Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca8-14-02780/USCOURTS-ca8-14-02780-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 

---

United States Court of Appeals

For the Eighth Circuit

___________________________

No. 14-2780

___________________________

Tammy Hesseltine

lllllllllllllllllllll Plaintiff - Appellant

v.

Carolyn W. Colvin, Acting Commissioner of Social Security

lllllllllllllllllllll Defendant - Appellee

____________

Appeal from United States District Court 

for the Southern District of Iowa - Davenport

____________

 Submitted: April 17, 2015

 Filed: August 26, 2015

____________

Before MURPHY, COLLOTON, and KELLY, Circuit Judges.

____________

KELLY, Circuit Judge.

TammyHesseltine applied for disability insurance benefits under Title II ofthe

Social Security Act. An administrative law judge (ALJ) found Hesseltine was not

disabled because the combination of her mental and physical impairments did not

meet the listed impairment under 20 C.F.R. § 404, Subp. P. App. 1, § 12.05C. The

Social Security Appeals Council denied Hesseltine’s request for review, and the

Appellate Case: 14-2780 Page: 1 Date Filed: 08/26/2015 Entry ID: 4309886 
district court affirmed. On appeal, Hesseltine argues the ALJ failed to sufficiently

address whether her impairments medically equal Listing 12.05C. We agree, and

remand the case for further proceedings.

I. Background

In 1993, when Hesseltine was eight years old, she was given IQ testing by a

school psychologist. Under the Wechsler Intelligence Scale for Children, she

1

obtained a full scale IQ score of 70, a 72 in processing, and a 73 in verbal. The

psychologist noted that Hesseltine was “within the Borderline range of mental

functioning.” The psychologist also found that Hesseltine’s “adaptive behavior

composite score” was a 71, which placed her in the third percentile of her peers. 

When Hesseltine graduated from high school in 2003, she read at a sixth grade level.

Hesseltine underwent several surgeries as a child to treat an impairment in her

left leg caused by Perthes disease, a disorder that cuts off blood flow to the hip. In

2004, when Hesseltine was age 18, David Speigel, M.D., noted that there had been

no changes in her hip since 2001 and that her Perthes disease was asymptomatic. Her

left leg was 1.5 centimeters shorter than her right leg, and her mobility was limited

by the condition. 

In 2005, Roger Mraz, Ph.D., a licensed psychologist, administered a Wechsler

Adult Intelligence Scale and determined that Hesseltine had a full scale IQ score of

71, a processing score of 73, and a verbal score of 74. Dr. Mraz noted that “[o]verall,

the results of the intellectual assessment suggests [sic] that Tammy is functioning

near the lower end of the Borderline Range, at the 3rd percentile.” Dr. Mraz

additionally assessed Hesseltine’s adaptive behavior, based on consultations with her

School psychologists are “acceptable medical sources” under 20 C.F.R. 1

§ 404.1513(a)(2). 

-2-

Appellate Case: 14-2780 Page: 2 Date Filed: 08/26/2015 Entry ID: 4309886 
aunt. Her daily living skills were low-average, in the 25th percentile, but her

communication skills were “below the 0.1 percentile” due to her “low academic

skills” and “borderline adaptive functioning.” The assessment concluded that

“Tammy should have no difficulty following simple instructions, and would probably

do better on repetitive type tasks.”

From 2004 to 2005, Hesseltine worked irregularly as a cook’s helper in a

school cafeteria. From 2005 to 2007, Hesseltine worked part-time at a laundry

business with the help of a job coach. Her supervisor at the laundry indicated that

Hesseltine “works better than most in the same position,” that she required little

supervision and sometimes had “ a lot of independence,” and that he “would hire her

again.” In 2009, Hesseltine worked briefly as a housekeeper in a casino. 

In 2006, Hesseltine was diagnosed with polycystic ovarian syndrome, but after

several months her symptoms resolved and she was able to manage her syndrome

with medication. In 2007, C.W. Huang, M.D., gave Hesseltine a physical

examination and observed limitation in flexion of her left hip and knee, “probably due

to obesity.” He noted that left hip pain would occur if she stood for more than one

hour.

