United States District Court, N.D. Alabama, Western Division
KARON OWEN BOWDRE, Chief District Judge.
The claimant, Leopold Blakley, filed a Title II application for a period of disability and disability insurance benefits on February 22, 2010, alleging disability commencing on July 24, 2009, because of osteoarthritis in the right knee, alcoholic hepatitis, borderline intellectual functioning, sickle cell anemia, hypertension, and gastroesophageal reflux disease. (R. 21, 132). The Commissioner denied the claim. (R. 83). The claimant filed a timely request for a hearing before an Administrative Law Judge, and the ALJ held a video hearing on August 18, 2011, with the claimant in Tuscaloosa and the ALJ in Birmingham, Alabama. (R. 41, 43).
In a decision dated September 23, 2011, the ALJ found that the claimant was not disabled within the meaning of the Social Security Act and, thus, was ineligible for disability insurance benefits. (R. 19). On appeal, the Appeals Council denied the claimant's request for review on January 10, 2013. (R. 1). The claimant has exhausted his administrative remedies, and this court has jurisdiction under 42 U.S.C. §§ 405(g) and 1631(c)(3). For the reasons stated below, this court REVERSES and REMANDS the decision of the Commissioner because substantial evidence does not support the ALJ's finding that the claimant did not meet Listing § 12.05(C).
II. ISSUE PRESENTED
The issue before the court is whether substantial evidence supports the ALJ's finding that the claimant did not meet Listing § 12.05(C).
III. STANDARD OF REVIEW
The standard for reviewing the Commissioner's decision is limited. This court must affirm the Commissioner's decision if the Commissioner applied the correct legal standards and if the factual conclusions are supported by substantial evidence. See 42 U.S.C. § 405(g); Graham v. Apfel, 129 F.3d 1420, 1422 (11th Cir. 1997); Walker v. Bowen, 826 F.2d 996, 999 (11th Cir. 1987).
"No... presumption of validity attaches to the [Commissioner's] legal conclusions, including determination of the proper standards to be applied in evaluating claims." Walker, 826 F.2d at 999. This court does not review the Commissioner's factual determination de novo. The court will affirm those factual determinations that are supported by substantial evidence. "Substantial evidence" is "more than a mere scintilla. It means that such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1971).
The court must keep in mind that opinions such as whether a claimant is disabled, the nature and extent of a claimant's residual functional capacity, and the application of vocational factors "are not medical opinions, ... but are, instead, opinions on issues reserved to the Commissioner because they are administrative findings that are dispositive of a case; i.e., that would direct the determination or decision of disability." 20 C.F.R. §§ 404.1527(d), 416.927(d). Whether the claimant meets the listing and is qualified for Social Security disability benefits is a question reserved for the ALJ, and the court "may not decide facts anew, reweigh the evidence, or substitute [its] judgment for that of the Commissioner." Dyer v. Barnhart, 395 F.3d 1206, 1210 (11th Cir. 2005). Thus, even if the court were to disagree with the ALJ about the significance of certain facts, the court has no power to reverse that finding as long as substantial evidence in the record supports it.
The court must "scrutinize the record in its entirety to determine the reasonableness of the [Commissioner]'s factual findings." Walker, 826 F.2d at 999. A reviewing court must not look only to those parts of the record that support the decision of the ALJ, but also must view the record in its entirety and take account of evidence that detracts from the evidence relied on by the ALJ. Hillsman v. Bowen, 804 F.2d 1179, 1180 (11th Cir. 1986).
IV. LEGAL STANDARD
Under 42 U.S.C. § 423(d)(1)(A), a person is entitled to disability benefits when the person cannot "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). To make this determination, the Commissioner employs a five-step sequential evaluation process:
(1) Is the person presently unemployed?
(2) Is the person's impairment severe?
(3) Does the person's impairment meet or equal one of the specific impairments set forth in 20 C.F.R. pt. 404, subpt. P, app. 1?
(4) Is the person unable to perform his or her former occupation?
(5) Is the person unable to perform any other work within the economy? An affirmative answer to any of the above questions leads either to the next question, or, on steps three and five, to a finding of disability. A negative answer to any question, other than step three, leads to a determination of "not disabled."
McDaniel v. Bowen, 800 F.2d 1026, 1030 (11th Cir. 1986); 20 C.F.R. §§ 404.1520, 416.920.
To meet Listing § 12.05 for "mental retardation, " the claimant must have "significantly subaverage general intellectual functioning with deficits in adaptive functioning initially manifested during the developmental period; i.e., the evidence demonstrates or supports onset of the impairment before age 22." Listing § 12.05; see also Perkins v. Comm'r, Soc. Sec. Admin., No. 13-12024, 2014 WL 223905 at *2 (11th Cir. Jan 22, 2014) (quoting Crayton v. Callahan, 120 F.3d 1217, 1219 (11th Cir. 1997)). To meet the required level of severity in § 12.05(C), the claimant must show "[a] valid verbal, performance, or full scale IQ of 60-70 and a physical or other mental impairment imposing an additional and significant work-related limitation of function[.]" The additional mental or physical impairment must have more than a "minimal effect' on the claimant's ability to perform basic work activities." Smith v. Comm'r of Soc. Sec., 535 F.Appx. 894, 897 (11th Cir. 2013) (emphasis added) (quoting Lowery v. Sullivan, 979 F.2d 835, 837 (11th Cir. 1992)).
Because the IQ score is essential in evaluating § 12.05(C), the Eleventh Circuit provides guidance for an ALJ in how to properly consider an IQ score. The Eleventh Circuit established that a valid IQ score of 60 to 70 creates a rebuttable presumption of "a fairly constant IQ score throughout [his or] her life[, ] absent evidence of sudden trauma that can cause retardation, " thus, indicating that the deficits in adaptive functioning manifested before the age of twenty-two. Hodges v. Barnhart, 276 F.3d 1265, 1268-69 (11th Cir. 2001).
However, in Popp v. Heckler , the Eleventh Circuit held that "[t]he ALJ is required to examine the results [of an IQ test] in conjunction with other medical evidence and the claimant's daily activities and behavior [;]" an IQ score alone is not conclusive evidence of a mental disability. 779 F.2d 1497 , 1499-1500 (11th Cir. 1986) (emphasis added). The ALJ should look to the narrative report that accompanies the IQ test results, as it "should comment on whether the IQ scores are considered valid and consistent with the developmental history and the degree of functional limitation." Listing § 12.00(D)(6)(a); see also Hickel v. Comm'r of Soc. Sec., 539 F.Appx. 980, 984 n.6 (11th Cir. 2013).
While the burden rests with the claimant to prove a disability, the ALJ has a duty to develop a full and fair record. Ellison v. Barnhart, 355 F.3d 1272, 1276 (11th Cir. 2003); 20 C.F.R. § 416.912(c). When the evidence shows that the claimant has a mental impairment, the ALJ may determine that the claimant is not disabled "only if the [ALJ] has made every reasonable effort' to obtain the opinion of a qualified psychiatrist of psychologist.'" McCall v. Bowen, 846 F.2d 1317, 1320 (11th Cir. 1988) (quoting 42 U.S.C.A. § 421(h)); see also 20 C.F.R. § 416.903(e). Because the ALJ has a duty to develop the medical record fully and fairly, "it is reversible error for an ALJ not to order a consultative examination when such an evaluation is necessary for him to make an informed decision." Holladay v. Bowen, 848 F.2d 1206, 1209-10 (11th Cir. 1988); see also Reeves v. Heckler, 734 F.2d 519, 522 n.1 (11th Cir. 1984). The ALJ's ...