The Honor able John R. Gibs on, United States Circuit J udg e for the Eig hth Circuit Court of * Appea ls, sitt ing by

desig nation. NO T R EC OM M EN DE D F OR F UL L- TEX T P UB LIC AT ION F ile Nam e: 09a0084n.06 F iled: F ebruary 2, 2009 Uni te d St at e s C our t o f Appe als FO R TH E SIX T H C IR C U IT



### ____ ____ ___ No. 07-5897

___________ Vivian Kelly , on behalf

of Aa ron * Ho llo we ll, * * Pla int if f - Ap pe lla

nt, *

* On Appea l from the United States v. * District Court for the Western * District of Ke ntucky C o m m i s s i o n e r

o f S o c i a l S e c u r i t y, * * Def endant - Appellee
. *
B e fo re : MA RTI

N, GR I F F I

N, and JOHNR. G I B SON , Cir c uit Judg e s. *
J OHN R. GI BSON, Circ uit J udg e. Vi v i an Ke l l y , au n tan d

gu ar d i an o f A ar o nHo l l o w e l l , ap p ea l s fr o m t h e d i s t ri ct co u rt 's judgme nt in favor of

the Commiss ioner of Social Security denying Aaron' s application for childhood Sup ple me nta l Se c ur ity I nc ome be ne fi ts. Aa ro n su ff e rs fr om Atte nti on

Defi c it- Hy

pe ra c tiv ity Disorder , which the AL J found did not meet or e qual the " listi ng s," i.e ., disabli ng conditions
rec og nized a

nd descr ibed in the social secur ity regulations. Mrs. Kelly contends that the A L J was oblige d to obtain a new opinion from a medical e x pert in re sponse to new e vidence she pre sented at the hea ring , but that the AL J failed t o d o s o . S he also a rg ues that the AL J ' s conclusion that

### N o. 07- 5897

Ke llyv . Co m m . of Soc ial Se cu rit y

2 Aar on' s condition did not m eet or equal the listi ng s was not suppor ted by substantial evidence on the
re c or d a s a

wh ole . We a ff

ir m th e jud g me nt o f t

he dis tr ic t c ourt
. I. F ac ts . Aar on was born on Fe bruar y 8, 1996. He was remove d from his mother' s home when he was four, due to neg lect. He now lives wi t h Vi v i an Kelly , his aunt, who by all acc ounts does an admirable job of ca

ring for him. He ha s a history of septic a

rthritis in his l eft kne e, but that problem ha s b e e n r e so lve d a

nd he do e s n ot c on te nd

that hi s k ne e is c ur re ntl y a se ve re imp a ir

me nt. Aar on' s remainingproblem is that he suff ers f rom deve lopmental delay s and Attention De f ic it

- H y p e r a c ti v it y D is o r d e r , w h ic h w a s d ia g n o s e d in M ay 2 0 0 2 , w h e n h e w a s s ix. H e was presc ribed medic ation, which helps but does not f u l ly corr ect his problem. He was re fer red f or testing for special education in 2001-02, when he was in kinderg arte n. For 2002-03, he w as g iven specia l education services f or 50 minutes eac h wee k, but ke pt in a re g ular fir st-g rade classroom. He was ke pt back in sec ond g rade , so that he attende d second g rade in both 2003-04 and 2004-05. Mr s. Ke lly

a pp lie d f or SSI be ne fi ts f

or Aa ro n o n Se pte mbe r 3 0, 20 02 , a lleg in g dis a bil ity beg inning January

15, 2000 , d u e t o j u venile ar thritis, developmental delay s in cog nitive and fine
m o t o r s k i l l s , an d

a c a d e m i c d e f

i c i t s . H e w a s e x a m i n e d

o n J a n u a r y 4 , 2 0 0 3 b y S t e v e nL
. G o u dy, M
. D
. , a m e d i c a l c o n s u l t an t , w h o o p i n e d t h a tA a r o n ' s m e d i c a t i o nh e l p e d c o n t r o l h i s h yp e r a c t i v i t y, but that he would have to be followed in c as e h e d ev el o ped fur ther proble ms with attention and cog nitive function. The Kent ucky Division of Disability

