Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca8-09-01123/USCOURTS-ca8-09-01123-0/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 Lawrence L. Piersol, United States District Judge for the

District of South Dakota, sitting by designation.

2

The Honorable Charles R. Wolle, United States District Judge for the Southern

District of Iowa.

United States Court of Appeals

FOR THE EIGHTH CIRCUIT

___________

No. 09-1123

___________

Justan Carlson, *

*

Appellant, *

* Appeal from the United States

v. * District Court for the 

* Southern District of Iowa. 

Michael J. Astrue, Commissioner of *

Social Security, *

*

Appellee. * 

___________

Submitted: October 22, 2009

 Filed: May 10, 2010

___________

Before COLLOTON and BENTON, Circuit Judges, and PIERSOL,1

 District Judge.

___________

COLLOTON, Circuit Judge.

Justan Carlson appeals the judgment of the district court2

 upholding the

Commissioner of Social Security’s denial of Carlson’s application for supplemental

security income. We affirm. 

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3

We refer to Listing 5.08 before its recent amendment, effective December 18,

2007. See Revised Medical Criteria for Evaluating Digestive Disorders, 72 Fed. Reg.

59,398 (Oct. 19, 2007).

-2-

I.

 Justan Carlson applied for disability insurance benefits under Title II of the

Social Security Act, 42 U.S.C. § 423, and for supplemental security income under

Title XVI of that Act, id. § 1382, claiming a disability onset date of March 20, 2004.

Carlson’s disability claims were based on his low body weight and diabetes with

neuropathy in his feet.

Carlson has had diabetes mellitus since he was seventeen years old. He was

twice admitted to the hospital with diabetic ketoacidosis. During the first

hospitalization on May 17, 2003, doctors assessed Carlson as having diabetic

ketoacidosis, dehydration, and protracted nausea and vomiting. Approximately nine

months later, on February 10, 2004, Carlson was again admitted to the hospital with

nausea and vomiting. Carlson was diagnosed with “[d]iabetic ketoacidosis with a

mixed metabolic acidosis and a metabolic alkalosis from vomiting.” (A.R. 168). 

Carlson’s medical records also track his low body weight. These records show

that Carlson’s weight was 134 pounds on April 19, 2004, fell to as low as 123.8 and

123.4 pounds in September and October 2004, respectively, and increased to 136

pounds and 141 pounds in June and July 2005, respectively.

The Social Security Administration (“SSA”) denied Carlson’s claims after

initial review. After Carlson sought reconsideration, Dr. Lawrence Staples, a state

agency medical consultant, reviewed Carlson’s case. Dr. Staples considered whether

Carlson met Listing 5.08,3

 weight loss due to any persisting gastrointestinal disorder,

and Listing 9.08, diabetes mellitus. He determined that Carlson did not meet either

listing. After this review, the SSA denied Carlson’s claims again.

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Carlson then filed a request for hearing by an administrative law judge (“ALJ”).

After a hearing at which Carlson was represented by counsel, the ALJ determined that

Carlson was not entitled to disability insurance benefits or supplemental security

income because he was not disabled. With respect to disability insurance benefits, the

ALJ concluded alternatively that Carlson was ineligible because he was no longer

insured under Title II of the Social Security Act as of his alleged disability onset date.

The Appeals Council denied Carlson’s request for review, thus making the ALJ’s

opinion the final decision of the Commissioner.

In determining that Carlson was not disabled, the ALJ used the familiar fivestep disability evaluation process outlined in 20 C.F.R. § 416.920. See, e.g.,

Eichelberger v. Barnhart, 390 F.3d 584, 590-91 (8th Cir. 2004). At steps one and

two, the ALJ concluded that Carlson had not engaged in substantial gainful activity

since the alleged disability onset date, and that Carlson’s diabetes mellitus, peripheral

neuropathy, and lower extremity pain were severe impairments. At step three, the

ALJ determined that Carlson’s impairments did not meet or medically equal an

impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. Like Dr. Staples, the

ALJ explicitly considered Listing 5.08 and Listing 9.08, and concluded that Carlson

did not meet or equal those two listings.

