United States District Court, S.D. California
REPORT AND RECOMMENDATION ON CROSS-MOTIONS FOR
SUMMARY JUDGMENT [Doc. Nos. 13, 15.]
William V. Gallo United States Magistrate Judge
an action for judicial review of a decision by the Acting
Commissioner of Social Security, Carolyn W. Colvin
(“the Commissioner, ” or
“Defendant”), denying Plaintiff Arlene Elizabeth
Masterson supplemental security income (“SSI”)
benefits under Title XVI of the Social Security Act. The
parties have filed cross-motions for summary judgment, and
the matter is before the undersigned Magistrate Judge for
preparation of a Report and Recommendation. For the reasons
stated below, the Court RECOMMENDS that Plaintiff's
motion for summary judgment be GRANTED, Defendant's
cross-motion for summary judgment be DENIED, and the matter
be remanded for further proceedings.
Overview of Social Security Claim Proceedings
to the Act, the Social Security Administration
(“SSA”) administers the SSI program. 42 U.S.C.
§ 901. The Social Security Act authorizes the SSA to
create a system by which it determines who is entitled to
benefits and by which unsuccessful claimants may obtain
review of adverse determinations. Id. §§
423 et seq. Defendant, as Acting Commissioner of the
SSA, is responsible for the Act's administration.
Id. § 902(a)(4), (b)(4).
SSA's Sequential Five-Step Process
employs a sequential five-step evaluation to determine
whether a claimant is eligible for benefits. 20 C.F.R.
§§ 416.920, 404.1520. To qualify for disability
benefits under the Act, a claimant must show that (1) he or
she suffers from a medically-determinable
impairment that can be expected to result in death or
that has lasted or can be expected to last for a continuous
period of twelve months or more and (2) the impairment
renders the claimant incapable of performing the work that he
or she previously performed or any other substantially
gainful employment that exists in the national economy.
See 42 U.S.C. §§ 423(d)(1)(A), (2)(A);
claimant must meet both of these requirements to qualify as
“disabled” under the Act, id. §
423(d)(1)(A), (2)(A), and bears the burden of proving that he
or she “either was permanently disabled or subject to a
condition which became so severe as to create a disability
prior to the date upon which [his or] her disability insured
status expired.” Johnson v. Shalala, 60 F.3d
1428, 1432 (9th Cir. 1995). An administrative law judge
(“ALJ”) presides over the five-step process to
determine disability. See Barnhart v. Thomas, 540
U.S. 20, 24-25 (2003) (summarizing the five-step process). If
the Commissioner finds that a claimant is disabled or not
disabled at any step in this process, the review process is
terminated at that step. Corrao v. Shalala, 20 F.3d
943, 946 (9th Cir. 1994).
one in the sequential evaluation considers a claimant's
“work activity, if any.” 20 C.F.R. §
404.1520(a)(4)(i). An ALJ will deny a claimant disability
benefits if the claimant is engaged in “substantial
gainful activity.” Id. §§
claimant cannot provide proof of gainful work activity, the
ALJ proceeds to step two to ascertain whether the claimant
has a medically severe impairment or combination of
impairments. The so-called “severity regulation”
dictates the course of this analysis. Id.
§§ 404.1520(c), 416.920(c); see also Bowen v.
Yuckert, 482 U.S. 137, 140-41 (1987).
will deny a claimant's disability claim if the ALJ does
not find that a claimant suffers from a severe impairment or
combination of impairments which significantly limits the
claimant's physical or mental ability to do “basic
work activities.” 20 C.F.R. § 404.1520(c). The
ability to do “basic work activities” means
“the abilities and aptitudes necessary to do most
jobs.” Id. §§ 404.1521(b),
if the impairment is severe, the evaluation proceeds to step
three. At step three, the ALJ determines whether the
impairment is equivalent to one of several listed impairments
that the SSA acknowledges are so severe as to preclude
substantial gainful activity. Id. §§
404.1520(d), 416.920(d). An ALJ conclusively presumes a
claimant is disabled so long as the impairment meets or
equals one of the listed impairments. Id.
