Administrative – Social Security – Disability Benefits Denial – Remand

Meyer v. Astrue (Lawyers Weekly No. 11-01-1246, 12 pp.) (Motz, J.) No. 10-1581, Dec. 2, 2011; USDC at Columbia, S.C. (Anderson, J.) 4th Cir. Click here for the full-text opinion.

Holding: A claimant who suffered back, wrist and shoulder injuries when he fell 25 feet from a deer stand has his claim for social security disability benefits remanded to the Appeals Council because the 4th Circuit cannot determine from the record if substantial evidence supports the denial of benefits.

The administrative law judge (ALJ) concluded claimant could perform the full range of light work. The ALJ found claimant’s assertion that he suffered from “constant, unrelenting” pain not entirely “credible” because it was “inconsistent with the medical evidence of record,” including claimant’s report to his physicians, and the treatment sought and received. The ALJ considered claimant’s testimony that he was able to drive and assist his wife in caring for their horses and dog, and evidence suggesting that claimant continued, although to a lesser degree, to ride horseback and operate his trailer.

After the ALJ denied benefits, claimant sought review by the Appeals Council. With his request for review, claimant submitted new evidence, including an opinion letter from his treating physician, Dr. Bailey, dated Aug. 18, 2008. In the letter, Dr. Bailey described claimant’s post-operative course as complicated by chronic, debilitating back pain which was anticipated due to the magnitude of his injury. Dr. Bailey opined that claimant’s long-term restrictions included no lifting greater than 10 pounds, avoiding bending, stooping, squatting and no sitting, standing or walking for more than 30 minutes without rest periods. He explained claimant will continue to require frequent follow-up and medical management and will likely require further surgical intervention in the future.

Claimant argues the Appeals Council erred by failing to make “specific findings of fact” as to why the new evidence he submitted – particularly Dr. Bailey’s letter – did not require reversal of the ALJ’s decision. This argument rests on a misunderstanding of the role of the Appeals Council and misreading of our precedent.

If upon consideration of all the evidence, including any new and material evidence, the Appeals Council finds the ALJ’s action, findings or conclusions not contrary to the weight of the evidence, the Appeals Council can simply deny the request for review. Contrary to claimant’s contention, nothing in the Social Security Act or regulations promulgated pursuant to it requires that the Appeals Council explain its rationale for denying review.

The regulatory scheme does not require the Appeals Council to do anything more than what it did in this case. i.e., consider new and material evidence in deciding whether to grant review.

Although the regulatory scheme does not require the Appeals Council to articulate any findings when it considers new evidence and denies review, we are certainly mindful that an express analysis of the Appeals Council’s determination would be helpful for purposes of judicial review.

On consideration of the record as a whole, we simply cannot determine whether substantial evidence supports the ALJ’s denial of benefits here. We must remand the case for further fact finding.

We reverse the district court judgment and remand with instructions to reverse the decision of the commissioner and remand the case for a rehearing pursuant to sentence four of 42 U.S.C. § 405(g).

Reversed and remanded.