KATHERINE P. NELSON, Magistrate Judge.
Plaintiff Danyel Hill filed this action seeking judicial review of a final decision of the Commissioner of Social Security ("Commissioner") that she was not entitled to Supplemental Security Income ("SSI") under Title XVI of the Social Security Act (the Act), 42 U.S.C. §§ 1381-83c, on behalf of her son, M.H., a minor child (Tr. 125-127). Pursuant to the consent of the parties (doc. 27), this action has been referred to the undersigned Magistrate Judge to conduct all proceedings and order the entry of judgment in accordance with 28 U.S.C. § 636(c) and Fed. R.Civ.P. 73. See Doc. 22. The parties' joint motion to waive oral arguments (doc. 26) was granted on February 26, 2013 (doc. 29). Upon consideration of the administrative record (doc. 15)
Plaintiff Danyel Hill filed an applications for SSI benefits on September 30, 2008, on behalf of her son, M.H., (Tr. 125-127), claiming an onset of disability beginning September 1, 2008, due to low birth weight and hearing loss in one ear (Tr. 153). The application was denied on November 20, 2008 (Tr. 50-55). Plaintiff timely requested a hearing on January 12, 2009 (Tr. 56-58) before an Administrative Law Judge ("ALJ"). A hearing was held on August 3, 2010 (Tr. 31-44). The ALJ issued an unfavorable decision on September 27, 2010 (Tr. 11-27). Plaintiff requested a review by the Appeals Council on November 19, 2010,
In reviewing claims brought under the Social Security Act, including those involving benefits for an individual under the age of 18, such as this one, this Court's role is a limited one. Specifically, the Court's review is limited to determining: 1) whether the decision is supported by substantial evidence, and 2) whether the correct legal standards were applied. See, 42 U.S.C. § 405(g);
In determining whether substantial evidence exists, a court must view the record as a whole, taking into account evidence favorable as well as unfavorable to the Commissioner's decision.
The Personal Responsibility and Work Opportunity Act of 1996 became effective on August 22, 1996. See Pub.L. No. 104-193, 110 Stat. 2105 § 211(b)(2) (1996) (codified at 42 U.S.C. § 1382c). This legislation defined childhood disability as follows:
42 U.S.C. § 1382c(a)(3)(C)(i) (1997). The regulations state that an "impairment(s) causes marked and severe functional limitations if it meets or medically equals the severity of a set of criteria for an impairment in the listings, or if it functionally equals the listings." 20 C.F.R. § 416.924(d).
The regulations set forth a three-step sequential evaluation process that applies to a childhood disability determination:
20 C.F.R. § 416.924(a). At step one, plaintiff's age and work activity are identified. At step two, the impairments are identified. A severe impairment is one that is more than "a slight abnormality or a combination of slight abnormalities that causes no more than minimal functional limitations." 20 C.F.R. § 416.924(c). At step three, if plaintiff has a severe impairment, then plaintiff must establish that his or her impairment or combination of impairments meets or medically equals in severity and duration, an impairment listed in the Listings of Impairments (the Listings). 20 C.F.R. Pt. 404, Subpt P, App. 1. If not, then the Commissioner must determine whether plaintiff's impairments or combination of impairments functionally equal the criteria for a Listing. 20 C.F.R. §416.926a(a)("If you have a severe impairment or combination of impairments that does not meet or medically equal any listing, we will decide whether it results in limitations that functionally equal the listings. By `functionally equal the listings,' we mean that your impairment(s) must be of listing-level severity; i.e., it must result in `marked' limitations in two domains of functioning or an `extreme' limitation in one domain, as explained in this section.").
The structure of the mental disorders listings for children under age 18 parallels the structure for the mental disorders listings for adults but is modified to reflect the presentation of mental disorders in children, which are arranged in 11 diagnostic categories. 20 CFR Pt. 404, Subpt. P, App. 1, Listing 112.00. The diagnostic category at issue in this case is titled Mental Retardation, which is designated as Listing 112.05. Id.
Listing 112.05 states the following in the introductory remarks: "Characterized by significantly subaverage general intellectual functioning with deficits in adaptive functioning." 20 C.F.R. Part 404, Subpart P, Appendix 1, Listing 112.05. Subsection D requires "[a] valid verbal, performance, or full scale IQ of 60 through 70 and a physical or other mental impairment imposing additional and significant limitation of function." 20 C.F.R. Part 404, Subpart P, Appendix 1, Listing 112.05D.
