Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-almd-2_10-cv-00139/USCOURTS-almd-2_10-cv-00139-0/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)

---

IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE MIDDLE DISTRICT OF ALABAMA

NORTHERN DIVISION

GALE CARTER, )

)

Plaintiff, )

)

vs. ) CIVIL ACTION NO. 2:10cv139-CSC

)

MICHAEL J. ASTRUE, )

Commissioner of Social Security, )

)

Defendant. )

MEMORANDUM OPINION and ORDER

I. Introduction

Plaintiff Gale Carter (“Carter”) applied for disability insurance benefits pursuant to

Title II of the Social Security Act, 42 U.S.C. §§ 401 et seq., and for supplemental security

income benefits under Title XVI of the Social Security Act, 42 U.S.C. § 1381 et seq.,

alleging that she was unable to work because of a disability. Her application was denied at

the initial administrative level. The plaintiff then requested and received a hearing before

an Administrative Law Judge (“ALJ”). Following the hearing, the ALJ concluded that the

plaintiff was not under a “disability” as defined in the Social Security Act. The ALJ,

therefore, denied the plaintiff’s claim for benefits. The Appeals Council rejected a

subsequent request for review. The ALJ’s decision consequently became the final decision

of the Commissioner of Social Security (Commissioner). See Chester v. Bowen, 792 F.2d

1

Pursuant to the Social Security Independence and Program Improvements Act of 1994, Pub.L. No. 1

103-296, 108 Stat. 1464, the functions of the Secretary of Health and Human Services with respect to Social

Security matters were transferred to the Commissioner of Social Security.

Case 2:10-cv-00139-CSC Document 14 Filed 08/08/11 Page 1 of 13
129, 131 (11 Cir. 1986). Pursuant to 28 U.S.C. § 636(c), the parties have consented to th

entry of final judgment by the United States Magistrate Judge. The case is now before the

court for review pursuant to 42 U.S.C. §§ 405 (g) and 1383(c)(3). Based on the court's

review of the record in this case and the parties’ briefs, the court concludes that the

Commissioner’s decision should be reversed and this case should be remanded to the

Commissioner for further proceedings consistent with this opinion.

II. Standard of Review

Under 42 U.S.C. § 423(d)(1)(A), a person is entitled to disability benefits when the

person is unable 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 . . . 

To make this determination, the Commissioner employs a five-step, sequential 2

evaluation process. See 20 C.F.R. §§ 404.1520, 416.920.

(1) Is the person presently unemployed?

(2) Is the person’s impairment severe?

(3) Does the person's impairment meet or equal one of the specific

impairments set forth in 20 C.F.R. Pt. 404, Subpt. P, App. 1?

(4) Is the person unable to perform his or her former occupation?

(5) Is the person unable to perform any other work within the economy?

An affirmative answer to any of the above questions leads either to the next

question, or, on steps three and five, to a finding of disability. A negative

A “physical or mental impairment” is one resulting from anatomical, physiological, or 2

psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory

diagnostic techniques.

2

Case 2:10-cv-00139-CSC Document 14 Filed 08/08/11 Page 2 of 13
answer to any question, other than step three, leads to a determination of “not

disabled.”

McDaniel v. Bowen, 800 F.2d 1026, 1030 (11 Cir. 1986). th 3

The standard of review of the Commissioner’s decision is a limited one. This court

must find the Commissioner’s decision conclusive if it is supported by substantial evidence.

42 U.S.C. § 405(g); Graham v. Apfel, 129 F.3d 1420, 1422 (11 Cir. 1997). “Substantial th

evidence is more than a scintilla, but less than a preponderance. It is such relevant evidence

as a reasonable person would accept as adequate to support a conclusion.” Richardson v.

Perales, 402 U.S. 389, 401 (1971). A reviewing court may not look only to those parts of

the record which supports the decision of the ALJ but instead must view the record in its

entirety and take account of evidence which detracts from the evidence relied on by the ALJ. 

Hillsman v. Bowen, 804 F.2d 1179 (11 Cir. 1986). th

[The court must] . . . scrutinize the record in its entirety to determine the

reasonableness of the [Commissioner’s] . . . factual findings . . . No similar

presumption of validity attaches to the [Commissioner’s] . . . legal

conclusions, including determination of the proper standards to be applied in

evaluating claims.

