A Social Security Disability Determination Case From Start To Finish.



Let’s take the case of Jack Smith*, a resident of Compton, California who applied for disability insurance benefits (DIB) and Supplemental Security Income (SSI) benefits in October 1992. Claiming an on the job back injury on February 14, 1989, from lifting 75 pounds of metal castings, he filed applications for disability insurance benefits (DIB) and SSI benefits on October 28, 1992. Smith alleged that he had become unable to work since his date last worked (DLW) of March 9, 1989 due to severe pain in his back, legs, neck and head. As a result, he had allegedly also suffered a severe mental impairment, specifically anxiety, depression and alcohol abuse. His Alleged Onset Date (AOD) is March 9, 1989.


His claim was initially denied by the California State Disability Determination Service (DDS). He requested a reconsideration of the DDS denial and was again denied benefits.

He appealed the Reconsideration denial and was given a hearing before Administrative Law Judge (ALJ) London Steverson at the Downey OHA on February 18, 1993. The Social Security hearing is considered a federal hearing. Mr. Smith appeared before the judge alone and the Government was not represented. He was represented by his own personal attorney, a member of the California Bar in good standing.

Mr. Smith was initially treated with chiropractic care and physical therapy. On March 27, 1989, a Magnetic Resonance Imaging (MRI) test revealed moderately severe central disc herniations at L4-5 and at L5-S1 of the lumbar spine. After experiencing numbness and further pain, Mr. Smith sought treatment from Dr. Omar Epps, a neurosurgeon. In July 1989, these symptoms abated and Mr. Smith received physical therapy for lower back problems until August 1989. Surgery scheduled for November 11, 1989 was cancelled. Mr. Smith continued to improve until a slip and fall accident in a grocery store on December 19, 1989. After reporting some improvement, he declined acupuncture treatment in January 1990. On February 22, 1990, Dr. Epps determined that Mr. Smith’s condition was permanent and stationary, but that he had shown marked improvement in both subjective assessment and objective findings. Dr. Epps concluded that Mr. Smith could perform only light work that did not involve prolonged standing or sitting. Light work involves lifting a maximum of 25 pounds occasionally and 10 pounds frequently.

On August 20, 1991, a California state ALJ found Mr. Smith disabled and eligible for Medi-Cal benefits.

After an auto accident on March 10, 1992, Mr. Smith was treated by Dr. Charlie Luke for headache and back and neck pain. On April 29, 1992, the Los Angeles County and University of Southern California (LAC/USC) Medical Center Emergency Room treated him for chronic back pain. Abut June 1992, Dr. Luke reported that Mr. Smith had improved sufficiently to discontinue treatment.

On July 25, 1992, Dr. Sammy Kumar reported that Mr. Smith was receiving psychotherapy for depression and anxiety.

Mr. Smith again received treatment at the LAC/USC center from August 5, 1992 to February 10, 1993. From November 1992 to January 1993, he reported pain relief due to epidural blocks. In February 1993, Mr. Smith’s treating physician reported that he had no disability. The opinion of a treating physician is entitled to controlling weight.

At the hearing before ALJ Steverson, Mr. Smith testified that his daily routine included reading law, history and other types of books for six hours, and that he watched television for three and a half hours, spent considerable time talking on the phone to friends, cleaned up around the apartment and was able to do his laundry and drive a car. Mr. Smith also testified that he could lift under 20 pounds, walk up and down stairs and play a musical instrument.

(Standard of Review In The Ninth Circuit.)

A district court’s order affirming a Social Security Commissioner’s denial of benefits is reviewed by the circuit court court de novo. (Smolen v. Chater, 80 F.3d 1273, 1279 (9th Cir.1996)). The decision by the Commissioner must be upheld, however, if it is supported by substantial evidence and the Commissioner correctly applied the law. (Smolen, 80 F.3d at 1279; Flaten v. Secretary, 44 F.3d 1453, 1457 (9th Cir.1995)). Substantial evidence is more than a mere scintilla, but less than a preponderance. (Matney ex rel. Matney v. Sullivan, 981 F.2d 1016, 1019 (9th Cir.1992)). The ALJ cannot discount a claim of excess pain without making specific findings supporting that decision. (Johnson v. Shalala, 60 F.3d 1428, 1433 (9th Cir.1996))

Fortunately the Standard of Review in the same in all Federal Circuits. A quick glance at the standard in the Sixth Circuit will serve as an illustration.

