Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-almd-1_11-cv-00448/USCOURTS-almd-1_11-cv-00448-0/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

SOUTHERN DIVISION

CLEOLA B. CINTRON, )

)

Plaintiff, )

)

v. ) CIVIL ACTION NO. 1:11CV448-SRW

) (WO)

CAROLYN W. COLVIN, ) 

Acting Commissioner of Social Security, )

)

Defendant. )

MEMORANDUM OPINION AND ORDER

Plaintiff Cleola B. Cintron brings this action pursuant to 42 U.S.C. § 405(g) seeking

judicial review of a decision by the Commissioner of Social Security (“Commissioner”)

denying her application for a period of disability and disability insurance benefits under Title

II 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). Upon review of the record and briefs

submitted by the parties, the court concludes that this action is due to be reversed and

remanded to the Commissioner pursuant to sentence four of 42 U.S.C. § 405(g).

BACKGROUND

Plaintifffiled an application for a period of disabilityand disabilityinsurance benefits,

pursuant to Title II of the Social SecurityAct, on September 9, 2008, alleging disability since

June 15, 2008. (Exhibit 2D). After her application was denied at the initial administrative 1

Plaintiff also filed an application for supplemental security income under Title XVI. 

1

(Exhibit 1D). However, plaintiff’s appeal to this court relates to plaintiff’s Title II claim only (see

Plaintiff’s brief, Doc. # 14, p. 1 ¶ 1) and the administrative transcript includes no final decision of

the Commissioner on plaintiff’s SSI application. (See Exhibits 1B, 2B (initial denial of Title II

Case 1:11-cv-00448-SRW Document 20 Filed 07/19/13 Page 1 of 7
level, plaintiff requested and received a hearing before an administrative law judge. 

(Exhibits 1B, 2B, 5B, 6B, R. 27-63). The ALJ issued a decision on April 2, 2010, concluding

that the plaintiff was not under a disability, as defined in the Social Security Act, from her

alleged onset date through the date of the decision. (R. 10-22). Plaintiff requested review of

the ALJ’s decision and, on April 13, 2011, the Appeals Council denied review. (R. 1-9). 

Plaintiff filed the present action thereafter. (Doc. # 1).

DISCUSSION

Plaintiff argues, inter alia, that “[t]he Appeals Council erred by failing to properly

consider the new and material evidence from Dr. Kesserwani.” (Doc. # 14, p. 7)(capitalized

in original). Plaintiff attaches to her brief Dr. H. Kesserwani’s treatment note for plaintiff’s

examination on June 1, 2010, including the results of EMG and nerve conduction studies

performed on that date and on June 7, 2010. (Doc. # 14-1, Exhibit A to Plaintiff’s Brief,

pp. 3-7). The attachment includes a cover letter dated July 7, 2010, addressed to the Appeals

Council; it refers to enclosed “Medical Records dated 06/01/10 through 06/07/10 from

Comprehensive Neurodiagnostic Center” and thanks the Appeals Council “for allowing

additional time to submit this evidence.” (Id., p. 2). Exhibit A also includes a fax cover

sheet and a confirmation report, the latter showing a successful transmission of six pages to

claim); Exhibit 5B (request for hearing stating “I disagree with the determination made on my claim

for disability-worker or child benefits because I am disabled” – i.e., the Title II claim); Exhibit 6B

at R. 77, 83 (Notice of Hearing specifying the issues to be considered at the hearing); Exhibit 10B

(plaintiff’s 2/3/10 appointment of representativesfor purposes of “Title II(RSDI)” claim only; R. 13-

22 (ALJ decision as to Title II application); R. 8 (AC annotation of request for review of “DisabilityWorker (DIWE)” claim). 

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“17036057421” on July 7, 2010 at 16:13. (Id., pp. 1, 7). In her brief to this court, plaintiff

points to the Appeals Council’s order of April 13, 2011 identifying the “additional evidence

which [the Appeals Council] is making a part of the record,” and notes that it lists only

evidence from Dr. Lett. (Doc. # 14, pp. 8-9). Citing and quoting 20 C.F.R. § 404.976(b)(1),

she argues that the Appeals Council was required to either consider the evidence of her

evaluation by Dr. Kesserwani or return it to her with an explanation as to why it was not

accepted, and that its failure to do either “is legal error warranting remand for proper

consideration of this evidence.” (Id., p. 9). 

The Commissioner does not contend that the submission to the Appeals Council was

untimely, nor has she offered evidence that the Appeals Council did not receive the

additional records. The evidence attached to plaintiff’s brief demonstrates that plaintiff

submitted this additional evidence to the Appeals Council properly and the Commissioner

does not argue otherwise. Instead, she maintains that “[p]laintiff’s reliance upon evidence 2

after the ALJ’s decision submitted to the Appeals Council is without merit” because the new

evidence “did not render the ALJ’s decision denying benefits erroneous.” (Doc. # 15, pp.

