Kenneth S. Apfel has been appointed to serve as Commissioner of the Socia l 1 Security Administration and is automatically substi tuted as appellee. See Fed. R. App. P. 43(c)(1). The Honorable Pasco M. Bowman succeeded the Ho norable Richard S. Arnold 2 as Chief Judge of the United States Court of Appeals for the Eighth Circuit at the close of business on April 17, 1998. The H onorable Stephen N. Limbaugh, United States District Judge for th e 3 Eastern District of Missouri, sitting by designation.



## United States Court of Appeals
FOR THE EIGHTH CIRCUIT

___________ No. 97-3185

___________ Hazel Pyland, * * Appellant, * * Appeal from the United States v. * District Court for the Eastern * District of Arkansas Kenneth S. Apfel, Commissioner, * 1 Social Security Administration, * * Appellee. *

___________ Submitted: February 9, 1998 Filed: July 22, 1998

___________ Before RICHARD S. ARNOLD, Chief Judge, McMILLIAN, Circuit Judge, and 2 LIMBAUGH, District Judge.

3The Honorable Henry Jones, Jr., United States Magistra te Judge for the Eastern 4 District of Arka

nsas, to whom this case was referred for decision upon the consent of the parties pursuant to 28 U.S.C. § 636(c).
-2- ___________ McMILLIAN, Circuit Judge.

Hazel Pyl and (Pyland) appeals from a final order entered in the United State s District Court for the Eastern District of Arkansas affirming the final decision of the

4 Commi ssioner

of the Social Security Administration (Commissioner). Pyland v

. Callahan , No. J-C-95-286 (E.D. Ark. July 9, 1997) (Memorandum and Order ) (hereinafter

“slip op.”). Pyland applied for disability insurance benefits in Augus t 1992, alleging that she became disabled on September 10, 1979, due to menta l impairment. The district court found that substantial evi dence on the record as a whole supported the decision of the administrative law judge (ALJ) that Pyland was no t disabled before the expiration of her insured status on September 30, 1981, and , therefore, was not entitled to disability insurance benefits under Title II of the Social Security Act, 42 U.S.C. §§ 401-433. For reversal, Pyland argues that the ALJ erred in concl uding that substantial evidence on the record as a whole supported th e Commissioner’s decision to deny her benefits. For the reasons discussed below, we affirm the order of the district court.

Jurisdiction

Ju risdiction in the district court was proper based upon 42 U.S.C. § 405(g)

. Jurisdiction in this court is proper b ased upon 28 U.S.C. § 1291. The notice of appeal was timely filed pursuant to Rule 4(a) of the Federal Rules of Appellate Procedure.-3- Background

At the ti me Pyland’s insured status expired on September 30, 1981, she wa s forty years old. Pyland alleges tha t she became disabled on September 10, 1979. She has a high school education, several hours of college credit, and past relevant work experience as a secretary. She filed her most recent app lication for disability insurance bene fits on the basis of mental impairment due to depression and seizures o n August 31, 1992.
Pyland has had a long history of physical and mental ailments. We discuss only th ose relevant to her disability claim. In 1973 Pyland was admitted to Communit y Methodis t

Hospital and diagnosed with depressive neurosis and suicidal tendencies

. In August 1979 she was admitted to Craighead Memorial Hospital for chest pains and sho rtness of breath. She complained of seizure activity while in the hospital, bu t
neu rological examinations showed nothing abnormal. The doctors recommended a psychiatric evaluation.

InSeptember 1979 she was admitted to the hospital twice. On September 10, her last day of work as a secretary and the date on which she claims to have become disabled, she was admi tted for a staphylococcus infection. On September 14 she was admit ted for a prescription drug overdose. During her second admittance, doctor s stabilized her on antidepressants and seizure medication and then released her.

