*3 KLEINFELD, Circuit Judge:
We address harmless error in the context of Social Security disability.
I. Facts
Gene R. McLeod applied at age 51 for supplemental secur-
ity income based on disability. The Administrative Law Judge
(ALJ) found that he had three severe impairments—
degenerative changes of the lumbar spine, history of coronary
artery disease, and sleep apnea—but none so severe as to rise
to the level of “listed” impairments. He lacked significant pro-
trusion or herniation of the discs or compression of the nerve
root where there was narrowing at L4-5, and catheterization
Hoa Hong Van v. Barnhart
,
The medical record, consisting mostly of information from McLeod’s treating physicians and physicians to whom his treating physicians referred him for consultation at Depart- ment of Veterans Affairs facilities, was mixed as to the sever- ity of McLeod’s condition. A neurosurgeon to whom McLeod was referred said that McLeod had “no muscle weakness” and recommended against surgery because of the unlikelihood of improvement “particularly with unsettled litigation and his pain behavior on examination.” The VA Neurosurgery Chief wrote that McLeod’s spinal canal was “open throughout his lumbosacral region” (which means no compression on account of narrowing) and that “he has some evidence of degenerated discs but there is not any evidence of nerve root compression from these discs.” One treating physician at the VA said that because McLeod had “back pain with minimal activity,” and “any work he has done exacerbates the prob- lem,” he was “unemployable.” But another treating VA physi- cian said McLeod should be restricted to “light manual sedentary” work, rather than no work at all.
*5 McLeod’s appeal focuses on the ALJ’s failure to develop the record further regarding his veteran’s disability and medi- cal condition. McLeod testified that he received a $296 non- service-connected pension, based on unemployability, from the VA. When the ALJ asked him if he had a VA disability rating, he answered, “I have no idea, Your Honor.” The record does not reveal whether the VA found McLeod par- tially or entirely disabled. No evidence of his disability rating was submitted to the Social Security Administration at any stage of the proceedings, or to the district court. Based on McLeod’s testimony about his “pension,” there is a fair chance he has a disability rating, but the record shows neither that he has one nor what it is.
Though McLeod had only a lay representative before the VA, he was represented by an attorney in district court and is represented, by different counsel, here.
II. Analysis
McLeod argues under Tonapetyan v. Halter that the ALJ erred by failing to develop the record adequately. According to McLeod, the ALJ should have requested more explanation from two of his treating physicians at the VA, Dr. Dietz and Dr. Rossetto, about his ability to work. McLeod also argues that the ALJ should have obtained whatever VA disability rat- ing McLeod might have. The ALJ had no duty to request more information from
the two physicians. It appears from the record that substan-
tially all of their medical records throughout the time they
treated McLeod were before the ALJ. There was nothing
unclear or ambiguous about what they said. They both
thought McLeod had a bad lower back condition, based on his
symptom reports, their examinations, and objective medical
tests. Dr. Dietz thought McLeod could do sedentary work, and
*6 Dr. Rossetto thought McLeod could not work at all. As for the ALJ rejecting Dr. Rossetto’s opinion on whether McLeod could work at any job, he was correct that this determination is for the Social Security Administration to make, not a physi- cian. “Although a treating physician’s opinion is generally afforded the greatest weight in disability cases, it is not bind- ing on an ALJ with respect to the existence of an impairment or the ultimate determination of disability.” [2] McLeod argues that Dr. Rossetto’s opinion could be read as an evaluation of his “functional exertional capacity” rather than a conclusion on his ability to work, but we do not agree. The words are clear and unambiguous: an “ALJ’s duty to develop the record further is triggered only when there is ambiguous evidence or when the record is inadequate to allow for proper evaluation of the evidence.” A treating physician’s evaluation of a patient’s ability
to work may be useful or suggestive of useful information, but a treating physician ordinarily does not consult a voca- tional expert or have the expertise of one. An impairment is a purely medical condition. A disability is an administrative determination of how an impairment, in relation to education, age, technological, economic, and social factors, affects abil- ity to engage in gainful activity. The “relationship between impairment and disability remains both complex and difficult, if not impossible, to predict. . . The same level of injury is in no way predictive of an affected individual’s ability to partici- pate in major life functions (including work) . . . Disability may be influenced by physical, psychological, and psychoso- cial factors that can change over time.” The law reserves the disability determination to the Commissioner. Rejection of at 1148; 20 C.F.R. § 404.1527(e)(1). Mayes v. Massanari , 276 F.3d 453, 459-60 (9th Cir. 2001). See also
Bayliss v. Barnhart
,
the treating physician’s opinion on ability to perform any remunerative work does not by itself trigger a duty to contact the physician for more explanation. [6]
[3] The issue of the VA disability rating is more complex. The record suggests a likelihood that McLeod has some sort of VA disability rating, yet does not show what it is. That Mc- Leod failed to submit the rating to the ALJ is not the end of the matter.
