Stevens v. Colvin, 1:13-cv-01150

Background

Plaintiff Sarah J. Stevens applied for DIB and SSI alleging disability beginning March 2, 2005; ALJ denied benefits in an August 10, 2009 decision.
Administrative record before the ALJ did not include hospitalizations and serious diagnoses (pulmonary embolism, severe anemia, morbid obesity, and colon cancer) that occurred between the March 6, 2009 hearing and the ALJ’s August 10, 2009 decision.
Plaintiff’s counsel asked the Appeals Council to obtain the mid-2009 hospital records; the Appeals Council did not obtain them and denied review.
Plaintiff subsequently filed a new claim and was approved for benefits with an onset date of June 30, 2010, and later filed this civil action challenging the 2009 denial for the earlier period.
The Magistrate Judge found the ALJ’s original decision was supported by substantial evidence based on the record before the ALJ, but the newly submitted mid-2009 medical records are “new and material” and there is good cause for their absence from the administrative record.
Recommendation: deny Defendant’s summary judgment motion and remand under sentence six of 42 U.S.C. § 405(g) for the Commissioner to consider the new evidence; no opinion on whether plaintiff was disabled before August 10, 2009.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether court may consider medical evidence arising after the hearing but before the ALJ’s decision	Stevens contends mid-2009 hospital and cancer records are new, material, and were not obtained by Appeals Council despite counsel’s request	Commissioner relies on administrative record before ALJ and argues ALJ’s decision was supported by substantial evidence	Court: evidence is new, material, and there is good cause for late submission; remand under sentence six is warranted
Whether ALJ’s 2009 RFC and nondisability finding were supported by substantial evidence	Stevens argues later serious treatment suggests her condition post-hearing would have altered ALJ’s RFC assessment	Commissioner argues pre-opinion record showed limited treatment and medical opinions supporting light work RFC and past-PRW finding	Court: ALJ’s original decision was supported by substantial evidence on the record before him, but new records create reasonable possibility of a different outcome and must be considered on remand
Whether procedural irregularities (attorney/assistant misconduct) affect merits	Stevens alleges counsel/assistant misconduct prevented timely appeal and loss of benefits/payments	Commissioner did not concede counsel misconduct as basis to alter the ALJ outcome; administrative remedies available	Court: misconduct allegations not adjudicated here; they support good cause for failure to submit new evidence to agency but are not a basis for damages in this forum
Proper remedy for newly submitted evidence	Stevens seeks judicial consideration/relief based on new records	Commissioner opposes judicial fact-finding beyond administrative record; remedy is remand if evidence qualifies	Court: remand under sentence six of 42 U.S.C. § 405(g) to allow agency to consider new, material evidence is appropriate

Key Cases Cited

Craig v. Chater, 76 F.3d 585 (4th Cir. 1996) (standard that Commissioner’s decision must be supported by substantial evidence)
Coffman v. Bowen, 829 F.2d 514 (4th Cir. 1987) (judicial review confined to whether ALJ applied proper legal standards and substantial evidence supports decision)
Meyer v. Astrue, 662 F.3d 700 (4th Cir. 2011) (new evidence is material if there is a reasonable possibility it would change the outcome)
Wilkins v. Secretary, Dept. of Health & Human Servs., 953 F.2d 93 (4th Cir. 1991) (defining materiality standard for new evidence)
Jones v. Callahan, 122 F.3d 1148 (8th Cir. 1997) (discussing sentence-six remand when evidence is new, material, and good cause exists for not presenting it earlier)