The structure of the listings for Mental Retardation (112.05) is different from that of the other mental disorders. 20 CFR Pt. 404, Subpt. P, App. 1, Listing 112.00. Instead of a predicating a finding of listed impairment on the satisfaction of criteria set forth in both Paragraph A (a composite of medical findings which are used to substantiate the existence of a disorder) and Paragraph B (describe impairment-related functional limitations), Listing 112.05 (Intellectual Disability) provides that "if an impairment satisfies the diagnostic description in the introductory paragraph and any one of the six sets of criteria, we will find that the child's impairment meets the listing." 20 CFR Pt. 404, Subpt. P, App. 1, Listing 112.00. The regulations also provide:
20 CFR Pt. 404, Subpt. P, App. 1, Listing 112.00.
To determine functional equivalence, the Commissioner must consider plaintiff's limitation of specific functioning, broad areas of development, episodic impairment, and effect of treatment or medication. 20 C.F.R. § 416.926a(b). To determine plaintiff's level of function in the broad areas of development, the ALJ must address six domains of development or functioning:
20 C.F.R. § 416.926a(b)(1)(i-vi). If plaintiff has an extreme limitation in one domain or marked limitation in two domains, a finding of functional equivalence will be made. 20 C.F.R. § 416.926a(d),(e),(f).
An extreme limitation of function occurs when the impairment "interferes very seriously with [plaintiff's] ability to independently initiate, sustain or complete activities". 20 C.F.R. § 416.926(e)(3)(i). This limitation may occur whether the impairment limits one activity or the cumulative effect of plaintiff's impairments limit several activities, and is given to the "worst limitations." Id. Also, the regulations state that an extreme limitation is "the equivalent of the functioning we would expect to find on standardized testing with scores that are at least three standard deviations below the mean." Id.
A marked limitation of function occurs when the impairment "interferes seriously with [plaintiff's] ability to independently initiate, sustain or complete activities". 20 C.F.R. § 416.926(e)(2)(i). This limitation may occur whether the impairment limits one activity or the cumulative effect of plaintiff's impairments limit several activities. Id. Also, the regulations state that a marked limitation is "the equivalent of the functioning we would expect to find on standardized testing with scores that are at least two, but less than three, standard deviations below the mean." Id.
M.H. began treatment with Milton S. Brasfield, III, MD, on June 10, 1998. Records show he was born at 25 weeks gestation on September 20, 1997, and weighed one pound, seven ounces at birth. (Tr. 229). Most of the treatment records are illegible or show treatment for upper respiratory infection, tinea,
M.H. had an audiology examination on March 27, 2007, at Children's Hospital. Audiogram showed "mild high-frequency sensorineural hearing loss" in the left ear with normal hearing in the right ear (Tr. 225-227). The hearing loss was confirmed in 2008 and again in 2010 at Childrens Rehabilitation Services ("CRS") (Tr. 249-251, 287-314). During the September 2, 2008, CRS Hearing Assessment Clinic, plaintiff reported that her main concern was that M.H. was "not doing well in school, especially with math and reading, however, he is doing well in spelling and science [and] does not receive special education services at this time" (Tr. 251, 307-308). Dr. James H. Walburn, ENT, reported on September 18, 2008, that:
(Tr. 250, 306). M.H.'s presented for follow-up visits to the CRS Hearing Assessment Clinic on May 20, 2009 (Tr. 300-305) and February 18, 2010 (Tr. 289-299). His hearing loss was described as "stable" and it was recommended each time that he receive "preferential classroom seating" (Tr. 289, 295, 300).
On October 17, 2008, M.H.'s fourth-grade teacher, Inez Craig, completed a teacher questionnaire (Tr. 162-71) which specifically addressed, through a series of related questions, the six domains of functioning that the ALJ was required to assess in this case. Ms. Craig indicated that M.H. had "an obvious problem" with respect to two aspects
On October 20, 2008, M.H.'s former special education teacher, K. Scarbough, completed a "function report — child," indicating that M.H. had a sensorineneural hearing loss, which was a "[h]igh frequency loss [for which the] Doctor doesn't think an [sic] hearing aid would help" (Tr. 174). She also noted that he was able to talk and was not limited in his ability to communicate (Tr. 175-176). M.H.'s ability to progress in learning was limited in that he could not read and understand stories in books or magazines, write longhand, write a simple story with 6-7 sentences, understand money and make correct change, or tell time (Tr. 177). M.H.'s physical abilities were not limited, and his impairments did not affect his behavior with other people or his ability to help himself and cooperate with others in taking care of personal needs (Tr. 179-80). His ability to pay attention and stick with a task was limited in that, although he could keep busy on his own, he could not finish things he started, work on arts and crafts projects, complete homework, or complete chores most of the time (Tr. 180).