Hesseltine twisted her hip while at work in July 2009. She sought treatment,

and an X-ray revealed “extensive changes consistent with Perthes disease.” Her

treating physician, Gregory Bell, M.D., diagnosed “acute exacerbation of left hip

pain” but indicated that no MRIs or other follow up was necessary and that Hesseltine

“can go back to work in a week like she is planning to do.”

Hesseltine completed a function report form in 2007, and again in 2012. She

indicated that she lived with her husband, that she “prepare[d] food all the time

daily,” as well as “small amounts of cleaning, laundry, [and] mowing” with breaks. 

She reported that she went shopping for household items and food, but that she had

-3-

Appellate Case: 14-2780 Page: 3 Date Filed: 08/26/2015 Entry ID: 4309886 
trouble counting change and got confused. She stated that she followed cooking

recipes “Ok.” She also reported that she could not walk more than a block without

needing to rest and could lift a gallon of milk at a maximum.

Hesseltine’s insured status expired on September 30, 2009. She applied for

disability insurance benefits on July 28, 2010. At the request of the ALJ and

Hesseltine’s attorney, on January 31, 2012, Dr. Mraz met Hesseltine for a second IQ

evaluation. This time her results included: a full scale IQ of 72, a processing score

of 79, and a verbal score of 76. Dr. Mraz noted that “the results of the intellectual

assessment indicate that Tammy is functioning near the lower end of the Borderline

range.” Her Global Assessment of Functioning (GAF) was assessed at 65.

Following an administrative hearing, the ALJ denied Hesseltine’s claim for

insurance benefits in February 2012. In reaching her decision the ALJ engaged in the

familiar five step analysis outlined in 20 C.F.R. § 416.920(a)(4). At the first step she

found that Hesseltine had not engaged in substantial gainful activity after January 1,

2007, the alleged onset date. Next, she found that Hesseltine suffered from the

following severe impairments: borderline intellectual functioning, Perthes disease of

the left hip, polycystic ovarian syndrome, and obesity. Third, she found that this

combination of impairments did not meet or medically equal one of the listed

impairments in 20 C.F.R. § 404, Subp. P. App. 1, including Listing 12.05C. 

The ALJ then evaluated Hesseltine’s residual functional capacity and

concluded that through the last insured date Hesseltine could lift and carry twenty

pounds occasionally and ten pounds frequently; could push and pull within the same

weight restrictions; could stand or walk for two hours in an eight hour workday;

could sit for six hours in an eight hour workday; could occasionally climb ramps and

stairs, but never ladders, ropes, or scaffolds; could occasionally balance and stoop,

but never kneel; could occasionally crouch, but never crawl; should avoid

concentrated exposure to hazards such as heights and machinery; and could perform

-4-

Appellate Case: 14-2780 Page: 4 Date Filed: 08/26/2015 Entry ID: 4309886 
only simple, routine tasks with a specific vocational preparation level of one or two. 

At the hearing a vocational expert testified that a hypothetical person with these

limitations could perform work as an ampoule sealer, lens gauger, or final assembler. 

The ALJ therefore concluded that there were jobs in the national economy that

Hesseltine could perform and denied her application for disability benefits. 

The Appeals Council denied review of the ALJ’s decision and the district court

affirmed. On appeal, Hesseltine argues that her impairments “medically equal”

Listing 12.05C. She maintains that the ALJ failed to provide a reviewable decision

as to her equivalence findings. 

II. Discussion

“We review de novo a district court’s denial of social security benefits.” 

Halverson v. Astrue, 600 F.3d 922, 929 (8th Cir. 2010). We must “determine whether

the ALJ’s decision complies with the relevant legal requirements and issupported by

substantial evidence in the record as a whole.” Id. (quotation omitted). We have

defined substantial evidence as “such relevant evidence that a reasonable mind might

accept as adequate to support a conclusion.” Id. (citing Heino v. Astrue, 578 F.3d

873, 878 (8th Cir. 2009)). 

Hesseltine argues that the ALJ erred in step three of the sequential evaluation

by finding that her impairments did not satisfy the requirements of Listing 12.05C. 

