Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-almd-2_11-cv-00747/USCOURTS-almd-2_11-cv-00747-0/pdf.json

Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 42:405 Review of HHS Decision (SSID)

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IN THE DISTRICT COURT OF THE UNITED STATES

FOR THE MIDDLE DISTRICT OF ALABAMA

NORTHERN DIVISION

CYNTHIA JONES, )

)

Plaintiff, )

)

v. ) CIVIL ACTION NO. 2:11cv747-WC

)

MICHAEL J. ASTRUE, ) 

Commissioner of Social Security, )

)

Defendant. )

MEMORANDUM OPINION

I. INTRODUCTION

Plaintiff, Cynthia Jones, applied for Supplemental Security Income (“SSI”) benefits

under Title XVI of the Social Security Act (“the Act”), 42 U.S.C. §§ 1381 et seq. Her

application was denied at the initial administrative level on December 5, 2008. Tr. 12. 

Plaintiff then requested and received a hearing before an Administrative Law Judge (“ALJ”),

held on March 15, 2010. Tr. 25. Following the hearing, the ALJ issued a decision in which

he found Plaintiff not disabled since September 17, 2008, the date the application was filed. 

Tr. 21. The Appeals Council rejected Plaintiff’s request for review of the ALJ’s decision. 

Tr. 1-5. The ALJ’s decision consequently became the final decision of the Commissioner

of Social Security (“Commissioner”). See Chester v. Bowen, 792 F.2d 129, 131 (11th Cir. 1

 Pursuant to the Social Security Independence and Program Improvements Act of 1994, Pub. L.

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No. 103-296, 108 Stat. 1464, the functions of the Secretary of Health and Human Services with

respect to Social Security matters were transferred to the Commissioner of Social Security.

Case 2:11-cv-00747-WC Document 17 Filed 10/25/12 Page 1 of 11
1986). The case is now before the court for review under 42 U.S.C. § 405(g). Pursuant to

28 U.S.C. § 636(c), both parties have consented to the conduct of all proceedings and entry

of a final judgment by the undersigned United States Magistrate Judge. Pl.’s Consent to

Jurisdiction (Doc. 10); Def.’s Consent to Jurisdiction (Doc. 9). Based on the court’s review

of the record and the briefs of the parties, the court concludes that the decision of the

Commissioner must be reversed and this case remanded with directions to award benefits.

II. STANDARD OF REVIEW

Under 42 U.S.C. § 423(d)(1)(A), a person is entitled to disability benefits when the

person is unable to

engage in any substantial gainful activity by reason of any medically

determinable physical or mental impairment which can be expected to result

in death or which has lasted or can be expected to last for a continuous period

of not less than 12 months.

42 U.S.C. § 423(d)(1)(A).2

To make this determination, the Commissioner employs a five-step, sequential

evaluation process. See 20 C.F.R. §§ 404.1520, 416.920 (2006).

(1) Is the person presently unemployed?

(2) Is the person’s impairment severe?

(3) Does the person’s impairment meet or equal one of the specific 

impairments set forth in 20 C.F.R. Pt. 404, Subpt. P, App. 1? [the Listing of

Impairments]

(4) Is the person unable to perform his or her former occupation?

(5) Is the person unable to perform any other work within the economy?

 A “physical or mental impairment” is one resulting from anatomical, physiological, or 2

psychological abnormalities which are demonstrable by medically acceptable clinical and

laboratory diagnostic techniques.

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An affirmative answer to any of the above questions leads either to the next

question, or, on steps three and five, to a finding of disability. A negative

answer to any question, other than step three, leads to a determination of “not

disabled.”

McDaniel v. Bowen, 800 F.2d 1026, 1030 (11th Cir. 1986).3

The burden of proof rests on a claimant through Step 4. See Phillips v. Barnhart, 357

F.3d 1232, 1237-39 (11th Cir. 2004). A claimant establishes a prima facie case of qualifying

disability once they have carried the burden of proof from Step 1 through Step 4. At Step 5,

the burden shifts to the Commissioner, who must then show there are a significant number

of jobs in the national economy the claimant can perform. Id. 

