UNPUBLISHED
UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT
No. 19-1511
HAROLD L. KISER,
Plaintiff - Appellant,
v.
ANDREW SAUL, Commissioner of Social Security,
Defendant - Appellee.
Appeal from the United States District Court for the Western District of North Carolina, at
Charlotte. Frank D. Whitney, District Judge. (3:17-cv-00739-FDW)
Submitted: June 1, 2020 Decided: July 30, 2020
Before WILKINSON and FLOYD, Circuit Judges, and TRAXLER, Senior Circuit Judge.
Reversed and remanded by unpublished opinion. Judge Floyd wrote the opinion in which
Judge Wilkinson joined. Judge Traxler wrote a separate dissenting opinion.
George C. Piemonte, Charlotte, North Carolina, Denise A. Sarnoff, MARTIN, JONES, &
PIEMONTE, Decatur, Georgia, for Appellant. R. Andrew Murray, United States Attorney,
Charlotte, North Carolina, Gill P. Beck, Assistant United States Attorney, OFFICE OF
THE UNITED STATES ATTORNEY, Asheville, North Carolina; Stephen Dmetruk,
Special Assistant United States Attorney, Office of the General Counsel, SOCIAL
SECURITY ADMINISTRATION, Seattle, Washington, for Appellee.
Unpublished opinions are not binding precedent in this circuit.
FLOYD, Circuit Judge:
This appeal follows an action for review of a final decision of Defendant-Appellee
Andrew Saul, the Commissioner of Social Security (the “Commissioner”), denying
Plaintiff-Appellant Harold L. Kiser’s application for a period of disability and disability
insurance benefits under Title II of the Social Security Act (the “Act”) and supplemental
security income under Title XVI of the Act. The sole issue on appeal is whether the
Administrative Law Judge (ALJ), in finding that Kiser was not disabled, afforded proper
weight to an earlier decision by the North Carolina Department of Health and Human
Services (NCDHHS) finding that Kiser was disabled (the “Medicaid Decision”). For the
reasons that follow, we hold that the ALJ did not. Accordingly, we reverse the district
court’s judgment and remand with instructions to vacate the denial of benefits and remand
for further administrative proceedings.
I.
Before turning to the facts of Mr. Kiser’s case, we outline the approach that the
Commissioner takes to evaluating social security disability claims.
In evaluating whether an individual is disabled, the Commissioner uses a five-step
process. See 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4). Under this process, an ALJ
evaluates, in sequence, whether the claimant: “(1) worked during the alleged period of
disability; (2) had a severe impairment; (3) had an impairment that met or equaled the
requirements of a listed impairment; (4) could return to her past relevant work; and (5) if
2
not, could perform any other work in the national economy.” Hancock v. Astrue, 667 F.3d
470, 472 (4th Cir. 2012) (citing 20 C.F.R. § 416.920(a)(4)).
Importantly, at step three, if a claimant fails to demonstrate that they have a
disability that meets or medically equals a listed impairment, the ALJ must assess the
claimant’s residual functional capacity (RFC) before proceeding to step four, which is “the
most [the claimant] can still do despite [her physical and mental] limitations [that affect
h[er] ability to work].” Lewis v. Berryhill, 858 F.3d 858, 861–62 (4th Cir. 2017)
(alterations in original) (quoting 20 C.F.R. §§ 404.1545(a)(1), 416.945(a)(1)). An ALJ
may define the claimant’s RFC “in terms of the exertional levels of work, sedentary, light,
medium, heavy, and very heavy.” Id. (quoting SSR 96-8p, 61 Fed. Reg. 34474 (July 2,
1996)); see also 20 C.F.R. §§ 404.1567, 416.967 (defining “sedentary, light, medium,
heavy, and very heavy” exertional requirements of work).
For the first four steps, the claimant has the burden of production. Monroe v. Colvin,
826 F.3d 176, 179–80 (4th Cir. 2016). “If the claimant fails to carry that burden at any
step, she is determined not to be disabled.” Lewis, 858 F.3d at 861. “If the claimant does
meet her burden of proof, the burden then shifts to the Commissioner at step five.” Id. If
a determination of disability can be made at any step, then the ALJ need not analyze
subsequent steps. See 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4).
