CHARLES S. COODY, Magistrate Judge.
On April 26, 2007, the plaintiff applied for supplemental security income benefits under Title XVI of the Social Security Act, 42 U.S.C. § 1381 et seq., and disability insurance benefits pursuant to Title II of the Social Security Act, 42 U.S.C. §§ 401 et seq., alleging that he was unable to work because of a disability. His application was denied at the initial administrative level. The plaintiff then requested and received a hearing before an Administrative Law Judge ("ALJ"). Following the hearing, the ALJ also denied the claim. The Appeals Council rejected a subsequent request for review. (R. 13).
On September 23, 2009, the plaintiff filed a second application which was approved on December 12, 2009. (Id.). The Appeals Council then consolidated the two applications, and, on June 1, 2011, remanded the claims to reconcile the denial of the first application with the approval of the second application regarding whether the plaintiff meets the requirements of Listing 12.05, Mental Retardation.
The case is now before the court for review pursuant to 42 U.S.C. §§ 405 (g) and 1383(c)(3). Pursuant to 28 U.S.C. § 636(c)(1) and M.D. Ala. LR 73.1, the parties have consented to a United States Magistrate Judge conducting all proceedings in this case and ordering the entry of final judgment. Based on the court's review of the record in this case and the briefs of the parties, the court concludes that the decision of the Commissioner should be reversed and remanded with instructions that benefits be awarded.
Under 42 U.S.C. § 423(d)(1)(A), a person is entitled to disability benefits when the person is unable to
To make this determination
McDaniel v. Bowen, 800 F.2d 1026, 1030 (11th Cir. 1986).
The standard of review of the Commissioner's decision is a limited one. This court must find the Commissioner's decision conclusive if it is supported by substantial evidence. 42 U.S.C. § 405(g); Ingram v. Comm'r of Soc. Sec. Admin., 496 F.3d 1253, 1260 (11th Cir. 2007). "Substantial evidence is more than a scintilla, but less than a preponderance. It is such relevant evidence as a reasonable person would accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1971); Crawford v. Comm'r of Soc. Sec., 363 F.3d 1155, 1158-59 (11th Cir. 2004). A reviewing court may not look only to those parts of the record which support the decision of the ALJ but instead must view the record in its entirety and take into account evidence which detracts from the evidence relied on by the ALJ. Hillsman v. Bowen, 804 F.2d 1179, 1180 (11th Cir. 1986). The court "may not decide the facts anew, reweigh the evidence, or substitute . . . [its] judgment for that of the [Commissioner]." Phillips v. Barnhart, 357 F.3d 1232, 1240 n.8 (11th Cir. 2004) (alteration in original) (quotation marks omitted).
Walker v. Bowen, 826 F.2d 996, 999 (11th Cir. 1987).
(Doc. # 14, Pl's Br. at 1).
This court's ultimate inquiry is whether the Commissioner's disability decision is supported by the proper legal standards and by substantial evidence. See Bridges v. Bowen, 815 F.2d 622 (11th Cir. 1987). "Social Security proceedings are inquisitorial rather than adversarial. It is the ALJ's duty to investigate the facts and develop the arguments both for and against granting benefits." Sims v. Apfel, 530 U.S. 103, 110-111 (2000).
Crawford & Co. v. Apfel, 235 F.3d 1298, 1304 (11th Cir. 2000).
The ALJ must also state, with sufficient specificity, the reasons for his decision referencing the plaintiff's impairments.
42 U.S.C. § 405(b)(1) (emphases added).
The ALJ is not free to simply ignore medical evidence, nor may he pick and choose between the records selecting those portions which support his ultimate conclusion without articulating specific, well supported reasons for crediting some evidence while discrediting other evidence. Marbury v. Sullivan, 957 F.2d 837, 839-41 (11th Cir. 1992). When there is a conflict, inconsistency or ambiguity in the record, the ALJ has an obligation to resolve the conflict, giving specific reasons supported by the evidence as to why he accepted or rejected one opinion or record over another. "In the absence of such a statement, it is impossible for a reviewing court to determine whether the ultimate decision on the merits is rational and supported by substantial evidence." Cowart v. Schweiker, 662 F.2d 731, 735 (11th Cir. 1981).
At step three of the sequential evaluation process, the ALJ is required to determine whether the claimant's impairments meet or equal one of the specific impairments set forth in 20 C.F.R. Pt. 404, Subpt. P, App. 1. See McDaniel, 800 F.2d at 1030. "The structure of the listing for intellectual disability (12.05) is different from that of the other mental disorders listings." 20 C.F.R. Pt. 404, Subpt. P. App. 1, 12.00 MENTAL DISORDERS.