Deter minations obtained evaluations by Mary K. Thompson, Ph. D., and J
. Howell, M.D., dated Dec ember 12, 2002 and Apr il 15, 2003,

### N o. 07- 5897

Ke llyv . Co m m . of Soc ial Se cu rit y

3 re sp e c tiv e ly , w hic h c on c lud e d th a t A aro n' s im pa ir me nt w a s se ve re , b ut d id n ot m e e t, m e dical ly equal, or functionally

equal the list ings. I n particula r, t he age ncy evaluations stated t hat Aaron had
a mark e d im

pa ir me nt o f his a

bil ity to atte nd and c omp le te ta sk s, bu t le ss t ha n ma rk e d im pa ir me nts or no impairment in other f unctional ar eas. The claim was initially denied on Apr il 17, 2003. Mrs. Kelly

reque sted rec onsideration on May 21, 2003, rely ing on the s ame disabili ty

alleg ed
ear lier. The a g ency

obtained a r eview of

the re cord by

a new state phy sician and psycholog ist, who ag ain conc luded t hat Aaron' s impairments wer e severe, but did not meet or equal the listing s. Ag ain, the state me dic a l e xpe rt s c on c lud e d that Aa ro n' s a bil ity to a tte nd and c omp le te ta sk s wa s ma rk e dly impaired, b u t t h e i m p airment of othe r func tional are as wa s less than marke d or there was no impairment. The c laim was ag ain denied on Aug ust 4, 2003. On September

18, 2003, Mrs. Kelly

reque sted a he aringbefor e an A L J . The h ea ri ng took place on October

22, 2004, when Aa

ron wa s eig ht a

nd beg inning his se cond y ear in second g rade
. At the hea

ring , Mrs. Kelly

submitt ed two new teac her repor ts, a nd additional medical r ecor ds from his tr e a tin g ph y sic ia

ns , w hic h h a d n ot b e e n in

the re c or d w he n th e a g e nc y or ig ina lly

de nie d b e ne fi ts. Mrs. Kelly

testified as the only

witness. After the hear ing, the AL J denied benef its. Applying the three -step inquiry

appropr iate for

childhood disability

case s, 20 C.F.R. § 416.924(a) , he found (1) that A aro n h a d n e ve r e ng a g e d in g a inf ul a c tiv ity ; ( 2) that Aaro n' s ADH D wa s a sev e re imp a ir me nt; but (3) that it did not meet or equa l the listi ng s. To deter mine whether

Aar on' s condition met or equale d the listings, the AL J had to consider first, whethe r it met a listing, second, whether it was the medical equivalent of a li sted condition, or

### N o. 07- 5897

Ke llyv . Co m m . of Soc ial Se cu rit y

4 third, whether

it wa s the functional equivalent of a listed condition. Mrs. Kelly does not contend that Aa ro n' s c on dit ion

me t or e qu a le d th e lis tin g s o r w a s th e me dic a l e qu iva le nt o f a lis te d c on dit ion , s o the only disputed issue is whether his condition was the functional e quivalent of a listed condition. Func tional equivalenc e is deter mined by 20 C.F.R. § 416.926a, which r equire s a " marke d" i mp a i r m e n ti nt w o " d o m a i n s " o r an" e x t r e m e " i m

p a i r m e n ti no n e d o m a i n . § 4 1 6
. 9 2 6 a . T h e A LJ found that the only

domain in which Aar on had a ma rked impairme nt was "attendingand completing t a s k s , " § 4 1 6
. 9 2 6 a ( b ) ( 1 ) ( i i ) , an d t h a th i s i mp a i r m e n ti nt h i s d o m a i nw a s n o t" e x t r e m e . " A c c o r d i n g l y, the AL J conclude d that Aar on was not disabled. Mr s. Ke lly

a pp e a le d to the Ap pe a ls C ounc il, c on te nd ingthat t h e A L J v i o l a

