Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca10-15-01283/USCOURTS-ca10-15-01283-0/pdf.json

Parties Involved:
Nancy A. Berryhill
Appellant
Carolyn W. Colvin
Appellant
Marla Vallejo
Appellee

Document Text:

PUBLISH 

UNITED STATES COURT OF APPEALS 

FOR THE TENTH CIRCUIT 

_________________________________ 

MARLA VALLEJO, 

 Plaintiff - Appellee, 

v. 

NANCY A. BERRYHILL

, Acting 

Commissioner of Social Security, 

 Defendant - Appellant. 

No. 15-1283 

_________________________________ 

Appeal from the United States District Court 

for the District of Colorado 

(D.C. No. 1:13-CV-01196-MSK)

_________________________________ 

Submitted on the briefs:**

Benjamin C. Mizer, Principal Deputy Assistant Attorney General, John F. Walsh, United 

States Attorney, Alisa B. Klein, Appellate Attorney, Civil Division, and Gerard Sinzdak, 

Appellate Attorney, Civil Division, U.S. Department of Justice, Washington, D.C., for 

Defendant-Appellant. 

Michael W. Seckar, Michael W. Seckar, P.C., Pueblo, Colorado, for Plaintiff-Appellee. 

_________________________________ 

Before MATHESON, BACHARACH, and MORITZ, Circuit Judges. 

 

 Nancy A. Berryhill became the Acting Commissioner of the United States 

Social Security Administration on January 20, 2017, and is substituted for Carolyn 

W. Colvin as the Defendant-Appellant in this case. See Fed. R. App. P. 43(c)(2). ** After examining the briefs and appellate record, this panel has determined 

unanimously that oral argument wouldn’t materially assist in the determination of 

this appeal. See Fed. R. App. P. 34(a)(2); 10th Cir. R. 34.1(G). The case is therefore 

ordered submitted without oral argument. 

FILED 

United States Court of Appeals

Tenth Circuit 

February 28, 2017

Elisabeth A. Shumaker 

Clerk of Court

Appellate Case: 15-1283 Document: 01019771638 Date Filed: 02/28/2017 Page: 1 
2 

_________________________________ 

MORITZ, Circuit Judge. 

_________________________________ 

The Acting Commissioner appeals the district court’s order reversing her 

decision to deny Marla Vallejo’s application for supplemental security income 

benefits and remanding the case for further administrative proceedings. Because the 

district court’s order rests on a misapplication of controlling law, we reverse and 

remand to the district court for further proceedings. 

BACKGROUND

Vallejo applied for supplemental security income benefits in April 2010, 

alleging she had been disabled since November 2009. After the agency 

administratively denied her claim, she received a hearing with an administrative law 

judge (ALJ). The ALJ evaluated Vallejo’s testimony and the medical opinions of a 

consulting physician, a state-agency physician, an examining psychologist, and a 

state-agency psychologist. Although the record contained no medical opinions from 

treating physicians, Vallejo informed the ALJ at the hearing that her treating 

physician, Dr. Jerald Ratner, was preparing a mental health opinion. The ALJ agreed 

to consider the opinion if she received it before issuing her decision. One week later, 

the ALJ issued a decision adverse to Vallejo. 

The next day, Ratner completed his opinion, titled “Residual Functional 

Capacity Evaluation (Mental).” App. 206. Ratner opined that Vallejo had bipolar 

disorder, and he rated her level of impairment as “extreme” in 13 of 20 functional 

Appellate Case: 15-1283 Document: 01019771638 Date Filed: 02/28/2017 Page: 2 
3 

areas. Id. at 206-07. He further advised that Vallejo wouldn’t be able to “work at any 

job 8 hours per day, 5 days per week,” because her impairment would cause her to be 

“off task” one hundred percent of the time. Id. at 208. 

Vallejo requested that the Appeals Council review the ALJ’s decision and 

submitted Ratner’s opinion with her request. The Appeals Council denied review, 

stating that it “considered” Ratner’s opinion, along with other additional evidence, 

but found that evidence didn’t “provide a basis for changing the [ALJ’s] decision.” 