Frame v. Comm'r, Soc. Sec. Admin., ___ F. App'x ___, 2015 WL 150733, *2 (11th Cir. 2015) (No. 13-15347).
Listing 12.05 then specifically addresses the impairment of intellectual disability.
20 C.F.R. Part 404, Subpart P, App. 1, Listing 12.05C.
Consequently, "a claimant meets the criteria for presumptive disability under section 12.05(C) when the claimant presents a valid IQ score of 60 to 70 inclusive, and evidence of an additional mental or physical impairment that has more than `minimal effect' on the claimant's ability to perform basic work activities." See Monroe v. Comm'r of Soc. Sec., 504 F. App'x 808, 810 (11th Cir. 2013) quoting Lowery v. Sullivan, 979 F.2d 835 (11th Cir. 1992). See also Edwards v. Heckler, 755 F.2d 1513, 1517 (11th Cir. 1985).
After thoroughly reviewing the record, the court concludes that the ALJ's determination that Grant does not meet Listing 12.05C is not supported by substantial evidence. School records indicate that, on December 15, 1992, Grant was administrated the Wechsler Intelligence Scale for Children — Revised ("WISC-R"), and he scored a verbal IQ of 51, a performance IQ of 57, and a full scale IQ of 50. (R. 554). On July 24, 1995, and December 15, 1995, Grant's WISC-R scores were again noted as verbal IQ of 51, performance IQ of 57, and full scale IQ of 50. (R. 545, 581). On May 21, 1996, it was noted that Grant had a full scale IQ score of 50. (R. 553). In 1992, 1996 and 1997, Grant's school records reflect a primary diagnosis of mental retardation. (R. 554, 584-85). When Grant was in the tenth grade, in special education classes, he was reading on or below kindergarten level and performing math on the second grade level. (R. 566) (emphasis added). Grant was in a graduation certificate program in special education classes. (R. 575-76).
On April 17, 2009, Dr. Peggy Thornton, a consultative licensed psychologist, conducted a psychological evaluation of Grant and tested his intellectual functioning. (R. 662-66.) On the Wechsler Adult Intelligence Scale — Third Edition ("WAIS-III") test, Grant achieved a verbal IQ of 68, a performance IQ of 69, and a full scale IQ of 66. (R. 663). Dr. Thornton noted that Grant "gave a good effort and all environmental requirements were met. However, supportive school records and other test results were not available. Therefore, his scores are deemed to be provisionally valid." (R.664). Dr. Thornton concluded that the intellectual assessment indicated Grant was functioning in the "Extremely Low Range of Intellectual Functioning, Provisional." (Id.). She opined that he would be unable to manage benefits "due to poor math skills," but he would be able to make appropriate work decisions "in unskilled-type jobs." (Id.).
On November 18, 2009, Dr. John Gam, a consultative licensed psychologist, conducted a psychological evaluation of Grant at the request of the Commissioner. (R. 809-12). Dr. Gam noted that Grant's IQ "has been tested and is in the Extremely Low range." (R. 809). Although Dr. Gam noted that Grant was "working towards getting his GED," he also noted that Grant does not read. (R. 810) (emphasis added). Dr. Gam suggested that "it is not likely that he will get his GED." (R.811). Dr. Gam's examination revealed the following:
(R. 810-11) (italicized emphasis added).
Dr. Gam opined that Grant's level of motivation was low but "[h]e does not appear to be antagonistic or suspicious. His social skills are poor. There are no indications of malingering." (R.811). Finally, Dr. Gam suggested that Grant's "long history of mental slowness" would preclude him from functioning independently. (R.811).
Finally, Dr. David Ghostley, a licensed clinical psychologist, conducted a third psychological evaluation of Grant on August17, 2011. (R. 831-33). Dr. Ghostley noted that Grant completed the 11th grade but "[n]otably, no school records were made available for review. Mr. Grant claims that he was enrolled in special education classes for slow learners." (R. 831). Dr. Ghostley administered to Grant the Wechsler Adult Intelligence Scale — Fourth Edition ("WAIS-IV") test. (R. 832). He achieved a full scale IQ of 62. (Id.). With no explanation at all, Dr. Ghostley opined
(Id.)
Again, without explanation, Dr. Ghostley concluded that "Mr. Grant's ability to function independently and manage finances is considered unimpaired, given his history. Otherwise, his ability to understand, remember and carry out simply instructions, as well as respond appropriately to supervisors, co-workers, and work pressures in a work setting, is generally unimpaired." (R.833).
