LEO T. SOROKIN, District Judge.
Plaintiff Joseph Arthur Maloof has filed a Motion to Reverse the decision by Defendant Carolyn Colvin, Acting Commissioner of the Social Security Administration ("SSA"), to deny Plaintiff's application for Title II disability insurance benefits ("DIB"). Docs. 19, 20. Defendant has filed a Motion to Affirm the denial of benefits. Docs. 24, 25. For the reasons set forth below, Plaintiff's Motion is ALLOWED to the extent that it requests remand, and Defendant's Motion is DENIED.
On March 19, 2012, Plaintiff filed an application for DIB. Administrative Record ("AR") at 69. Plaintiff originally alleged an onset date of disability ("AOD") of December 1, 2009, but later (on September 11, 2013) amended the AOD to January 1, 2012.
On September 11, 2013, a hearing was held, at Plaintiff's request, before Administrative Law Judge ("ALJ") William Ramsey.
On November 27, 2013, the ALJ issued a decision finding Plaintiff was not disabled from his AOD through the date of the decision.
On December 27, 2013, Plaintiff filed a claim for "service connected compensation" with the Department of Veterans Affairs ("VA"). Doc. 20-1 at 2.
On January 24, 2014, Plaintiff submitted a Request for Review of the ALJ's decision ("Request for Review") to the SSA's Appeals Council. AR at 7. The Request for Review instructed Plaintiff as follows:
On May 16, 2014, the VA issued a decision ("VA rating decision") assigning Plaintiff a 100 percent disability rating as of April 27, 2012, based on Plaintiff's "bipolar depression with anxiety (claimed originally as posttraumatic stress disorder)." Doc. 20-1 at 9. In reaching that decision, the VA found Plaintiff's mental condition caused, inter alia, "[t]otal occupational and social impairment."
According to Plaintiff's counsel, on June 3, 2014, counsel mailed the VA rating decision to the SSA's Appeals Council, with a letter requesting "the Appeals Council remand [Plaintiff's] application for benefits back to the Administrative Law Judge for reconsideration of the [sic] this new and material evidence." Doc. 20 at 10; Doc. 20-2. Defendant does not dispute that Plaintiff's counsel mailed the VA rating decision to the Appeals Council on that date.
On March 29, 2015, the Appeals Council issued a letter denying Plaintiff's Request for Review. AR at 1. The letter stated: "In looking at your case, we considered the reasons you disagree with the decision and the additional evidence listed on the enclosed Order of Appeals Council."
On May 29, 2015, Plaintiff initiated this action. Doc. 1. On February 29, 2016, Plaintiff filed the instant Motion to Reverse. Docs. 19, 20. On May 10, 2016, Defendant filed the instant Motion to Affirm. Docs. 24, 25.
Courts "may at any time order additional evidence to be taken before the Commissioner of Social Security, but only upon a showing that there is new evidence which is material and that there is good cause for the failure to incorporate such evidence into the record in a prior proceeding" on a "timely basis." 42 U.S.C. § 405(g);
"New evidence is material if the ALJ's decision might reasonably have been different if the evidence had been considered."
Particularly given the SSA's own requirement to evaluate a disability decision by another governmental agency, as well as its explanation that such a decision may provide insight into an individual's impairments, the Court finds that the ALJ's decision in this case might reasonably have been different if the ALJ had considered the VA rating decision. Thus, the Court finds the VA rating decision is material.
The parties of course agree that Plaintiff could not have submitted the VA rating decision with his Request for Review: Plaintiff submitted his Request for Review on January 24, 2014, and the VA rating decision was not issued until May 16, 2014. Nevertheless, Defendant argues that Plaintiff's submission of the VA rating decision is procedurally defaulted because, when he filed the Request for Review, he failed to request an extension of time to submit additional evidence. Doc. 25 at 11-12 (noting the instruction on the Request for Review that "[i]f you need additional time to submit evidence . . ., you must request an extension of time in writing now"). Defendant thus argues that Plaintiff is responsible for his untimeliness in submitting the VA rating decision to the Appeals Council, and that the Court should decline to find good cause for Plaintiff's untimely submission.
Good cause for failure to present new and material evidence in a prior proceeding on a timely basis "will be found . . . where the proferred evidence was unavailable at the time of the administrative proceeding."
Here, the VA rating decision was unavailable when Plaintiff submitted his Request for Review to the Appeals Council. In addition, Defendant does not argue, and the Court has no basis to conclude, that Plaintiff acted in bad faith or sought the VA rating decision as a "backdoor means of appeal." Finally, the Appeals Council had ample time to consider the VA rating decision: Plaintiff's counsel mailed the decision to the Appeals Council on June 3, 2014, and the Appeals Council did not issue its letter denying Plaintiff's Request for Review until March 29, 2015.
For the reasons set forth above, the Court DENIES Defendant's Motion to Affirm (Doc. No. 24) and ALLOWS Plaintiff's Motion to Reverse (Doc. No. 19) to the extent that it requests remand.
SO ORDERED.