Hesseltine wasrequired to establish: “(1) a valid verbal, performance, or fullscale IQ

score of 60 through 70, (2) an onset of the impairment before age 22, and (3) a

physical or other mental impairment imposing an additional and significant workrelated limitation of function.” Phillips v. Colvin, 721 F.3d 623, 625 (8th Cir. 2013)

(quoting McNamara v. Astrue, 590 F.3d 607, 610–11 (8th Cir. 2010)); see also 20

C.F.R. § 404, Subp. P, App. 1, § 12.05C. Because Hesseltine had received IQ scores

-5-

Appellate Case: 14-2780 Page: 5 Date Filed: 08/26/2015 Entry ID: 4309886 
of 71 and 72, above the range of 60–70, the ALJ determined that she failed to meet

the first element of Listing 12.05C.2

However, a finding that a claimant does not meet a given listing “does not end

the inquiry.” Shontos v. Barnhart, 328 F.3d 418, 424 (8th Cir. 2003). “The

regulations provide that if a claimant has more than one impairment, the combined

effect of the impairments will be considered.” Id. The medical equivalence

regulation provides:

If you have a combination of impairments, no one of which meets a

listing . . . , we will compare your findings with those for closely

analogous listed impairments. If the findings related to your

impairments are at least of equal medicalsignificance to those of a listed

impairment, we will find that your combination of impairments is

medically equivalent to that listing.

20 C.F.R. § 404.1526(b)(3).

Instructions for determining whether a person’s combination of impairments

is medically equal to a given listing are outlined in the Program Operations Manual

System (POMS). “Although POMS guidelines do not have legal force, and do not

bind the Commissioner, this court has instructed that an ALJ should consider the

POMS guidelines.” Shontos, 328 F.3d at 424. The applicable POMS guideline for

Listing 12.05C provides:

When Hesseltine was eight years old she received a full scale IQ score of 70,

2

which would place her within the limits of Listing 12.05C. Under SSA regulations,

however, this score is outdated and her more recent scores must be used for

determining her IQ (which ranged from 71 to 79 from 2005 to 2012). See 20 C.F.R.

§ 404, Subp. P, App. 1, § 112.00(D)(1) (“IQ test results obtained between ages 7 and

16 should be considered current . . . for 2 years when the IQ is 40 or above.”)

Hesseltine does not contest this regulation. 

-6-

Appellate Case: 14-2780 Page: 6 Date Filed: 08/26/2015 Entry ID: 4309886 
D. Determining Medical Equivalence in Particular Situations

1. MEDICAL EQUIVALENCE AND MENTAL RETARDATION

Listing 12.05C, Mental Retardation and Autism, applies primarily to

adults with significantly subaverage intellectual functioning and deficits

in adaptive behavior that were initially manifested in the individual’s

developmental period (before age 22). As with other mental impairment

categories, the focus of Listing 12.05 is on the individual’s inability to

perform and sustain critical mental activities of work.

* * *

c. 12.05 C

Listing 12.05 C is based on a combination of an IQ score with an

additional and significant mental or physical impairment. The criteria

for this paragraph are such that a medical equivalence determination

would very rarely be required. However, slightly higher IQ’s (e.g.,

70–75) in the presence of other physical or mental disorders that

impose additional and significant work-related limitation of function

may support an equivalence determination. It should be noted that

generally the higher the IQ, the less likely medical equivalence in

combination with another physical or mental impairment(s) can be

found.

POMS § DI 24515.056 (emphasis added).

Hesseltine achieved IQ scores of 71 in 2005, and 72 in 2012—both within the

70–75 range that would render her eligible for an equivalency finding under the

POMS guidelines for Listing 12.05C. In addition to her borderline intellectual

functioning, the ALJ found that Hesseltine suffered from three other “severe

impairments:” Perthes disease of the left hip, polycystic ovarian syndrome, and

obesity. Hesseltine urges that she is especially suited for an equivalence finding

because of her deficits in adaptive functioning. Dr. Mraz found that Hesseltine’s

“overall adaptive behavior skills were generally commensurate with her intellectual

-7-

Appellate Case: 14-2780 Page: 7 Date Filed: 08/26/2015 Entry ID: 4309886 
functioning, placing her at the 1st percentile.” He described her communication skills

as “below the 0.1 percentile.”