te d So c ia l Se c ur ity Ruling 96- 6 p b y

f a il in g to o b ta in

anu p d a te d me d ic a l e xp e rt o p in io nin v ie w o f th e n e w evidenc e prese nted at the he aring
. She also submitt ed to t he Appe als Council a new psycholog ical eva luation dated Aug
. 29, 2005. The psy cholog ist's repor t mostly rec ounted information alre ad y i n o t her
rec ords and g ave ne w testing results showing that Aar on was a littl e behind gr ade le vel in math, but
a t a b o u t g r a d e le v e l in r e a d in g . T h e p s y c h o lo g is t c o n c lu d e d , " [A ar o n ] w o u ld a p p e ar to mee t the criter ia for SSIat this time." The psy cholog ist also completed an e valuation shee t showing A aron h a d m ark edi mp ai rm en t s i nfi v e o u to f s i x d o m ai n s . M rs . Ke l l y al s o s u b m i t t eda n ew t ea ch er 's repor t, completed on May

18, 2005, afte r the A L J 's d ecision of Nove mber 19, 2004. The new te a c he r' s r e po rt sh ow s per fo rm anc e wo rs e tha n the pr e vio us y e ar' s re po rt on e ve ry thi ng re latin g to attention span and r esponsibility . Mrs. Kelly does not rely

on the psy cholog ist's repor t or the new teac her' s repor

t in her brief

, appar ently

beca use they wer e produc ed af

ter the A L J ' s decision.

### N o. 07- 5897

Ke llyv . Co m m . of Soc ial Se cu rit y

5 Mrs. Kelly

also contende d there was no substantial e vidence to suppor t the AL J ' s conclusion that Aar on was not disabled. The Appea ls Council denied Mrs. Kelly ' s reque st for re view. Mr s. Ke lly

fi le d a n a c tio n und e r 4 2 U .S. C. § 40 5( g ). Th e c a se wa s re fe rr e d to a Ma g istrate J udg e, who c onsidered Mr s. Kelly ' s arguments (1) that the A L J err ed in fai l i n g t o ca l l a medica l expert to evaluate the new evidenc e Mrs. Kelly adduce d, and (2) that the evidenc e demonstrated a n
e xtre me imp a ir

me nt i n th e " att end ingand c omp le tin g ta sk s" do ma in a nd mark e d im

pa ir me nts in other domains. As to the medic al expert issue, the Mag istrate Judge r easone d that the new e vidence did not "fatally

undermine" the ac cura cy of the state ag ency assessment and there fore did not require
a new medical e x pert' s opinion. As to the sufficie ncy of the e vidence , the Mag istrate Judge he ld that the evidenc e did not show that Aar on had mar ked def icits in more than one domain. There was no such showing fo r "se lf-ca re" since a

test showing him at the .4 pe rce ntile in April 2002 covere d a broade r ra

ng e of c oncer

ns than "se lf-ca

re" and ther efor e wa s not conclusive as to self -ca re. O ther evidenc e about his diffic ulties in self-ca re was m o re proper ly

char acte rized as re lating to lac k of attentiveness, in which he was admittedly marke dly impaired, rathe r than a s self-c are . The re cord showed Aa

ron could fe ed, bathe , and clothe himself and use the toilet. Aar on was not shown to be
mark e dly imp a ir e d in

" a c qu ir ingand

us inginf or matio n, " sin c e sc ho ol a

uth or iti e s h a d d e c ide d to pla c e him in a re g ula r s e c on d g ra de c la ssr oo m. Te sti ngin 2 00 2 s ho we d h is r e a din g wa s at th e 26 th perc entile, his math at the 31st, a nd his w ritten lang uag e at the 33d perc entile, which was not shown to be two standar d deviations below the mean. The g uidance counselor inter pretingthe re sults noted that Aar on was at one standar d deviation below the me an. The Mag istrate Judge did not find any

