Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_14-cv-02364/USCOURTS-azd-2_14-cv-02364-0/pdf.json

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

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WO 

IN THE UNITED STATES DISTRICT COURT 

FOR THE DISTRICT OF ARIZONA 

Alejandro Bermudez, 

Plaintiff, 

v. 

Carolyn W. Colvin, Acting Commissioner 

of Social Security, 

Defendant. 

No. CV-14-02364-PHX-NVW 

ORDER 

Plaintiff Alejandro Bermudez seeks review under 42 U.S.C. § 405(g) of the final 

decision of the Commissioner of Social Security (“the Commissioner”), which denied 

him disability insurance benefits under sections 216(i) and 223(d) of the Social Security 

Act. Because the decision of the Administrative Law Judge (“ALJ”) is supported by 

substantial evidence and is not based on legal error, the Commissioner’s decision will be 

affirmed. 

I. BACKGROUND 

A. Factual Background 

Plaintiff lives in Surprise, Arizona. He was born in February 1961 and was 48 

years old on the alleged disability onset date, November 1, 2009. He previously worked 

as a construction superintendent, has at least a high school education, and speaks English. 

He injured his back when he was 20 years old, but he does not recall any incident causing 

his current lower back pain. Before November 1, 2009, he worked building walls for 

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houses and had to leave early most days because of back pain. After a month or so, he 

was told there was no work and he was laid off. He is obese and has been diagnosed with 

degenerative disc disease of the lumbar spine. He has received treatment at the Arizona 

Neurological Institute and the Banner Boswell Medical Center in Sun City, Arizona. 

B. Procedural History 

On August 4, 2011, Plaintiff applied for disability insurance benefits and 

supplemental security income, alleging disability beginning November 1, 2009. On April 

15, 2013, he appeared with his attorney and testified at a hearing in Phoenix, Arizona, 

before the ALJ. A vocational expert also testified. During the hearing, Plaintiff’s 

counsel requested that a post-hearing orthopedic consultative examination be performed. 

Subsequently, the requested examination was performed by Jeffrey Levison, M.D. Dr. 

Levison’s evaluation and medical source statement were provided to Plaintiff and his 

counsel for an opportunity to respond, however, no response was received by the ALJ. 

On July 11, 2013, the ALJ issued a decision that Plaintiff was not disabled within 

the meaning of the Social Security Act. The Appeals Council denied Plaintiff’s request 

for review of the hearing decision, making the ALJ’s decision the Commissioner’s final 

decision. On October 24, 2014, Plaintiff sought review by this Court. 

II. STANDARD OF REVIEW 

The district court reviews only those issues raised by the party challenging the 

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

may set aside the Commissioner’s disability determination only if the determination is 

not supported by substantial evidence or is based on legal error. Orn v. Astrue, 495 F.3d 

625, 630 (9th Cir. 2007). Substantial evidence is more than a scintilla, less than a 

preponderance, and relevant evidence that a reasonable person might accept as adequate 

to support a conclusion considering the record as a whole. Id. As a general rule, 

“[w]here the evidence is susceptible to more than one rational interpretation, one of 

which supports the ALJ’s decision, the ALJ’s conclusion must be upheld.” Thomas v. 

Barnhart, 278 F.3d 947, 954 (9th Cir. 2002) (citations omitted); accord Molina v. Astrue, 

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674 F.3d 1104, 1111 (9th Cir. 2012) (“Even when the evidence is susceptible to more 

than one rational interpretation, we must uphold the ALJ’s findings if they are supported 

by inferences reasonably drawn from the record.”). 

Harmless error principles apply in the Social Security Act context. Molina v. 

Astrue, 674 F.3d 1104, 1115 (9th Cir. 2012). An error is harmless if there remains 

substantial evidence supporting the ALJ’s decision and the error does not affect the 

ultimate nondisability determination. Id. The claimant usually bears the burden of 

showing that an error is harmful. Id. at 1111. 

