Court Opinion

ID: 9951343
Source: CourtListenerOpinion
Date Created: 2024-03-15 20:00:46.595316+00
Date Added: 2024-06-11T14:39:34.052780
License: Public Domain

NOT RECOMMENDED FOR PUBLICATION
                                File Name: 24a0125n.06

                                         Case No. 23-5718

                          UNITED STATES COURT OF APPEALS
                               FOR THE SIXTH CIRCUIT
                                                                                    FILED
                                                       )                          Mar 15, 2024
DAMIAN DICKERSON on behalf of minor A.C.,                                 KELLY L. STEPHENS, Clerk
                                                       )
       Plaintiff-Appellant,                            )
                                                       )         ON APPEAL FROM THE
v.                                                     )         UNITED STATES DISTRICT
                                                       )         COURT FOR THE WESTERN
COMMISSIONER OF SOCIAL SECURITY,                       )         DISTRICT OF KENTUCKY
       Defendant-Appellee.                             )
                                                       )                              OPINION

Before: COLE, CLAY, and BLOOMEKATZ, Circuit Judges.

       COLE, Circuit Judge. Damian Dickerson, on behalf of minor A.C., appeals the district

court’s order affirming the decision of an administrative law judge (ALJ) denying A.C.

supplemental social security disability benefits. Dickerson contends that the ALJ ignored medical

evidence demonstrating that A.C. met, medically equaled, and functionally equaled impairments

that require a positive disability determination under the Social Security Act (the Act). Because

there is substantial evidence to support the ALJ’s decision, we affirm the district court.

                                                 I.

                                                 A.

       A.C. was born on June 19, 2012. A.C.’s mother suffered from drug addiction, and his great

uncle and great aunt, Damian and Donna Dickerson, obtained permanent custody of A.C. when he

was three years old.
No. 23-5718, Dickerson v. Comm’r of Soc. Sec.

       A.C. has the following severe impairments: attention deficit hyperactivity disorder

(ADHD), incontinence, functional neurologic disorder (nervous system condition causing

movement difficulties), conversion disorder (seizures, weakness, or paralysis caused by mental

health issues), anxiety, and tethered cord syndrome (nervous system disorder caused by tissue

attaching to the spinal cord). A.C. also has non-severe impairments: allergic rhinitis, esotropia

(eyes turning inward), chin laceration, pneumonia, chromosomal abnormalities, adjustment

disorder (unhealthy emotional reactions to stress), autism spectrum disorder, and multiple minor

phenotypic anomalies.

       These impairments manifest in different ways. For example, in January and February

2019, A.C. had several episodes where he appeared to lose consciousness but was revived by

ammonia salts. Following scans of A.C.’s brain, his doctors concluded that these episodes were

not seizures but instead seizure-like activity. To address his incontinence, in November 2018,

A.C. had surgery to correct his tethered cord syndrome, which resulted in a short-term

improvement. In early 2019, however, A.C.’s daytime bowel and bladder incontinence returned,

which eventually required him to wear padded underwear. A.C.’s incontinence usually improved

when he was put on a voiding, or fixed-time bathroom, schedule. A.C. also had difficulty flexing

his fingers, he made “tic-like movements of his head, face, mouth, and body,” and his speech was

sometimes difficult to understand. (Admin R., R. 8, PageID 1074–75.) In May 2020, A.C. was

temporarily hospitalized due to these abnormal movements. On July 30, 2020, he was diagnosed

with autism.

       Dickerson alleges that A.C. has behavioral issues at home. As of October 2019, A.C. had

significant deficits in adaptive skills, was unable to dress himself properly, and lacked the fine

motor skills to drink from an open cup. A.C. had bladder and bowel accidents and smeared his

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No. 23-5718, Dickerson v. Comm’r of Soc. Sec.

feces on the wall of his room at least six different times. Between May and July of 2020, A.C.’s

therapist observed impulsive behaviors and difficulty following directions, further noting that A.C.

had to be supervised 24-hours a day. The Dickersons installed a security system to control A.C.’s

nighttime wandering. As of September 2020, his medical records detail episodes of extreme

agitation and that he tried to remove his seat belt while in the car.

