Source: http://al.findacase.com/research/wfrmDocViewer.aspx/xq/fac.20180320_0000272.NAL.htm/qx
Timestamp: 2019-04-26 00:46:07+00:00

Document:
NANCY A. BERRYHILL, ACTING COMMISSIONER OF SOCIAL SECURITY, RESPONDENT.
On March 18, 2013, the claimant, Sonya Delores Horton, protectively applied for supplemental social security income and disability insurance benefits under Titles II and XVII of the Social Security Actbecause of degenerative disc disease of the cervical spine, history of cervical spine fracture with fixation, degenerative disc disease of the lumbar spine, leg pain, and HIV. The Commissioner denied the claims initially on September 11, 2013 because of lack of evidence. The claimant timely requested a hearing before an Administrative Law Judge, who held a hearing on April 14, 2015. (R. 44-69, 99-103, 108-09).
In a decision dated May 14, 2015, the ALJ found the claimant not disabled under Title II or XVII. The claimant filed a timely request for a hearing before the Appeals Council on May 20, 2015. The Appeals Council denied the claimant's appeal because the new evidence “was about a later time” and did not “affect the [ALJ's decision] that the claimant was not disabled on or before the ALJ's decision.” Thus, the ALJ's decision became the final decision of the Commissioner on May 14, 2015. (R. 1-7, 26-43).
The claimant has exhausted her administrative remedies, and this court has jurisdiction pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3). For the reasons stated below, this court REVERSES AND REMANDS the decision of the Commissioner because the Appeals Council failed to adequately evaluate new, chronologically relevant, and material evidence.
The issue before the court is whether the Appeals Council erred by failing to adequately evaluate the new, chronologically relevant, and material evidence that the claimant submitted to it dated after the ALJ's decision.
The standard for reviewing the Commissioner's decision is limited. This court must affirm the Commissioner's decision if the ALJ applied the correct legal standards and if substantial evidence supports his factual conclusions. See 42 U.S.C. § 405(g); Graham v. Apfel, 129 F.3d 1420, 1422 (11th Cir. 1997); Walker v. Bowen, 826 F.2d 996, 999 (11th Cir. 1987).
“No . . . presumption of validity attaches to the [Commissioner's] legal claims.” Walker, 826 F.2d at 999. This court does not review the Commissioner's factual determinations de novo. The court will affirm those factual determinations that are supported by substantial evidence. “Substantial evidence” is “more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 401 (1971).
The court must keep in mind that opinions such as whether a claimant is disabled, the nature and extent of a claimant's residual functional capacity (RFC), and the application of vocational factors “are not medical opinions, . . . but are, instead, opinions on issues reserved to the Commissioner because they are administrative findings that are dispositive of a case; i.e., that would direct the determination or decision of disability.” 20 C.F.R. §§ 404.1527(d), 416.927(d). Whether the claimant meets a Listing and is entitled to Social Security disability benefits is a question reserved for the ALJ, and the court “may not decide facts anew, reweigh the evidence, or substitute [its] judgment for that of the Commissioner.” Dyer v. Barnhart, 395 F.3d 1206, 1210 (11th Cir. 2005). Thus, even if the court were to disagree with the ALJ about the significance of certain facts, the court has no power to reverse that finding as long as substantial evidence in the record supports it.
The court must “scrutinize the record in its entirety to determine the reasonableness of the [Commissioner]'s factual findings.” Walker, 826 F.2d at 999. A reviewing court must not look only to those parts of the record that support the decision of the ALJ, but also must view the record in its entirety and take account of evidence that detracts from the evidence relied on by the ALJ. Hillsman v. Bowen, 804 F.2d 1179, 1180 (11th Cir. 1986).
The issue in this case involves evidence submitted by the claimant to the Appeals Council dated after the ALJ's decision. Generally, a claimant may present new evidence at each stage of the administrative process. Washington v. Comm'r of Soc. Sec. Admin., 806 F.3d 1317, 1320 (11th Cir. 2015). The Appeals Council has the discretion to not review the ALJ's denial of benefits. See 20 C.F.R. § 416.1470(b). But, in making its decision whether to review the ALJ's decision, the Appeals Council “must consider new, material, and chronologically relevant evidence” that the claimant submits. Hargress v. Soc. Sec. Admin., 874 F.3d 1284, 1290-91 (11th Cir. 2017); Washington, 806 F.3d at 1320.