11). She then argues why this is so, evaluating the opinions presented by Dr. Kesserwani in

Exhibit A. (Id., p. 12). However, the Commissioner ignores plaintiff’s argument that the

Appeals Council had a duty either to consider the evidence or return it to her with an

Because this evidence should, therefore, have been included in the certified administrative 2

record the Commissioner filed in this action, the court considers it in reviewing the Commissioner’s

decision for legal error.

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explanation.

This court is tasked with reviewing the Commissioner’s final decision. Where, as

here, the plaintiff challenges the Commissioner’s decision on grounds arising subsequent to

the ALJ’s decision, the court’s review necessarily extends to the action of the Appeals

Council. Cf. Ingram v. Commissioner of Social Security Administration, 496 F.3d 1253,

1262–66 (11th Cir.2007)(“[A] decision of the Appeals Council to deny review after refusing

to consider new evidence is a part of the ‘final decision’ of the Commissioner subject to

judicial review under sentence four of section 405(g).”); Sneed v. Barnhart, 214 Fed. Appx.

883, 885 (11th Cir.2006)(holding that, where the Appeals Council did not receive the

claimant’s new evidence until after it issued its decision, the court had no jurisdiction to

review the Appeals Council’s refusal to reopen; observing, in dicta, that “[b]ecause the

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

amounts to an error of law, that decision is subject to judicial review”). 

The Commissioner’s regulation cited by the plaintiff provides that, 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.” 20 C.F.R. § 404.976(b).

Implicit in this mandate is a requirement that the Appeals Council evaluate all of the

evidence a claimant submits properly on review and make a threshold determination

regarding whether the evidence is new and material. See 20 C.F.R. § 404.976(b)(if Appeals

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Council finds that evidence submitted to the Appeals Council does not relate to the time

period on or before the date of the ALJ’s decision, it will return evidence to the claimant

“with an explanation as to why it did not accept the additional evidence and will advise [the

claimant] of [her] right to file a new application”) ; cf. HALLEX I-3-5-20 (“The Appeals 3

Council only evaluates evidence that is not new and material to the period through the date

of the ALJ hearing decision to the extent necessary to determine that it is not new and

material.”). In its denial notice in the present case, the Appeals Council makes no reference 4

to the June 2010 evidence from Dr. Kesserwani. (See R. 1-6). Instead, as plaintiff notes, the

Appeals Council refers only to new evidence of an “[o]ffice visit dated July 8, 2010 from

physician, Patrick Lett[,]” making that evidence a part of the record as “Exhibit 16F.” (R.

The Commissioner argues, in part, that plaintiff’s new evidence does not relate to the 3

relevant period. (Doc. # 15, Commissioner’s brief, p. 12)(plaintiff’s complaint to Dr. Kesserwani

of headaches pertained to a period of time “clearly after the ALJ’s hearing and thus the period at

issue in this case”). There is no indication in the record or in the briefs of the parties that the

Appeals Council reviewed the evidence but returned it to the plaintiff, as it might have done if it had

reviewed the evidence and determined that it did not relate to the time period on or before the date

of the ALJ’s decision. See 20 C.F.R. § 404.976(b). 

The court does not here decide whetherthe HALLEX creates rights which may be enforced 4

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, HALLEX I-3-5-20 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

“provide language for the denial notice” explaining why the evidence is not material and, for

evidence that is not “new,” describing how the submitted evidence duplicates evidence already of

record.

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4-5).5

In reviewing the Commissioner’s decision, the court is required to defer to the

Commissioner’s factual findings and scrutinize closely his legal conclusions. Cornelius v.

Sullivan, 936 F.2d 1143, 1145 (11th Cir.1991) (citations omitted). “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.” Id. at

1145-46 (citation omitted). The court cannot conclude, on the present record, that the

Appeals Council made the required threshold determination that the evidence was not new

and material or, indeed, that it reviewed plaintiff’s evidentiary submission at all. Because

the Appeals Council’s decision lacks any basis from which the court could determine that the

Appeals Council conducted the required legal analysis of Dr. Kesserwani’s June 2010

evaluation and opinion, the Commissioner’s decision is due to be reversed.6

CONCLUSION

For the foregoing reasons, it is

ORDERED that the administrative record is hereby supplemented to include the

evidence attached to plaintiff’s brief as Exhibit A, which the Commissioner erroneously

omitted from the certified transcript. Further, the court concludes that the decision of the

Exhibit 16F is not included in the administrative transcript before the court. (See Doc. 5

# 16).

In view of this conclusion, the court does not address the remaining issues raised by 6

plaintiff. The court expects that the Commissioner will consider plaintiff’s arguments as to these

issues on remand.

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Commissioner is due to be REVERSED, and this action REMANDED to the Commissioner

for further proceedings consistentwith thisMemorandumOpinion. A separate judgment will

be entered.

DONE, this 19 day of July, 2013. th

/s/ Susan Russ Walker 

SUSAN RUSS WALKER

CHIEF UNITED STATES MAGISTRATE JUDGE

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