ALJ has not yet deemed a claimant disabled, but before
formally proceeding to step four, the ALJ must establish the
claimant's Residual Functional Capacity
(“RFC”). Id. §§ 404.1520(e),
404.1545(a). An individual's RFC is his or her ability to
do physical and mental work activities on a sustained basis
despite limitations from his or her impairments. Id.
§§ 404.945(a)(1), 404.1545(a)(1). The RFC analysis
considers “whether [the claimant's] impairment(s),
and any related symptoms, such as pain, may cause physical
and mental limitations that affect what [the claimant] can do
in a work setting.” Id. §§
404.1545(a)(1), 416.945(a)(1). In establishing a
claimant's RFC, the ALJ must assess relevant medical and
other evidence, as well as consider all of the claimant's
impairments, including impairments categorized as non-severe.
Id. § 404.1545(a)(3), (e). If an ALJ does not
conclusively determine a claimant's impairment or
combination of impairments is disabling at step three, the
evaluation advances to step four.
four, the ALJ uses the claimant's RFC to determine
whether the claimant has the RFC to perform the requirements
of their past relevant work. Id. § 404.1520(f).
So long as a claimant has the RFC to carry out his or her
past relevant work, the claimant is not disabled.
Id. §§ 404.1560(b)(3). Conversely, if the
claimant either cannot perform or does not have any past
relevant work, the analysis presses onward.
fifth and final step of the SSA's evaluation, the ALJ
must verify whether the claimant is able to do any
other work in light of his or her RFC, age, education, and
work experience. Id. § 404.1520(g). If the
claimant is able to do other work, the claimant is not
disabled. However, if the claimant is not able to do other
work and meets the duration requirement, the claimant is
disabled. Id. Although the claimant generally
continues to have the burden of proving disability at step
five, a limited burden of going forward with the evidence
shifts to the SSA.
stage, the SSA must present evidence demonstrating that other
work that the claimant can perform-allowing for his RFC, age,
education, and work experience-exists in significant numbers
in the national economy. Id. §§ 404.1520,
1560(c), 416.920, 404.1512(f).
SSA Hearings and Appeals Process
accordance with Defendant's delegation, the Office of
Disability Adjudication and Review administers a nationwide
hearings and appeals program. SSA regulations provide for a
four-step process for administrative review of a
claimant's application for disability payments. See
Id. §§ 416.1400, 404.900. Once the SSA makes
an initial determination, three more levels of appeal exist:
(1) reconsideration, (2) hearing by an ALJ, and (3) review by
the Appeals Council. See Id. §§ 416.1400,
404.900. If the claimant is not satisfied with the decision
at any step of the process, the claimant has sixty days to
seek administrative review. See Id. §§
404.933, 416.1433. If the claimant does not request review,
the decision becomes the SSA's-and hence
Defendant's-binding and final decree. See Id.
§§ 404.905, 416.1405.
network of SSA field offices and state disability
determination services initially process applications for
disability benefits. The processing begins when a claimant
completes both an application and an adult disability report,
and submits those documents to one of the SSA's field
offices. If the SSA denies the claim, the claimant is
entitled to a hearing before an ALJ in the SSA's Office
of Disability Adjudication and Review. Id.
§§ 404.929, 416.1429. A hearing before an ALJ is
informal and non-adversarial. Id. § 404.900(b).
claimant receives an unfavorable decision by an ALJ, the
claimant may request review by the Appeals Council.
Id. §§ 404.967, 416.1467. The Appeals
Council will grant, deny, dismiss, or remand a claimant's
request. Id. §§ 416.1479, 404.979. If a
claimant disagrees with the Appeals Council's decision or
the Appeals Council declines to review the claim, the
claimant may seek judicial review in a federal district court
pursuant to 42 U.S.C. § 405(g) or § 1383(c).
See Id. §§ 404.981, 416.1481. If a
district court remands the claim, the claim is sent to the
Appeals Council, which may either make a decision or refer
the matter to another ALJ. Id. § 404.983.
2012, Plaintiff protectively filed an application for SSI,
alleging disability as of February 12, 2011. (AR 178-87.)
