting, but she “tie[s] it to [her] migraines.” Id. Plaintiff also testified that

since 2013, she has been getting Botox injections for the headaches every ten to twelve

weeks, which help “take the edge offfor a few weeks.” Id. at 50-51. Regarding her work

history, plaintifftestified that her last full time job was in June 2009, and then she had a

consistent part-time job until January 2011, when she was fired for having migraines and

calling out sick. Id. at 51.

The ALJ then asked plaintiff details of her work history, starting with her

employment with Fairway Enterprises as an administrative assistant for a physical therapy

office from August 2007 until June 2009. [AR 52.] She said she left the job “because of

difference of view with [her] boss and her threatening to fire [her] over [her] migraines.”

[AR 52.] At J.C. Penney, plaintiff worked as a shoe associate; then she was an

administrative assistant for Braden Partners LP, Pacific Pulmonary Services. [AR 52.] She

also worked at San Diego Digestive Services, where she did “check out and scheduling of

patients.” [AR 53.] She also worked early on in her career at Macy’s and subsequently at

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Money Mailer. The ALJ asked plaintiffwhy she wanted to be a pharmacy technician and

get out ofthe medical assistant role. [AR 55.] Plaintiffsaid she wanted to try something

new and was still entitled to military benefits to go to school. Id. However, plaintiff

explained that in pharmacy technician school, she was required to go to school four hours

a day, but she missed a lot ofschool due to her migraines. Id.

The ALJ also asked plaintiff about her “stress incontinence.” [AR 60.] Plaintiff

mentioned that she starting using pads for it in 2006, after the delivery of her third child.

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[AR 61.] The ALJ asked plaintiffwhether she received any medication for it, and plaintiff

said she did not. Id. Plaintifftestified during the hearing that:

It’sjust a little confusing to me because I was -I’m 100 percent disabled

through the VA, and when I originally did my application for Social

Security benefits I was approved. We went to appeal the date of onset

because they had changed my date of onset, and that’s when they came

back saying that I was overall denied. So that’sjust a little confusing to

me that they would right offthe bat say, ‘Yes, you’re disabled. We agree

with the VA,’ and then come back and change their decision.

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[AR 62.] 15

The ALJ responded that “there’s several levels of review in these files. . . I don’t

know what their rationale was.” [AR 62-63.] The ALJ noted that the details ofplaintiffs

reapplication were “not on [his] cover sheet” “[s]o somebody didn’t delve into that.” [AR

63.] The ALJ said that he will “take a look at that also.” Id.

The ALJ said that he was going to order plaintiff to be examined by an internal

medicine physician, which will include her orthopedic problem. [AR 63.] He also noted

he was going to order plaintiffto get a psychiatric clinical exam. Id.

VocationalExpert's Testimony.

Mr. Stock, a vocational expert, answered two hypothetical questions posed by the

ALJ. First, Mr. Stock testified that plaintiffcould not perform any ofher past work in light

ofplaintiffs age, education, prior work experience, and her restriction “to a light range of

work, no work on unprotected heights, no work on dangerous machinery, no ladders,

occasional stairs and ramps, occasional stopping and bending, occasional lifting above

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shoulder level, no sustained, intense interaction with the public, coworkers, or

supervisors.” [AR 57-58.] Mr. Stock opined that plaintiff could perform other work

including a mail clerk, laundry worker, or silver wrapper. [AR 58.]

The second hypothetical question posed by the ALJ included the same restrictions

as the first hypothetical, but also provided that the person would have to be restricted to a

sedentary range of work. [AR 58.] The vocational expert opined that plaintiff could

perform the following work with these restrictions: (1) a leaftier; or (2) a press clippings

cuttings-paster.” Id.

IV. TheALJ’s Five Step Disability Analysis.

To qualify for disability benefits under the SSA, an applicant must show that he or

she is unable to engage in any substantial gainful activity because of a medically

determinable physical or mental impairment that has lasted or can be expected to last at

least 12 months. 42 U.S.C. § 423(d). The Social Security regulations establish a five-step

sequential evaluation for determining whether an applicant is disabled under this standard.

20 CFR § 404.1520(a); Batson v. Comm'r ofthe Social SecurityAdmin., 359 F.3d at 1193-

1194.

