Y.F.L. v. Commissioner of Social Security

Background

Y.F.L. sought judicial review of the Commissioner of Social Security’s decision denying her application for Supplemental Security Income under Title XVI of the Social Security Act. She alleged disability beginning March 30, 2018, based on back problems, asthma, her legs giving out, and injuries connected to a motor-vehicle accident.

An administrative law judge (ALJ) denied the claim after a hearing. The ALJ found severe impairments including hypertension, degenerative changes in Y.F.L.’s lumbar and cervical spine, obesity, and alcohol use disorder. The ALJ determined that Y.F.L. could perform a limited range of medium work and could perform jobs existing in significant numbers in the national economy, including cashier, cafeteria attendant, and merchandise marker. The Social Security Appeals Council denied review.

Additional Evidence

After the ALJ’s August 19, 2019 decision, Y.F.L. submitted medical records to the Appeals Council. Most of the records were dated before the ALJ’s decision, and a few were dated shortly afterward. The records concerned ongoing left-foot problems. They included treatment notes, an April 2019 x-ray showing osteopenia and no fracture, and an August 5, 2019 MRI showing a nondisplaced fracture of the talus.

The Appeals Council said the evidence from before the ALJ’s decision did not show a reasonable probability of changing the result. It said the later evidence did not relate to the period being considered. Y.F.L. argued that the Appeals Council should have considered the evidence because it documented the same left-foot problems she had reported before the ALJ’s decision.

Court’s Analysis

The court explained that the Appeals Council must review additional evidence when it is new, material, related to the period on or before the hearing decision, and reasonably likely to change the outcome. Evidence is new when it is not duplicative or cumulative. Evidence dated after an ALJ’s decision can still relate to the earlier period when it concerns ongoing treatment for impairments documented before the decision.

The court found that Y.F.L.’s additional evidence was not cumulative or duplicative and related to the period covered by the ALJ’s decision. The records showed continuing treatment for left-foot problems that had already appeared in the earlier administrative record. The court also found a reasonable probability that the evidence could have changed the disability determination, particularly because the MRI showing a fracture could affect whether Y.F.L.’s left-foot condition was a medically determinable impairment, as well as the assessment of her testimony, the medical opinions, and her residual functional capacity.

The court rejected the Commissioner’s limited argument that the later evidence would matter only in a later disability decision. The court concluded that the additional evidence related to the period on or before the ALJ’s decision.

Disposition

The court did not reach Y.F.L.’s other challenges to the ALJ’s decision. It granted Y.F.L.’s motion for summary judgment, denied the Commissioner’s motion for summary judgment, and remanded the matter for further proceedings. On remand, the ALJ must reevaluate whether Y.F.L. is entitled to benefits in light of the additional evidence. The Clerk was directed to enter judgment and close the case.