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Parties Involved:
Commissioner, Social Security Administration
Appellee
Alice Frame
Appellant

Document Text:

[DO NOT PUBLISH]

IN THE UNITED STATES COURT OF APPEALS

FOR THE ELEVENTH CIRCUIT

________________________

No. 13-15347

________________________

D.C. Docket No. 1:12-cv-00162-MP-CAS

ALICE FRAME,

Plaintiff–Appellant,

versus

COMMISSIONER, SOCIAL SECURITY ADMINISTRATION,

Defendant–Appellee.

________________________

Appeal from the United States District Court

for the Northern District of Florida

________________________

(January 13, 2015)

Before ED CARNES, Chief Judge, DUBINA and GILMAN,* Circuit Judges.

 * Honorable Ronald Lee Gilman, United States Circuit Judge for the Sixth Circuit, sitting 

by designation.

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PER CURIAM:

Alice Frame appeals the district court’s affirmance of the decision by the 

Commissioner of Social Security denying her application for disability insurance 

benefits and supplemental security income. After carefully reviewing the record, 

and after reading the parties’ briefs, we affirm.1

I.

In June 2006, Frame filed an application for social security disability 

benefits. After her application was denied, she sought judicial review of the 

Commissioner’s decision in federal court. At the Commissioner’s request, the 

district court remanded her application to the Appeals Council under sentence four 

of 42 U.S.C. § 405(g).

In March 2012, following a hearing on Frame’s application, the 

administrative law judge (“ALJ”) concluded that she was not disabled and denied 

her benefits claims. Because the Appeals Council did not assume jurisdiction, the 

ALJ’s decision became the Commissioner’s final decision and is thus subject to 

judicial review. See 20 C.F.R. §§ 404.984, 416.1484.

Once more, Frame sought judicial review of the denial of her benefits 

application. The district court affirmed the ALJ’s decision. This appeal followed.

 1 Though originally scheduled for oral argument, this appeal was removed from the oralargument calendar by unanimous agreement of the panel. See 11th Cir. R. 34-3(f).

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II.

In social security appeals, we review de novo the district court’s judgment 

regarding whether substantial evidence exists to support the Commissioner’s final 

decision. See Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005). During 

this review, we do not reweigh the evidence, decide facts anew, make credibility 

determinations, or substitute our judgment for the ALJ’s. Id. at 1211, 1213. The 

ALJ’s factual findings are conclusive if supported by “substantial evidence.” 42 

U.S.C. § 405(g). Substantial evidence means more than a scintilla but less than a 

preponderance; it is enough “relevant evidence as a reasonable person would 

accept as adequate to support a conclusion.” Crawford v. Comm’r of Soc. Sec., 

363 F.3d 1155, 1158 (11th Cir. 2004) (quoting Lewis v. Callahan, 125 F.3d 1436, 

1439 (11th Cir. 1997)) (internal quotation mark omitted). In the end, so long as 

substantial evidence exists, we must affirm the ALJ’s decision even if the evidence 

preponderates against it. Id. at 1158–59.

III.

The Social Security Act makes disability insurance benefits and 

supplemental security income available to a claimant who is “under a disability” or 

“disabled.” 42 U.S.C. §§ 423(a), 1382(a). The Act defines disability and disabled

as being “unable to engage in any substantial gainful activity” because of a 

“medically determinable physical or mental impairment” that is expected to result 

in death or that has lasted (or is expected to last) for at least 12 straight months. Id.

§§ 423(d)(1)(A), 1382c(a)(3)(A); see also 20 C.F.R. §§ 404.1505(a), 416.905(a).

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A claimant seeking social security disability benefits must prove that she is 

disabled. Moore, 405 F.3d at 1211. To do so, she must shoulder the “very heavy 

burden” of showing that she has “both a qualifying disability and an inability to 

perform past relevant work.” Id.

To decide whether a claimant is disabled, the ALJ uses a “five-step 

sequential evaluation process.” 20 C.F.R. §§ 404.1520(a)(1), 416.920(a)(1). 

Throughout this process, the claimant must introduce evidence to support her 

benefits application. Ellison v. Barnhart, 355 F.3d 1272, 1276 (11th Cir. 2003). 