Walker v. Bowen, 826 F.2d 996, 999 (11 Cir. 1987). th

III. The Issues

A. Introduction. The plaintiff was 49 years old at the time of the hearing before the

McDaniel v. Bowen, 800 F.2d 1026 (11 Cir. 1986) is a supplemental security income case (SSI). 3 th

The same sequence applies to disability insurance benefits. Cases arising under Title II are appropriately

cited as authority in Title XVI cases. See e.g. Ware v. Schweiker, 651 F.2d 408 (5 Cir. 1981) (Unit A).

th

3

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ALJ and had completed the high school. (R. 401). Following the hearing, the ALJ

4

concluded that the plaintiff has severe impairments of “major depressive disorder with

psychotic features, hypertension, obesity, and gastroesophageal reflux disease.” (R. 19). 

Her prior work experience includes work “as a monitor technologist.” (R. 26). Moreover,

relying on the testimony of a vocational expert, the ALJ concluded that there were jobs

existing in significant numbers in the national economy that Carter could perform. (Id.). 

Consequently, the ALJ concluded that she was not disabled. (Id.).

 B. The Plaintiff’s Claims. The plaintiff presents a single issue for the court’s

review. As stated by the plaintiff, the issue is “whether the case should be remanded for

consideration of new medical evidence submitted by the claimant prior to the decision that

was not considered by the ALJ or included in the record.” (Pl’s Br., doc. # 11 at 2). It is to

this issue that the court now turns.

IV. Discussion

Section 405(g), in part, permits courts to remand a case to the Social Security

Administration for consideration of new evidence under certain circumstances. Ingram v.

Comm’r of Soc. Sec. Adm., 496 F.3d 1253, 1261 (11 Cir. 2007). The plaintiff asserts that th

she presented new medical evidence to the ALJ that he did not consider and that was not

included in the record. (Pl’s Br., doc. # 11, at 2). The United States asserts that the material

provided by the plaintiff is neither new nor material and asserts that the “[p]laintiff has not

Carter also testified that she had two years of college but she did not complete a degree. (R. 401).

4

4

Case 2:10-cv-00139-CSC Document 14 Filed 08/08/11 Page 4 of 13
demonstrated that she presented this evidence to the ALJ.” (Def’s Br. at 4, doc. # 10). It is

undisputed that the medical evidence in question is not in the record. Consequently, the court

concludes that the medical evidence was not considered by the ALJ or the Appeals Council,

and this court cannot consider that material when considering a sentence four remand. 

Ingram, 496 F.3d at 1267-68. 

However, “a sentence six remand is available when evidence not presented to the

Commissioner at any stage of the administrative process requires further review.” Ingram,

496 F.3d at 1267. “[R]emand . . . is appropriate under sentence six when “evidence, that was

not before the Secretary, has been submitted for the first time to [a federal] court.”” Id. at

1268. Because the plaintiff seeks a remand based upon new medical evidence presented to

this court, the question for the court is whether a remand pursuant to sentence six of 42

U.S.C. § 405(g) is warranted.

In order to prevail on a claim for remand under § 405(g), a plaintiff must show 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.” Ingram, 496 F.3d at 1261. 

See also Shalala v. Schaefer, 509 U.S. 292, 297 fn 2 (1993). Thus, Carter must demonstrate

that “(1) there is new, noncumulative 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 failure to submit the evidence at the administrative

level.” Milano v. Bowen, 809 F.2d 763, 766 (11 Cir. 1987); Robinson v. Astrue, 365 Fed. th

5

Case 2:10-cv-00139-CSC Document 14 Filed 08/08/11 Page 5 of 13
Appx. 993, 996 (11 Cir. 2010); Pichette v. Barnhart, 185 Fed. Appx. 855, 857 (11 Cir. th th

2006). See also Falge v. Apfel, 150 F.3d 1320, 1323 (11 Cir. 1998); Hyde v. Bowen, 823 th