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At step one, the ALJ must determine whether the applicant is engaged in substantial

gainful activity. 20 CFR § 404.1520(a)(4)(I). “Substantial gainful activity is work activity

that is both substantial and gainful.” 20 CFR § 416.972. Here, the ALJ concluded plaintiff

had not engaged in substantial gainful activity since January 1,2011, the alleged onset date

of plaintiffs alleged impairments. [AR 23.]

At step two, the ALJ must determine whether the applicant is suffering from a

“severe” impairment within the meaning of Social Security regulations.

§ 404.1520(a)(4)(h). “An impairment or combination of impairments is not severe if it

does not significantly limit [the applicant's] physical or mental ability to do basic work

activities.” 20 CFR § 404.1521(a). For example, a slight abnormality or combination of

slight abnormalities that only have a minimal effect on the applicant's ability to perform

basic work activities will not be considered a “severe” impairment. Webb v. Barnhart, 433

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1 F.3d 683,686 (9th Cir. 2005). Examples ofbasic work activities include walking, standing,

sitting, lifting, pushing, pulling, reaching, carrying, handling, seeing, hearing, speaking,

understanding, carrying out and remembering simple instructions, use of judgment,

responding appropriately to supervision, co-workers and usual work situations, and dealing

with changes in a routine work setting. 20 CFR § 404.152 l(b)(l)-(6). “Ifthe ALJ finds

that the claimant lacks a medically severe impairment, the ALJ must find the claimant not

to be disabled.” Webb v. Barnhart, 433 F.3d at 686.

Here, at step two, the ALJ concluded that plaintiff has the following severe

impairments: history of a pars defect at L5-S1 ofthe lumbar spine; history of migraine

headaches; history of herniated disc thoracic spine; alcohol dependence; and

depression/mood disorder. [AR 23.] The ALJ also found that these impairments “cause

more than minimal limitations on the claimant’s ability to perform basic work activities.”

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13 Id.

14 Ifthere is a severe impairment, the ALJ must then determine at step three whether it

meets or equals one of the “Listing of Impairments” in the Social Security regulations.

20 CFR § 404.1520(a)(4)(iii). Ifthe applicant's impairment meets or equals a Listing, he

or she must be found disabled. Id. In this case, the ALJ concluded at step three that

plaintiffs impairments or combination of impairments did not meet or equal a listed

impairment. [AR 23.] As a result, the ALJ concluded plaintiff was not disabled based on

medical considerations alone. Id.

If an impairment does not meet or equal a Listing, the ALJ must make a step four

determination of the claimant's residual functional capacity based on all impairments,

including impairments that are not severe. 20 CFR § 404.1520(e), § 404.1545(a)(2).

“Residual functional capacity” is “the most [an applicant] can still do despite [his or her]

limitations.” 20 CFR § 404.1545(a)(1). The ALJ must determine whether the applicant

retains the residual functional capacity to perform his or her past relevant work. 20 CFR

§ 404.1520(a)(4)(iv).

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If the applicant cannot perform past relevant work, the ALJ-at step five-must

consider whether the applicant can perform any other work that exists in the national

economy. 20 CFR § 404.1520(a)(4)(v). While the applicant carries the burden ofproving

eligibility at steps one through four, the burden at step five rests on the agency. Celaya v.

Halter, 332 F.3d 1177, 1180 (9th Cir. 2003). The ALJ must consider all of plaintiff’s

medically determinable impairments, including any pain that could “cause a limitation of

function” and any impairments that were not “severe,” and then determine plaintiffs

residual functional capacity to perform other work in the national economy. 20 CFR

§§ 404.1520; 404.1545; 416.929. “In determining [the claimant’s] residual functional

capacity, the ALJ must consider whether the aggregate of [the claimant’s] mental and

physical impairments may so incapacitate him that he is unable to perform available work.”

Light v. Soc. Sec. Admin., 119 F.3d 789, 793 (9th Cir. 1997), as amended on reh’g (Sept.

17, 1997). As noted above, “residual functional capacity” is “the most [an applicant] can

still do despite [his or her] limitations.” 20 CFR § 404.1545(a)(1).

