Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-almd-2_13-cv-00108/USCOURTS-almd-2_13-cv-00108-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:405 Review of HHS Decision (SSID)

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IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE MIDDLE DISTRICT OF ALABAMA

NORTHERN DIVISION

TERESA McMEANS, o/b/o M.L.M., )

)

Plaintiff, )

)

v. ) CIVIL ACTION NO. 2:13cv108-SRW

)

CAROLYN W. COLVIN, )

Acting Commissioner of Social Security, )

)

Defendant. )

MEMORANDUM OPINION

Plaintiff Teresa McMeans, on behalf of her minor child, brings this action pursuant

to 42 U.S.C. § 405(g) and § 1383(c)(3) seeking judicial review of a decision by the

Commissioner of Social Security (“Commissioner”) denying her application for child

disability benefits under Title XVI of the Social Security Act. The parties have consented

to entry of final judgment by the Magistrate Judge, pursuant to 28 U.S.C. § 636(c). (Doc.

## 22, 23). Upon review of the record, the court concludes that the Commissioner’s decision

is due to be reversed because the administrative record does not demonstrate that the Appeals

Council evaluated the new medical evidence submitted by the plaintiff on November 17,

2011, as it was required to do. 

RELEVANT PROCEDURAL BACKGROUND 

On October 12, 2011, after an administrative hearing, the ALJ issued a decision

denying plaintiff’s claim for benefits. (R. 8-32). Thereafter, plaintiff requested review by

the Appeals Council. (R. 7). Plaintiff’s counsel transmitted the request for review to the

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Appeals Council with a memorandum brief alleging error, a medical source statement from

Dr. Clemmie Palmer, updated progress notes from Dr. Palmer, an appointment of 1

representative form, and plaintiff’s contract with counsel for representation. (R. 7, 202-05,

412-18). On January 9, 2013, the Appeals Council denied review. (R. 1-5). Thereafter,

plaintiff commenced the present action seeking review ofthe Commissioner’s final decision. 

(Doc. # 1). 

THE PARTIES’ CONTENTIONS

Plaintiff argues, inter alia, that “[t]he Appeals Council failed to show in its written

denial that it adequately evaluated the new evidence submitted by Ms. McMeans before

denying review.” (Doc. # 11, p. 3). She notes that she transmitted fourteen pages to the

Appeals Council by facsimile on November 17, 2011, but that the sole exhibit identified in

the Appeals Council’s exhibit list is her brief. (Id., pp. 3-4)(citing R. 4, 5, 7 and R. 202-205

(Exhibit 13E)). She points out that the last “F” exhibit in the administrative transcript is

Exhibit 18F – a June 2011 progress note from Dr. Palmer – and that Dr. Palmer’s medical

source opinion and progress notes submitted with her request for review do not appear in the

administrative transcript. (Doc. # 11, p. 4 and n. 3)(citing R. 410-11 and the “Court

Transcript Index,” Doc. # 21-1, pp. 1-3). Plaintiff attaches to her brief the fourteen pages

that she sent to the Appeals Council on November 17, 2011, and a fax confirmation showing

successful transmission of fourteen pages to the Appeals Council. (Doc. # 11-2). Plaintiff

 Dr. Palmer is MLM’s treating psychiatrist. (See Exhibit 14F). 1

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further observes that the Appeals Council did not return the omitted evidence to her, as it

should have if the evidence were not material. (Doc. # 11, p. 7 n. 7 and p. 8 n. 8). After

noting the omission of the additional medical evidence from the administrative transcript,

plaintiff argues that the AC failed to explain its analysis of the new, material evidence

adequately (Doc. # 11, pp. 4-8), and, further, that the Appeals Council erred by failing to

remand her claim to the ALJ in light of that new and material evidence (id., pp. 8-12). 

The Commissioner does not dispute that plaintiffsubmitted Dr. Palmer’s signed MSO

form and treatment notes to the Appeals Council with her request for review. (See

Commissioner’s brief, Doc. # 20, pp. 9-10). On October 28, 2013, the Commissioner

appended a copy of the medical evidence that plaintiff had filed in this court to the

administrative transcript, with a “supplemental certification” stating “that the documents

annexed hereto are true and accurate copies of Medical Records submitted on November 17,

2011 that were omitted from the administrative record[.]” (Doc. # 21-10 through Doc. # 21-

12). The Commissioner argues that the Appeals Council’s notice denying review “is not a

2

final decision of the Commissioner” that is subject to judicial review and, further, that the

Appeals Council is not required to explain its denial of review. (Doc. # 20, pp. 10-11). She

notes that “‘new evidence first submitted to the Appeals Council is part of the administrative

The evidence added to the administrative transcript bears an electronic case filing legend 2

at the top of each page, showing that it was first filed in this court on July 8, 2013 as Doc. # 11-2 –

i.e., as an attachment to plaintiff’s brief. The Commissioner’s use of documents filed in this court

to supplement the administrative record suggests that the Appeals Council itself no longer has the

documents or could not locate them. 