The evaluation moves from step to step until the ALJ finds that the claimant is 

either disabled or not disabled. §§ 404.1520(a)(4), 419.920(a)(4).

These are the steps in this process:

(1) determine whether the claimant is currently engaged in substantial 

gainful activity; 

(2) determine whether the claimant’s alleged impairment (or combination 

of impairments) is “severe”;

(3) determine whether the claimant’s severe impairment satisfies or 

medically equals an impairment listed in 20 C.F.R. pt. 404, subpt. P, 

app. 1;

(4) determine whether the claimant has the residual functional capacity to 

perform past relevant work; and

(5) determine whether the claimant can perform other work in the 

national economy given her residual functional capacity, age, 

education, and work experience.

§§ 404.1520(a)(4)(i)–(iv), 416.920(a)(4)(i)–(v).

To prevail at step three, the claimant must provide specific evidence—such 

as medical signs, symptoms, or laboratory-test results—showing that her 

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impairment meets or medically equals a listed impairment. Sullivan v. Zebley, 493 

U.S. 521, 530, 110 S. Ct. 885, 891 (1990). “For a claimant to show that h[er] 

impairment matches a listing, it must meet all of the specified medical criteria. An 

impairment that manifests only some of those criteria, no matter how severely, 

does not qualify.” Id. But a claimant whose severe impairment satisfies or 

medically equals a listed impairment is “conclusively presumed to be disabled 

based on his or her medical condition.” Crayton v. Callahan, 120 F.3d 1217, 1219 

(11th Cir. 1997). Of course, even if a claimant cannot prove that she is disabled at 

step three, she may do so at steps four and five. See Phillips v. Barnhart, 357 F.3d 

1232, 1238–40 (11th Cir. 2004).

A.

To meet listing 12.05 (“intellectual disability”2

), “a claimant must at least 

(1) have significantly subaverage general intellectual functioning; (2) have deficits 

in adaptive behavior; and (3) have manifested deficits in adaptive behavior before 

age 22.” Crayton, 120 F.3d at 1219. These requirements are referred to as the 

listing’s “diagnostic criteria.” See 20 C.F.R. pt. 404, subpt. P, app. 1, § 12.00 

(“Listing 12.05 contains an introductory paragraph with the diagnostic description 

 2 Effective September 3, 2013, the Social Security Administration replaced the term 

mental retardation with the term intellectual disability as a listed impairment. Change in 

Terminology: “Mental Retardation” to “Intellectual Disability,” 78 Fed. Reg. 46,499, 46,4501 

(Aug. 1, 2013) (to be codified at 20 C.F.R. pt. 404, subpt. P, app. 1). This change was made

because “the term ‘mental retardation’ has negative connotations,” and “has become offensive to 

many people.” Id. at 46,499. But this change “d[id] not affect the actual medical definition of 

the disorder or available programs or services.” Id. at 49,500. So while the ALJ, whose decision 

issued before the change took effect, and the parties use the old terminology, we follow the 

agency’s new nomenclature.

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for [intellectual disability].”) In addition to satisfying the diagnostic criteria, a 

claimant must meet one of the four severity requirements in paragraphs A through 

D of the listing. See id. § 12.05. Under paragraph C, the only paragraph at issue 

here, a claimant must show that she has both “[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.”

A valid IQ score of 60 to 70 satisfies the first prong of paragraph C and 

creates a rebuttable presumption that the claimant satisfies the diagnostic criteria 

for intellectual disability. See Hodges v. Barnhart, 276 F.3d 1265, 1268–69 (11th 

Cir. 2001). At the same time, it is well established that such a presumption does 

not arise where a qualifying IQ score is inconsistent with other record evidence 

concerning her daily activities and behavior. Lowery v. Sullivan, 979 F.2d 835, 

837 (11th Cir. 1992) (citing Popp v. Heckler, 779 F.2d 1497, 1499 (11th Cir. 

1986)). But once the ALJ accepts an IQ score as valid and finds that the claimant’s 

impairments meet or medically equal the other criteria of listing 12.05C, the 

disability determination cannot be based on the claimant’s age, education, or work 

experience. Id.

In sum, a claimant proves that she meets listing 12.05C by establishing the 

diagnostic criteria for intellectual disability, including deficits in adaptive 

functioning; showing onset before age 22; producing a valid, qualifying IQ score; 

and exhibiting the requisite deficits in work-related functioning.

