United States District Court, N.D. Alabama, Southern Division
KARON OWEN BOWDRE, District Judge.
On March 28, 2011, the claimant, Tammy Edwards, applied for disability insurance benefits and supplemental security income under Title II and Title XVI of the Social Security Act. (R. 149-156). In both applications, the claimant alleged disability beginning January 1, 2008 because of bipolar disorder with psychotic tendencies, mood disorder, depression, anxiety, panic attacks, fatigue, a feeling of fear, and discomfort in public. (R. 94, 149-156). The Social Security Administration denied both claims on June 16, 2011. (R. 82-87). On July 6, 2011, the claimant filed a timely request for a hearing before an Administrative Law Judge. (R. 96-98). The ALJ held a video hearing on October 15, 2012. (R. 20).
In a decision dated October 25, 2012, the ALJ found that the claimant was not disabled as defined by the Social Security Act and, therefore, was ineligible for disability insurance benefits and supplemental security income. (R. 36). On April 17, 2014, the Appeals Council denied the claimant's request for review; consequently, the ALJ's decision became the final decision of the Commissioner of the Social Security Administration. (R. 1). The claimant has exhausted her administrative remedies, and this court has jurisdiction pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3). For the reasons stated below, this court reverses and remands the decision of the Commissioner to the ALJ for reconsideration.
II. ISSUE PRESENTED
Whether the Appeals Council erred by failing to remand the case to the ALJ for reconsideration after the claimant presented new and material evidence.
III. STANDARD OF REVIEW
The standard for reviewing the Commissioner's decision is limited. This court must affirm the Commissioner's decision if she applied the correct legal standards and if substantial evidence supports the factual conclusions. See 42 U.S.C. § 405(g); Graham v. Apfel, 129 F.3d 1420, 1422 (11th Cir. 1997); Walker v. Bowen, 826 F.2d 996, 999 (11th Cir. 1987).
"No... presumption of validity attaches to the [Commissioner's] legal conclusions, including determination of the proper standards to be applied in evaluating claims." Walker, 826 F.2d at 999. This court does not review the Commissioner's factual determinations de novo. The court will affirm factual determinations that substantial evidence supports. "Substantial evidence" is "more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support such a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1971).
The court must keep in mind that opinions such as whether a claimant is disabled, the nature and extent of a claimant's residual functional capacity, and the application of vocational factors "are not medical opinions... but are, instead, opinions on issues reserved to the Commissioner because they are administrative findings that are dispositive of a case; i.e., that would direct the determination or decision of disability." 20 C.F.R. §§ 404.1527(d), 416.927(d). Whether the claimant meets the listing and qualifies for Social Security disability benefits is a question reserved for the ALJ, and the court "may not decide facts anew, reweigh the evidence, or substitute [its] judgment for that of the Commissioner." Dyer v. Barnhart, 395 F.3d 1206, 1210 (11th Cir. 2005). Thus, even if the court were to disagree with the ALJ about the significance of certain facts, the court has no power to reverse that finding as long as substantial evidence in the record supports it.
The court must "scrutinize the record in its entirety to determine the reasonableness of the [Commissioner]'s factual findings." Walker, 826 F.2d at 999. A reviewing court must not look only to those parts of the record that support the decision of the ALJ, but also must view the record in its entirety and take account of the evidence that detracts from the evidence relied on by the ALJ. Hillsman v. Bowen, 804 F.2d 1179, 1180 (11th Cir. 1986).
IV. LEGAL STANDARD
Under 42 U.S.C. §423(d)(1)(A), a person is entitled to disability benefits when the person cannot "engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months...". 42 U.S.C. §423(d)(1)(A). To make this determination, the Commissioner employs a five-step, sequential evaluation process:
(1) Is the person presently unemployed?
(2) Is the person's impairment severe?
(3) Does the person's impairment meet or equal one of the specific impairments set forth in 20 C.F.R. pt. 404, subtpt. P, app. 1?
(4) Is the person unable to perform his or her former occupation?
(5) Is the person unable to perform any other work within the economy?
An affirmative answer to any of the above questions leads either to the next question or, on steps three and five, to a finding of disability. A negative answer to any question, other than step three, leads to a determination of "not disabled."