Id. at 51-52. The Appeals Council’s denial of Vallejo’s request for review rendered 

the ALJ’s decision the Commissioner’s final decision. See 20 C.F.R. § 416.1481. 

Vallejo then sought judicial review of the Commissioner’s final decision. 

Ruling from the bench, the district court found one of Vallejo’s five arguments 

dispositive: that the Appeals Council erred “in not properly articulating its 

assessment” of Ratner’s opinion in denying Vallejo’s request for review. App. 215. 

Based on Ratner’s status as a treating physician, the court reasoned that the Appeals 

Council was required to “follow the same rules” as the ALJ by evaluating Ratner’s 

opinion and either assigning it controlling weight or articulating reasons for assigning 

it a lesser weight. Id. at 217. See 20 C.F.R. § 416.927(c) (requiring agency factfinder 

to evaluate all medical opinions and give controlling weight to opinions from treating 

sources or explain why lesser weight is given). 

Because neither the ALJ nor the Appeals Council expressly evaluated Ratner’s 

opinion, the district court reversed the Commissioner’s decision and remanded for 

Appellate Case: 15-1283 Document: 01019771638 Date Filed: 02/28/2017 Page: 3 
4 

the Appeals Council to either (1) determine what weight, if any, to give Ratner’s 

opinion or (2) remand to an ALJ with directions to make that determination. 

DISCUSSION

I 

Preliminarily, we must consider whether we have jurisdiction to consider the 

Commissioner’s appeal. Because the district court remanded the case for further 

administrative proceedings, we directed the Commissioner to clarify whether the 

remand was a sentence-four remand or sentence-six remand. See Pettyjohn v. 

Shalala, 23 F.3d 1572, 1573-74 (10th Cir. 1994) (noting that district court may 

remand case to Commissioner under either sentence four or sentence six of 42 U.S.C. 

§ 405(g), and explaining that “whether a final judgment has been entered depends on 

what kind of remand is made”). 

Under sentence four, “[t]he court may remand the case after passing on its 

merits and issuing a judgment affirming, reversing, or modifying the 

[Commissioner’s] decision.” Nguyen v. Shalala, 43 F.3d 1400, 1403 (10th Cir. 1994). 

Sentence six authorizes remand only when (1) the Commissioner requests a remand 

for good cause before filing an answer, or (2) “new and material evidence comes to 

light, and there is good cause for failing to incorporate such evidence in the earlier 

[administrative] proceeding.” Id. 

Sentence-four remands are final and appealable because the court rules on the 

merits of the Commissioner’s decision and issues a final judgment before remanding 

the case. Sullivan v. Finkelstein, 496 U.S. 617, 629 (1990). Sentence-six remands are 

Appellate Case: 15-1283 Document: 01019771638 Date Filed: 02/28/2017 Page: 4 
5 

interlocutory and non-appealable because the district court retains jurisdiction and 

remands solely for consideration of new evidence that wasn’t before the 

Commissioner, and the parties must then return to court to obtain a final judgment. 

Melkonyan v. Sullivan, 501 U.S. 89, 102 (1991). 

For two reasons, we agree with the Commissioner that the district court 

ordered a sentence-four remand here. First, this case presents neither of the 

circumstances required for a sentence-six remand: the Commissioner didn’t request 

the remand, and Vallejo presented no evidence to the district court that wasn’t before 

the Commissioner. True, the Appeals Council didn’t expressly evaluate Ratner’s 

opinion. But it did incorporate the opinion into the agency record.1

 

Second, the remand in this case bears the hallmarks of a sentence-four remand: 

the court reversed the Commissioner’s final decision, immediately entered judgment 

against the Commissioner, and later granted attorney’s fees to Vallejo. See Shalala v. 

Schaefer, 509 U.S. 292, 297 (1993) (noting that “[i]mmediate entry of judgment . . . 

is in fact the principal feature that distinguishes a sentence-four remand from a 

sentence-six remand”). Because the district court issued a sentence-four remand, we 

exercise jurisdiction and proceed to the merits. 

