Randall v. Astrue

IN THE UNITED STATES COURT OF APPEALS
FOR THE FIFTH CIRCUIT United States Court of Appeals
Fifth Circuit

FILED
June 8, 2009
No. 08-30783
Charles R. Fulbruge III
Clerk

ANNETTE RANDALL,

Plaintiff-Appellant,

versus

MICHAEL J. ASTRUE, Commissioner of Social Security,

Defendant-Appellee.

Appeal from the United States District Court
for the Western District of Louisiana

Before JOLLY, SMITH, and BENAVIDES, Circuit Judges.
PER CURIAM:

Annette Randall appeals a judgment denying her application for supple-
mental security income benefits. We affirm.
 No. 08-30783

I.
A.
We first describe the legal framework.1 The Social Security Act (“SSA”),
42 U.S.C. ch. 7, entitles certain “disabled” individuals to supplemental security
income benefits (“SSI benefits”). 42 U.S.C. § 1381a. Under the statute, disabled
individuals are those who are “unable to engage in any substantial gainful
activity by reason of any medically determinable physical or mental impairment
which can be expected to result in death or which has lasted or can be expected
to last for a continuous period of not less than twelve months.” § 1382c(a)(3)(A).
The statute requires that the Commissioner of Social Security “establish by reg-
ulation uniform standards which shall be applied at all levels of determination,
review, and adjudication in determining whether individuals are under disabili-
ties.” § 421(k)(1); see § 1382c(a)(3)(H)(i).
Accordingly, the Commissioner promulgated a complex scheme of regula-
tions for administering benefits, see 20 C.F.R. ch. III, pts. 404, subpt. P, 416,
subpt. I, including a “five-step sequential evaluation process” for disability deter-
minations, § 416.920(a)(1). “A finding that a claimant is disabled or is not disa-
bled at any point in the five-step review is conclusive and terminates the analy-
sis.” 2 Step three provides that “[i]f you have an impairment(s) that meets or
equals one of our listings in appendix 1 to subpart P of part 404 of this chapter
and meets the duration requirement, we will find that you are disabled.”

1
See Richardson v. Perales, 402 U.S. 389, 399 (1971) (“The [social security] system’s
administrative structure and procedures, with essential determinations numbering into the
millions, are of a size and extent difficult to comprehend.”).
2
Lovelace v. Bowen, 813 F.2d 55, 58 (5th Cir. 1987); accord § 416.920(d); see generally
Bowen v. Yuckert, 482 U.S. 137, 141-42 (1987).

2
 No. 08-30783

§ 416.920(a)(4)(iii).
Appendix 1, in turn, includes diagnostic descriptions for various disabili-
ties and addresses mental disorders in Listing 12, 20 C.F.R. ch. III, pt. 404,
subpt. P, app. 1 (the “C.F.R. Listing”). Listing 12.05 contains “an introductory
paragraph with the diagnostic description for mental retardation” and “four sets
of criteria (paragraphs A through D).” C.F.R. Listing 12.00(A).
12.05 Mental retardation: Mental retardation 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.

The required level of severity for this disorder is met when the re-
quirements in A, B, C, or D are satisfied.

A. Mental incapacity evidenced by dependence upon others for per-
sonal needs (e.g., toileting, eating, dressing, or bathing) and inabili-
ty to follow directions, such that the use of standardized measures
of intellectual functioning is precluded;

OR

B. A valid verbal, performance, or full scale IQ of 59 or less;

OR

C. A valid verbal, performance, or full scale IQ of 60 through 70 and
a physical or other mental impairment imposing an additional and
significant work-related limitation of function;

OR

D. A valid verbal, performance, or full scale IQ of 60 through 70, re-
sulting in at least two of the following:

3
 No. 08-30783

1. Marked restriction of activities of daily living; or

2. Marked difficulties in maintaining social functioning; or

3. Marked difficulties in maintaining concentration, persis-
tence, or pace; or

4. Repeated episodes of decompensation, each of extended
duration.

C.F.R. Listing 12.05.