II.
Mr. Kiser is a fifty-three-year-old male who suffers from a plethora of ailments. In
July 2009, he was hospitalized for multiple conditions, including respiratory failure, renal
3
failure, and pancreatitis, and he fell into a prolonged coma. In December 2009, he applied
for supplemental security income, alleging that he became disabled as of the July 2009
hospitalization. On December 1, 2011, for reasons that are not germane to the current
appeal, an ALJ denied Kiser’s claim. On October 26, 2012, the Appeals Council denied
Kiser’s request for review of the ALJ’s decision.
A.
In February 2013, Kiser applied for Medicaid benefits in North Carolina. His
application was initially denied, so he appealed to the NCDHHS. On August 14, 2013,
applying the same five-step test employed for social security disability benefits discussed
above, the NCDHHS issued the Medicaid Decision finding that Kiser was disabled and
therefore eligible for Medicaid benefits. Importantly, at step three, the NCDHHS found
that Kiser “equal[ed] the disability requirement referenced in 20 [C.F.R. §] 416. 920(d),
Appendix 1, Listing 12.05C, which directs a finding of disabled.” Administrative Record
(A.R.) 341.
4
At the relevant time, 1 Listing 12.05 provided the listed impairment for an
intellectual disability. 2 See 20 C.F.R. Part 404, Subpt. P, App. 1, Listing 12.05 (effective
January 2, 2015). Listing 12.05(C) had three prongs. See Hancock, 667 F.3d at 473
(discussing Listing 12.05(C)). First, it required a showing of “deficits in adaptive
functioning initially manifested during the developmental period; i.e., the evidence
demonstrates or supports onset of the impairment before age 22” (Prong 1). 20 C.F.R. Part
404, Subpt. P, App. 1, Listing 12.05. It also required a “valid verbal, performance, or full
scale IQ of 60 through 70” (Prong 2) and “a physical or other mental impairment imposing
an additional and significant work-related limitation of function” (Prong 3). Id. Listing
12.05(C).
1
The Commissioner revised the listings regarding mental disorders effective
January 17, 2017, to reflect, among other things, “advances in medical knowledge.”
Revised Medical Criteria for Evaluating Mental Disorders, 81 Fed. Reg. 66,138, 66,138
(Sept. 26, 2016). However, the version of the listings in effect as of the date of the
Commissioner’s final decision controls. See id. at 66,138 n.1 (“We expect that Federal
courts will review our final decisions using the rules that were in effect at the time we
issued the decisions.”). As discussed below, because the Appeals Council denied Kiser’s
request for review, the ALJ’s decision is the final decision, and we consider Listing
12.05(C) as it existed before it was overhauled. See 20 CFR § 404.900(a)(4)–(5); Sims v.
Apfel, 530 U.S. 103, 107 (2000) (“[I]f, as here, the Council denies the request for review,
the ALJ’s opinion becomes the final decision.”).
2
Listing 12.05 has had a change in nomenclature over the years. At the time of the
Medicaid Decision, Listing 12.05 provided the listed impairment for “mental retardation.”
Effective September 3, 2013, the Social Security Administration replaced the term mental
retardation with the term intellectual disability. Change in Terminology: “Mental
Retardation” to “Intellectual Disability,” 78 Fed. Reg. 46,499 (Aug. 1, 2013). The change
was merely a change in form, not substance, and “d[id] not affect how [the Social Security
Administration] evaluate[s] a claim based on ‘intellectual disability’ under listing 12.05.”
Id. at 46,500. The current version of Listing 12.05 uses the term “intellectual disorder.”
However, to avoid confusion, we will use the nomenclature as existed at the time of the
ALJ’s decision, namely “intellectual disability.”
5
B.
