Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_07-cv-00828/USCOURTS-azd-2_07-cv-00828-1/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:405 Review of HHS Decision (DIWW)

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WO

NOT FOR PUBLICATION

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Lupe C. Hernandez, 

Plaintiff, 

vs.

Michael J. Astrue, Commissioner of

 Social Security Administration,

Defendant. 

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No. CV-07-828-PHX-GMS

ORDER

Pending before this Court are the Motion for Summary Judgment of Plaintiff

Hernandez (Doc. 16) and the Cross-Motion for Summary Judgment of Defendant Astrue

(Doc. 26) following the Ninth Circuit’s mandate (Doc. 42) to vacate this Court’s Order (Doc.

31), which granted Plaintiff’s motion and denied Defendant’s cross-motion. In our previous

Order, this Court remanded for further proceedings after finding that the Administrative Law

Judge (“ALJ”) erred at step five of the sequential evaluation process for determining

disability. (Doc. 31). Without vacating this Court’s determination of the ALJ’s step five

analysis, the Ninth Circuit remanded for consideration of step three as well. (Doc. 42).

For the reasons set forth below, the Court vacates the ALJ’s decision and remands the case

for further proceedings consistent with this Order and the September 5, 2008 Order. (Doc.

31).

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BACKGROUND

I. Factual Background

The evidence contained in the administrative record includes the following.

Hernandez, born January 17, 1956, was raised in the United States and has an eighth grade

education. (R. at 20). Plaintiff repeated the fourth grade and received poor grades while in

school. (R. at 222, 475). While Plaintiff’s primary language is Spanish, English is her second

language and she is able to communicate, read, and write in English. (Id.). Plaintiff has six

children and lives with and cares for her four youngest children. (Id. at 25). Prior to the

alleged disability date, Hernandez had work experience as an unskilled/medium prep cook

and cafeteria cook. (Id. at 20).

Hernandez alleges that as of September 1, 1999, she became disabled as a result of

diabetes mellitus, depression, anxiety, degenerative joint disease, and mental retardation.

(Id.). Since her alleged disability onset date, Plaintiff has not engaged in substantial gainful

activity. (Id. at 21). She reports pain, fatigue, depression, difficulty concentrating, and an

inability to sit, stand or walk for any significant period. (Id.). 

The ALJ’s review of the medical evidence revealed that Hernandez has a history of

type II diabetes mellitus, which was diagnosed in 2000, as well as a history of right knee

pain, and a mood disorder. (Id.). Her diabetes was originally treated with oral medication and

subsequently with insulin. (Id.). Plaintiff, who is approximately five feet two inches tall and

weighs more than 280 pounds, is also morbidly obese. (Id. at 24). In addition, Plaintiff has

a history of cholecystitis and was hospitalized for several days in 2002 and treated for an

upper respiratory infection, chest pain, and back pain. (Id. at 22). 

Plaintiff has been examined by three independent psychologists at the request of the

State agency. In October 2000, psychologist Daniel Watkins examined Hernandez and found

that she appeared to be suffering from ongoing adjustment problems to her medical condition

and reduced financial circumstances. (Id. at 25). Watkins concluded that Hernandez appeared

to retain the cognitive capacity to understand, remember, and carry out concrete instructions

to simple or moderate complexity; to maintain attention and concentration for one hour plus;

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to make simple decisions; to ask questions and request assistance; to take ordinary

precautions in travel to unfamiliar places; to interact appropriately with the general public;

and to maintain socially appropriate behavior as long as she was not asked to perform beyond

her cognitive capacity. (Id.). He further noted that Hernandez’s ability to respond

appropriately to stressors, to maintain emotional stability, and to demonstrate reliability and

consistency were moderately impaired as were her common sense judgement skills. (Id.).

While she appeared capable of dealing with the public on a casual short-term basis, Watkins

concluded that she may have difficulty interacting on a sustained basis. Even though he did

not test Plaintiff’s cognitive capacity, he estimated that she was likely functioning at a

borderline to low average range. (Id.). 

