United States District Court, N.D. Alabama, Southern Division
OWEN BOWDRE CHIEF UNITED STATES DISTRICT JUDGE
December 3, 2014, the claimant, Jeremy Dwayne Naish,
protectively applied for disability and disability insurance
benefits under Title II of the Social Security Act, as well
as supplemental security income under Title XVI, because of
tendonitis in the right Achilles tendon, reflex sympathetic
dystrophy, obesity, panic disorder with agoraphobia,
post-traumatic stress disorder, and major depressive
disorder. The Commissioner denied the claims on April 29,
2015. The claimant timely requested a hearing before an
Administrative Law Judge, who held a hearing on February 1,
2017. (R. 35; Doc. 1).
decision dated March 16, 2017, the ALJ found the claimant not
disabled within the meaning of the Social Security Act and,
therefore, ineligible for disability, disability insurance
benefits, and supplemental security income. The claimant
filed a timely request for review of the ALJ's decision
by the Appeals Council on March 28, 2017 and submitted new
evidence of knee and low back pain to it. (R. 10-26).
Appeals Council denied the claimant's request for review
on October 26, 2017, indicating that the new evidence
submitted by the claimant on June 20, 2017 did not relate to
the period at issue. Thus, the ALJ's decision became the
final decision of the Commissioner. (R. 32-48, 6, 9-29, 1-4).
claimant has exhausted his 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 erred when it declined to review
the claimant's new evidence.
issue before the court is whether the Appeals Council erred
by declining to evaluate the claimant's new,
chronologically relevant, and material evidence.
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 ALJ'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 upon which the court will reverse the
Commissioner's decision in this case involves evidence
submitted by the claimant to the Appeals Council 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
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 upon which the doctor bases his
opinion relate to the period on or before the date of the
ALJ's decision. See 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 [his] report of symptoms during the relevant time
period and there was no evidence of a decline in [his]
condition since the ALJ's decision.” Ashley v.
Comm'r of Soc. Sec. Admin., 707 Fed.Appx. 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 Fed.Appx. 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 thirty-six years of age and weighed slightly
more than 300 pounds at the time of the ALJ's final
decision; had completed high school; has past relevant work
as a corrections officer, head corrections officer, manager
of fast food service, and tool repair clerk; and alleges
disability based on tendonitis of the right Achilles tendon,
reflex sympathetic dystrophy, obesity, panic disorder with
agoraphobia, post-traumatic stress disorder, major depressive
disorder, and back pain. (R. 59-63, 68-71, 10-26; Doc. 1).
of Physical and Mental Impairments in the Record Before the
November 6, 2009, after the claimant failed a comprehensive
course of conservative therapy including a boot, nonsteroidal
anti-inflammatories, and stretching exercises, Dr. William
Krauss performed surgery on the claimant to repair his
Achilles tendon. The procedure included a right Achilles
tendon debridement, right Strayer procedure, excision of
Haglund's deformity, and detachment and reattachment of
the right Achilles tendon. (R. 329).
claimant presented to Southlake Orthopaedics after
experiencing prolonged burning, aching, and stabbing pain in
his hand on February 1, 2013. He underwent various tests
which showed electrophysiologic changes consistent with
bilateral carpal tunnel syndrome. Dr. Ekkehard Bonatz
eventually recommended surgery to alleviate the
claimant's pain, but he declined because of a high
deductible. (R. 623-25).
November 24, 2014, the claimant returned to Southlake
Orthopaedics complaining of severe burning, aching, sharp,
and throbbing pain in his right ankle. The claimant reported
that he felt a pop in his ankle while walking up the stairs.
He noted that the pain is aggravated by standing and walking
and that he often wakes from his sleep because of it. He also
mentioned an associated history of swelling, bruising, and
range-of-movement limitations. Dr. Kraus diagnosed the
claimant with a fractured osteophyte at the insertion of the
Achilles tendon and placed him in a medical boot. The
claimant returned six weeks later complaining that his
symptoms had not improved. On January 16, 2015, Dr. Kraus
performed a second surgery on the claimant's right
Achilles tendon. The procedure included a right open Achilles