After considering Carlson’s residual functional capacity (“RFC”) at step four,

the ALJ found that it was feasible for Carlson to perform his past job as a telephone

solicitor. Finally, at step five, the ALJ found that Carlson could perform jobs that

exist in significant numbers in the national economy. Based on these conclusions, the

ALJ ultimately determined that Carlson was not disabled.

The district court upheld the ALJ’s decision. Carlson now appeals only the

denial of his claim for supplemental security income, arguing that the record does not

support the ALJ’s conclusion that he was not disabled.

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II.

We review the district court’s decision de novo, and “will affirm if the

Commissioner’s decision is supported by substantial evidence on the record as a

whole.” Davidson v. Astrue, 578 F.3d 838, 841 (8th Cir. 2009) (internal quotation

omitted); see also 42 U.S.C. § 405(g). “Substantial evidence is less than a

preponderance, but enough that a reasonable mind would find it adequate to support

the ALJ’s decision.” Gonzales v. Barnhart, 465 F.3d 890, 894 (8th Cir. 2006). When

determining whether substantial evidence exists, we consider evidence that supports

the Commissioner’s conclusion, along with evidence that detracts from that

conclusion. Id. To the extent that Carlson also challenges the ALJ’s legal

conclusions, we review those determinations de novo. See Brueggemann v. Barnhart,

348 F.3d 689, 692 (8th Cir. 2003). 

Carlson first argues that the ALJ’s decision has no medical support in the

record, because no agency medical expert explicitly determined that Carlson’s

impairments did not equal a listed impairment as required by SSA policy. The

determination of whether a claimant meets or equals an impairment described in the

Listing of Impairments, 20 C.F.R. Part 404, Subpart P, Appendix 1, is made at step

three of the disability determination process. 20 C.F.R. § 416.920(a)(4)(iii). During

this step, the ALJ has the responsibility to decide whether “medical equivalence” has

been established. Id. § 416.926(e). An impairment is medically equivalent under the

regulations if it is “at least equal in severity and duration to the criteria of any listed

impairment.” Id. § 416.926(a). If the ALJ finds that a claimant has an impairment

that meets or equals one of the listings, then the claimant will be found disabled. Id.

§ 416.920(a)(4)(iii). 

Here, Carlson argues that SSA policy also requires the ALJ to receive expert

evidence on the issue of equivalence. Carlson cites Social Security Ruling 96-6p,

which notes that “longstanding policy requires that the judgment of a physician . . .

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designated by the Commissioner on the issue of equivalence on the evidence before

the administrative law judge . . . must be received into the record as expert opinion

evidence and given appropriate weight.” Social Security Ruling (“SSR”) 96-6p, 61

Fed. Reg. 34,466, 1996 WL 374180 (July 2, 1996). The policy also states that when

an ALJ determines that equivalency is not established, the requirement to receive

expert opinion evidence into the record may be satisfied by a Disability Determination

and Transmittal form or other document that reflects the findings of the consultant and

is signed by the consultant. Id.

We conclude that the ALJ fulfilled the requirement established by SSR 96-6p.

In Jones ex rel. Morris v. Barnhart, 315 F.3d 974 (8th Cir. 2003), we concluded that

an agency physician necessarily gave the requisite opinion on medical equivalence,

albeit not explicitly, where the physician stated that an evaluation of residual

functional capacity was required. Because no assessment of RFC would have been

necessary if the physician had found that the claimant’s condition was equivalent to

a listed impairment, we reasoned that the physician implicitly rejected a determination

of equivalence. Id. at 978 n.2. 

Jones compels rejection of Carlson’s first argument, because Carlson’s records

contain a similar determination signed by a state medical consultant. The record

shows that Dr. Staples served as a state medical consultant who evaluated Carlson.

Like the physician in Jones, Dr. Staples concluded that an RFC assessment was

necessary for Carlson, and thus implied that Carlson did not equal Listing 5.08. The

ALJ’s consideration of Dr. Staples’s signed RFC assessment satisfied the obligation

to receive an expert opinion on equivalence.