Also in June 2012, the SSA denied Plaintiff's initial
application. (AR 61-87.) In December 2012, Plaintiff was
again denied benefits upon reconsideration. (AR 88-101.)
2, 2014, the ALJ held a hearing to review Plaintiff's
claim. (AR 35-59.) Plaintiff and a vocational expert
(“VE”) testified at the hearing. (AR 36.) The ALJ
issued her written decision on September 9, 2014. (AR 16-29.)
At step one of the sequential evaluation process described
above, the ALJ found Plaintiff had not engaged in substantial
gainful activity since her alleged onset date of February 12,
2011. (AR 18.)
two, the ALJ found Plaintiff had severe impairments of (1) a
spine disorder, (2) right shoulder disorder, and (3) cystitis
(an inflammation of the bladder), but found various other
claimed impairments were either not severe or lacked medical
support. (AR 18-22.)
three, the ALJ concluded that Plaintiff did not have an
impairment or combination of impairments that met or
medically equaled one of the listed impairments in 20 C.F.R.
Part 404, Subpart P, Appendix 1. (AR 22.)
steps three and four, in her RFC assessment, the ALJ found
Plaintiff could perform light work, except that she was
limited to lifting and carrying no more than 20 pounds
occasionally and 10 pounds frequently; pushing and pulling
within the same weight limits; standing and walking six out
of eight hours with no prolonged walking for more than
approximately 60 minutes at a time; sitting for six out of
eight hours with the ability to stand and stretch for no more
than 10 percent of the day; avoiding ladders, ropes, or
scaffolds; no work hazards; occasional overhead reaching with
the right extremity; unskilled work; and close proximity to a
restroom facility. (Id.)
four, the ALJ found Plaintiff was able to perform her past
relevant work as a caregiver. (AR 27.) The ALJ concluded the
caregiver work qualified as past relevant work because
Plaintiff had performed it within the prior 15 years, had
done so for a sufficient period of time to learn the position
and to provide average performance, and she had performed it
“at the level of substantial gainful activity.”
(Id.) However, the ALJ did not explain the specific
bases behind each of these findings.
five, based on the VE's testimony, the ALJ made an
alternative finding that considering Plaintiff's age,
education, work experience, and RFC, there were jobs in
significant numbers in the national economy that Plaintiff
could perform. (AR 27-28.) These jobs were “mail clerk,
” “small parts assembler, ” and
“garment folder.” (AR 28.)
the ALJ found that Plaintiff was not disabled from February
12, 2011, her alleged onset of disability date, through the
date of the decision. (AR 28-29.)
thereafter requested a review of the ALJ's decision (AR
7-12), but the Appeals Council denied her request for review
(AR 1-6). The ALJ's decision thereafter became the
SSA's final and definitive determination in
Plaintiff's case. 42 U.S.C. § 405(g).
February 18, 2016, Plaintiff commenced the instant action for
judicial review. (Doc. No. 1.) Plaintiff thereafter filed a
motion for summary judgment (“MSJ”) (Doc. No.
14), and Defendant filed a cross-motion for summary judgment
(“Cross-MSJ”) and opposition to Plaintiff's
MSJ (Doc. No. 16). Plaintiff did not file an opposition to
Defendant's Cross-MSJ or a reply to Defendant's
opposition to her MSJ.
Summary of Medical Records Submitted to the ALJ for
January 23, 2009, more than two years before the date
Plaintiff alleged she became disabled, Luis C. Maas, III,
M.D., conducted an MRI on Plaintiff's right shoulder. (AR
324-27.) The MRI indicated tears in her tendon, moderate
degenerative change, and trace bursal fluid, but otherwise
the findings were unremarkable. (AR 324.) Dr. Maas also
investigated Plaintiff's complaint of pain in her neck
and arm, and diagnosed her with mild diffuse degenerative
spondylosis (degeneration) of the cervical spine, mild
central canal stenosis (narrowing), and mild to moderate
bilateral neural foraminal narrowing at multiple levels. (AR
326-27.) Later, on ...