L.G. Caulder, Jr. appeals from a district court order affirming the denial of his claim to disability benefits by the Secretary of Health and Human Services (the “Secretary”). We reverse the district court and remand to that court with instructions to remand the case to the Secretary for consideration of the new medical evidence which Caulder proffered to the district court. This court has jurisdiction to review the district court’s decision under 28 U.S.C. § 1291.
I. BACKGROUND OF CLAIM AND ADMINISTRATIVE PROCEEDINGS
. L.G. Caulder, Jr. filed a claim on July 1, 1983, for a period of disability and for disability insurance benefits under Title II of the Social Security Act, 42 U.S.C. §§ 416(i) and 423, alleging an onset date of April, 1983. Caulder claims that he is disabled due to advanced emphysema and back and leg problems.
Caulder proceeded through the administrative process, culminating in a hearing before an Administrative Law Judge (“AU”) on March 22, 1984. Caulder and his wife testified that he no longer works, experiences shortness of breath, cannot perform household chores, and can walk only 100 to 200 yards before stopping to rest. Caulder’s work history includes experience as a heavy equipment operator, a supervisor in the construction industry, a printing pressman, and a service station manager. He completed the eighth grade of school. According to Caulder, he stepped down from a supervisory position to operator work in 1978-79, taking a 50% pay cut on the advice of his doctor due to emphysema. During 1980, he did not work for three quarters because of illness, but returned to work when his brother gave him a job in which, according to Caulder, “he did not actually have to earn his way.” In May 1981, Caulder was hospitalized for chronic obstructive pulmonary disease (COPD). Caulder asserts that he ceased working altogether in April, 1983, due to advanced emphysema and back and leg problems. He filed his claim for a period of disability and disability insurance benefits on July 1, 1983. Caulder was 52 years old at the time of the hearing.
The medical evidence presented at the hearing included reports from physicians concerning both Caulder’s breathing problems and his back and leg complaints. Because the decision to remand this case is based in part on the new medical evidence’s relevance to and affect on the AU’s findings, we set forth a summary of the various medical reports that were part of the administrative record.
Dr. Elmore, Caulder’s treating physician, provided reports dated July 16 and August 19, 1983, which indicate that he first saw Caulder in January, 1981, and was currently seeing him approximately every three months. Dr. Elmore described Caulder as so short of breath that he could not tolerate any exertion, nor could he stand on his legs for long because of cramping, therefore placing him under a severe disability that precludes his working. Dr. Elmore diagnosed emphysema, relying on the clinical and laboratory findings in reports of specialists to whom he had sent Caulder in 1981 for further testing. Dr. Avery received the referral and apparently arranged for Caulder to be hospitalized for testing and for his examination by Dr. Berglund, a cardiologist. Dr. Berglund’s clinical impression of Caulder’s breathing problem in his report dated May 5, 1981, was COPD, probably severe, and he suggested minor coronary artery disease. Dr. Hixson interpreted the pulmonary function test given on that date and stated that it indicated moderate non-reversible obstructive ventilatory impairment, and was consistent with advanced emphysema. Dr. Avery interpreted the results of the pulmo *874 nary function test as indicative of moderately severe COPD, not significantly reversible by bronchodilator therapy. In July, 1983, Dr. Reddy administered a pulmonary function test to Caulder and found moderate COPD.
Caulder’s back and leg problems were diagnosed by Dr. Elmore as progressive and peripheral neuropathy affecting the lower extremities. As noted above, Dr. Elmore opined that the combination of this problem with the breathing problem rendered Caulder unable to work. In September, 1983, Dr. Taylor examined Caulder concerning his increasing difficulty with his legs and found good dorsalis pulsations with good femoral pulsations, but he prescribed medication and noted that he would get a vascular consultation. Dr. Rollins, a neurologist, examined Caulder on October 25, 1983, and disagreed with Dr. Elmore’s diagnosis of peripheral neuropathy. His impression was that Caulder has either intermittent claudication of the lower extremities or claudication of the spinal roots in the back. Dr. Rollins recommended that Caulder undergo a lumbar myelogram and arteriogram to ascertain if his diagnosis was correct and whether the conditions would be amenable to surgical treatments as he believed. Caulder first tried medication before submitting to the hospitalization and testing. After the medication proved unsuccessful, Caulder returned to Dr. Rollins for the tests.
The AU rendered his opinion on Caulder’s claim prior to Caulder’s return to Dr. Rollins, however. Caulder’s attorney filed the request for review by the Appeals Council as required within the 60 days following the AU’s opinion. At that time, Caulder had just entered the hospital and the results of the tests were not yet available.