[4] The ALJ has a duty to conduct a full and fair hearing. We held in Tonapetyan v. Halter [8] that “[a]mbiguous evidence, or the ALJ’s own finding that the record is inadequate to allow for proper evaluation of the evidence, triggers the ALJ’s duty to conduct an appropriate inquiry.” [9] The ALJ must be “especially diligent” when the claimant is unrepresented or has only a lay representative, as McLeod did. [10] A specific finding of ambiguity or inadequacy of the record is not neces- sary to trigger this duty to inquire, where the record estab- lishes ambiguity or inadequacy.
[5] The record here was inadequate. McLeod testified that he was receiving a VA pension based on unemployability, but that he had no idea whether he had a disability rating. This testimony suggests a likelihood that he had one. If he did, it might very well matter. We held in McCartey v. Massenari [12] that “although a
VA rating of disability does not necessarily compel the SSA
[6]
20 C.F.R. §§ 404.1512(e), 416.912 (e).
Smolen v. Chater
,
Heckler
,
6626
to reach an identical result, 20 C.F.R. § 404.1504, the ALJ must consider the VA’s finding in reaching his decision” and the ALJ “must ordinarily give great weight to a VA deter- mination of disability.” That is not to say that the VA rating is conclusive. In McCartey , we commented that “because the VA and SSA criteria for determining disability are not identi- cal,” the record may establish adequate reason for giving the VA rating less weight. In some circumstances, the VA may assign a partial rather than a total disability rating to a veteran, and a partial disability rating might cut against rather than in favor of an SSA determination that the individual could not perform remunerative work of any kind.
Even though it is not binding or conclusive, the VA disabil- ity rating has to be considered. The ALJ did not mention it in her decision and did not consider it. No doubt she failed to consider the VA rating because it was not in the record and she did not know what disability rating if any the VA had assigned to McLeod. Nevertheless, she erred by not trying to get whatever VA disability rating existed. We must apply the holding in McCartey , that the VA
disability rating must be considered and ordinarily must be given great weight, together with the holding in Tonapetyan , that inadequacy of the record to allow for proper evaluation triggers a duty of inquiry. These two holdings taken together establish that when the record suggests a likelihood that there is a VA disability rating, and does not show what it is, the ALJ has a duty to inquire. McLeod might have had a letter Id. at 1076. Id. See 38 C.F.R. §§ 4.1 (explaining that VA disability percentage ratings
represent the average impairment in earning capacity resulting from dis- eases and injuries), 4.15 (limiting VA total disability ratings to “any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation”). *9 6627 from the VA telling him what his disability rating was, or pro- viding him with the basis on which he got his pension, that he could have brought in had the ALJ given him a continu- ance and told him to bring in his letter. Alternatively, the ALJ could have obtained McLeod’s disability rating herself. Then she could have evaluated his disability properly under Tonapetyan . By failing to obtain and consider McLeod’s VA disability rating, the ALJ erred, denying him the “full and fair hearing” to which he was entitled.
That leads us to the next question, what we are to do about the error. We still do not know what determination the VA made regarding McLeod’s claimed disability. We therefore do not know whether the ALJ’s failure to obtain the rating caused McLeod any harm.