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B.

Here, Frame injured her neck in 2002 and underwent surgery in January 

2003. She returned to work the next month and continued to work until 2006. She 

contends that she became disabled in May 2006 at age 43. Her disability claim 

was initially based on the neck injury and resulting surgery, herniated discs, lowback pain, cardiovascular muscle spasms, high blood pressure, and depression.

In April 2009, Frame took a Wide Range Intelligence Test (WRIT) 

administered by Rick Robinson, a vocational rehabilitation counselor. Frame 

received the following scores: verbal (crystallized) IQ of 65, visual (fluid) IQ of 

85, and general IQ of 71. According to the report accompanying her test results, 

Frame’s scores corresponded to intelligence profiles of very low, low average, and 

borderline, respectively.

3

 The report did not opine about the validity of these 

scores.

In January 2012, Frame had a hearing before an ALJ on her benefits 

application. She testified about her health impairments, memory problems, and 

limited education. Dr. Hershel Goren, a neurologist and medical expert, testified 

that Frame’s impairments met the requirements of listing 12.05C because she had a

verbal IQ of 65 and additional severe physical impairments.

Two months later, the ALJ denied Frame’s benefits application, finding that 

she was not disabled under the Social Security Act. The ALJ determined that 

 3 When multiple IQ scores are derived from a standard general intelligence test in the 

Wechsler series, the ALJ uses “the lowest of these in conjunction with 12.05.” 20 C.F.R. pt. 

404, subpt. P, app. 1, § 12.00D6c. Here, therefore, the relevant score is Frame’s verbal 

(crystalized) IQ of 65.

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Frame satisfied steps one and two of the sequential review. That is, she was not 

engaged in substantial gainful activity and had the following severe impairments: 

degenerative disc disease of the cervical spine, bipolar affective disorder, 

neuropathy, pain disorder, borderline intellectual function, and panic attacks. But 

despite Dr. Goren’s testimony, the ALJ determined that she did not meet the 

criteria for intellectual disability under listing 12.05C.

At step four, the ALJ determined Frame’s residual functional capacity. And 

based on a vocational expert’s answer to a hypothetical question about a person 

with characteristics like Frame’s, the ALJ found that Frame was not disabled 

because she could perform her past relevant work. See Jones v. Apfel, 190 F.3d 

1224, 1230 (11th Cir. 1999) (explaining that an ALJ may rely solely on the 

testimony of a vocational expert in making stage-five determination).

C.

On appeal, Frame does not challenge the ALJ’s assessment of her residual 

functional capacity, nor does she object to the ALJ’s reliance on the vocational 

expert’s testimony. But she does take issue with the ALJ’s step-three analysis. In 

her view, the ALJ’s finding that she does not meet the requirements of listing 

12.05 was not supported by substantial evidence. We disagree.

The ALJ concluded that Frame did not meet the criteria of listing 12.05C 

because she failed to present a valid, qualifying IQ score.4

 The ALJ rejected this 

 4 The ALJ also concluded that Frame had not proven that she met the diagnostic criteria 

of listing 12.05. Specifically, the ALJ found that 

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score for two reasons. First, he found that this score was inconsistent with the 

findings of Dr. Jeff Gedney, her treating psychologist. Specifically, in February 

2007, Dr. Gedney described Frame’s intelligence, global executive function, 

insight, and judgment as “normal.” In June 2008, he concluded that she did not 

have a “low IQ or reduced intellectual functioning.” And in May 2009, he 

characterized her level of dysfunction during the previous month—when she took 

the IQ test—as only “moderate.”5

 Second, the ALJ noted that the report 

accompanying her IQ test did not comment on the test’s validity.

Although the ALJ’s step-three analysis rested on the invalidity of her IQ test, 

Frame does not argue on appeal that her score is valid. Instead, she appears to rely 

on the score’s mere existence and the testimony of a nonexamining physician, Dr. 

Goren. In any event, we conclude that the ALJ’s conclusion—that Frame’s IQ 

score was invalid—was supported by substantial evidence.

