United States District Court, W.D. Missouri, Western Division
ORDER REMANDING CASE TO ALJ
GREG KAYS, District Judge.
Plaintiff Terry Lee Thomas seeks judicial review of the Commissioner of Social Security's denial of his applications for disability insurance benefits under Title II of the Social Security Act, 42 U.S.C. §§ 401-434 and supplemental security income benefits under Title XVI of the Act, 42 U.S.C. §§ 1381-1383f. The Administrative Law Judge ("ALJ") found Plaintiff had multiple severe impairments including seizure disorder, affective disorder, and anxiety, but he retained the residual functional capacity ("RFC") to perform work as a linen room attendant, counter supply worker, light collator operator, and light mail router.
Because the Court cannot conclude that the ALJ's opinion is supported by substantial evidence in light of the new, material opinion evidence submitted to the Appeals Council, the Court REMANDS the case to the ALJ for further proceedings.
Factual and Procedural Background
A summary of the entire record is presented in the parties' briefs and is repeated here only to the extent necessary.
Plaintiff filed his initial applications on January 14, 2009, alleging a disability onset date of January 1, 2009. After the Commissioner denied these applications, an administrative law judge affirmed this decision. Plaintiff challenged this decision and the Appeals Council remanded, ordering the ALJ to obtain updated medical records, consider evidence spanning the entire disability period, determine whether Plaintiff could perform his past relevant work, and elicit testimony from a vocational expert on whether he could perform other work. R. at 238.
Upon remand, the ALJ expanded the record, conducted another hearing, and concluded that Plaintiff failed to establish disability. Plaintiff appealed to the Appeals Council and presented new opinion evidence from his treating physician Thomas Maxwell, M.D. ("Dr. Maxwell"). The Appeals Council denied review, holding that despite the new evidence, the ALJ's opinion was still supported by substantial evidence. This denial left the ALJ's opinion as the Commissioner's final decision. Plaintiff has exhausted all administrative remedies and judicial review is now appropriate under 42 U.S.C. § 405(g) and 42 U.S.C. § 1383(c)(3).
Standard of Review
A federal court's review of the Commissioner's decision to deny disability benefits is limited to determining whether the Commissioner's findings are supported by substantial evidence on the record as a whole. Buckner v. Astrue, 646 F.3d 549, 556 (8th Cir. 2011). Substantial evidence is less than a preponderance, but enough evidence that a reasonable mind would find it sufficient to support the Commissioner's decision. Id. In making this assessment, the court considers evidence that detracts from the Commissioner's decision, as well as evidence that supports it. McKinney v. Apfel, 228 F.3d 860, 863 (8th Cir. 2000). The court must "defer heavily" to the Commissioner's findings and conclusions. Hurd v. Astrue, 621 F.3d 734, 738 (8th Cir. 2010). The court may reverse the Commissioner's decision only if it falls outside of the available zone of choice, and a decision is not outside this zone simply because the court might have decided the case differently were it the initial finder of fact. Buckner, 646 F.3d at 556.
In determining whether a claimant is disabled, that is, unable to engage in any substantial gainful activity by reason of a medically determinable impairment that has lasted or can be expected to last for a continuous period of not less than twelve months, 42 U.S.C. § 423(d), the Commissioner follows a five-step sequential evaluation process.
Plaintiff challenges the ALJ's Step Four determination in numerous respects, but the Court only addresses the single issue that necessitates remand: whether, in light of the opinion evidence presented for the first time to the Appeals Council, the ALJ's opinion is still supported by substantial evidence.
The ALJ determined that Plaintiff could perform a full range of work, subject to additional non-exertional limitations seemingly related to his seizure disorder. R. at 50. The ALJ limited Plaintiff to work that did not involve climbing ladders, ropes, or scaffolds, and that avoided exposure extreme heat, humidity, operational control of machinery, unprotected heights, and hazardous machinery. R. at 50. The ALJ did not find more restrictive limitations in part because she rejected Plaintiff's allegations that his seizures were disabling. The ALJ cited to numerous medical records from 2009 demonstrating that Plaintiff's seizures were primarily attributable to his failure to take prescribed seizure medication. R. at 51. Based on these records, the ALJ concluded, "Overall, the record indicates that the claimant's seizures would be controlled if he took his medications regularly. It is reasonable that he could perform work if normal and reasonable seizure precautions were taken." R. at 51.
When the ALJ rendered her opinion, there was no medical opinion evidence on how Plaintiff's seizure disorder impacted his ability to work. Plaintiff, however, subsequently submitted two letters from Dr. Maxwell to the Appeals Council. In the first letter, dated November 15, 2012, Dr. Maxwell remarked that he primarily treated Plaintiff for his seizure disorder. R. at 1124. He further explained that Plaintiff experienced most seizures when he forgot to take his medications, but he also had them once every three months, even when properly medicated. R. at 1124. Dr. Maxwell then concluded that this uncontrollable seizure disorder would render him unable to perform the normal work-related activities of an average job. R. at 1124. His ...