III. FIVE-STEP SEQUENTIAL EVALUATION PROCESS 

To determine whether a claimant is disabled for purposes of the Social Security 

Act, the ALJ follows a five-step process. 20 C.F.R. § 404.1520(a). The claimant bears 

the burden of proof on the first four steps, but the burden shifts to the Commissioner at 

step five. Tackett v. Apfel, 180 F.3d 1094, 1098 (9th Cir. 1999). 

At the first step, the ALJ determines whether the claimant is engaging in 

substantial gainful activity. 20 C.F.R. § 404.1520(a)(4)(i). If so, the claimant is not 

disabled and the inquiry ends. Id. At step two, the ALJ determines whether the claimant 

has a “severe” medically determinable physical or mental impairment. 

§ 404.1520(a)(4)(ii). If not, the claimant is not disabled and the inquiry ends. Id. At step 

three, the ALJ considers whether the claimant’s impairment or combination of 

impairments meets or medically equals an impairment listed in Appendix 1 to Subpart P 

of 20 C.F.R. Pt. 404. § 404.1520(a)(4)(iii). If so, the claimant is automatically found to 

be disabled. Id. If not, the ALJ proceeds to step four. At step four, the ALJ assesses the 

claimant’s residual functional capacity and determines whether the claimant is still 

capable of performing past relevant work. § 404.1520(a)(4)(iv). If so, the claimant is not 

disabled and the inquiry ends. Id. If not, the ALJ proceeds to the fifth and final step, 

where he determines whether the claimant can perform any other work based on the 

claimant’s residual functional capacity, age, education, and work experience. 

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§ 404.1520(a)(4)(v). If so, the claimant is not disabled. Id. If not, the claimant is 

disabled. Id. 

At step one, the ALJ found that Plaintiff meets the insured status requirements of 

the Social Security Act through March 31, 2014, and that he has not engaged in 

substantial gainful activity since November 1, 2009. At step two, the ALJ found that 

Plaintiff has the following severe impairments: obesity and degenerative disc disease of 

the lumbar spine. At step three, the ALJ determined that Plaintiff does not have an 

impairment or combination of impairments that meets or medically equals an impairment 

listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. 

At step four, the ALJ found that Plaintiff “has the residual functional capacity to 

perform the full range of medium work as defined in 20 CFR 404.1567(c).” “Medium 

work involves lifting no more than 50 pounds at a time with frequent lifting or carrying 

of objects weighing up to 25 pounds.” 20 C.F.R. § 404.1567(c). If someone can do 

medium work, he can also do sedentary and light work. Id. The ALJ further found that 

Plaintiff is capable of performing past relevant work as a construction superintendent. At 

step five, the ALJ alternatively concluded that, considering Plaintiff’s age, education, 

work experience, and residual functional capacity, there are jobs that exist in significant 

numbers in the national economy that Plaintiff can also perform. 

IV. ANALYSIS 

A. The ALJ Did Not Err in Giving Little Weight to the Medical Statement 

by Terrie Pasch. 

Under 20 C.F.R. § 404.1513(a), only licensed physicians, licensed or certified 

psychologists, licensed optometrists, licensed podiatrists, and qualified speech-language 

pathologists are considered “acceptable medical sources.” Molina v. Astrue, 674 F.3d 

1104, 1111 (9th Cir. 2012). “Other sources” are not entitled to the same deference as 

“acceptable medical sources.” Id. The ALJ may discount testimony from “other 

sources” if the ALJ gives reasons germane to the witness for doing so. Id. Under 20 

C.F.R. 404.1513(d), “other sources” include nurse practitioners and physicians’ 

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assistants. Information from “other sources” cannot establish the existence of a 

medically determinable impairment, but the information “may be based on special 

knowledge of the individual and may provide insight into the severity of the 

impairment(s) and how it affects the individual’s ability to function.” SSR 06-03p, 2006 

WL 2329939. 

Plaintiff contends the ALJ erred by affording “little weight” to the November 7, 

2012 Medical Statement Regarding Spine Disorders for Social Security Disability Claim 

completed by Terrie Pasch, whom he refers to as his “treating nurse practitioner.” On the 

medical statement, however, she identifies herself as a physicians’ assistant. Moreover, 

despite the ALJ’s reference to her as a “treating provider” and inconsistencies “with her 

own treatment records,” neither the parties nor the ALJ cite to any treatment records or 

other evidence showing that Ms. Pasch ever treated Plaintiff. The heading on the form 

represents it came from Freedom Disability, The Social Security Disability Experts, with 

a Connecticut address, and the record lacks any evidence that Plaintiff received treatment 

from Ms. Pasch or anyone in Connecticut. 

