Adams v. Bisignano

Background

Plaintiff Stacey A. applied on May 5, 2021 for two forms of Social Security disability benefits: Disabled Widow(er)'s Benefits (DWB) under Title II, and Supplemental Security Income (SSI) under Title XVI of the Social Security Act. She alleged disability beginning January 1, 2020, stemming from blurry vision, type two diabetes, tuberculosis, back pain, heart issues, chest palpitations, and human papillomavirus symptoms. At the time of her application she was 50 years old with one year of college and prior work as a call agent, cashier, and warehouse associate.

Administrative Proceedings

The Commissioner denied both applications initially and on reconsideration. On January 12, 2023, an Administrative Law Judge (ALJ) held a hearing at which Plaintiff (represented by an attorney) and a vocational expert testified.

The ALJ applied the standard five-step sequential evaluation for disability. At steps one through three, the ALJ found Plaintiff met the non-disability eligibility requirements for DWB, identified several non-severe impairments (including carpal tunnel syndrome), and found that her combination of severe impairments — obesity, thoracic degenerative disc disease, borderline intellectual function, history of learning disorder, depression, anxiety, and diabetes mellitus — did not meet or equal a listed impairment.

At step four, the ALJ assessed Plaintiff's residual functional capacity (RFC) — the most she can still do despite her limitations — finding she could perform light work with restrictions: frequent climbing of ramps and stairs but never ladders, ropes, or scaffolds; frequent balancing, stooping, kneeling, crouching, and crawling; avoidance of concentrated exposure to hazards; ability to persist in simple, routine tasks; and only superficial interactions with others. The ALJ found she could not perform her past relevant work in customer service because it exceeded her RFC.

At step five, relying on vocational-expert testimony, the ALJ found Plaintiff could perform three light-work jobs existing in significant numbers nationally: Routing Clerk (approximately 140,000 jobs), Mail Clerk (approximately 11,000 jobs), and Merchandise Marker (approximately 137,000 jobs). The ALJ concluded Plaintiff was not disabled from January 1, 2020 through May 3, 2023 (the date of his decision).

Plaintiff appealed to the Social Security Appeals Council on December 3, 2023, and submitted additional evidence: electromyography (EMG) and nerve conduction velocity (NCV) studies conducted on May 18–23, 2023 — fifteen days after the ALJ's decision. Those studies showed severe bilateral ulnar neuropathies (nerve damage at the elbow, consistent with cubital tunnel syndrome), moderate bilateral median neuropathies (nerve damage at the wrist, consistent with carpal tunnel syndrome), and likely diffuse axonal polyneuropathy (widespread nerve damage). The Appeals Council refused to consider this evidence, stating it fell outside the time period the ALJ addressed, and denied review, making the ALJ's decision final.

Issues Before the Court

Plaintiff raised four arguments: (1) the Appeals Council erred by refusing to consider the additional nerve studies; (2) the ALJ wrongly found her bilateral upper-extremity neuropathies non-severe; (3) the ALJ overlooked certain mental impairments; and (4) the ALJ improperly evaluated the opinion of Dr. Grace Totoe. Defendant argued the court lacked jurisdiction to review the Appeals Council's denial of review and that substantial evidence supported the ALJ's decision.

Standard of Review

The court's review of the Commissioner's decision is limited to determining whether it is supported by substantial evidence — meaning more than a mere scintilla of evidence that a reasonable mind might accept as adequate to support a conclusion. The court may also review de novo (independently, without deference) whether new evidence submitted to the Appeals Council is new, material, and related to the relevant time period.

Holdings

Jurisdiction Over Appeals Council's Decision

Defendant relied on Browning v. Sullivan, 958 F.2d 817 (8th Cir. 1992), arguing the court lacked jurisdiction because the Appeals Council's denial of review is not a final agency action. The court distinguished Browning on the ground that in Browning the Appeals Council actually considered the new evidence before declining review, whereas here the Appeals Council refused to consider the evidence at all. The court held it had jurisdiction to review whether the Appeals Council's refusal to consider the new evidence was erroneous, citing substantial post-Browning Eighth Circuit and district court authority.

The Additional Evidence Was New, Material, and Related to the Relevant Period

The court found the nerve studies constituted new evidence — not merely cumulative of existing record evidence — and that they were material and related to the period under review, even though conducted fifteen days after the ALJ's decision. The court reasoned that the timing of evidence is not dispositive of materiality under Williams v. Sullivan, 905 F.2d 214, 216 (8th Cir. 1990), and that it was implausible the condition suddenly worsened in fifteen days. The studies directly addressed the same chronic upper-extremity conditions the ALJ had already evaluated and found non-severe, and were therefore related to the period at issue.

The court found the evidence was plainly material for three reasons: (1) it provided specific diagnostic detail about the severity of upper-extremity impairments the ALJ deemed non-severe; (2) it was relevant to the ALJ's discounting of Dr. Totoe's opinion — the ALJ had found no apparent cause for Plaintiff's hand weakness, but the studies supplied that cause; and (3) the vocational expert had testified that limiting Plaintiff to only occasional handling and fingering would eliminate all identified jobs, so the studies could directly affect the disability determination if the ALJ revised the RFC.

Neither party addressed the "good cause" requirement under 20 C.F.R. § 404.970(b) for late submission of evidence, and the Appeals Council made no finding on good cause. Following other courts in similar circumstances, the court held that remand was appropriate absent any good cause determination.

Factual and Legal Errors in the ALJ's Decision

The court identified two errors in the ALJ's carpal tunnel analysis that must be corrected on remand:

1. Factual error: The ALJ found Plaintiff did not receive treatment for carpal tunnel until late 2021. But the record from a December 2021 appointment showed Plaintiff had previously been treated for carpal tunnel, was prescribed gabapentin, and had a nerve test cancelled due to COVID-19. The ALJ's factual finding was contradicted by the record.

2. Legal error: The ALJ applied an incorrect standard by stating there was "no objective evidence that limitations from the impairment will persist for 12 months now that treatment has begun." The correct legal standard is that the twelve-month duration may be measured from any date the claimant's impairment became disabling — not from when treatment began. The court cited SSR 23-1p, a November 7, 2023 Social Security Administration policy ruling.

Mental Impairments

Plaintiff argued the ALJ's failure to specifically mention schizophrenia spectrum disorder and post-traumatic stress disorder was independent grounds for remand. The court rejected this argument. An ALJ does not err by omitting a specific diagnosis if it is not "separate and apart" from other listed impairments already addressed. The court found that the record showed only a single December 2022 mention of these diagnoses, that Plaintiff elsewhere denied related symptoms, and that the ALJ had thoroughly reviewed Plaintiff's full mental health picture, including symptoms related to those disorders.

Disposition

Judge Foster granted Plaintiff's motion for summary judgment in part, denied Defendant's request for relief, reversed the Commissioner's denial of benefits, and remanded the case to the Commissioner under sentence four of 42 U.S.C. § 405(g) for further administrative proceedings. On remand, the ALJ must: (1) consider whether the additional nerve studies alter the finding that Plaintiff can perform jobs existing in significant numbers nationally; (2) re-weigh Dr. Totoe's medical opinion in light of those studies; (3) correct the factual and legal errors described above; and (4) recall a vocational expert for new testimony if the RFC is modified. The case was dismissed with prejudice.