In July 2002, psychologist Elliot Salk also examined Hernandez and diagnosed her

with major depressive disorder, single episode, chronic for the past year, moderate and a

moderate anxiety disorder. (Id.). Based on his examination, Salk concluded that Hernandez

had a very good ability to understand, remember and carry out simple job instructions,

maintain her personal appearance, relate predictably in social situations, follow work rules,

function independently, and maintain attention and concentration. (Id.). She also exhibited

a fair ability to demonstrate reliability, behave in an emotionally stable manner, understand,

remember and carry out detailed, but not complex job instructions, relate to co-workers, deal

with the public, use judgment, interact with supervisors, and deal with work stresses. (Id.).

In October 2002, a third psychologist, David Biegen, examined Hernandez and

diagnosed her with mild mental retardation and major depressive disorder, moderate. (Id. at

21). His diagnosis was based on intelligence aptitude testing on Hernandez, which yielded

a Full Scale Intelligence Quotient (IQ) of 64, a Verbal IQ of 66, and a Performance IQ of 68.

(Id.). These scores placed Hernandez in the mild mental defective range of general

functioning intelligence. (Id.).

At Plaintiff’s hearing, medical expert Edward Jasinski testified that the IQ scores

reported by Biegen were invalid because he believed Plaintiff’s primary language is not

English. (Id. at 21). Jasinski reported that in such cases the IQ scores tended to run 10 to 15

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1

The five-step sequential evaluation of disability is set out in 20 C.F.R. § 404.1520

(governing disability insurance benefits) and 20 C.F.R. § 416.920 (governing supplemental

security income). Under the test:

A claimant must be found disabled if she proves: (1) that she is

not presently engaged in a substantial gainful activity[,] (2) that

her disability is severe, and (3) that her impairment meets or

equals one of the specific impairments described in the

regulations. If the impairment does not meet or equal one of the

specific impairments described in the regulations, the claimant

can still establish a prima facie case of disability by proving at

step four that in addition to the first two requirements, she is not

able to perform any work that she has done in the past. Once the

claimant establishes a prima facie case, the burden of proof

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points below actual abilities. (Id.). Further examination of Plaintiff revealed that she has

spent her entire life in the U.S., was educated in English, and speaks English with her

daughter and grandchild, with whom she lives. (Id. at 484–85). After learning this

information, Jasinski noted that he would consider the IQ scores “more valid.” (Id. at 485).

Jasinski concluded that the record supported a diagnosis of mood disorder but not of mental

retardation. (Id. at 21, 477).

To the extent more specific evidence in the record is relevant to reviewing the ALJ’s

opinion, those facts are set forth in more detail below. 

II. Procedural Background

On March 27, 2000, Hernandez filed an application for Supplemental Security

Income, alleging a disability onset date of September 1, 1999. (R. at 19). Hernandez’s

claim was denied both initially on July 12, 2000, and upon reconsideration. (Id.). Plaintiff

then appealed to an ALJ. (Id.). The ALJ issued an unfavorable decision, but that decision

was subsequently reversed by the Appeals Council. (Id.). On remand, the ALJ issued a partly

favorable decision to the effect that Hernandez had been disabled as of January 16, 2006. (Id.

at 20).

In evaluating whether Plaintiff was disabled, the ALJ undertook the five-step

sequential evaluation for determining disability.1

 (R. at 20). The ALJ found that the Plaintiff

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shifts to the agency at step five to demonstrate that the claimant

can perform a significant number of other jobs in the national

economy. This step-five determination is made on the basis of

four factors: the claimant’s residual functional capacity, age,

work experience and education.

Hoopai v. Astrue, 499 F.3d 1071, 1074–75 (9th Cir. 2007) (internal citations and quotations

omitted).

