Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_15-cv-00223/USCOURTS-azd-2_15-cv-00223-0/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 (SSID)

---

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

WO 

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Casondra Kelsay, 

Plaintiff, 

v. 

Carolyn W. Colvin, 

Defendant.

No. CV-15-00223-PHX-GMS

ORDER 

 Pending before the Court is the appeal of Plaintiff Casondra Kelsay, which 

challenges the Social Security Administration’s decision to deny benefits. (Doc. 13.) For 

the reasons set forth below, the Court vacates that decision and remands for further 

consideration. 

BACKGROUND 

 On July 8, 2011, Kelsay filed an application for supplemental security income, 

alleging a disability onset date of December 31, 2005. (Tr. 174.) After Kelsay’s claim 

was denied initially and on reconsideration, she requested a hearing, which the ALJ held 

on June 27, 2013. (Tr. 41-65.) At the hearing, Kelsay’s disability onset date was 

amended to May 19, 2011. (Tr. 45.) On August 30, 2013, the ALJ issued a decision 

finding Kelsay not disabled. (Tr. 22-38.) 

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

sequential evaluation for determining disability.1

 (Id.) At step one, the ALJ determined 

 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: 

Case 2:15-cv-00223-GMS Document 20 Filed 04/04/16 Page 1 of 8
- 2 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

that Kelsay “has not engaged in substantial gainful activity since May 9, 2011, the 

amended alleged onset date.” (Tr. 27.) At step two, the ALJ determined that Kelsay 

suffered from the severe impairments of chronic pain syndrome, lumbago status post 

osteomyelitis and shunt, degenerative disc disease, blind in left eye, borderline diabetes, 

bronchitis and lupus. (Id.) At step three, the ALJ determined that none of these 

impairments, either alone or in combination, met or equaled any of the Social Security 

Administration’s listed impairments. (Tr. 28.) 

 At that point, the ALJ made a determination of Kelsay’s residual functional 

capacity (“RFC”),2

 concluding that Kelsay could “perform the full range of sedentary 

work as defined in 20 CFR 404.1567(a) and 416.967(a).” (Tr. 28.) The ALJ thus 

determined at step four that Kelsay could perform her past relevant work as a 

telemarketer. (Tr. 32.) Thus, the ALJ did not proceed to step five. Given this analysis, 

the ALJ concluded that Kelsay was not disabled. (Tr. 33.) 

 The Appeals Council declined to review the decision. (Tr. 1-6.) Kelsay filed the 

complaint underlying this action on February 9, 2015, seeking this Court’s review of the 

 

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 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

 RFC is the most a claimant can do despite the limitations caused by her impairments. See S.S.R. 96-8p (July 2, 1996). 

Case 2:15-cv-00223-GMS Document 20 Filed 04/04/16 Page 2 of 8
- 3 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

ALJ’s denial of benefits.3 (Doc. 1.) The matter is now fully briefed before this Court. 

(Doc. 13, 17, 18.) 

DISCUSSION

I. Standard of Review 

 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 disability benefits only if that denial is 

either unsupported by substantial evidence or based on legal error. Thomas v. Barnhart, 

278 F.3d 947, 954 (9th Cir. 2002). “Substantial” evidence amounts to “more than a 

scintilla but less than a preponderance.” Id. (quotation omitted). “Substantial evidence 

is relevant evidence which, considering the record as a whole, a reasonable person might 

accept as adequate to support a conclusion.” Id. (quotation omitted). 

 Here, Defendant Commissioner of Social Security concedes that the ALJ erred in 

evaluating Kelsay’s application. (Doc. 17 at 2.) The parties disagree only as to whether 

the Court should remand for further proceedings or for an award of benefits. As such, the 

sole issue before this Court is remedy. 

II. Remedy 

 Kelsay requests that the Court remand her case for an award of benefits. (Doc. 13 

at 10-11.) Remanding for an award of benefits is proper in certain circumstances 

pursuant to the Ninth Circuit’s “credit-as-true rule,” under which the Court should 

remand for benefits where: 

(1) the record has been fully developed and further administrative proceedings would serve no useful purpose; (2) the ALJ has failed to provide legally sufficient reasons for rejecting evidence, whether claimant testimony or medical opinion; and (3) if the improperly discredited evidence were credited as true, the ALJ would be required to find the claimant disabled on remand. 

Garrison v. Colvin, 759 F.3d 995, 1020 (9th Cir. 2014). If these three criteria are 

 

3

 Kelsay has authority to file this action pursuant to 42 U.S.C. § 405(g) (“Any individual, after any final decision of the Commissioner of Social Security made after a hearing to which he was a party . . . may obtain a review of such decision by a civil action . . . .”). 

Case 2:15-cv-00223-GMS Document 20 Filed 04/04/16 Page 3 of 8
- 4 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

satisfied and the Court determines that “the record, taken as a whole, leaves not the 

slightest uncertainty as to the outcome of the proceeding,” the Court may exercise its 

“discretion to depart from the ordinary remand rule.” Treichler v. Comm’r of Soc. Sec. 