B.
In 2004, then thirty-nine-year-old Annette Randall applied to the Social
Security Administration for SSI benefits, claiming that a disability had befallen
her earlier that year. She was married and lived with her husband and one of
her six children. She claimed to suffer from high blood pressure, dizziness, mi-
graine headaches, and nerves. Tests conducted in 2004 revealed congestive
heart failure and related complications. To evaluate her functional capacities,
multiple medical professionals examined her, including clinical psychologist Al-
fred Buxton, who conducted a review of her personal history, a clinical interview,
and a psychometric assessment.
Randall obtained an overall IQ score of 69, and Buxton rendered the fol-
lowing findings: She could cook, clean, communicate, manage time, and travel
independently; she was alert and responsive; and she possessed good receptive
and expressive skills for everyday conversational purposes, good social skill, good
abilities to attend and concentrate, good judgment and reflective cognition, and
fair reasoning. According to Buxton, Randall “would function in the mild/border-
line range of mental retardation adaptively,” and “[o]n a day-to-day basis overall

4
 No. 08-30783

general functioning is felt to more closely approximate borderline mental re-
tardation as opposed to mild mental retardation.” Buxton concluded that Ran-
dall’s physical and mental conditions “would not preclude gainful competitive
employment though there may be some parametric restrictions placed on the
type of employment she could engage in on an ongoing basis.”
Dr. Lawrence Klusman also assessed Randall’s functional capacities and
found that she exhibited no marked limitations in understanding or memory,
sustained concentration and persistence, social interaction, or adaptation. Ac-
cording to Klusman’s assessment,

[Randall’s] level of intellectual development will permit her to ac-
quire simple skills and work-related knowledge. She understands
verbal directives and is able to follow them. She can attend to a
task and work at an adequate pace during the course of a regular
work period. She may not be suited for extensive interaction with
the public but would be able to manage brief, structured encounters.
[She] would be most suited for work that has minimal requirements
for flexibility, reading skills, or changing task demands.

In six of the seven years preceding her application, Randall was employed as a
housekeeper.
The regional social security commissioner denied Randall’s application for
SSI benefits, so she requested a hearing before an administrative law judge
(“ALJ”), to whom she argued that her impairments satisfied Listing 12.05(C).
At step three of the evaluative process, the ALJ premised her analysis on an im-
portant legal conclusion:

The threshold requirement of Listing 12.05 . . . is that and [sic] in-
dividual have mental retardation, which is defined as significantly
subaverage general intellectual functioning with deficits in adaptive

5
 No. 08-30783

functioning initially manifested during the developmental period.
Beyond that, there are a number of different ways to meet the re-
quirement of the listing, all depending on either valid IQ scores or
a limitation of function . . . .

The ALJ concluded that Randall did not “have an impairment or combination of
impairments that meets or medically equals one of the listed impairments” in
Appendix 1, because Randall had failed to meet “the threshold requirement of
mental retardation, defined as significantly subaverage general intellectual func-
tioning with deficits in adaptive functioning initially manifested during the de-
velopmental period.” 3 Accordingly, the ALJ found that Randall suffered from no
“disability” within the meaning of the SSA. The Appeals Council denied Ran-
dall’s request for review.
Randall sought review in federal court, arguing that substantial evidence
did not support the ALJ’s rejection of the Listing 12.05(C) argument and that the
diagnostic description’s “adaptive functioning” term ought not operate as an in-
dependent measurement of mental retardation under Listing 12.05; the Commis-
sioner presented multiple grounds for affirming the ALJ’s denial. A magistrate
judge (“MJ”) recommended affirming by concluding that Listing 12.05(C)’s diag-
nostic description required an independent showing of deficits in adaptive func-
tioning and that the ALJ’s decision on that ground was supported by substantial
evidence.
Randall objected, arguing that Listing 12.05(C) imposes no such require-
ment. The district court agreed with Randall and directed the MJ to consider
only whether the paragraph C conditions had “manifested before [Randall]

3
The ALJ also discussed Randall’s physical abilities and determine that she could en-
gage in work as a housekeeping cleaner.