In the portion of the ALJ’s decision addressing whether Hesseltine meets a

listed impairment, the ALJ stated:

At the hearing the claimant’s representative argued that the claimant met

Listing 12.05C. The severity of the claimant’s mental impairment does

not meet or medically equal the criteria of Listing 12.05. . . . To satisfy

the “paragraph C” criteria, the claimant must 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.

The decision does not further discuss Listing 12.05C, nor does it address whether 

Hesseltine’s impairments are medically equal to this listing. In Shontos, this court

determined that the ALJ had erred when there was “no evidence that the ALJ

considered the POMS guidelines” despite evidence that Shontos suffered from

“marked disabilitiesthat would interfere with her ability to work.” Shontos, 328 F.3d

at 425, 427. Shontos had a full scale IQ score of 72, placing her outside the range

required by Listing 12.05C. Id. at 424. Nevertheless, she suffered from anxiety and

depression to the extent that her treating medical professionals determined that her

ability to perform work was severely limited. Id. at 422. 

Similarly, the ALJ’s decision in this case does not mention the POMS guideline

for determining medical equivalence, let alone explain why Hesseltine fails to meet

it. We have ruled that “a remand is appropriate where the ALJ’s factual findings,

considered in light of the record as a whole, are insufficient to permit this Court to

conclude thatsubstantial evidence supportsthe Commission’s decision.” Scott ex rel.

Scott v. Astrue, 529 F.3d 818, 822 (8th Cir. 2008). Hesseltine has (1) “a valid verbal,

performance, or full scale IQ score” that hovers slightly above the 60–70 range, (2)

“an onset of the impairment before age 22,” and (3) several other physical

-8-

Appellate Case: 14-2780 Page: 8 Date Filed: 08/26/2015 Entry ID: 4309886 
impairments that impose additional work-related limitations: Perthes disease of the

left hip, polycystic ovarian syndrome, and obesity. See 20 C.F.R. § 404, Subp. P,

App. 1, § 12.05C. The ALJ summarily concluded that Hesseltine’s combination of

impairments did not medically equal the criteria of Listing 12.05C, but she did not

provide the reasons for her conclusion. Without further explanation, we cannot say

whether there was sufficient evidence to support her decision. See Chunn v.

Barnhart, 397 F.3d 667, 672 (8th Cir. 2005) (remanding to the ALJ for further

proceedings because it was “not clear from his decision that he even considered

whether [claimant] met the requirements for listing 12.05C”); cf. Phillips v. Colvin,

721 F.3d 623, 629 (8th Cir. 2013) (affirming ALJ’s rejection of medical equivalence

because Phillips did not have any “physical ormental disordersthat impose additional

and significant work-related limitation of function”).

III. Conclusion

We reverse the district court’s judgment and remand with instructionsto return

the case to the Commissioner for proceedings consistent with this opinion. 

COLLOTON, Circuit Judge, dissenting.

To establish eligibility for socialsecuritydisabilitybenefits, TammyHesseltine

was required to show that she met or equaled a listed impairment for intellectual

disability in the governing regulations. See 20 C.F.R. § 404, Subp. P App. 1. The

“required level of severity” for intellectual disability is met when a claimant has 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.” Id. § 12.05C.

Unlike the administrative law judge in Chunn v. Barnhart, 397 F.3d 667, 671

(8th Cir. 2005), who did not even mention listing 12.05C, or the ALJ in Scott ex rel.

-9-

Appellate Case: 14-2780 Page: 9 Date Filed: 08/26/2015 Entry ID: 4309886 
Scott v. Astrue, 529 F.3d 818, 822 (8th Cir. 2008), who did not cite or reference any

listing, the ALJ in this case expressly found that Hesseltine did not meet or equal

listing 12.05C: “The severity of the claimant’s medical impairment does not meet or

medically equal the criteria of listing 12.05. In making this finding, the undersigned

has considered whether the ‘paragraph A, B, C, or D’ criteria are satisfied.” R. 19.