 1

 When a claimant submits new evidence to the Appeals Council and the 

Council accepts that evidence, it becomes part of the administrative record for the 

district court to consider in performing its substantial-evidence review. O’Dell v. 

Shalala, 44 F.3d 855, 858-59 (10th Cir. 1994). 

Appellate Case: 15-1283 Document: 01019771638 Date Filed: 02/28/2017 Page: 5 
6 

II 

We review a district court’s ruling reversing the Commissioner’s final decision 

de novo, applying the same standards as the district court. Thus, we ask whether the 

Commissioner applied the correct legal standards and whether her factual findings 

are supported by substantial evidence. Nguyen, 43 F.3d at 1402. 

Here, the district court reversed the Commissioner’s decision based solely on 

the court’s determination that the Appeals Council failed to apply the correct legal 

standards. Specifically, the district court concluded that the Appeals Council erred in 

denying Vallejo’s request for review without first expressly evaluating Ratner’s 

medical opinion. 

The Commissioner disagrees. According to the Commissioner, the district 

court’s decision to remand this case based on the Appeals Council’s failure to explain 

its assessment of Ratner’s opinion conflicts with our decision in Martinez v. 

Barnhart, 444 F.3d 1201 (10th Cir. 2006), and rests on a misunderstanding of the 

relevant regulations. 

In Martinez, as here, the Appeals Council denied review of an ALJ’s 

determination that the claimant wasn’t entitled to benefits. After the district court 

affirmed the ALJ’s decision, the claimant appealed. The claimant argued, in part, that 

the Appeals Council erred in “fail[ing] to articulate an analysis showing the opinions 

of [the claimant’s] treating physician, Dr. Olivares, were not supported by his 

treatment records.” Id. at 1204. In rejecting that argument, we recognized that “an 

express analysis of the Appeals Council’s determination would [be] helpful for 

Appellate Case: 15-1283 Document: 01019771638 Date Filed: 02/28/2017 Page: 6 
7 

purposes of judicial review.” Id. at 1207-08. But we concluded that “nothing in the 

statutes or regulations . . . require[s] such an analysis where new evidence is 

submitted and the Appeals Council denies review.” Id. at 1208. Rather, the Appeals 

Council is required only to “consider” the new evidence—and a conclusory statement 

that it has done so is sufficient. Id. at 1207. 

Vallejo acknowledges Martinez’ holding but urges us to apply an exception to 

Martinez when, as here, (1) a claimant submits a treating-physician’s opinion to the 

Appeals Council that (2) wasn’t provided to the ALJ, that (3) undermines the ALJ’s 

decision, and that (4) is the only treating-physician’s opinion in the administrative 

record. Vallejo also suggests than an exception to Martinez would resolve the 

“tension,” Aplee. Br. 17, between two principles of social security law: (1) an agency 

fact-finder must “give good reasons” for its allocation of weight to the opinion of a 

treating physician, 20 C.F.R. § 416.927(c)(2);2

 yet (2) when a claimant submits new 

evidence to the Appeals Council for review, and the Council denies the request for 

review, it’s not required to “specifically discuss the effect of [the evidence] . . . in 

light of the record as a whole,” Martinez, 444 F.3d at 1207. 

While these two principles may well be in tension, that tension doesn’t permit 

us to ignore the relevant regulations governing administrative review, which appear 

to specifically anticipate the outcome in this case. 

 2

 Our cases have clarified this “good reasons” requirement: The explanation 

“must be sufficiently specific to make clear to any subsequent reviewers the weight 

the adjudicator gave to the treating source’s medical opinion and the reasons for that 

weight.” Watkins v. Barnhart, 350 F.3d 1297, 1300 (10th Cir. 2003) (quoting Social 

Security Ruling 96-2p, 1996 WL 374188 (July 2, 1996), at *5). 

