Opinion ID: 470409
Heading Depth: 3
Heading Rank: 2

Heading: Caulder's Proffered Evidence Meets the Criteria

Text: 20 Caulder's evidence proffered to the district court consists of records of a hospitalization in July and August, 1984; a letter from Dr. Craddock, a treating physician; and a Physical Capacities Evaluation (PCE). The hospital reports contain the results of a lumbar myelogram and CT scan of the spine which revealed a block at the L4-5 level and diagnosis of spinal stenosis. They indicate that an elective lumbar laminectomy with decompression at L3, 4, and 5, and S1 was performed, and that Caulder was readmitted at one point to mend a cerebrospinal fluid leak. The surgeon, Dr. Craddock, found that the procedure did not eliminate Caulder's pain, weakness, or numbness in the legs. The Secretary argues that the additional medical evidence does not meet any of the three above criteria. We find that it meets all three. 21 First, the Secretary asserts that the additional evidence is cumulative because evidence of the ailment was before the ALJ in the form of Caulder's testimony about his back trouble at the hearing. Although Caulder testified about his back trouble, the nature of the proferred additional medical evidence is such that one could not reasonably say that it is cumulative to lay testimony by a claimant. In Boyd v. Heckler, 704 F.2d 1207 (11th Cir.1983), this court explained that: 22 [t]he ALJ is guided by four considerations in determining whether a claimant is disabled within the meaning of the Social Security Act: (1) objective medical facts or clinical findings; (2) diagnoses of examining physicians; (3) subjective evidence of pain and disability, e.g., the testimony of the claimant and his family; and (4) the claimant's age, education, and work history. 23 704 F.2d at 1210 (citations omitted). New objective medical evidence would be especially important where the ALJ, as in the instant case, stopped the sequential evaluation when he found no severe impairment. At the hearing, the evidence of Caulder's back and leg impairments was inadequate, consisting simply of one doctor's diagnosis contradicted by another without a proper diagnosis by the latter physician despite his recommendation for further testing. The proffered medical evidence containing the results of the lumbar myelogram and laminectomy is the product of the only comprehensive medical evaluation of a possible cause of Caulder's back and leg complaints and thus is not cumulative. 24 Second, the Secretary argues that the evidence is not material in that it will not alter the Secretary's determination. To be material, the evidence must be relevant and probative so that there is a reasonable possibility that it would change the administrative outcome. Wright v. Heckler, 734 F.2d 696 (11th Cir.1984); Chaney v. Schweiker, 659 F.2d 676, 679 (5th Cir.1981). This court has held that when determining whether to remand a case to the Secretary for consideration of new evidence, the mere statement by the Secretary that the new evidence would not ultimately change the decision cannot be accorded any weight since the statement concerning the materiality of the evidence not in the certified administrative record is advisory at best. Cherry v. Heckler, 760 F.2d 1186, 1194 (11th Cir.1985). The other aspects of the Secretary's argument that the evidence is not material are unpersuasive. 25 The evidence is relevant and probative in that it pertains to a condition that Caulder listed in his applications at the administrative level as a source of his disability. The evidence also contains a medical opinion on the presence of the impairment during the time period for which benefits are sought. The fact that Dr. Craddock's treatment and examination of Caulder took place later in the proceedings does not undermine the weight to be given his diagnosis. Boyd v. Heckler, 704 F.2d 1207, 1211 (11th Cir.1983). We agree with the Secretary's assertion that a physician's statement that a claimant is disabled is not dispositive of the issue of disability; the statement, however, must be considered in the Secretary's examination of the totality of the evidence. 26 We reject the Secretary's contention that the proffered evidence of the PCE is not relevant. He contends that because the ALJ determined that Caulder did not have a severe impairment, the sequential evaluation stopped and thus the issue of his residual function capacity was not reached. This begs the question, as the other new evidence may establish that Caulder does have a severe impairment. Consequently, he either would be found to be disabled because he meets one of the listed impairments, or the sequential evaluation would continue, moving next to the determination of residual function capacity and the results of the PCE would be relevant. 