It is clear that none of the psychologists had access to Grant's school records which demonstrate that as a child, Grant had IQ scores that fall within the range of mental retardation. (R.553-584). For example, as early as 1992, Grant had a full scale IQ score of 50, a performance IQ score of 57 and a verbal IQ score of 51. (R. 554). His school records consistently reflect a primary diagnosis of mental retardation. (R. 584-85). "Mental retardation is not normally a condition that improves as an affected person ages. . . . Rather a person's IQ is presumed to remain stable over time in the absence of any evidence of a change in a claimant's intellectual functioning.'" Hodges, 276 F.3d at 1268-69 (quoting Muncy v. Apfel, 247 F.3d 728, 734 (8th Cir. 2001)). Given that Dr. Thornton's determination was provisional because she lacked Grant's school records and Dr. Ghostley commented on the lack of school records to support Grant's claim that he was enrolled in special education classes, it is probable that information concerning Grant's prior diagnosis of mental retardation, his similar IQ scores as a child, and documentation indicating Grant attended special education classes throughout most of his schooling would have assisted the psychologists in assessing Grant's intelligence level. Cf. Lowery, supra (recognizing that a claimant's attendance in special education classes and evidence that the claimant read at a third grade level while in junior high were consistent with a longstanding deficit in intellectual performance).
The Commissioner argues that the ALJ's determination that Grant does not meet Listing 12.05C is supported by substantial evidence because Grant does not have a diagnosis of mental retardation and he has "substantial adaptive functioning." First, Listing 12.05C does not require a diagnosis of mental retardation; rather, it requires a "valid verbal, performance, or full scale IQ of 60 through 70." Grant's test results fall within the parameters of Listing 12.05C. Thus, the plaintiff plainly has the requisite IQ score to meet the first prong of the listing.
More importantly, however, the ALJ applied an inproper legal standard when determining whether Grant meets the requirements of Listing 12.05C. The ALJ found that Grant does not meet Listing 12.05(C) based on his level of adaptive functioning.
(R. 18-19).
The ALJ concluded that Grant does not meet or equal the criteria of Listing 12.05C not because he does not have the requisite deficits in adaptive functioning but rather because he has some adaptive functioning. (R. 18-19). Stated another way, the ALJ did not consider whether Grant had the requisite deficits in adaptive functioning. Instead, the ALJ concluded that because Grant had some functioning, he did not meet the Listing.
The law in this Circuit holds that a claimant "meets the criteria for presumptive disability under section 12.05(C) when the claimant presents a valid IQ score of 60 to 70 inclusive, and evidence of an additional mental or physical impairment that has more than `minimal effect' on the claimant's ability to perform basic work activities." See Monroe, 504 F. App'x at 810 quoting Lowery, supra; Harris, 330 F. App'x at 815. See also Edwards, 755 F.2d at 1517. The ALJ concluded, and the Commissioner does not dispute, that Grant also suffers from depressive disorder and migraine headaches. (R. 16). Both conditions have more than a "minimal effect" on Grant's ability to perform work. Consequently, Grant meets the requirements of Listing 12.05C, and the ALJ erred as a matter of law when he applied the incorrect legal standard in ascertaining whether Grant meets Listing 12.05C.
The Listing's plain language requires Grant to demonstrate some deficits in adaptive functioning to meet the Listing, and the court concludes that he has done so. He cannot live independently. He cannot read or do simple math. He cannot cook. He cannot get alone with others. He has slow speech with a limited vocabulary. Grant has demonstrated that he suffers from the requisite deficits in adaptive functioning necessary to meet the Listing.
In addition to applying the incorrect legal standard, the ALJ erred by culling the record for selective references, and ignoring comments that did not support his conclusions. For example, the ALJ found, based on Dr. Ghostley's report, that Grant was "fully independent in performing daily activities." (R. 18). He ignores, however, Dr. Ghostley's comment that Grant "now lives with his brother," and Grant's testimony that he does not drive by himself, he does not own a car, he does not shop on his own, and although he has a checking account, he goes into the bank to get money. (R. 47, 58, 68,70, 516, 590). Grant further testified that he does not write checks on the account, but that his sister writes any checks. (R.145, 590). Grant further testified that he cannot read or do math, and his school records reflect that he reads at or below kindergarten level and does math at the second grade level. Although Grant indicated that he takes care of his dogs, he also indicated that the "[w]hole family helps with [the] dogs." (R. 588). Grant does not cook because he is "afraid of the stove since childhood accident."