In December 2012, before the Medicaid Decision, Kiser again applied for
supplemental security income—this time also applying for disability insurance benefits and
a period of disability. A.R. 34. Kiser claimed disability based on memory loss, prostate
cancer, arthritis, obstructive sleep apnea, hypertension, diabetes, renal failure, pneumonia,
and pancreatitis. A.R. 295.
Kiser’s claim was initially denied and denied again upon reconsideration. Kiser
filed a request for rehearing, and an ALJ held a video hearing on September 8, 2014. In a
written decision issued on May 7, 2015, the ALJ employed the five-step sequential
evaluation. 3 At step one, the ALJ found that Kiser had not engaged in substantial gainful
activity since July 21, 2009. At step two, the ALJ found that Kiser had the following severe
impairments that “more than minimally limit [his] ability to perform basic work activities”:
prostate cancer, urinary tract disorder, degenerative disc disease, and an organic mental
disorder. A.R. 37–38.
At step three, the ALJ found that Kiser’s impairments did not, individually or in
combination, meet or medically equal an impairment listed in 20 C.F.R. Part 404, Subpart
P, Appendix 1. As to Kiser’s claimed mental impairments, the ALJ held that they did not
“meet or medically equal the criteria of listing 12.02, or any other listing.” A.R. 40. In
particular, the ALJ considered whether Listing 12.02 (the listing for “Organic Mental
3
As discussed above, on December 1, 2011, a prior ALJ denied Kiser’s previous
application for supplemental security income. Therefore, even though Kiser claimed in his
current application a disability onset date of July 21, 2009, the ALJ held that Kiser’s
disability claim from July 21, 2009 to December 1, 2011 was barred under the doctrine of
res judicata.
6
Disorders”) was satisfied and held that the requirements set forth in paragraph (B) of that
listing were not met. Paragraph (B) of Listing 12.02 required at least two of the following:
(1) marked restriction of activities of daily living; (2) marked difficulties in maintaining
social functioning; (3) marked difficulties in maintaining concentration, persistence, or
pace; or (4) repeated episodes of decompensation, each of extended duration. As to
restriction of activities of daily living, the ALJ found that Kiser had a mild (i.e., not marked)
restriction. As to social functioning and issues with concentration, persistence, or pace,
the ALJ said that Kiser had only moderate (again, not marked) difficulties. And the ALJ
found no evidence of repeated episodes of decompensation of extended duration.
Consequently, the ALJ found that Listing 12.02 was not met or medically equaled. 4 After
considering the whole record, the ALJ held that Kiser had the RFC to perform a reduced
range of only sedentary work.
In analyzing step three, the ALJ mentioned briefly the Medicaid Decision and that
Kiser had been found disabled under the listing for intellectual disabilities, Listing
12.05(C). A.R. 48. But the ALJ gave “[t]his opinion . . . minimal weight” and stated that
it was “not binding on our agency.” A.R. 48. According to the ALJ, the record before him
did not support the Medicaid Decision. First, the ALJ stated that Kiser had reported on
multiple occasions that he performs his daily activities independently, indicating only mild
limitations in that area. Second, the ALJ reasoned that Kiser’s history of memory
impairment supported only a moderate limitation in his concentration, persistence, and
4
The ALJ also briefly considered whether Listing 12.02(C) was met. However, the
ALJ quickly reasoned it was not.
7
pace. Lastly, the ALJ said that he found the opinions of the “State agency medical and
psychological experts to be more accurate and persuasive.” A.R. 48.
Turning to step four, the ALJ held that Kiser was unable to perform any of his past
relevant work (e.g., auto mechanic, electrician’s helper, or construction worker). Finally,
as to step five, the ALJ found that considering Kiser’s RFC, Kiser could perform
representative occupations such as document preparer/scanner, final assembler of optical
goods, or an addresser. Therefore, the ALJ found that Kiser was not disabled and denied
his application.
On October 27, 2017, the Appeals Council denied Kiser’s request for review of the
ALJ’s decision.
C.
On July 6, 2018, Kiser filed a complaint in the United States District Court for the
Western District of North Carolina seeking judicial review of the ALJ’s decision.