(Standard of Review In The Sixth Circuit)

The District Court exercises de novo review of district court decisions in Social Security disability cases. White v. Comm’r of Soc. Sec., 572 F.3d 272, 281 (6th Cir.2009); Lindsley v. Comm’r of Soc. Sec., 560 F.3d 601, 604 (6th Cir.2009). The Social Security Commissioner’s conclusion will be affirmed absent a determination that the ALJ failed to apply the correct legal standard or made fact findings unsupported by substantial evidence in the record. White, 572 F.3d at 281 (citing 42 U.S.C. § 405(g)). Substantial evidence is “such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Lindsley, 560 F.3d at 604 (citing Richardson v. Perales, 402 U.S. 389, 401 (1971)); see also Walker v. Sec’y of Health and Human Services, 980 F.2d 1066, 1070 (6th Cir.1992); McGlothin v. Comm’r of Soc. Sec., 299 Fed. Appx. 516, 522 (6th Cir.2008) (noting that substantial evidence is “more than a scintilla of evidence but less than a preponderance; it is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.”) (internal quotations omitted).

In deciding whether to affirm the Commissioner’s decision, “it is not necessary that the District Court agree with the Commissioner’s finding, as long as it is substantially supported in the record.” Beinlich v. Comm’r of Soc. Sec., 345 Fed.Appx. 163, 167 (6th Cir.2009). Even if the District Court might have reached a contrary conclusion of fact, the Commissioner’s decision must be affirmed so long as it is supported by substantial evidence. Lindsley, 560 F .3d at 604-05 (administrative findings are not subject to reversal merely because substantial evidence exists in the record to support a different conclusion) (quoting Felisky v. Bowen, 35 F.3d 1027, 1035 (6th Cir.1994)); Roe v. Apfel, 211 F.3d 1270, at *7 (6th Cir. April 25, 2000) (unpublished table decision).


Mr. Smith claimed that the ALJ based his decision that he was not disabled on five incorrect or inadequate reasons. First, he contends that the ALJ failed to explain why Mr. Smith failed to equal, even if he did not meet, section 1.05 of the Listing of Impairments (the Listings). (Marcia v. Sullivan, 900 F.2d 172, 176 (9th Cir.1990)). The ALJ has a duty to make this determination 20 C.F.R. § 416.920(d).

The Ninth Circuit Court found the ALJ’s  explanation sufficient .

The degenerative disc disease of the claimant’s spine, and most particularly the herniated disc shown on MRI studies in August 1990 and in August 1992, did not meet or equal the requisite level of severity of section 1.05(c) of the Listing of Impairments inasmuch as a pain syndrome requiring ongoing treatment for back pain is not shown, and as there had been no dermatomal neurological deficits on clinical examination.

Mr. Smith claimed that the ALJ failed to give any reason for rejecting Dr. Epps’s finding that he is restricted from prolonged sitting in violation of the rule that evidence cannot be rejected without any reason. Cotter v. Harris, 642 F.2d 700, 706 (3d Cir.1981). The ALJ does provide a reason, however, for not accepting that particular finding: “The claimant’s refusal of back surgery and his refusal of even acupuncture treatment reflects a lack of motivation to improve and return to work.”

Mr. Smith contended that the ALJ incorrectly found that his claims of pain were contradicted by Dr. Luke’s medical findings and statements made to Dr. Luke by Mr. Smith. There is substantial evidence for the ALJ’s finding.

Also Mr. Smith maintained that the ALJ incorrectly found that records of the LAC/USC Medical Center indicated that he was not disabled. There was substantial evidence for the ALJ’s finding.

Mr. Smith argued that the ALJ incorrectly found a number of inconsistencies in his complaints about continuing and excruciating pain. ” ‘The ALJ is responsible for determining credibility and resolving conflicts in medical testimony.’ “( Saelee v. Chater, 94 F.3d 520, 522 (9th Cir.1996)) (quoting Magallanes v. Bowen, 881 F.2d 747, 752 (9th Cir.1989)). In addition to the deference accorded the ALJ’s findings of credibility, there was substantial evidence for the ALJ’s finding.