Assuming Ms. Pasch actually treated Plaintiff, however, she is not an acceptable 

medical source, and the Medical Statement Regarding Spine Disorders for Social 

Security Disability Claim is not entitled to greater weight than opinions of acceptable 

medical sources as Plaintiff contends. Ms. Pasch opined that Plaintiff can stand 15 

minutes at one time and sit 15 minutes at one time. She did not respond regarding the 

total amount of time he can stand in a workday or the total amount of time he can sit in a 

workday. She opined that Plaintiff can lift 5 pounds on an occasional basis and 5 pounds 

on a frequent basis but can never bend or stoop. She indicated that Plaintiff suffered 

from pain that is moderate, and objective signs of pain are tenderness to palpation and 

limitation of motion. She further opined that Plaintiff will frequently need unscheduled 

interruptions of work routine to alleviate pain during the day and will probably frequently 

miss work due to exacerbations of pain. The ALJ identified the following reasons for 

giving the Medical Statement little weight: (1) the opinions regarding exertional 

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activities did not indicate how long Plaintiff can do these activities in an 8-hour day; (2) 

assessment of “moderate” pain is unhelpful because “moderate” is undefined; and (3) it is 

inconsistent with treatment records indicating the claimant’s condition is stable and wellcontrolled. These reasons are germane to the Medical Statement and supported by 

substantial evidence. 

Moreover, Plaintiff has not satisfied his burden to prove that this source has 

“special knowledge of the individual.” He has not identified any evidence in the record 

showing any basis for the source’s knowledge of Plaintiff’s functional limitations. 

B. The ALJ Did Not Err in Evaluating Plaintiff’s Credibility. 

In evaluating the credibility of a claimant’s testimony regarding subjective pain or 

other symptoms, the ALJ is required to engage in a two-step analysis: (1) determine 

whether the claimant presented objective medical evidence of an impairment that could 

reasonably be expected to produce some degree of the pain or other symptoms alleged; 

and, if so with no evidence of malingering, (2) reject the claimant’s testimony about the 

severity of the symptoms only by giving specific, clear, and convincing reasons for the 

rejection. Vasquez v. Astrue, 572 F.3d 586, 591 (9th Cir. 2009). 

In making a credibility determination, an ALJ “may not reject a claimant’s 

subjective complaints based solely on a lack of objective medical evidence to fully 

corroborate the claimant’s allegations.” Bray v. Comm’r of Soc. Sec. Admin., 554 F.3d 

1219, 1227 (9th Cir. 2009) (internal quotation marks and citation omitted). But “an ALJ 

may weigh inconsistencies between the claimant’s testimony and his or her conduct, 

daily activities, and work record, among other factors.” Id. The ALJ must make findings 

“sufficiently specific to permit the court to conclude that the ALJ did not arbitrarily 

discredit claimant’s testimony.” Thomas v. Barnhart, 278 F.3d 947, 958 (9th Cir. 2002); 

accord Tommasetti v. Astrue, 533 F.3d 1035, 1039 (9th Cir. 2008). 

First, the ALJ found that Plaintiff’s medically determinable impairments could 

reasonably be expected to cause the alleged symptoms. Second, the ALJ found 

Plaintiff’s statements regarding the intensity, persistence, and limiting effects of the 

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symptoms not credible to the extent they are inconsistent with the ALJ’s residual 

functional capacity assessment. 