Relying on treatment records from SpectraCare, the ALJ found that Grant "is very knowledgeable about cars, and the evidence shows he has bought and sold multiple cars during the alleged period of disability (Exhibit 19F)." (R. 18). The ALJ's interpretation of the treatment notes is disingenuous at best. On September 13, 2011, Grant commented in group therapy that "he has no reliable transportation to pursue his GED, goal 3 is on hold."
(R. 853).
In January 2012, Grant reported wanting to "pay off his car and become independent living (sic)." (R. 854). On February 14, 2012, Grant was excited about having a new girlfriend but he planned on living with his brother "until he can get his car paid off." (R. 856). Finally, on April 4, 2012, Grant reported that he had reliable transportation and "he has left women alone and has put his energy into Kingdom Hall." (R. 857). This evidence does not support the ALJ's conclusion that Grant is "very knowledgeable about cars . . . and bought and sold multiple cars." While the ALJ is entitled to make findings of fact, he cannot create facts out of whole cloth.
The ALJ also found that Grant was "able to act upon his own initiative" because he keeps a calendar with appointments in his room. (R. 18). This finding is speculative and unsupported by substantial evidence because the undisputed evidence demonstrates that Grant cannot read which would make it difficult to record or track appointments on a calendar. Finally, the ALJ relied on a treatment report that "indicated the Claimant did not have a cognitive impairment, which further indicates the Claimant does not have mild mental retardation (Ex.19F)." (R. 19). The ALJ is simply wrong. The court has scoured Grant's treatment records from SpectraCare (Ex. 19F) and has found no such notation about Grant's cognitive abilities.
The ALJ also relied on Grant's prior work experience in several "semi-skilled" jobs to conclude that he has a level of adaptive functioning. The record simply does not support the ALJ's conclusion that Grant's prior work constituted semi-skilled work, particularly in light of the ALJ's colloquy with the vocational expert.
(R. 88-92).
Thus, the court concludes that the ALJ erred as a matter of law in concluding that Grant's previous work history demonstrates that he worked in several semi-skilled jobs. Moreover, the ALJ does not explain how, if at all, Grant's prior work experience stacking veneer and sod or unloading trucks is inconsistent with mild mental retardation.
The ALJ further compounded his errors when he relied on Dr.Ghostley's opinion that Grant has "greater functional abilities" than suggested by the test results. (R. 19). According to Dr. Ghostley, "[t]he results of WAIS-IV cognitive testing indicate that Mr. Grant functions in the Mild Range of Mental Retardation. However, Mr. Grant's level of adaptive behavior is estimated to be such that a diagnosis of Mild Mental Retardation would be ruled out in favor of Borderline Intellectual Functioning." (R. 832). Beyond this conclusory statement, Dr. Ghostley offers no explanation and articulates no reasons for concluding that Grant is not suffering from mild mental retardation.
Thus, the court concludes that the ALJ's determination that Grant did not meet Listing 12.05C because Grant has some adaptive functioning is erroneous as a matter of law. Grant has valid IQ scores between 60 and 70. He also suffers from severe impairments of depressive disorder and migraines which impose additional and significant work-related limitations of function.
Accordingly, the decision of the ALJ must be reversed because, in considering whether Grant had an impairment that met or medically equalled the listing for mental retardation found in Listing 12.05C, the ALJ failed to follow the applicable regulations and law, and did not base his findings on substantial evidence. Walker, 826 F.2d at 999. Further, because the evidence establishes that Grant does meet the requirements of Listing 12.05C, the case will be remanded with instructions that benefits be awarded. Davis v. Shalala, 985 F.2d 528, 534 (11th Cir. 1993) (recognizing that reversal with award of benefits is appropriate where the Commissioner "has already considered the essential evidence and it is clear that the cumulative effect of the evidence establishes disability without any doubt"); Ambers, 736 F.2d at 1470 (holding that, if a claimant meets requirements of Listing 12.05C, "the claimant is determined disabled" at that point in the sequential analysis, and further consideration is unnecessary).
Accordingly, this case will be reversed and remanded to the Commissioner and the case remanded to the Commissioner with instructions that benefits be awarded. A separate judgment will be entered.
Further, it is
The Court will enter a separate final judgment.
(R. 109-110).
It is completely unclear how the vocational expert concluded that Grant, who cannot read or do math, could perform duties that involve taking inventory, requisitioning merchandise, or checking invoices.
Moreover, although Grant identified his position as "shipping and receiving," it is clear from his testimony that Grant simply unloaded pallets from trucks and placed the pallets under or on shelves. (R. 39, 45-46).