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Gallegos v. Berryhill

United States District Court, D. Colorado

April 4, 2018

JOE V. GALLEGOS, Plaintiff,
NANCY A. BERRYHILL, Acting Commissioner of Social Security, Defendant.



         Plaintiff 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 this appeal.

         Mr. 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.

         I. Background

         A. Procedural History

         In July 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).

         II. Legal Standards

         A. SSA's Five-Step Process for Determining Whether a Claimant Is “Disabled”

         A 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.

         At step 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.

         B. Standard for Reviewing SSA's Decision

         My 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).

         III. The ALJ's Decision

         The ALJ 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 ...

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