A grade report card for the first nine weeks of the fourth grade showed that M.H. received two A's (90-100) in spelling and physical education, four C's (70-79) in Language (71) handwriting (79), science (75) and social studies (75), and one D (60-69) in reading (69) (Tr. 192).
Samuel Williams, M.D., a State agency medical consultant, reviewed the record and completed a childhood disability evaluation form in November 2008, indicating that M.H.'s left sensorineural hearing loss and history of low birth weight were severe impairments, but did not meet, medically equal, or functionally equal the listings (Tr. 253). Dr. Williams found that M.H. had a less than marked limitation in acquiring and using information, a marked limitation in attending and completing tasks, no limitation in interacting and relating with others, moving about and manipulating objects, and caring for himself, and a less than marked limitation in health and physical well-being (Tr. 255-56). Dr. Williams noted, with respect to the domain of "acquiring and using information," that M.H. was passing all his courses according to his grade report dated October 20, 2008 (Tr. 255).
On March 29, 2010, M.H. was seen by Milton Brasfield, M.D., for a well child exam (Tr. 316). M.H. reported that he was in the fifth grade and was doing well in school (Tr. 316). His grades were mostly C's (Tr. 316). He was involved in football and basketball (Tr. 316).
On July 7, 2010, Donald Blanton, Ph.D., evaluated M.H. at the request of Plaintiff's attorney (Tr. 320-23). Plaintiff reported that M.H. was entering the sixth grade in a special education class (Tr. 320). IQ testing showed that M.H. had a full scale IQ of 63 (Tr. 321). Dr. Blanton diagnosed M.H. with mild mental retardation (Tr. 322). He assigned M.H. a global assessment of functioning (GAF) rating of 60
At the August 2010 hearing, Plaintiff testified that M.H. went to kindergarten and repeated the first grade (Tr. 34). M.H. was born with hearing problems in both ears (Tr. 34). His hearing aides were not helping, and it would not improve with an operation (Tr. 35). M.H. was in regular class, but a Special Education teacher comes to his regular class to help him with reading and math (Tr. 36). He did not participate in sports, but played basketball by himself (Tr. 37-38). M.H. watched television, did homework, and played a game (Tr. 38). He did not play video games (Tr. 38). He went to Sunday school every Sunday and was involved in the choir (Tr. 38). M.H. was suspended when he was in the first grade, but had not been suspended or expelled from school since 2008 (Tr. 40). M.H. could not tell time or count money (Tr. 42). When M.H. was in the fourth grade, it was decided he needed special education after failing his hearing test (Tr. 43). He took the hearing test every year, but had never passed it (Tr. 43).
The ALJ found that M.H. was born in 1997 and was, therefore, a school-age child on September 19, 2008, the amended alleged onset date, and an adolescent at the time of the ALJ's decision (Tr. 14). M.H. had not engaged in substantial gainful activity since the onset date (Tr. 14). The ALJ found that M.H. had the following "severe" impairments: bilateral sensorineural hearing loss and status post history of low birth weight (Tr. 14). The ALJ also found that M.H. did not have an impairment or combination of impairments that met or medically equaled one of the listed impairments in 20 C.F.R. pt. 404, Subpt. P, App. 1 (Tr. 14-15). The ALJ noted (Tr. 17) the Function Report (Tr. 171-182) completed on October 20, 2008, by M.H.'s Special Education Teacher and found that his "ability to progress in learning is limited in reading and understanding stories in books and magazines; writing in longhand (script); writing a simple story with 6-7 sentences; understanding money — [i.e. the ability to] make correct change; and telling time" (Tr. 17).
The ALJ acknowledged the report submitted by Donald W. Blanton, Ph.D. in which it was reported that M.H. "will be in the 6
The ALJ determined, based on his review of the evidence (Tr. 15-21), that M.H.'s performance in the six domains of functioning was as follows:
The ALJ concluded that M.H.'s impairments did not functionally equal a listing because he did not have "marked" limitations in two domains or an "extreme" limitation in one domain, (Tr. 15). The ALJ concluded, therefore, that M.H. was not disabled under the Act (Tr. 27).
