Lesterhuis v. Colvin
805 F.3d 83
| 2d Cir. | 2015Background
- Lesterhuis, a 47-year-old former heavy truck driver, stopped full-duty work after a June 2008 back injury and applied for SSDI with an alleged onset July 12, 2008.
- Multiple treating and consultative providers assessed significant lumbar limitations; treating surgeons and examiners recommended heavy restrictions, some finding temporary total disability.
- After an ALJ found Lesterhuis capable of a limited range of sedentary work (identifying jobs existing in the national economy), Lesterhuis appealed to the Appeals Council and submitted a new treating opinion from Dr. Donovan Holder.
- Dr. Holder’s opinion (added by the Appeals Council) limited Lesterhuis to about four hours per day, required sit/stand changes, allowed <10 lb lifting, and stated Lesterhuis would likely miss more than four workdays per month.
- The Appeals Council denied review without explaining the weight given to Dr. Holder’s opinion; the district court affirmed the ALJ. The Second Circuit reviewed the administrative record including Holder’s opinion.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether ALJ decision is supported by substantial evidence when a new treating-physician opinion submitted to Appeals Council is added to the record | Dr. Holder’s opinion, added post-ALJ, contradicts ALJ findings and, if credited, is dispositive (esp. absences >4 days/mo) | ALJ’s original evaluation and other medical opinions support denial; Appeals Council properly denied review | Court held ALJ decision not supported by substantial evidence after adding Dr. Holder’s opinion and remanded |
| Whether the Appeals Council was required to explain rejection or weight of a treating physician’s opinion submitted only to it | Lesterhuis: Appeals Council must give reasons before disregarding a treating physician’s new opinion | Commissioner: Appeals Council denial need not provide a detailed explanation; ALJ decision remains the final agency determination | Court did not decide this independent obligation; remand on substantial-evidence ground made that question unnecessary |
| Whether a treating physician’s opinion on absenteeism is contradicted by substantial evidence | Lesterhuis: No substantial contrary evidence; vocational expert testified >4 absences/month precludes competitive employment | Commissioner: Other treating/examining opinions undermine Holder’s conclusions | Court found no substantial contrary evidence to Holder’s opinion on absences; VE testimony makes that opinion dispositive if credited |
| Whether district court may affirm on grounds not considered by the agency | Lesterhuis: Courts must not affirm administrative action on different grounds | Commissioner: District court’s critiques of Holder justified affirmance | Court reiterated rule against post hoc grounds and vacated judgment, remanding to agency for explanation/consideration |
Key Cases Cited
- Perez v. Chater, 77 F.3d 41 (2d Cir. 1996) (new, material medical evidence submitted to Appeals Council becomes part of the administrative record for judicial review)
- Snell v. Apfel, 177 F.3d 128 (2d Cir. 1999) (ultimate determination of disability is for the Commissioner)
- Richardson v. Perales, 402 U.S. 389 (U.S. 1971) (definition of substantial evidence standard)
- Consol. Edison Co. v. NLRB, 305 U.S. 197 (U.S. 1938) (quoted in defining substantial evidence)
- Burgess v. Astrue, 537 F.3d 117 (2d Cir. 2008) (court may not affirm administrative action on new grounds)
- Melville v. Apfel, 198 F.3d 45 (2d Cir. 1999) (same restriction on post hoc rationales)