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Harold Dwane Gibbons v. Commissioner of Social Security Administration

March 22, 2012


The opinion of the court was delivered by: Kendall J. Newman United States Magistrate Judge


Plaintiff Harold Dwane Gibbons ("plaintiff"), who is representing himself in this action, seeks judicial review of a final decision of the Commissioner of Social Security ("Commissioner" or "defendant") denying plaintiff's request for retroactive payment of additional Title II benefits.*fn1 Plaintiff argues he is entitled to these additional payments because the Social Security Administration improperly withheld them based on the belief that plaintiff was married to another Social Security benefits recipient, namely, Ms. Rebecca Diskin. Plaintiff argues that he and Ms. Diskin were housemates but were not married, such that his benefits payments should not have been reduced. Plaintiff further argues that a Social Security Administration employee told plaintiff and Ms. Diskin that they could not receive any benefits unless they claimed to be married, and that as a result of the employee's coercion, plaintiff and Ms. Diskin reluctantly claimed they were married. (See generally Pl.'s Mot. for Summ. J., Dkt. No. 19-1.)

In his motion for summary judgment, plaintiff argues that the administrative law judge ("ALJ") in this case erred in determining that plaintiff and Ms. Diskin held themselves out as married.*fn2 (See generally Pl.'s Mot. for Summ. J.) Defendant filed an opposition to plaintiff's motion and a cross-motion for summary judgment. (Def.'s Opp'n & Cross-Motion for Summ. J., Dkt. No. 20.) For the reasons stated below, the court denies plaintiff's motion for summary judgment and grants the Commissioner's cross-motion for summary judgment.


Plaintiff filed applications for Supplemental Security Income and Disability Insurance Benefits in August of 2003. (Admin. Record ("AR") 66-68, 389-401.) An ALJ issued a decision dated August 13, 2005, finding that plaintiff was disabled.*fn4 (AR 27-35.) The agency determined that plaintiff was entitled to retroactive benefits, and plaintiff requested reconsideration of the amount of his retroactive benefits (AR 433) and requested a hearing before an ALJ (AR 435), on the grounds that he had not received the proper payment amounts due to the agency's belief that plaintiff was married to Ms. Diskin. The ALJ conducted a hearing regarding plaintiff's claim on December 10, 2007. (AR 479-502.) Plaintiff was represented by counsel at the hearing and testified. (Id.)

In a written decision dated February 7, 2008, the ALJ found that the agency properly determined plaintiff's retroactive benefit amount, on the grounds that plaintiff and Ms. Diskin held themselves out as a married couple under the applicable rules from May 2003 through December 2006. (AR 16-21.) The ALJ's decision became the final decision of the Commissioner when the Appeals Council denied plaintiff's request for review. (AR 7-10.) Plaintiff subsequently filed this action.

B. Summary of the ALJ's Findings

This case differs from the typical Social Security case in that plaintiff is not challenging a finding that he is not disabled or claiming that the ALJ did not properly conduct the requisite five-step analysis. See Lester, 81 F.3d at 828 n.5 Instead, plaintiff challenges the agency's determination of his marital status. Stated differently, plaintiff challenges the ALJ's finding that plaintiff and Ms. Diskin held themselves out as married, which resulted in a reduction of plaintiff's retroactive benefits under the applicable regulations. (AR 19-21.)

In his decision, the ALJ described plaintiff's hearing testimony, discussed the applicable law regarding whether a claimant is "married" for the agency's purposes, described several specific documents in the record whereby plaintiff identified Ms. Diskin as his spouse, noted generally the "multiple documents" in the record whereby plaintiff and/or Ms. Diskin indicated they were married to each other. (AR 20-21.) The ALJ also noted that the lack of any documents in the record suggesting that plaintiff had been "coerced" into describing Ms. Diskin as his spouse and/or that he disputed being married.*fn5 (AR 21.) The ALJ then concluded that, after "careful consideration of the evidence of record," plaintiff and Ms. Diskin held themselves out as married from May 2003 through December 2006. (Id.) The ALJ also concluded that, as a result, the agency's correctly applied the "windfall offset provision"*fn6 to plaintiff. (Id.)