In Se ptember 1980 Pyland was admitted twice to St. Bernard’s Regiona l Medical Center (St. Bernard’s). On September 14 she was admitted for depression and grand ma l seizures. On September 27 she was admitted for dizziness and unstead y ga it. After another neurological exam showed nothing abnormal, a psychiatris t determined that her seizures were psychiatrically based and diagnosed her with manic depression. In Apri l 1981 Pyland was again admitted to St. Bernard’s. This time she was diagnosed with unipolar depressive disorder, pseudo seizures and seizure disorder.-4-

She was given intensive psychotherapy to help her control her seizures. Her insured status expired on September 30, 1981.
Pylan d’s husband testified that she was suicidal and had attempted suicide b y ju mping from a car. Although the date of this event is not clear from the record, th e evidence suggests that it occurred in late 1981 or in earl y 1982. In March 1982 Pyland underwent a psychiatric evaluation to determine whether she qualified for disabilit y be nefits from the Social Security Administration. Noting her history of seizures an d claims of attempted suicide and depression, the evaluating psychiatrist observed that Pyland was pleasant and cooperative, her thinking was relevant and u sually logical, and she was neither delusional nor did she experience hallucinations. The evaluatin g ps ychiatrist

also found that Pyland was somewhat depressed and apathetic. In 198 2 doctors took Pyland off seizure medication, and she no longer suffers from seizures.
Pyl andhas unsuccessfully attempted to obtain disability benefits since 1980

. She filed applications for benefits in July and August 1980, which were both denied in September 1981. T he Appeals Council denied her Request For Review in November 1981. She filed another application in February 1982, which was denied in Marc h 1983. The Appeals Council denied another Request For Review in July 1983.
Pyland filed her present application for benefits in August 1992. The ALJ , relying on the denials of her previous applications, dismissed her request for a hearing based on res judicata . In Oc tober 1993 the Appeals Council remanded Pyland’s case to the ALJ to consider Pyland’s most recent application under the new sequentia l standard set forth at 20 C.F.R. § 404.1 520. Although this standard was not in place at the time of Pyland’s initial applications for benefits, it allows applicants previousl y denied benefits to reapply under the new standard.-5-

A he aring de novo was held in January 1994. The ALJ issued a decision i n Ja nuary 1995 denying Pyland’s disability claim. The ALJ, working through the fivestep sequential standard, made the following determinations: (1) Pyland had no t engaged in substantial gainful activity since the onset of her alleged disability; (2) she suff ered from a severe mental impairment (bipolar disorder); (3) the impairment di d not, howe ver, meet or equal the level of severity for one of the Social Securit y Administration’s listed impairments prior to the expiration of her insured status; (4) she hadthe residual functional capacity to perform her past relevant work as a secretary, despite any impairment; and (5) she could perform other substantial or gainful work. See Administrative Transcript, v.1, Notice of Decision at 1-5 (hereinafter AL J Dec ision); see also 20 C.F.R. § 404.1520(b)-(f). The ALJ further determined tha t Py land’s allegations were not borne out by the record and that her subjectiv e complaints of pain and fatigue were not “fully credible.” ALJ Decision at 6.
Pyland again sought review from th e Appeals Council which denied her request in Nov ember 1995, making the decision of the ALJ the final decision of th e Commissioner. Pyland then sought judicial review in the United States District Court for the Eastern District of Arkansas which granted summary judgment in favor of the Commissioner in

July 1997. See slip op. at 11. The district court affirmed the ALJ’s findings t hat Pyland’s impairment did not meet or equal one of the Social Securit y Adm inistration’s listed impairments and that she retained the residual functiona l capacity for her past work. The district court held that substantial evidence on th e record as a whole supported these conclusions. This appeal followed.

Discussion

Our review of an ALJ’s decision to deny Social Security benefits is limited and deferential to the agency

. See Ostronski v. Chater , 94 F.3d 413, 416 (8th Cir. 1996). We will not disturb an ALJ's determination if it is supported by substantial evidence-6-