F.2d 456, 459 (11 Cir. 1987). th

Applying the three-prong remand standard, the court concludes that the medical

evidence is new and non-cumulative because it was not before the ALJ when he rendered his

unfavorable opinion on May 16, 2008. (R. 14, 27). The ALJ held an administrative hearing

on November 5, 2007. (R. 297). The plaintiff was hospitalized for chronic paranoid

schizophrenia with acute exacerbation on March 17, 2008. The ALJ makes no mention of

these records in his adverse determination. New, non-cumulative evidence is evidence not

included in the administrative record that relates to the time on or before the ALJ rendered

his decision. Cannon v. Bowen, 858 F.2d 1541, 1546 (11 Cir. 1988); Vlamakis v. Comm’r th

of Soc. Sec., 172 Fed. Appx. 274, 277 (11 Cir. 2006); Cummings v. Comm’r of Soc. Sec.,

th

165 Fed. Appx. 809, 812 (11 Cir. 2006); Magill v. Comm’r of Soc. Sec., 147 Fed. Appx. th

92, 95-95 (11 Cir. 2005). Because the evidence was not before the ALJ, was not included th

in the administrative record, and relates to the time period before the ALJ reached his

decision, the court concludes that the evidence is new and non-cumulative.

Furthermore, the evidence is not cumulative because the medical records demonstrate

a substantial change in the plaintiff’s condition, specifically, that she suffers from chronic

paranoid schizophrenia with acute exacerbation. The plaintiff had previously been

hospitalized three times for major depressive disorder. (R. 118-193, 194-239,261, 365, 369-

6

Case 2:10-cv-00139-CSC Document 14 Filed 08/08/11 Page 6 of 13
370). She has since been diagnosed as suffering from chronic paranoid schizophrenia.

Consequently, the medical evidence before the court is both new and non-cumulative. 

Next, the evidence is material because it reflects a deterioration of Carter’s mental

condition and her inability to comply with the medication regime necessary for her

schizophrenia to remain in remission. The plaintiff was first hospitalized on June 30, 2005,

suffering from paranoia, depression, anxiety and experiencing hallucinations. (R. 120-21). 

She was diagnosed with psychosis and major depression. (R. 122-23). During her

hospitalization, it was noted that she was depressed, delusional, with a flat or odd affect,

confused, isolated, paranoid, suspicious, and hallucinating. (R. 140-150, 189). She was

prescribed Lexapro and Risperdal. (R. 159). She was discharged on July 10, 2005 to live

with her sister. (R. 155).

On July 15, 2005, she was hospitalized again by court order. (R. 194-239). She was

experiencing psychosis and depression. (R. 196, 203). Her affect was flat, she was paranoid

and guarded, and her insight and judgment were impaired. (R. 205). She was discharged on

July 21, 2005. Her assessment at that time was “probably psychosis, not otherwise specified

versus schizoaffective disorder.” (R. 203). She was prescribed Lexapro, Abilify and Ativan. 

(Id.; 226) 

On August 4 2005, a treatment note fromthe HSI Adult Medicine Clinic indicates that

Carter was assessed as schizophrenic. (R. 249). 

On October 1, 2005, Carter was hospitalized for the third time suffering from

7

Case 2:10-cv-00139-CSC Document 14 Filed 08/08/11 Page 7 of 13
psychosis. (R. 267-355). At that time, she was diagnosed as suffering from schizophrenia,

paranoid type with psychosis. (R. 293, 310). “She is diagnosed as having schizophrenia

versus schizoaffective disorder who presents with symptoms of hallucinations, paranoid

ideations, confusion.” (R. 294). Carter agreed to “not wander and to take medication.” (R.

276). She was released on October 6, 2005, after her Abilify medication was increased. (R.

288). 

The new records demonstrate that Carter was hospitalized again through the

emergency room to Meadhaven Psychiatric ward on March 17, 2008 for “bizarre behavior.”

The patient was recently not showering, confused, paranoid, for the last few

weeks, noncompliant with psychotropic medications for 2 months, established

patient at Montgomery area mental health. She has been prescribed Lexapro

20 milligrams daily; Abilify 20 milligrams daily; some trazodone at night. She

is not taking medication. Has been getting up in the middle of the night,

packing, convinced she is moving her sister. Sister has no idea patient is going

to move out. The patient recently put all her belongings on the street, saying

none of them were any good. She was brought to the emergency room because

of threat to self and others, and has been admitted for inpatient psychiatric

care.

