S. ALLAN ALEXANDER, Magistrate Judge.
This case involves an application under 42 U.S.C. § 405(g) for judicial review of the decision of the Commissioner of Social Security denying the application of plaintiff Tarshon M. Phillips for supplemental security income (SSI) payments under Section Title XVI of the Social Security Act. Plaintiff protectively filed his application for SSI on August 12, 2008
Plaintiff was born on March 21, 1974 and was 35 years old on the date of the administrative hearing. Docket 8, p. 30. He completed the eleventh grade without the aid of special education classes. Docket 8, p. 30-31. The plaintiff claimed disability beginning March 17, 2003 due to cirrhosis, high blood pressure, swollen feet, shortness of breath, memory loss and fatigue (Docket 8, p. 33-39, 128). He has not engaged in substantial gainful activity.
The ALJ determined that plaintiff's cirrhosis, obesity, and mild mental retardation constituted "severe" impairments but that these impairments did not meet or equal a listed impairment in 20 C.F.R. Part 404, Subpart P, App. 1 (20 C.F.R. 416.920(d), 416.925 & 416.926). Docket 8, p. 15-18. He concluded that the plaintiff's liver disease did not meet Listing 5.05 and plaintiff's mental impairments did not meet Listing 12.05 because the medical evidence and the plaintiff's testimony did not demonstrate adaptive functioning deficits manifested before age 22, as required. Docket 8, p. 17. The ALJ found that Listing 12.05's "paragraph B" criteria were not satisfied because the plaintiff experienced only "moderate" restrictions in activities of daily living, moderate difficulties in social functioning and in maintaining concentration, persistence or pace and no episodes of decompensation. He found plaintiff did not satisfy the "paragraph C" criteria because plaintiff did demonstrate that he had a valid verbal, performance, or full scale IQ of 60 through 70 with deficits which manifested before age 22.
Considering the entire record, the ALJ concluded that the plaintiff retained the Residual Functional Capacity (RFC) to
Docket 8, p. 18-19. The ALJ found that the plaintiff's impairments "could reasonably be expected to cause the alleged symptoms" but his testimony of the "intensity, persistence, and limiting effects" of his symptoms was "not credible" because it is not supported by the objective medical evidence. Docket 8, p. 19.
Based on testimony of a vocational expert [VE], the ALJ held that although the plaintiff has no past relevant work, his "severe" impairments do not prevent him from performing unskilled jobs at the light level of exertion, such as cafeteria attendant, clipper and bagger. Docket 8, p. 21. Considering plaintiff's age, education, work experience and RFC, the ALJ concluded that the plaintiff could perform work that exists in significant numbers in the national economy, and he therefore was "not disabled" under the Social Security Act. Docket 8, p. 22.
The plaintiff claims that the ALJ erred in evaluating the severity of the plaintiff's mental disorder under Listing 12.05(C).
In determining disability, the Commissioner, through the ALJ, works through a five-step sequential evaluation process.
The court considers on appeal whether the Commissioner's final decision is supported by substantial evidence and whether the Commissioner used the correct legal standard. Crowley v. Apfel, 197 F.3d 194, 196 (5th Cir. 1999), citing Austin v. Shalala, 994 F.2d 1170 (5th Cir. 1993); Villa v. Sullivan, 895 F.2d 1019, 1021 (5th Cir. 1990). It is the court's responsibility to scrutinize the entire record to determine whether the ALJ's decision was supported by substantial evidence and whether the Commissioner applied the proper legal standards in reviewing the claim. Ransom v. Heckler, 715 F.2d 989, 992 (5th Cir. 1983). The court has limited power of review and may not reweigh the evidence or substitute its judgment for that of the Commissioner,
The plaintiff has not engaged in substantial gainful activity since his alleged onset date of March 17, 2003, satisfying step one. At step two, the ALJ found that plaintiff's impairments (cirrhosis, obesity, and mild mental retardation) were severe, but he determined at step three that the impairments did not meet the stringent requirements set out in the listings,
Listing 12.05 of 20 C.F.R. Part 404, Subpart P, App. 1, states, in part:
The ALJ found that "[n]either the medical evidence of record nor testimony from claimant suggests that adaptive functioning deficits were manifested during this developmental period [before age 22]." Docket 8, p. 17. In support, the ALJ noted that the plaintiff completed the eleventh grade at the average age of seventeen and that he did not report or present evidence of enrollment in special education courses while in school. Docket 8, p. 17. According to plaintiff, however, even though he finished the eleventh grade,
The plaintiff further argues that an assessment by consultative physician Dr. Powers indicated an impairment before age 22. Docket 11, p. 8. In his Psychiatric Review Technique, Dr. Powers checked the box under 12.05 Mental Retardation stating "[s]ignificantly 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, with . . . [a] valid verbal, performance, or full scale IQ of 60 through 70."