Plaintiff alleges that his disability began on November 1, 2009. On February 15, 

2010, Plaintiff’s prescription for Percocet was renewed for chronic back pain, and 

examination by a treating medical provider revealed “moderate lower lumbar tenderness 

without radiation.” On April 9, 2010, Plaintiff’s prescription for Percocet was refilled, 

and Plaintiff reported he had been having more back pain and had to use more medication 

recently. He also reported that he normally sleeps well. On June 29, 2010, Plaintiff 

reported he had had a significant increase in back pain since he helped someone unload 

concrete blocks five days before. He was prescribed Percocet and referred to a pain 

management specialist. On August 16, 2010, Plaintiff reported that Percocet generally 

gives him enough relief to carry on a somewhat normal life, and the nurse practitioner 

described his lower back pain as “normally well controlled by the Percocet.” On 

September 17, 2010, Plaintiff was “encouraged to be as active as he can and also to 

consider the possibility of going to pain management for his back pain.” On October 18, 

2010, Plaintiff saw the nurse practitioner for a refill of Percocet, and she noted that “he 

feels that he is stable and doing well but certainly could not maintain a normal life 

without having the medication to ease his back pain.” Plaintiff reported that he “mostly 

sleeps well if he has his pain medication.” 

On July 5, 2011, Dr. Jeranfel Hernandez changed Plaintiff’s prescription from 

Percocet to Vicodin, noted that Plaintiff had missed his appointment with a pain 

management specialist, and advised Plaintiff to keep the appointment rescheduled for 

August 2011. On August 10, 2011, Plaintiff was seen by Dr. Lawrence Kutz of the 

Arizona Neurological Institute for evaluation of back pain. On September 6, 2011, and 

again on October 4, 2011, Dr. Kutz performed a bilateral lumbar selective nerve root 

block at L5 at the Banner Boswell Medical Center. 

On October 10, 2011, Plaintiff completed an Exertional Daily Activities 

Questionnaire in which he stated that he is not able to do very much because his lower 

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back pain prevents him from bending over, and he cannot run, walk for more than five 

minutes, lift more than five pounds, or get a good night’s sleep. He said his lower back 

pain also makes his legs hurt. He reported that on an average day he watches television, 

goes outside for a while, and eats. He also reported that he does his own grocery 

shopping weekly and can drive a car for approximately 20 minutes before getting lower 

back pressure. He said that he does not do any activities outside of his home and he does 

no household chores except microwave cooking. He reported that he must lie down for 

about 30 minutes every two or three hours. The only medication he identified was one 

“acetaminophen 5-500” tablet two times per day, which likely refers to a combination of 

5 mg hydrocodone and 500 mg acetaminophen, a generic form of Vicodin. 

On November 17, 2011, Plaintiff rated his chronic low back pain at 7/10 and 

reported to Dr. Kutz that his leg symptoms had resolved after the epidurals. Dr. Kutz 

noted that Plaintiff walked without difficulty, had no apparent distress, and had not 

attended physical therapy. Dr. Kutz encouraged Plaintiff to do home exercises. On 

December 13, 2011, Dr. Kutz performed bilateral lumbar facet joint nerve ablations at 

L4-5 and L5-S1. 

On February 9, 2012, Plaintiff reported to psychologist Carl Mansfield, Ph.D., that 

he does light cooking, such as preparing sandwiches and frozen foods, and is able to do 

lighter household chores, such as washing dishes and dusting. He said that he does his 

own laundry and some raking and lawn mowing with short breaks. He reported that his 

brother takes him grocery shopping once or twice a week, and he does not use an electric 

scooter in the store. He also reported that he walks his dog for a block and tries to do it 

three times daily. He said he watches television, reads magazines, sometimes listens to 

music, and enjoys sitting outside. Plaintiff also said he performs self-care independently, 

but it is sometimes painful. 

On April 18, 2012, Dr. Kutz’s notes state that Plaintiff obtained moderate relief 

from the facet joint nerve ablation. He experienced a significant increase in pain for 

approximately three days with “near complete relief” for three to four weeks and then a 

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gradual increase of pain over the next several months. Physical examination revealed 

moderate tenderness of the lumbar spine. Dr. Kutz recommended stretching exercises. 

On August 17, 2012, Dr. Kutz performed a bilateral sacral selective nerve root block at 

S1. 