2

 Medical-Vocational Rule 201.09 provides that a claimant is disabled if he is closely

approaching advanced age, has a limited education, and is unskilled in terms of previous

work experience. The ALJ determined that Hernandez entered the “closely approaching

advancing age” category on January 16, 2006. (R. at 29). 

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had established a prima facie case of disability by showing that she was not engaged in

substantial gainful activity, that her disability was severe, and that she was unable to perform

any relevant past work. (R. at 29). At step five, however, the ALJ concluded, based on the

testimony of a vocational expert, that there were a significant number of jobs in the national

economy that Plaintiff could have performed between September 1, 1999, and January 15,

2006. (Id. at 28–29). On that basis, the ALJ concluded that Hernandez was not disabled

during that period. (Id. at 30). The ALJ further concluded that Plaintiff became disabled on

January 16, 2006, pursuant to Medical-Vocational Rule 201.09.2

 (Id.). 

The Appeals Council declined to review the decision. (R. at 8). Plaintiff filed the

complaint underlying this action on April 20, 2007, arguing that she was physically and

mentally disabled as of September 1, 1999, rather than January 16, 2006. (Doc. 1). Plaintiff

filed a Motion for Summary Judgment on December 20, 2007, and Defendant filed a CrossMotion on March 31, 2008. (Doc. 16, 26). 

On September 5, 2008, this Court granted Plaintiff’s motion and denied Defendant’s

cross-motion. (Doc. 31). We ordered the ALJ’s decision vacated and remanded for further

proceedings to reconcile the conflict between the vocational expert’s testimony and the

Dictionary of Occupational Titles (“DOT”). (Doc. 31). On November 7, 2008, Plaintiff filed

a notice of appeal to the Ninth Circuit. (Doc. 35). The Ninth Circuit vacated this Court’s

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order and remanded for sequential consideration of the alleged errors, in particular a

determination of whether the ALJ erred at the third step. (Doc. 42). We requested

supplemental briefing from the parties regarding whether the ALJ erred at step three and

what, if any, remedy is appropriate. (Doc. 43).

DISCUSSION

I. Standard of Review

The Court has the “power to enter, upon the pleadings and transcript of 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). A

reviewing federal court will only address the issues raised by the claimant in the appeal from

the ALJ’s decision. See Lewis v. Apfel, 236 F.3d 503, 517 n.13 (9th Cir. 2001). A federal

court “may set aside a denial of benefits only if it is not supported by substantial evidence

or is based on legal error.” Robbins v. Soc. Sec. Admin., 466 F.3d 880, 882 (9th Cir. 2006)

(citing Flaten v. Sec’y of Health & Human Servs., 44 F.3d 1453, 1457 (9th Cir. 1995)).

“‘Substantial evidence’ means more than a mere scintilla, but less than a preponderance, i.e.,

such relevant evidence as a reasonable mind might accept as adequate to support a

conclusion.” Id. (citing Young v. Sullivan, 911 F.2d 180, 183 (9th Cir. 1990)). 

The Court may not “substitute [its] own judgment for that of the ALJ.” Id. The ALJ

is responsible for resolving conflicts in testimony, determining credibility, and resolving

ambiguities. See Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir. 1995). “When the

evidence before the ALJ is subject to more than one rational interpretation, [the Court] must

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

(9th Cir. 2004). 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.’” Id. (citing

Hammock v. Bowen, 879 F.2d 498, 501 (9th Cir. 1989)). The Court also may not “affirm the

ALJ’s . . . decision based on evidence that the ALJ did not discuss.” Connett v. Barnhart,

340 F.3d 871, 874 (9th Cir. 2003); see also SEC v. Chenery Corp., 332 U.S. 194, 196 (1947)

(emphasizing the fundamental rule of administrative law that a reviewing court “must judge

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3

 The Court only addresses Plaintiff’s step three argument because the error alleged

at step five was decided in a previous Order, entered September 5, 2008. (Doc. 31, vacated

on other grounds). 