       A.C. had an independent educational plan (IEP) at school because he had difficulty

focusing and communicating, misunderstood danger, and was below grade level in reading and

writing. His behavior in school, however, varied. As of October 2018, A.C. was behaviorally

“doing extremely well in the classroom.” (Id. at PageID 1581–82.) While he struggled with

impulse control, he was generally social and got along with others. In February 2019, A.C. bit

another student, and his teacher reported that he “created two more [neurological] episodes as a

means to get out of work.” (Id. at PageID 351, 1634.)

       A.C.’s March 2019 IEP states that while he was “argumentative with following directions

and require[d] cues for appropriate behaviors,” he “ask[ed] questions, participate[d] and

complete[d] classwork.” (Id. at PageID 2042–43). His behavior improved with medication but

worsened in the afternoon as it wore off. His October 2019 IEP indicated he had met his adaptive

behavior goals, but not his on-task goals. His self-care skills at school were good, but he had

difficulty with grooming at home. In October 2019, A.C. was reported to have no significant

behavioral concerns at school and to be commensurate with his peers in academic performance.

       In January 2020, however, A.C. had “[i]ncreased behavior problems at school,” which

included running around, making unsafe choices, not completing his class work, and acting like

he was fainting. (Id. at PageID 1869.) Several times, A.C. refused to get off the school bus in the

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No. 23-5718, Dickerson v. Comm’r of Soc. Sec.

morning, pretending to be asleep. Over the next few weeks, however, A.C.’s teachers reported

that his behavior had improved substantially and required less redirection.

       A.C. had difficulty completing his schoolwork when he transitioned to online school during

the COVID-19 pandemic. A July 2020 psychological report detailed A.C.’s “difficulty sustaining

attention and concentration long enough to learn and store new information immediately and after

a delay of time.” (Id. at PageID 2333.) It also explained that he had difficulty coping with changes

in his environment and routine, often “becom[ing] anxious and engag[ing] in emotional outbursts

when frustrated.”    (Id. at PageID 2334.)     In August 2020, A.C.’s therapist reported some

improvement but noted that A.C. continued to work with speech and occupational therapists to

address his motor skills and toilet training. Additionally, in September 2020, his neurologist noted

that he was struggling to focus on schoolwork and had lost some academic skills.

                                                B.

       On October 11, 2018, Dickerson, on behalf of A.C., applied for supplemental security

income (SSI), alleging an onset of disability as of June 19, 2015. A.C. was in preschool at that

time. The application was denied on March 19, 2019, and denied upon reconsideration on August

20, 2019. A hearing was held before ALJ Steven Collins on August 11, 2020. During the hearing,

Donna Dickerson testified that A.C. struggled to dress himself properly in the morning, required

assistance with bathing and brushing his teeth, and was a messy eater. Further, despite general

improvement, A.C.’s incontinence had continued; his great aunt described the three urine and two

bowel movement accidents the week before the hearing as “one of the best weeks we’ve had.”

(Admin. R., R. 8, PageID 88–89.)

       On December 29, 2020, the ALJ issued a written decision, finding that A.C. was not

disabled within the meaning of the Act. On March 23, 2022, the Social Security Appeals Council

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No. 23-5718, Dickerson v. Comm’r of Soc. Sec.

declined review, finalizing the decision. On May 17, 2022, Dickerson filed a civil action seeking

judicial review of the ALJ’s decision. The district court upheld the ALJ’s decision. This appeal

followed.

                                                II.

                                                A.

       Our review of an ALJ decision is limited to “whether the ALJ applied the correct legal

standards and whether the findings of the ALJ are supported by substantial evidence.” Hargett v.

Comm’r of Soc. Sec., 964 F.3d 546, 551 (6th Cir. 2020) (quoting Blakley v. Comm’r of Soc. Sec.,

581 F.3d 399, 405 (6th Cir. 2009)); see also 42 U.S.C. § 405(g). Substantial evidence exists where

“relevant evidence as a reasonable mind might accept as adequate” supports the ALJ’s findings.