On April 15, 2013, Plaintiff testified that pain medication reduces the severity of 

his pain about 30%. He said that after he received injections, he could not walk for about 

three days, and then his pain would improve for about three weeks. He also testified that 

his legs hurt all of the time, and he would be able to sit in an office chair for only 15 

minutes before he would need to get up and walk for about five minutes before sitting 

down again. He testified that leg and back pain prevents him from sleeping well at night 

so he takes a nap for an hour or two during the daytime. He said he lives with his parents 

and does no household chores except occasionally washing a dish he has used. 

The ALJ found Plaintiff’s statements concerning the intensity, persistence, and 

limiting effects of his symptoms not entirely credible not only because they were not 

corroborated by objective medical evidence, such as X-rays and MRIs, but also because 

clinical findings, including physical examinations, documented only minimal 

abnormalities, and treatment records indicate pain medication and other treatments 

permitted Plaintiff to function somewhat normally. The ALJ noted that although Plaintiff 

testified that he experiences side effects from his medications, treatment records did not 

show that he had reported side effects to his treatment providers. The ALJ also found his 

delay in seeking pain management treatment and his failure to attend prescribed physical 

therapy indicate Plaintiff’s pain was not as severe as he alleges. Further, the ALJ said 

that Plaintiff’s credibility was impugned by admissions that he was “let go” from his last 

job, received unemployment insurance benefits, looked for work after his last work ended 

in November 2009, exercised by walking two or three times per week, had helped a 

friend unload concrete blocks, and had helped a friend with “some work.” Thus, 

substantial evidence supports finding that the ALJ provided specific, clear, and 

convincing reasons for discrediting Plaintiff’s subjective symptom testimony. 

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C. The ALJ Did Not Err in Her Examination of the Vocational Expert. 

“An ALJ may use the testimony of a vocational expert to determine whether the 

claimant can perform past relevant work.” Ghanim v. Colvin, 763 F.3d 1154, 1166 (9th 

Cir. 2014). An ALJ may rely on a vocational expert’s testimony that is based on a 

hypothetical that contains all of the limitations the ALJ found credible and supported by 

substantial evidence in the record. Id. 

Here, the ALJ posed a hypothetical with limitations based on the physical residual 

functional capacity assessment prepared by the state agency reviewing physician on 

reconsideration, Ernest Griffith, M.D. The ALJ included three environmental limitations 

(i.e., extreme cold, vibration, and hazards) as described by Dr. Griffith: “Avoid 

concentrated exposure.” Dr. Griffith did not explain what he meant by “concentrated 

exposure,” and it is not apparent how an individual could have “concentrated exposure” 

to extreme cold, vibrations, or hazards such as machinery or heights. When the 

vocational expert questioned the meaning of “concentrated exposure,” the ALJ tried to 

give the phrase some reasonable meaning and reframed the hypothetical to include 

“occasional exposure.” However, the ALJ must not have found the environmental 

limitations to be credible and supported by substantial evidence in the record because she 

did not include any in the residual functional capacity assessment. Therefore, how the 

ALJ presented environmental limitations in the hypothetical posed to the vocational 

expert is immaterial. 

D. “New” Evidence Regarding Consultative Examining Physician Jeffrey 

Levison, M.D., Does Not Warrant Remand. 

During the April 15, 2013 hearing, Plaintiff’s counsel requested that a posthearing orthopedic consultative examination be performed. On May 8, 2013, Jeffrey 

Levison, M.D., examined Plaintiff and prepared a Medical Source Statement of Ability to 

Do Work-Related Activities (Physical). Dr. Levison’s evaluation and medical source 

statement were provided to Plaintiff and his counsel for an opportunity to respond, 

however, no response was received by the ALJ. The ALJ afforded “more weight” to Dr. 

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Levison’s opinion than to the opinions of the state agency reviewing consultants because 

he was able to personally examine Plaintiff and his examination was more current. 

Dr. Levison reported that he reviewed medical records but did not see any 

objective diagnostic testing results regarding Plaintiff’s alleged bulging/herniated discs.1

 

He also reported that Plaintiff said he was “not taking any medications whatsoever.” 

