Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-4_07-cv-00432/USCOURTS-azd-4_07-cv-00432-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 28:7422 Appeal from Administrative Decision

---

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 THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

George R. Molitoris, 

Plaintiff, 

vs.

Michael J. Astrue, 

Defendant. 

)

)

)

)

)

)

)

)

)

)

)

)

No. CV 07-432-TUC-CKJ (HCE)

REPORT & RECOMMENDATION

Pending before the Court is Defendant’s Motion to Dismiss for Lack of Subject Matter

Jurisdiction Pursuant to Federal Rule of Civil Procedure 12(b)(1) (Doc. No. 8). Defendant

also submitted a Memorandum of Points and Authorities in support of his Motion to Dismiss

(Doc. No. 9) (hereinafter “Defendant’s Memo.”) For the following reasons, the Magistrate

Judge recommends that the District Court deny Defendant’s Motion to Dismiss.

I. FACTUAL & PROCEDURAL BACKGROUND

Plaintiff, through counsel, has filed the instant action pursuant to 42 U.S.C. 405(g) of

the Social Security Act. (Complaint, p.1 (Doc. No.1))

Case 4:07-cv-00432-CKJ Document 13 Filed 02/19/09 Page 1 of 14
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

1

Plaintiff’s date last insured for disability benefits is June 30, 2003. (Defendant’s

Memo., Ex. 8 (Doc. No. 9-2, p.27))

2

Plaintiff’s attorney at the time signed the Request for Hearing on December 17, 2003;

Plaintiff signed the Request on March 4, 2004; and the Request was ultimately received by

the Social Security Administration on March 5, 2004. (Defendant’s Memo., Ex. 3) Plaintiff’s

present counsel states that Plaintiff’s attorney “at the time timely submitted a Request for

Hearing on December 17, 2003, but failed to provide the Claimant’s signature until March

4, 2004.” (Plaintiff’s Response, Ex. (Doc. No. 12-3, p.2))

- 2 -

Plaintiff protectively filed an application for disability insurance benefits under Title

II of the Social Security Act on June 19, 20031

 (hereinafter “2003 Application” or “2003

claim”). Therein, Plaintiff alleged he was disabled since April 1, 2001 under the Social

Security Act “due to diabetic neuropathy, myasthenia gravis, and double vision.”

(Defendant’s Memo., Ex. 2, 8 (Doc. No. 9-2, pp.9, 27)) Plaintiff’s application was denied

initially on August 15, 2003 and upon reconsideration on December 3, 2003. (Defendant’s

Memo., Ex. 1, 2. 8) In March 2004, Plaintiff requested a hearing before the Administrative

Law Judge (hereinafter “ALJ”).2

 (Defendant’s Memo., Ex. 3). 

On June 4, 2004, ALJ Yvonne K. Stam dismissed Plaintiff’s Request for Hearing

because it was untimely. (Defendant’s Memo., Ex. 4) In so ruling, ALJ Stam stated in

pertinent part:

Despite a delay, of which the attorney was aware, a good cause statement was

not submitted with the late filing. The District Office attempted

unsuccessfully to obtain a statement from the attorney explaining the reason

for the untimely filing of the request for hearing. Accordingly, there is no

good cause to extend the time for filing.

(Id.) Plaintiff did not appeal this dismissal. (Defendant’s Memo., Ex. 8,(Doc. No. 9-2,

p.27)). 

On April 7, 2005, Plaintiff submitted a second application for disability insurance

benefits alleging inability to work since April 1, 2001. (hereinafter “2005 Application” or

“2005 claim”). (See Defendant’s Memo., Ex. 8) Plaintiff claimed disability due to “diabetic

neuropathy, pains on arms, legs and feet, double vision, heart attack, congenital heart failure,

weakness on left side, and...” dragging his left leg when he walks. (Defendant’s Memo., Ex.