Presented with cross-motions for summary judgment, the district court awarded
summary judgment to the Commissioner and affirmed the ALJ’s decision. Importantly,
with regard to how the ALJ treated the Medicaid Decision, the district court held that the
ALJ provided “persuasive, specific, and valid reasons” for affording the Medicaid Decision
less than substantial weight. Kiser v. Berryhill, No. 3:17-CV-00739-FDW, 2019 WL
1173376, at *4 (W.D.N.C. Mar. 13, 2019) (quoting Woods v. Berryhill, 888 F.3d 686, 692
(4th Cir. 2018)). In explaining why the ALJ properly considered Listing 12.02, rather than
12.05, the district court stated that the “ALJ reasonably believed the evidence contained in
8
the record more appropriately supported evaluating for an organic mental disorder under
Listing 12.02.” Id. Furthermore, the district court observed that Kiser “raise[d] no
arguments for why Listing 12.05 was implicated by his impairments.” Id. Therefore, the
district court held that the ALJ’s decision to afford the Medicaid Decision less than
substantial weight was proper.
Kiser timely appealed to this Court.
III.
We review the district court’s decision de novo, and we will affirm the ALJ’s
disability determination if the ALJ has applied the “correct legal standards and the ALJ’s
factual findings are supported by substantial evidence.” Shinaberry v. Saul, 952 F.3d 113,
120 (4th Cir. 2020) (quoting Mascio v. Colvin, 780 F.3d 632, 634 (4th Cir. 2015)).
In this appeal we are presented with a single issue: whether the ALJ properly
afforded less than substantial weight to the Medicaid Decision.
Although a “disability decision by another entity does not bind the SSA,” Woods,
888 F.3d at 691, the “default rule” is that an ALJ must give “substantial weight” to another
agency’s decision, id. at 692. In Woods, this Court held that an ALJ must give “substantial
weight” to a disability decision by the NCDHHS because both NCDHHS and Social
Security disability insurance benefits “serve the same governmental purpose of providing
benefits to persons unable to work because of a serious disability” and because NCDHHS’s
provision of Medicaid is for those who are considered disabled for social security purposes.
Id. (quoting Bird v. Comm’r of Soc. Sec. Admin., 699 F.3d 337, 343 (4th Cir. 2012)).
9
Per Woods, an ALJ may afford another agency’s disability determination less than
substantial weight only if the ALJ provides “persuasive, specific, valid reasons for doing
so that are supported by the record.” Id. (quoting McCartey v. Massanari, 298 F.3d 1072,
1076 (9th Cir. 2002)). For example, an “ALJ could explain which aspects of the prior
agency decision he finds not credible and why, describe why he finds other evidence more
credible, and discuss the effect of any new evidence made available after NCDHHS issued
its decision.” Id. Without such explanation by the ALJ, a reviewing court “cannot engage
in meaningful review.” Id. at 693.
Here, we are convinced that the ALJ failed to provide “persuasive, specific, [and]
valid” reasons why he afforded less than substantial weight to the Medicaid Decision. Id.
at 692. This is because the ALJ failed to consider whether the three prongs of Listing
12.05(C) were met or medically equaled; instead, the ALJ only analyzed the requirements
of Listing 12.02. In explaining why he was affording the Medicaid Decision minimal
weight, the ALJ stated that Kiser only had a mild impairment in performing his daily
activities independently, and a moderate memory impairment that affects his concentration,
persistence, and pace. However, these reasons pertain to the requirements of Listing
12.02(B), which require two of the four listed conditions, such as “[m]arked restriction of
activities of daily living” (Listing 12.02(B)(1)) and “marked difficulties in maintaining
concentration, persistence, or pace” (Listing 12.02(B)(3)). The Medicaid Decision,
however, found that Kiser’s condition medically equaled Listing 12.05(C), not Listing
12.02. Simply put, the ALJ failed to analyze whether Kiser met or medically equaled
Listing 12.05(C). As a result, the reasons the ALJ proffered for affording minimal weight
10
to the Medicaid Decision were non-responsive to the reasons why the NCDHHS found
Kiser disabled.