Upon examination, Dr. Levison noted Plaintiff had “moderate callouses over either 

hand.” Dr. Levison reported “no palpation or percussion tenderness of the spine” and 

“full range of motion about the cervical, thoracic, and lumbar spine.” Dr. Levison 

observed Plaintiff “bending at the waist applying and removing his shoes without 

difficulty or evidence of pain or limitations” and sitting “in a seated position bringing his 

knees up to his chest and then crossing his legs in order to tie his shoes” “without 

significant evidence of pain or limitation.” Lumbrosacral spine X-rays were performed at 

the time of Dr. Levison’s examination, which showed “very minor and minimal 

degenerative changes at L2 through L4,” “very minor and mild anterior osteophyte 

formation at T12/L1,” and normal disc heights throughout the thoracolumbar spine. Dr. 

Levison said that Plaintiff reported low back pain, but “is likely markedly exaggerating 

his condition and limitations.” Dr. Levison opined that Plaintiff has no physical 

functional limitations except for lifting/carrying more than 50 pounds no more than 

occasionally. 

Plaintiff contends that remand is necessary because “new” and “material” 

evidence gives rise to a “reasonable possibility” that the ALJ would not have given “more 

 1

 Plaintiff incorrectly contends Dr. Levison’s failure to see objective diagnostic 

testing results in the records demonstrates that he did not sufficiently review the medical 

records. Plaintiff does not cite to any objective diagnostic testing results in the medical 

records and relies (without citation) only on Plaintiff’s reports of pain to his doctors. 

Plaintiff also contends that Dr. Kutz referred to an MRI, which Dr. Kutz described as 

showing a “small L4/5 disc protrusion, spondylosis with mild spinal stenosis.” Dr. 

Levison did not overlook the MRI because it was not in the record, and he ordered and 

reviewed the results of an X-ray performed the same day as his examination, which also 

showed only minor and minimal degenerative changes. 

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weight” to Dr. Levison’s opinion if she had considered two prior licensing Advisory 

Letters. Plaintiff has submitted to the Court a letter from the Arizona Medical Board 

dated April 6, 2012, stating that during a public meeting on April 4, 2012, the Board 

voted to issue Dr. Levison an “Advisory Letter for inadequate medical records and for 

prescribing testosterone refills without performing a physical examination.” It also 

states, “This matter does not rise to the level of discipline.” Plaintiff also submitted to the 

Court a letter from the Arizona Medical Board dated February 27, 2004, stating that “the 

Board voted to issue Dr. Levison an Advisory Letter for obtaining inadequate history of a 

patient in an urgent care setting.” It also states, “The violation is a technical violation 

that is not of sufficient merit to warrant disciplinary action.” Neither letter provides any 

basis for questioning Dr. Levison’s competence in performing a physical examination or 

in understanding a radiologist’s report of X-ray results. 

Upon judicial review of a final decision of the Commissioner of Social Security, 

the court has the power to enter a judgment affirming, modifying, or reversing the 

decision, with or without remanding the cause for a rehearing, under sentence four of 42 

U.S.C. § 405(g). The court has discretion to reverse and remand either for an award of 

benefits or for further administrative proceedings only if the ALJ’s decision is not 

supported by substantial evidence or suffers from legal error. Smolen v. Chater, 80 F.3d 

1273, 1292 (9th Cir. 1996). The Court may not remand this case under sentence four of 

42 U.S.C. § 405(g) because the ALJ’s decision is supported by substantial evidence and 

is not based on legal error. 

Under sentence six of 42 U.S.C. § 405(g), the court “may at any time 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 in a prior proceeding.” The 

two Advisory Letters are not new evidence because they existed before Dr. Levison 

examined Plaintiff and before the ALJ issued her decision. Regardless of whether 

Plaintiff had good cause for not submitting the Advisory Letters to the ALJ in response to 

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Dr. Levison’s opinion, the Advisory Letters are not material because they do not bear 

directly and substantially on the matter in dispute. See Luna v. Astrue, 623 F.3d 1032, 

1034 (9th Cir. 2010). Therefore, this matter may not be remanded for the Commissioner 

to consider the two Advisory Letters. 

IT IS THEREFORE ORDERED that the final decision of the Commissioner of 

Social Security is affirmed. The Clerk shall enter judgment accordingly and shall 

terminate this case. 

Dated this 29th day of April, 2015. 

Neil V. Wake

United States District Judge

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