LAURA FASHING, Magistrate Judge.
THIS MATTER comes before the Court on plaintiff Larry Holder's Substitute Motion to Reverse and/or Remand (Doc. 25), which was fully briefed on November 20, 2018. See Docs. 26, 27, 28.
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). "The failure 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) (internal quotation marks and brackets omitted). The Court must meticulously review the entire record, but may neither reweigh the evidence nor substitute its 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. A 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 the 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 ALJ'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. F.A.A., 372 F.3d 1195, 1200 (10th Cir. 2004)).
To qualify for disability benefits, a claimant must establish that he or 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); 20 C.F.R. §§ 404.1505(a), 416.905(a).
When considering a disability application, the Commissioner is required to use a five-step sequential evaluation process. 20 C.F.R. §§ 404.1520, 416.920; Bowen v. Yuckert, 482 U.S. 137, 140 (1987). At the first four steps of the evaluation process, the claimant must show: (1) the claimant is not engaged in "substantial gainful activity"; (2) the claimant 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) the impairment(s) either meet or equal one of the Listings
Mr. Holder was born in 1964, completed the tenth grade, and worked for approximately 14 years as a carpet installer, for approximately seven months as a fiberglass finisher, and for six months as a maintenance person. AR 54, 65, 82, 190, 242.
The ALJ found that Mr. Holder met the insured status requirements of the Social Security Act through June 30, 2018. AR 17. At the hearing, Mr. Holder amended his alleged onset date to February 1, 2015. AR 15, 17, 52. At step one, the ALJ found that Mr. Holder had not engaged in substantial, gainful activity since his amended alleged onset date. AR 17. At step two, the ALJ found that Mr. Holder's bilateral arthritis of the wrists, degenerative disc disease of the cervical spine, and left shoulder impairment were severe impairments. AR 17-18. At step three, the ALJ found that none of Mr. Holder's impairments, alone or in combination, met or medically equaled a Listing. AR 18-19. Because the ALJ found that none of the impairments met a Listing, the ALJ assessed Mr. Holder's RFC. AR 19-24. The ALJ found Mr. Holder had the RFC to
AR 19.
At step four, the ALJ concluded that Mr. Holder could not perform his past relevant work as a carpet installer, but could return to his past relevant work as a fiberglass finisher. AR 24. The ALJ thus found Mr. Holder not disabled at step four. Alternatively, the ALJ found Mr. Holder not disabled at step five because he could perform jobs that exist in significant numbers in the national economy—such as bench assembler, photo copy machine operator, and small products assembler. AR 24-25.
Mr. Holder requested that the Appeals Council review the ALJ's unfavorable decision. AR 188-89, 310. Mr. Holder submitted additional evidence to the Appeals Council. See AR 11, 32-48. The Appeals Council did not consider or "exhibit" most of the additional evidence and found the rest "did not relate to the period at issue." AR 2. On October 24, 2017, the Appeals Council denied the request for review. AR 1-5. Mr. Holder timely filed his appeal to this Court on December 7, 2017. Doc. 1.
Mr. Holder raises three arguments for reversing and remanding this case: (1) the Appeals Council erred in refusing to consider his June 21, 2017 MRI; (2) the ALJ failed to explain why key medical evidence was rejected or not considered; (3) the ALJ's finding that he can perform his past relevant work and three other jobs is inconsistent with the RFC that states he must avoid overhead reaching. Doc. 25 at 16-21. I find that the Appeals Council erred by failing to consider additional evidence submitted by Mr. Holder. Because the Appeals Council failed to consider the evidence Mr. Holder submitted, the case will be remanded so that the Appeals Council may reevaluate the ALJ's decision in light of the completed record.
The ALJ issued her unfavorable decision on June 27, 2017. See AR 12-31. Thereafter, Mr. Holder submitted additional evidence and requested that the Appeals Council consider the following:
The Appeals Council found that the evidence listed in 1, 2, and 3 above "does not show a reasonable probability that it would change the outcome of the decision," and therefore it "did not consider and exhibit this evidence." AR 2 (emphasis added). As for the evidence listed in number 4, the Appeals Council stated that "[t]he Administrative Law Judge decided your case through June 27, 2017. This additional evidence does not relate to the period at issue. Therefore, it does not affect the decision about whether you were disabled beginning on or before June 27, 2017." Id. The Appeals Council thus did not consider any of the additional evidence submitted by Mr. Holder. See Padilla v. Colvin, 525 F. App'x 710, 712 (10th Cir. 2013) (unpublished) ("the Appeals Council's dismissal of the additional evidence's import on the grounds that it was not temporally relevant indicates that it ultimately found the evidence did not qualify for consideration at all.").
