JOHN E. OTT, Chief Magistrate Judge.
Plaintiff John William Strange brings this action pursuant to 42 U.S.C. § 405(g), seeking review of the final decision of the Acting Commissioner of Social Security ("Commissioner")
On July 16, 2012, Plaintiff filed applications for a period of disability, disability insurance benefits ("DIB"), and supplemental security income ("SSI"), alleging disability beginning February 22, 2005. (R. 35).
The court's review of the Commissioner's decision is narrowly circumscribed. The function of the court is to determine whether the Commissioner's decision is supported by substantial evidence and whether proper legal standards were applied. Richardson v. Perales, 402 U.S. 389, 390, 91 S.Ct. 1420, 1422 (1971); Wilson v. Barnhart, 284 F.3d 1219, 1221 (11th Cir. 2002). The court must "scrutinize the record as a whole to determine if the decision reached is reasonable and supported by substantial evidence." Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983). Substantial evidence is "such relevant evidence as a reasonable person would accept as adequate to support a conclusion." Id. It is "more than a scintilla, but less than a preponderance." Id.
The court must uphold factual findings that are supported by substantial evidence. However, it reviews the ALJ's legal conclusions de novo because no presumption of validity attaches to the ALJ's determination of the proper legal standards to be applied. Davis v. Shalala, 985 F.2d 528, 531 (11th Cir. 1993). If the court finds an error in the ALJ's application of the law, or if the ALJ fails to provide the court with sufficient reasoning for determining that the proper legal analysis has been conducted, it must reverse the ALJ's decision. See Cornelius v. Sullivan, 936 F.2d 1143, 1145-46 (11th Cir. 1991).
To qualify for DIB and SSI under the Social Security Act, a claimant must show the inability 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); 42 U.S.C. § 1382(a)(3)(A). A physical or mental impairment is "an impairment that results from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques." 42 U.S.C. § 423(d)(3); 42 U.S.C. § 1382(a)(3)(D).
Determination of disability under the Social Security Act requires a five step analysis. 20 C.F.R. §§ 404.1520(a)(4). Specifically, the Commissioner must determine in sequence:
Evans v. Comm'r of Soc. Sec., 551 F. App'x 521, 524 (11th Cir. 2014)
Plaintiff was 43 years old at the time of the ALJ's decision. (R. 43, 79). He possesses a 12th grade education, including special education classes through graduation. (R. 37, 42). He has worked as a groundskeeper and a fast food worker. (R.72, 184). He has been unemployed since 2006. (R. 40). As noted above, his original alleged onset of disability date was February 22, 2015, which was later amended to July 16, 2012. (R. 37, 79). Plaintiff's alleged disability was due to a status post fracture of the distal right tibia and fibula, chronic pain with toeing out of the right foot and muscle atrophy of the right thigh and right calf, diabetes mellitus, vision loss, depression, and a learning disability. (R. 37, 79).
The ALJ found that Plaintiff's severe impairments include a status post fracture of the distal right tibia and fibula with post open reduction and internal fixation, and chronic pain with toeing of the right foot and muscle atrophy of the right thigh and right calf. (R. 37). The ALJ further found that Plaintiff's vision impairment and diabetes mellitus were not "severe." (R. 38). Finally, the ALJ found that Plaintiff's alleged depression and learning disabilities were not supported within the record as medically determinable impairments, as both alleged disabilities appeared to be self-diagnosed. (R. 38).
After careful consideration of Plaintiff's impairments, the ALJ found that Plaintiff has the residual functional capacity ("RFC") to perform light work
Following the ALJ's decision, Plaintiff filed a Request for Review of the Hearing Decision. (R. 28). The Appeals Council denied review on January 9, 2015. (R. 15). On June 4, 2015, Plaintiff's representative requested that the Appeals Council vacate its previous order because neither he nor Plaintiff had notice of the Appeals Council's denial. (R. 52). On December 10, 2015, the Appeals Council set aside its January 9, 2015 order and again denied Plaintiff's request for review. (R. 1). In its written denial, the Appeals Council stated that it "considered" Plaintiff's argument and determined that the information provided to the Council did "not provide a basis for changing the Administrative Law Judge's decision." (R. 2).
On February 5, 2016, Plaintiff filed his complaint in this court challenging the denial of his claims for DIB and SSI. (Doc. 1). Thereafter, the Social Security Administration mandated that Plaintiff obtain a psychological evaluation with IQ testing in conjunction with a subsequent disability claim filed by Plaintiff. (Doc. 9 at 5). On July 28, 2016, Plaintiff was given a WAIS-IV IQ test. (Doc. 9-1 at 2). This testing demonstrated that Plaintiff had a valid full scale IQ of 63. (Doc. 9-1 at 2).
Plaintiff asserts four arguments in support of reversal and remand of his case: (1) new and material evidence, namely the results of his IQ test, warrants a remand (doc. 1 at 4-8); (2) the ALJ failed to order a psychological consultative exam in light of Plaintiff's allegation of slow learning, his special education in school, and a consultative medical examiner's diagnosis of a learning disability (id. at 8-11); (3) the transcript lacks two items of evidence and is therefore incomplete (id. at 11-13); and (4) the ALJ improperly evaluated the opinion of Dr. Samuel D. Williams, a non-examining physician (id. at 13-15).