Here, the ALJ acknowledged at step four that plaintiff was unable to perform any

past relevant work. [AR 28.] Considering the totality of plaintiffs symptoms and pain,

the ALJ concluded at step five that plaintiff has the residual functional capacity to make a

“successful adjustment to other work that exists in significant numbers in the national

economy.” [AR 29.] The ALJ cited the vocational expert’s testimony regarding

representative occupations for plaintiffincluding, for example, (1) mail clerk; (2) domestic

laundry worker; (3) silver wrapper; (4) leaf tier; (5) addresser; or (6) press clippings

cutter/paster. Id. In reaching this determination, the ALJ concluded that plaintiff is “not

disabled” under the framework ofMedical-Vocational Rule 202.21. Id.

The ALJ considered the testimony of the vocational expert and plaintiffs age,

education, work experience, and residual functional capacity. [AR 28]. In addition, the

ALJ specifically considered plaintiffs testimony regarding “migraine headaches,

depression and PTSD since 2001, a unilateral pars defect, and stress incontinence.” [AR

25.] However, the ALJ reasoned that plaintiffs “statements concerning the intensity,

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persistence and limiting effects of her symptoms” were “not fully credible.” Id. The ALJ

cited other objective medical evidence in the record, including plaintiffs disability findings

by the Department ofVeterans Affairs, which he found “fail[ed] to provide strong support

for the claimant’s allegations of disabling symptoms and limitations.” Id. Regarding the

disability findings by the Department ofVeterans Affairs, the ALJ noted as follows:

A decision by any agency about disability is based on that agency’s rules

and is not binding on the Social Security Administration (20

C.F.R. 404.1504 and 416.904). Accordingly, although I considered the

medical findings and related treatment within the VA records, I accord

the disability ratings from the VA agency no weight.

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11 V. Discussion.

12 A. SubstantialEvidence Standard.

In her Motion for Summary Judgment, plaintiff argues that the Court should reverse

the ALJ’s decision and award benefits, because the ALJ failed to articulate “persuasive,

specific and valid reasons” for rejecting the VA’s disability rating. [Doc. No. 16, at pp. 8-

9.] Defendant argues that the Court should affirm the ALJ’s decision because the ALJ

adequately considered the VA’s disability ratings and disability decisions by other agencies

are not binding upon the Commissioner. [Doc. No. 22-1, at pp. 2-8.]

It is well established in the Ninth Circuit that “an ALJ must ordinarily give great

weight to a VA determination of disability.” Valentine v. Commissioner Social Security

Administration, 574 F.3d 685, 695 (9th Cir. 2009) (quoting McCartey v. Massanari, 298

F.3d 1072, 1076 (9th Cir. 2003) (reversing a denial of benefits because the ALJ “failed to

consider the VA finding and did not mention it in his opinion”)). [Although a VA rating

of disability does not necessarily compel the SSA to reach an identical results, 20 CFR

§ 404.1504, the ALJ must consider the VA’s finding in reaching his decision.” McCartey,

298 F.3d at 1076. In reaching this holding, the Ninth Circuit relied on “the marked

similarity between these two federal disability programs. Both programs serve the same

governmental purpose - providing benefits to those unable to work because of a serious

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disability. Both programs evaluate a claimant’s ability to performfull-time work in the

national economy on a sustained and continuing basis; both focus on analyzing a

claimant’s functional limitations; and both require claimants to present extensive

medical documentation in support oftheir claimsId. (emphasis added). However,

because the criteria for determining disability are not identical, “the ALJ may give less

weight to a VA disability rating ifhe gives persuasive, specific, valid reasons for doing so

that are supported by the record.” Id.

In Valentine, the VA rated plaintiff 100 percent disabled while his case was pending

before the ALJ. 574 F.3d at 694. Notwithstanding the VA’s disability rating, the Ninth

Circuit court found that the ALJ provided “specific and legitimate reasons that [were]

supported by substantial evidence in the record” to reject the VA’s disability rating. Id. at

695. The Ninth Circuit court noted that the ALJ specifically stated in her opinion that “the

VA’s determination was not based on a comprehensive evaluation ofthe evidence available

to [her].” Id. The court concluded that “the acquisition of new evidence or a properly

justified reevaluation of old evidence constitutes a persuasive, specific, and valid reason

. .. supported by the record.” Id. (internal citation omitted).