Biestek v. Berryhill, 139 S.Ct. 1148, 1154 (2019) (quoting Consol. Edison Co. of N.Y. v. NLRB,

305 U.S. 197, 229 (1938)). It is “more than a scintilla of evidence but less than a preponderance.”

Rogers v. Comm’r of Soc. Sec., 486 F.3d 234, 241 (6th Cir. 2007) (quoting Cutlip v. Sec’y of Health

& Hum. Servs., 25 F.3d 284, 286 (6th Cir. 1994)). It is not “[o]ur role . . . to resolve conflicting

evidence in the record or to examine the credibility of the claimant’s testimony.” Foster v. Halter,

279 F.3d 348, 353 (6th Cir. 2001). We will affirm the ALJ’s findings if they are “reasonably

drawn from the record or supported by substantial evidence even if that evidence could support a

contrary decision.” Wright-Hines v. Comm’r of Soc. Sec., 597 F.3d 392, 395 (6th Cir. 2010).

                                                B.

       At issue is whether A.C. is disabled under the Act. A guardian may seek SSI on behalf of

a child who “has a medically determinable physical or mental impairment, which results in marked

and severe functional limitations, and . . . which has lasted or can be expected to last for a

continuous period of not less than 12 months.” 42 U.S.C. § 1382c(a)(3)(C)(i). The ALJ’s findings

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No. 23-5718, Dickerson v. Comm’r of Soc. Sec.

followed the governing three-step inquiry: (1) whether the minor engages in substantial gainful

activity; (2) whether the minor has an impairment or combination of impairments that are severe;

and (3) whether the impairment or combination of impairments “meet, medically equal, or

functionally equal” impairments listed in the Code of Federal Regulations. 20 C.F.R. § 416.924.

If steps one and two are met, a child is “presumed to be disabled if they suffer from an infirmity

that appears on the SSA’s special list of impairments” or its medical or functional equivalent.

Combs v. Comm’r of Soc. Sec., 459 F.3d 640, 643 (6th Cir. 2006).

        The parties do not dispute that A.C. meets the requirements of step one and two. On appeal,

the dispute turns on step three—whether A.C.’s impairments meet, medically equal, or

functionally equal a listed impairment. We will address A.C.’s claims in reverse order.

                                                   1.

        Dickerson must demonstrate that A.C.’s impairments are “functionally equivalent in

severity to any of the listed impairments.” Elam ex rel. Golay v. Comm’r. of Soc. Sec., 348 F.3d

124, 126 (6th Cir. 2003); see also 20 C.F.R. § 416.912(a). The ALJ must compare the “whole

child[’s]” functioning in all activities at home, school, and in their community to children of the

same age without impairments. SSR 09-1P, 2009 WL 396031, at *2 (Feb. 17, 2009); 20 C.F.R.

§ 416.926a(b). A child need not “have serious or very serious limitations every day.” 2009 WL

396031, at *9. The ALJ should “consider the effects of the impairment(s) longitudinally,” and

“[t]he fact that a child can do a particular activity or set of activities relatively well does not negate

the difficulties the child has in doing other activities.” Id. at *9–10.

        The ALJ evaluated A.C.’s functioning in six domains: (1) “[a]cquiring and using

information”; (2) “[a]ttending and completing tasks”; (3) “[i]nteracting and relating with others”;

(4) “[m]oving about and manipulating objects”; (5) caring for oneself; and (6) “[h]ealth and

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No. 23-5718, Dickerson v. Comm’r of Soc. Sec.

physical well-being.” 20 C.F.R. § 416.926a(b)(1). To functionally equal the listed disabilities and

be found disabled, A.C.’s impairments or combination of impairments must result in: (1) “marked”

limitations that seriously interfere with his “ability to independently initiate, sustain, or complete

activities” in at least two domains; or (2) an “extreme” limitation which “interferes very seriously”

in one domain with those same abilities. 20 C.F.R. § 416.926a(a), (e)(2)–(3).

       The ALJ determined that A.C.: (1) had no limitation in domain one—acquiring and using

information; (2) less than marked limitations in domains two through four and domain six—

attending and completing tasks, interacting and relating with others, moving about and

manipulating objects, and health and physical well-being; and (3) a marked limitation in domain

five—caring for oneself. On appeal, Dickerson argues that A.C. is markedly limited in domains

two and three—attending and completing tasks and interacting and relating with others—and

extremely limited in domain five—caring for himself.

