IN THE UNITED STATES COURT OF APPEALS

FOR THE FIFTH CIRCUIT

No. 13-40367

UNITED STATES OF AMERICA, 

 Plaintiff–Appellee,

versus

JUAN CARLOS RAMOS-DELGADO, 

 Defendant–Appellant.

* * * * * * * * * * * * * * *

Consolidated with

No. 13-40394

UNITED STATES OF AMERICA, 

 Plaintiff–Appellee,

versus

WILSON SALGADO-FLORES, 

 Defendant–Appellant.

Appeals from the United States District Court 

for the Southern District of Texas

United States Court of Appeals

Fifth Circuit

FILED

June 30, 2014

Lyle W. Cayce

Clerk

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No. 13-40394

Before SMITH, WIENER, and PRADO, Circuit Judges.

JERRY E. SMITH, Circuit Judge:

Juan Ramos-Delgado and Wilson Salgado-Flores appeal the application 

of a ten-level enhancement under United States Sentencing Guidelines 

§ 2L1.1(b)(7). Because their actions meet the but-for causation standard 

required by the guidelines, we affirm.

I.

Ramos-Delgado drove a number of illegal aliens and Salgado-Flores, a 

coyote, north on I-35 in a stolen truck. When Ramos-Delgado saw border patrol 

agents running his plates behind them, he attempted to lose them by making 

an abrupt left turn over the median, crossing the southbound lanes, and crashing through a fence into a tree. 

Two of the illegal aliens riding unrestrained in the bed of the truck were 

seriously injured. One, Solomon Carcamo-Bautista, was thrown from the truck 

and suffered massive skull fractures and a diffuse anoxic brain injury involving 

the cerebral cortex and basal ganglia. He was initially unresponsive and soon 

slipped into a coma from which he did not emerge; he suffered from frequent 

bouts of fever and tachycardia brought on by unknown infections and was 

treated with antibiotics. Although his prognosis was poor, he was transferred

to his home country, Honduras, at the request of his family. 

Ramos-Delgado and Salgado-Flores pleaded guilty to various counts 

related to the transportation of illegal aliens. Initially, the probation officer 

recommended a six-level enhancement under § 2L1.1(b)(7)(C) based on the permanent or life-threatening injuries to Carcamo-Bautista and the other alien. 

Before sentencing, however, the government received an email from the 

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Honduran consulate informing them of Carcamo-Bautista’s death. As a result, 

the probation officer changed his recommendation to a ten-level enhancement 

under § 2L1.1(b)(7)(D). Because of poverty, however, the family members were 

unable to obtain a death certificate. 

At sentencing, defense counsel objected to the increased enhancement, 

asserting that there was no proof of Carcamo-Bautista’s death and insufficient

evidence to show that his death was the result of the crash. Instead, counsel 

urged, the six-level enhancement for life-threatening injuries was appropriate. 

The district court disagreed. After reviewing the medical records, it

found that Carcamo-Bautista had died from the injuries. Consequently, it 

applied the ten-level enhancement and sentenced Ramos-Delgado and 

Salgado-Flores to sentences near the high and low ends, respectively, of the 

resulting guideline range. 

II.

We review de novo a district court’s interpretation or application of the 

sentencing guidelines and its factual findings for clear error. See United States 

v. Cisneros-Gutierrez, 517 F.3d 751, 764 (5th Cir. 2008). “Furthermore, in 

determining whether an enhancement applies, a district court is permitted to 

draw reasonable inferences from the facts, and these inferences are factfindings reviewed for clear error as well.” United States v. Caldwell, 448 F.3d 

287, 290 (5th Cir. 2006). “Under the clearly erroneous standard, we will uphold 

a finding so long as it is plausible in light of the record as a whole.” United 

States v. Ekanem, 555 F.3d 172, 175 (5th Cir. 2009) (internal quotation marks 

omitted). “The government must prove sentencing enhancements by a preponderance of the evidence.” United States v. Juarez, 626 F.3d 246, 251 (5th Cir. 

2010).

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III.

The defendants challenge only the application of a ten-level, and not sixlevel, enhancement, maintaining that § 2L1.1(b)(7) requires that the defendant’s actions caused the injury or death. Because the cause of CarcamoBautista’s death is unknown, they claim, there is no evidence of the required 

causal relationship, so they cannot be held accountable. We disagree.

Although this court has yet to address what causation is required under 

§ 2L1.1(b)(7),1 our sister circuits have split on this issue. The Eighth and the 

Ninth Circuits have read the section to require direct or proximate causation.2 

The Tenth and Eleventh Circuits, on the other hand, have rejected a requirement of proximate causation because “[t]he guideline contains no causation 

requirement and we have no license to impose one.”3 After reviewing the plain 

language of § 2L1.1(b)(7), we agree with the Tenth Circuit that the guideline 

enhancement has no causation requirement.4

1 We have pretermitted whether or what form of causation is required, holding that if 

such a requirement existed it was met in the cases presented. See United States v. de JesusOjeda, 515 F.3d 434, 443–44 (5th Cir. 2008) (“Even if foreseeability is required before this 

enhancement may be applied, an issue we do not decide, it was foreseeable . . . .”); United 

States v. Garcia-Guerrero, 313 F.3d 892, 898–99 (5th Cir. 2002) (“We need not decide whether 

a causal link between the substantially risky conduct . . . and the death of an individual . . . 

must exist for an enhancement under [§ 2L1.1(b)(7)]. Here, the conduct creating a substantial risk of death or serious bodily injury . . . and the death . . . are causally yoked . . . .”).