To perform the fourth and fifth steps, the ALJ must determine the claimant’s Residual

Functional Capacity (RFC). Id. at 1238-39. RFC is what the claimant is still able to do

despite his impairments and is based on all relevant medical and other evidence. Id. It also

can contain both exertional and nonexertional limitations. Id. at 1242-43. At the fifth step,

the ALJ considers the claimant’s RFC, age, education, and work experience to determine if

there are jobs available in the national economy the claimant can perform. Id. at 1239. To

do this, the ALJ can either use the Medical Vocational Guidelines (grids) or call a vocational 4

expert (VE). Id. at 1239-40.

The grids allow the ALJ to consider factors such as age, confinement to sedentary or

McDaniel v. Bowen, 800 F.2d 1026 (11th Cir. 1986), is a supplemental security income case 3

(SSI). The same sequence applies to disability insurance benefits. Cases arising under Title II

are appropriately cited as authority in Title XVI cases. See, e.g., Ware v. Schweiker, 651 F.2d

408 (5th Cir. 1981).

See 20 C.F.R. pt. 404 subpt. P, app. 2. 4

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light work, inability to speak English, educational deficiencies, and lack of job experience. 

Each factor can independently limit the number of jobs realistically available to an

individual. Phillips, 357 F.3d at 1240. Combinations of these factors yield a statutorilyrequired finding of “Disabled” or “Not Disabled.” Id. 

The court’s review of the Commissioner’s decision is a limited one. This court must

find the Commissioner’s decision conclusive if it is supported by substantial evidence. 42

U.S.C. § 405(g); Graham v. Apfel, 129 F.3d 1420, 1422 (11th Cir. 1997). “Substantial

evidence is more than a scintilla, but less than a preponderance. It is such relevant evidence

as a reasonable person would accept as adequate to support a conclusion.” Richardson v.

Perales, 402 U.S. 389, 401 (1971). See also Crawford v. Comm’r of Soc. Sec., 363 F.3d

1155, 1158 (11th Cir. 2004) (“Even if the evidence preponderates against the

Commissioner’s findings, [a reviewing court] must affirm if the decision reached is

supported by substantial evidence.”). A reviewing court may not look only to those parts of

the record which support the decision of the ALJ, but instead must view the record in its

entirety and take account of evidence which detracts from the evidence relied on by the ALJ. 

Hillsman v. Bowen, 804 F.2d 1179 (11th Cir. 1986). 

[The court must] . . . scrutinize the record in its entirety to determine the

reasonableness of the [Commissioner’s] . . . factual findings. . . . No similar

presumption of validityattaches to the [Commissioner’s] . . . legal conclusions,

including determination of the proper standards to be applied in evaluating

claims.

Walker v. Bowen, 826 F.2d 996, 999 (11th Cir. 1987). 

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III. ADMINISTRATIVE PROCEEDINGS

Plaintiff was forty-five years old at the time of the hearing before the ALJ. Tr. 28. 

Plaintiff attended special education classes and received a high school diploma after

completing the special education requirements for graduation. Tr. 254. Plaintiff’s past

relevant work experience was as an “Institutional Cleaner,” “Food Services Worker,

Hospital,” “Cook Helper,” and “Housekeeping/Cleaner.” Tr. 36. Following the

administrative hearing, and employing the five-step process, the ALJ found that Plaintiff has

“not engaged in substantial gainful activity since September 17, 2008, the application date.” 

(Step 1) Tr. 14. At Step 2, the ALJ found that Plaintiff suffers from the following severe

impairments: “major depression; mild mental retardation; and gastroesophageal reflux

disease (GERD).” Tr. 14. At Step 3, the ALJ found that “[Plaintiff] does not have an

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

impairments.” Id. Next, the ALJ found that Plaintiff “has the residual functional capacity

to perform a full range of work at all exertional levels but with the following nonexertional

limitations: the need for frequent posturals; and limited to jobs which are simple, repetitive

and routine. She would work better with things rather than with people.” Tr. 16. The ALJ

then found that Plaintiff “is capable of performing past relevant work as a cleaner; food

service worker; cook’s helper; and housekeeper. This work does not require the performance

of work-related activities precluded by [Plaintiff’s] residual functional capacity.” (Step 4)

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Tr. 21. Accordingly, the ALJ determined that Plaintiff “has not been under a disability . . .

since September 17, 2008, the date the application was filed.” Id. 

