Vallejo v. Berryhill
849 F.3d 951
| 10th Cir. | 2017Background
- Vallejo applied for SSI in April 2010 alleging disability from November 2009; ALJ denied benefits after a hearing.
- At the hearing Vallejo said her treating physician, Dr. Jerald Ratner, was preparing a mental RFC opinion; the ALJ asked to consider it if received before decision, but issued the decision one week before Ratner completed the form.
- Ratner’s post-decision RFC rated Vallejo as having bipolar disorder and "extreme" impairment in many functional areas, concluding she would be off-task 100% of the time and could not work full time.
- Vallejo submitted Ratner’s opinion to the Appeals Council with a request for review; the Appeals Council denied review and stated it had considered the opinion but that it did not provide a basis for changing the ALJ’s decision.
- The district court reversed, holding the Appeals Council had to apply the same treating-source rules as an ALJ and either give Ratner controlling weight or explain why not; it remanded for evaluation.
- The Tenth Circuit reversed the district court: it held the remand was a sentence-four remand (so the court had jurisdiction), but concluded the Appeals Council was not required to articulate weight when it merely denied review; it remanded to the district court to perform a substantial-evidence review of the full administrative record (including Ratner’s opinion).
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Jurisdiction: nature of district-court remand (sentence 4 v. 6) | Remand ordered for the Appeals Council to evaluate Ratner’s opinion (effectively a sentence-four remand) | Commissioner argued it was sentence-four and thus appealable | Court: remand was sentence-four; appellate jurisdiction proper |
| Whether Appeals Council must articulate weight for a treating-physician opinion when denying review | Vallejo: Martinez should be excepted where a treating opinion first submitted to Appeals Council is the only treating opinion and undermines the ALJ’s decision; Appeals Council must apply treating-source rules and explain weight | Commissioner: Martinez controls; Appeals Council need only "consider" new evidence when denying review and is not required to follow ALJ treating-source articulation rules unless it makes a decision | Held: Appeals Council not required to follow §416.927(c)(2) articulation when it denies review; district court erred in reversing on that basis |
| Proper remedy when Appeals Council denies review but new treating opinion is in record | Vallejo: remand for fact-finder weighing of new treating opinion necessary because district court cannot perform substantial-evidence review without ALJ/AC evaluation | Commissioner: Martinez precludes remand to Appeals Council; district court must review the whole administrative record (including new evidence) for substantial-evidence support | Held: Remand to Appeals Council for express evaluation was improper; district court must assess whether Commissioner applied correct law and whether substantial evidence (including Ratner) supports the final decision |
Key Cases Cited
- Martinez v. Barnhart, 444 F.3d 1201 (10th Cir. 2006) (Appeals Council need only "consider" new evidence when denying review; no required express analysis)
- Pettyjohn v. Shalala, 23 F.3d 1572 (10th Cir. 1994) (distinguishing sentence-four and sentence-six remands)
- Nguyen v. Shalala, 43 F.3d 1400 (10th Cir. 1994) (standards for sentences four and six remands)
- Sullivan v. Finkelstein, 496 U.S. 617 (1990) (sentence-four remands are final and appealable)
- Melkonyan v. Sullivan, 501 U.S. 89 (1991) (sentence-six remands are interlocutory and nonappealable)
- Shalala v. Schaefer, 509 U.S. 292 (1993) (immediate entry of judgment distinguishes sentence-four remand)
- O'Dell v. Shalala, 44 F.3d 855 (10th Cir. 1994) (when Appeals Council accepts new evidence it becomes part of the record for the court's substantial-evidence review)
- Watkins v. Barnhart, 350 F.3d 1297 (10th Cir. 2003) ("good reasons" requirement: explanations must make clear the weight given to a treating source's opinion)