### N o. 07- 5897

Ke llyv . Co m m . of Soc ial Se cu rit y

6 support for Mrs. K elly ' s argument that Aar on was " extremely " impair ed in attendingand completing tasks. The district cour

t adopted the Ma g istrate Judge' s Report and Rec ommendation. On a pp e a l, M rs . K e lly

c on te nd s th a t the AL J e rr e d b y fa ili ngto o bta in a

me dic a l e xpe rt

to
re n d er an u p d at edm ed i ca l j u d gm en tan d t h at t h er e i s n o ts u

b s t an t i al ev i d en ce t o s u

p p o rt t h e A L J 's finding that Aar on was not disabled. I I . St a nd a r d o f r e v ie w. Under 42 U.S.C. § 405(g) , "[t]he findings of the Commi ssioner of Social Sec urity as to any fac t, if supported by

substantial evidence , shall be concl u s i v e . . . . " Substantial evide nce me ans "suc h rele vant evidenc e as a rea s o n ab l e m i n d might ac cept" to support a conc lusion. Foster v. Halter , 2 7 9 F. 3 d

3 4 8 , 3 5 3 ( 6 t h C i r. 2 0 0 1 ) ( qu o t i n g Richardson v. Pe rales , 402 U.S. 389, 401 (1 97 1) ). We r e vie w the dis tr ic t c ourt ' s d e c isi on in s oc ia l se c ur ity

c a se s de novo , and we revie w the administrative finding s and conclusions as if we wer e the f irst review ing c ourt. Crum v. Sullivan , 921 F.2d 642, 644 ( 6th Cir. 1990).

III . N e e d for updat e d m e dic al e xpe r t o pinio n. S o c i a l S e c u r i t y

R u l i n g 9 6
- 6 p g o v e r

n s t h e n e e d

f o r u p d a t e d

m e d i c a l e x p e rto p i n i o n s . It
re qu ir e s an upd ate when e ith e r ( 1) the re is e vid e nc e of sy mpt oms , s ig ns and

fi nd ing s th a t su g g e st to the AL J or Appea ls Council that the applica nt's c ondition may

be equiva lent to the listi ng s; or (2)
w h e n a d d i t i o n al m ed i ca l ev i d en ce i s re ce i v edt h at "i nt h e o p i n i o no f t h e a dm i n i s t ra t i v e l aw j u d ge

### N o. 07- 5897

Ke llyv . Co m m . of Soc ial Se cu rit y

7 o r t h e A p p ea l s C o u n ci l m ay ch an ge th e S t at e agen cy m ed i ca l o r p s y ch o l o gi ca l co n s u l t an t 's fi n d i n g" that the impairment does not equa l the listi ng s. Thus, Mrs. Kelly

has to show that t here is evidenc e calling f or an updated medica l opinion. He r n e w e vid e nc e c on sis te d ma inl y of tw o te a c he rs ' re po rt s. Th e tw o ne w t e a c he rs ' re po rt s are bo th from the se cond gra de, which Aar on repe ated, and are dated September 24, 2003 and October 20, 2004. The ne w t eac hers' repor ts are not ve ry

differ ent from the f

irst-g rade repor

t dated Nove mber 13 , 2 00 2, wh ic h e xiste d w he n th e state a g e nc y e xpe rt s re nd e re d the ir op ini on s and

wh ic h M rs . K e lly d o es n o tar gu e w as u n av ai l ab l e t o t h o s e ex p er t s . T h e n ew re p o rt s agr ee wi t h t h e o l d o n e t h at Aa ro n 's worst are a was "attending and completing tasks." I n the first g rade repor t se ction on attending and completing tasks, he had a "se rious problem" rankingon seven out of thirte en items. One se cond gra de re po rt wa s sli g htl y be tte r, on e sli g htl y wo rs e . I n the 20 03 se c on d g ra de re po rt , he ha d "a
s e r i o u s p r o b l e m " r an k i n g o n f o u r o u to f t h i rt e e ni t e m s i nt h e a t t e n d i n g an d c o mp l e t i n g s e c t i o n . In the 2004 sec ond g rade repor t, he h ad five "e x tremely

serious problem" ranking s and five " serious pr ob le m" ra

nk ing s, wi th o nl y th ree it ems at " a sli g ht p ro ble m." Th e ne w r e po rt s d o n ot p re se nt a sig nif ic antl y dif fe re nt p ic tur e on

a tte nd ingand

c omp le tin g ta sk s th an th e 20 02 re po rt
. M rs . Ke l l y

ar gu es t h at Aa ro ni s m ark ed l y i mp ai re d i n o th er d o m ai n s , b u t t h e 2 0 0 4 t ea ch er 's repor t does not support that asser tion. Specifica lly , in the domain of car ing for himself, e ight of the ranking s are either " no problem" or " slight problem." The only "e x tremely

serious problem" ranking
on that pa g e is a c tua lly

mor e re late d to the "att e nd ingand c omp le tin g ta sk s" do ma in, sin c e it

