BERNARDO P. VELASCO, Magistrate Judge.
Plaintiff, Joseph John Rocha, applied for Supplemental Security Income (SSI) and Disability Insurance Benefits (DIB) on July 20, 2007, alleging disability since February 7, 2007. Tr. 117-127. Plaintiff's date last insured was September 2006 (Tr. 128), and apparently for this reason only his application for SSI benefits under Title XVI was considered. The application was denied initially, (Tr. 58), on reconsideration (Tr. 63), and after an administrative hearing before an Administrative Law Judge (ALJ) held on April 22, 2009 (Tr. 35-55). The ALJ issued a written decision on August 12, 2009, finding Plaintiff is under a disability, but that a substance use disorder is a contributing factor to the determination of disability, and, accordingly, Plaintiff is not disabled within the meaning of the Social Security Act. Tr. 22-34. This decision became the final decision for purposes of judicial review under 42 U.S.C. § 405(g) when the Appeals Council denied review. Tr. 1-5.
Plaintiff now brings this action for review of the final decision of the Commissioner for Social Security pursuant to 42 U.S.C. §§ 405(g). The United States Magistrate Judge has received the written consent of both parties, and, accordingly, presides over this case pursuant to 28 U.S.C. § 636 (c) and Fed.R.Civ.P. 73.
After considering the record before the Court and the parties' briefing of the issues, the Court affirms Defendant's decision.
The Court has the "power to enter, upon the pleadings and transcript of the record, a judgment affirming, modifying, or reversing the decision of the Commissioner of Social Security, with or without remanding the cause for a rehearing." 42 U.S.C. § 405(g). The court will set aside a denial of benefits only if the Commissioner's findings are based on legal error or are not supported by substantial evidence in the record as a whole. Kail v. Heckler, 722 F.2d 1496, 1497 (9
Whether a claimant is disabled is determined using a five-step evaluation process. "A finding of `disabled' under the five-step inquiry does not automatically qualify a claimant for disability benefits." Bustamante v. Massanari, 262 F.3d 949, 954 (9
Under the implementing regulations, the ALJ must conduct a drug abuse and alcoholism analysis by determining which of the claimant's disabling limitations would remain if the claimant stopped using drugs or alcohol. 20 C.F.R. § 416.935
The key factor is whether the ALJ would still find the claimant disabled if he stopped using alcohol. Id.; Ball v. Massanari, 254 F.3d 817, 821 (9
The ALJ determined that Plaintiff had not engaged in substantial gainful activity since July 12, 2007, and had the following severe impairments: hepatitis C; depressive disorder; anxiety disorder; and history of polysubstance abuse. Tr. 25, ¶¶ 1, 2. While those impairments do not meet or equal a listed impairment (Tr. 26, ¶ 3), they do preclude Plaintiff from performing his past relevant work as a laborer and landscape laborer, and that considering Plaintiff's age, education, work experience, residual functional capacity (RFC) based on all of the impairments, including the substance use disorders, there are no jobs that exist in significant numbers in the national economy that Plaintiff could perform. Tr. 29, ¶ 9.
The ALJ further concluded that if Plaintiff stopped the substance use, the remaining limitations, specifically the hepatitis C, depressive disorder, and anxiety disorder, would cause more than a minimal impact on claimant's ability to perform basic work activities, but that Plaintiff would not have an impairment or combination of impairments that meets or medically equals a listed impairment. Tr. 30, ¶¶ 10, 11. The ALJ assessed Plaintiff's RFC if he stopped the substance use and concluded that Plaintiff's ability to perform a full range of work at all exertional levels would be compromised by the following nonexertional limitations: mild limitations in the ability to complete a normal workday and workweek without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods; was limited to one- or two-step routine tasks, had an insufficient pace for detailed tasks but was okay for simple tasks; and had the ability to be able to meet the basic mental demands of competitive remunerative, unskilled work on a sustained basis. Tr. 31, ¶ 12. Accordingly, the ALJ found that if Plaintiff stopped the substance use, he would still be unable to perform past relevant work, but that considering the claimant's age, education, work experience, and RFC, there would be a significant number of jobs in the national economy that the claimant could perform. Tr. 31, ¶ 15. The ALJ found that because the Plaintiff would not be disabled if he stopped the substance use, the Plaintiff's substance use disorders are a contributing factor material to the determination of disability, and thus, the Plaintiff has not been disabled within the meaning of the Social Security Act. Tr. 34, ¶ 16.
Plaintiff contends that the ALJ erred in determining that substance abuse was a material factor in causing Plaintiff's disability and in not correctly applying the listing at 5.00D(3) and (4) for evaluating chronic liver disease; and that the Appeals Council must remand the case to allow the ALJ to consider newly submitted evidence relevant to the case and not previously available.
