Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca8-06-03578/USCOURTS-ca8-06-03578-0/pdf.json

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

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1

The Honorable Henry L. Jones, United States Magistrate Judge for the Eastern

District of Arkansas, to whom the case was assigned by consent of the parties pursuant

to 28 U.S.C. § 636(c). 

United States Court of Appeals

FOR THE EIGHTH CIRCUIT

___________

No. 06-3578

___________

Leo England, *

*

Appellant, *

* Appeal from the United States

 v. * District Court for the

* Eastern District of Arkansas.

Michael J. Astrue, Commissioner *

of Social Security, *

*

Appellee. *

___________

Submitted: April 13, 2007

Filed: July 26, 2007

___________

Before WOLLMAN, BEAM, and COLLOTON, Circuit Judges.

___________

WOLLMAN, Circuit Judge.

Leo England appeals from the district court’s1

 order affirming the final decision

of the Commissioner of Social Security (Commissioner) that denied England’s

application for benefits. We affirm. 

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2

We omit a full recitation of this case’s procedural history as it is not germane

to this appeal. 

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I.

England, who is now twenty-two years old, was born with hydrocephalus, a

condition marked by cerebrospinal fluid within the skull. He received childhood

social security disability benefits from 1989 to 1997, when his case was reviewed

pursuant to the Personal Responsibility and Work Opportunity Reconciliation Act of

1996. Pub. L. No. 104-193, 110 Stat. 2105 (1996). After this review, the Social

Security Administration determined that England was not disabled and was ineligible

for benefits effective May 1, 1997. An administrative appeal, as well as a new

application for benefits, followed.2

 

A hearing on England’s claims was held in May 2004. Because England had

turned eighteen by the time of the hearing, the Administrative Law Judge (ALJ)

considered both whether England should have received child disability benefits and

whether England was eligible for adult disability benefits. The evidence England

submitted included reports from his school and evaluations conducted by a

consultative psychologist, Dr. Stephen Harris. The ALJ heard testimony from

England, his mother, and a medical expert, Dr. Paul Deyoub, who had reviewed

England’s records. The ALJ determined that England was ineligible for child

disability benefits because his impairments did not meet, medically equal, or

functionally equal any impairments listed in 20 C.F.R. Pt. 404, Subpt. P, App. 1. The

ALJ also determined that England was not eligible for adult disability benefits because

he had the capacity to work in jobs that exist in significant numbers in the local,

regional, and/or national economies. 

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II.

A. Child Disability Benefits 

England argues that the ALJ’s determination that he was not eligible for child

disability benefits was not supported by substantial evidence. We disagree. 

“We review de novo a district court decision affirming a denial of social

security benefits.” Reed v. Barnhart, 399 F.3d 917, 920 (8th Cir. 2005) (citing

Strongson v. Barnhart, 361 F.3d 1066, 1069 (8th Cir. 2004)). We will affirm the

denial of benefits so long as the Commissioner’s decision “conforms to the law and

is supported by substantial evidence on the record as a whole.” Id. (quoting Collins

ex rel. Williams v. Barnhart, 335 F.3d 726, 729 (8th Cir. 2003)). “‘Substantial

evidence is less than a preponderance, but is enough that a reasonable mind would

find it adequate to support the Commissioner’s conclusion.’” Stormo v. Barnhart, 377

F.3d 801, 805 (8th Cir. 2004) (quoting Prosch v. Apfel, 201 F.3d 1010, 1012 (8th Cir.

2000)). “We consider both evidence that detracts from and evidence that supports the

Commissioner’s decision.” Id. (citing Prosch, 201 F.3d at 1012). If substantial

evidence supports the decision, we will not reverse, even if substantial evidence could

have been marshaled in support of a different outcome. Id. (citation omitted).

In determining whether a claimant under the age of eighteen is disabled, the

ALJ undertakes a sequential three-step evaluation. 20 C.F. R. § 416.924(a). The first

step is to inquire whether the claimant is engaged in substantial gainful activity. Id.

The second step is to ascertain whether the impairment or combination of impairments

is severe. Id. The third step is to determine whether the claimant has an impairment

or impairments that “meet[], medically equal[], or functionally equal[]” a listed

impairment. Id. A claimant will not be considered disabled unless he meets the

requirements for each of these three steps. Id. 