### N o. 07- 5897

Ke llyv . Co m m . of Soc ial Se cu rit y

8 c on c e rn s " [b]e ingpatie nt whe n n e c e ssa ry ." Mo re ov e r, th e 20 04 re po rt e nd s w ithon e of

the mos t po sit ive thi ng s in

his fi le : th e te a c he r wrot e, "Aaron is a g re a t ki d, a ha pp y kid ! H e me ans we ll, howeve r, he ha s problems fo cu s i ng ." T he 2003 re port shows Aar on had begun rec eiving specia l
e du c a tio n s e rv ic e s d a ily , a lth ou g h h e wa s st ill pr ima ri ly in t he re g ula r c la ssr oo m. Th e AL J sp eci fi c a lly

c on sid e re d th e 20 03 and 20 04 te a c he rs ' re po rt s. Takin g tho se int o
acc ount, he found that the attending a nd completing tasks i m p airment was marke d and all other imp a ir me nts we re le ss t

ha n ma rk e d. He did

no t sp e c if

ic a lly fi nd tha t the ne w t e a c he rs ' re po rt s d id not require an update d medical opinion, but it appear s that Mrs. Kelly ' s counsel did not make that
ar gu m en tt o t h e A L J
. I n t h e tr an s cr i p t , M rs . Ke l l y 's co u n s el t o l d t h e A L J t h at "t h i s re ce n tt ea ch er 's
re p o rt t h at we p u ti nt o d ay . . . s ee m s t o i n d i ca t e t h e s am e o r . . . wo rs e t h an t h e [ p re v i o u s ] t ea ch er 's repor ts . . . . " The Mag istrate Judge c onsidered the argument about updating the medica l opinion and
c o n c l u d e d

t h e r e w a s n o n e w e v i d e n c e t h a tm a d e i tn e c e s s ar y: There will alway s b e a gap betwee n the time the ag ency experts reviewthe re cord and g ive their opini on with respe ct t o the L isting and the time the hea ring decision is issued. Absent a cle ar showing that the ne w evidenc e re nders the pr ior opinion untenable, the mere fac t that a g ap exis ts doe s not w arr ant the expense and dela y of a judicial re mand. I n this case, the e vidence submitt ed af ter the state ag ency a sse ssm e nt d oe s n ot f

a ta lly un de rm ine the a c c ur a c y

of that a sse ssm e nt. Slip op. at 7.

### N o. 07- 5897

Ke llyv . Co m m . of Soc ial Se cu rit y

Mrs. Kelly

also relies on Lashley v. Se cretary of He alth and Human Servic es , 708 F.2d 1048 1 (6th Cir. 1983), in arguing that the AL J failed in his duty to de velop the re cord. L ashley conce rned an AL J ' s duty in the case of a pr o se cla imant, id . at 1051, wher eas Mr s. Kelly was re prese nted by c ouns e l a t th e hear ing . M rs . K e lly ha s ma de no sh ow ingthat sh e wa s una ble fo r a ny re a so n to prese nt her c ase. 9 Mrs. Kelly

has not shown that the AL J err ed in fa iling to obtain an updated medica l expert opinion. 1 I V . Su bs t a nt ia l e v id e nc e r e v ie w. The leg al fra

mework f or a c hildhood disabili ty

claim is a three -step inquiry presc ribed in 20 C.F.R. § 416.924. The questions a re (1) is the claimant working , (2) doe s the claimant have a se vere , medical ly d e te r mi n a b le im p a ir me n t, an d ( 3 ) d o e s th e im

p a ir me n t m e e t o r

e qu a l t h e li s ti n g s ? The only step at issue is whether

Aar on' s impairment equals the listi ng s. An impairment ca n equal the l i s t i n gs m ed i ca l l y