IV. PLAINTIFF’S CLAIMS

Plaintiff presents one issue for this court’s consideration in review of the ALJ’s

decision: whether “[t]he ALJ failed to develop the record by not making a proper

determination as to whether Plaintiff met the requirements of Listing 12.05C at 20 CFR Part

404 subpart P, Appendix 1.” Pl.’s Br. (Doc. 12) at 8. 

V. DISCUSSION

Whether the ALJ failed to properly apply listing 12.05C.

Plaintiff argues that “the ALJ’s failure to find that she met the second prong of Listing

12.05C shows a failure to develop the record and that the ALJ failed to look fully into the

issues regarding this listing.” Pl.’s Br. (Doc. 12) at 11. Plaintiff asserts that the ALJ’s

decision should be reversed and she should be awarded benefits because “she has a lifelong

history of meeting the first prong of Listing 12.05C” as well as “other impairments of

gastroesophageal reflux disease and depression.” Id. at 11-12. 

Under the regulations, mental retardation is defined as a “significantly 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.” 20 C.F.R., pt. 404, subpt. P, app. 1, § 12.05. If a claimant

satisfies the introductory paragraph, in order to meet the listing for mental retardation, the

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claimant must also meet one of the four requirements described in subparagraphs A through

D. A claimant meets the requirements of subparagraph C by presenting evidence of “[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.” 20

C.F.R., pt. 404, subpt. P, app. 1, § 12.05C (emphasis added). Thus, taken together, in order

to establish disability under Listing 12.05C, a claimant must satisfy three criteria: 1)

significantlysubaverage general intellectual functioning with deficits in adaptive functioning

initially manifested before age 22; 2) a valid verbal, performance, or full scale IQ score of

60 to 70; and 3) a physical or other mental impairment imposing an additional and significant

work-related limitation of function. 

The court finds that Plaintiff satisfies the introductory paragraph of the listing for

mental retardation. First, in evaluating whether Plaintiff met the requirements of mental

retardation as set forth in Listing 12.05, the ALJ stated, “[t]he claimant’s mental

impairments, considered singly and in combination, do not meet or medically equal the

criteria of listings 12.04 and 12.05.” Tr. 14. The ALJ then immediately began to analyze the

requirements of paragraphs A, B, C, and D following the above statement, suggesting that

the ALJ found that Plaintiffsatisfied the requirements of the introductory paragraph. Tr. 14-

16. Moreover, “because the ALJ concluded that plaintiff has a severe impairment of mild

mental retardation, plaintiffsatisfies the requirement ofthe introductoryparagraph of Listing

12.05.” Carwile v. Astrue, Case No. 2:10cv456-SRW, 2011 WL 2601450, at *4, n.7 (M.D.

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Ala. June 30, 2011) (citing DSM IV–TR, p. 41 (“The essential feature of Mental Retardation

is significantly subaverage general intellectual functioning . . . that is accompanied by

significant limitations in adaptive functioning[.]”)). Additionally, Plaintiff presented

educational records which reveal that Plaintiff attended special education classes (Tr. 254),

and results from her school IQ tests reveal full scale IQ scores of 62, 54, and 61 at ages 7,

11, and 13, respectively. Tr. 248. There was also evidence that Plaintiff was considered a

“non-reader” at age 13. Tr. 249, 250. And, while Plaintiff must also satisfy the diagnostic

description of mental retardation found in the introductory paragraph of Listing 12.05, the

United States Court of Appeals for the Eleventh Circuit has held that “there is a rebuttable

presumption that a claimant manifested deficits in adaptive functioning before the age of 22

if the claimant established a valid IQ score between 60-70.” Grant v. Astrue, 255 F. App’x

374, 375 (11th Cir. 2007) (citing Hodges v. Barnhart, 276 F.3d 1265, 1266 & 1268-69 (11th

Cir. 2001)). Thus, in this case, Plaintiff clearly satisfies the introductory paragraph as she

has in fact presented evidence that she manifested deficits in adaptive functioning before the

age of 22. 

As to the requirements of subparagraph C, “Defendant does not dispute that Plaintiff

met the first prong of Listing 12.05C, because the ALJ accepted that she had IQ scores in the

60’s, and found that she had medically determinable ‘mild’ mental retardation.” Def.’s Br.