A transcript report showed that M.H. repeated the first grade. In his repeated first grade, he received 2 A's, 10 B's, and four C's (Tr. 214). In second grade, M.H. received three A's, six B's, four C's, and one D (Tr. 214). In third grade, M.H. received three A's, three C's, five D's, and three F's (Tr. 214).
A student transcript showed that in fourth grade (1st and 2nd semesters), M.H. received three A's, eight C's, and five D's (Tr. 220). In fifth grade (1st and 2
M.H.'s May 2010 Individualized Education Program (IEP)
Although plaintiff contends that "an updated transcript that included first grade through fourth grade" was submitted on June 16, 2010, and that "the IEP for 2010-2011" was submitted on August 10, 2010, plaintiff concedes that "[t]he ALJ did not acknowledge receipt of the evidence and the evidence did not appear on the exhibit list attached to his decision." (Doc. 18 at 8). Plaintiff has proffered no proof that the ALJ ever received this evidence. In addition, plaintiff's counsel was given the opportunity at the commencement of the hearing on August 3, 2010, to examine the exhibits admitted into evidence and he made no assertion that the record was in any manner incomplete (Tr. 33). Nor did counsel ever request that the record be kept open in order to supplement the record. The ALJ did not, therefore, reject this evidence or commit reversible error.
Moreover, this evidence was submitted to the Appeals Council (Tr. 201-214), and considered as part of its denial of review (Tr. 1-7). The Appeals Council specifically concluded that the "new" evidence "does not provide a basis for changing the Administrative Law Judge's decision" (Tr. 2).
Plaintiff argues that the ALJ erred in rejecting Dr. Blanton's opinion because, in sum, (1) it is irrelevant that M.H. was not in separate special education classes (it was sufficient that he was getting special education assistance with his reading and math); (2)records not before the ALJ for reasons previously stated showed that M.H. failed the first grade and was doing poorly until his performance "was enhanced after the accommodation allowed by the IEP"; (3) the fact that he "passed his classes after the application of his IEP simply . . . supports a finding of mental retardation"; (4) Dr. Blanton's opinion is uncontroverted; and (5) the ALJ should have ordered additional testing if he was uncertain as to the validity of the IQ scores obtained by Dr. Blanton. (Doc. 18 at 8-9).
The ALJ may discount a medical source opinion for good cause where the medical source's opinion was not bolstered by the evidence, or where the evidence supported a contrary finding. See
(Tr. 20). The ALJ's opinion is, however, in error because he not only failed to acknowledge that "the claimant's teacher" who completed the Function Report he referred to in his decision (Tr. 17) was M.H.'s Special Education Teacher (Tr. 173), but he ignores prevailing law regarding "mainstreaming" and special education under the Individuals with Disabilities Education Act ("IDEA"), 20 U.S.C. § 1400 et seq.
At the outset, the Supreme Court emphasized that the IDEA "requires participating States to educate handicapped children with nonhandicapped children whenever possible."
"IDEA requires the development of an individualized education program ("IEP") for each child falling within the purview of IDEA [which] are created and periodically reviewed following meetings at which parents, teachers, other school personnel, and educational experts all participate."
In this case, the ALJ erred when he held that Dr. Blanton's finding of mental retardation was inconsistent with the fact that M.H. is not in special education classes for all subjects but merely receives "special help in math and reading" (Tr. 20). The fact that mainstreaming constituted the least restrictive environment within which M.H. could be educated was not evidence inconsistent with a diagnosis of mental retardation.
The ALJ further erred when he concluded that "the limits set forth in Dr. Blanton's assessment appear additionally inconsistent with someone with a Global Assessment Functioning of 60."
The ALJ also concluded that Dr. Blanton's opinion was inconsistent with M.H.'s school grades (Tr. 20). However, the ALJ only considered M.H.'s partial fourth-grade transcript (Tr. 192). He made no effort to obtain the additional school transcripts from first through sixth grades (Tr. 214, 219-221), even though the evidence established that M.H. was receiving Special Education. See Tr. 173-182. The fact that the special assistance M.H. received in reading and math may have enhanced his grades in those specific areas as well as his other courses is not inconsistent with M.H.'s IQ score of 63, Dr. Blanton's assessment or the diagnosis of mental retardation. Consequently, the ALJ's decision is not supported by substantial evidence because he erroneously rejected Dr. Blanton's opinion.