27 We find that there is a reasonable possibility that the new evidence would change the administrative outcome because it consists of medical evidence that relates directly to one of Caulder's principal alleged impairments, about which there was inadequate evidence presented to the ALJ. The ALJ noted that Caulder's assertion of possible intermittent claudication of the lower extremities or claudication of the spinal roots was unsubstantiated and that Dr. Rollins recommended further examination; yet the ALJ failed to order further evaluation. The ALJ is charged with the responsibility of ensuring that the record is fully and fairly developed. Todd v. Heckler, 736 F.2d 641 (11th Cir.1984); Cowart v. Schweiker, 662 F.2d 731, 735 (11th Cir.1981). Although the claimant has the burden of proving that he is under a disability, the ALJ must inquire fully into the matters at issue. Ford v. Secretary of Health & Human Services, 659 F.2d 66, 69 (5th Cir. Unit B 1981). 4 An administrative decision is not supported by substantial evidence if the administrative law judge does not have before him sufficient facts on which to make an informed decision. Id. Consultative examinations are not required by statute, but 20 C.F.R. Sec. 404.1517 provides for them where warranted. Although the issue of the ALJ's failure to order further examination in light of Dr. Rollins' report at the time of the hearing is not before us, we find that the proffered evidence diagnosing a possible source of the ailment in Caulder's lower extremities fills a gap as to material facts that resulted from the ALJ's inadequate development of the record. Without this evidence, a proper view of the case is skewed, making it impossible to conclude that a decision is supported by substantial evidence. See Dorsey v. Heckler, 702 F.2d 597, 605 (5th Cir.1983) (quoting Essig v. Secretary of Health & Human Services, 531 F.Supp. 55, 57 (E.D.N.Y.1981)). The evidence could substantiate Caulder's assertion that he has a severe impairment, or that his combination of impairments presents more than a slight abnormality which has such minimal effect on the individual that it would not be expected to interfere with the individual's ability to work, irrespective of age, education, or work experience. Brady v. Heckler, 724 F.2d 914, 920 (11th Cir.1984); 20 C.F.R. Sec. 404.1520(b)-(c). 28 Third, the Secretary concludes, without support, that Caulder has failed to show good cause as to why the evidence was not presented to the Secretary. We disagree and find that Caulder did establish good cause for the failure to submit the evidence at the administrative level because the evidence did not exist at that time. Nonexistence of the evidence at the time of the administrative proceedings may constitute good cause. Cherry v. Heckler, 760 F.2d at 1192; Johnson v. Harris, 612 F.2d 993, 998 (5th Cir.1980). 29 We also are guided by the Fifth Circuit's decision in a factually similar case in which the claimant was hospitalized during the time period in which the ALJ decision was issued and review by the Appeals Council was sought. Dorsey v. Heckler, 702 F.2d 597, 606 (5th Cir.1983). After filing suit in federal court, Dorsey requested a remand in light of the new medical reports concerning her hospitalization. The court granted the request for remand noting that the brief period of time between Dorsey's release from the hospital and the issuance of the Appeals Council's decision limited her opportunity to present the evidence to the Appeals Council and fulfilled the good cause requirement. We agree with this approach, finding it reasonable and consistent with the line of authority in this circuit. 5 30 Caulder's case is not one in which the claimant procrastinated in obtaining copies of evidence readily available. Neither is there any indication in the record that the ALJ ordered Caulder to submit to additional tests. On the facts of this case, we find that Caulder's decision to continue a course of prescribed medication for a short period before submitting to the surgical procedures was reasonable when faced with conflicting medical diagnoses. Caulder was admitted to the hospital on July 9, 1984, and on July 11th, the surgical procedure was performed. On that same date, his memorandum in support of his request for review by the Appeals Council was filed. Caulder was not discharged until the 17th. During the following few months, Caulder was hospitalized for another week-long period and then visited Dr. Craddock several times over a period of several weeks. In the meantime, the Appeals Council had denied his request for review and a civil action had been commenced within the 60 day period following that denial to avoid foreclosure of future proceedings. We conclude that Caulder was limited in his opportunity to present the new evidence to the Appeals Council to an extent that satisfies the good cause requirement. Caulder has met the Cherry criteria and is entitled to a remand of his case to the Secretary. 31