A man applied for Social Security Disability Insurance (SSDI) and supplemental security income (SSI) benefits. The man claimed disability due to insulin-dependent diabetes, hypertension, and a mental disorder. A clinical psychologist diagnosed the man with psychotic disorder, not otherwise specified; antisocial personality disorder; and mild intellectual disability (the court’s decision includes the term “mental retardation”; this term has been changed in this casenote to reflect the commonly used term “intellectual disability”). The clinical psychologist did not administer an IQ test as part of the mild intellectual disability diagnosis.
At a hearing before an administrative law judge (ALJ), the man testified that he was thirty-six years old and had completed tenth grade. He took special education classes in math and science only, even though he could barely read when he dropped out of high school. He cannot read or understand newspaper articles or grocery lists. He cannot count the change given from a dollar bill. He passed the test to obtain a driver's license on the third try with the help of another person who read the test aloud. He had worked as a short-order cook at a truck stop and as a construction laborer. After he testified, the ALJ formulated the man’s residual functional capacity (RFC), and a vocational expert (VE) testified that a person with the man’s RFC would not be able to perform his past relevant work, but would be able to work other available jobs.
The ALJ applied the five-step process to determine whether an individual is disabled: 1) whether the claimant is currently employed; 2) whether the claimant is severely impaired; 3) whether the impairment is, or is comparable to, a listed impairment; 4) whether the claimant can perform past relevant work; and if not, 5) whether the claimant can perform any other kind of work. At Step 1, the ALJ found the man had not engaged in substantial gainful work activity since the alleged onset date. At Step 2, the ALJ found the man had the following severe impairments: diabetes without complication, obesity, mild intellectual disability, and an unspecified psychotic disorder. At Step 3, the ALJ found the man did not have an impairment or combination of impairments that met or medically equaled the severity of one of the impairments in the Social Security regulations' disability listing, including intellectual disability. At Step 4, the ALJ determined the man could not perform his past relevant work. Finally, at Step 5, the ALJ concluded, based on the vocational expert's testimony, the man could perform other available jobs and was not disabled. The United States District Court for the Eastern District of Arkansas affirmed the ALJ’s denial of the man’s application for SSDI and SSI benefits.
The Eighth Circuit United States Court of Appeals reversed and remanded. The court held that substantial evidence did not support the ALJ's decision that the man was not disabled by his intellectual disability. The ALJ should have developed the record further by ordering an IQ test to determine whether the man met the Social Security regulations' disability listing for intellectual disability and determining whether the record suggested the man's intellectual and adaptive disabilities had their onset before the age of 22.
The ALJ should have developed the record further by ordering an IQ test to determine whether the man met the Social Security regulations' disability listing for intellectual disability. It may be reversible error for an ALJ not to order a consultative examination before rendering a decision as to a claimant's request for SSDI or SSI when, without such an examination, she cannot make an informed choice. The Social Security regulations' disability listing for intellectual disability refers to significantly below average general intellectual functioning with deficits in adaptive functioning initially manifested during the developmental period; i.e., the evidence demonstrates or supports onset of the impairment before age 22. In addition, one of four sets of requirements must also be satisfied. To meet one set of requirements (12.05C) a claimant would need (1) a valid verbal, performance, or full scale IQ of 60 to 70; (2) an additional “severe” impairment; and (3) evidence supporting the onset of intellectual and adaptive functioning disability before age 22. The court found that the man met the second requirement because the ALJ found the man had “the following severe impairments: diabetes without complication, obesity, mild mental retardation[,] and an unspecified psychotic disorder.” Thus, the ALJ found the man had three additional severe impairments. However, the court found that the man did not meet the first requirement because the record did not reflect he had ever been administered an IQ test. The ALJ did not explicitly acknowledge the man had not had an IQ test. Both the clinical psychologist and the ALJ found the man had mild intellectual disability, which, according to the DSM, corresponds with an IQ in or below the 12.05C listing range (“IQ level 50–55 to approximately 70”). The clinical psychologist diagnosed the man as mildly mentally retarded by observation alone, without an IQ test to support his determination.
The ALJ should have developed the record further by determining whether the record suggested the man's intellectual and adaptive disabilities had their onset before the age of 22. With regard to the third requirement, the court found the ALJ did not make specific findings as to whether the record evidence supported an onset of intellectual and adaptive functioning disability before age 22. The court held that an IQ at an earlier age can be inferred because a person's IQ is presumed to remain stable over time in the absence of any evidence of a change in a claimant's intellectual functioning. A claimant can establish an onset of intellectual and adaptive functioning disability before age 22 with an IQ test score recorded after the developmental period plus evidence such as placement in special education classes in school; inability to complete high school; trouble with math, reading, and writing; and evidence of violent altercations before age 22.The man completed the tenth grade. In school he was in special education classes. His math, reading, and writing skills were limited. He exhibited deficits in adaptive functioning at a young age because he had violent altercations at school and at home. A clinical psychologist diagnosed the man with intellectual disability based on his educational history, nature of prior work, general level of adaptive functioning, and the results of his mental status examination, which indicated he had intellectual deficits.
The Eighth Circuit United States Court of Appeals reversed the district court’s affirmation of the Social Security Commissioner’s and ALJ’s denial of the man’s application for SSDI and SSI benefits based on his alleged intellectual impairment.
See: Lott v. Colvin, 2014 WL 6704564 (C.A.8 (Ark.), November 28, 2014) (not designated for publication).
See also Medical Law Perspectives, June 2013 Report: Independent Medical Evaluations: Legal Risks and Responsibilities