Case 4:07-cv-00432-CKJ Document 13 Filed 02/19/09 Page 2 of 14
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

- 3 -

6) The claim was denied initially on September 27, 2005 and upon reconsideration on

January 13, 2006. (Defendant’s Memo., Ex. 5, 6) Thereafter, Plaintiff timely requested a

hearing before an ALJ. (Defendant’s Memo., Ex. 7) 

A hearing took place before ALJ Normal R. Buls on December 20, 2006. (Plaintiff’s

Response, p. 3) On March 16, 2007, ALJ Buls issued an order of dismissal. (Defendant’s

Memo., Ex. 8) The ALJ determined that (1)”the final determination made on the claimant’s

application filed protectively on June 19, 2003, may not be reopened”; and (2) Plaintiff’s

request for hearing was subject to dismissal because the doctrine of res judicata barred such

request. (Defendant’s Memo., Ex. 8, (Doc. No. 9-2, p.28)) The ALJ concluded that “[t]he

determination dated August 18, 2003, remains in effect.” (Id.) 

Plaintiff timely requested review of the ALJ’s decision. (Defendant’s Memo., Ex. .9)

The Appeals Council denied Plaintiff’s request for review. (Defendant’s Memo., Ex. 10)

“The Appeals Council’s denial did not afford Plaintiff any appeal rights.” (Defendant’s

Memo., p. 3 (citing Defendant’s Ex. 10)) 

Plaintiff filed the instant Complaint on August 28, 2007. Plaintiff seeks review of 

the decision of the Appeals Council of the Social Security Administration

denying the Request for Review of the Administrative Law Judge’s decision

in which the ALJ dismissed Plaintiff’s request for a hearing, and decided that

the final determination on Plaintiff’s prior application would not be reopened

based on the doctrine if res judicata.

(Complaint, p.1) (emphasis omitted) Plaintiff alleges that the Appeal Council’s denial of his

request for review “constituted a final decision of the Social Security Administration.” (Id.

at p.2) Plaintiff further alleges that the Court has jurisdiction to consider his complaint

pursuant to 42 U.S.C. § 405(g).

II. STANDARD: MOTION TO DISMISS FOR LACK OF SUBJECT MATTER

JURISDICTION

 Pursuant to Rule 12(b)(1) of the Federal Rules of Civil Procedure, dismissal is

appropriate when the court lacks subject matter jurisdiction over a claim. Fed. R. Civ.

12(b)(1). Subject matter jurisdiction involves the power of the court to hear the plaintiff’s

claims in the first place and, therefore, imposes upon courts an affirmative obligation to

Case 4:07-cv-00432-CKJ Document 13 Filed 02/19/09 Page 3 of 14
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

- 4 -

ensure that they are acting within the scope of their jurisdictional power. Because federal

courts are courts of limited jurisdiction, it is presumed that a cause lies outside the

jurisdiction of federal courts unless proven otherwise. Kokkonen v. Guardian Life Ins. Co.,

511 U.S. 375, 377 (1994). The plaintiff bears the burden of establishing that jurisdiction

exists. Tosco Corp. v. Communities for a Better Environment, 236 F.3d 495, 499 (9th Cir.

2001); Thornhill Publishing Co. v. General Telephone & Electronics Corp., 594 F.2d 730,

733 (9th Cir. 1979). 

"'A motion to dismiss for lack of subject matter jurisdiction may either attack the

allegations of the complaint or may’" attack the existence of subject matter jurisdiction as a

matter of fact. National Union Fire Insur. Co. v. ESI Ergonomic Solutions, LLC., 342

F.Supp.2d 853 (D. Ariz. 2004) (quoting Thornhill Publishing Co., 594 F.2d at 733). "When

a motion to dismiss attacks the allegations of the complaint as insufficient to confer subject

matter jurisdiction, all allegations of material fact are taken as true and construed in the light

most favorable to the nonmoving party." Id. (citing Federation of African Amer. Contractors

v. City of Oakland, 96 F.3d 1204, 1207 (9th Cir. 1996)). Where the jurisdictional issue is

separable from the merits of the case, the court may consider the evidence presented with

respect to the jurisdictional issue, resolving factual disputes if necessary. Thornhill, 594 F.2d

at 733. "When the motion is a factual attack on subject matter jurisdiction, a defendant may

