891 F.3d 872
9th Cir.2018Background
- Carol Ann Luther applied for DIB and SSI in February 2013, alleging PTSD and degenerative disc disease, with an onset date later amended to December 6, 2012 (to match a VA rating).
- The VA awarded Luther a 100% disability rating effective December 6, 2012 (PTSD), plus smaller service-connected ratings for other conditions; she submitted only the first two pages of the VA decision to the ALJ and later submitted the full decision to the Appeals Council.
- The ALJ held a hearing on October 27, 2014, briefly acknowledged the VA 100% rating, and ultimately denied Social Security benefits in a December 3, 2014 decision; the ALJ made only limited references to the VA rating and stated it "has no bearing."
- The Appeals Council denied review; it commented that the ALJ had sufficient records and that VA evidence did not compel a Social Security disability finding, but the Appeals Council’s reasoning was not part of the ALJ’s decision.
- The district court affirmed the Commissioner; Luther appealed to the Ninth Circuit challenging (inter alia) the ALJ’s failure to give the VA rating great weight and failure to provide valid reasons for rejecting it.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the ALJ improperly discounted the VA 100% disability rating | Luther: ALJ failed to give VA rating "great weight" and gave no persuasive, specific, valid reasons for rejecting it | Commissioner: ALJ acknowledged the VA rating and considered it; Appeals Council explained the record supported ALJ’s decision | Court: ALJ erred — simply mentioning the VA rating was insufficient; ALJ did not provide persuasive, specific, valid reasons for discounting it |
| Whether the Appeals Council’s reasoning denying review may be relied on by the reviewing court | Luther: District court improperly relied on Appeals Council reasoning | Commissioner: A reviewing court may consider Appeals Council’s explanation (citing Ramirez) | Court: Appeals Council’s reasoning denying review is not considered; when Appeals Council denies review ALJ’s decision is final and controls |
| Whether remand should be for benefits or further proceedings | Luther: Seeks benefits or alternative remand | Commissioner: Case should be affirmed | Court: Remand for further proceedings — ALJ must properly evaluate and explain treatment of VA rating and develop record on other service-connected conditions |
| Whether the ALJ had a duty to develop the record regarding other VA service-connected conditions | Luther: ALJ failed to develop record re: urinary tract infection and degenerative disc disease | Commissioner: Not expressly argued below | Court: ALJ should develop record and question claimant about other service‑connected conditions on remand |
Key Cases Cited
- McCartey v. Massanari, 298 F.3d 1072 (9th Cir. 2002) (ALJ must ordinarily give great weight to VA disability determinations and explain reasons for discounting them)
- McLeod v. Astrue, 640 F.3d 881 (9th Cir. 2011) (VA ratings ordinarily warrant great weight though not conclusive)
- Valentine v. Comm’r Soc. Sec. Admin., 574 F.3d 685 (9th Cir. 2009) (ALJ may reject VA rating only with persuasive, specific, valid reasons supported by record)
- Ramirez v. Shalala, 8 F.3d 1449 (9th Cir. 1993) (courts may consider additional evidence submitted to Appeals Council when Appeals Council considered the entire record)
- Sims v. Apfel, 530 U.S. 103 (2000) (if Appeals Council denies review, ALJ’s opinion becomes Commissioner’s final decision)
- Brewes v. Comm’r of Soc. Sec. Admin., 682 F.3d 1157 (9th Cir. 2012) (when Appeals Council declines review, district court reviews ALJ decision as final)
- Taylor v. Comm’r of Soc. Sec. Admin., 659 F.3d 1228 (9th Cir. 2011) (remand for further proceedings appropriate when outstanding issues remain)
- Hiler v. Astrue, 687 F.3d 1208 (9th Cir. 2012) (ALJ may deviate from VA decisions only on persuasive, specific, valid contrary evidence)