Mr. Holder primarily argues that the Appeals Council erred by failing to consider a June 21, 2017
Having considered the parties' arguments and the applicable law, I find that the ALJ erred in failing to consider the new evidence submitted by Mr. Holder.
Whether evidence qualifies for consideration by the Appeals Council is a question of law subject to de novo review. Threet, 353 F.3d at 1191. The Appeals Council must review a case if it "receives additional evidence that is new, material, and relates to the period on or before the date of the hearing decision, and there is a reasonable probability that the additional evidence would change the outcome of the decision." 20 C.F.R. §§ 404.970(a)(5); 416.1470(a)(5) (both effective Jan. 17, 2017).
The Commissioner erroneously states that "the Appeals Council's denial of [Mr. Holder's] request for review is not judicially reviewable." Doc. 26 at 4. The Commissioner cites 20 C.F.R. § 404.972 for this assertion. Id. at 5. However, 20 C.F.R. § 404.972 states that "[t]he
Next, the Commissioner argues that this Court must "consider the additional evidence alongside the evidence in the case that was available to the ALJ . . . to determine whether the ALJ's decision remains supported by substantial evidence." Doc. 26 at 5 (citing Vallejo v. Berryhill, 849 F.3d 951, 956 (10th Cir. 2017)). Vallejo does not support this proposition. In Vallejo, the Tenth Circuit held that when a claimant submits new evidence to the Appeals Council and the Appeals Council accepts and considers it, that evidence becomes a part of the record to be considered by the Court in performing a substantial evidence review. 849 F.3d at 955. That is not the case here. In this case, the Appeals Council did not accept or consider the additional evidence. AR 2. Thus, the only question before the Court is whether the Appeals Council should have done so. See Padilla, 525 F. App'x at 712 n.1 ("If the Appeals Council did not consider the additional evidence because it did not qualify for consideration . . ., then the question on appeal is whether the Appeals Council erred in failing to do so. If the Appeals Council did accept and consider the new evidence, then the question on appeal is whether the ALJ's decision was supported by substantial evidence in light of the new evidence."). Only after the Appeals Council reviews the entire record—including the qualifying new evidence—under the standard provided in 20 C.F.R. § 404.970(a)(5), may the Court "properly review the denial of benefits . . . under the deferential substantial-evidence standard." Chambers v. Barnhart, 389 F.3d 1139, 1143 (10th Cir. 2004). However, "[i]f the Appeals Council fails to consider qualifying new evidence, the case should be remanded for further proceedings." Id. Because the Appeals Council did not accept or consider the new evidence and should have, it would be improper for this Court to perform a substantial evidence review of the ALJ's decision.
For the reasons explained below, the Court finds that Mr. Holder submitted evidence that was new, chronologically pertinent, and material in that there is a "reasonable probability" that the additional evidence would change the outcome of the decision. The Appeals Council failed to consider this qualifying new evidence. The Court therefore remands so that the Appeals Council may reevaluate the ALJ's decision in light of the complete evidence.
First, there is no dispute that the June 21, 2017 MRI of Mr. Holder's lumbar spine is new evidence. It is not "duplicative or cumulative," as there was no other MRI of the lumbar spine in the record before the ALJ. The June 21, 2017 MRI indicates the following:
AR 47. The MRI thus provides substantial new evidence concerning Mr. Holder's lower back impairment. As Mr. Holder points out, the ALJ did not consider Mr. Holder's lower back impairment at any step of the sequential evaluation process. Doc. 25 at 16-17. The Commissioner concedes that "there [were] no medical records addressing a lower back impairment in the record that was before the ALJ." Doc. 26 at 7. Thus, the MRI is new evidence.
Second, the June 21, 2017 MRI is chronologically pertinent. The MRI was done before June 21, 2017. The ALJ rendered her decision on June 27, 2017. See AR 12-31. Thus, the MRI relates to the time period on or before the ALJ's decision and is chronologically pertinent. Threet, 353 F.3d at 1191. The Commissioner appears to concede that the MRI is chronologically pertinent. See Doc. 26 at 7 ("the new evidence may be sufficient to show that [Mr. Holder] had a lower back impairment as early as June 2017—about a month before the date of the ALJ's decision.").
Third, the June 21, 2017 MRI is material because there is a reasonable probability that it would have changed the outcome. See Threet, 353 F.3d at 1191; 20 C.F.R. §§ 404.970(a)(5), 416.1470(a)(5). As Mr. Holder explains, there is a reasonable probability that consideration of the MRI would have affected the sequential evaluation process, and that this would have changed the outcome of the case. At step two, the MRI would have established that Mr. Holder had a severe impairment of the lumbar spine, an impairment not considered by the ALJ.