 

there is no evidence that shows significantly sub-average general intellectual functioning 

with deficits in adaptive functioning initially manifested during the developmental 

period. Indeed, there is no evidence of deficits in the development period. Moreover, 

[Frame] has a demonstrated history of remarkably good adaptive functioning. In fact, the 

record describes her prior occupations wherein she worked full time at different jobs. In 

one job, [she] had to select parts in a stock room by using alphanumeric indicators. In 

another job, [she] was the leader of a crew and was responsible for making sure the parts 

were manufactured correctly. These jobs show significant capabilities and functioning.

Because we conclude that substantial evidence supported the ALJ’s finding that Frame’s IQ 

score is invalid, we need not address whether substantial evidence also supported this reason for 

finding that Frame failed to prove that she met the criteria of listing 12.05.

5 The ALJ also noted that Frame’s IQ score was inconsistent with the conclusions of 

another examining psychologist, Dr. Linda Abeles. In November 2006, Dr. Abeles examined 

Frame and concluded that she exhibited borderline intellectual functioning and that she could 

likely obtain and maintain employment with appropriate treatment. 

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For starters, the ALJ did not err by considering whether Frame’s IQ score 

was consistent with the other evidence in the record. The regulations provide that 

the results of standardized intelligence tests “are only part of the overall 

assessment.” 20 C.F.R. pt. 404, subpt. P, app. 1, § 12.00D6a. And while such test

results are “essential” for all claims of intellectual disability not covered by listing 

12.05A, id. § 12.00D6b, the regulations “do[ ] not require the ALJ to make a 

finding of [intellectual disability] based on the results of an IQ test alone,” Popp, 

779 F.2d at 1499. Indeed, they require the ALJ to “examine the results in 

conjunction with other medical evidence and the claimant’s daily activities and 

behavior.” Id. at 1500. So by considering the medical evidence of Frame’s

examining physicians, the ALJ did not err. Nor did the ALJ err by according little 

weight to Dr. Goren’s testimony that Frame met the criteria of listing 12.05C. See 

Sharfarz v. Bowen, 825 F.2d 278, 280 (11th Cir. 1987) (concluding that the 

opinions of reviewing, nonexamining physicians, “when contrary to those of 

examining physicians, are entitled to little weight”); see also 20 C.F.R. 

§§ 404.1527(d)–(e), 416.927(d)–(e).

Next, the regulations make clear that “the narrative report that accompanies 

the test results should comment on whether the IQ scores are considered valid and 

consistent with the developmental history and the degree of functional limitation.” 

§ 12.00D6a. Because a comment about the IQ test’s validity is not required, it is 

unlikely that the ALJ could reject Frame’s verbal IQ score on this basis alone. But 

this does not mean that the report’s lack of comment could not factor into his 

analysis. After all, reports that “[do] not include the quantum of medical evidence 

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required to document whether the results of the intelligence test were consistent 

with the plaintiff’s daily behavior” are generally given less weight than those that 

“ma[k]e the required specific findings regarding plaintiff’s mental condition, and 

extensively discuss[ ] her personal and medical history and current lifestyle in 

support of [their] findings.” Strunk v. Heckler, 732 F.2d 1357, 1360 (7th Cir. 

1984).6

IV.

Given our highly deferential review, we hold that a reasonable person could 

conclude from the record that Frame’s verbal IQ score of 65 was invalid. See 

Crawford, 363 F.3d at 1158–59. Accordingly, we conclude that substantial 

evidence supported the ALJ’s conclusion that Frame did not meet listing 12.05C. 

And because Frame did not challenge the ALJ’s step-four analysis, we affirm the 

denial of her benefits application.

AFFIRMED.

 6 As Frame notes, we have recognized that IQ is presumed to remain fairly constant 

throughout life. Hodges, 276 F.3d at 1268–69. For this reason, we have held that a valid IQ 

score after age 22 creates a rebuttable presumption that the claimant satisfies the diagnostic 

criteria of listing 12.05. See id.

But contrary to Frame’s suggestion, Hodges does not apply here. In that case, the ALJ 

accepted the IQ score determined by the examining physician “as a valid assessment of Hodges’ 

mental capabilities at age 49.” Id. at 1268. Not so here. Thus, the ALJ did not err by failing to 

presume that Frame satisfied the diagnostic criteria of listing 12.05.

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