In his decision issued on April 30, 1984, the AU found that Caulder had a history of COPD and a back impairment, but that he did not meet the severity standard of the Social Security Act and therefore was not disabled. The AU refused to give Dr. Elmore’s opinion the considerable weight ordinarily given to a treating physician,
Wilson v. Heckler,
As to Caulder’s back and leg problems, the AU report is less than clear. 2 Although the report states at one point that “a consultative neurologist stressed that the claimant does have” peripheral neuro-pathy, the context of the opinion indicates that this is a misstatement and that in fact the AU relied on Dr. Rollins’ finding that Caulder does not have peripheral neuropa-thy. As noted above, Rollins had recognized that Caulder was suffering from an ailment, albeit misdiagnosed, and had recommended further testing to correctly identify the problem. The AU report also erred in noting that Rollins had doubted that either problem would be amenable to surgical treatment. In fact, Rollins’ report indicates that at that time he had thought *875 that either would be amenable to treatment. In conclusion, the AU stated that “there is no indication that the claimant sought further evaluation as recommended. Physical examination of the lower extremities has been essentially negative and without medical data to the contrary, the evidence fails to show an incapacitating vascular problem.” At the hearing the AU questioned Caulder as to whether he had ever undergone a lumbar myelogram or an arteriogram. When Caulder responded negatively, the AU did not inquire whether Caulder planned to do so in the future so that the decision should be postponed and the results included in the record. The AU discounted Caulder’s allegations of pain, as well as his wife’s testimony about his pain, finding that they were not supported by the evidence.
Once the AU found that Caulder was not suffering from a severe impairment, singly or in combination, he stopped the sequential evaluation. The Appeals Council denied Caulder’s request for review of the AU decision, making the AU determination the final decision of the Secretary subject to review in federal court.
Caulder then commenced this action in federal district court under the jurisdiction of 42 U.S.C. § 405(c). By that time, Caulder had undergone the myelogram and presented the results of that test to the district court. He requested the district court to remand the case to the Secretary for consideration of the new evidence. The district court held that it had no jurisdiction to consider the additional evidence and affirmed the denial of benefits.
II. QUESTIONS ON APPEAL
A. Consideration of Evidence Not Presented During the Administrative Proceedings
Caulder’s dispositive claim at this point is his request that the case be remanded to the Secretary for consideration of the new evidence proffered to the district court consisting of the results of the medical examinations which occurred after the Appeals Council denied review. The district court did not apply the proper standard to determine whether remand was warranted in this case. Under the appropriate analysis, a remand of this case to the Secretary is warranted. As we have clearly stated before, “the judicial determination whether remand is necessary is a
de novo
proceeding.”
Cherry v. Heckler,
1. Appropriate Legal Standard
The district court stated that it would not consider the additional medical evidence proffered by Caulder because “the evidence is not proper for consideration at this stage of the proceeding. The court’s determination is limited to the record presented to the AU.” The court cited as support the House Conference Report on the Social Security Disability Amendments of 1980. We find that the district court mischarac-terized the issue. Caulder’s claim, as stated in his brief in support of his motion for judgment on the pleadings and/or remand filed in the district court on March 22,1985, is not that the district court should have considered the new evidence in the first instance, but rather that the district court should have considered it to determine whether he had established good cause for remanding the case to the Secretary for reconsideration of his case in light of the new evidence. 3
*876 On appeal the Secretary argues that the legislative history of the Social Security Disability Amendments of 1980, Pub.L. No. 96-265, 94 Stat. 441, indicates that Congress wished to foreclose introduction of new evidence. The Secretary relies on language in the Senate Report to the effect that the intent of the legislation was to end the “floating application” procedure by which new evidence could be introduced at each step of the appeals process. Sen.Rep. No. 408, 96th Cong., 1st Sess. 57, reprinted in 1980 U.S.Code Cong. & Ad.News 1277, 1335. A reading of the statement in context, however, clarifies that Congress intended to preclude introduction of evidence pertaining to new impairments or worsening conditions. The Senate Report clearly stated that this “would not affect remand authority to remedy an insufficiently documented case or other defect.” Id.