Section 405(g) "authorizes district courts to review administrative decisions in Social Security benefit cases." Akopyan v. Barnhart, 296 F.3d 852, 854 (9
The Government argues that, in this case, though Plaintiff submitted new evidence to the Appeals Council, because the Appeals Council did not specifically consider the new evidence the Court should not consider the new evidence unless Plaintiff meets his burden of proving that the additional evidence is new and material and that he "had good cause for having failed to produce that evidence earlier." (Doc. 22, at 12) citing Mayes v. Massanari, 276 F.3d 453, 462 (9
The Appeals Council received two additional exhibits into evidence, a brief from Plaintiff's counsel (Tr. 183-85), and further medical evidence of record in the form of a mental RFC assessment completed by Dale Hawkins, N.P.
Applicable regulations provide that, if "new and material evidence is submitted," the Appeals Council "shall consider the additional evidence only where it relates to the period on or before the date of the administrative law judge hearing decision. ... It will then review the case if it finds that the administrative law judge's action, findings, or conclusion is contrary to the weight of the evidence currently of record." 20 C.F.R. § 416.1470(b).
The Appeals Council stated that they looked at the mental RFC assessment submitted by Dale Hawkins, N.P., and found that this did not affect the decision because the ALJ decided Plaintiff's case through August 12, 2009, and the new information was about a later time, and therefore it did not affect the decision about whether Plaintiff was disabled beginning on or before August 12, 2009. Tr. 2. The Appeals Council did not err in finding that the new evidence of Plaintiff's mental RFC assessment by Dale Hawkins did not relate to the period prior to the ALJ's date of decision, August 12, 2009, as the assessment took place on December 7, 2009, and Plaintiff did not establish, through treatment notes or other medical evidence of record, an ongoing treatment relationship or any other means that would have allowed a retrospective extrapolation of Plaintiff's mental RFC prior to the date of assessment.
The Government is correct, that the Appeals Council did not "consider" this evidence. Accordingly, this Court considers this evidence under the lens of 42 U.S.C. § 405(g), sentence six. Remand for reconsideration under sentence six of 42 U.S.C. § 405(g) is appropriate only where a plaintiff submits new evidence and further shows that: (1) the new evidence is material to his disability; and (2) he had good cause for failing to submit the evidence earlier. See Mayes, 276 F.3d at 462; see also 42 U.S.C. § 405(g) (sentence six: a court may "order additional evidence to be taken before the Commissioner of Social Security, but only upon a showing that there is new evidence which is material and that there is good cause for the failure to incorporate such evidence into the record"). To be material, the new evidence must bear "directly and substantially on the matter in dispute," and the plaintiff must show a "reasonable probability" that the new evidence would have changed the outcome of the administrative hearing. See Mayes, 276 F.3d at 462.
With regard to the good cause requirement, "[i]f new information surfaces after the [Commissioner's] final decision and the claimant could not have obtained that evidence at the time of the administrative proceeding, the good cause requirement is satisfied." Key v. Heckler, 754 F.2d 1545, 1552 (9
Even if Plaintiff met the good cause requirement, or the Court considered the evidence under Ramirez, supra, Plaintiff has not established materiality. If the new evidence is material, then we must remand the case to the ALJ for reconsideration. Booz v. Secretary of Health and Human Serv., 734 F.2d 1378, 1380 (9
Because the Appeals Council clearly rejected the portion of the assessment that related to the post-decision period, the Court finds that only the portion of the assessment and opinion that the Appeals Council considered as a possible basis for changing the ALJ's decision was the evidence presented regarding Plaintiff's alcohol and drug use.
As to the new evidence provided by Plaintiff that he was not currently using alcohol (Dr. Posadas' letter, Tr. 269; Dale Hawkins' assessment, Tr. 267-68); or drugs (Dale Hawkins' letter, id.), and had not used any drugs for the last six years (Dale Hawkins' letter, id), the Appeals Council considered the reasons Plaintiff disagreed with the decision and the additional evidence and found that the "additional evidence ... does not provide a basis for changing the Administrative Law Judge's decision." Tr. 2. Where the claimant submits evidence after the ALJ's decision and the Appeals Council specifically considers that evidence, "we consider the rulings of both the ALJ and the Appeals Council," and the record for review includes the new evidence. Ramirez v. Shalala, 8 F.3d 1449, 1451-52 (9
The Court finds that the new evidence is not material for several reasons. First, as noted by the Government, "reports . . . issued after the Commissioner's decision . . . are less persuasive," Macri v. Chater, 93 F.3d 540, 544 (citing Weetman v. Sullivan, 877 F.2d 20, 23 (9
Thus remand for reconsideration pursuant to sentence six of 42 U.S.C. § 405(g) is inappropriate because Plaintiff has failed to demonstrate either good cause for failing to submit the evidence earlier or that the new evidence is material to his disability.