o r f u n ct i o n a l l y ; M r s . Ke l l y

co n t en d s Aa ro n 's i mp ai rm en teq u al s t h e l i s t i n gs f u n c ti o n a ll y . The c r it e r ia f o r f u n c ti o n a l e qu iv a le n c e to a li s ti n g ar e s e t o u t in § 4 16.926a. Tha t regul ati on di vi des fun cti on up in to si x "dom ain s": (1) Ac quiring and using information; (2 ) A tte nd ingand

c omp le tin g ta sk s; (3 ) I nte ra c tin g and

re latin g wi th o the rs ; (4 ) M ov inga

bo ut a nd manip ulatin g ob

je c ts; (5) Car ing f

or y ourself; a

nd (6 ) H ea l t h an d

p h y s i ca l we l l -b ei n g.

### N o. 07- 5897

Ke llyv . Co m m . of Soc ial Se cu rit y

10 § 416 .9 26 a(b) (1 ). To e sta bli sha fu nc tio na l im

pa ir me nt e qu a l to the lis tin g s, the c la ima nt h a s to show an extreme limit ation in one domain or a marke d impairment in mor e than one. § 416.926a(d)
. L eng thy definitions for mar

ked and e x treme a

re se t out in § 416.926a(e ). Eac h includes instructions
on ho w t o u se te st r e su lts :

“ Mark e d” lim itatio n a lso me ans a lim itatio n th a t is " mor e tha n mo de rate " bu t " le ss than extre me . " I t is th e e qu iv a le n t o f th e f un c ti o n in g w e w o u ld e xp e c t to f in d on stan d ar d i z ed t est ing w ith scores that a re at least two, but less than three , standard deviations below the me an. § 416.926a(e )(2) (i). "E x treme" limitation is t he rating we g ive to the worst limitations. However, " e xtre me lim itatio n" do e s n ot n e c e ssa ri ly me an a to tal la c k o r l os s o f a

bil ity to function. I t is the equivalent of the f unctioni n g we would e x pect to find on standardized testing with scores that are at least thre e standa rd deviations below the mean. § 416.926a(e )(3) (i). (A ) W he th e r subs t ant iale vid e nc e suppo r ts AL J's finding th atim pai r m e nt in a tt e nding and com pleting tasks i s m arked but n ot ext rem e. The re g u lati o n d e s c r ib in g li mi tati o n s in th e a tt e n d in g an d c o mp le ti n g d o ma in, § 416.926a(h) (3), g ives a list of examples of limit ations a per son might have i n t h i s d o main. The
rec ord shows that Aa

ron has many

of those limitations, su ch as, "You r epeatedly become sidetrac ked from y our ac tiviti es or you fre quently interrupt other s," e tc. Id
. Neve rtheless, the regulation cautions that just beca

use a pe rson has the limitations d es cr ibed does not mea n the per son has an
e xtr e me o r e v e n a ma

r k e d im p airment. Id
. (" Also, the examples do not necessa rily descr ibe a

### N o. 07- 5897

Ke llyv . Co m m . of Soc ial Se cu rit y

11 ' marke d' or ' extreme' limit ation.") Thus, the fac t that A aron' s behavior s coincide w ith the examples i nt h e r egu l at i o n s d o es n o tco mp el a r es u l td i ff er en tfr o m t h e A L J 's fi n d i n g. Th e str on g e st e vid e nc e su pp or tin g the AL J' s fin din g is that the state a g e nc y me dic a l e xpe rt s opined in their eva luations that Aar on' s impairment in attending and completing wa s marked but not
e xtre me . T he re wa s n o me dic a l e vid e nc e be fo re th e AL J tha t c on tr a dic te d th e a g e nc y ph y sic ians '
o p i n i o n s , an d

ev en t h e p s y ch o l o gi s t 's re p o rt t h at M rs . Ke l l y i n t ro d u ce d at t h e A p p ea l s C o u n ci l s t age sh ow e d o nly

a mark e d im

pa ir me nt i n atte nd ingand

c omp le tin g ta sk s. The AL J relied on the teac hers' repor ts in fi nding a

marke d limit ation in the attending and completing domain, saying: " Despite pr escribed medication for ADHD , he continues to have dif fi c ult y sta y ing on ta sk and mus t be re dir e c te d re g ula rl y . He re qu ir e s one -o n- on e int e ra c tio n w ith his te a c he r a