       According to Dickerson, the ALJ failed to address the “continuous symptomology”

detailed in the 2019 Bingham records and 2020 Whitten psychological report that “seriously

affected” A.C.’s “attendance and completion of tasks, interaction and relating with others and

ability to care for self.” (Appellant Br. 25.) For example, Dickerson argues that A.C.’s ADHD

medication wore off throughout the day and that his behavior worsened in the afternoons. In

February 2020, A.C. began getting up at night, cutting up his socks, and attempting to leave the

home, demonstrating impaired sleep hygiene and insomnia. Finally, Dickerson argues that in

2020, A.C. remained “aggressive and destructive,” and kicked and bit people around him.

(Appellant Br. 31.) Therefore, Dickerson maintains that the ALJ should have concluded that

A.C.’s limitations remained severe, and not that A.C.’s symptoms had improved. Substantial

evidence, however, supports the ALJ’s findings.

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No. 23-5718, Dickerson v. Comm’r of Soc. Sec.

       Pursuant to domain two—attending and completing tasks—a school-age child is expected

to focus their attention, “follow directions,” complete schoolwork, organize school materials,

avoid careless mistakes, and “complete family chores.” 20 C.F.R. § 416.926a(h)(2)(iv). A.C.’s

2018 teacher evaluations indicate that A.C. had limited or no problems in this area when properly

medicated, with the exception of completing work without mistakes, and generally functioned at

grade level. While A.C. certainly had difficulty staying focused, he received extra support in

school through an IEP, and in February 2020, his teachers reported A.C. could stay on task with

redirection. After transitioning to online learning during the COVID-19 pandemic, A.C. continued

to work with a therapist on maintaining focus, responding to redirection, and using self-soothing

techniques to control his behavior. Donna Dickerson initially reported that the transition to online

learning was very difficult for A.C. and that his behavioral outbursts had increased. While A.C.

often required redirection, his April and September 2020 behavioral therapy notes indicate,

however, that A.C. responded to that redirection and used calming techniques to complete tasks.

Finally, when directed, A.C. sometimes helped his guardian with chores at home, such as taking

out the trash and cleaning his bed after bladder or bowel accidents, although at times he resisted.

       While A.C.’s issues with focus were not completely resolved, A.C.’s medical record

indicates that A.C. can attend to and complete tasks with assistance and firm redirection. See

Barnett ex rel. D.B. v. Comm’r of Soc. Sec., 573 F. App’x 461, 464 (6th Cir. 2014) (finding

substantial evidence supported ALJ decision that minor had less than marked limitation in

attending and completing tasks because minor’s medication managed his ADHD, his “behaviors

stemmed from his desire for attention,” and he “could ‘maintain attention when motivated’ and

when ‘working one-on-one.’”). Therefore, there was substantial evidence that A.C.’s impairments

did not seriously interfere with his “ability to independently initiate, sustain,” attend to, or

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No. 23-5718, Dickerson v. Comm’r of Soc. Sec.

complete activities at school and home, warranting a less than marked limitation in this domain.

See 20 C.F.R. § 416.926a(e)(2).

       The ALJ’s conclusion that A.C. has a less than marked limitation in domain three—

interacting and relating with others—is also supported by substantial evidence. In this domain, a

child’s ability to “initiate and sustain emotional connections with others, develop and use the

language of [their] community, cooperate with others, comply with rules, respond to criticism, and

respect and take care of the possessions of others” is evaluated. 20 C.F.R. § 416.926a(i). Donna

Dickerson testified that A.C. does not play with other children, does not know when to stop talking,

and screams when frustrated. An October 2019 report detailed that A.C. was argumentative when

asked to follow directions. Finally, the July 2020 Whitten psychological evaluation explained that

A.C. had difficulty understanding other perspectives and used anger to get what he wanted.

       That same October 2019 genetic report, however, also indicated that A.C. “will interact

with others” and has “no significant behavioral concerns at school.” (Admin R., R. 8, PageID

1027.) Further, 2020 behavioral therapy notes demonstrate that A.C. worked with therapists to

help control his mood swings and reactions to others. The purpose of these sessions was to address

A.C.’s limitations in relating to others, and the July 2020 Whitten evaluation explains that A.C.

would benefit from the continuation of these sessions. Finally, the ALJ acknowledged that A.C.

was diagnosed with autism spectrum disorder in July 2020, but this impairment was not so severe

as to interfere seriously with his ability to verbally communicate with others.