She was paranoid, her thought process was disorganized, her speech was slow, and her affect

was blunted. Her insight and judgment were poor. She was diagnosed with chronic

paranoid schizophrenia with acute excerbation. Thus, the court concludes that the medical

evidence is material because it demonstrates the chronic and debilitating nature of Carter’s

condition.

The medical evidence is also material because although the ALJmentioned that Carter

had been diagnosed schizophrenic, (R. 22), he did not consider whether her schizophrenia

8

Case 2:10-cv-00139-CSC Document 14 Filed 08/08/11 Page 8 of 13
constituted a severe impairment, or whether she met or equaled Listing 12.03, Schizophrenia,

Paranoid and Other Psychotic Disorders. See 20 C.F.R. Pt. 220, App. 1. Listing 12.03. The

Listing provides, in pertinent part, that a claimant is disabled if she meets the following

criteria:

12.03 Characterized by the onset of psychotic features with

deterioration from a previous level of functioning. 

The required level of severity for these disorders is met when the

requirements in both A and B are satisfied, or when the requirements of C are

satisfied.

A. Medically documented persistence, either continuous or

intermittent, of one or more of the following:

1. Delusions or hallucinations; or

2. Catatonic or other grossly disorganized behavior; or

3. Incoherence, loosening of associations,illogicalthinking,

or poverty of content of speech if associated with one of

the following:

a. Blunt affect; or

b. Flat affect; or

c. Inappropriate affect;

or

4. Emotional withdrawal and/or isolation;

AND

B. Resulting in at least two of the following:

1. Marked restriction of activities of daily living; or

2. Marking difficulties in maintaining socialfunctioning; or

3. Marking difficulties in maintaining concentration,

persistence or pace; or

4. Repeated episodes of decompensation, each of extended

duration;

OR

C. Medicallydocumented historyof a chronic schizophrenic, paranoid,

or other psychotic disorder of at least 2 years’ duration that has caused more

than a minimal limitation of ability to do basic work activities, with symptoms

or signs currently attenuated by medication or psychosocial support, and one

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Case 2:10-cv-00139-CSC Document 14 Filed 08/08/11 Page 9 of 13
of the following:

1. Repeated episodes of decompensation, each of extended

duration;

2. A residual disease process that has resulted in such marginal

adjustment that even a minimal increase in mental demands or

change in environment would be predicted to cause the

individual to decompensate;

3. Current history of 1 or more years’ inability to function outside

a highly supportive living arrangement, with an indication of

continued need for such an arrangement.

20 C.F.R. Pt. 220, App. 1. Listing 12.03, Schizophrenia, Paranoid and Other Psychotic

Disorders. 

The plaintiff has clearly been diagnosed with chronic paranoid schizophrenia. 

Consequently, the ALJ has an obligation to determine whether she meets or equals this

listing. The court refrains from deciding on the present record whether the plaintiff’s

medical condition meets or equals the listing because it is within the province of the

Commissioner to determine whether the plaintiff’s impairments rise to the level that render

her disabled.5

The Commissioner contends that the new evidence is not material because “there is

no reasonable possibility that the evidence would change the administrative result.” (Def’s

Br., doc. # 12, at 5). The Commissioner fails to explain the basis for this conclusory

assertion. More disturbing, however, is the Commissioner’s position that the ALJ’s failure

The court notes that because it has concluded that remand is proper to consider new evidence,

5

doubt is necessarily cast on the ALJ’s articulated reasons for discrediting the plaintiff’s testimony as well

as upon the ALJ’s determination that the plaintiff can return to her past relevant work.

10

Case 2:10-cv-00139-CSC Document 14 Filed 08/08/11 Page 10 of 13
to consider Carter’s schizophrenia at step two is simply harmless error because the plaintiff

6

has not demonstrated that the limitations caused by major depressive disorder and chronic

paranoid schizophrenia are different. “The essential feature of Paranoid Type of 7

Schizophrenia is the presence of prominent delusions or auditory hallucinations in the

context of a relative preservation of cognitive functioning and affect.” American Psychiatric

Association: Diagnostic and Statistical Manual of Mental Disorders, 295.30 (4 ed. 1994). th

Diagnostic criteria include delusions, hallucinations, disorganized thought process, and flat

affect. Id. Major Depressive Disorder, on the other hand, is characterized by depressive

episodes, with delusions or auditory hallucinations the contents of which involve guilt,

punishment and berating. Id, p. 412. Schizophrenia is classified as a Psychotic Disorder

while Major Depressive Disorder is classified as a Mood Disorder. Clearly, the conditions

are different and not interchangeable. The Commissioner’s assumption that regardless of

which condition Carter suffers from, Major Depressive Disorder or Paranoid Schizophrenia,

The Commissioner’s position that chronic paranoid schizophrenia is not a severe impairment

6

sufficient to meet step two is simply ridiculous, and warrants no further discussion.