Similarly, in Davis v. Astrue, No. 10cvl732-BEN-NLS, 2011 WL 3740365, at *9

(S.D. Cal. July 29, 2011), the court affirmed the ALJ’s decision that the claimant could

perform sedentary work notwithstanding his VA disability rating of 100% because “the

ALJ independently addressed and assessed the evidentiary basis for the VA rating as

required.” (internal citation omitted). The court reasoned:

The ALJ explicitly mentioned the 100 percent disabled rating when

issuing his decision and noted that disability ratings between the two

agencies do not necessarily have the same meaning. The ALJ provided

a specific example of John McCain, who is 100 percent disabled

according to the VA, but has proven to be capable of performing work.

Here, while Plaintiffs VA disability rating is 100 percent, according to

the ALJ he is capable ofperforming sedentary work, which is the lowest

exertional level of work as defined by the SSA. While the ALJ cannot

reject the VA rating solely because the SSA and VA’s governing rules

differ, the difference in rules was not the sole basis ofthe rejection. The

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ALJ reviewed the evidentiary basis for the VA’s rating and addressed it

three times in his order.... [T]he ALJ appropriately considered the VA

rating and gave persuasive, specific and valid reasons for affording less

weight to the VA’s determination of disability.”

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Id. (internal citation omitted).

It is insufficient for an ALJ to impliedly reject a VA disability rating on the basis

that the VA and SSA criteria for determining disability are not identical. See, e.g., Courtney

v. Colvin, 2016 WL 3869844, at *2 -*3 (E.D. Cal. July 15,2016); Hamblin v. Astrue, 2009

WL 113858, at *2 (C.D. Cal. Jan. 14, 2009) (stating that “[t]he Ninth Circuit has made

clear what is required to discount a VA rating -silently, or impliedly, rejecting it does not

meet this standard”).

In Courtney v. Colvin, 2016 WL 3869844, at *1 (E.D. Cal. July 15, 2016), the court

reversed the Social Security Commissioner’s decision and remanded the case for further

administrative proceedings. Plaintiffs “sole contention [was] that the ALJ failed to give

sufficient reasons for rejecting a determination by the Department of Veterans Affairs

(“VA”) that plaintiffis disabled.” Id. The ALJ noted that the “VA and [SSA] criteria for

determining disability are not identical,” and that he may give “less weight to a VA

disability rating,” so long as he provides “persuasive, specific, valid reasons for doing so

that are supported by the record.” Id. at *2. The ALJ claimed that he “considered and

included most of the identified impairments found in the rating decision and [had]

considered such impairments in formulating [plaintiffs] maximum residual functional

capacity.” Id. However, the District Court found “[t]he ALJ’s discussion of the VA

disability rating was insufficient” because although “the ALJ purported to have read and

considered the VA’s disability determination, his RFC assessment implicitly rejected the

VA’s finding that plaintiffs combined mental and physical impairments precluded

employment.” Id. The District Court further explained “the error was not harmless because

the ALJ’s rejection of the VA disability rating, which is entitled to ‘great weight’ under

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McCartey, was not inconsequential to the ultimate nondisability determination.” Id.

(internal citation omitted).

Here, the ALJ purports to have “considered the medical findings and related

treatment within the VA records,” but the ALJ “accordfed] the disability ratings from the

VA agency no weight.” [AR 25.] The ALJ, however, acknowledged in his written decision

that plaintiffThe ALJ implicitly rejected the VA’s finding ofplaintiffs service-connected

disability noting that “[a] decision by any agency about disability is based on that agency’s

rules and is not binding on the Social Security Administration.” Id. The ALJ erred in giving

the disability ratings from the VA “no weight” because Ninth Circuit precedent requires

the ALJ to give “great weight to a VA determination of disability.” McCartey, 298, F.3d

at 1075. While the ALJ could have given “less weight” to the VA disability ratings ifhe

had given “persuasive, specific, valid reasons for doing so that are supported by the

record,” the ALJ failed to provide any reasons for rejecting the VA’s disability ratings of

plaintiff. Id.

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15 Defendant asserts in the Cross-Motion for Summary Judgment and Opposition to

Plaintiffs Motion for Summary Judgment that “the VA only considered evidence up to

April 2013 and June 2013, respectively, in issuing its migraine and cystitis ratings.” [Doc.