t ti me s to c omp le te a ssi g nme nts ." Th e 20 02 and 20 03 te a c he r re po rt s do not i nd ic a te that Aar on was in the " extreme" cate g ory for a ny items in thi s domain, and the 2004 re port showed him in the ex treme c ateg ory for f ive out of thirteen items. Mrs. Kelly

relies on he r own testimony at t h e hea ring . She did indicate that Aa ron had pr ob le ms w itha tte nd ingand c omp le tin g ta sk s a

nd that sh e ha d to sta

y on him to g e t hi m to do his chore s, but nothing in her testimony compels a f

inding that his impairment is extreme instead of marke d. Sub sta nti a l e vid e nc e su

pp or ts the AL J' s f

ind ing s o n th is p oin t. (B) Whether s u b s ta n ti a l ev i d en ce s u p p o rt s th e A L J ' s f i n d i n g th a t n o n e of

Aaron's other im pai r m e nt s a r e m ar ke d.

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12 The AL J conclude d that Aar on' s impairment in acquiringand using information is less than marke d beca

use he is g ener ally

functioning at g rade level, albe it after he was held back a y ear . The
s t at e age ncy

m ed i ca l ex p er t s ch ar ac t er i z edAa ro n 's ac ad em i c p er fo rm an ce as l o w- av er age t o av er age rang e and r ated his impairment in this domain as less than mar ked. His g uidance counselor r eporte d that hi s a c hie ve me nt t e st s c or e s pla c e d him in the 26 th pe rc e nti le in r e a din g , th e 31 st p e rc e nti le in math, the 33rd perc entile in w ritten lang uag e, and the 23rd perc entile overa ll. Mrs. Kelly argues that these tests should not be counted be cause the re port did not include a full bat t er y of tests; the counselor r eporte d that Aar on was not able to complete all of the subparts. Even so, the g uidance
c ouns e lor c on c lud e d that he wa s in the low -a ve ra g e ra ng e of c og nit ive fu

nc tio nin g , w hic h s he sa id
was c onsistent with his aca demic ac hievement. The psy cholog ist's report that Mrs. Ke lly introduced at the Appe als Council stag e indicate d that Aar on had a ma rked impairm en t i n the domain of acquir ing a

nd using infor

mation, but the individual test scores on which the psy cholog ist relied wer e very close to his g rade level in August when he was a bout to beg in fourth g rade , except for math, in which he wa s about a y ear behind. The AL J ' s finding that Aaron' s impairment in acquiringand using infor

mation is less than marked is supported by substantial evidence in the rec ord as a w hole. The domain of se lf-ca

re c oncer ns "how well y ou maintain a hea lthy emotional and phy sical state , in c lud ingho w w e ll you g e t y our p hy sic a l and

e mot ion a l w ants and ne e ds me t in a pp ro pr iate way s; how y ou cope with stre ss a nd chang es in y our environme nt; and whether y ou take c are of y our
ow n h e a lt h , p o s s e s s io n s , an d li v in g ar e a . " § 4 1 6
. 9 2 6 a ( k )
. M r s . K e ll y c o n te n d s th a t A ar on was
mark e dly lim ited in t his do ma in, re lyingon

the sc ho ol guid anc e c ouns e lor ' s r e po rt a ft e r t e sti ngin

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Ke llyv . Co m m . of Soc ial Se cu rit y

13 April 2002 that Aar on was in the .4 pe rce ntile on the Adaptive B ehav i o r Assessment Sy stem (“A BA S”) eva luation completed by his kinderg arte n teac her K elli Creamer . The guid a n c e counselor conclude d that Aar on had def icits in self-help/ad ap t i v e behaviors of more than two standar d de viatio ns . Th is wa s be fo re he be g an me dic a tio n fo r AD HD in Ma y 20 02
. Th e AL J sa id thi s r e su lt should be taken w ith a g rain of sa lt b ec ause Aaron " was ofte n off task a nd results should be considere d to be less than his best ef fort." This is consistent with t he g ener al caveat in the guidance counselor' s assessment: "T he results of the c urre nt assessments may need to be viewed w ith caution due to inattentive beha