'rely on affidavits or any other evidence properly before the Court.'" National Union Fire

Insur. Co., 342 F.Supp.2d at 861 (citing St. Clair v. City of Chico, 880 F.2d 199, 201 (9th

Cir. 1989)). In the instance of a factual challenge, no presumption of truthfulness attaches

to the plaintiff's allegations, and the existence of disputed material facts will not preclude the

court from evaluating the merits of jurisdictional claims. Thornhill, 594 F.2d at 733.

III. DISCUSSION

A. Introduction

Title 42 U.S.C. § 405(g) is the exclusive means for judicial review of the

Commissioner’s determinations regarding disability insurance benefits. Weinberger v. Salfi,

422 U.S. 749, 857 (1975) (The Social Security Act “prevent[s] review of decisions of the

Case 4:07-cv-00432-CKJ Document 13 Filed 02/19/09 Page 4 of 14
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

3

Plaintiff refers to a January 15, 2006 decision from the Social Security

Administration (“SSA”). (Plaintiff’s Response, p.2) The only January 2006 decision from

the SSA in the record before this Court is dated January 13, 2006. (Defendant’s Memo., Ex.

6) Plaintiff states in his brief filed before the ALJ that “[o]n January 13, 2006, the Social

Security Administration determined that Claimant was disabled as of April 20, 2005, for the

purpose of Supplemental Security Income, due to diabetic neuropathy, pain in arms, legs, and

feet, double vision, heart attack, congenital heart failure, and weakness on the left side. They

determined, however, that he was not disabled between April 1, 2001, and June 30, 2003, i.e.

prior to his [date last insured].” (Plaintiff’s Ex. (Doc. No. 12-2,p.1)) Defendant did not file

a Reply, or otherwise address Plaintiff’s assertion that he was found disabled after 2005 for

purposes of supplemental security income.

- 5 -

[Commissioner] save as provided in...” section 405(g)). Section 405(g) sets forth the

requirements that must be satisfied for judicial review. Id. at 763-764. Among the

requirements is that there must be a final decision of the Commissioner made after a hearing.

Id.; 42 U.S.C. § 405(g). It is well-settled that the Commissioner’s decision “‘not to re-open

a previously adjudicated claim for social security benefits’ is purely discretionary, and is

therefore not considered a ‘final’ decision within the meaning of section 405(g).”

Krumpelman v. Heckler, 767 F.2d 586, 588 (9th Cir. 1982) (citing Califano v. Sanders, 430

U.S. 99, 107-109 (1977); Davis v. Schweiker, 665 F.2d 934, 935 (9th Cir. 1982)). 

Defendant seeks dismissal pursuant to Fed.R.Civ.P. 12(b)(1) on the basis that the

Court lacks subject matter jurisdiction because Plaintiff did not receive a final reviewable

decision for appeal and the application of res judicata by the Commissioner is not subject to

judicial review on the instant facts.

Plaintiff argues that in January 20063

, the SSA found he was disabled. (Plaintiff’s

Response, p.2) According to Plaintiff, in January 2006, the SSA:

determined that the new evidence provided supported disability, but that the

evidence from 2001-2003 did not. We asked for a hearing to review the onset

date arguing that the new evidence produced after 2003 sheds new light on

observations made prior to June 2003 (D[ate] L[ast] I[nsured] [(hereinafter

“DLI”)]), and specifically on durational issues.

(Id.) Plaintiff stresses that he is “not appealing the administrative denial of 2003, but rather

the January 15, 2006 decision finding no disability prior to the DLI of June 30, 2003.” (Id.)