The ALJ’s ultimate decision that Carlson did not meet or equal Listing 5.08 is

supported by substantial evidence. The claimant has the burden of proving that his

impairment meets or equals a listing. Johnson v. Barnhart, 390 F.3d 1067, 1070 (8th

Cir. 2004). “To meet a listing, an impairment must meet all of the listing’s specified

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criteria.” Id. Listing 5.08 covers “[w]eight loss due to any persisting gastrointestinal

disorder.” 20 C.F.R. Pt. 404, Subpt. P, App. 1, § 5.08. The introduction to Listing

5.08 clarifies that “[w]hen the primary disorder of the digestive tract has been

established . . . the resultant interference with nutrition will be considered under the

criteria in 5.08. This will apply whether the weight loss is due to primary or

secondary disorders of malabsorption, malassimilation or obstruction.” Id. § 5.00(B).

At Carlson’s height of 74 inches, Listing 5.08 requires a weight less than or

equal to 128 pounds, or a weight less than or equal to 136 pounds if the claimant has

uncontrolled diabetes. Id. § 5.08. In this case, the ALJ concluded that Carlson failed

to meet Listing 5.08. While the ALJ’s opinion is unclear on the issue of the weight

requirement, the ALJ found that Carlson did not meet the listing because “there has

been no primary disorder of the digestive tract established, nor is there evidence of a

secondary disorder . . . as required under 5.00B.” (A.R. 20).

The record contains substantial evidence to support the ALJ’s conclusion on

this point. Dr. Staples found that Carlson failed to meet Listing 5.08 because there

was no evidence that Carlson suffered from a gastrointestinal disorder. No other

physician suggested that Carlson had such a disorder. Carlson consistently presented

to doctors with a soft, nontender abdomen with normal bowel sounds. Consistent with

these records, Carlson admitted during the administrative hearing that he had regular

bowel movements, and that doctors did not know what caused his weight loss.

Therefore, the record provides substantial evidence to support the ALJ’s conclusion

that Carlson does not have a gastrointestinal disorder and does not meet Listing 5.08.

The ALJ also did not err by determining that Carlson did not suffer from an

impairment equal to Listing 5.08. To establish equivalency, a claimant “must present

medical findings equal in severity to all the criteria for the one most similar listed

impairment.” Sullivan v. Zebley, 493 U.S. 521, 531 (1990). Therefore, to equal

Listing 5.08, a claimant’s low weight must be as severe as the listing requirement and

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must be due to an impairment that is as severe as a gastrointestinal disorder. In this

case, the ALJ found that equivalence was not established because “no treating or

examining physician has mentioned findings equivalent in severity to the criteria of

any listed impairment.” (A.R. 20). 

Carlson argues that his impairments equal Listing 5.08 in each of the three ways

outlined by the governing regulations. See 20 C.F.R. § 416.926. Carlson contends

that the first medical equivalence test applies because he is missing one of the findings

for Listing 5.08, a gastrointestinal disorder, but that his diabetes is another finding

related to weight loss that has equal medical significance. Similarly, under the third

test for equivalence, Carlson claims that his weight loss and diabetes combine to be

medically equivalent to Listing 5.08. Under the second equivalence test, Carlson

asserts that if his weight loss is the result of an unknown process, this process can be

considered an equivalent impairment not described in the listings, because Carlson’s

weight loss itself demonstrates the equal severity of the unknown impairment. 

Two of these arguments are based on Carlson’s assertion that diabetes is

equivalent to a gastrointestinal disorder because it affects weight by influencing

nutrition and digestion. To support this claim, Carlson points to two occurrences

when he was hospitalized with nausea and vomiting as a result of his diabetes. The

two hospitalizations, however, show that the weight loss was caused by diabetic

ketoacidosis, which likely occurred because Carlson’s diabetes was not under control.

After those events, Carlson began to control his diabetes. It was reasonable for the

ALJ to conclude that this control of the diabetes prevented future episodes of

ketoacidosis with vomiting and nausea, and thereby limited the severity of the

impairment.