2 See United States v. Flores-Flores, 356 F.3d 861, 862 (8th Cir. 2004); United States 

v. Herrera-Rojas, 243 F.3d 1139, 1144–45 n.1 (9th Cir. 2001) (“We assume, however, that for 

[§ 2L1.1(b)(7)] to apply, the relevant death or injury must be causally connected to dangerous 

conditions created by the unlawful conduct, as it was in this case.”).

3 United States v. Cardena-Garcia, 362 F.3d 663, 666 (10th Cir. 2004); see also United 

States v. Zaldivar, 615 F.3d 1346 (11th Cir. 2010).

4 “If any person died or sustained bodily injury, increase the offense level according to 

the seriousness of the injury:

. . .

(C) Permanent of Life-Threatening Bodily Injury add 6 levels

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Therefore, the only causation requirement is that contained in § 1B1.3, 

which describes the general relevant conduct that may be considered in determining the guideline range.5 In pertinent part, under § 1B1.3(a)(3), relevant 

conduct includes “all harm that resulted from the acts and omissions specified 

in subsections (a)(1) and (a)(2) above, and all harm that was the object of such 

acts and omissions.”6 Because the ordinary meaning of “resulted from”

imposes a requirement of actual or but-for causation7 and textual and contextual reasons do not justify the use of an alternative causation,8 we conclude

that—unless otherwise specified—the defendant’s relevant conduct must be a 

but-for cause of a harm for that harm to be considered in assigning the guideline range. In other words, Ramos-Delgado’s and Salgado-Flores’s conduct in 

transporting illegal aliens must be the but-for cause of Carcamo-Bautista’s 

death for that death to be considered in applying the ten-level enhancement.

“This standard requires the plaintiff to show that the harm would not 

have occurred in the absence of—that is, but for—the defendant’s conduct.”9 

(D) Death add 10 levels.”

U.S.S.G. § 2L1.1(b)(7).

5 “Chapters Two (Offense Conduct) and Three (Adjustments). Unless otherwise specified, (i) the base offense level where the guideline specifies more than one base offense level, 

(ii) specific offense characteristics and (iii) cross references in Chapter Two, and (iv) adjustments in Chapter Three, shall be determined on the basis of the following: . . . .” U.S.S.G. 

§ 1B1.3(a).

6 We have preserved the question whether § 1B1.3(a)(3) contains a causation requirement. See United States v. Valenzuela-Contreras, 340 F. App’x 230, 236 (5th Cir. 2009) (per 

curiam).

7 See Burrage v. United States, 134 S. Ct. 881, 887–88 (2014).

8 See Paroline v. United States, 134 S. Ct. 1710, 1727 (2014) (quoting Burrage, 

134 S. Ct. at 888).

9 Univ. of Tex. Sw. Med. Ctr. v. Nassar, 133 S. Ct. 2517, 2525 (2013) (internal quotation 

marks omitted).

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For example, the Supreme Court has described but-for causation in terms of 

a baseball game in which the visiting team’s leadoff batter hits a 

home run in the top of the first inning. If the visiting team goes on 

to win by a score of 1 to 0, every person competent in the English 

language and familiar with the American pastime would agree 

that the victory resulted from the home run. This is so because it 

is natural to say that one event is the outcome or consequence of 

another when the former would not have occurred but for the 

latter.10

This differs from contributing-factor causation standards: if the visiting team 

had won 5 to 2 rather than 1 to 0, each of the five runs would have contributed 

to the win but no one run could be considered a but-for cause of the victory.11

But-for causation, in the absence of a requirement of direct or proximate 

causation, however, is not a difficult burden to meet. As long as the defendants’ 

actions were a but-for cause of the ultimate harm, it does not matter whether 

the initial action directly resulted in the harm but only that the harm would 

not have occurred but-for the initial action. For example, if in the present case 

defendants’ actions had merely sprained a passenger’s hand, making him go to 

the hospital, and the hospital exploded from a gas leak, the defendants’ actions 

would still have been a but-for cause of death. But for his sprained hand the 

passenger would not have gone to the hospital. Obviously proximate cause 

would not be met in that situation, but proximate or legal causation is not

required by the guidelines.

Additionally, an incident may have many but-for causes. Take a 

10 Burrage, 134 S. Ct. at 888. “The same conclusion follows if the predicate act combines with other factors to produce the result, so long as the other factors alone would not 

have done so—if, so to speak, it was the straw that broke the camel’s back.” Id. “Thus, if 

poison is administered to a man debilitated by multiple diseases, it is a but-for cause of his 

death even if those diseases played a part in his demise, so long as, without the incremental 

effect of the poison, he would have lived.” Id.

11 See id.

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variation of Justice Scalia’s baseball example: If the starting pitcher in the 

first inning had not left his fastball hanging over the plate, the leadoff batter 

would not have hit a home run in the first inning. Therefore, the victory 

resulted from the hanging fastball just as much as the homerun.

Under that standard, the district court did not reversibly err. Based on

Carcamo-Bautista’s medical condition and the email from the Honduran consulate, the court committed no clear error in finding that Carcamo-Bautista is 

deceased. Similarly, considering his medical records, it is plausible that he 

died from the injuries sustained in being thrown from the bed of a truck. In 

light of these findings of fact, the defendants’ conduct was the but-for cause of 

the injuries and death.

The judgment of sentence is AFFIRMED. 

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