FRANK P. GERACI, JR., Chief District Judge.
On January 23, 2014,
The parties make competing motions for judgment on the pleadings pursuant to Federal Rule of Civil Procedure 12(c). ECF Nos. 17, 24. For the reasons that follow, Jackson's motion is GRANTED, the Commissioner's motion is DENIED, and this matter is REMANDED for further administrative proceedings.
When reviewing a final decision of the SSA, it is not the Court's function to "determine de novo whether [the claimant] is disabled." Schaal v. Apfel, 134 F.3d 496, 501 (2d Cir. 1998). Rather, the Court "is limited to determining whether the SSA's conclusions were supported by substantial evidence in the record and were based on a correct legal standard." Talavera v. Astrue, 697 F.3d 145, 151 (2d Cir. 2012) (citing 42 U.S.C. § 405(g)).
The Commissioner's decision is "conclusive" if it is supported by substantial evidence. 42 U.S.C. § 405(g). "Substantial evidence means more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Moran v. Astrue, 569 F.3d 108, 112 (2d Cir. 2009) (citations omitted).
In conducting the requisite five-step analysis,
The AC must consider additional evidence that a claimant submits if the claimant can show good cause for not submitting it to the ALJ; it is new, material, and relates to the period on or before the ALJ's decision; and there is a reasonable probability that it would change the outcome of the decision. Simon v. Berryhill, No. 1:16-cv-04088(FB), 2017 WL 4736732, at *2 (E.D.N.Y. Oct. 19, 2017) (citing 20 C.F.R. § 404.970(a)(5), (b)).
"`Good cause' for failing to present evidence in a prior proceeding exists where . . . the evidence surfaces after the Secretary's final decision and the claimant could not have obtained the evidence during the pendency of that proceeding." Lisa v. Sec'y of Dep't of Health & Human Servs., 940 F.2d 40, 44 (2d Cir. 1991); see also Pollard v. Halter, 377 F.3d 183 193 (2d Cir. 2004). Evidence is new if it is not cumulative of what is already in the record. Simon, 2017 WL 4736732, at *2 (citation omitted). It is material if it is relevant to the claimant's condition during the time period for which benefits were denied and probative, meaning there is a reasonable probability that it would have influenced the Commissioner to decide the claimant's application differently. Webb v. Apfel, No. 98-CV-791, 2000 WL 1269733, at *14 (W.D.N.Y. Feb. 8, 2000) (citing Jones v. Sullivan, 949 F.2d 57, 60 (2d Cir. 1990)).
Here, Plaintiff submitted to the AC a Retrospective Medical Opinion ("RMO") from Dr. Mikhail Strut dated October 6, 2017.
Dr. Strut's opinion is new and material evidence that may have changed the outcome of the ALJ's decision. First, because the opinion did not exist at the time of the ALJ's decision, Plaintiff has shown good cause for not submitting it earlier. Pollard, 377 F.3d at 193; Vosburgh v. Comm'r of Soc. Sec., No. 17-CV-6587P, 2019 WL 2428501, at *3 (W.D.N.Y. June 11, 2019). Second, the evidence is new because it is not cumulative of what already exists in the record. Though several of Dr. Strut's treatment notes are in the record, there was no functional capacity assessment from Dr. Strut. See Tr. 219-33; Marchetti v. Colvin, No. 13-CV-02581 (KAM), 2014 WL 7359158, at *15 (E.D.N.Y. Dec. 24, 2014) (finding impairment questionnaire submitted to AC that post-dated ALJ decision was new where treating source's treatment notes were in record but the questionnaire "provide[d] a more detailed assessment than is available in the record of plaintiff's physical limitations and ability to work.").
Third, the evidence is material because it clearly relates to Plaintiff's condition during the relevant period, as it discusses her physical limitations stemming directly from her car accident on her date of disability. See Vosburgh, 2019 WL 2428501, at *5 (finding treatment notes that post-dated ALJ's decision were material because their focus on the claimant's medical conditions that "existed at least to some extent prior to the ALJ's decision" made them "more likely to reflect a diagnosis that sheds considerable new light on the seriousness of [claimant's] condition." (internal quotation marks and citation omitted)). The opinion does not discuss any new conditions or impairments that arose after the date of the ALJ's decision. Rather, it is clear from the record that Dr. Strut treated Plaintiff previously for the exact back and shoulder pain that he references in the RMO, and that the RMO sheds new light on the seriousness of her condition.
Moreover, because Dr. Strut's opinion is much more limiting than the RFC the ALJ assigned, the Court finds that there is a reasonable probability that the ALJ may have decided Plaintiff's application differently had she seen this evidence. See Knight v. Astrue, No. 10 Civ. 5301(BMC), 2011 WL 4073603, at *12-13 (E.D.N.Y. Sept. 13, 2011) (finding questionnaire newly submitted to AC was material where it "significantly undermined" the ALJ's RFC). Whereas the ALJ determined that Plaintiff could lift as much as 10 pounds frequently and 20 pounds occasionally, Dr. Strut opined that Plaintiff could only occasionally lift 5 pounds and lift less than 5 pounds frequently. Tr. 7, 14. Whereas the ALJ found that Plaintiff was capable of sitting, standing, and walking for up to 6 hours in an 8-hour day, Dr. Strut assessed that Plaintiff could not do any of those activities for more than 15 to 20 minutes at a time. Id. The RFC contains no limitations that allow Plaintiff to shift positions throughout the day, as Dr. Strut's assessment suggests may be necessary. Moreover, the ALJ did not find Plaintiff's headaches to be a severe impairment but Dr. Strut opined that Plaintiff needed 20 to 30-minute breaks a few times a day to alleviate her headaches. Id.
Dr. Strut's opinion is clearly new and material evidence the Appeals Council should have considered. For this reason, the Court remands Plaintiff's case for reconsideration upon the entire record. Though Plaintiff raises additional arguments, having already found sufficient basis for remand, the Court need not consider them. See ECF No. 17-1 at 21-30.
Jackson's Motion for Judgment on the Pleadings (ECF No. 17) is GRANTED, the Commissioner's Motion for Judgment on the Pleadings (ECF No. 24) is DENIED, and this matter is REMANDED to the Commissioner for further administrative proceedings consistent with this opinion pursuant to sentence four of 42 U.S.C. § 405(g). The Clerk of Court will enter judgment and close this case.
IT IS SO ORDERED.