The court reviews the Commissioner's decision to determine whether it is (1) free of legal error, and (2) supported by substantial evidence in the record as a whole. Bruce v. Astrue, 557 F.3d 1113, 1115 (9th Cir. 2009); accord Vernoff v. Astrue, 568 F.3d 1102, 1105 (9th Cir. 2009). This standard of review has been described as "highly deferential." Valentine v. Comm'r of Soc. Sec. Admin., 574 F.3d 685, 690 (9th Cir. 2009). "Substantial evidence means more than a mere scintilla but less than a preponderance; it is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Bray v. Comm'r of Soc. Sec. Admin., 554 F.3d 1219, 1222 (9th Cir. 2009) (citing Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir. 1995)); accord Valentine, 574 F.3d at 690. "The ALJ is responsible for determining credibility, resolving conflicts in medical testimony, and for resolving ambiguities." Andrews, 53 F.3d at 1039; see also Tommasetti v. Astrue, 533 F.3d 1035, 1041 (9th Cir. 2008) ("[T]he ALJ is the final arbiter with respect to resolving ambiguities in the medical evidence."). Findings of fact that are supported by substantial evidence are conclusive. 42 U.S.C. § 405(g); see also McCarthy v. Apfel, 221 F.3d 1119, 1125 (9th Cir. 2000). "Where the evidence as a whole can support either a grant or a denial, [the court] may not substitute [its] judgment for the ALJ's." Bray, 554 F.3d at 1222; see also Ryan v. Comm'r of Soc. Sec., 528 F.3d 1194, 1198 (9th Cir. 2008) ("'Where evidence is susceptible to more than one rational interpretation,' the ALJ's decision should be upheld.") (quoting Burch v. Barnhart, 400 F.3d 676, 679 (9th Cir. 2005)). However, the court "must consider the entire record as a whole and may not affirm simply by isolating a 'specific quantum of supporting evidence.'" Ryan, 528 F.3d at 1198 (quoting Robbins v. Soc. Sec. Admin., 466 F.3d 880, 882 (9th Cir. 2006)); accord Lingenfelter v. Astrue, 504 F.3d 1028, 1035 (9th Cir. 2007). "To determine whether substantial evidence supports the ALJ's decision, [a court] review[s] the administrative record as a whole, weighing both the evidence that supports and that which detracts from the ALJ's conclusion." Andrews, 53 F.3d at 1039. "If additional proceedings can remedy defects in the original administrative proceedings, a social security case should be remanded." Lewin v. Schweiker, 654 F.2d 631, 637 (9th Cir. 1981). However, the court's review is constrained to the reasons asserted by the ALJ in the ALJ's decision. Orn v. Astrue, 495 F.3d 625, 630 (9th Cir. 2007) ("We review only the reasons provided by the ALJ in the disability determination and may not affirm the ALJ on a ground upon which he did not rely."); accord Tommasetti, 533 F.3d at 1039 n.2 (declining to review reasons provided by the district court in support of the ALJ's credibility decision that were not "expressly relied on" by the ALJ during the administrative proceedings); accord Pinto v. Massanari, 249 F.3d 840, 847 (9th Cir. 2001) (noting that the Court "cannot affirm the decision of an agency on a ground that the agency did not invoke in making its decision"); Gonzalez v. Sullivan, 914 F.2d 1197, 1201 (9th Cir. 1990) ("[W]e are wary of speculating about the basis of the ALJ's conclusion -- especially when his opinion indicates that the conclusion may have been based exclusively upon an improper reason."); Barbato v. Comm'r of Soc. Sec. Admin., 923 F. Supp. 1273, 1276 n.2 (C.D. Cal. 1996) (remand is appropriate when a decision does not adequately explain how a decision was reached, "[a]nd that is so even if [the Commissioner] can offer proper post hoc explanations for such unexplained conclusions," because "the Commissioner's decision must stand or fall with the reasons set forth in the ALJ's decision, as adopted by the Appeals Council") (citation omitted).


A. The ALJ Did Not Commit Legal Error

As described above, plaintiff applied for benefits under two separate titles of the Act, Title II and Title XVI. (AR 66-68, 389-401.) If an individual is found to be disabled and to be owed retroactive benefits for previous months, the agency will not pay that individual the full Title II and Title XVI benefits for those months. Instead, the agency reduces the retroactive Title II benefit payment amount for those previous months by the amount of any Title XVI payments that the individual has already received. See 42 U.S.C. § 1320a-6; 20 C.F.R. § 404.408b, 416.1123(d)(1). For a married couple, the agency will reduce the retroactive Title II benefits by the Title XVI payments received by both spouses. 42 U.S.C. § 1320a-6; 20 C.F.R. § 404.408b; see also Soc. Sec. Admin., Program Operations Manual System ("POMS") § GB ...

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