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the propriety of [administrative] action solely by the grounds invoked by the agency” and

stating that if “those grounds are inadequate or improper, the court is powerless to affirm the

administrative action”). Even if the ALJ erred, however, “[a] decision of the ALJ will not

be reversed for errors that are harmless.” Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir.

2005).

II. Analysis

Plaintiff argues that the ALJ erred at: (1) step three by not finding that Hernandez’s

impairments met or equaled the requirements of a listed impairment under 12.05(C) and/or

12.05(D), and (2) step five by not reconciling the conflict between the vocational expert’s

testimony and the DOT’s statement. (Doc. 21, 46).3

If a claimant has an impairment or combination of impairments that meets or equals

one found in the Listing of Impairments, then the ALJ must find the claimant disabled. 20

C.F.R. § 404.1520(d). For a claimant’s impairment to match a listing, it must, for a period

of twelve continuous months, “meet all of the specified medical criteria. An impairment that

manifests only some of those criteria, no matter how severely, does not qualify.” Sullivan v.

Zebley, 493 U.S. 521, 530 (1990); see also 20 C.F.R. § 404.1525(d) (“To meet the

requirements of a listing, [the claimant] must have a medically determinable impairment(s)

that satisfies all of the criteria in the listing.”); 20 C.F.R. pt. 404, subpt. P, app’x. 1 (stating

the twelve-month rule). Similarly, for a claimant to show that an impairment is “equivalent”

to a listed impairment, she “must present medical findings equal in severity to all the criteria

for the one most similar listed impairment. Zebley, 493 U.S. at 531 (citing 20 C.F.R. §

416.926). Because more than a “boilerplate finding” is required in making this determination

at step three, Lewis, 236 F.3d at 512, the ALJ “must adequately explain his [or her]

evaluation of alternative tests and the combined effect of the impairments,” Marcia v.

Sullivan, 900 F.2d 172, 175 (9th Cir. 1990). The ALJ is required, however, only “to discuss

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4

 Plaintiff does not argue that her impairments meet or equal the severity requirements

of either Listing 12.05(A) or 12.05(B). 

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and evaluate the evidence that supports his or her conclusion[,]” but not necessarily “under

the heading ‘Findings.’” Lewis, 236 F.3d at 513. Therefore, even if not in the section

expressly addressing step three, an ALJ does not err if he or she, for example, adequately

discusses relevant “subjective symptoms, medical and treatment history, impressions and

diagnosis from . . . physicians, as well as information about [the claimant’s] daily activities

and living situation.” Harris v. Astrue, 2009 WL 801347 at *7 (N.D. Cal. Mar. 25, 2009). 

The ALJ concluded that Hernandez’s impairments did not meet or equal any listed

impairment, specifically considering Listing 1.02 (major dysfunction of a joint), 9.08

(diabetes mellitus), and 12.05 (mental retardation). (R. at 22). Plaintiff, however, only

challenges the ALJ’s determination under 12.05, specifically subsections C and D. (Doc. 21,

46). 

 Listing 12.05 in 20 C.F.R. Appendix 1 to Subpart P of Part 404 defines mental

retardation, which “refers to significantly subaverage general intellectual functioning with

deficits in adaptive functioning initially manifested during the developmental period; i.e., the

evidence demonstrates or supports onset of the impairment before age 22.”

The required level of severity for this disorder is met when the requirements in A, B,

C, or D are satisfied.4

...