Indeed, based on the record, it appears that Listing 12.05(C) was the appropriate
listing for analyzing Kiser’s cognitive impairments. For example, recall that prong two of
Listing 12.05(C) required a “valid verbal, performance, or full-scale IQ of 60 through 70.”
As the December 1, 2011 ALJ decision and Medicaid Decision outlined, intelligence
testing performed in 2010 after Kiser’s 2009 hospitalization yielded verbal, performance,
and full-scale IQ scores of 66, 69, and 65, respectively. A.R. 101, 340. These scores would
place Kiser squarely within the 60–70 IQ score range, thus satisfying prong two.
Given that the ALJ failed to address whether Kiser met or medically equaled the
requirements of Listing 12.05(C), the ALJ’s reasons for not giving substantial weight to
the Medicaid Decision were non-responsive and, therefore, were neither persuasive,
specific, nor valid. For that reason, we vacate and remand for further consideration. 5
5
As discussed supra note 2, effective January 17, 2017, the Commissioner
significantly altered the listings for mental disorders and, among other things, removed
Listing 12.05(C). In amending the listings, the Commissioner stated that “[i]f a court
reverses our final decision and remands a case for further administrative proceedings after
the effective date of these final rules, we will apply these final rules to the entire period at
issue in the decision we make after the court’s remand.” 81 Fed. Reg. at 66,138 n.1. Thus,
according to the Commissioner, on remand an ALJ will apply the revised listings, not
Listing 12.05(C). Id. Though application of the revised listings, as proposed by the
Commissioner, may generate retroactivity concerns, we do not reach that issue here, as it
would be premature to do so.
11
IV.
For the foregoing reasons, we reverse the district court’s judgment and remand
with instructions to vacate the denial of benefits and remand for further administrative
proceedings.
REVERSED AND REMANDED
12
TRAXLER, Senior Judge, dissenting:
The majority concludes that the ALJ failed to adequately explain why he gave
minimal weight to the Medicaid Decision finding Kiser’s condition equaled the impairment
in Listing 12.05, and the majority reverses the district court’s order and directs the case be
returned to the ALJ for reconsideration. In my view, the ALJ sufficiently explained why
he gave minimal weight to the Medicaid Decision, and substantial evidence supports the
ALJ’s denial of benefits. Because I would affirm the judgment of the district court, which
in turn affirmed the judgment of the ALJ, I respectfully dissent.
I.
While Kiser’s claim for Social Security disability benefits and supplemental
security income was pending, a North Carolina state agency determined that Kiser was
disabled and therefore qualified for Medicaid benefits. The Medicaid Decision determined
that Kiser qualified for Medicaid because his impairments medically equaled the severity
of the intellectual disability impairment of Listing 12.05(C).
Although the Medicaid Decision is not binding on the ALJ, see 20 C.F.R. §
404.1504, the general rule is that an ALJ considering a disability claim must give
substantial weight to a state-agency’s disability finding. See Woods v. Berryhill, 888 F.3d
686, 692 (4th Cir. 2018). The ALJ “may deviate from this default rule and accord [the]
disability decision less than substantial weight if the record before the ALJ clearly
demonstrates that such a deviation is appropriate.” Id. (internal quotation marks omitted).
“[I]n order to demonstrate that it is appropriate to accord less than substantial weight to
[the] disability decision, an ALJ must give persuasive, specific, valid reasons for doing so
13
that are supported by the record.” Id. (internal quotation marks omitted). To provide a
valid reason for rejecting a state-agency finding, “an ALJ could explain which aspects of
the prior agency decision he finds not credible and why, describe why he finds other
evidence more credible, and discuss the effect of any new evidence. . . . This list is not
exclusive, but the point of this requirement—and of these examples—is that the ALJ must
adequately explain his reasoning; otherwise, we cannot engage in a meaningful review.”
Id. at 692-93.
A.