TheCourtreminds theCommissioner that “Social Security proceedings are inquisitorialrather than

7

adversarial. It is the ALJ’s duty to investigate the facts and develop the arguments both for and against

granting benefits.” Sims v. Apfel, 530 U.S. 103, 110-111 (2000). 

The SSA is perhaps the best example of an agency that is not based to a significant extent

on the judicial model of decisionmaking. It has replaced normal adversary procedure with

an investigatory model, where it is the duty of the ALJ to investigate the facts and develop

the arguments both for and against granting benefits; review by the Appeals Council is

similarly broad. Id. The regulations also make the nature of the SSA proceedings quite

clear. They expressly provide that the SSA “conducts the administrative review process in

an informal, nonadversary manner.” 20 C.F.R. § 404.900(b).

Crawford & Co. v. Apfel, 235 F.3d 1298, 1304 (11 Cir. 2000). th

11

Case 2:10-cv-00139-CSC Document 14 Filed 08/08/11 Page 11 of 13
her limitations are the same is speculative and simply erroneous. In addition, it is possible

that Carter suffers from both. Thus, the court concludes that the new evidence is material 

because there is a reasonable possibility that it would change the administrative

determination.

Furthermore, the new medical records reveal chronic mental illness that appear to

directly contradict some of the conclusions of the ALJ. For example, the ALJ found that

Carter’s major depressive disorder was controlled by medication, and that her mental

restrictions were “mild to moderate.” (R. 24). Obviously, paranoid delusions, hallucinations,

disorganized thought process, blunted affect, poor insight and poor judgments are more than

mild to moderate limitations. It is clear from the new medical evidence that Carter’s chronic

paranoid schizophrenia is recurrent, uncontrolled and debilitating. Thus, the court concludes

that the plaintiff has demonstrated that the medical records are material. 

Finally, the plaintiff has shown good cause as to why the new evidence was not

presented to the ALJ. Generally, in order to satisfy the good cause prong a claimant must

prove that the evidence did not exist at the time of the administrative hearing. See Hyde, 823

F.2d at 459; Caulder v. Bowen, 791 F.2d 872, 878 (11 Cir. 1986). As previously noted, the th

medical records were not available until after the administrative hearing. In addition, the

plaintiff attempted to submit the records by facsimile but was unaware that the records were

not received. Thus, the court concludes that good cause exists for not presently the medical

evidence to the ALJ. 

12

Case 2:10-cv-00139-CSC Document 14 Filed 08/08/11 Page 12 of 13
V. Conclusion

For the reasons as stated, the court concludes that the evidence satisfies all three

requisite criteria for remand under sentence six of 42 U.S.C. § 405(g). Accordingly, it is 

ORDERED and ADJUDGED as follows:

1. That the decision of the Commissioner be and is hereby REVERSED and this

case be and is hereby REMANDED to the Commissioner pursuant to sentence six of 42

U.S.C. § 405(g) for further proceedings consistent with this opinion. 

2. That the Clerk ofthe Court shall close this case administrativelypending a final

decision by the Commissioner on remand.

3. That within sixty (60) days of the final decision of the Commissioner of Social

Security following remand, if the decision is adverse to the plaintiff, the Commissioner shall

file with the Clerk of the Court a motion to reopen and an answer, and shall serve on the

plaintiff a copy of the administrative record. 

4. That within sixty (60) days of the final decision of the Commissioner of Social

Security following remand, if the decision is favorable to the plaintiff, the Commissioner

shall file with the Clerk of the Court a motion to reopen and a motion for entry of final

judgment for the plaintiff.

Done this 8 day of August, 2011.

th

 /s/Charles S. Coody 

CHARLES S. COODY

UNITED STATES MAGISTRATE JUDGE

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