Plaintiff argues that his July 2016 WAIS-IV testing and the results thereof constitute new and non-cumulative evidence warranting a remand of this case pursuant to the sixth sentence of 42 U.S.C. § 405(g), which permits a remand "when the district court learns of evidence not in existence or available to the claimant at the time of the administrative proceeding that might have changed the outcome of that proceeding." Ingram v. Comm'r Soc. Sec., 496 F.3d 1253, 1257 (11th Cir. 2007). To be entitled to remand for consideration of newly discovered evidence, a "claimant must establish that: (1) there is new, non-cumulative evidence; (2) the evidence is `material,' that is, relevant and probative so that there is a reasonable possibility that it would change the administrative result, and (3) there is good cause for the failure to submit the evidence at the administrative level." Vega v. Comm'r of Soc. Sec., 265 F.3d 1214, 1218 (11th Cir. 2001); see also Falge v. Apfel, 150 F.3d 1320, 1323 (11th Cir. 1998); Cherry v. Heckler, 760 F.2d 1186, 1192 (11th Cir. 1985). The Commissioner argues that the court should deny Plaintiff's request for remand if it determines that he has not met this three-pronged standard. (Doc. 10 at 9). The court will consider each prong below.
New and non-cumulative evidence must be evidence that is dissimilar to the evidence found in the administrative record which relates to a period on or before the date of the ALJ's decision. See 20 C.F.R. § 404.970(b); Cannon v. Bowen, 858 F.2d 1541, 1546 (11th Cir. 1988); see also Falge, 150 F.3d at 1324. Here, Plaintiff's IQ testing is non-cumulative in that it is Plaintiff's only comprehensive psychological evaluation. See Milano v. Bowen, 809 F.2d 763, 766 (11th Cir. 1987) (holding that the only comprehensive psychological evaluation of the claimant's condition constituted non-cumulative evidence). Put another way, "[n]o similar evidence was introduced in the administrative record." Cannon, 858 F.2d at 1546. Although the administrative record includes an opinion from consultative examiner Dr. Will R. Crouch, concluding that Plaintiff possessed a learning disability, the evaluation did not include any specific testing. (R. 256-57). Dr. Crouch's opinion on Plaintiff's mental state appeares to be based solely on Plaintiff's self-reported history and Dr. Crouch's immediate observations. His opinion was not supported by any other evidence within the record. (R. 38, 257). Despite this, as noted, he did conclude that Plaintiff had a learning disability with a history of special education classes. (R. 257).
Additionally, Plaintiff's "mental examination" relates back to a period before the ALJ's decision. (Doc. 9-1 at 1). In Hodges v. Barnhart, 276 F.3d 1265, 1268 (11th Cir. 2001), the Eleventh Circuit Court of Appeals stated that "IQ tests create a rebuttable presumption of a fairly constant IQ throughout . . . life." Therefore, absent evidence of a sudden trauma that may cause mental retardation, Plaintiff's IQ test results create a presumption that Plaintiff's full scale IQ was 63 before the date of the ALJ's decision. Plaintiff's IQ scores are new and non-cumulative evidence. Thus, the court finds Plaintiff's IQ testing evidence meets the first prong of the remand consideration.
Plaintiff's mental examination is material in that a reasonable possibility exists that the new evidence would change the administrative result. See Falge, 150 F.3d at 1323; Hyde v. Bowen, 823 F.2d 456, 459 (11th Cir. 1987). In Wright v. Heckler, 734 F.2d 696, 697 (11th Cir. 1984), the Eleventh Circuit held that additional evidence consisting of a psychiatric evaluation indicating that a claimant's IQ was between 65 and 68 was sufficient to warrant a remand. The court determined that if the psychiatric examination was accepted, a disability based upon the claimant's mental impairments might well exist. Id. at 697. Similar to the claimant in Wright, Plaintiff now presents his IQ test results which demonstrate he has a valid full scale IQ of 63. (Doc. 9-1 at 2). Consideration of this additional evidence along with Dr. Crouch's assessment and Plaintiff's physical impairments could well change the previous administrative result.
Additionally, Plaintiff's test results are relevant and probative to a condition that Plaintiff enumerated at the outset of this process — "slow reading and writing went [sic] to special education classe[s]" (see R. 79, 183), further supporting the materiality of the evidence. See Caulder v. Bowen, 791 F.2d 872, 877-78 (11th Cir. 1991) ("The evidence is relevant and probative in that it pertains to a condition that Caulder listed in his applications at the administrative level as a source of his disability"). The new evidence arguably provides objective medical support for Plaintiff's claim that he suffers from a learning disability.
The final prong requires that the proponent show that there is good cause for failing to present the evidence at the administrative level. This requirement may be satisfied by showing that the evidence in question did not exist at the time of the administrative proceeding. Cannon, 858 F.2d at 1546; Caulder, 791 F.2d at 878-79 (citing Cherry, 760 F.2d at 1192; Johnson v. Harris, 612 F.2d 993, 998 (5th Cir. 1980)).
In this instance, the testing was performed seven months after the Appeals Council denied review and after this case was filed. (R. 1; Doc. 1 at 1, Doc. 9 at 5, 7). Furthermore, Plaintiff could not have obtained a psychological evaluation prior to July 28, 2016, since he did not have health insurance and could not afford such testing. (R. 68; Doc. 9 at 7). Thus, the good cause requirement is satisfied because the evidence did not exist and could not have been reasonably obtained by Plaintiff at the time the ALJ or the Appeals Council reviewed his case.
Because of the court's determination as to the first issue, the undersigned pretermits further discussion of Plaintiff's other arguments.
For the reasons set forth above, the undersigned concludes that the case is due to be reversed and remanded to the Commissioner for further proceedings consistent with this opinion. An appropriate order of remand will be entered.