on the record as a whole. See42 U.S.C. § 405(g); Spradling v. Chater , 126 F.3d 1072, 1073-74 (8th Cir. 1997); Whitehouse v. Sullivan , 949 F.2 d 1005, 1006 (8th Cir. 1991). This standard requires us to consider relevant evidence which a reasonable mind would accept as adequate to support the Commissioner's conc lusion, Woolf v. Shalala , 3 F.3d 1210, 1213 (8th Cir. 1993), as w ell as evidence that detracts from the Commissioner's decision, Robinson v. Sullivan , 956 F.2d 836, 838 (8th Cir. 1992). We may not reverse the Commissi oner’s decision merely because substantial evidence exists supporting a different outcome. See Smith v. Shalala , 987 F.2d 1371, 1374 (8th Cir. 1993).
In order to receive disability i nsurance benefits, an applicant must establish that she was disabled before the exp iration of her insured status. See 42 U.S.C. §§ 416(i), 423(c); Stephens v. Shalala , 46 F.3d 37 , 39 ( 8th Cir. 1995) (per curiam) (citing Battles
v. Sullivan , 902 F.2d 657, 659 (8th Cir. 1990))

. Evidence of a disability subsequent to the expiration of one’s insured status can be relevant, however, in helping t o elucidate a medical condition during the time for which benefits might be rewarded

. See Fowler v. Bowen , 866 F.2d 249, 252 (8th Cir. 1989) ( Fowler ); Martonik v

. Heckler , 773 F.2d 236, 240-41 (8th Cir. 1985) ( Martonik ). But see Milton v

. Schweiker , 669 F.2d 554 , 555 n.1 (8th Cir. 1982) (per curiam) (noting that a hear t attack s ubsequent to the expiration of insured status without evidence of a hear t condition d uring the relevant time period cannot serve as a basis for recoverin g disability benefits)

.
Th e five-step sequential standard is the test by which an ALJ determines if a claimant is disabled. 20 C.F.R. § 404.1520. The first step involves a determination of whether the claimant is presently working. Id. § 404.1520(b). The second ste p inv olves a determination, based solely on medical evidence, of whether the claiman t has a severe impairment or combin ation of impairments. Id. § 404.1520(c). The third step requires the ALJ to compare this impairment to a Listing of Impairments (Listing) and determine whether it meets or equals one of tho se listed. Id. § 404.1520(d). If thePyland claims to suffer from (a) anhedonia or pervasive loss of intere st in almost 5 all act ivities; (b) appetite disturbance with change in weight; (c) sleep disturbance ; (d) psychomotor agitation; (e) decreased energy; (f) feelings of guilt or worthlessness; (g) difficulty concentra

ting or thinking; and (h) thoughts of suicide. See 20 C.F.R. Pt. 404, Subpt. P , App. 1, § 12.04(A)(1)(a)-(h). She does not claim, on this appeal, t o have suffered from any “[h]allucinations, delusions or paranoid thinking.” Id

. § 12.04(A)(1)(i). Pyla ndclaims that her bipolar disorder results in (a) marked restriction o f 6 activities o f daily living; (b) marked difficulties in maintaining social functioning; and (c) repeated episodes of deterioration or dec ompensation in work or work-like settings which cause her to withdraw from that s ituation or to experience exacerbation of signs and symptoms. See 20 C.F.R. Pt. 404, Subpt. P, App. 1, § 12.04(B). She does no t claim, on this appeal, to have suffered from any “[d]eficiencies of concentration , persistence or pace resulting in a failure to complete tasks in a timely manner.” Id

. § 12.04(B)(3).
-7- claimant does not qualify for disability benefits at step three, steps four and five involve
a determination of whether the claimant can perform past relevant work or any other work. Id. § 404.1520(e), (f).
Pyland argues that the ALJ erred in determining, at step three of the analy sis, that her me ntal impairment did not have the symptoms meeting or equaling a depressiv e syndrome, which is one of the impairments in the Listing, and did not result in th e funct ional limitations of an affective disorder. See 20 C.F.R. Pt. 404, Subpt. P, App. 1, § 12.04. To meet or equal a depressive syndrome, the claimant must have at least f o ur of the nine listed symptoms and the impairment must result in at least two of the four listed functional limitations of an affective disorder. Id. Pyland claims to manifest all but one of the symptoms for a depressive syndrome disability and all but one of the 5 functional limitations of an affective disorder. In support of these claims, she presents 6 evidence based on a psychiatric evaluation in March 1982, several months after th e expiration of her insured status. She presents no further evidence to support “feelings of guilt or worthlessness,” “decreased energy,” “anhedonia or pervasive lossThe A LJ found the testimony of Pyland’s husband to be unpersuasive an d 7 “motivated by the desire to see [his wife] obtain benefits.” ALJ Decision at 5.
-8- of in terest in almost all activities,” “difficulty in concentrating or thinking,” “slee p disturbance,” or “appetite disturbance with change of weight.” See id. § 12.04(A).