Case 4:07-cv-00432-CKJ Document 13 Filed 02/19/09 Page 5 of 14
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

- 6 -

Plaintiff’s 2005 Application (i.e., his second application) was initially denied on

September 27, 2005 as follows in pertinent part:

You were last insured for Social Security disability benefits on 6/30/03. This

means that the evidence must clearly show that your condition was disabling

on or before this date, in order for you to be considered eligible for Social

Security disability benefits. Although, we have current evidence that indicates

you have a memory loss that limits your work capability, we have been unable

to obtain information which shows [sic] your medical status was on or before

6/30/03, the time period before you were last insured. Evidence shows you

were capable of doing sedentary work from 4/01 to present and there was

insufficient evidence to evaluate your memory loss from 4/01 to 6/03.

Therefore, we cannot find you disabled.

We have determined that your condition was not severe enough to be

considered disabling. In deciding this, we considered the medical and other

information, and how your condition affected your ability to work.

We have determined that your condition was not disabling on any date through

06/30/2003, the last day insured status for disability was met.

(Defendant’s Memo., Ex. 5).

Plaintiff’s request for reconsideration was denied on January 13, 2006 as follows in

pertinent part:

The medical evidence shows you have a history of the aforementioned

conditions. Although these caused you some problems in daily functioning,

the evidence also shows that between the period of 4/01/2001 and 06/30/2003,

which is the last time you were insured for disability benefits, you retained the

capacity to function at a level of exertion and mental awareness which enabled

you to do your past work as a loan officer. As you retained the capacity to do

work which you had previously done, we are unable to say you were disabled

during the necessary eligible period.

We have determined that your condition was not severe enough to keep you

from working. We considered the medical and other information, your age,

education, training, and work experience in determining how your condition

affected your ability to work.

We have determined that your condition was not disabling on any date through

06/30/2003, the last day insured status for disability was met. 

(Defendant’s Memo., Ex. 6) Nothing in the SSA’s January 13, 2006 decision suggests a

finding that Plaintiff was disabled after June 30, 2003 for purposes of disability insurance

benefits.

On March 16, 2007, the ALJ issued an Order of Dismissal. That decision does not

reflect that the SSA found Plaintiff was disabled after June 30, 2003 for purposes of either

Case 4:07-cv-00432-CKJ Document 13 Filed 02/19/09 Page 6 of 14
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

4

Plaintiff informed the ALJ of the disability finding for purposes of supplemental

security income in a pre-hearing brief. (Plaintiff’s Response, Ex. (Doc. No. 12-2, p.1))

- 7 -

disability insurance benefits or supplemental security income.4 The ALJ declined to reopen

the 2003 determination and found that Plaintiff’s request for hearing was barred under the

doctrine of res judicata.

The regulations provide that the Commissioner may dismiss a request for hearing if

the ALJ decides that:

The doctrine of res judicata applies in that we have made a previous

determination or decision under this subpart about your rights on the same

facts and on the same issue or issues, and this previous determination or

decision has become final by either administrative or judicial action

20 C.F.R. §404.957(c)(1). Before applying the doctrine of res judicata, the ALJ must

determine whether reopening or revising is appropriate. (Defendant’s Memo., p.6 (citing

Program Operations Manual System GN 03101.160(A)). The SSA may decide to reopen a

final, binding decision within four years of the initial determination if there is good cause to

do so. 20 C.F.R. §§404.987-404.989. Good cause is shown where: (1) new and material

evidence is furnished; (2) a clerical error in the computation or recomputation of benefits

occurred; or (3) the evidence considered in making the determination or decision clearly

shows on its face that an error was made. 20 C.F.R. §404.989.

The ALJ herein pointed out that “if a claimant is dissatisfied with a determination or

decision, but does not request further review within the stated time period...” that claimant

loses the right to further review. (Defendant’s Memo., Ex. 8 (Doc. No. 9-2, p.27)) (citing 20

C.F.R. § 404.987). The ALJ also acknowledged that a binding decision may be reopened

“within four years of the notice of the initial determination if there is good cause to do so”

pursuant to 20 C.F.R. §404.989. In considering whether good cause existed to reopen the

prior decision, the ALJ stated:

Here, the new evidence consists of the claimant’s testimony and medical

evidence, some of which is duplicative...but it does not describe any additional

impairments or any greater limitations in the claimant’s ability to work than

the evidence previously considered in issuing the prior determination.