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record that goes to the district court for review’” (id. at p. 11)(quoting Keeton v. Dep’t. of

Health & Human Servs., 21 F.3d 1064, 1067 (11th Cir. 1994), and contends that, under

Ingram v. Commissioner of Soc. Sec. Admin., 496 F.3d 1253 (11th Cir. 2007), this court

should determine whether the new evidence deprives the ALJ’s decision to deny benefits of

substantial evidentiary support (id.)(citing Ingram, 496 F.3d at 1266). In other words, the

Commissioner contends that this court may not review the Appeals Council’s decision at all

and that, in reviewing the ALJ’s decision, it should apply the “sentence four” substantial

evidence standard to the record as a whole, including the additional medical evidence.

DISCUSSION

The judicial review provision of the Social Security Act provides that “[a]ny

individual, after any final decision of the Commissioner of Social Security ... may obtain a

review of such decision by a civil action[.]” 42 U.S.C. § 405(g). In such a civil action,

[t]he court shall have power to enter, upon the pleadings and transcript of the

record, a judgment affirming, modifying, or reversing the decision of the

Commissioner of Social Security, with or without remanding the cause for a

rehearing. ... The court ... 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.

Id. (sentences four and six). In this action, plaintiff challenges the decision of the Appeals

Council to deny review, based on the new evidence she submitted to the Appeals Council.

(See plaintiff’s statement of issues, Doc. # 11, p. 3). Contrary to the Commissioner’s

contention, the Appeals Council’s denial of review is a final decision of the Commissioner

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subject to judicial review. See Ingram, 496 F.3d at 1262 (“The settled law of this Circuit is

that a court may review, under sentence four of section 405(g), a denial of review by the

Appeals Council.”)). 

While this case involves “new evidence” first presented properly – as the parties

agree – at the Appeals Council level, it does not present the paradigmatic “sentence four”

appeal in which the Appeals Council has denied review after considering a claimant’s new

evidence and finding it insufficient to impeach the ALJ’s decision. Here, instead, the

administrative record does not demonstrate that the Appeals Council considered the new

evidence in denying review, or that it even evaluated the new evidence at all. In its notice

denying review, under the heading “What We Considered[,]” the Appeals Council states:

In looking at your case we considered the reasons you disagree with the

decision in the material listed on the enclosed Order of Appeals Council.

We found that this information does not provide a basis for changing the

Administrative Law Judge’s decision.

(R. 2)(emphasis added). The referenced “Order of Appeals Council” lists onlyExhibit 13E, 3

identified as “Representative correspondence, dated October 27, 2011 that included medical

evidence from Clemmie Palmer III, M.D.” (R. 5); the Appeals Council exhibit list reveals

that his exhibit consists of four pages (R. 4). As plaintiff notes, Exhibit 13E (four pages in

length, including the bar code sheet) consists of her brief alleging error only. (R. 202-05). 

In her brief, the Commissioner summarizes this finding as follows: “In denying review of 3

the ALJ’s decision, the Appeals Council stated that it had considered the additional evidence

Plaintiff submitted, but was denying review because that evidence did not provide a basis for

changing the ALJ’s decision.” (Doc. # 20, p. 10)(emphasis added).

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Within that brief, plaintiff sets forth all of Dr. Palmer’s responses to the questions on the

medical source opinion form. (R. 203; see R. 412-13). 

The court cannot conclude that the Appeals Council’s reference, in its order and

exhibit list, to “Exhibit 13E[,]” the “Representative correspondence, dated October 27, 2011

that included medical evidence from Clemmie Palmer III, M.D.” – a document consisting of

four pages – establishes that the Appeals Council considered the four-page Exhibit 13E at

R. 202-205 and additional “medical evidence from Clemmie Palmer III, M.D.” Instead, the

Appeals Council’s notice, exhibit list, and order reflect that the Appeals Council considered

only Exhibit 13E, which recounts some (but not all) of the additional medical evidence from

Dr. Palmer that plaintiff transmitted to the Appeals Council with the request for review.4

This conclusion is further supported by the Commissioner’s failure to include the additional

evidence in the administrative transcript as originally certified (see Doc. ## 21 and 21-1) and

by the Commissioner’s inclusion, in her supplement to the transcript, of copies of that

medical evidence reproduced from this court’s record (see n. 2, supra), rather than from the

The Appeals Council’s summary denial of review gives no indication of its reason for 4

concluding that Dr. Palmer’s opinions, as described in counsel’s correspondence to the Appeals

Council, do not “provide a basis for changing the Administrative Law Judge’s decision.” (R. 1-5). 

The Appeals Council, in denying review, is not required to explain its reasons for concluding that

new evidence does not provide a basis for changing the ALJ’s decision. Edwards v. Colvin, 2013

WL 6772975, ** 3-4 (M.D. Ala. Dec. 20, 2013). However, in the absence of an explanation from

the Appeals Council, the court declines to speculate that the Appeals Council considered the

substance of Dr. Palmer’s opinions as if it had the actual MSO form before it; it is possible that the

Appeals Council discounted the opinions as described by plaintiff’s counsel in Exhibit 13E because

of a misconception that plaintiff had failed to submit Dr. Palmer’s underlying MSO form for the

Appeals Council’s consideration. 