Mr. Smith’s claim that sufficient evidence existed as to his nonexertional limitations, mental impairment and severe pain, so as to make the ALJ’s application of the grids inappropriate was not persuasive. The use of the grids can be appropriate even when a claimant alleges both exertional limitations and nonexertional limitations.( Bates v. Sullivan, 894 F.2d 1059, 1063 (9th Cir.1990)) , overruled on other grounds,( Bunnell v. Sullivan, 947 F.2d 341, 342 (9th Cir.1991)) (en banc). The ALJ properly applied the grids to Mr. Smith since the ALJ found that the alleged pain did not significantly detract from his exertional capabilities.  Though the ALJ failed to consider whether mental impairment significantly detracted from his exertional capabilities, evidence of mental impairment was not properly submitted to the ALJ. Though Mr. Smith maintained that there were numerous references in the record to his mental impairment, he failed to claim a significant mental impairment in his benefits application, failed to submit a medical or psychological report that such impairment was sufficiently serious to limit work activities, failed to raise it at the hearing, and failed to raise it before the Appeals Council. Mr. Smith’s argument that the mentally impaired frequently do not realize that they are impaired as such and thus he should not be penalized for failing to raise the issue was undermined by his attorney also not raising the issue before the Appeals Council. Since Mr. Smith’s claim of mental impairment, as a basis for his claim that the ALJ improperly applied the grids, was untimely, therefore the Circuit Court declined to consider it in ascertaining whether the ALJ erred in applying the grids. (Avol v. Secretary of HHS, 883 F.2d 659, 661 (9th Cir.1989))

With respect to Mr. Smith’s alleged nonexertional limitation of pain, the ALJ had substantial evidence to support its determination that Mr. Smith’s claims of severe and excruciating pain were not sufficiently severe to detract from his exertional capabilities. (See Bates, 894 F.2d at 1063; Perminter v. Heckler, 765 F.2d 870, 872 (9th Cir.1985)) (grids inapplicable only if evidence shows that pain prevents claimant from working at any job). There was also substantial evidence to warrant the ALJ’s finding that the medical evidence was insufficient and that Mr. Smith’s subjective assessment was not credible. Since the ALJ made specific reference as to why Mr. Smith’s claims of pain were not entirely credible and the ALJ did not make his finding based on medical evidence alone, there was substantial evidence to support that the ALJ’s finding of lack of credibility was proper.( Bates, supra at 1062-63.)

Mr. Smith claimed that the ALJ did not obtain a valid waiver of his right to counsel. Relying on Binion v. Shalala, 13 F.3d 243, 245 (7th Cir.1994), he argued that in order for his waiver to be valid the ALJ should have advised him how an attorney could be of aid, the possibility of a contingency arrangement, limitations on attorney fees and the requirement of court approval of fees. In addition to the above requirements not being controlling for the Ninth Circuit Court, it has been well established  that a claimant has to make a showing of the resulting prejudice or unfairness stemming from lack of counsel. (Key v. Heckler, 754 F.2d 1545, 1551 (9th Cir.1985)) ; Hall v. Secretary of Health, Ed. and Welfare, 602 F.2d 1372, 1378 (9th Cir.1979). Mr. Smith neither established the requisite resulting prejudice nor even argued that any resulting prejudice stemmed from his lack of counsel.

Mr. Smith’s claim that the ALJ failed to meet its heavier burden when the claimant is without counsel to “scrupulously and conscientiously probe into, inquire of and explore for all relevant facts,” Vidal v. Harris, 637 F.2d 710, 713 (9th Cir.1981), was not persuasive. When the ALJ fails to meet his or her heavier burden for a claimant without counsel, remand is appropriate. Id. at 715. Considering that evidence of mental impairment (including alcohol abuse, anxiety and depression) was not fully raised by Mr. Smith before the ALJ, the ALJ satisfactorily met his heavier burden to explore all relevant facts under Vidal. Though the ALJ failed to obtain medical reports mentioned in state ALJ Hall’s decision, whether such reports should have been considered was within the sound discretion of the ALJ. Wilson v. Heckler, 761 F.2d 1383, 1385 (9th Cir.1985). Without a showing from Mr. Smith that the ALJ abused his discretion, the Circuit Court would not upset the ALJ’s discretionary judgment.

Mr. Smith argued that the ALJ failed to give due consideration to state ALJ Hall’s ruling that he was disabled. The ALJ must explain why significant and probative evidence has been rejected. Vincent v. Heckler, 739 F.2d 1393, 1395 (9th Cir.1984). The determinations of another agency, however, are not binding on the Social Security Commissioner and in his or her discretion may give it much or little weight. Wilson, 761 F.2d at 1385.

Mr. Smith’s reliance on Allen v. Heckler, 749 F.2d 577, 579 (9th Cir.1984) (a prior determination of disability gives rise to a presumption of disability requiring the government to show that a claimant has improved in order to deny benefits), is misplaced. Allen, unlike the instant case, involved a prior determination by the same agency and in order to terminate benefits the government had to show that the claimant had improved. Id.

