STEPHAN M. VIDMAR, Magistrate Judge.
THIS MATTER is before the Court on Plaintiff's Motion to Reverse or Remand [Doc. 24] ("Motion"), filed on June 20, 2018. The Commissioner responded on August 9, 2018. [Doc. 29]. Plaintiff replied on September 18, 2018. [Doc. 30]. The parties have consented to my entering final judgment in this case. [Doc. 23]. Having meticulously reviewed the entire record and being fully advised in the premises, the Court finds that the Appeals Council erred in failing to consider the evidence submitted to it. Accordingly, the Motion will be GRANTED, and the case will be remanded for further proceedings. See 42 U.S.C. § 405(g) (2018) (sentence four).
The standard of review in a Social Security appeal is whether the Commissioner's final decision is supported by substantial evidence and whether the correct legal standards were applied. Maes v. Astrue, 522 F.3d 1093, 1096 (10th Cir. 2008). If substantial evidence supports the Commissioner's findings and the correct legal standards were applied, the Commissioner's decision stands and the plaintiff is not entitled to relief. Langley v. Barnhart, 373 F.3d 1116, 1118 (10th Cir. 2004). Courts must meticulously review the entire record, but may neither reweigh the evidence nor substitute their judgment for that of the Commissioner. Flaherty v. Astrue, 515 F.3d 1067, 1070 (10th Cir. 2007).
"Substantial evidence is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Langley, 373 F.3d at 1118. The decision "is not based on substantial evidence if it is overwhelmed by other evidence in the record or if there is a mere scintilla of evidence supporting it." Id. While a court may not reweigh the evidence or try the issues de novo, its examination of the record as a whole must include "anything that may undercut or detract from the [Commissioner]'s findings in order to determine if the substantiality test has been met." Grogan v. Barnhart, 399 F.3d 1257, 1262 (10th Cir. 2005). "The possibility of drawing two inconsistent conclusions from the evidence does not prevent [the] findings from being supported by substantial evidence." Lax v. Astrue, 489 F.3d 1080, 1084 (10th Cir. 2007) (quoting Zoltanski v. FAA, 372 F.3d 1195, 1200 (10th Cir. 2004)).
"[F]ailure to apply the correct legal standard or to provide this court with a sufficient basis to determine that appropriate legal principles have been followed is grounds for reversal." Jensen v. Barnhart, 436 F.3d 1163, 1165 (10th Cir. 2005) (quoting Byron v. Heckler, 742 F.2d 1232, 1235 (10th Cir. 1984)).
In order to qualify for disability benefits, a claimant must establish that she is unable "to 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) (2015); 20 C.F.R. § 404.1505(a) (2012).
When considering a disability application, the Commissioner is required to use a five-step sequential evaluation process. 20 C.F.R. § 404.1520 (2012); Bowen v. Yuckert, 482 U.S. 137, 140 (1987). At the first four steps of the evaluation process, the claimant must show: (1) she is not engaged in "substantial gainful activity"; and (2) she has a "severe medically determinable . . . impairment . . . or a combination of impairments" that has lasted or is expected to last for at least one year; and (3) her impairment(s) either meet or equal one of the Listings
Plaintiff applied for a period of disability and disability insurance benefits on July 8, 2014. Tr. 11. She alleged a disability-onset date of March 31, 2014. Id. Her claim was denied initially and on reconsideration. Id. Administrative Law Judge ("ALJ") Stephen Gontis held a hearing on February 27, 2017, in Albuquerque, New Mexico. Tr. 11, 35-69. Plaintiff appeared in person with her attorney. Id. The ALJ heard testimony from Plaintiff and an impartial vocational expert ("VE"), Marsha N. Heald. Id.
The ALJ issued his unfavorable decision on May 30, 2017. Tr. 23. The ALJ found that Plaintiff would meet the insured status requirements through December 31, 2019. Tr. 13. At step one he found that Plaintiff had not engaged in substantial gainful activity since her alleged onset date. Id. At step two, the ALJ found that Plaintiff suffered from the following severe impairments: bipolar disorder, anxiety, depression, and post-traumatic stress disorder. Id. Further, he found that Plaintiff's substance abuse disorder and disorders of the gastrointestinal system, alone or in combination, were not severe. Tr. 13-14.
At step three the ALJ determined that none of Plaintiff's impairments, alone or in combination, met or medically equaled a Listing. Tr. 14-16. Because none of Plaintiff's impairments met or medically equaled a Listing, the ALJ went on to assess Plaintiff's RFC. Tr. 16-21. The ALJ found that Plaintiff had:
Tr. 20.
At step four the ALJ found that Plaintiff was not able to return to her past relevant work. Tr. 21. Accordingly, the ALJ went on to consider Plaintiff's RFC, age, education, work experience, and the testimony of the VE at step five. Tr. 21-22. He found that Plaintiff could perform work that exists in significant numbers in the national economy and, therefore, was not disabled. Id. After the ALJ denied the claim, Plaintiff requested review by the Appeals Council. See Tr. 1-3. She submitted additional evidence to the Appeals Council that had not been before the ALJ.