Plaintiff contends that M.H. meets the criteria for Listing 112.05D because Dr. Blanton presented evidence of a valid Full Scale IQ score of 63 (Tr. 321) and "[t]he ALJ found M.H. had the severe impairments of sensorineural hearing loss bilateral; and status post history of low birth weight. (Tr. 33)." (Doc. 18 at 9). Neither the IQ score nor the designation of M.H.'s hearing loss as "severe" is sufficient here alone or in combination.
Although the ALJ characterized M.H.'s high frequency left-ear hearing loss as a severe impairment, the medical record shows that no hearing aid—or any other treatment—was prescribed for it other than "preferential classroom seating" (Tr. 290, 289-314). School records have provided no indication that M.H's hearing loss has affected his ability to perform his school work (see Tr. 170,
In addition, as stated above, M.H. must have "significantly subaverage general intellectual functioning
"[A] valid I.Q. score need not be conclusive of mental retardation where the I.Q. score is inconsistent with other evidence in the record of the claimant's daily activities and behavior."
DSM-IV-TR (emphasis in original).
Here, the ALJ does not challenge the validity of M.H.'s full scale IQ score of 63. To the extent the ALJ held that the record evidence with regard to M.H.'s adaptive functioning was not consistent with mental retardation, the ALJ applied an incorrect standard by assuming that a child with mental retardation could not be mainstreamed but, instead, had to be placed in special education classes for all subjects. The case must be remanded and M.H.'s impairments evaluated under the proper standard, including consideration of all the relevant school transcripts and the I.E.P. developed in May of 2010 pursuant to the requirements of the IDEA.
Plaintiff contends that "updated school records and an updated IEP" was submitted to the Appeals Council on December 12, 2011 and they did not properly evaluate the new evidence. (Doc. 18 at 10). Plaintiff relies on
There are school records in the transcript (Id. citing Tr. 219-221) that have been designated by the Appeals Council as Exhibit C14E (Tr. 5). These records report M.H.'s grades in increments of "1
There is some confusion regarding the two I.E.P's at issue on this appeal. In counsel's letter dated December 12, 2011, plaintiff is said to be submitting an "IEP dated November 18, 2011" (Tr. 216). Plaintiff complains that the Appeals Council "did not respond to the IEP in any manner" (doc. 18 at 4) and "did not acknowledge the IEP" (doc. 18 at 10). The Commissioner argues that "Plaintiff has not shown that the Appeals Council ever received this evidence." (Doc. 24 at 13). However, the Appeals Counsel included in its Exhibit C14E a page entitled "Notice of Proposed Meeting/Consent for Agency Participation" dated November 18, 2011 (Tr. 222). This page (Tr. 222) corresponds to the first page of the document plaintiff sought to add to the record (doc. 16-1 at 5), which is an I.E.P. developed for the school year from August 11, 2011 to May 11, 2012 (doc. 16-1 at 15). A question, therefore, remains as to whether the Appeals Council received only one page or the entire I.E.P dated November 18, 2011 and governing the 2011-2012 school year. However, the Commissioner also challenges this IEP's relevance inasmuch as it pertains to a period after the September 27, 2010 decision by the ALJ.
There is also a second I.E.P. in this record that was before the Appeals Council, as evidenced by its designation as Exhibit C12E (Tr. 5), and is relevant because it was developed on May 7, 2010 to govern the school year from August 8, 2010 to May 25, 2011 (Tr. 201-211). The Appeals Council stated that it had considered the additional evidence Plaintiff submitted, namely the "updated school records" (Tr. 215-222), but was denying review because that evidence did not provide a basis for changing the ALJ's decision (Tr. 1-2). The Appeals Council therefore did not reverse the ALJ's opinion to the extent that it was based on the application of an incorrect standard, namely the assumption that a child with mental retardation could not be mainstreamed but, instead, had to be placed in special education classes for all subjects. Nor did the Appeals Council remand the case to the ALJ for further evaluation of M.H.'s impairments under the proper standard and with directions to include consideration of all the relevant school transcripts and the I.E.P. developed in May of 2010 pursuant to the requirements of the IDEA.
"[T]he Appeals Council was not required to provide a more thorough explanation than it did."
For the reasons stated above, the Court concludes and it is therefore
In light of the foregoing, and the plain language of sentence four of 42 U.S.C. § 405(g), the undersigned Magistrate Judge recommends that this cause be reversed and remanded pursuant to sentence four of 42 U.S.C. § 405(g) for further proceedings. See