The Commissioner concedes that Pyland suffered psychomotor agitation fro m her psy chologically based seizures, but contends that the evidence on the record fails to supp ort Pyland’s claims regarding any of the other required symptoms for a depressive syndrome disorder. See id. § 12.04(A)(1)(a)-(i). The Listing requires proof of at least four symptoms before the Commissioner can determine that a claiman t suffers from a depressive syndrome. See id. § 12.04(A )(1). The Commissioner argues that Pyland has the burden of showing that she suffered at least four of the liste d symptoms dur

ing the relevant time and has failed to carry that burden. See Bowen v. Yuckert , 482 U.S. 137, 14 6 n.5 (1987); see also 20 C.F.R. § 404.1520(a). We agree.
As noted above, evidence concerning ailments outside of the relevant time period
can su pport or elucidate the severity of a condition. See Fowler , 866 F.2d at 252 ; Martonik , 773 F.2d at 240-41

. However, evidence outside the relevant time perio d cannot serve as the only support for the disability claim. Such a holding would b e contrary to the Social Se curity Act, 42 U.S.C. §§ 416(i), 423(c), which requires proof of disability during the time for which it is claimed. The only evidence that Pylan d pr ovides for meeting six of the nine depressive syndrome symptoms is a psychiatri c evaluation performed almost 6 months after her insured status expired. Substantia l evidence on the record supports, at most, a manifestation of two symptoms : psychomotor agitation, which the Commissi oner concedes, and thoughts of suicide. A
reason able mind could conclude that her husband’s testimony of a suicide attempt , wh ichmay or may not have occurred during the relevant time period, points to th e existence of that symptom during the time for which benefits might be aewarded. Two 7 of the required four symptoms, however, is not enough.-9-

In ad dition, we note that Pyland’s claim of functional limitations unde r § 12. 04(B) is not supported by the record. There is some evidence that, prior to th e expirati on of her insured status, she was restricted in daily living, had troubl e function ing socially, and had problems working. The Listing, however, requires th e ALJ to assess whether the limitations on daily living and social functioning wer e “marked” or “seriously interfere[d] with the ability to function independently , appro priately and effectively” and whether deterioration or decompensation in wor k was “repeated.” 20 C.F.R. Pt. 404, Subpt. P, App. 1, § 12.00(C). The ALJ determined that Pyland only suffered from “moderate” restrictions in daily activities and “slight” difficulties in social functioning with no deterioration or decompensation in work

. Admin istrative Transcript, v.1, Psychiatric Review Technique Form at 3. Thes e moderate and slight restrictions do not rise to the Listing’s required level of severity. The substantial evidence standard requires that we evaluate the eviden ce in terms of the reasonableness of the ALJ’s determination. The findings of moderate re strictions in her daily activities, slight difficulties in social functioning and no deterioration o r decompensation in work are reasonable.
Likewise, the ALJ’s determination that Pyland retained the residual functional capacity to perform her past relevant work as a secretary is supported by substantia l
ev idence. The ALJ found that, if she observed routine seizure precautions such a s avoid ing unprotected high places or the operation of automotive equipment, Pylan d could engage i n substantial gainful activities. ALJ Decision at 3. He determined that her work as a secretary did not require a great deal of interpersonal contact and did not require any activity precluded by routine seizure precautions. ALJ Decision at 5. A reasonable mind could conclude that, based on t he evidence, Pyland could perform her past relevant work as a secretary and, therefore, was not disabled. See Stephens v

. Shalala , 50 F. 3d 538, 542 (8th Cir. 1995).-10- Conclusion
In light of the foregoing, we hold that the re is substantial evidence on the record
as a whole to support the Commissioner's decision to deny disability benefits

. Accordingly, the judgment of the district court is affirmed.

A true copy.
Attest: CLERK, U.S. COURT OF APPEALS, EIGHTH CIRCUIT.