McDaniel v. Bowen, 800 F.2d 1026, 1030 (11th Cir. 1986); 20 C.F.R. §§ 404.1520, 416.920.
When a claimant requests an appeal of the ALJ's decision and submits new evidence to the Appeals Council, the Appeals Council is required to evaluate the entire record including "new and material evidence submitted to it if [the new evidence] relates to the period on or before the date of the administrative law judge hearing decision." 20 C.F.R. § 404.970(b); Keeton v. Dep't of Health & Human Servs., 21 F.3d 1064, 1066 (11th Cir. 1994). If the Appeals Council denies review, the evidence is part of the administrative record that goes to the district court for review. Id. at 1067.
"When a claimant takes issue with the adequacy of Appeals Council's evaluation of new evidence, the district court may properly review the new evidence to see whether it is of a type the Appeals Council should consider." Fry v. Massanari, 209 F.Supp.2d 1246, 1252 (N.D. Ala. 2001) ( citing Keeton, 21 F.3d at 1067-1068). The district court may determine that the failure of the Appeals Council to adequately consider that evidence warrants a remand. Flowers v. Comm'r of Soc. Sec., 441 F.Appx. 735, 745 (11th Cir. 2001) ( quoting Hyde v. Bowen, 823 F.2d 456, 459 (11th Cir. 1987). New evidence is considered material and potentially worthy of remand if a reasonable possibility exists that the new evidence would change the administrative outcome. Id. This court has the authority to remand a case based on such evidence pursuant to 42 U.S.C. § 405(g), under a sentence four remand or reversal. See 20 C.F.R. §§ 404.940, 404.946.
When a claimant contends that the Appeals Council failed to evaluate evidence proffered, the claimant must establish that the evidence is new, material, and relates to the time period on or before the ALJ rendered his decision. Fry, 209 F.Supp.2d at 1253 (citing 20 C.F.R. 404.970(b)). "Materiality, ' as required by the Social Security Act for evaluation of new evidence, means that the new evidence is relevant and probative so that there is a reasonable possibility that it would change the administrative outcome.'" Id. ( quoting Caulder v. Bowen, 791 F.2d 872, 877 (11th Cir. 1986)).
The claimant was thirty-three years old when the ALJ issued the administrative decision. (R. 17, 149). She has a GED and her past relevant work experience includes employment as a server/waitress, cashier, housekeeper, receptionist, and a hostess. (R. 46-48, 207). The claimant alleged that she was disabled because of bipolar disorder, mood disorder, bipolar disorder with psychotic tendencies, depression, anxiety, panic attacks, "a feeling of impending fear, " and because she "feel[s] nervous and scared to leave [her] home, " "[does] not feel comfortable going into public places, " and "can not [ sic ] seem to remember anything." (R. 206).
Although the claimant primarily alleged mental limitations, as discussed below, she alleged that her disabilities caused physical limitations at times. On May 13, 2011 in her disability report, the claimant alleged fatigue and stated that because of this fatigue, some days she has no energy to get out of bed, shower, or get dressed. (R. 206, 213-14). On June 1, 2011, the Social Security Administration contacted the claimant regarding these allegations of fatigue, and the claimant stated that the fatigue was brought on by her bipolar disorder. (R. 250). On June 11, 2011, the claimant saw consulting psychologist Dr. Robert Kline, and Dr. Kline described the claimant's energy level as a four on a scale of one-to-ten. (R. 309).
On May 13, 2011, the claimant stated in her disability report that she first began experiencing the alleged anxiety, panic attacks, depression, fatigue, fears, discomfort, forgetfulness, and mood swings in 2004, but she did not give a specific date. She stated that in February of 2004, she began seeing psychiatrist Dr. Armand Schachter, her treating physician, but the record contains no record of visits to Dr. Schachter or any other medical treatment prior to June 2005. (R. 205-12).
On June 6, 2005, the claimant's mother took the claimant to the Brookwood Medical Center Emergency Room after the claimant attempted suicide by overdosing on Xanax and Risperdal. Dr. Joseph Hudson attended to the claimant upon her arrival to the emergency room and diagnosed her with bipolar disorder with suicidal ideation. The claimant's toxicology screen showed the presence of benzodiazepine, but her laboratory report indicated a low lithium level consistent with medication noncompliance. Following the claimant's ...