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Masterson v. Colvin

United States District Court, S.D. California

July 11, 2017



          Hon. William V. Gallo United States Magistrate Judge

         This is 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.

         I. Overview of Social Security Claim Proceedings

         Pursuant 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).

         A. SSA's Sequential Five-Step Process

         The SSA 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[1] 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); 1382(c)(3)(A).

         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).

         Step 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. §§ 404.1520(b), 416.920(b).

         If a 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).

         An ALJ 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), 416.921(b).

         However, 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. §§ 404.1520(d).

         If the 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.

         At step 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.

         At the 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.

         At this 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).

         B. SSA Hearings and Appeals Process

         In 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.

         A 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).

         If the 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.

         II. Background

         A. Administrative Proceedings

         In June 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.)

         On July 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.)

         At step 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.[2] (AR 18-22.)

         At step 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.)

         Between 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.)

         At step 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.

         At step 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.)

         Accordingly, 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.)

         Plaintiff 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).

         On February 18, 2016, Plaintiff commenced the instant action for judicial review. (Doc. No. 1.)[3] 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.

         B. Summary of Medical Records Submitted to the ALJ for Review

         On 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 ...

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