Opinion ID: 768166
Heading Depth: 2
Heading Rank: 3

Heading: Evidence Submitted to the Appeals Council

Text: 19 Bergmann argues that the Commissioner erred in failing to give the appropriate weight to her treating physician's opinion that she would be disabled for the requisite twelve months. It is well-settled that a treating physician's opinion is entitled to substantial weight unless it is unsupported by medically acceptable clinical or diagnostic data. Kirby v. Sullivan, 923 F.2d 1323, 1328 (8th Cir. 1991); see also Jenkins, 196 F.3d at 924-25 (citing Ward v. Heckler, 786 F.2d 844, 846 (8th Cir. 1986)); Ghant, 930 F.2d at 639; McGhee v. Harris, 683 F.2d 256, 259 (8th Cir. 1982). 20 Dr. Burnap was Bergmann's treating physician and the basis of his opinion is not challenged; consequently, his opinion is entitled to great weight. This court, however, is not faced with the simple question of due-weight to be given a treating physician's opinion; rather, this court must consider that question in light of the fact the evidence was submitted subsequent to the ALJ's decision. 21 20 C.F.R. 404.970(b) provides: If new and material evidence is submitted, the Appeals Council shall consider the additional evidence only where it relates to the period on or before the date of the administrative law judge hearing decision. The Appeals Council shall evaluate the entire record including the new and material evidence submitted if it relates to the period on or before the date of the administrative law judge hearing decision. 22 Thus, the Appeals Council must consider evidence submitted with a request for review if it is (a) new, (b) material, and (c) relates to the period on or before the date of the ALJ's decision. Box v. Shalala, 52 F.3d 168, 171 (8th Cir. 1995) (quoting Williams v. Sullivan, 905 F.2d 214, 216-17 (8th Cir. 1990)). Whether evidence meets these criteria is a question of law this court reviews de novo. Id. 23 To be new, evidence must be more than merely cumulative of other evidence in the record. See Williams, 905 F.2d at 216 (concluding that psychiatrist's report was new because it was not merely cumulative but instead presented more specific findings and conclusions). To be material, the evidence must be relevant to claimant's condition for the time period for which benefits were denied. Id. Thus, to qualify as material, the additional evidence must not merely detail after-acquired conditions or post-decision deterioration of a pre-existing condition. See Jones v. Callahan, 122 F.3d 1148, 1154 (8th Cir. 1997) (holding immaterial evidence detailing a single incident occurring after decision and noting proper remedy for post-ALJ deterioration is a new application); Williams, 905 F.2d at 216 (finding that despite failure to identify onset date, doctor's report was material because it provided sufficient basis to conclude it related to the relevant time). 24 Prior to the administrative hearing, Bergmann saw Dr. Burnap on June 4, 1996, January 20, 1997, and February 25, 1997. The evidence from these visits indicates a diagnosis of Bergmann's relatively longstanding depression or dysthymic disorder. Further, the reports note an ongoing deterioration in her condition, and, as early as June 4, 1996, predict that she would not be able to maintain gainful employment over an extended period of time. Subsequent to the administrative hearing, Bergmann again saw Dr. Burnap. The medical reports from these post-hearing visits on August 27, 1997, September 25, 1997, and October 2, 1997, constitute the additional evidence submitted to the Appeals Council. These post-hearing reports continue to discuss the medical condition presented to the ALJ, but provide a more specific and conclusive diagnosis regarding Bergmann's disability and work capacity. 25 Specifically, the August 27, 1997, report notes that Bergmann's major mental illness remains the same, yet it identifies changes in her condition: 26 During the past three weeks she has had no appetite, feels she is losing weight and also sleeps very poorly. . . . 27 During the past seven months she has had no social contact with others and no other personal involvement in any activities outside her mobile home. In the past three weeks she has not been able to do any cooking, housework or any other household activities. She sits in a chair. 28 (emphasis added). This same report notes, [a]t the present time her condition is significantly worse than it was seven months ago and an obvious factor is the death of her ex-husband several weeks ago. (emphasis added). The September 25, 1997, report again indicates no change in the overall diagnosis, but states her mental disorder is gradually getting worse. She has now been off work since April 4, 1997. Finally, the October 2, 1997, report states: 29 I can say with reasonable medical certainty that [Bergmann] will be disabled for 12 months and probably much longer. My opinion is based on the nature of her back disorder and level of depression. I have now been following her illness since June, 1996, and during this time her condition has steadily worsened. Without assistance she will soon be in serious trouble and even with treatment she will probably not be able to maintain any sort of gainful employment for at least 2 years. 30 (emphasis added). 31 This additional evidence outlines the progress of Bergmann's condition from before the time of the ALJ's decision and culminates in Dr. Burnap's October 2, 1997, conclusion that she is disabled and cannot maintain gainful employment. This evidence is both new and material to the claim for disability before the ALJ. The evidence is new because it describes deterioration and provides, for the first time, a conclusive psychiatric determination of disability and inability to work. It is material because, although it involves deterioration, that deterioration occurred over the course of Dr. Burnap's treatment, specifically including the time period before the ALJ. 32 Accordingly, the picture presented to the ALJ is significantly altered by the additional evidence. Now the evidence shows a claimant who had engaged in gainful employment in the recent past, who is currently on unpaid medical leave, and, despite her expressed hope, has been unable to return to work. Furthermore, a treating physician has clearly indicated disability and inability to return to any work for a prolonged period. Thus, the ALJ's conclusion that there was no evidence that the claimant is expected to remain off work for one year is no longer supported by substantial evidence on the record as a whole. 33 In Jenkins, this court's most recent opinion dealing with the question of new evidence, the claimant submitted to the Appeals Council medical reports from a treating physician indicating less residual functional capacity than the ALJ had determined. Jenkins, 196 F.3d at 924. Relying on the weight to be accorded treating physicians, and the fact that the new evidence undermined the ALJ's sole reason for crediting the non-treating doctor's assessment, the court reversed the finding of no disability. Id. at 927. 5 Similarly, the ALJ in the present case emphasized a single reason for his finding - Bergmann's testimonial intent to return to work. Bergmann, however, did not return to work and her treating physician strongly indicates her inability to do so in the foreseeable future; thus, the ALJ's reason for denying a disability finding is no longer supported by substantial evidence. 34 In light of the weight generally owed treating physicians and the fact that Dr. Burnap's psychiatric evaluation is uncontroverted, this court holds that Bergmann is entitled to disability benefits. However, while Dr. Burnap's opinion is clear regarding a finding of disability and inability to engage in gainful employment for the immediate future, the evidence does not reveal a clear onset date. In addition, Dr. Burnap's opinion is now more than two years old, so we do not know whether Bergmann's condition has improved such that she is no longer disabled and thus, entitled to only a closed period of disability benefits. Such factual determinations are within the province of the Commissioner; thus, this court remands to the Commissioner.