Additionally, the plaintiff argues that the ALJ failed to consider evidence of previous SSI benefits. Docket 11, p. 8. Under 20 CFR 416.211(a)(1), SSI benefits are not available to residents of public institutions. According to information on the official website of the U.S. Social Security Administration, if confinement last for twelve consecutive months or longer, SSI benefits terminate and a claimant must file a new application for benefits.
Although the record does not contain evidence that the plaintiff requested review and inclusion in the record of his previous application for SSI benefits, the ALJ knew that plaintiff had been a past recipient of SSI payments. Docket 8, p. 32. An ALJ has an affirmative duty to develop the record and to "ensure that his decision is an informed decision based upon sufficient facts," Brock v. Chater, 84 F.3d 726, 728 (5th Cir. 1996).
This duty becomes even more important in the peculiar circumstances of this case. The Commissioner argues that the "prior information is not relevant because the relevant time period for Plaintiff's Title XVI application is August 12, 2008, his application date, through March 12, 2010, the date of the administrative law judge's decision." But a claimant who seeks SSI payments because of mental retardation must demonstrate deficits in adaptive behavior which manifested before the age of 22, making the time period of plaintiff's previous award critically important to the determination of disability in this case. The ALJ relied solely on evidence that the plaintiff attended high school through a regular curriculum, rather than a special education curriculum, to determine that those deficits were not present before plaintiff turned 22 years of age. Even though the ALJ was told that the plaintiff had received SSI benefits in the past, he neither sought to elicit further testimony on the issue, nor to obtain plaintiff's prior Social Security Administration file nor to otherwise obtain evidence relating to the prior award.
In evaluating the "paragraph C" requirements, the ALJ gave significant weight to consultative physician Dr. Drumheller's opinions because he personally evaluated the plaintiff on June 3, 2003. Docket 8, p. 15-16. Dr. Drumheller found "mild" impairment in the plaintiff's ability to interact with co-workers; "mild" impairment in his ability to receive supervision; and "poor" concentration and attention. Docket 8, p. 192. However, Dr. Drumheller also found plaintiff had a full scale IQ score of 64, which places the plaintiff's level of intellectual functioning in the mild range of mental retardation. Docket 8, p. 191.
The ALJ nevertheless concluded that the plaintiff did not have a valid verbal, performance, or full scale IQ of 60 through 70 and a physical or other mental impairment imposing an additional and significant work-related limitation of function, because the plaintiff "did not put forth his best effort" in completing the test performed by Dr. Drumheller. The undersigned has reviewed the entire psychological evaluation and finds no basis for discounting the IQ score. Indeed, Dr. Drumheller reported that the plaintiff's reliability was "fair to good" (Docket 8, p. 188) and that the plaintiff "put forth his best effort during the testing session." Docket 8, p. 189.
The ALJ ignored evidence of a prior disability award that could potentially establish the criteria of the threshold requirement of Listing 12.05 — deficits in adaptive behavior prior to age 22 — and erroneously discounted the IQ score required to satisfy the "paragraph C" requirements. As a consequence, the ALJ's decision was not supported by substantial evidence and must be remanded for further proceedings.
Because this case is being remanded for further proceedings consistent with this opinion, the court need not address the merits of the plaintiff's remaining arguments at this time. A separate judgment in accordance with this Memorandum Opinion will issue this date.
www.socialsecurity.gov/pubs/10133.