       Dickerson counters, however, that the tics and speech difficulties A.C. developed in early

2020 impacted his communication, warranting a marked limitation. While these episodes were

severe enough for A.C. to be hospitalized in May 2020, A.C.’s doctors determined that these

symptoms were not caused by epileptic or movement disorders, but instead resulted from an

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No. 23-5718, Dickerson v. Comm’r of Soc. Sec.

autoimmune response, which improved after A.C. received steroid medication. Therefore, the

record supports a finding that substantial evidence exists for a less than marked limitation in this

category.

       The ALJ concluded that the record supported a marked limitation in domain five, or A.C.’s

ability to care for himself. Under the Act, school-age children “should be independent in most

day-to-day activities (e.g., dressing yourself, bathing yourself), although [one] may still need to be

reminded sometimes to do these routinely” and “should begin to develop understanding of what is

right and wrong, and what is acceptable and unacceptable behavior.” 20 C.F.R.

§ 416.926a(k)(2)(iv).

       A.C. needs support at home and in school with exercising coping skills and remaining calm,

has limited judgment regarding his personal safety, exhibits below-average adaptive skills, and

needs self-care reminders. In 2020, A.C.’s unsafe behavior consisted of trying to jump from his

bed, wandering into a neighbor’s home without permission, and removing his seat belt and

thrashing agitatedly while in a moving vehicle. In an April 2020 therapy session, however, A.C.

indicated that he understood that he needed to “stop and think” before acting, such as going into

his neighbor’s home without permission, because it was unacceptable behavior. (Admin. R., R. 8,

PageID 2214.) In September 2020, Donna Dickerson reported that the alarm system intended to

keep him from wandering was still in place and she had no new safety concerns. Further, at home,

A.C. could “dress, bathe, and brush teeth with reminders and assistance.” (Id. at PageID 56.) The

2018 teacher reports and 2019 school psychoeducational evaluations indicated that at school—

when properly medicated—A.C. could care for himself and complete self-feeding, toileting, and

clothing management at an age-appropriate level with, at most, slight problems.

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No. 23-5718, Dickerson v. Comm’r of Soc. Sec.

        There is substantial evidence to support the ALJ’s findings that A.C.’s impairments

seriously interfered with his ability to independently initiate, sustain, or complete self-care

activities. The fact that A.C. could course correct with direction and acknowledge when his actions

were wrong, however, does not support a finding of an extreme limitation that very seriously

interfered with his self-care abilities. See 20 C.F.R. § 416.926a(a), (e)(2)–(3).

        Although not initially challenged by Dickerson, the government argues that the ALJ’s

findings of less than marked limitations in health and physical well-being—domain six—were

reasonable. Dickerson argues in his reply brief that the ALJ should have concluded that A.C. had

a marked limitation in this category as well. While appellants cannot raise new arguments for the

first time in their reply briefs, they can “respond to arguments raised for the first time in appellee’s

brief.” United States v. Crozier, 259 F.3d 503, 517 (6th Cir. 2001) (quoting United States v.

Jerkins, 871 F.2d 598, 602 n. 3 (6th Cir. 1989)). This argument, however, must fail.

        Domain six addresses the effects of “[a] physical or mental disorder” that can result in

physical symptoms such as “bladder or bowel incontinence,” somatic symptoms such as “seizure

or convulsive activity, . . . [and] changes in weight or eating habits,” and the impact of associated

medication.    20 C.F.R. § 416.926a(l)(1)–(2), (4)(ii).      The ALJ also evaluates whether the

symptoms manifest as chronic illness or as episodic periods of worsening physical condition.

20 C.F.R. § 416.926a(l)(3).

        Dickerson argues that the ALJ explained only how A.C.’s ongoing struggles with

incontinence, insomnia, and somatic symptoms improved, but not that A.C. was cured of these

impairments. The ALJ’s finding of a less than marked limitation under this domain, however, is

supported by: (1) improved incontinence after tethered cord surgery and a timed voiding schedule;

(2) resolution of the seizure-like events; (3) behavioral therapy; and (4) steroid medication for

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No. 23-5718, Dickerson v. Comm’r of Soc. Sec.