[8] The answer to what we must do about the error is pro- vided by a recent Supreme Court decision, Shinseki v. Sanders . In Sanders , the VA had denied disability benefits to two vet- erans, Woodrow Sanders and Patricia Simmons, because the record failed to adequately support their claims. In one instance, the VA had told the veteran what additional infor- mation was needed, but failed to specify what portion of that evidence the veteran would be responsible for providing. In the other, the VA failed to tell the veteran what information she needed to provide and failed to notify her of a relevant medical exam the VA had scheduled on her behalf. In both instances, the VA failed to perform its duty to help a veteran develop his claim. The Court held that to determine whether the error
caused prejudice the Veterans Court was to “apply the same
kind of ‘harmless-error’ rule that courts ordinarily apply in
38 C.F.R. § 1.506 (stating that VA records required for official pur-
poses will be furnished to any other agency of the U.S. Government “in
response to an official request, written, or oral”).
6628
civil cases.” [19] The Court went further, holding that the burden is on the party attacking the agency’s determination to show that prejudice resulted from the error. [20] Overruling the Federal Circuit, the Court held that prejudice cannot be presumed from any kind of error. [21] Where harmfulness of the error is not apparent from the circumstances, the party seeking reversal must explain how the error caused harm. The first veteran had not told the Veterans Court, the Court of Appeals, or the Supreme Court what specific evidence he would have sought, had the VA told him he needed it, and the Court denied relief. The second veteran’s record suggested the error might have been harmful, so the Court required a remand to the Veterans Court, even though she had not shown what additional evi- dence she might have submitted. The distinction the Court drew appears to be that in the case of the second veteran, some “features of the record suggest” that the error was prejudi- cial. We conclude that Sanders applies to Social Security
cases as well as VA cases. In both, the agency has a duty to help the claimant, so the Social Security Administration’s duty to assist claimants [23] does not distinguish the cases. The Veterans Court has a statute providing for a harmless error rule and the Social Security statute does not so provide, [25] but this makes no difference, because the Court held that all the Vet- erans Court statutory provision did was import the Adminis- trative Procedure Act rule and the general federal rule for civil cases. [26] The Court cited 28 U.S.C. § 2111, under which the [19] Id. at 1704.
[20]
Id.
at 1705-06.
Id.
at 1705.
at 1708.
Tonapetyan v. Halter
,
But
Sanders
does not mean that the claimant necessarily
has to show what other evidence could have been obtained.
Despite its generalizations about the burden to show preju-
dice, the Court directed remand to the Veterans Court in one
of the two cases before it, even though that veteran had not
shown what additional evidence she might have to show
harm. The Court held that although some features of the
record suggested that the error was harmless, others suggested
the opposite, and “[g]iven the uncertainties, we believe it is
appropriate to remand this case so that the Veterans Court can
decide whether re-consideration is necessary.” We infer from
Sanders
that, despite the burden to
show prejudice being on the party claiming error by the
administrative agency, the reviewing court can determine
from the “circumstances of the case”
[29]
that further administra-
tive review is needed to determine whether there was preju-
dice from the error. Mere probability is not enough. But
where the circumstances of the case show a substantial likeli-
hood of prejudice, remand is appropriate so that the agency
“can decide whether re-consideration is necessary.”
[30]
By con-
trast, where harmlessness is clear and not a “borderline ques-
tion,” remand for reconsideration is not appropriate.
tion to social security disability claims, for the social security administra-
tive procedure does not vary from that prescribed by the APA. Indeed, the
latter is modeled upon the Social Security Act.”
Richardson v. Perales
,
*12 Though the exact distinction between the two veterans in Sanders is not crystal clear, it is quite clear that no pre- sumptions operate, and we must exercise judgment in light of the circumstances of the case. In this case, the circumstances suggest prejudice at least as strongly as for the veteran whose case was remanded in Sanders . McLeod’s physicians differ in their evaluations, and McLeod’s testimony, if true, establishes that the VA has made some sort of disability determination. Because we give VA disability determinations great weight, failure to assist McLeod in developing the record by getting his disability determination into the record is reasonably likely to have been prejudicial. We remand under sentence four of 42 U.S.C. § 405(g), concluding that “the agency erred in some respect in reaching a decision to deny benefits.” The ALJ’s failure to help McLeod develop the record by putting his VA disability determination into the record was an error under Tonapetyan and McCartey , so the district court should remand.
REVERSED.
Hoa Hong Van v. Barnhart
,