United States District Court, N.D. Alabama, Middle Division
OWEN BOWDRE CHIEF UNITED STATES DISTRICT JUDGE
March 18, 2013, the claimant, Sonya Delores Horton,
protectively applied for supplemental social security income
and disability insurance benefits under Titles II and XVII of
the Social Security Actbecause of degenerative disc disease
of the cervical spine, history of cervical spine fracture
with fixation, degenerative disc disease of the lumbar spine,
leg pain, and HIV. The Commissioner denied the claims
initially on September 11, 2013 because of lack of evidence.
The claimant timely requested a hearing before an
Administrative Law Judge, who held a hearing on April 14,
2015. (R. 44-69, 99-103, 108-09).
decision dated May 14, 2015, the ALJ found the claimant not
disabled under Title II or XVII. The claimant filed a timely
request for a hearing before the Appeals Council on May 20,
2015. The Appeals Council denied the claimant's appeal
because the new evidence “was about a later time”
and did not “affect the [ALJ's decision] that the
claimant was not disabled on or before the ALJ's
decision.” Thus, the ALJ's decision became the
final decision of the Commissioner on May 14, 2015. (R. 1-7,
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
because the Appeals Council failed to adequately evaluate
new, chronologically relevant, and material evidence.
issue before the court is whether the Appeals Council erred
by failing to adequately evaluate the new, chronologically
relevant, and material evidence that the claimant submitted
to it dated after the ALJ's decision.
STANDARD OF REVIEW
standard for reviewing the Commissioner's decision is
limited. This court must affirm the Commissioner's
decision if the ALJ applied the correct legal standards and
if substantial evidence supports his 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).
. . . presumption of validity attaches to the
[Commissioner's] legal claims.” Walker,
826 F.2d at 999. This court does not review the
Commissioner's factual determinations de novo.
The court will affirm those factual determinations that are
supported by substantial evidence. “Substantial
evidence” is “more than a mere scintilla. It
means such relevant evidence as a reasonable mind might
accept as adequate to support a conclusion.”
Richardson v. Perales, 402 U.S. 389, 401 (1971).
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 (RFC), 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 a Listing and is entitled to 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.
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 evidence
that detracts from the evidence relied on by the ALJ.
Hillsman v. Bowen, 804 F.2d 1179, 1180 (11th Cir.
issue in this case involves evidence submitted by the
claimant to the Appeals Council dated after the ALJ's
decision. Generally, a claimant may present new evidence at
each stage of the administrative process. Washington v.
Comm'r of Soc. Sec. Admin., 806 F.3d 1317, 1320
(11th Cir. 2015). The Appeals Council has the discretion to
not review the ALJ's denial of benefits. See 20
C.F.R. § 416.1470(b). But, in making its decision
whether to review the ALJ's decision, the Appeals Council
“must consider new, material, and chronologically
relevant evidence” that the claimant submits.
Hargress v. Soc. Sec. Admin., 874 F.3d 1284, 1290-91
(11th Cir. 2017); Washington, 806 F.3d at 1320.
is material if a reasonable possibility exists that it would
change the administrative result. Washington, 806
F.3d at 1321. Evidence is chronologically relevant if
“it relates to the period on or before the date of the
[ALJ] hearing decision.” Hargress, 874 F.3d at
1291. Medical opinions based on treatment occurring after the
date of the ALJ's decision may still be chronologically
relevant if the records relate to the period on or before the
date of the ALJ's decision. Washington, 806 F.3d
at 1323. The claimant can show that a medical opinion dated
after the ALJ's decision is chronologically relevant if
it is based on a “review of the claimant's medical
history and [her] report of symptoms during the relevant time
period and there was no evidence of a decline in [her]
condition since the ALJ's decision.” Ashley v.