A.C.’s speech- and movement-related tics. The ALJ acknowledges that A.C. regressed with regard

to some of these issues in mid-2019, and again in 2020 when schools closed due to the COVID-

19 pandemic, but improved significantly with medication and a consistent voiding schedule. The

regulation does not require a complete cure of impairments affecting physical well-being to find a

less than marked limitation. Because the ALJ’s findings are supported, we must defer to the ALJ’s

conclusion, even if there is also substantial evidence to support a marked limitation. See Key v.

Callahan, 109 F.3d 270, 273 (6th Cir. 1997) (concluding that the court must defer to an ALJ

decision “even if there is substantial evidence in the record that would have supported an opposite

conclusion, so long as substantial evidence supports the conclusion reached by the ALJ.”).

       A.C.’s impairments should not be discounted. A.C. experiences significant health issues

punctuated by periods of respite, but the improvements are often followed by new and serious

concerns. We do not doubt that it is difficult for A.C. and his guardians to navigate his many

health challenges, especially because the challenges keep evolving. Indeed, given the frequent and

significant changes, we do not foreclose the possibility that A.C. may be able to successfully apply

for disability income in the future if his condition worsens or does not respond positively to

intervention such that his symptoms persist for the time period required by the regulations. But

because the evidence in this record is so mixed, there is substantial evidence for the ALJ’s

conclusion. In the broader context of A.C.’s improvement based on use of medication, a voiding

schedule, assistance in the classroom, and ability to socialize with his peers, the ALJ could find

that the Bingham records and Whitten report were insufficient to establish functional equivalence

to a listed impairment. See Foltz obo R.B.K.F. v. Comm’r of Soc. Sec., No. 23-3362, 2023 WL

7391701, at *5 (6th Cir. Nov. 8, 2023) (finding that the ALJ correctly concluded that doctor and

nurse practitioner’s medical opinions were insufficient to establish medical equivalence to stem

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No. 23-5718, Dickerson v. Comm’r of Soc. Sec.

cell transplantation, where other medical evidence demonstrated that the child’s health had

improved overall). Therefore, not only did the ALJ assess and reference A.C.’s medical records

from 2020, but the arc of A.C.’s medical history in the record provides “more than a scintilla of

evidence” that substantial evidence supported the ALJ’s non-disability determination under the

functional equivalence framework. Rogers, 486 F.3d at 241 (quoting Cutlip, 25 F.3d at 286).

                                                  2.

       A.C. can also prove disability under the Social Security Act by demonstrating his

impairments meet or medically equal a listed impairment. 20 C.F.R. §§ 416.924–416.926. To

medically meet a listed impairment, a claimant “must meet all of the specified medical criteria.”

Sullivan v. Zebley, 493 U.S. 521, 530 (1990) (emphasis in original). An impairment is medically

equivalent to a listed impairment “if it is at least equal in severity and duration to the criteria of

any listed impairment.”      20 C.F.R. § 416.926(a).      The ALJ should compare a claimant’s

impairments “with those for closely analogous listed impairments.” Id. at (b)(2). At this step, the

ALJ “must consider the combined effect of all medically determinable impairments, even those

that are not severe.” (Admin R., R. 8, PageID 53–54.).

       Dickerson argues that the record demonstrates continuous symptoms present through June

2020 that, in combination, met or were medically equivalent to listings 111.02—epilepsy—and

112.07—somatic symptoms and related disorders (conversion disorder). Dickerson points to “over

12 months of symptomology including confusion, staring ahead or looking around and

unresponsiveness” that occurred frequently and at length, requiring accommodations in school and

at home. (Appellant Br. 23.) He also argues that evidence of “disruptive behavior, multiple events

of smearing feces on the wall, bowel and bladder incontinence and illegible hand writing”

contradict the ALJ’s ruling. (Id. at 24.) Although A.C.’s seizure-like symptoms abated, Dickerson

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No. 23-5718, Dickerson v. Comm’r of Soc. Sec.

maintains that the February 2019 Bingham records and July 2020 Whitten psychological report

demonstrate that they “were replaced by other symptoms caused by the same [neurological]

impairment, conversion reaction.” (Appellant Br. 24–25.)