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The ALJ determined that because England was not engaged in gainful activity

and had severe impairments, he satisfied the requirements of the first two steps. The

ALJ rejected England’s contention that his impairments were functionally equivalent

to a listed impairment, however, and thus determined that England did not meet the

requirements of the third step. An impairment is functionally equivalent to a listing

when the impairment results in an “extreme” limitation in one domain of functioning

or a “marked” limitation in two domains of functioning. 20 C.F.R. § 416.926a(a).

There are five domains of functioning, see § 416.926a(b)(1) (listing the domains), but

the only domains relevant here are the domains of “interacting and relating with

others,” “acquiring and using information,” and “attending and completing tasks.” A

marked limitation in a domain is a limitation that seriously interferes with a child’s

ability to “independently initiate, sustain, or complete activities.” § 416.926a(e)(2)(i).

A marked limitation is “more than moderate” but “less than extreme.” Id. “[I]t 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. Test scores will be considered along with other evidence. § 416.926a(e)(4). 

The ALJ determined that England had a marked limitation in interacting and

relating with others, but that he did not have marked limitations in any additional

domains. Accordingly, the ALJ concluded that England did not meet the requirements

for functional equivalency under the third step. England contends that the ALJ’s

determination is unsupported by substantial evidence. 

1. Acquiring and Using Information

The domain of acquiring and using information pertains to how well a child

acquires, learns, and uses information. § 416.926a(g). In concluding that England

did not suffer from a marked limitation in this domain, the ALJ noted that in

2001,“school personnel reported that while [England’s] overall intellectual ability was

in the borderline range, his general fund of knowledge and long term verbal memory

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This assessment may bear on the attending and completing tasks domain as

well. 

4

England remarks that his 2000 verbal IQ score of 65, coupled with his other

limitations, suffice to qualify him as disabled. Cf. 20 C.F.R. Pt. 404, Subpt. P, App.

1 § 112.05D (retardation may be found, inter alia, if the 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 limitation of function”). In other

words, England appears to imply that his impairments meet or medically equal a listed

impairment: mental retardation under § 112.05D. England’s references to § 112.05D,

however, occur only in the context of his argument about functional equivalency.

Accordingly, we confine our review to his functional equivalency argument. 

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skills were in the average range with total language skills and oral expression also

reported in the average range and with listening skills in the low average range.” The

ALJ also observed that England had successfully progressed through school and had

never been held back in any grade. In addition, the ALJ’s decision took note of

England’s 2000 and 2001 evaluations by Dr. Harris. During the 2001 evaluation,

England achieved a verbal IQ score of 77, a performance IQ score of 77, and a full

scale IQ score of 75. In 2000, England achieved a verbal IQ of 65, a performance IQ

of 82, and a full scale IQ of 71. Moreover, in 2001, Dr. Harris completed a “Medical

Source Statement of Ability to Do Work-Related Activities,” in which he reported that

England had only moderate (as opposed to marked or extreme) limitations in such

work-related activities as carrying out detailed instructions and making judgments on

simple work-related decisions.3

England argues that his IQ scores and other evidence indicate that he suffers

from borderline to mild mental retardation, which compels the conclusion that he

suffers from a marked limitation. England points out that Dr. Harris had determined

in 2001 that England’s adaptive functioning appeared to fall within the mildly retarded

range. He also notes that – with the exception of his 2000 verbal IQ score of 65,

which indicates mild retardation – his IQ scores indicate borderline mental

retardation.4

 There was other evidence of low intellectual functioning. During Dr.

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The IQ tests administered in this case, the Wechsler Intelligence Scale for

Children, has a testing mean of 100 and a standard deviation of 15. See § 112.00D(9)

(“The IQ scores in listing 112.05 reflect values from tests of general intelligence that

have a mean of 100 and a standard deviation of 15, e.g., the Wechsler series.”). 

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Harris’s 2001 examination, he observed that England could not perform simple

arithmetic without errors, could not interpret proverbs, and had difficulty following

normal conversation. An examination in 1999 showed that England could not spell

his name backwards or perform simple calculations. In 1997, when England was in

seventh grade, his resource teacher stated that he was reading at a second grade level

and that his math was at a fourth grade level. England also argues that although he

had never been kept back in school, he was placed in special education classes in

several subjects. 

