Ballance v. Social Security Administration Commissioner
3:16-cv-03070
W.D. Ark.Sep 5, 2017Background
- Jackson E. Ballance filed for SSI on December 10, 2012, alleging diabetes, hypertension, seizures, high cholesterol, and degenerative back conditions; hearing held November 12, 2014.
- ALJ found severe impairments: degenerative disc disease, diabetes mellitus, and seizure disorder, but that none met or equaled a listing; assigned an RFC for light work with occasional postural activities, limited overhead reaching, avoidance of hazards, and restriction to simple, routine, repetitive tasks with minimal social contact.
- ALJ relied on a vocational expert to find Ballance could perform work as a machine tender and assembler; ALJ denied benefits in a decision dated February 18, 2015.
- Ballance submitted additional medical evidence (treatment notes, pain management referral, and March 2015 cervical and lumbar MRIs showing severe central canal stenosis at C5–C6 with cord impingement/edema and multi-level lumbar disc disease) to the Appeals Council; the Council denied review but made the new evidence part of the record.
- District court reviewed whether the ALJ’s decision remained supported by substantial evidence when the Appeals Council’s added records are considered and concluded the new MRI findings were material and likely outcome-determinative.
- Court remanded the case under sentence four of 42 U.S.C. § 405(g) for the ALJ to consider the new evidence, reassess RFC, and pose proper hypotheticals to a vocational expert; noted the ALJ’s decision might nonetheless be the same after proper analysis.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether ALJ’s decision is supported by substantial evidence when Appeals Council evidence is included | Ballance argued the new treatment notes and MRIs showing severe cervical stenosis and multilevel disc disease are material and could change the RFC and disability outcome | Commissioner argued denial should stand; Appeals Council considered but declined review and ALJ’s original analysis was supported by the record before him | Court held the additional evidence is new and material; remand required so ALJ can evaluate that evidence, reassess RFC, and update vocational hypotheticals |
| Proper procedure when Appeals Council adds new evidence but denies review | Ballance contended the court must consider the new evidence and determine if substantial evidence supports the ALJ’s decision in light of it | Commissioner relied on finality of ALJ’s decision absent reversal | Court applied precedent requiring consideration of Appeals Council evidence and remanded for proper analysis |
Key Cases Cited
- Ramirez v. Barnhart, 292 F.3d 576 (establishes substantial-evidence review standard)
- Edwards v. Barnhart, 314 F.3d 964 (ALJ decision affirmed if supported by substantial evidence)
- Haley v. Massanari, 258 F.3d 742 (court may not reverse merely because record could support a different outcome)
- Young v. Apfel, 221 F.3d 1065 (if two inconsistent positions possible, ALJ’s may be affirmed)
- Pearsall v. Massanari, 274 F.3d 1211 (claimant bears burden to prove disability lasting at least 12 months)
- McCoy v. Schweiker, 683 F.2d 1138 (age, education, work considered only at final step)
- Riley v. Shalala, 18 F.3d 619 (when Appeals Council considers new evidence, court must factor it into substantial-evidence review)
- Flynn v. Chater, 107 F.3d 617 (reviewing court must speculate how ALJ would have weighed new evidence)
- Groeper v. Sullivan, 932 F.2d 1234 (remand appropriate when proper analysis could change outcome)
- Browning v. Sullivan, 958 F.2d 817 (Appeals Council’s denial of review is nonfinal; court considers ALJ decision as final agency action)