       Substantial evidence exists to support the ALJ’s conclusion that A.C.’s impairments do not

meet or medically equal listing 111.02 for epilepsy. An epilepsy impairment requires:

       A. Generalized tonic-clonic seizures (see 111.00F1a) occurring at least once a
       month for at least 3 consecutive months (see 111.00F4) despite adherence to
       prescribed treatment (see 111.00C);

       or

       B. Dyscognitive seizures (see 111.00F1b) or absence seizures (see 111.00F1c),
       occurring at least once a week for at least 3 consecutive months (see 111.00F4)
       despite adherence to prescribed treatment (see 111.00C).

20 C.F.R. pt. 404, subpt. P, App. 1, Listing 111.02. A.C. was not diagnosed with tonic-clonic,

dyscognitive, absence, or febrile seizures.       20 C.F.R. pt. 404, subpt. P, App. 1, Listing

111.00(F)(1). Further, “medical equivalency is not a refuge for claimants who show only

intermittent signs of impairment.” Biestek v. Comm’r of Soc. Sec., 880 F.3d 778, 784 (6th Cir.

2017). It requires that A.C.’s impairments are “at least equal in severity and duration to the criteria

of any listed impairment.”       20 C.F.R. § 416.926(a) (emphasis added).          A.C. experienced

approximately seven seizure-like incidents from December 2018 to February 2019, but he does

not meet the duration requirements of continued symptoms for three months after adherence to

prescribed treatment. 20 C.F.R. pt. 404, subpt. P, App. 1, Listing 111.02(A)–(B). A medical

evaluation from April 14, 2020 demonstrates that his last seizure-like episode occurred on

February 21, 2019—shortly after he began taking seizure medication. Because A.C.’s seizure-like

episodes did not continue after treatment, they are not medically equivalent in terms of severity

and duration to listing 111.02 for epilepsy.

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No. 23-5718, Dickerson v. Comm’r of Soc. Sec.

       Substantial evidence also exists to support the ALJ’s conclusion that A.C.’s impairments

do not meet or medically equal listing 112.07 for conversion disorder. A finding of somatic

symptom impairments requires:

   A. Medical documentation of one or both of the following:
        1. Symptoms of altered voluntary motor or sensory function that are not
            better explained by another medical or mental disorder; or
        2. One or more somatic symptoms that are distressing, with excessive
            thoughts, feelings, or behaviors related to the symptoms.

           and

   B. Extreme limitation of one, or marked limitation of two, of the following areas of
      mental functioning (see 112.00F):
         1. Understand, remember, or apply information (see 112.00E1).
         2. Interact with others (see 112.00E2).
         3. Concentrate, persist, or maintain pace (see 112.00E3).
         4. Adapt or manage oneself (see 112.00E4).

20 C.F.R. pt. 404, subpt. P, App. 1, Listing 112.07.

       The ALJ explained that A.C.’s impairments resulted in mild to moderate limitations in the

first three “B criteria.” In support, the ALJ cited 2018 and 2019 teacher evaluations and a 2019

psychoeducational assessment indicating that while A.C. needed classroom support, his behavior

improved with medication, he responded to redirection, was on grade level at school, and generally

got along with his peers. Therefore, A.C.’s impairments did not seriously interfere with his ability

to understand and apply information, interact with others, or maintain concentration. See 20 C.F.R.

pt. 404, subpt. P, App. 1, Listing 112.07(B). The ALJ acknowledged, however, that deficits in

A.C.’s adaptive functioning and understanding of danger warranted a marked limitation in “B

criterion” four—adapting or managing oneself.

       The “B criteria” factors are similar to some of the six domains evaluated supra under the

functional equivalence standard: specifically, domains one through three—acquiring and using

information, attending and completing tasks, and interacting and relating with others—and domain
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No. 23-5718, Dickerson v. Comm’r of Soc. Sec.

five—caring for yourself. 20 C.F.R. § 416.926a(b)(1). As stated supra, substantial evidence

supports the ALJ’s conclusion that A.C.’s: (1) abilities to attend and complete tasks and interact

and relate with others warrant a less than marked limitation; and (2) abilities to care for himself

warrant a marked limitation.