Comm'r of Soc. Sec. Admin., 707 F. App'x 939,
944 (11th Cir. 2017) (citing Washington, 806 F.3d at
1322-23); see also Hargress, 874 F.3d at 1291
(discussing Washington, 806 F.3d at 1319, 1322-23).
court has the authority to remand a case based on such new,
material, and chronologically relevant 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. “To obtain a sentence four remand, the
claimant must show that, in light of the new evidence
submitted to the Appeals Council, the ALJ's decision to
deny benefits is not supported by substantial evidence in the
record as a whole.” Hearn v. Soc. Sec. Admin.,
619 F. App'x 892, 894 (11th Cir. 2015) (citing Ingram
v. Comm'r Soc. Sec. Admin., 496 F.3d 1253, 1266-67
(11th Cir. 2007)). When the evidence submitted to the Appeals
Council “undermine[s] the substantial evidence
supporting the ALJ's decision, ” the Appeals
Council errs in failing to review the ALJ's decision.
Mitchell v. Comm'r, Soc. Sec. Admin., 771 F.3d
780, 785 (11th Cir. 2014). “The Appeals Council must
grant the petition for review if the ALJ's ‘action,
findings, or conclusion is contrary to the weight of the
evidence, ' including the new evidence.”
Hargress, 874 F.3d at 1291 (citing Ingram,
496 F.3d at 1261.
claimant was twenty-eight years of age at the time of the
ALJ's final decision; has an eleventh-grade education;
has past substantial gainful experience as fast food worker,
a poultry grader and re-hanger, and a housekeeper in
healthcare; and alleges disability based on degenerative disc
disease of the cervical spine, history of cervical spine
fracture with fixation, degenerative disc disease of the
lumbar spine, leg pain, and HIV. (R. 63, 69, 554).
26, 2006, the claimant fractured her C6 disc in her spine in
an automobile accident. An MRI dated July 30 revealed that
the claimant had an inferior cervical spine injury including
C6-C7 subluxation; a tear on the C6-C7 interspinous ligament;
suggestion of facet joint changes; and minimal to mild spinal
cord compression predominately toward the left of her C6-C7
disc. On July 31, Dr. Terry M. Andrade, a surgeon at Gadsden
Regional Medical Center, performed surgery to reduce pressure
on and fix the discs in her neck. Doctors discharged the
claimant on August 4, 2006 with instructions for her to wear
a hard collar neck brace at all times and a prescription for
Norco 10 for pain and Soma as a muscle relaxer. (R. 364-65,
409, 425, 430-33, 440, 467).
August 8, 2006, until January 16, 2007, Dr. Andrade treated
the claimant nine times for neck discomfort and follow-ups
from her accident and spine surgery. During several visits,
Dr. Andrade counseled the claimant on the importance of not
loosening her cervical collar. On September 12, 2006, Dr.
Andrade reported that the claimant had “pulled her
previous instrumentation apart by not wearing her cervical
collar as instructed.” Consequently, on September 18,
Dr. Andrade performed an open reduction surgery with internal
fixation of the claimant's C6-C7 disc; anterior cervical
decompression with discectomies, neural foramintomies, and
fusion; and a Bremer halo brace placement on the
claimant's neck. (R. 453). (R. 521-523, 527-538,
the claimant's surgery, between September 2006 and
January 2007, she complained of constant neck pain, and Dr.
Andrade treated her with several medications at different
times, including Lorcet Plus, Oxycodone, Darvocet, and
Butalbital Acetaminophen. By late October, Dr. Andrade
reported that the claimant could return to regular work duty
in six weeks at the latest on December 13, 2006. In follow-up
appointments on October 31, and November 2, 2006, Dr. Andrade
instructed the claimant that if she tried to remove the halo
neck brace again she would have to find another doctor. (R.
January 25, 2007, Dr. Andrade treated the claimant because
she improperly wore her neck brace, and noted the
claimant's collar brace was “extremely loose and
cut her where it was totally ineffective.” By February
13, 2007, the claimant's pain in her neck had improved
some and her condition was stable. (R. 458, 518-20).
February 2007 and February 2011, the record contains no
reports of medical visits for the claimant for neck or back
pain. On February 1 and 9, 2011, Dr. Alan Pernick at Doctors
Medical Care of Gadsden treated the claimant for neck and
lower back pain. An x-ray of her neck and back showed minimal
to mild spondylosis at the C6-C7 disc and mild rotatory
lumbar dextroscoliosis in her lumbar spine. The ...