C. A valid verbal, performance, or full scale IQ of 60 through 70 and a physical

or other mental impairment imposing an additional and significant work-related

limitation of function; 

OR

D. A valid verbal, performance, or full scale IQ of 60 through 70, resulting in at

least two of the following: 

1. Marked restriction of activities of daily living; or 

2. Marked difficulties in maintaining social functioning; or 

3. Marked difficulties in maintaining concentration, persistence, or pace;

or

4. Repeated episodes of decompensation, each of extended duration. 

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The ALJ determined that Hernandez does not suffer from mental retardation, as

defined under Listing 12.05. (R. at 21). As an initial requirement of either Listing 12.05(C)

or 12.05(D), Plaintiff must establish that she has a valid verbal, performance, or full scale IQ

between 60 and 70. To this end, Plaintiff raises evidence from psychologist Biegen, who

reported that Hernandez’s Intelligence aptitude testing yielded a Full Scale Intelligence

Quotient (IQ) of 64, a Verbal IQ of 66, and Performance IQ of 68. However, the ALJ

explained that she found Biegen’s testimony unpersuasive because of the testimony of Dr.

Jasinski, a medical expert who explained that the IQ scores reported by Biegen were invalid

because Hernandez’s primary language is not English. (R. at 21). The ALJ found persuasive

Jasinski’s testimony that it is well accepted that the results of standardized Intelligence

Aptitude Tests are invalid when administered with individuals whose primary language is

not English. (Id.). In such cases, Jasinski testified, and the ALJ agreed, IQ scores tend to run

10 to 15 points below actual abilities. (Id.). Accordingly, the ALJ adopted Jasinski’s

conclusion that Hernandez did not meet the criteria for a diagnosis of mental retardation.

(Id.). 

On appeal, Plaintiffs point out that after hearing Hernandez’s testimony about her

English language usage, Dr. Jasinski testified that he would find Plaintiff’s IQ scores, as

measured by Biegen, to be “more valid,” and that if the scores were assumed valid,

Hernandez’s impairments would equal Listing 12.05(C). (Doc. 46). Nevertheless, nothing

from the record definitively demonstrates that this resulted in Dr. Jasinksi changing his

opinion that the test was, in the end, invalid in light of Plaintiff’s primary language being

Spanish. It is possible that the ALJ could have rationally interpreted Jasinski’s statement to

mean that while more valid than what he considered them before learning the extent of

Hernandez’s English skills, the scores still remained invalid because Spanish is, as

Hernandez confirmed, her primary language. (R. at 474, 485). However, because the ALJ

does not explicitly address Dr. Jasinski’s equivocal testimony, in particular his ambiguous

statement with respect to the IQ scores being “more valid,” the validity of the scores remains

unclear to this Court. Accordingly, we remand for consideration of whether Hernandez’s IQ

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scores were valid in light of Dr. Jasinski’s ambiguous testimony. See Andrews, 53 F.3d at

1039 (finding, in part, that the ALJ is responsible for resolving ambiguities). 

Despite finding that the IQ scores were invalid, the ALJ nevertheless went on to

consider if Hernandez suffered from any significant work-related limitation of function for

the purposes of 12.05(C) or any of the four adaptive functioning criteria under 12.05(D).

With respect to the work-related limitation of function under 12.05(C), the ALJ adopted Dr.

Jasinski’s testimony that Hernandez “had the ability to respond appropriately to supervision

and co-workers.” (R. at 22). He noted that even though her “primary job duty should not

require social interaction” and that she should be “restricted from complicated/detailed

work,” Hernandez “could use basic judgment and sustain basic concentration through an

eight hour workday and maintain pace.” (Id.). He also noted that her tasks did not have to be

repetitive in nature so long as they were not constantly changing either. (Id.). With respect

to the four criteria under 12.05(D), the ALJ was persuaded that Plaintiff had a mild

restriction of daily activities, moderate restriction in social functioning, moderate difficulties

maintaining concentration, persistence and pace, and no evidence of episodes of

decompensation of extended duration. (R. at 22, 25–26). Thus, the ALJ concluded that

Hernandez did not satisfy the 12.05(D) criteria, which require marked difficulty or restriction

with respect to the first three adaptive functioning indicators, and repeated episodes of

decompensation, each of extended duration. 