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Appeals Council’s files. 

The Commissioner’s regulations provide that, “[i]n reviewing decisions based on an

application for benefits, if new and material evidence is submitted, the Appeals Council shall

consider the additional evidence only where it relates to the period on or before the date of

the administrative law judge hearing decision. ... It will then review the case if it finds that

the administrative law judge’s action, findings, or conclusion is contrary to the weight of the

evidence currently of record.” 20 C.F.R. § 416.1470(b); see also § 416.1476(b)(on review,

“[t]he Appeals Council will consider all the evidence in the administrative law judge hearing

record as well as any new and material evidence submitted to it which relates to the period

on or before the date of the administrative law judge hearing decision”). Implicit in this

regulatory mandate is a requirement that the Appeals Council evaluate all of the evidence a

claimant submits properly to it and make a threshold determination regarding whether the

evidence is new and material and relates to the relevant period. See id. (“If you submit

evidence which does not relate to the period on or before the date of the administrative law

judge hearing decision, the Appeals Council will return the additional evidence to you with

an explanation as to why it did not accept the additional evidence and will advise you of your

right to file a new application.”); cf. HALLEX I-3-5-20 (“When a claimant or appointed

representative submits additional evidence in association with a request for review, the

Appeals Council (AC) must determine whether it is new, material, and relates to the period

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on or before the date of the administrative law judge (ALJ) decision.”).5

While plaintiff suggests that the Appeals Council did not consider the new evidence,

she stops short of addressing the legal consequences of such a failure. The Commissioner,

for her part, argues the case as if there is no issue regarding whether the Appeals Council did

what it is required by regulation to do with regard to new evidence. She urges the court to

conclude that “[t]he new evidence, at least in part, did not pertain to the time period

considered by the ALJ” and contends that – even if the entirety of the additional records

pertained to the relevant time period – “it does not affect the ALJ’s decision.” (Doc. # 20,

pp. 11-12). Both parties suggest that this court may consider the additional evidence to

determine whether the decision denying benefits is supported by substantial evidence. The

court concludes that it may not. 

“Judicial review of decisions of[the Commissioner] denying benefits under the Social

Security Act is both provided for and limited by 42 U.S.C. § 405(g).” Western v. Harris, 633

F.2d 1204 (5th Cir. Jan. 9, 1981). The record before the court does not reflect that the

Appeals Council considered the additional evidence in denying review or, even, that it

The court does not here decide whetherthe HALLEX creates rights which may be enforced 5

judicially – a subject of some debate (see Cohan v. Commissioner of Social Security, 2011WL

3319608 (M.D. Fla. Jul. 29, 2011) (discussing cases) – because, as noted above, the requirement for

a threshold evaluation is implicit in the Commissioner’s regulation. Consistent with this implied

requirement, the HALLEX directs the Appeals Council analyst who evaluates additional evidence

submitted by a claimant on review and finds it to be not new and/or not material to “include language

in the denial notice specifically identifying the additional evidence (by source, date range, and

number of pages)” and explaining that the evidence is “not new and/or material” or “does not relate

to the period on or before the date of the ALJ decision[.]” HALLEX I-3-5-20. 

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conducted the required threshold evaluation of the evidence to determine whether it was new

and material evidence that it should consider on the question of whether to grant review. The

court finds nothing in either § 405(g) or Eleventh Circuit case law interpreting it to support

the premise that a district court may consider – in reviewing the Commissioner’s final

decision for substantial evidentiarysupport – evidence that the Commissioner never reviewed

at all in reaching her final decision, or that the court may itself conduct a threshold “new

evidence” evaluation to eliminate some of that evidence fromconsideration, when the record

does not demonstrate that the Appeals Council has performed such an evaluation. “The

[Commissioner’s] failure to apply the correct law or to provide the reviewing court with

sufficient reasoning for determining that the proper legal analysis has been conducted

mandates reversal.” Cornelius v. Sullivan, 936 F.2d 1143, 1145-46 (11th Cir.1991). 

Because the administrative record, including the Appeals Council’s notice denying review,

does not support a conclusion that the Appeals Council conducted the required legal analysis

of the additional evidence, the Commissioner’s decision is due to be reversed.6

CONCLUSION

For the foregoing reasons, the decision ofthe Commissioneris due to be REVERSED,

and this action REMANDED to the Commissioner for further proceedings consistent with

See Sneed v. Barnhart, 214 Fed. Appx. 883, 885 (11th Cir.2006)(in dicta, describing the 6

“Appeals Council’s refusal to consider the submission of new evidence before denying review” as

an “error of law” that is subject to judicial review). The court expresses no opinion regarding

whether the Appeals Council should have granted review or whether plaintiff is entitled to prevail

on her claim. It holds only that the record does not establish that the Appeals Council evaluated or

considered the new medical evidence.

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this Memorandum Opinion. A separate judgment will be entered.

DONE, this 1 day of July, 2014. st

/s/ Susan Russ Walker 

SUSAN RUSS WALKER

CHIEF UNITED STATES MAGISTRATE JUDGE

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