viors." Mr s. Kelly

argues that it is "non-se nsical" to apply this caveat to the AB AS beca u s e t h e AB AS was complete d by the kinderg arte n teac her, not by Aar on. There is no citation in he r brief supporting this assertion, and no fur ther infor mation about this test in t he re cord. There fore , it was not err or for the AL J to take the g uidance counselor at her w ord and to discount the te st res ul ts
. Th e AL J' s r e a so nin g dis tin g uis he s th is c a se fr om Slusser v. Apfel , 85 F. Supp.2d 63 4, 63 7 ( W. D . V a . 2 00 0) , in wh ic h th e AL J simp ly

ig no re d th e te st r e su lts
. I n her br ief, Mrs. Kelly relies ex tensively on her own testimony that Aar on cannot c are for himself beca

use he doe s not do a g ood job of bathing himself, g ets his right a nd left shoes mix ed up, and dawdles when he is suppose d to be doing c hores. This see ms to be a ver y small part of what the
re gu l at i o n s m ea nb y

s el f- ca re , an d t h er e i s co u n t erv ai l i n g ev i d en ce t h at h e d o es fe edh i m s el f, ch an ge clothes, and use the toilet without help. Th e state a g e nc y

me dic a l e xpe rt s f

ound no lim itatio n in

the se lf -c are do ma in. Th e re is evidenc e in the re st of the re cord that Aaron is not i mpaired in " self ca re" in the sense of

g etting

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Ke llyv . Co m m . of Soc ial Se cu rit y

14 emotional needs me t, etc. For instance, the concluding rema rks in his 2004 teac her' s repor t, "Aa ron is a g reat kid, a happy

kid!" indicate that he is emotionally normal. The teache rs' repor ts for 2003 and 2004 g ener ally

g ive him g ood marks in se lf car e, with the notable exception of " being patient when ne cessa

ry .” The re g ulations state that the AL J does not have to give conclusive e ffe ct to any particula r test score . 20 C.F.R. § 416.926a(e )(4) (" [W ]e will not rely on any test score alone. No sing le piece of information taken i n isolation can establish whether y ou have a ' marke d' or an ' extreme' limit ation in a domain." ). I n this c ase it is clea r that the AL J considere d the AB AS te st r esult and g ave a rea son for qua lify ing his re l i an ce o n i t. I n view of a ll the other counte rvailing evidenc e, ther e is rec ord support for his conc lusion that Aaron wa s not markedly impaired in self c are . Th e A L J f

o u n d A ar o nh a s ani mp a i r

m e n ti nt h e d o m a i no f

i n t e r a c t i n g an d

r e l a t i o nwi th oth e rs , b ut i t is le ss t

ha n ma rk e d. Th is i s th e same a s th e state a g e nc y me dic a l e xpe rt s' op ini on s. Th e y wr ote , " Som e tim e s dis ru

pti ve bu t g e ne ra lly

re late s w e ll t o p e e rs and

a du lts –p lay s w ithoth e rs , etc." His teac hers' repor

ts show he does have pr oblems in controlling himself, but he othe rwise ha s normal social r elationships. One tea cher noted, "Meds have helped." Everyone see ms to ag ree that Aar on is a happy

child, and his teac hers se em to like him even though h e re q uires extra attention from them. Nothing compels a diff ere nt conclusion than the AL J rea ched r eg ardingthis domain. Th e AL J' s fi nd ing s are a fa ir a sse ssm e nt o f t

he e vid e nc e , a

nd the y are c on sis te nt w iththe on ly med ica l e xpe rt s' op ini on s in the re c or d b e fo re the AL J. Aa ro n c le arl y

ha s atte nti on/ im

pu lsi vit y problems. Howe ver, in lig ht of the def ere nce inherent in our standa rd of r eview, the AL J ' s finding

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15 that there was no functional e quivalence to a listed condition is supportable. The a g ency ' s denial of SSI benef its should be affirme d.

*** We A F F I RM the jud g me nt o f t he dis tr ic t c ourt
.