Admin., 775 F.3d 1090, 1101 (9th Cir. 2014). 

 Ninth Circuit precedent “foreclose[s] the argument that a remand for the purpose 

of allowing the ALJ to have a mulligan qualifies as a remand for a ‘useful purpose’ under 

the first part of credit-as-true analysis.” Id. at 1021; see also Benecke v. Barnhart, 379 

F.3d 587, 595 (9th Cir. 2004) (“Allowing the [ALJ] to decide the issue again would 

create an unfair ‘heads we win; tails, let’s play again’ system of disability benefits 

adjudication.”). Therefore, “where there are no outstanding issues that must be resolved 

before a proper disability determination can be made, and where it is clear from the 

administrative record that the ALJ would be required to award benefits if the [improperly 

discredited evidence] were credited,” a reviewing court “will not remand solely to allow 

the ALJ to make specific findings regarding that [evidence].” Varney v. Sec’y of Health 

& Human Servs., 859 F.2d 1396, 1401 (9th Cir. 1988). 

 Nonetheless, any “significant factual conflict in the record . . . should be resolved 

through further proceedings on an open record before a proper disability determination 

can be made.” Brown-Hunter v. Colvin, 806 F.3d 487, 495-96 (9th Cir. 2015). Courts 

must “assess whether there are outstanding issues requiring resolution before considering 

whether to hold that the claimant’s testimony is credible as a matter of law.” Id. at 1105; 

see also Dominguez v. Colvin, 808 F.3d 403, 407 (9th Cir. 2015), as amended (Feb. 5, 

2016) (“If the district court does determine that the record has been fully developed, and 

there are no outstanding issues left to be resolved, the district court must next consider 

[the third step of the credit-as-true analysis].” (emphasis added) (citations omitted)). A 

significant factual conflict is an outstanding issue requiring resolution through further 

proceedings. Treichler, 775 F.3d at 1101 (“Where there is conflicting evidence, and not 

all essential factual issues have been resolved, a remand for an award of benefits is 

inappropriate.”). 

Case 2:15-cv-00223-GMS Document 20 Filed 04/04/16 Page 4 of 8
- 5 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

 The credit-as-true rule should not be applied where “the record raises crucial 

questions as to the extent of [a claimant’s] impairment given inconsistencies between his 

[or her] testimony and the medical evidence in the record.” Treichler, 775 F.3d at 1105. 

In Brown-Hunter, the Ninth Circuit determined that a remand for benefits was 

inappropriate where medical records undermined the claimant’s allegations that her pain 

was debilitating: “Although medical reports of adequate pain control on medication do 

not foreclose the possibility that” a claimant’s pain is as debilitating as alleged, such 

reports “do create a significant factual conflict in the record that should be resolved 

through further proceedings on an open record before a proper disability determination 

can be made by the ALJ in the first instance.” 806 F.3d at 496. 

 Here, both Kelsay and Defendant Commissioner agree that “the ALJ did not 

adequately consider the credibility of [Kelsay’s] allegations.” (Doc. 17 at 5.) Kelsay 

testified to a level of pain so debilitating that she could not work. In response to the 

ALJ’s questions at the hearing on June 27, 2013, Kelsay testified that her most disabling 

medical problem was her lupus and accompanying joint pain, as well as her back pain, 

which extends down into her left buttock and into her left leg. (Tr. 47-48.) Kelsay also 

noted that she is blind in her left eye. (Tr. 48.) Kelsay testified that she can be on her 

feet for ten to fifteen minutes, that she can sit for thirty to forty-five minutes, that she can 

lift five to ten pounds and can carry a gallon of milk across the kitchen, that she can bend 

but tries to avoid doing so because it causes back pain, and that she cannot kneel or squat. 

(Tr. 49-50.) Kelsay testified that her pain is predominately on the left side of her body 

but sometimes also on the right, although the left side hurts more. (Tr. 51.) She testified 

that bending, cleaning, too much walking, sitting too much, and lifting something heavy 

will make the pain flare up. (Tr. 51-52.) She attempts to manage her pain by getting up 

if she’s sitting down, walking around, and taking medications, but “the pain comes right 

back.” (Tr. 52.) Kelsay testified that her lupus causes her to be “always in pain” and 

“weak,” as well as “sick all the time.” (Id.) She added that she is very limited in what 

she can do. (Id.) 

