United States District Court, D. Colorado
JOE V. GALLEGOS, Plaintiff,
NANCY A. BERRYHILL, Acting Commissioner of Social Security, Defendant.
T. BABCOCK, JUDGE.
Joe Gallegos appeals the final decision of the Acting
Commissioner of Social Security (“SSA”) denying
his application for disability insurance benefits under Title
II Social Security Act, 42 U.S.C. § 401 et seq.
I have considered the parties' briefs (ECF Nos. 12-13)
and the administrative record (ECF No. 9) (“AR”).
Oral argument would not materially assist me in determining
Gallegos argues the administrative law judge (ALJ) improperly
weighed the medical opinion evidence in the record and
improperly evaluated Mr. Gallegos's testimony. He also
argues that SSA's Appeals Council failed to properly
consider relevant medical evidence on appeal. Because I agree
that the Appeals Council failed to consider new, relevant,
and material evidence, I REVERSE this case and REMAND with
instructions to consider that evidence. I decline to reach
Mr. Gallegos's other arguments, which may be impacted by
the new evidence.
2014, Mr. Gallegos filed an application for disability
insurance benefits with SSA, alleging disability beginning
June 19, 2014. AR 136-37. After SSA initially denied his
claim, AR 58-73, Mr. Gallegos requested a hearing before an
ALJ, AR 85. The hearing took place on April 5, 2016. AR
38-57. On May 12, 2016, the ALJ denied Mr. Gallegos's
claim, concluding he was not disabled within the meaning of
the Social Security Act. AR 20-37. Mr. Gallegos asked
SSA's Appeals Council to review the ALJ's decision.
AR 18-19. On May 4, 2017, the Appeals Council denied review,
AR 1-7, making the ALJ's decision the final decision of
SSA, see Doyal v. Barnhart, 331 F.3d 758, 759 (10th
Cir. 2003). On July 10, 2017, Mr. Gallegos timely filed this
appeal. (ECF No. 1.) I have jurisdiction pursuant to 42
U.S.C. § 405(g).
SSA's Five-Step Process for Determining Whether a
Claimant Is “Disabled”
claimant is “disabled” under Title II of the
Social Security Act if he is unable to “engage in any
substantial gainful activity by reason of any medically
determinable physical or mental impairment which can be
expected to result in death or which has lasted or can be
expected to last for a continuous period of not less than 12
months.” 42 U.S.C. § 423(d)(1)(A); see also
Bowen v. Yuckert, 482 U.S. 137, 140 (1987). SSA has
established a five-step sequential evaluation process for
determining whether a claimant is disabled and thus entitled
to benefits. 20 C.F.R. § 404.1520.
one, SSA asks whether the claimant is presently engaged in
“substantial gainful activity.” If he is,
benefits are denied and the inquiry stops. §
404.1520(b). At step two, SSA asks whether the claimant has a
“severe impairment”-that is, an impairment or
combination of impairments that “significantly limits
[his] physical or mental ability to do basic work
activities.” § 404.1520(c). If he does not,
benefits are denied and the inquiry stops. If he does, SSA
moves on to step three, where it determines whether the
claimant's impairment(s) “meet or equal” one
of the “listed impairments”-impairments so severe
that SSA has determined that a claimant who has them is
conclusively disabled without regard to the claimant's
age, education, or work experience. § 404.1520(d). If
not, SSA goes to step four. At step four, SSA determines the
claimant's residual functional capacity
(“RFC”)-that is, what he is still able to do
despite his impairments, and asks whether the claimant can do
any of his “past relevant work” given that RFC.
§ 404.1520(e). If not, SSA goes to the fifth and final
step, where it has the burden of showing that the
claimant's RFC allows him to do other work in the
national economy in view of his age, education, and work
experience. § 404.1520(g). At this step, SSA's Grid
rules may mandate a finding of disabled or not disabled
without further analysis based on the claimant's age,
education, and work experience. 20 C.F.R. Pt. 404, Subpt. P,
App. 2. In contrast with step five, the claimant has
“the burden of establishing a prima facie case of
disability at steps one through four.” Doyal,
331 F.3d at 760.
Standard for Reviewing SSA's Decision
review is limited to determining whether SSA applied the
correct legal standards and whether its decision is supported
by substantial evidence in the record. Williamson v.
Barnhart, 350 F.3d 1097, 1098 (10th Cir. 2003). With
regard to the law, reversal may be appropriate when SSA
either applies an incorrect legal standard or fails to
demonstrate reliance on the correct legal standards. See
Winfrey v. Chater, 92 F.3d 1017, 1019 (10th Cir. 1996).
With regard to the evidence, I must “determine whether
the findings of fact . . . are based upon substantial
evidence, and inferences reasonably drawn therefrom. If they
are so supported, they are conclusive upon the reviewing
court and may not be disturbed.” Trujillo v.
Richardson, 429 F.2d 1149, 1150 (10th Cir. 1970).
“Substantial evidence is more than a scintilla, but
less than a preponderance; it is such evidence that a
reasonable mind might accept to support the
conclusion.” Campbell v. Bowen, 822 F.2d 1518,
1521 (10th Cir. 1987) (citing Richardson v. Perales,
402 U.S. 389, 401 (1971)). The record must demonstrate that
the ALJ considered all of the evidence, but an ALJ is not
required to discuss every piece of evidence. Clifton v.
Chater, 79 F.3d 1007, 1009-10 (10th Cir. 1996). I may
not reweigh the evidence or substitute my judgment for that
of the ALJ. Casias v. Secretary of Health & Human
Servs., 933 F.2d 799, 800 (10th Cir. 1991).
The ALJ's Decision
followed the five-step analysis outlined above. At step one,
the ALJ found that Mr. Gallegos had not engaged in
substantial gainful activity from his alleged onset date of
June 19, 2014, and met the insured requirements of the Social
Security Act through December, 31, 2019. AR 25. At step two,
the ALJ found Mr. Gallegos had several severe impairments:
(1) obesity; (2) degenerative disc disease of the cervical
spine, C4-C7, status post-anterior cervical discectomy and
fusion, C4-C7; (3) degenerative disc disease, L1-L4, status
post-remote lumbar discectomy/laminectomy; (4) gout; and (5)
obstructive sleep apnea. Id. At step three, the ALJ
concluded that Mr. Gallegos's impairments did not meet or
equal any of the ...