The Conference Report explains how the 1980 Amendments modified section 307 of the Act concerning the remand of cases back to the Secretary once the claimant has filed a complaint in federal court. H.R. Conf.Rep. No. 944, 96th Cong., 2d Sess. 58, reprinted in 1980 U.S.Code Cong. & Ad. News 1392, 1406. The main result of the legislation was the elimination of the Secretary’s authority to remand cases on his own motion and the shift of that authority to the court. Under the former statute, the Secretary had absolute authority to remand a case that had been filed in district court anytime prior to his filing an answer in that court. The statute as amended requires that “such remands ... be discretionary with the court upon a showing by the Secretary of good cause.” Id. at 58-59, 1980 U.S.Code Cong. & Ad.News at 1406. The 1980 legislation also limited the court’s authority to remand a case on its own motion or on motion of the claimant. Prior to the amendment, the court was authorized to do so for “good cause.” Under the statute as amended the court is authorized to remand a case “only on a showing that there is new evidence which is material, and that there was good cause for failure to incorporate it into the record in a prior proceeding.” Id. at 58-59, 1980 U.S.Code Cong. & Ad.News at 1406. The Conference Report listed examples of what would constitute a showing of good cause by the Secretary. The examples included procedural difficulties such as problems in obtaining the transcript or files of the case. The conferees expressed their hope that such remands would be kept to a minimum so that undue burdens would not be placed on persons appealing their decisions. The Conference Report does not explain or give examples of what would constitute a showing of good cause by a claimant. This court, however, has addressed this issue on several occasions.
Although the Secretary’s argument in his brief to this court followed the district court’s reading of the legislative history, both parties seemed to acknowledge at oral argument that the standard governing remands by the district court to the Secretary on the basis of new evidence is found in
Cherry v. Heckler,
2. Caulder’s Proffered Evidence Meets the Criteria
Caulder’s evidence proffered to the district court consists of records of a hospitalization in July and August, 1984; a letter from Dr. Craddock, a treating physician; and a Physical Capacities Evaluation (“PCE”). The hospital reports contain the results of a lumbar myelogram and CT scan of the spine which revealed a block at the L4-5 level and diagnosis of spinal stenosis. They indicate that an elective lumbar laminectomy with decompression at L3, 4, and 5, and SI was performed, and that Caulder was readmitted at one point to mend a cerebrospinal fluid leak. The surgeon, Dr. Craddock, found that the procedure did not eliminate Caulder’s pain, weakness, or numbness in the legs. The Secretary argues that the additional medical evidence does not meet any of the three above criteria. We find that it meets all three.
First, the Secretary asserts that the additional evidence is cumulative because evidence of the ailment was before the ALJ in the form of Caulder’s testimony about his back trouble at the hearing. Although Caulder testified about his back trouble, the nature of the profferred additional medical evidence is such that one could not reasonably say that it is cumulative to lay testimony by a claimant. In
Boyd v. Heckler,
[t]he AU is guided by four considerations in determining whether a claimant is disabled within the meaning of the Social Security Act: (1) objective medical facts or clinical findings; (2) diagnoses of examining physicians; (3) subjective evidence of pain and disability, e.g., the testimony of the claimant and his family; and (4) the claimant’s age, education, and work history.
Second, the Secretary argues that the evidence is not material in that it will not alter the Secretary’s determination. To be material, the evidence must be relevant and probative so that there is a reasonable possibility that it would change the administrative outcome.
Wright v. Heckler,
The evidence is relevant and probative in that it pertains to a condition that Caulder listed in his applications at the administrative level as a source of his disability. The evidence also contains a medical opinion on the presence of the impairment during the
*878
time period for which benefits are sought. The fact that Dr. Craddock’s treatment and examination of Caulder took place later in the proceedings does not undermine the weight to be given his diagnosis.
Boyd v. Heckler,
We reject the Secretary’s contention that the proffered evidence of the PCE is not relevant. He contends that because the AU determined that Caulder did not have a severe impairment, the sequential evaluation stopped and thus the issue of his residual function capacity was not reached. This begs the question, as the other new evidence may establish that Caulder does have a severe impairment. Consequently, he either would be found to be disabled because he meets one of the listed impairments, or the sequential evaluation would continue, moving next to the determination of residual function capacity and the results of the PCE would be relevant.
We find that there is a reasonable possibility that the new evidence would change the administrative outcome because it consists of medical evidence that relates directly to one of Caulder’s principal alleged impairments, about which there was inadequate evidence presented to the AU. The AU noted that Caulder’s assertion of possible intermittent claudication of the lower extremities or claudication of the spinal roots was unsubstantiated and that Dr. Rollins recommended further examination; yet the AU failed to order further evaluation. The AU is charged with the responsibility of ensuring that the record is fully and fairly developed.
Todd v. Heckler,
Third, the Secretary concludes, without support, that Caulder has failed to show good cause as to why the evidence was not presented to the Secretary. We disagree and find that Caulder did establish good cause for the failure to submit the evidence at the administrative level because the evidence did not exist at that time. Nonexistence of the evidence at the time of the administrative proceedings may constitute good cause.