Substantial evidence exists to support the ALJ’s finding that Mr. Smith can perform a full range of sedentary work. Mr. Smith’s reliance on Delgado v. Heckler, 722 F.2d 570, 574 (9th Cir.1983) (“A man who cannot walk, stand or sit for over one hour does not have the capacity to do most jobs available in the national economy.”) for his claim that he cannot perform sedentary work is not persuasive. Mr. Smith only claims that he cannot sit for prolonged periods, he does not fix a particular duration as to how long that he can or cannot sit. Based not only on objective medical evidence but also on Mr. Smith’s description of his daily activities of prolonged reading, watching TV, talking on the telephone etc., and his lack of credibility regarding his claims of severe pain, substantial evidence exists that Mr. Smith can perform sedentary work. Even Dr. Espinosa, the physician whose determinations and diagnoses Mr. Smith principally relies on, opined that Makshanoff could perform light work.

Mr. Smith claims that the ALJ’s four cited reasons for concluding that his testimony regarding severe pain was not credible is not based on substantial evidence. Despite Mr. Smith’s arguments, there is substantial evidence to support the ALJ’s finding that since his medical records show significant improvement in his experiences of pain, his claims of no significant relief from pain are not credible.


Mr. Smith’s argument that substantial evidence does not exist to support the ALJ’s second finding that Mr. Smith’s refusal of surgery “reflects a lack of motivation to improve and return to work,” ER at 8, is not entirely persuasive. Although failure to seek medical treatment cannot be used to infer a lack of credibility of the claimant regarding his or her experience of pain, Penny v. Sullivan, 2 F.3d 953, 958 (9th Cir.1993), the unexplained absence of treatment for pain may be used to impeach credibility. Orteza v. Shalala, 50 F.3d 748, 750-51 (9th Cir.1995). While Mr. Smith’s present explanations for the absence of treatment for his pain may be compelling, the explanations were not offered to the ALJ at the hearing. The ALJ’s determination was supported by substantial evidence.


Substantial evidence supports the ALJ’s third finding that Dr. Luke’s medical records show Mr. Smith’s significant improvement and Mr. Smith’s statement to Dr. Luke that he felt well undermine Mr. Smith’s allegation of continuing severe pain.


The ALJ’s fourth finding that physicians rejected Mr. Smith as a suitable candidate for surgery because his claimed back pain failed to match any anatomical distribution is also supported by substantial evidence. Mr. Smith’s argument that allegations of pain cannot be discredited solely on the basis of a lack of objective medical evidence, Penny, 2 F.3d at 957, is not persuasive. The ALJ discredits the pain allegations not merely from objective medical evidence but also from statements made by Mr. Smith about his daily routine. Doing laundry, reading law and history for at least 6 hours a day, playing a musical instrument, watching television and talking on the telephone with friends is incompatible with the pain that Mr. Smith claims. See Fair v. Bowen, 885 F.2d 597, 604 (1989); Orteza, 50 F.3d at 750-51.


Mr. Smith also claims that if the ALJ noted the disparity between the objective medical evidence and his allegations of severe pain “the possibility of a mental impairment as the basis for the pain should have been investigated.” Bunnell, 947 F.2d at 343. Since the ALJ did not consider the possibility of mental impairment, Mr. Smith argues, the ALJ’s determination is legally deficient. The ALJ’s findings that Mr. Smith’s pain allegations were not credible, his refusal to seek treatment, and his lack of motivation to improve and return to work, however, support an inference that the ALJ found Mr. Smith’s pain allegations to be exaggerated so as to obtain benefits and not work which would foreclose the necessity of considering mental impairment. See Saelee, 94 F.3d at 522.


Mr. Smith contends that the magistrate, in adopting the ALJ’s incorrect findings, committed three abuses of discretion. First, Mr. Smith argues the magistrate erroneously found that the ALJ properly developed the record since the magistrate found that there was no reason for the ALJ to inquire into a mental impairment. As discussed in the analysis to issue III, the ALJ satisfactorily met his heavier burden, under the Vidal standard, to develop a full record.


Second, Mr. Smith claims the magistrate incorrectly agreed with the ALJ that Mr. Smith did not meet section 1.05 of the listings without considering whether he equaled the listings. As discussed in the analysis of issue I, there is substantial evidence that the ALJ fully considered, under Marcia, whether Mr. Smith equaled, even if he did not meet, the Medical Listings of Impairments.


Third, Mr. Smith asserts that the magistrate erroneously accepted the ALJ’s determination to reject Dr. Espinosa’s opinion that Mr. Smith was precluded from prolonged sitting. As discussed in the analysis of issue I, given the substantial evidence regarding Mr. Smith’s daily activities and his unwillingness to seek treatment, the magistrate properly accepted the ALJ’s determination.



We AFFIRM the district court’s grant of summary judgment.

*NOTE: Name of the claimant was changed.

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