The ALJ reasonably rejected Carlson’s third argument on equivalence, because

the record supports a conclusion that Carlson’s weight loss was not caused by an

unknown disorder as severe as a gastrointestinal disorder. Dr. Zachary Alexander

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stated that Carlson “is unable to eat well due to financial concerns and [Carlson] states

that he only has one good meal a day.” (A.R. 262). Dr. Alexander also concluded that

“[t]he most likely explanation is that [Carlson’s] weight loss is due to poor controlled

diabetes or nutritional deficit.” (A.R. 263). On the record as a whole, therefore,

substantial evidence supports the ALJ’s conclusion that Carlson’s impairments do not

equal the severity of all the criteria in Listing 5.08.

Carlson next argues that remand is necessary on the issue of medical

equivalence because the ALJ applied an incorrect legal standard. He contends that the

ALJ erroneously required Carlson to show that he suffered from a gastrointestinal

disorder instead of any equivalent impairment. Carlson’s argument is based on the

ALJ’s statement that “in the absence of either a primary or secondary [digestive tract]

disorder, [Listing 5.08] can not be met or equaled. That is a legal decision, [and

Carlson’s] request for a medical advisor is denied.” (A.R. 20). 

Although this statement in isolation seems in tension with the governing

regulations, the opinion in its entirety demonstrates that the ALJ applied the correct

legal standard to the question of medical equivalence. The ALJ’s disputed statement

appears below a heading declaring that “[t]he claimant does not have an impairment

or combination of impairments that meets or medically equals one of the listed

impairments.” (A.R. 20). This statement reflects the correct legal standard, which

provides that when determining medical equivalency, an impairment can be

considered alone or in combination with other impairments. See 20 C.F.R. § 416.926.

The heading also cites several relevant regulations, including the regulation governing

equivalency, which tends to confirm that the ALJ recognized and applied the correct

legal standard. Most significant, the ALJ applied the correct standard later in the

opinion by considering whether Carlson met or equaled the two listings in question.

Therefore, the record as a whole shows that the ALJ applied the correct legal standard

to the issue of medical equivalence.

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Carlson also contends that the ALJ erred by failing to obtain an updated opinion

from a medical expert as required by SSA policy. Carlson’s argument is again based

on SSR 96-6p, which identifies two situations when an ALJ must consider updated

medical evidence. See SSR 96-6p, 61 Fed. Reg. 34,466, 1996 WL 374180 (July 2,

1996). First, an updated medical opinion is needed “[w]hen no additional medical

evidence is received, but in the opinion of the administrative law judge . . . the

symptoms, signs, and laboratory findings reported in the case record suggest that a

judgment of equivalence may be reasonable.” Id. Second, an updated medical

opinion is required if “additional medical evidence is received that in the opinion of

the administrative law judge . . . may change the State agency medical . . . consultant’s

finding that the impairment(s) is not equivalent in severity to any impairment in the

Listing of Impairments.” Id. 

Carlson argues that both of these conditions were met, but we conclude that the

ALJ’s contrary conclusion is supported by substantial evidence. As discussed,

substantial evidence supported the ALJ’s conclusion that Carlson’s low weight was

caused by his previously uncontrolled diabetes or his inability to afford meals. Thus,

the record supports the ALJ’s conclusion that a finding of equivalence was “not

reasonable,” and that additional medical testimony was unnecessary. The ALJ also

properly concluded that updated medical testimony would not have changed Dr.

Staples’s conclusion on equivalence. On this point, Carlson argues that Dr. Staples

was unable to consider new evidence showing that Carlson’s low weight persisted

after Dr. Staples’s review. New evidence on weight loss alone, however, could not

change Dr. Staples’s conclusion on equivalence, because Carlson also must show an

impairment as severe as a gastrointestinal disorder. See Zebley, 493 U.S. at 531.

Therefore, the ALJ did not err by rejecting Carlson’s request for updated medical

testimony.

For these reasons, the judgment of the district court is affirmed.

 _____________________________

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