Case 4:07-cv-00432-CKJ Document 13 Filed 02/19/09 Page 7 of 14
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

- 8 -

Furthermore, review of the evidence supporting the prior determination of

August 18, 2003, as well as the new evidence submitted with the current

application, reveals that there has been no clerical error or error on the face of

the evidence on which such determination was based.

In view of the above, the final determination made on the claimant’s

application filed protectively on June 19, 2003, may not be reopened.

(Id. (Doc. No. 9-2, p.28))

The ALJ then relied on the doctrine of res judicata to dismiss Plaintiff’s request for

hearing:

Res judicata is present when the claimant has had a previous determination or

decision about rights on the same facts and on the same issue or issues, and the

previous determination or decision has become final by either administrative

or judicial action.

The claimant’s current request for hearing involves the rights of the same

claimant on the same facts and on the same issues which were decided in the

final and binding determination dated August 18, 2003, made on the prior

application. Accordingly, the claimant’s request for hearing filed on March

13, 2006 is hereby dismissed. The determination dated August 18, 2003

remains in effect.

(Id.) 

B. Refusal to Reopen

The Supreme Court has held that federal courts lack jurisdiction under 42 U.S.C. §405

to review the Commissioner’s decision not to reopen a previously adjudicated claim.

Califano, 430 U.S. 99. “Once a decision becomes administratively final, the

[Commissioner’s] decision [whether] to reopen a claim is purely discretionary” and is not

reviewable under section 405(g). Davis, 665 F.2d at 935; see also Lester v. Chater, 81 F.3d

821, 827 (9th Cir. 1996) (“As a general matter, the Commissioner’s refusal to reopen [his or]

her decision as to an earlier period is not subject to judicial review.”). However, if “the

Commissioner considers ‘on the merits’ the issue of the claimant’s disability during the

already-adjudicated period”, then “a de facto reopening occurs, [and] the Commissioner’s

decision as to the prior period is subject to judicial review.” Id. (citations omitted) Moreover,

“[i]f...a person makes a colorable constitutional claim that the decision not to reopen violates

the due process clause of the fifth amendment, this court has jurisdiction.” Gonzalez v.

Sullivan, 914 F.2d 1197, 1203 (9th Cir. 1990) (citing Califano, 430 U.S. at 109)). The Ninth

Case 4:07-cv-00432-CKJ Document 13 Filed 02/19/09 Page 8 of 14
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

- 9 -

Circuit has held that under Califano v. Sanders, “[t]he constitutional claims must relate to the

manner or means by which the [Commissioner] decided not to reopen the prior decision,

rather than to the merits of the prior decision or the means by which that [prior] decision was

reached.” Panages v. Bowen, 871 F.2d 91, 93 (9th Cir. 1989); see also Evans v. Chater, 110

F.3d 1480, 1482 (9th Cir. 1997) (“it is clear that Panages’ holding is that an attack on the

merits of the prior decision will not suffice and that a constitutional claim must implicate a

due process right to a meaningful opportunity to be heard.”)(internal quotation marks

omitted).

Plaintiff argues that the ALJ’s decision “clearly supports our argument that the claim

filed in 2005 was denied, not dismissed administratively” because the ALJ’s decision was

rendered upon the ALJ’s “review of the evidence...” of record. (Plaintiff’s Response, p. 4)

A clear reading of the ALJ’s decision shows that no de-facto reopening occurred in

this case. The ALJ’s decision does not discuss the merits of Plaintiff’s 2003 or 2005 claims

of disability. Cf. Gregory v. Bowen, 844 F.2d 664, 666 (9th Cir. 1988) (“[T]he ALJ’s decision

to reopen the 1981 claim by considering on the merits the issue of [plaintiff’s] disability

during the time covered by the 1981 claim precludes agency reliance upon res judicata.”)