(Doc. 15) at 8. However, Defendant contends that “substantial evidence supports the ALJ’s

finding that Plaintiff did not meet the second prong of Listing 12.05C, because she did not

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have a physical or other mental impairment that imposed an additional and significant workrelated limitation of function.” Id. Thus, the only question before this court is whether or not

Plaintiff satisfies the second prong of Listing 12.05C, i.e., has presented evidence of “a

physical or other mental impairment imposing an additional and significant work-related

limitation of function.” 20 C.F.R., pt. 404, subpt. P, app. 1, § 12.05C. 

In determining the second prong of subparagraph C, the ALJ must assess “the degree

of functional limitation the additional impairment(s) imposes to determine if it significantly

limits [a claimant’s] physical or mental ability to do basic work activities, i.e., is a ‘severe’

impairment(s), as defined in §§ 404.1520(c) and 416.920(c).” 20 C.F.R., pt. 404, subpt. P,

app. 1, § 12.00A para. 4. Thus, if the ALJ determines that a claimant has a “severe

impairment” as defined in Step 2 ofthe ALJ’s evaluation, then subparagraph C’s requirement

of an “additional and significant work related limitation of function is satisfied.” See Carroll

v. Astrue, Case No. 1:08cv74-SRW, 2009 WL 1708073, at *1, n.2 (M.D. Ala. June 17, 2009)

(citing 65 Fed. Reg. 50746 at 50754 (Aug. 21, 2000) (“In final listing 12.05C . . . we used

the word ‘an’ before the word ‘additional’ to clarify that the additional impairment must be

‘severe’ in order to establish ‘an additional and significant work-related limitation of

function.”); id. at 50772 (“We have always intended the phrase [significant work-related

limitation of function] to mean that the other impairment is a ‘severe’ impairment, as defined

in §§ 404.1520(c) and 416.920(c).”)).

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In evaluating, the subparagraph C criteria, the ALJ determined “the ‘paragraph C’

criteria of listing 12.05 are not met because[,] . . . [e]ven though [Plaintiff’s] IQ scores were

in the 60’s[,] she does not have a physical or other mental impairment which would impose

an additional and significant work-related limitation of function.” Tr. 16. The problem with

the ALJ’s decision is that his determination that Plaintiff “does not have a physical or other

mental impairment” directly conflicts with the his finding that Plaintiff suffers from the

severe impairments of “major depression; mild mental retardation; and gastroesophageal

reflux disease (GERD).” Tr. 14. In finding that these impairments are severe, the ALJ must

also find that Plaintiff’s impairments satisfysubparagraph C’srequirement of “additional and

significant work-related limitation of function.” See, e.g., Carroll, 2009 WL 1708073, at *2

(finding that the ALJ’s “determination that Plaintiff ‘does not have another impairment . .

.’–directly conflicts with the ALJ’s finding that plaintiff suffers from the severe impairment

of hypertension”). As such, the ALJ erred in his determination that Plaintiff did not prove

her impairments met Listing 12.05C. Moreover, because Plaintiff also meets the diagnostic

description of mental retardation found in the introductory paragraph, Plaintiff meets the

listing for mental reatardation, and is entitled to benefits.

Because Plaintiff has established that she meets the criteria for presumptive disability

under Listing 12.05C, and because the Commissioner has not rebutted that presumption, the

court finds that it is appropriate to reverse the decision of the Commissioner and award

benefits. See Nettles v. Astrue, Case No. 3:08cv186-MHT, 2009 WL 3157227, at *6 (M.D.

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Ala. Sept. 28, 2009); Davis v. Shalala, 985 F.2d 528, 534 (11th Cir. 1993) (holding that it

is appropriate to reverse and remand “for an entry of an order awarding disability benefits

where the Secretary has already considered the essential evidence and it is clear that the

cumulative effect of the evidence establishes disability without any doubt.” (citing Bowen

v. Heckler, 748 F.2d 629, 635-36 (1984))). 

VI. CONCLUSION

The court has carefully and independently reviewed the record and concludes that, for

the reasons given above, the decision of the Commissioner is REVERSED and this case is

REMANDED to the Commissioner with instructions that benefits be awarded to Plaintiff. 

A separate judgment will issue.

Done this 25th day of October, 2012.

/s/ Wallace Capel, Jr.

WALLACE CAPEL, JR.

UNITED STATES MAGISTRATE JUDGE

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