Renee Maines v. Carolyn Colvin
666 F. App'x 607
9th Cir.2016Background
- Renee Maines appealed on behalf of her minor daughter L.M., challenging denial of SSI benefits for ages 6–18; district court previously granted benefits for L.M. prior to age six and the appeal concerns only ages six through eighteen.
- L.M. has juvenile diabetes mellitus requiring parental insulin and alleged “[r]ecent, recurrent episodes of hypoglycemia,” a criterion in the listings in effect when she filed her application.
- The ALJ evaluated L.M.’s claim under listings amended in 2011, which postdate L.M.’s application and the agency’s initial/reconsideration decisions.
- Maines argued the ALJ should have applied the listings in effect on the application date; the Commissioner defended the ALJ’s use of the amended listings and relied on existing medical records.
- The Ninth Circuit held the ALJ erred by applying post-application listing criteria, remanded for further proceedings, and directed the ALJ to obtain a qualifying pediatric case evaluation (pediatrician or pediatric diabetes specialist).
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Which version of the listings governs review | Maines: apply listings in effect when application filed | Commissioner: ALJ applied amended 2011 listings | Court: apply listings in effect at filing; ALJ erred by using 2011 listings |
| Whether record supports immediate award of benefits under original listing | Maines: L.M. meets original listing for recent, recurrent hypoglycemia; award benefits | Commissioner: factual record insufficient for immediate award | Court: record lacks necessary findings and definition of "recent, recurrent"; cannot award now; remand for ALJ factfinding |
| Whether ALJ satisfied requirement to obtain pediatric specialist evaluation | Maines: ALJ should obtain qualified pediatric/pediatric diabetes case evaluation | Commissioner: existing treating and agency physician records suffice | Court: ALJ must make reasonable efforts to secure a qualified pediatrician/pediatric diabetes specialist evaluation; prior records insufficient |
Key Cases Cited
- Dale v. Colvin, 823 F.3d 941 (9th Cir. 2016) (standard of review: district court de novo; ALJ for substantial evidence)
- Ball v. Massanari, 254 F.3d 817 (9th Cir. 2001) (apply rules in effect when application filed)
- Benecke v. Barnhart, 379 F.3d 587 (9th Cir. 2004) (record inadequacy precludes immediate benefits award)
- Howard ex rel. Wolff v. Barnhart, 341 F.3d 1006 (9th Cir. 2003) (requirement to obtain/consider qualifying case evaluation from appropriate pediatric expert)