Plaintiff argues that the ALJ's conclusion that abuse of cannabis is a contributing factor material to the determination that Plaintiff is disabled is pure speculation, (Doc. 19, at 3),
The parties do not disagree that, under 42 U.S.C. § 423(d)(2)(C), a claimant cannot receive disability benefits "if alcoholism or drug addiction would ... be a contributing factor material to the Commissioner's determination that the individual is disabled." Under the implementing regulations, the ALJ must conduct a drug abuse and alcoholism analysis by determining which of the claimant's disabling limitations would remain if the claimant stopped using drugs or alcohol. 20 C.F.R. § 416.935
Based on the record before him, the ALJ determined that Plaintiff's mental condition was such that Plaintiff would be "unable to meet the basic mental demands of competitive[,] remunerative, unskilled work on a sustained basis." (Tr. 28.) However, the ALJ also determined that Plaintiff's continuing, frequent marijuana use had a material effect on Plaintiff's "ability to complete a normal workday and workweek without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods"—when using drugs, the ALJ found Plaintiff was moderately limited in this area (Tr. 28), but without drugs found him to have only a mild limitation (Tr. 31). Thus, if Plaintiff were to stop using drugs his condition would improve to the point where he would be mentally and physically capable of working. (Tr. 31.) In making this determination, the ALJ relied primarily on the opinions of Dr. Rau and Dr. Estes. (See Tr. 32.) Both of these doctors specifically stated that Plaintiff's mental limitations, specifically in the areas of understanding and memory, as well as sustained concentration and persistence, were possibly attributable to the effects of his marijuana use (Tr. 235, 238), and their opinions were completely uncontradicted—at the time of the ALJ's decision, they were the only doctors to provide any opinion on how Plaintiff's drug use might affect his functioning. The ALJ's determination that drug abuse was a material factor in Plaintiff's disability was supported by substantial evidence and will therefore be upheld.
Plaintiff argues that the ALJ erred in not applying correctly the listing at 5.00D(3) and (4) for evaluating chronic liver disease and chronic viral hepatitis. Plaintiff's argument focuses on the generalized descriptions of hepatitis and chronic liver disease in 20 C.F.R. pt. 404, supbart P, app. 1 § 5.00D. (See Pl.'s Br. 15.) The language Plaintiff quotes is from the introduction related to digestive system impairments, not any of the listings themselves. The introduction "contains information relevant to the use of the listings in that body system; for example, examples of common impairments in the body system and definitions used in the listings for that body system." 20 C.F.R. § 416.926(c) (2010). But it is the specific listings, which "follow the introduction . . . after the heading, Category of Impairments," that a claimant must show he meets, not some generalized description in the introduction. Id. By arguing that he fits within the descriptions of chronic liver disease and viral hepatitis in the introduction, all Plaintiff has done is show that it was proper for the ALJ to consider whether Plaintiff's condition met listing 5.05. In fact, those generalized descriptions specifically direct the Agency to evaluate the general conditions of chronic liver disease and chronic viral hepatitis infections (a sub-category of chronic liver disease) under the specific requirements of listing 5.05. See 20 C.F.R. pt. 404, supbart P, app. 1 §§ 5.00D(2); 5.00D(4)(1)(i) and (ii).
Because there is no evidence of hemorrhaging, ascites or hydrothorax, bacterial peritonitis, hepatorenal syndrome, hepatopulmonary syndrome, or end stage liver disease, evaluations under listings 5.05A-E, or G were appropriately disregarded.
The listing for hepatic encephalopathy, indicating a severe loss of hepatocellular function and characterized by abnormal behavior, cognitive dysfunction, altered state of consciousness, and ultimately coma and death, is met by showing:
20 C.F.R. pt. 404, supbart P, app. 1 § 5.05F.
The Commissioner concedes that Plaintiff demonstrated some cognitive dysfunction before both Dr. Suarez (March 12, 2008) and Dr. Rau (April 17, 2008), though neither of these doctors diagnosed Plaintiff with hepatic encephalopathy, and the examinations were not the required 60 days apart, thus failing to meet the first criteria. Additionally, Plaintiff has not demonstrated placement of a shunt. While Plaintiff's INR is elevated, it does not meet the criteria of listing 5.05F in any of his blood tests reported in the medical records, (Tr. 200-01, 212-13, 225, 256-57, 265-66), and his serum albumin results ranged from 4.0 to 4.35/dL, well within range of the Listings. Though the elevation of Plaintiff's liver enzymes did not meet the exacting criteria of listing 5.05, the ALJ considered the laboratory results but nonetheless concluded that because the results were elevated on three occasions, each a year apart, without evidence of additional testing or treatment in the interim, the results represented a "snap shot" of an indication of the disease but [did] not establish a continuum" and thus neither a listing or its equivalency was met. The ALJ did not err in concluding that Plaintiff's condition did not meet or equal a listed impairment.
Because the Court finds that the ALJ did not err in determining that substance abuse was a material factor in causing Plaintiff's disability nor did the ALJ err in applying the Listings for evaluating chronic liver disease, and because Plaintiff did not meet his burden in demonstrating good cause for having failed to produce new evidence, nor did he demonstrate the materiality of the new evidence in order to demonstrate cause for remand, the Court will not reverse the agency's denial of benefits.
IT IS ORDERED:
1. Defendant's administrative decision denying benefits is affirmed.
2. The Clerk is directed to terminate this action.