Despite this evidence of low intellectual functioning, we conclude that the

ALJ’s assessment is supported by substantial evidence. First, England’s 2001 IQ

scores and two of his three 2000 scores are less than two standard deviations below

the mean (two standard deviations below the mean would be 70).5

 While these

numbers are not necessarily dispositive, see § 416.926a(e)(4)(ii) (noting that the

disability determination will not be restricted to test scores alone), they constitute

meaningful support for the ALJ’s determination. 

Second, although Dr. Harris characterized England’s adaptive functioning as

falling within the mildly retarded range, he also described England’s “overall level of

intellectual functioning” as borderline and remarked that England’s limitations in

carrying out work-related activities were only moderate, rather than marked. The

ALJ’s task was to interpret the significance and import of Dr. Harris’s assessments

and to resolve any pertinent tensions or contradictions. In so doing, the ALJ properly

relied upon Dr. Deyoub, a medical expert, for assistance. See Hudson ex rel. Jones

v. Barnhart, 345 F.3d 661, 666 (8th Cir. 2003) (noting that the role of the medical

expert is to “aid the ALJ in evaluating the medical evidence”). 

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Dr. Harris remarked in 2001, that “at times [England] does show some

difficulties in staying on track.” Dr. Harris noted in 2000, that England “does have

some difficulty in keeping on track but seems to attempt to work in this area quite a

bit.” 

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Third, the record contains school assessments that place England in the

borderline range of overall intellectual functioning, and in an average to low-average

range with respect to more specific intellectual functions. Finally, the fact that

England evidently progressed through school while taking at least some general

education classes constitutes some support for the ALJ’s conclusion. In sum, we

conclude that the ALJ’s determination that England lacks a marked impairment in the

domain of acquiring and using information is supported by substantial evidence. 

2. Attending and Completing Tasks 

When considering the attending and completing tasks domain, the inquiry

focuses on how well the child is able to focus and maintain his or her attention and

how well the child begins, carries through, and finishes activities. § 416.926a(h). 

One must also determine the pace at which the child performs activities and the ease

with which he changes them. Id. The ALJ determined that England had “some degree

of limitation” in attending and completing tasks, but did not have a marked limitation

in this area. In reaching this conclusion, the ALJ reiterated that England had not

repeated any grades at school and noted that Dr. Harris had reported in 2001 that

England had only “some difficulty” in staying on track during his interview.6

 The

government contends that the ALJ’s conclusion is also supported by Dr. Deyoub’s

assessment that England did not suffer a marked limitation in this domain.

England argues that the ALJ’s determination is unsupported by substantial

evidence because the ALJ had ignored evaluations from England’s teachers, who

reported that England’s limitations in “concentration, persistence, and pace” are a

“serious detriment to [England’s] school success.” We disagree with England’s

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It bears mention that the record reflects that evaluators have, at different times,

assigned to England various GAF scores, ranging from the 30s to the 70s. 

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contention. Although the ALJ did not discuss these reports, “an ALJ’s failure to cite

specific evidence does not indicate that it was not considered.” Craig v. Apfel, 212

F.3d 433, 436 (8th Cir. 2000). Nor are we persuaded that the ALJ was obliged to

credit the assessments by England’s teachers over the opinions of Dr. Harris and Dr.

Deyoub.

England also argues that a marked limitation is indicated by Dr. Harris’s 2001

assessment that England is “markedly limited” in his ability to respond “appropriately

to work pressures in a usual work setting” and to “changes in a routine work setting.”

While these limitations may be relevant to England’s ability to attend and complete

tasks, they do not necessarily comprise the entirety of this domain. The ALJ could

have reasonably concluded that, if they did, neither Dr. Harris nor Dr. Deyoub would

have arrived at their respective determinations. In sum, although a contrary

conclusion may have been justifiable on this evidence, we cannot say that the ALJ’s

determination was unsupported by substantial evidence. 

3. Dr. Deyoub’s Testimony

England contends that the ALJ should not have relied upon Dr. Deyoub’s

testimony regarding the two contested domains of functioning, which, England

contends, was inconsistent with the Global Assessment of Functioning (GAF) score

of 50 that two examining psychologists assigned to England.7

 We can discern no

material inconsistency between Dr. Deyoub’s testimony and England’s GAF score.