The ALJ made no independent finding whether Plaintiff was disabled under either of his

applications for disability. The ALJ’s decision solely addresses reopening of the 2003

decision and the applicability of res judicata. In addressing these issues, the ALJ must

necessarily consider the “evidence of record.” The ALJ explicitly found the evidence of

record was insufficient to warrant re-opening the 2003 claim, he explicitly refused to reopen

such claim, and he explicitly refused to consider Plaintiff’s 2005 disability claim on the

merits under the doctrine of res judicata. An ALJ’s explicit finding that “the evidence was

insufficient to warrant the re-opening” of a disability claim and explicit refusal to re-open

such claim is not subject to federal court review. See Krumpelman, 767 F.2d at 589.

Additionally, “[w]here a discussion of the merits is accompanied by a specific conclusion

that the claim is res judicata, the decision should not be treated as a reopening of the claim.”

Pearson v. Secretary of Health and Human Servs., 780 F.Supp. 682, 686 (E.D. Cal. 1991)

Case 4:07-cv-00432-CKJ Document 13 Filed 02/19/09 Page 9 of 14
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

- 10 -

(citing Krumpelman, 767 F.2d at 589). Consequently, under the instant circumstances, the

ALJ herein did not de facto reopen Plaintiff’s 2003 disability claim.

Plaintiff also raises a Fifth Amendment Due Process argument that the ALJ failed to

adhere to applicable regulations regarding: (1) determining disability onset; (2) determining

the durational aspect of disability; and (3) reopening prior decisions. Yet, Plaintiff argues

that he is not challenging the denial of the 2003 application but instead takes issue with the

“2006" decision not to accept the DLI as the onset date of Plaintiff’s disabilities. Plaintiff’s

constitutional claims, therefore, more appropriately apply to the ALJ’s res judicata finding,

and not his refusal to reopen Plaintiff’s 2003 claim.

C. Res Judicata

“The principles of res judicata applies to administrative decisions....” Chavez v.

Bowen, 844 F.2d 691, 693 (9th Cir. 1988); see also Thompson v. Schweiker, 665 F.2d. 936,

940 (9th Cir. 1982) (“Administrative res judicata may apply even though the claimant has

never had a hearing, where the claimant has failed to pursue administrative appeals and no

new facts are presented in the subsequent application.”) The Ninth Circuit has stated that

“[d]istrict courts...have no jurisdiction to review a refusal to re-open a claim for disability

benefits or a determination that such claim is res judicata.” Krumpelman, 767 F.2d at 588

(citing Davis, 665 F.2d at 935). However, the Ninth Circuit has also recognized that “the

doctrine [of res judicata] is applied less rigidly to administrative proceedings than to judicial

proceedings.” Chavez, 844 F.2d at 693; see also Thompson, 665 F.2d at 941. Although “an

ALJ’s finding that a claimant is not disabled ‘create[s] a presumption that [the plaintiff]

continued to be able to work after that date,” such presumption does not apply if there are

“changed circumstances.” Lester, 81 F.3d at 827 (citations omitted); see also Chavez, 844

F.2d at 693 (a change in age status may constitute a changed circumstance precluding

application of res judicata). Additionally, “the Commissioner may not apply res judicata

where the claimant raises a new issue, such as the existence of an impairment not considered

in the previous application...Nor is res judicata to be applied where the claimant was

unrepresented by counsel at the time of the prior claim.” Id. at 827-828 (citations omitted);

Case 4:07-cv-00432-CKJ Document 13 Filed 02/19/09 Page 10 of 14
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

- 11 -

see also Thompson, 665 F.2d. at 940 (“We recognize the importance of administrative res

judicata; however, enforcement of that policy must be tempered by fairness and equity.”)

Moreover, “where the record is patently inadequate to support the findings the ALJ made,

application of res judicata is tantamount to a denial of due process.” Thompson, 665 F.2d

at 941.

