Opinion ID: 3059388
Heading Depth: 2
Heading Rank: 3

Heading: Appeals Council’s Denial of Remand

Text: 6 To the extent Flowers argues that the ALJ must make explicit findings as to each of the pain standard’s three steps, she cites no authority for this proposition. Even assuming arguendo that the ALJ erred in failing to make an explicit finding, any such error was harmless given that the ALJ proceeded to the next step and evaluated the intensity, persistence and limiting effects of Flowers’s pain. See Diorio v. Heckler, 721 F.2d 726, 728 (11th Cir. 1983). 20 After the ALJ’s decision, Flowers submitted additional evidence of her medical condition. Flowers contends the Appeals Council erred by not remanding her case to the ALJ to consider this new evidence. We agree. Generally, a claimant is allowed to present new evidence at each stage of this administrative process. See 20 C.F.R. §§ 404.900(b), 416.1470(b); Ingram v. Comm’r of Soc. Sec. Admin., 496 F.3d 1253, 1261 (11th Cir. 2007). The Appeals Council has the discretion not to review the ALJ’s denial of benefits. 20 C.F.R. §§ 404.970(b), 416.1470(b). However, the Appeals Council must consider “new and material evidence” that “relates to the period on or before the date of the administrative law judge hearing decision” and must review the case if “the administrative law judge’s action, findings, or conclusion is contrary to the weight of the evidence currently of record.” Id.7 The new evidence is material, and thus warrants a remand, if “there is a reasonable possibility that the new evidence would change the administrative outcome.” Hyde v. Bowen, 823 F.2d 456, 459 (11th Cir. 1987). 7 The parties do not dispute that the new evidence related to the period on or before the ALJ’s decision. Furthermore, the Appeals Council appears to have concluded that the new evidence related to the relevant period. See 20 C.F.R. §§ 404.970(b), 416.1470(b) (requiring the Appeals Council to consider new evidence “only where it relates to the period on or before the date of the administrative law judge hearing decision”). 21 When a claimant properly presents new evidence, and the Appeals Council denies review, the Appeals Council must show in its written denial that it has adequately evaluated the new evidence. Epps v. Harris, 624 F.2d 1267, 1273 (5th Cir. 1980).8 If the Appeals Council merely “perfunctorily adhere[s]” to the ALJ’s decision, the Commissioner’s findings are not supported by substantial evidence and we must remand “for a determination of [the claimant’s] disability eligibility reached on the total record.” Id.9 We conclude that the Appeals Council did not adequately consider Flowers’s new evidence. Indeed, apart from acknowledging that Flowers had submitted new evidence, the Appeals Council made no further mention of it or 8 Decisions of the former Fifth Circuit on or before September 30, 1981 are binding precedent in the Eleventh Circuit. Bonner v. City of Prichard, 661 F.2d 1206, 1209 (11th Cir. 1981) (en banc). 9 Flowers requests a “sentence four” remand under 42 U.S.C. § 405(g) because she submitted her new evidence to the Appeals Council and now argues that the Appeals Council did not adequately consider it in denying her request for review. See Ingram, 496 F.3d at 1268 (explaining that a sentence four, as opposed to sentence six, remand is appropriate when the evidence was properly before the Appeals Council, but “the Appeals Council did not adequately consider the additional evidence” (quotation marks omitted)). Notably, unlike with sentence six remands, the Appeals Council’s review power does not include a requirement that the claimant show good cause. See id. at 1262-69 (concluding the district court erred in refusing to consider new evidence that was submitted to the Appeals Council because the claimant had not shown good cause); 42 U.S.C. § 405(g) (imposing a “good cause” requirement in sentence six, but not sentence four); 20 C.F.R. §§ 404.970, 416.1470 (requiring the Appeals Council to evaluate new and material evidence related to the relevant period without imposing a good cause requirement). 22 attempt to evaluate it. Furthermore, there is a reasonable possibility that Flowers’s new evidence would change the ALJ’s decision. The ALJ based its finding that Flowers could do light work on the opinion of Dr. Caldwell, a non-examining physician. The ALJ took the unusual step of relying on a non-examining physician’s opinion and discounting entirely the opinions of treating and examining physicians because the treating and examining physicians’ clinical findings obtained during examinations of Flowers, such as grip strength or range of motion, were either normal or only mildly affected. The ALJ also partially discredited Flowers’s subjective complaints primarily for the same reason. Nonetheless, the Appeals Council adopted the ALJ’s decision without addressing the post-hearing evidence submitted by Dr. Lawrence-Elliott, a treating physician. In particular, the evidence from Dr. Lawrence-Elliott contained an RFC assessment that was supported by significant clinical findings from three examinations performed by Dr. Lawrence-Elliott over a ten-month period between June 2008 and April 2009. Specifically, Dr. Lawrence-Elliott’s April 8, 2009 RFC assessment indicated that, in an eight-hour work day, Flowers: (1) could only occasionally lift ten pounds and frequently lift less than ten pounds, (2) could walk less than one hour 23 and sit less than two hours; (3) would need to change position every fifteen minutes; and (4) would need to lie down at unpredictable times. As a basis for her opinion, Dr. Lawrence-Elliott noted the active tenosynovitis in Flowers’s hands, wrists, feet and ankles, her decreased range of motion and