Dr. Deyoub explained to the ALJ that the GAF score, which reflected a global

assessment of England’s psychological, social, and intellectual functioning, was not

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As England observes, we have considered GAF scores to be relevant evidence

in other cases. See, e.g., Brueggemann v. Barnhart, 348 F.3d 689, 695 (8th Cir. 2003)

(noting that a GAF score of 50 “reflects serious limitations in the patient’s general

ability to perform basic tasks of daily life”). Whatever relevance and significance

GAF scores may have in other cases, we cannot say that the ALJ erred in relying upon

Dr. Deyoub’s assessment of the GAF score in this case. Cf. Hudson ex rel. v.

Barnhart, 345 F.3d 661, 666 (8th Cir. 2003) (ALJ could rely on medical expert’s

testimony that claimant’s limitations were not as significant as the claimant’s GAF

scores indicated). 

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a particularly illuminating measure of England’s functioning in specific domains.8

 Dr.

Deyoub’s testimony was thus not inconsistent with the GAF score, but merely pointed

out its limited utility in this case. Although Dr. Deyoub also suggested that a GAF

score of 50 “would probably be more serious” than the limitations he had assessed,

his testimony was focused primarily on the score’s relevance and not toward whether

he might have arrived at a different number. 

B. Adult Disability Benefits 

England also contests the ALJ’s determination that England is ineligible for

adult disability benefits, arguing that the hypothetical posed to the ALJ did not

adequately reflect all of England’s limitations and that the ALJ did not adequately

explain why he rejected England’s subjective complaints. 

1. The Hypothetical

The ALJ asked the vocational expert (VE) to assume

an individual eighteen years of age with an 11th grade education and no

past relevant work. Assume no significant exertional limitations and

further assume that the individual is limited to work where there is no

more than routine interpersonal contact with others. Tasks are learned

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by rote and little judgment is required. Further assume the individual

would require simple, direct and concrete supervision. 

The VE testified that given those limitations, England could perform

housekeeping, janitorial, kitchen, or landscape work. England’s attorney then posed

an alternate hypothetical in which he asked the VE to assume limitations on

understanding and remembering simple and detailed instructions, interacting with

coworkers and supervisors, and responding work-related changes and pressures. The

VE testified in response that England could still perform jobs that exist in the

economy. 

England contends that the ALJ’s hypothetical should have included an express

reference to England’s borderline intellectual functioning, arguing that England’s need

for direct supervision, only routine interpersonal contact, and tasks requiring only

simple judgment could be the result of any number of conditions, such as depression

or lack of initiative. This argument is unavailing. The hypothetical need not “frame

the claimant’s impairments in the specific diagnostic terms used in the medical

reports, but instead should capture the ‘concrete consequences’ of those impairments.”

Lacroix v. Barnhart, 465 F.3d 881, 889 (8th Cir. 2006) (quoting Roe v. Chater, 92

F.3d 672, 676-77 (8th Cir. 1996)). We agree, however, that the hypothetical could

have more clearly conveyed the limitations on executing simple and detailed

instructions assessed by both Dr. Deyoub and Dr. Harris. Even if the hypothetical fell

short in this regard, however, England’s attorney posed to the VE a hypothetical that

reflected these limitations, in response to which the VE testified that there would still

be jobs that England could undertake. Any inadequacy in the hypothetical was thus

harmless. 

England argues next that the ALJ’s hypothetical understated his limitations in

interacting with others and that the ALJ neglected to incorporate Dr. Harris’s

assessment that England was “markedly limited” in his ability to respond

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We note that it is not clear from the record what specific testimony the ALJ

chose not to credit. Nor has England specified the testimony at issue or suggested

how the ALJ’s credibility determination might have borne on the outcome of his

claim. 

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“appropriately to work pressures in a usual work setting” and to “changes in a routine

work setting.” Although the hypothetical does appear to have understated these

limitations, this infirmity was harmless because the VE testified that even with the

additional limitations in social interaction proposed by England’s attorney, which

included those specifically assessed by Dr. Harris, England could perform jobs

available in the economy. 

2. Credibility Determination

The ALJ credited the testimony of England and his mother only insofar as this

testimony was supported by other substantial evidence.9

 The ALJ also remarked that

he believed that England’s mother’s testimony was motivated by her desire to see her

son receive benefits. England argues that the ALJ should have given specific reasons

why he discredited the their testimony. Having reviewed the record, we conclude that

the ALJ offered sufficient explanation for not accepting the England’ testimony in its

entirety. 

The judgment is affirmed. 

______________________________

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