In this case, the ALJ gave minimal weight to the Medicaid Decision’s disability
finding. The ALJ explained that
the record before me does not support [the finding of disability]. The
claimant has reported on multiple occasions that he performs his activities of
daily [living] independently, indicating only mild limitations in that area.
Furthermore, the claimant’s history of memory impairment supports only
moderate limitations in the claimant’s concentration, persistence, and pace
and does not rise to listing severity. I find the opinions of the State agency
medical and psychological experts to be more accurate and persuasive.
A.R. 48 (citations omitted).
While the ALJ’s discussion may be somewhat abbreviated, 1 I believe it nonetheless
provides a sufficiently persuasive, specific, and valid explanation to require affirmance.
The Medicaid Decision found that Kiser’s memory difficulties and reduced
intellectual functioning were severe impairments that significantly limited his ability to
1
The ALJ also stated that the Medicaid Decision was based on different standards
and was not binding on the ALJ. As we explained in Woods, such generic objections to a
state-agency finding do not amount to persuasive or specific reasons justifying a decision
to give less than substantial weight to the finding. See Woods v. Berryhill, 888 F.3d 686,
693 (4th Cir. 2018).
14
work and thus rendered him disabled. The ALJ gave those findings minimal weight
because the record evidence the ALJ found credible did not support the conclusion that
Kiser’s limitations were severe. A conflict with record evidence is clearly a valid and
persuasive reason to give minimal weight to the Medicaid Decision. See Woods, 888 F.3d
at 692 (explaining that “an ALJ could explain which aspects of the prior agency decision
he finds not credible and why, [and] describe why he finds other evidence more credible”).
The ALJ pointed to specific areas where the record conflicted with the severe-
impairment findings of the Medicaid Decision – Kiser was only mildly limited in his ability
to independently perform his activities of daily living; Kiser had only moderate limitations
in concentration, persistence, and pace; and the state-agency consultants found most
credible by the ALJ determined that Kiser had mild memory and cognitive limitations. As
to these points, the ALJ’s view is supported by substantial evidence in the record.
Kiser was working full-time as a car mechanic until July 2009, when he was
hospitalized and in a coma for a month. Kiser has suffered from memory loss and
concentration problems since recovering from the coma. Kiser has been unable to return
to his previous work. Medical records describe Kiser as presently suffering from “mild
cognitive impairment” and “mild memory deficits.” A.R. 591, 1011. The ALJ gave “great
weight,” A.R. 47, to the state agency’s psychological consultants, who concluded that Kiser
was not disabled. See A.R. 133, 151. Those consultants reported that Kiser had mild
cognitive impairment that moderately limited his ability to maintain social functioning and
to maintain concentration, persistence, and pace, but did not significantly limit his ability
to, inter alia, understand and remember short, simple instructions; interact with peers or
15
co-workers; make simple, work-related decisions; or sustain an ordinary routine without
special supervision. See A.R. 126, 130-31, 148-49. This evidence easily clears the
substantial-evidence threshold and supports the ALJ’s determination that Kiser suffered
from mild cognitive impairment that did not prevent him from working sedentary jobs. See
Biestek v. Berryhill, 139 S. Ct. 1148, 1154 (2019) (“[T]he threshold for [substantial
evidence] is not high. Substantial evidence . . . is more than a mere scintilla. It means --
and means only -- such relevant evidence as a reasonable mind might accept as adequate
to support a conclusion.”) (citation and internal quotation marks omitted). This same
evidence also supports the ALJ’s decision to reject the Medicaid Decision -- which found
Kiser to be severely impaired -- as contrary to the record before the ALJ.
Kiser, however, contends that the factors listed by the ALJ are not relevant under
Listing 12.05(C) and thus cannot constitute a valid reason to reject the Medicaid Decision.
I disagree. The question before the ALJ was the weight to be given the Medicaid
Decision’s finding that Kiser’s impairments medically equaled Listing 12.05(C). A listing
is medically equaled when its criteria are not met, but an impairment is “at least equal in
severity and duration to the criteria of any listed impairment.” 20 C.F.R. § 404.1526(a)
(emphasis added). Although the factors identified by the ALJ are not criteria under Listing
12.05, they nonetheless are relevant to determining the extent of Kiser’s impairment, which
is a necessary step when determining whether his impairments at least equaled the severity
of Listing 12.05(C). The ALJ therefore did not err by considering evidence of the extent
of Kiser’s impairment in areas other than those set out in Listing 12.05(C). See 20 C.F.R.