No. 20-1, at p. 9.] Defendant cites Valentine, supra, in support ofits contention that “the

VA did not consider all the evidence ofrecord before the ALJ, which supported his decision

to discount the VA ratings and find Plaintiff was not disabled under the Social Security

Act.” Id. However, this reason was not articulated by the ALJ in his decision. While a

reviewing court may draw specific and legitimate inferences from an ALJ’s decision, a

court cannot speculate on the ALJ’s reasoning or make “post hoc rationalizations that

attempt to intuit what the adjudicator may have been thinking.” Bray v. Comm V ofSoc.

Sec. Admin., 554 F.3d 1219, 1225-1226 (9th Cir. 2009) (stating that “[l]ong-standing

principles of administrative law require us to review the ALJ’s decision based on the

reasoning and factual findings offered by the ALJ - not post hac rationalizations that

attempt to intuit what the adjudicator may have been thinking”); Stout v. Comm V, Social

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Sec. Admin., 454 F.3d 1050, 1054 (9th Cir. 2006) (stating that the court is “constrained to

review the reasons the ALJ asserts” for the denial of benefits and “cannot affirm the

decision of an agency on a ground that the agency did not invoke in making its decision”)

(quoting Connett v. Barnhart, 340 F.3d 871, 874 (9th Cir. 2003)); Pinto v. Massanari, 249

F.3d 840, 847 (9th Cir. 2001). Accordingly, the Commissioner’s post hoc rationalizations

do not remedy the ALJ’s legal error in failing to articulate persuasive, specific, valid

reasons for rejecting the VA disability ratings.

Under the circumstances presented, it was not enough for the ALJ to give “no

weight” to the VA’s disability determinations. These detailed findings and conclusions

about plaintiffs medical conditions were not dispositive, asthe ALJ stated in this decision,

but they were entitled to significant weight.

Conclusion.

A decision to remand for further investigation and development of the record is

appropriate when outstanding issues remain that must be resolved before a determination

of disability can be made. Treichler v. Comm’r ofSocial Sec. Admin., 775 F.3d 1090,

1106-1107 (9th Cir. 2014); see also Moisa v. Barnhart, 367 F.3d 882, 886 (9th Cir. 2004)

(“the proper course, except in rare circumstances, is to remand to the agency for additional

investigation or explanation”) (internal citation omitted). Based on the foregoing, this

Court concludesthat a remand for further administrative proceedings is the proper remedy.

While a VA disability rating ordinarily is entitled to great weight, it “does not necessarily

compel the SSA to reach an identical result,” and it is not clearthat social security disability

benefits must be awarded in this case. Hiler v. Astrue, 687 F.3d 1208,1211-1212 (9th Cir.

2012) (holding that a remand for further administrative proceedings is appropriate where

the ALJ deviated from the claimant’s VA disability ratings and gave no reason for doing

so). On remand, the ALJ shall develop the record as needed and issue a new decision

containing appropriate findings consistent with this Report and Recommendation.

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Based on the foregoing, IT IS HEREBY RECOMMENDED THAT THE

DISTRICT COURT:

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GRANT plaintiffs Motion for Summary Judgment to the extent it seeks a

remand for further administrative proceedings [Doc. No. 16];

DENY defendant’s Cross-Motion for Summary Judgment [Doc. No. 19];

REMAND the matter to the SSA for further consideration, investigation, and

development ofthe record consistent with this Report and Recommendation;

and,

ENTER a judgment in plaintiffs favor remanding this matter for further

administrative proceedings.

This Report and Recommendation ofthe undersigned Magistrate Judge is submitted

to the United States District Judge assigned to this case, pursuant to the provisions of 28

U.S.C. § 636(b)(1) and Civil Local Rule 72.1(d). Within fourteen (14) days after being

served with a copy of this Report and Recommendation, “any party may serve and file

written objections.” 28 U.S.C. § 636(b)(l)(B)&(C). The document should be captioned

“Objections to Report and Recommendation.” The parties are advised that failure to file

objections within this specific time may waive the right to raise those objections on appeal

ofthe Court’s order. Martinez v. Ylst, 951 F.2d 1153, 1156-57 (9th Cir.1991).

IT IS SO ORDERED.

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Dated: May/£r 2017 21

22 Sjf

Hon. Karen S. Crawford 23 United States Magistrate Judge

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