Hesseltine complains that the ALJ did not adequately explain her finding, but

even the failure to address a specific listing, much less the non-binding POMS

guidelines, “is not reversible error if the record supports the overall conclusion.”

Pepper ex rel. Gardner v. Barnhart, 342 F.3d 853, 855 (8th Cir. 2003); see Moore ex

rel. Moore v. Barnhart, 413 F.3d 718, 721 n.3 (8th Cir. 2005). That an ALJ does not

elaborate on her finding that a claimant’s impairments do not equal a listing does not

require reversal if the record supports the ALJ’s overall conclusion. Karlix v.

Barnhart, 457 F.3d 742, 746 (8th Cir. 2006). “[A] deficiency in opinion-writing is

not a sufficient reason for setting aside an administrative finding where the deficiency

had no practical effect on the outcome of the case.” Senne v. Apfel, 198 F.3d 1065,

1067 (8th Cir. 1999). 

The ALJ’s decision must be supported by substantial evidence on the record

as a whole—that is, less than a preponderance, but “enough that a reasonable mind

would find it adequate to support the Commissioner’s conclusion.” McKinney v.

Apfel, 228 F.3d 860, 863 (8th Cir. 2000). As the district court observed, the ALJ’s

finding is “supported by a solid credibility analysis” that included reference to

evidence of Hesseltine’s capacity to work.

Hesseltine’s full-scale IQ scores—71 and 72 in 2005 and 2012,

respectively—are above the listing’s IQ range of 60 through 70. To “equal” the IQ

requirement, Hesseltine must present medical findings equal in severity to that lower

IQ range. Sullivan v. Zebley, 493 U.S. 521, 531 (1990). Hesseltine argues that her

deficits in adaptive functioning and low scores on the Vineland Adaptive Behavior

-10-

Appellate Case: 14-2780 Page: 10 Date Filed: 08/26/2015 Entry ID: 4309886 
Scalessupport a finding of equivalence. But according to a consultative examination

performed by Dr. Roger Mraz in 2005, Hesseltine’s “overall adaptive behavior skills

were generally commensurate with her intellectual functioning.” At another

consultative examination with Dr. Mraz in 2012, Hesseltine “presented no evidence

of a thought disorder or perceptual abnormalities,” and denied experiencing anxiety

or depression. Cf. Shontos v. Barnhart, 328 F.3d 418, 424 (8th Cir. 2003) (relying

on evidence from treating providers that claimant suffered from anxiety and

depression).

Dr. Mraz concluded that Hesseltine had “a history of being a responsible

worker,” and that she “should have no difficulty following simple instructions,” as

long as she had “an employer who [understood] her cognitive and academic

limitations.” Hesseltine’s former work supervisor at a laundry reported that she

worked “better than most in the same position,” required “less supervision,” and

demonstrated “some to a lot of independence.” The supervisor also rated as “good”

Hesseltine’s ability to “understand and carry out simple (1 and 2 step) instructions

and procedures” and to “concentrate and remain on task.” In a function report,

Hesseltine stated thatshe was able to “prepare food all the time daily,” shop for food,

and perform “small amounts” of cleaning, laundry, and mowing. 

A reasonable mind could find the record evidence adequate to buttress the

ALJ’s determination that Hesseltine’s impairments do not medically equal listing

12.05C. Substantial evidence on the record as a whole supports a finding that

Hesseltine does not suffer from other mental disorders that temporarily lowered her

IQ or rendered her equal to a person with an IQ between 60 and 70. The POMS

guidelines notwithstanding, physical disorders cannot support a finding of

equivalence to the IQ requirement of listing 12.05C. See Zebley, 493 U.S. at 530 n.8,

531; Kennedy v. Colvin, 738 F.3d 1172, 1177 (9th Cir. 2013). I would therefore

affirm the judgment.

______________________________

-11-

Appellate Case: 14-2780 Page: 11 Date Filed: 08/26/2015 Entry ID: 4309886