§ 404.1526(c) (“When we determine if your impairment medically equals a listing, we
16
consider all evidence in your case record about your impairment(s) and its effects on you
that is relevant to this finding.”).
B.
To the extent Kiser now contends that the ALJ should have considered whether
Kiser met (as opposed to medically equaled) the criteria of Listing 12.05(C), 2 I again
disagree. Listing 12.05 governs claims of intellectual disability, a lifelong disability that
involves low IQ along with adaptive deficits appearing before age 22. See 20 C.F.R. Pt.
404, Subpt. P, App. 1, Listing 12.05 (effective January 2, 2015). Listing 12.02 -- the
Listing applied by the ALJ -- governs claims of disability because of a decline in cognitive
function. See 20 C.F.R. Pt. 404, Subpt. P, App. 1, Listing 12.02 (explaining that Listing
12.02 is used to evaluate an impairment causing an “abnormal mental state and loss of
previously acquired functional abilities”).
Although Kiser received low scores on IQ tests given through the years, he
supported himself until 2009 by working as a heavy equipment operator, electrician’s
helper, groundskeeper, and car mechanic. As noted, he was working full time as a
mechanic until July 2009, when he was hospitalized and in a coma for a month. In his
2012 application for disability benefits, Kiser asserted that he became disabled in July
2009, when he was hospitalized and in an extended coma. See A.R. 279. In a brief
submitted to the ALJ in 2014, counsel for Kiser likewise focused on Kiser’s memory loss
2
As discussed above, the ALJ concluded that Kiser’s impairments did not medically
equal Listing 12.05(C) when he rejected the Medicaid Decision as contrary to the record.
17
following his hospitalization. See A.R. 346. Kiser never contended he was entitled to
benefits because he met the criteria of Listing 12.05(C). 3
Moreover, the mere existence of IQ scores in the range shown in this record does
not, in and of itself, establish disability under Listing 12.05(C); there must also be evidence
of adaptive deficits. See 20 C.F.R. Pt. 404, Subpt. P, App. 1, Listing 12.05 (“Intellectual
disability refers to significantly subaverage 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.”); id. Listing
12.00(A) (“Listing 12.05 contains an introductory paragraph with the diagnostic
description for intellectual disability. It also contains four sets of criteria (paragraphs A
through D). If your impairment satisfies the diagnostic description in the introductory
paragraph and any one of the four sets of criteria, we will find that your impairment meets
the listing.”). Given Kiser’s history of skilled work, the absence of any professional
assessment concluding that Kiser met the criteria of Listing 12.05, and Kiser’s failure to
argue to the ALJ that he qualified as intellectually disabled under Listing 12.05(C), I do
not believe the ALJ erred by evaluating Kiser’s claim under Listing 12.02 rather than
12.05(C).
II.
I believe substantial evidence supports the ALJ’s determination that Kiser suffered
from mild cognitive impairments that did not prevent him from working. The conclusion
3
Indeed, when seeking review of the ALJ’s decision by the Appeals Council, Kiser
did not argue that the ALJ erred by not evaluating his claim under Listing 12.05(C).
18
of the Medicaid Decision that Kiser suffered from significant mental impairments that
equaled the severity of Listing 12.05(C) was inconsistent with the ALJ’s understanding of
the record evidence, and that inconsistency provided a persuasive, specific, and valid
reason for the ALJ to give minimal weight to the Medicaid Decision. Because the ALJ
adequately explained his reasoning and his factual findings about the scope of Kiser’s
limitations are supported by substantial evidence, I would affirm the judgment of the
district court, which in turn affirmed the judgment of the ALJ.
Accordingly, for the foregoing reasons, I respectfully dissent.
19