Plaintiff argues that the Appeals Council erred in failing to consider the new evidence. [Doc. 24] at 16-17. Whether evidence qualifies for consideration by the Appeals Council is a question of law subject to de novo review. Threet v. Barnhart, 353 F.3d 1185, 1191 (10th Cir. 2003). Additional evidence should be considered only if it is new, chronologically pertinent, and material. 20 C.F.R. § 404.970(b). Evidence is new "if it is not duplicative or cumulative." Threet, 353 F.3d at 1191 (quoting Wilkins v. Sec'y, Health & Human Servs., 953 F.2d 93, 96 (4th Cir. 1991)). Evidence is chronologically pertinent if it relates to the time period adjudicated by the ALJ, i.e., the period on or before the date of the ALJ's decision. Chambers v. Barnhart, 389 F.3d 1139, 1142 (10th Cir. 2004).
Evidence is material "if there is a reasonable possibility that [it] would have changed the outcome." Threet, 353 F.3d at 1191 (alteration in original) (quoting Wilkins, 953 F.2d at 96). For example, in Threet, an ALJ had found the plaintiff disabled only through a certain date because after that date, she had had no further medical treatment. The plaintiff, however, submitted to the Appeals Council new medical records evidencing treatment after that date as well as a doctor's recommendation for surgery. Id. at 1188-89. The Appeals Council did not consider the evidence and denied review. Id. at 1189. The plaintiff filed suit but lost in district court. Id. On appeal, the Tenth Circuit Court of Appeals determined that the evidence was material and should have been considered. Id. The court explained that the evidence "reasonably call[ed] into question the disposition of the case in light of the ALJ's determination that [the plaintiff's] disability had ended as of September 16, 1998, based on his conclusion that she had no further medical treatment and the medical evidence showed her condition had improved." Id. at 1191.
Similarly, in Padilla v. Colvin, the Tenth Circuit found that a psychological evaluation and an audiological evaluation were material and should have been considered by the Appeals Council. 525 F. App'x 710, 712 n.1 (10th Cir. 2013). The court explained that "[t]he psychological report [showed mood and learning disorders, and the plaintiff]'s low intellectual functioning suggest[ed] he could be presumptively disabled under [Listing] 12.05, because he had a full scale IQ score of 67. These are all indicative of nonexertional limitations that could reasonably have changed the outcome." Id. at 713.
In contrast, in Chambers, the Tenth Circuit found that evidence submitted for the first time to the Appeals Council was not material where it related to conditions that had not been presented to the ALJ or at any time previously. 389 F.3d at 1144. The court found that the evidence "showed the existence of possible lung conditions[, but the plaintiff had] never complained of any impairments relating to her lungs. . . . Therefore, the new reports have no bearing on the question of Claimant's alleged disability." Id.
If evidence submitted to the Appeals Council for the first time does not meet all three requirements—new, chronologically pertinent, and material—the Appeals Council does not consider it, and it "plays no role in judicial review." Krauser v. Astrue, 638 F.3d 1324, 1328 (10th Cir. 2011). However, if the Appeals Council has failed to consider qualifying new evidence, the case should be remanded so that the Appeals Council may reevaluate the ALJ's decision in light of the complete evidence. Threet, 353 F.3d at 1191.
Here, there is no dispute that the additional evidence submitted by Plaintiff qualifies as "new"; there is no suggestion that it is duplicative or cumulative. Further, there is no dispute that the evidence is "chronologically pertinent." It is relevant to Plaintiff's mental health diagnoses, her testimony about her symptoms and functional limitations, as well as a medical opinion on her ability to function already in the record, see Tr. 448 (consultative opinion from Dr. Hughson, including a GAF score
The parties, however, disagree on whether the evidence is "material." Plaintiff argues that the evidence—in particular, the low GAF scores—reasonably would have changed the outcome because it shows more severe limitations than the ALJ had assessed. [Doc. 24] at 16-17. Plaintiff argues that the GAF scores "support Dr. Hughson's opinions on the GAF and Plaintiff['s] having marked limitations interacting with the public." Id. at 16. The new evidence contains at least two very low GAF scores: one of 48, assessed on December 23, 2013, and one of 40,
Defendant argues that the evidence is not material and that the Appeals Council was correct in declining to consider it. [Doc. 29] at 15-18. She does not dispute that the new evidence contains at least one very low GAF score. See id. Rather, she points to another higher GAF score and other evidence that could support the ALJ's decision. Id. at 16 (citing Tr. 656 (GAF of 64
The Court agrees with Plaintiff. The evidence at issue here is material because there is a "reasonable possibility" that it would have changed the outcome. Threet, 353 F.3d at 1191. Defendant is correct that not all the GAF scores are very low; indeed, there are two indicating moderate or mild symptoms. Tr. 649 (GAF score of 60
The Appeals Council erred in failing to consider the evidence submitted to it after the ALJ's decision. See Tr. 604-67. Therefore, the Motion will be granted, and the case will be remanded for consideration of the new evidence. The Court will not address the other errors alleged by Plaintiff at this time in order to allow the Appeals Council the first opportunity to evaluate the ALJ's decision in light of the complete record. See Chambers, 389 F.3d at 1143; Threet, 353 F.3d at 1191.