Plaintiff premises much of his argument on his assertion that the SSA found him “to

be disabled in 2006" and based upon this finding of disability, the ALJ was required to

consider whether the onset of disability began prior to the DLI. (Plaintiff’s Response, p. 12)

Defendant has not disputed that Plaintiff was found disabled “as of April 20, 2005, for the

purpose of Supplemental Security Income, due to diabetic neuropathy, pain in arms, legs, and

feet, double vision, heart attack, congenital heart failure, and weakness on left side.”

(Plaintiff’s Ex. (Doc. No. 12-2, p.1; see also Plaintiff’s Response, pp. 2, 12)) The definition

of “disability” for purposes of social security disability insurance benefits and supplemental

security income is the same: the inability to engage in any substantial gainful activity by

reason of any medically determinable physical or mental impairment which can be expected

to result in death or which has lasted or can be expected to last for a continuous period of not

less than twelve months. 42 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(A). 

Plaintiff’s 2005 application alleged disability based upon diabetic neuropathy and

double vision which were also alleged in his 2003 application. However, Plaintiff also

alleged the following impairments in 2005 which were not alleged in his 2003 application:

heart attack; congenital heart failure; pains in arms, legs, and feet; weakness in his left side

all with an onset date prior to his DLI. It is inappropriate to apply the doctrine of res judicata

to bar consideration of new impairments not raised in the earlier proceeding. See Gregory,

844 F.2d at 666. 

Plaintiff argues that he is not appealing the 2003 decision, “but rather [he] introduced

new information which shed new light on [his] medical condition prior to his date of last

insured to allow for revision of the onset date to June 2003. We argued that SSA regulations

mandate evaluation of onset of disability and that those regulations confirm this Claimant’s

Case 4:07-cv-00432-CKJ Document 13 Filed 02/19/09 Page 11 of 14
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

5

The ALJ’s decision regarding Plaintiff’s 2005 claim for disability benefits was made

in 2007. (See Defendant’s Memo., Ex. 8)

6

"Social Security Rulings constitute the Social Security Administration's

interpretations of the statute it administers and of its own regulations....Although Social

Security Rulings do not have the force of law,...once published, they are binding upon ALJs

- 12 -

right to reopen his claim.” (Plaintiff’s Response, p. 5; see also Id. at p. 8 (“we do not appeal

the administrative denial of Claimant’s 2003 application and are not asking for back pay for

that period. We challenge the decision of the ALJ in Claimant’s 2006[5] decision not to

accept the DLI as Claimant’s onset of disability.”)) Plaintiff’s position is that the onset date

for the disabilities alleged in his 2005 Application occurred prior to June 30, 2003 but the

medical records to establish this were not available until after 2003. (Id. at p. 14) For

example, Plaintiff points out that in 2003, the SSA determined that he was not disabled, in

part, because he had been prescribed medication for his double vision. (Defendant’s Memo.,

Ex. 2; see also Plaintiff’s Ex. (Doc. No. 12-2, p.15) (Dr. Mehelas noting in May 2003 that

Plaintiff’s diplopia “is essentially resolved with Mestinon...”)) However, by March 30, 2004,

“Dr. Mehelas determined that [Plaintiff]...was suffering from diplopia, which was not

corrected by his manipulation of the prisms or Mestinon therapy.” (Plaintiff’s Response, p.

21) Plaintiff persuasively contends that had the ALJ not applied res judicata to bar his current

(2005) claim, the ALJ could have determined, based on the post-2003 medical records, that

such condition was expected to last for a continuous period of not less than 12 months

commencing prior to expiration of Plaintiff’s DLI. (See Id., at pp. 10-19); see also Flaten v.

Secretary of Health and Human Servs., 44 F.3d 1453, 1461 n.5 (9th Cir. 1995) (recognizing

relevance of retrospective diagnoses by treating physicians and medical experts,

contemporaneous medical records and lay testimony to establish disability onset date); Smith

v. Bowen, 849 F.2d 1222, 1225 (9th Cir. 1988) (reports made after the period for disability

are relevant to assess the claimant’s disability and are acceptable for use in determining

disability onset date); Bilby v. Schweiker, 762 F.2d 716 (9th Cir. 1985) (same); see also SSR

83-206

 (discussing determination of disability onset date). 