her grip strength of 2+/5 bilaterally–i.e., her findings from her examination of Flowers performed that same day. Dr. Lawrence-Elliott opined that Flowers could twist, bend and climb stairs only occasionally; could never crouch or climb ladders; and was limited in her ability to reach, handle, finger, feel or push/pull. As support for these restrictions, Dr. Lawrence-Elliott again noted Flowers’s limited range of motion and also her pain and weakness. Dr. Lawrence-Elliott completed the RFC assessment on the same day she examined Flowers. Dr. Lawrence-Elliott’s treatment notes from this April 8, 2009 examination indicate that Dr. Lawrence-Elliott observed: (1) “[l]imitation of motion in lateral rotation and flexion” in the cervical spine; (2) “evidence of bilateral synovitis” in joints in Flowers’s fingers and wrists “with mild ulnar deviation”; (3) “[d]ecreased range of motion at hands with grip strength of 2+/5 bilaterally”; (4) “[m]arked tenosynovitis” in Flowers’s ankles; (5) tenderness in Flowers’s hip joints and knees; and (6) “[s]ynovial changes” in the joints in her feet. Dr. Lawrence-Elliott indicated that recent lab tests had produced high results 24 for C Reactive Protein and SGOT and SGPT (liver function tests) and that Flowers had tested positive for Hepatitis B. Dr. Lawrence-Elliott administered a corticosteriod injection to Flowers’s right hip, prescribed a fourteen-day taper of Prednisone (in addition to prescriptions for Naprosyn, Methrexate and Lortab), recommended daily bed rest of 45 to 60 minutes and range of motion exercises and ordered, inter alia, additional lab tests and X-rays of Flowers’s hands, wrists, feet and ankles.10 In other words, unlike the earlier, discounted RFC assessments, Dr. Lawrence-Elliott’s RFC assessment (dated April 8, 2009) is supported by her clinical findings from the June 2008, October 2008 and April 2009 examinations. As a treating physician, Dr. Lawrence-Elliott’s opinion must be given substantial weight absent good cause. See Lewis, 125 F.3d at 1440; 20 C.F.R. §§ 404.1527(d)(1)-(2), 416.927(d)(1)-(2). Moreover, as a non-examining physician, to the extent Dr. Caldwell’s opinion contradicted Dr. Lawrence-Elliott’s 10 Dr. Lawrence-Elliott made similar clinical findings during a June 5, 2008 exam, including: (1) grip strength of 3/5 bilaterally, (2) evidence of synovitis in Flowers’s finger joints and wrists (but normal range of motion) with mild ulnar deviation; (3) tenderness with palpation in the shoulder, elbow and wrist; (4) tenderness and decreased range of motion in the hip; (5) tenderness in the knee with hypertrophic changes; and (6) tenderness to palpation and soft tissue swelling and synovitis in the knees. During an October 9, 2008 exam, Dr. Lawrence-Elliott noted: (1) synovitis in Flowers’s finger joints and wrists with mild ulnar deviation; (2) tenderness in her hip with decreased range of motion; (3) tenderness in her knee with varus and hypertrophic changes; (4) tenderness to palpation and soft tissue swelling and tenosynovitis in her ankles. 25 opinion, Dr. Caldwell’s opinion must be accorded little weight. See Edwards, 937 F.2d at 585. In addition to Dr. Lawrence-Elliott’s records, Flowers also submitted other medical records indicating that, beginning on May 4, 2009, Flowers received home health care from Tugaloo Home Health. Dr. Lawrence-Elliott ordered the home health care to “improve independence and ease with” Flowers’s activities of daily living. According to a medical report prepared by Anna Sewell, RN, Flowers previously had been able to dress herself with assistance, bathe herself with intermittent supervision and help getting in and out of the tub, get to the toilet, walk with assistance or supervision, and feed herself with supervision or meal setup. However, as of May 4, 2009, Flowers was entirely dependent upon someone else to dress, needed assistance to bathe and eat, used a bedside commode because she could not get to the toilet and could not ambulate or wheel herself. Home health care lasted until June 30, 2009, during which time an occupational therapist provided self care, functional mobility and energy conservation training and therapeutic exercise. By the time Flowers was discharged, she could walk up to 40 or 50 feet with a cane or walker, dress herself 26 if the clothes were laid out and bathe and get to the toilet with assistance. Tugaloo discharged Flowers to the care of her husband. These records, as well as Dr. Lawrence-Elliott’s treatment notes and RFC assessment, provide support for the testimony of Flowers and her friend, Stevens, about the extent to which Flowers’s pain and other symptoms limited her daily activities. As such, there is a reasonable possibility that the ALJ would have more fully credited their testimony if he had seen this new evidence. Given the materiality of Flowers’s new evidence to the ALJ’s RFC finding, the Appeals Council’s failure to evaluate it, alone, requires us to remand this case to the Appeals Council for a disability determination based “on the total record.” See Epps, 624 F.2d at 1273. For the reasons stated above, we affirm the ALJ’s original decision to discount the opinions of Flowers’s treating and examining physicians as of May 2008 and to only partially credit Flowers’s subjective complaints. However, we reverse the Appeals Council’s decision not to remand the case to the ALJ based on Flowers’s new, post-hearing evidence, especially the April 2009 opinion of Dr. Lawrence-Elliott. Accordingly, we remand the case to the district court with instructions that it be returned to the Commissioner for consideration of the posthearing evidence in conjunction with all the other evidence in the record. 27 AFFIRMED IN PART, REVERSED IN PART and REMANDED. 28