In addition to considering Dr. Jasinski’s testimony in her step three analysis, the ALJ

noted that examining psychologists Watkins and Salk estimated that Hernandez’s intelligence

fell in the borderline to low average range, and that her medical doctors have not reported

that she suffers from mental retardation. (R. at 22). The ALJ took account of the fact that

Hernandez has been able to care for her children, in particular the four youngest with whom

she lives. (R. at 22, 25). Plaintiff also “performs her self-care skills independently, cleans the

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5

 It was reasonable for the ALJ to be unpersuaded by the inconsistent statements of

Plaintiff’s daughter, friend, and neighbor regarding Hernandez’s social functioning when

the inconsistencies were combined with relatively weak medical evidence as well. (R. at 23).

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house, waters the plants, prepares meals, shops and does light laundry.” (R. at 25).5

 She

spends leisure time visiting friends, watching television, and visiting with her mother. (Id.).

Further, Hernandez has sufficient concentration to be able to drive and manage bills. (Id.).

The ALJ also observed that Hernandez did not demonstrate any difficulty attending the

proceedings or answering questions during the hearing. (R. at 26). 

Nevertheless, the Ninth Circuit suggests that the fact that Hernandez repeated the

fourth grade, received poor grades in school, and did not attend high school was evidence

from which the ALJ could conclude that Plaintiff met the requirements of Listing 12.05.

(Doc. 42). The Ninth Circuit noted that these characteristics could suggest an early onset of

low mental functioning, specifically a manifestation of mental impairments before age 22,

as required by Listing 12.05. Because the ALJ does not consider whether these

characteristics satisfy the work-related limitation of function requirement under 12.05(C) or

the adaptive functioning criteria under 12.05(D), the Court remands for further proceedings.

Specifically, we remand for a determination of whether the requirements of 12.05(C) and/or

(D) are met in light of elements that could suggest that Plaintiff’s “subaverage general

intellectual functioning with deficits in adaptive functioning initially manifested during [her]

developmental period.” 

III. Remedy

Having decided to vacate the ALJ’s decision, the Court has the discretion to remand

the case either for further proceedings or for an award of benefits. See Reddick v. Chater, 157

F.3d 715, 728 (9th Cir. 1998). The rule in this Circuit is that a remand for an award of

benefits is appropriate in cases where there are no outstanding issues that must be resolved

and it is clear from the record that the ALJ would be required to award benefits. See id. In

this case, the ALJ erred at step three by not clarifying whether Hernandez’s IQ scores were

valid in light of Dr. Jasinski’s equivocal testimony, and whether the criteria under 12.05(C)

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or (D) were met in light of evidence that could suggest early onset of low mental functioning.

Because it is uncertain how the ALJ will resolve these issues, it is not clear from the record

that the ALJ would be required to award benefits. Therefore, the Court will remand the case

for further proceedings consistent with this Order. 

CONCLUSION

The ALJ’s step-three finding is unclear with respect to Listing 12.05. It is unclear to

the Court whether Plaintiff’s IQ scores are valid in light of Dr. Jasinski’s equivocal

testimony. It is also unclear to the Court whether the criteria under 12.05(C) and/or (D) are

met in light of evidence which could suggest Plaintiff’s early maladaptive functioning and

low intellectual functioning, including repetition of the fourth grade, poor grades, and

achieving no higher than an eighth grade education.

Furthermore, consistent with the Court’s September 5, 2008 Order, the ALJ made a

legal error at step five by failing to inquire into and explain conflicts between the vocational

expert’s testimony and the DOT’s statement that certain jobs required physical abilities

beyond Plaintiff’s residual functional capacity. (Doc. 31, vacated on other grounds). Because

both errors were not harmless, the ALJ’s decision must be vacated and the case must be

remanded for further proceedings.

IT IS THEREFORE ORDERED that the ALJ’s decision is VACATED.

IT IS FURTHER ORDERED that the Clerk of the Court is directed to REMAND

for further proceedings.

DATED this 24th day of November, 2010.

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