Cherry v. Heckler,
760 F.2d
*879
at 1192;
Johnson v. Harris,
We also are guided by the Fifth Circuit’s decision in a factually similar case in which the claimant was hospitalized during the time period in which the AU decision was issued and review by the Appeals Council was sought.
Dorsey v. Heckler,
Caulder’s case is not one in which the claimant procrastinated in obtaining copies of evidence readily available. Neither is there any indication in the record that the AU ordered Caulder to submit to additional tests. On the facts of this case, we find that Caulder’s decision to continue a course of prescribed medication for a short period before submitting to the surgical procedures was reasonable when faced with conflicting medical diagnoses. Caulder was admitted to the hospital on July 9, 1984, and on July 11th, the surgical procedure was performed. On that same date, his memorandum in support of his request for review by the Appeals Council was filed. Caulder was not discharged until the 17th. During the following few months, Caulder was hospitalized for another week-long period and then visited Dr. Craddock several times over a period of several weeks. In the meantime, the Appeals Council had denied his request for review and a civil action had been commenced within the 60 day period following that denial to avoid foreclosure of future proceedings. We conclude that Caulder was limited in his opportunity to present the new evidence to the Appeals Council to an extent that satisfies the good cause requirement. Caulder has met the Cherry criteria and is entitled to a remand of his case to the Secretary.
B. Assessing Subjective Complaints of Disabling Pain
Caulder’s other main contention on appeal is that the AU applied an erroneous legal standard in evaluating his subjective complaints of pain. Caulder alleges that he suffers from chest pain as well as from low back pain and leg cramps. Both Caulder and his wife testified as to the extent of the pain. The AU stated that he did not find Caulder’s testimony credible because “his description of an invalid-type existence ... was not convincingly supported by the objective medical findings and other evidence in the record.” Caulder asserts that it is improper to require objective clinical evidence to prove disabling pain.
This court recently has restated the standard of review for subjective allegations of pain in light of section 3(a)(1) of the Social Security Disability Benefits Reform Act of 1984, Pub.L. No. 98-460, 98 Stat. 1794.
See Hand v. Heckler,
C. Substantiality of Evidence
Caulder’s third argument on appeal is that the Secretary’s determination was not supported by substantial evidence. He challenges several aspects of the AU’s view of the evidence. He argues that the AU’s failure to give Dr. Elmore’s opinion the weight generally accorded the opinion of a treating physician was error. He asserts that the AU’s reliance on the one pulmonary function test administered by a consulting physician, and the AU’s discounting even that administering physician’s diagnosis and instead comparing the raw test results to a Social Security Ruling were inappropriate on the facts of this case. He contends that the AU’s finding that his back and leg impairment was non-severe simply because the physicians had presented conflicting diagnoses also was improper.
Because we are remanding this case to the AU for reconsideration of the case in light of the new evidence, our determination of the overall question of whether substantial evidence in the earlier record supported the AU’s finding is not necessary. As to the remaining claims of error, we find that Dr. Elmore’s reports are based on clinical and laboratory findings to the extent that they refer to the reports which he received from the specialists that examined Caulder upon his referral. Assessment of the results of the pulmonary function test must be made in light of the review of the entirety of the evidence, including results of other tests. In Caulder’s case, the AU’s opinion should reflect the specifics of his consideration of the totality of the evidence because the “need to consider all the available evidence in the record is particularly strong when a claimant has two or more impairments.”
Dorsey v. Heckler,
CONCLUSION
The court below erred in not remanding this case to the Secretary for consideration of the new evidence proffered by the claimant. We hereby REMAND the case to the district court with instructions to remand it to the Secretary for further proceedings not inconsistent with the purpose expressed above.
Notes
. In
Bonner v. City of Prichard,
. We believe this is primarily due to typographical or proofreading errors not reviewed and corrected by the AU when he signed the report.
. Given Caulder's presentation of the issue, we find it unnecessary to address the correctness of the district court’s narrow reading of its authority, but we note that at least one other circuit suggests that there may be situations in which it is appropriate for the district court to consider evidence that was not before the Appeals Council.
See Dorsey v. Heckler,
. The Eleventh Circuit, in
Stein
v.
Reynolds Securities, Inc.,
. The preferable approach, of course, would be for the AU to ensure that all relevant and material evidence is obtained before rendering his or her opinion. Further inquiry by the AU into the recommendations of the physicians and the claimants’ intended course of treatment would assist to this end. The AU can discourage claimants from delaying the process of developing evidence by placing them on notice that they will not gain any advantage in such action since the district court generally does not consider the impact of new evidence on the merits, but remands the case to the authority who would have evaluated it if it had heen produced earlier.