Case 4:07-cv-00432-CKJ Document 13 Filed 02/19/09 Page 12 of 14
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

and the Commissioner." Herrera v. Barnhart, 379 F.Supp.2d 1103, 1108 n.5 (C.D. Cal.

2005)(citations omitted).

7

Given the conclusion that application of res judicata to Plaintiff’s claim was

inappropriate, the Court need not address Plaintiff’s claim that the ALJ’s decision violated

Plaintiff’s Fifth Amendment Due Process rights.

- 13 -

In sum, Plaintiff alleged in his 2005 application disabling impairments not alleged in

the 2003 application. Defendant has not disputed that these impairments, when considered

alone or in combination with each other and the impairments of diabetic neuropathy and

double vision alleged in both applications resulted in a disability finding for purposes of

supplemental security income as of April 20, 2005. Although Defendant did not submit the

entire administrative record, consideration of the record before this Court supports the

conclusion that Plaintiff’s condition has materially changed since resolution of the 2003

application. Moreover, Plaintiff’s claims necessarily require consideration of evidence

pertaining to the 2003 claim to determine the appropriate disability onset date with regard

to his 2005 application. Under such circumstances it is unclear on this record how the ALJ

could have determined that Plaintiff’s 2005 application involved the “same facts and...the

same issues which were decided in the final binding determination dated August 18, 2003,

made on the prior application.” (Defendant’s Memo., Ex. 8 (Doc. No. 9-2, p.28)) On the

instant facts, Plaintiff has rebutted the presumption of non-disability that arose from the res

judicata effect of the 2003 denial of his benefits. The dismissal of Plaintiff’s 2005 disability

claim on the ground of res judicata is inappropriate and his claim should be remanded to the

Commissioner with instructions to conduct further proceedings with regard to Plaintiff’s

2005 claim.7

 See Thompson, 665 F.2d at 936 (remanding to Commissioner “with instructions

to conduct an appropriate hearing” where denial of disability claim on grounds of res judicata

was “inappropriate.”); Cf. Murray v. Schweiker, 555 F.Supp. 573, (D.Mont. 1982) (reviewing

court may order remand to Commissioner sua sponte) (citing Igonia v. Califano, 568 F.2d

1383 (D.C.Cir. 1977)). 

Case 4:07-cv-00432-CKJ Document 13 Filed 02/19/09 Page 13 of 14
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

- 14 -

IV. CONCLUSION

The Court lacks jurisdiction to review the ALJ’s decision not to reopen Plaintiff’s

2003 claim. However, because the ALJ’s finding of res judicata was inappropriate on the

instant record, Defendant’s Motion to Dismiss should be denied and the matter should be

remanded to the Commissioner for further proceedings.

V. RECOMMENDATION

For the foregoing reasons, the Magistrate Judge recommends that the District Court:

(1) deny Motion to Dismiss for Lack of Subject Matter Jurisdiction Pursuant to

Federal Rule of Civil Procedure 12(b)(1) (Doc. No.8); and

(2) remand this matter to the Commissioner for further proceedings with regard

to Plaintiff’s 2005 claim.

Pursuant to 28 U.S.C. §636(b), any party may serve and file written objections within

ten days after being served with a copy of this Report and Recommendation. A party may

respond to another party's objections within ten days after being served with a copy thereof.

Fed.R.Civ.P. 72(b). If objections are filed, the parties should use the following case number:

CV 07-432-TUC-CKJ.

If objections are not timely filed, then the parties' right to de novo review by the

District Court may be deemed waived. See United States v. Reyna-Tapia, 328 F.3d 1114,

1121 (9th Cir.) (en banc), cert. denied, 540 U.S. 900 (2003).

DATED this 18th day of February, 2009.

Case 4:07-cv-00432-CKJ Document 13 Filed 02/19/09 Page 14 of 14