Evidence is material if a reasonable possibility exists that it would change the administrative result. Washington, 806 F.3d at 1321. Evidence is chronologically relevant if “it relates to the period on or before the date of the [ALJ] hearing decision.” Hargress, 874 F.3d at 1291. Medical opinions based on treatment occurring after the date of the ALJ's decision may still be chronologically relevant if the records relate to the period on or before the date of the ALJ's decision. Washington, 806 F.3d at 1323. The claimant can show that a medical opinion dated after the ALJ's decision is chronologically relevant if it is based on a “review of the claimant's medical history and [her] report of symptoms during the relevant time period and there was no evidence of a decline in [her] condition since the ALJ's decision.” Ashley v. Comm'r of Soc. Sec. Admin., 707 F. App'x 939, 944 (11th Cir. 2017) (citing Washington, 806 F.3d at 1322-23); see also Hargress, 874 F.3d at 1291 (discussing Washington, 806 F.3d at 1319, 1322-23).
This court has the authority to remand a case based on such new, material, and chronologically relevant evidence pursuant to 42 U.S.C. §405(g) under a sentence four remand or reversal. See 20 C.F.R. §§ 404.940, 404.946. “To obtain a sentence four remand, the claimant must show that, in light of the new evidence submitted to the Appeals Council, the ALJ's decision to deny benefits is not supported by substantial evidence in the record as a whole.” Hearn v. Soc. Sec. Admin., 619 F. App'x 892, 894 (11th Cir. 2015) (citing Ingram v. Comm'r Soc. Sec. Admin., 496 F.3d 1253, 1266-67 (11th Cir. 2007)). When the evidence submitted to the Appeals Council “undermine[s] the substantial evidence supporting the ALJ's decision, ” the Appeals Council errs in failing to review the ALJ's decision. Mitchell v. Comm'r, Soc. Sec. Admin., 771 F.3d 780, 785 (11th Cir. 2014). “The Appeals Council must grant the petition for review if the ALJ's ‘action, findings, or conclusion is contrary to the weight of the evidence, ' including the new evidence.” Hargress, 874 F.3d at 1291 (citing Ingram, 496 F.3d at 1261.
The claimant was twenty-eight years of age at the time of the ALJ's final decision; has an eleventh-grade education; has past substantial gainful experience as fast food worker, a poultry grader and re-hanger, and a housekeeper in healthcare; and alleges disability based on degenerative disc disease of the cervical spine, history of cervical spine fracture with fixation, degenerative disc disease of the lumbar spine, leg pain, and HIV. (R. 63, 69, 554).
On July 26, 2006, the claimant fractured her C6 disc in her spine in an automobile accident. An MRI dated July 30 revealed that the claimant had an inferior cervical spine injury including C6-C7 subluxation; a tear on the C6-C7 interspinous ligament; suggestion of facet joint changes; and minimal to mild spinal cord compression predominately toward the left of her C6-C7 disc. On July 31, Dr. Terry M. Andrade, a surgeon at Gadsden Regional Medical Center, performed surgery to reduce pressure on and fix the discs in her neck. Doctors discharged the claimant on August 4, 2006 with instructions for her to wear a hard collar neck brace at all times and a prescription for Norco 10 for pain and Soma as a muscle relaxer. (R. 364-65, 409, 425, 430-33, 440, 467).
From August 8, 2006, until January 16, 2007, Dr. Andrade treated the claimant nine times for neck discomfort and follow-ups from her accident and spine surgery. During several visits, Dr. Andrade counseled the claimant on the importance of not loosening her cervical collar. On September 12, 2006, Dr. Andrade reported that the claimant had “pulled her previous instrumentation apart by not wearing her cervical collar as instructed.” Consequently, on September 18, Dr. Andrade performed an open reduction surgery with internal fixation of the claimant's C6-C7 disc; anterior cervical decompression with discectomies, neural foramintomies, and fusion; and a Bremer halo brace placement on the claimant's neck. (R. 453). (R. 521-523, 527-538, 541-552).
After the claimant's surgery, between September 2006 and January 2007, she complained of constant neck pain, and Dr. Andrade treated her with several medications at different times, including Lorcet Plus, Oxycodone, Darvocet, and Butalbital Acetaminophen. By late October, Dr. Andrade reported that the claimant could return to regular work duty in six weeks at the latest on December 13, 2006. In follow-up appointments on October 31, and November 2, 2006, Dr. Andrade instructed the claimant that if she tried to remove the halo neck brace again she would have to find another doctor. (R. 521-43).
On January 25, 2007, Dr. Andrade treated the claimant because she improperly wore her neck brace, and noted the claimant's collar brace was “extremely loose and cut her where it was totally ineffective.” By February 13, 2007, the claimant's pain in her neck had improved some and her condition was stable. (R. 458, 518-20).

References: § 405
 v. 
 v. 
 v. 
 v. 
 v. 
 v. 
 § 416
 v. 
 v. 
 §405
 v. 
 v. 
 v.