Case 2:15-cv-00223-GMS Document 20 Filed 04/04/16 Page 5 of 8
- 6 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

 In response to questions from her attorney at the hearing, Kelsay testified that at 

her last job—a part-time position where she worked four hours per day—she had 

difficulties and had to take more breaks than her employer allowed, at least five breaks 

lasting fifteen minutes at a time, during which she would alternate walking around and 

reclining with her feet up. (Tr. 53-54.) She rated her back pain on a scale of one to ten as 

“at least a seven to eight, all the time.” (Tr. 58.) She also testified that, as a side effect 

from one of her medications, Prednisone, she has headaches at least three times per day 

for thirty minutes to an hour per occurrence which cause her to put her head down, close 

her eyes, or put a hot rag over her eyes. (Tr. 54-55.) She further testified that she 

experiences severe headaches if she strains her right eye (the one in which she has vision) 

by reading small print or looking at a computer screen for longer than an hour. (Tr. 58-

59.) She treats these headaches with medication and by resting her eye for at least an 

hour or two before she can read or view a computer screen again. (Tr. 59.) Regarding 

her lupus, Kelsay testified that she experiences flares two to three times per week, 

sometimes lasting all day, and that a flare entails breaking out in hives and joint swelling, 

as well as weakness and sickness. (Tr. 56.) She testified that her children help her with 

cooking and cleaning, that her contributions to household chores take an inordinate 

amount of time to complete, that she sometimes needs help putting shoes and pants on 

(her mother lives with her), and that she is unable to grocery shop on her own because the 

bending and reaching causes too much pain. (Tr. 59-60.) 

 The vocational expert testified that assuming Kelsay’s testimony is believed, there 

is no work she can perform. (Tr. 63.) In reaching a conclusion to the contrary, the ALJ 

determined that Kelsay’s “statements concerning the intensity, persistence and limiting 

effects of these symptoms are not entirely credible.” (Tr. 29.) However, the ALJ failed 

to provide “specific, clear and convincing reasons” for this determination, and therefore 

the ALJ’s decision must be vacated. Brown-Hunter, 806 F.3d at 493. Nonetheless, the 

record contains medical reports in which the limitations doctors gave to Kelsay suggest a 

level of functionality inconsistent with Kelsay’s allegations regarding the intensity of her 

Case 2:15-cv-00223-GMS Document 20 Filed 04/04/16 Page 6 of 8
- 7 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

pain, and these are the kinds of inconsistencies that “should be resolved through further 

proceedings on an open record.” Id. at 496. 

 The report of A. Gomez, MD, dated October 24, 2011, noted that Kelsay’s past 

medical history includes “[b]lindness in the left eye which is congenital, lupus and 

diabetes mellitus diagnosed this year, and arthritis in the lower back.” (Tr. 376.) 

Kelsay’s listed medications included Percocet, ibuprofen, a headache medication, 

Baclofen, and gabapentin. (Id.) Dr. Gomez indicated that Kelsay “began to cry 

following gait/station exam, reportedly due to low back pain from the various tasks 

performed,” and the doctor concluded that she “appears to have discomfort with use of 

her lower back, but otherwise shows minor limitations at this time.” (Tr. 377-78.) Dr. 

Gomez opined that based on his medical assessment (not on Kelsay’s statements of what 

she can do), Kelsay has limitations that would continue for twelve consecutive months, 

including restrictions on lifting and walking due to lumbar arthritis and low back pain, 

with no limitations on sitting. (Tr. 379-80.) Dr. Gomez’s restrictions on lifting and 

walking would not preclude Kelsay from performing sedentary work. The ALJ assigned 

“some limited weight to Dr. Gomez’s opinion,” finding that it did not adequately account 

for Kelsay’s vision problems. (Tr. 30.) 

 The report of Mark Binette, MD, dated August 24, 2012, detailed that Kelsay 

“states that she has a sharp pain in her lumbar back that radiates into her left buttock” and 

that she “continues to be in pain management on medications, which she states does not 

help.” (Tr. 483.) He noted that Kelsay “was diagnosed with lupus in 2011” and that she 

“said that this causes her to be fatigued and have whole body muscle and bone aches and 

pains. She states that it hurts so much that she has a hard time breathing and just has total 

general malaise.” (Id.) During the “straight leg raising” exam, Kelsay reported the 

“sharp pain in her lumbar back radiated into her left buttock.” (Tr. 486.) Dr. Binette 

identified Kelsay’s diagnoses as “chronic back pain” and “lupus.” (Id.) Nonetheless, Dr. 

Binette opined (checking a box) that Kelsay’s condition would not “impose any 

limitations for 12 continuous months.” (Id.) The ALJ assigned “no weight” to Dr. 

Case 2:15-cv-00223-GMS Document 20 Filed 04/04/16 Page 7 of 8
- 8 - 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

Binette’s opinion. (Tr. 30.) 

 These medical reports suggest that the physicians who drafted them believed 

Kelsay’s pain to be less severe and less limiting than Kelsay’s testimony suggests. The 

doctors did not find Kelsay’s pain to be so limiting as to preclude her from working. 

 Because the record is not “free from conflicts, ambiguities, or gaps,” the Court 

remands for further consideration, rather than for benefits. Treichler, 775 F.3d at 1103. 

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

 IT IS FURTHER ORDERED that this case is REMANDED for further 

proceedings. The Clerk of Court is directed to enter judgment accordingly. 

 Dated this 4th day of April, 2016. 

Honorable G. Murray Snow

United States District Judge

Case 2:15-cv-00223-GMS Document 20 Filed 04/04/16 Page 8 of 8