       The remaining “B criterion” of understanding, remembering, or applying information

refers to the child’s “abilities to learn, recall, and use information to perform age-appropriate

activities.” 20 C.F.R. pt. 404, subpt. P, App. 1, Listing 112.00(E)(1). While A.C. needed help

with writing, he performed in either the average or above average range for his age group in

intellectual functioning, math concepts, and reading. Because this provides substantial evidence

to support the ALJ’s conclusion, A.C. fails to meet or medically equal the one extreme limitation

or two marked limitations required for conversion disorder. 20 C.F.R. pt. 404, subpt. P, App. 1,

Listing 112.07(B).

       Dickerson raises two main rejoinders. First, he argues that the ALJ erred when referencing

the functional equivalence portions of the opinion to justify finding A.C. had a marked limitation

in 112.07’s fourth “B criterion”—adapting and managing oneself—and not completing the

analysis in the medical equivalence section. An ALJ, however, “can consider all the evidence

without directly addressing in his written decision every piece of evidence submitted by a party.”

Kornecky v. Comm’r of Soc. Sec., 167 F. App’x 496, 508 (6th Cir. 2006) (citation omitted). The

ALJ referenced his substantial factual findings, appearing later in the opinion, to support his

conclusion that A.C.’s mental impairments did not meet or medically equal a listed impairment

under 112.07. An ALJ need not “spell out every fact a second time.” Bledsoe v. Barnhart, 165 F.

App’x 408, 411 (6th Cir. 2006).

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No. 23-5718, Dickerson v. Comm’r of Soc. Sec.

       Further, Dickerson’s reference to SSR 96-8p’s requirement that an ALJ rationalize

contradictory evidence and provide reasoning is inapplicable here, as the ruling addresses residual

functional capacity, or an “individual’s ability to do sustained work-related physical and mental

activities in a work setting on a regular and continuing basis.” SSR 96-8p, 1996 WL 374184, at

*1 (July 2, 1996). Because A.C. is a child, he does not operate in a work setting.

       Second, a medical report from April 2020 explains that while the seizure-like episodes had

ceased in February 2019, A.C.: (1) subsequently developed movement disorders, speech

difficulties, and tic-like movements of the face, mouth, and body; and (2) his behavioral symptoms,

incontinence, and inability to focus persisted. Dickerson argues that the ALJ failed to consider

these new symptoms, which together, equal the epilepsy and conversion disorder listings.

       The ALJ considered all objective medical evidence, information from teachers, family, and

friends, and Donna Dickerson’s hearing testimony. A review of the record demonstrates that the

new symptoms to which Dickerson points did not “fit epileptic or choreiform or other patterned

movement disorder[s],” but were believed to be the result of an autoimmune response, brain

swelling, and an acute dystonic reaction induced by medicine. (Admin. R., R. 8, PageID 1046,

1050, 1871, 2348.) Additionally, behavioral therapy greatly improved A.C.’s ability to follow

directions and process his emotions without acting out. For example, between January and

February 2020, A.C. admitted to pretending to have seizure-like events, requiring him to be carried

off the bus at school in the morning. This behavior was corrected when his teachers took away

one-on-one time with A.C. during the school day. Between April and September 2020, A.C.

worked with a therapist to implement deep breathing skills and generally responded to redirection

by adults, even if he initially resisted following directions at home and at school. Finally, the July

2020 Whitten psychological report observed that while A.C. had an impaired ability to learn,

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No. 23-5718, Dickerson v. Comm’r of Soc. Sec.

remember, pay attention, and regulate his emotions, he had no noticeable involuntary tics or

tremors during the session and demonstrated adequate ability for fluid reasoning.

       We are not persuaded that the ALJ’s findings are legally insufficient. The ALJ analyzed

the same 2020 medical records in the referenced functional equivalence analysis, acknowledging

A.C.’s limitations but explaining how medical and behavioral therapies largely helped with these

impairments. Further, Dickerson did not demonstrate how these symptoms are equivalent in

severity and duration to tonic-clonic or dyscognitive seizures, or otherwise increase the severity of

A.C.’s limitations in using information, interacting with others, and concentrating. See 20 C.F.R.

pt. 404, subpt. P, App. 1, Listings 111.02; 112.07. Therefore, the ALJ relied on substantial

evidence in concluding that A.C.’s symptoms do not meet or are not medically equivalent in

severity or duration to the neurological and mental impairment listings in the Act.

                                                III.

       For the reasons above, we affirm the district court’s judgment.

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