Mr. Holder argues that there is a reasonable probability that consideration of the MRI would have resulted in a finding that he met a Listing at step three. Mr. Holder, however, fails to point to any evidence showing he would meet the definition of "inability to ambulate effectively" included in the criteria of Listing 1.04. In order to meet this Listing, a claimant must show the following:
20 C.F.R. § Pt. 404, Subpt. P, App. 1.
But to meet the Listing, Mr. Holder also would have had to show an "inability to ambulate effectively, as defined in 1.00B2b." This section of the Listings defines inability to ambulate effectively as
20 C.F.R. § Pt. 404, Subpt. P, App. 1, 1.00B2b1. Ambulating effectively is defined as follows:
20 C.F.R. § Pt. 404, Subpt. P, App. 1, 1.00B2b2. Mr. Holder argues that his "testimony that he cannot walk without a cane or long enough to satisfy his doctor's instructions establishes that he cannot ambulate effectively." Doc. 25 at 17. Under the Listing definitions, however, inability to ambulate effectively requires the use of two handheld assistive devices, not just one. Mr. Holder testified that he used one cane. AR 74. And Mr. Holder's inability to follow his doctor's walking instructions also does not show that he meets the Listing relating to effective ambulation. On June 2, 2017, Mr. Holder advised Dr. Griggs that "he was told to walk every day since his neck surgery and is only able to get through part of his walk before his back starts hurting him." AR 33. There is no indication in this treatment note about how far Mr. Holder is able to walk, or that his walking is limited to the degree necessary to find ineffective ambulation under the Listings. Therefore, the Court concludes that Mr. Holder has not shown a reasonable probability that the new evidence would result in his meeting Listing 1.04.
Nonetheless, the Court finds that there is a reasonable probability that consideration of the new evidence would have changed Mr. Holder's RFC, and therefore would have changed the outcome in this case. The ALJ discounted evidence in the record showing that Mr. Holder was limited in his ability to sit and stand long enough to do light work. There is a reasonable probability that the ALJ would not have discounted this evidence had the newly submitted evidence been part of the record. Erica Eaton, a certified physician's assistant, opined that Mr. Holder needed a "job that permits shifting positions at will from sitting, standing, or walking." AR 366. She also opined that Mr. Holder would need to "take unscheduled breaks or include periods of walking around" for five to ten minutes every hour. Id. Mr. Holder testified that he had difficulty with prolonged sitting and standing. AR 73. He testified that he could sit for a maximum of ten minutes and stand for a maximum of ten minutes: "I got to sit down or walk around or. It just always coming in and out, and it goes from one spot to the other." AR 74. The ALJ, however, found Mr. Holder capable of light work. "[T]he full range of light work requires standing or walking, off and on, for a total of approximately 6 hours of an 8-hour workday. Sitting may occur intermittently during the remaining time." SSR 83-10 (S.S.A. 1983), 1983 WL 31251 at *5. The ALJ's RFC and hypothetical to the vocational expert ("VE") was an individual who could "stand or walk with normal breaks for a total of six hours in an eight-hour workday" and who could "sit with normal breaks for a total of six hours in an eight-hour workday." AR 19, 83. When the hypothetical was changed to an individual who needed "unscheduled breaks every hour, which would include walking around leaving the workstation for five to ten minutes," the VE testified that such an individual was precluded from employment. AR 84-85.
The Commissioner argues that
Doc. 26 at 7 (citing AR 20-22, 54-55, 71). The ALJ found that Mr. Holder's "statements concerning the intensity, persistence and limiting effects of [his reported] symptoms [were] not entirely consistent with the medical evidence and other evidence in the record." AR 21. But the ALJ did not specifically discuss why she rejected Mr. Holder's reported limitations in sitting and standing. See AR 20-26.
The probability of the additional evidence changing the outcome in this case is further illustrated by the ALJ's meticulous RFC analysis of the severe impairments she did consider. The ALJ specifically discussed the medical evidence and included limitations in Mr. Holder's RFC based on his wrist impairments, on his degenerative disc disease of the cervical spine, and on his shoulder impairments. AR 21-22. The Court finds there is a reasonable probability that had the ALJ considered the new evidence showing Mr. Holder's lower back impairment, she would have included sitting and standing limitations in his RFC, and that there is a reasonable probability that this would have changed the result in this case. The Appeals Council erred in failing to consider the new evidence.
The Appeals Council erred by failing to consider the additional evidence submitted by Mr. Holder. The Court remands so that the Appeals Council may reevaluate the ALJ's decision in light of the completed record.
IT IS THEREFORE ORDERED that plaintiff's Motion to Reverse and Remand for a Rehearing (Doc. 25) is GRANTED.
IT IS FURTHER ORDERED that the Commissioner's final decision is REVERSED, and this case is REMANDED for further proceedings in accordance with this opinion.