Appellate Case: 15-1283 Document: 01019771638 Date Filed: 02/28/2017 Page: 7 
8 

Most notably, the regulation Vallejo relies upon, by its very terms, doesn’t 

apply to the Appeals Council when it denies review. Instead, it requires the agency 

fact-finder—ordinarily the ALJ—to thoroughly evaluate treating-physician opinions 

and “give good reasons” for the weight given to each when issuing a “notice of 

determination or decision.” § 416.927(c)(2). But it does not require the Appeals 

Council to do so when denying review of the ALJ’s decision. Instead, it requires the 

Appeals Council to evaluate treating-physician opinions in the same manner as the 

ALJ only when the Appeals Council grants review and “makes a decision.” 

§ 416.927(e)(3) (“When the Appeals Council makes a decision, it will follow the 

same rules for considering opinion evidence as administrative law judges follow.”); 

see also § 416.1481 (“The Appeals Council may deny a party’s request for review or

it may decide to review a case and make a decision.”) (emphases added). Here, the 

Appeals Council did not “make[] a decision.” § 416.927(e)(3). Instead, it simply 

denied review. Thus, it was not required to follow the same rules for considering 

opinion evidence as the ALJ followed, and the district court erred in concluding 

otherwise and in reversing and remanding on that basis.3

 3

 In support for her argument to the contrary, Vallejo relies on Harper v. 

Astrue, 428 F. App’x 823 (10th Cir. 2011) (unpublished). In Harper, we remanded 

for further proceedings based, in part, on what we characterized as the Appeals 

Council’s failure to “properly evaluate the opinion of [the claimant’s] treating 

physician.” 428 F. App’x at 826. But in addition to Harper’s unpublished and nonprecedential status, we decline to rely on it here for two reasons: (1) Harper doesn’t 

cite Martinez, let alone attempt to square its decision with our holding in that case; 

and (2) Harper doesn’t address the Appeals Council’s limited requirement to 

“consider” new evidence under § 416.1470. 

Appellate Case: 15-1283 Document: 01019771638 Date Filed: 02/28/2017 Page: 8 
9 

Finally, we reject Vallejo’s alternative argument that the district court’s 

“ultimate decision to remand the case to the Commissioner was the appropriate 

remedy” even if the district court erred in concluding that the Appeals Council had a 

duty to explain its assessment of Ratner’s opinion. Aplee. Br. 22. Vallejo argues the 

district court “determined that a remand for a fact-finder’s weighing of the new 

evidence was necessary” because without the fact-finder’s evaluation of Ratner’s 

opinion, the court simply couldn’t determine whether substantial evidence supports 

the Commissioner’s decision. Id. at 23. 

But Martinez also precludes this argument. We recognized in Martinez that an 

express analysis from the Appeals Council would be helpful to judicial review. 444 

F.3d at 1207-08. But, as we said there—and reiterate here—“nothing in the statutes 

or regulations” requires the Appeals Council to provide that analysis. Id. at 1208. 

Remanding the case to the Appeals Council for further fact-finding when the Appeals 

Council did all it was required to do under the regulations wasn’t an option for the 

district court. The district court’s only option was to conduct a substantial-evidence 

review by assessing the entire agency record, including Ratner’s never-before 

assessed opinion. See O’Dell, 44 F.3d at 858-59 (noting that when claimant submits 

new evidence to Appeals Council and Appeals Council accepts it, that evidence 

becomes part of the record to be considered by court in performing substantialevidence review). 

Appellate Case: 15-1283 Document: 01019771638 Date Filed: 02/28/2017 Page: 9 
10 

Consequently, we reverse the district court’s order reversing the 

Commissioner’s final decision and remanding to the Appeals Council for an express 

evaluation of Ratner’s opinion. We remand to the district court with directions to 

address Vallejo’s remaining arguments and determine if the Commissioner applied 

the correct legal standards and if substantial evidence in the administrative record—

which now includes Ratner’s opinion—supports the Commissioner’s final decision. 

Appellate Case: 15-1283 Document: 01019771638 Date Filed: 02/28/2017 Page: 10