CRAIG M. KELLISON, Magistrate Judge.
Plaintiff, who is proceeding with retained counsel, brings this action for judicial review of a final decision of the Commissioner of Social Security under 42 U.S.C. § 405(g). Pending before the court is plaintiff's motion to remand (Doc. 18).
This action seeks review of the Commissioner's 2013 denial of benefits. However, the procedural history of plaintiff's request for benefits is more complex. Plaintiff has filed a total of three
In plaintiff's challenge to ALJ Ramsey's denial of benefits as to his second application, case number 08cv2470-FCD-CMK, plaintiff originally moved for an order remanding that case under sentence six, for further development arguing the administrative record was deficient for failure to include an argument by attorney Manuel Garcia and the exhibits relied on by the ALJ from plaintiff's previous claim. The motion to remand was denied, and plaintiff was ordered to prosecute this action by filing a motion for summary judgment. Plaintiff continued to argue for remand, but the court reviewed the ALJ's opinion, found no error and affirmed the Commissioner's denial of benefits. Plaintiff appealed that decision to the Ninth Circuit Court of Appeals. The Ninth Circuit determined
Here, again in lieu of filing a motion for summary judgment specifically addressing any potential errors in the ALJ's opinion, plaintiff chose to file a motion for remand. Plaintiff is again requesting the court remand this case back to the Commissioner for further development of the record, contending the record is incomplete. Specifically, plaintiff argues the record is incomplete, missing evidence material to a determination of an earlier onset date of benefits. The alleged missing evidence is the July 9, 2003, hearing transcript before ALJ Fong, and relevant records from plaintiff's initial application, the evidence supporting the Commissioner's 2003 determination of no disability. He argues that evidence should have been included in the Certified Administrative Record (CAR) filed in this case. He states that the ALJ had a duty to further develop the record by including all of the medical records supporting ALJ Fong's prior determination, including a hospitalization records regarding an alleged onset date back to 2001.
Defendant opposes remand in this case, as the information plaintiff seeks to include in the record relates to a prior application that was denied and is no longer subject to review. The evidence supporting a prior claim is not considered in any subsequent claim, thus the Commissioner was not required to include all of the evidence supporting the prior ALJ decision. Once a final agency decision of nondisability has issued, there is a presumption of continuing nondisability that the plaintiff has the burden to overcome with evidence showing a change in his condition. He has not done so here.
Plaintiff counters that a remand "is proper because the medical evidence of record presented at [his] first hearing . . . is new and material evidence because it was not considered at the hearing on remand, despite a prior reopening of that first application." (Plaintiff's Reply, Doc. 21, at 1). He contends that the Commissioner was required to consider the evidence supporting the ALJ's decision on his 2001 application, because that application was reopened by ALJ Ramsey during the 2007 hearing on his 2004 application. Specifically, plaintiff contends because ALJ Ramsey heard plaintiff's testimony dating back to 2001, and discussed his mental capacity dating back to 2001, he implicitly reopened the old application.
An unappealed denial of an application for disability benefits operates as res judicata as to the finding of non-disability.
In addition, the Commissioner does have the ability to reopen a claim.
However, there are some courts who have determined that the Commissioner can imply a de facto reopening of a prior claim, "where the Commissioner considers `on the merits' the issue of the claimant's disability during the already-adjudicated period."
Here, plaintiff contends ALJ Ramsey reopened his prior claim based on the testimony he accepted at the 2007 hearing, and his discussion "on the merits" of his claim dating back to 2001. However, as defendant argues, the 2007 decision by ALJ Ramsey was vacated when this case was remanded. It is not at all clear to the undersigned, even if that opinion had not been vacated, that in fact ALJ Ramsey reopened plaintiff's prior claim. There is no indication that plaintiff requested such an opening, and while not specifically necessary, there also does not appear to be any grounds for such a reopening to have occurred. ALJ Ramsey held the administrative hearing in 2007, and issued his opinion in 2007. ALJ Fong issued her opinion in 2003. Certainly more than one year occurred between the two opinions, indeed almost four years had passed. Within four years after a decision, the Commissioner may reopen a prior determination if there is new and material evidence, or the evidence used in the prior decision clearly shows on its face that an error was made. The undersigned does not find either of those reasons for reopening to be present in this case. In addition, after ALJ Ramsey's decision was vacated, ALJ Villere held a new administrative hearing and issued a revised decision, which became the final decision on plaintiff's 2004 application. Plaintiff's reliance on ALJ Ramsey's decision is misplaced.
ALJ Villere specifically discussed ALJ Fong's prior determination, and stated that the presumption of continuing nondisability applied, which plaintiff was required to rebut. (CAR 316). He then determined that presumption did not apply, that the medical expert opinion indicated an increase in the severity of plaintiff's impairments beginning in October 2003, which allowed plaintiff to rebut the presumption of continuing nondisability. (CAR 317). In addition, one of ALJ Villere's specific findings was the prior residual functional capacity finding was required to be applied to the period prior to October 28, 2003, since no evidence had been submitted which rebutted the ALJ's finding that plaintiff retained the residual functional capacity from his alleged date of onset up through the date of that prior decision, October 27, 2003. (CAR 318). Therefore, even if ALJ Ramsey had entertained the idea of reopening plaintiff's prior claim, that opinion was vacated and is no longer the controlling opinion. Instead ALJ Villere's January 29, 2013, opinion is the controlling opinion, and he specifically determined the prior claim to be closed and had not been rebutted.
In fact, the record indicates that plaintiff only requested ALJ Villere reopen his prior claim in December 2012. (CAR 508). No such request appears to have been submitted to ALJ Ramsey. ALJ Villere did agree at the hearing to take a look at plaintiff's request to include the prior medical records and submit the information to the medical expert if he determined it was necessary. (CAR 738). There is no indication in the record that he did so. The lack of additional interrogatories to the experts, and the ALJ's written opinion that plaintiff failed to rebut the prior findings, all indicate that the ALJ declined to reopen plaintiff's prior claim.
Therefore, the undersigned finds ALJ Villere, whose opinion is now controlling on plaintiff's September 15, 2004, application, did not reopen plaintiff's prior claim, de facto or otherwise. Plaintiff's prior claim, the October 27, 2003, denial, operates as a determination of non-disability, creating a presumption of continuing non-disability.
The court's scheduling order directs plaintiff may prosecute this action in one of two ways. First, plaintiff was to file a motion for summary judgment and/or remand after being served with a copy of the administrative record. Alternatively, if plaintiff has new evidence outside the evidentiary record, plaintiff may submit the new evidence with a request for voluntary remand to the Social Security Administration. If no voluntary remand agreement is reached, plaintiff was directed to file a motion for summary judgment and/or remand in this court. (
Accordingly, IT IS HEREBY ORDERED that:
1. Plaintiff's motion for remand (Doc. 18) is denied;
2. The Clerk of the Court is directed to close this case.