6
 No. 08-30783

reached the age of 22.”
Despite the court’s instruction, the MJ again evaluated Randall’s claim by
requiring proof of “deficits in adaptive functioning” and recommended affirming
the ALJ’s decision. After Randall objected again, the district court adopted the
MJ’s position of requiring proof of “deficits in adaptive functioning.” 4 The court
did not reject Randall’s claim on that ground, however, because it found that
substantial evidence supported the manifestation of the adaptive deficits during
the developmental period. Instead, the court concluded that substantial evi-
dence supported rejecting Randall’s claim for failure to satisfy the latter half of
paragraph C—the existence of “a physical or other mental impairment imposing
an additional and significant work-related limitation of function.”

II.
In an appeal from an ALJ’s denial of SSI benefits, we review the ALJ’s de-
cision alone to determine whether she applied the proper legal standard and, if
so, whether substantial evidence supports her decision.5 Our review of the ALJ’s

4
See 42 U.S.C. §§ 405(g), 1383(c)(3); Richardson v. Perales, 402 U.S. 389, 401 (1971);
Loza v. Apfel, 219 F.3d 378, 393 (5th Cir. 2000); Wingo v. Bowen, 852 F.2d 827, 829 (5th Cir.
1988). Cf. United States v. Matthews, 312 F.3d 652, 657 & n.5 (5th Cir. 2002) (“‘Under the law
of the case doctrine, an issue of fact or law decided on appeal may not be reexamined either
by the district court on remand or by the appellate court on a subsequent appeal.’ . . . At the
same time, law of the case is not a jurisdictional rule, but a discretionary practice. . . . The
doctrine has three exceptions: (1) The evidence at a subsequent trial is substantially different;
(2) there has been an intervening change of law by a controlling authority; and (3) the earlier
decision is clearly erroneous and would work a manifest injustice” (quoting Tollett v. City of
Kemah, 285 F.3d 357, 363 (5th Cir. 2002)).).
5
Though we are reviewing the district court’s judgment, we often recite our standard
of review without mentioning the court a quo, because the statute charges district and circuit
courts with performing an identical substantial-evidence review. See 42 U.S.C. § 405(g); Ward
(continued...)

7
 No. 08-30783

decision is further circumscribed in important respects by the Commissioner’s
specific position in this appeal. Before this court, the Commissioner separates
the question whether Randall satisfied Listing 12.05’s diagnostic description
from the question whether she satisfied paragraph C. The Commissioner con-
cedes that Randall satisfied the Listing 12.05(C) IQ and “physical or other men-
tal impairment” requirements 6 and argues only that “the ALJ properly found
that Randall did not meet the first requirement of listing 12.05C because she did
not have deficits in adaptive functioning manifested before age 22.” As a result,
the only questions before the court are (1) whether satisfaction of Listing
12.05(C) requires an independent demonstration of “significantly subaverage in-
tellectual functioning with deficits in adaptive functioning initially manifested
. . . before age 22,” C.F.R. Listing 12.05, and, (2) if so, whether substantial evi-
dence supports the ALJ’s decision.

A.
1.
The legal question is straightforward: We must construe Listing 12.05 and
determine the precise relationship between the diagnostic description’s substan-

5
(...continued)
v. Celebrezze, 311 F.2d 115, 116 (5th Cir. 1962) (“The Government makes an appealing argu-
ment that the Congress did not intend that there should be a review of the evidence by two
courts for a determination of the substantiality of the evidence. However plausible this con-
tention may be, we are not persuaded that we should depart from the judicial precedents hold-
ing otherwise.”).
6
According to the Commissioner, “[t]he District Court found that Randall did not meet
Listing 12.05C because she did not meet the third requirement—a physical or other mental
impairment imposing an additional and significant work related limitation of function. The
Commissioner concedes that the District Court’s reasoning is incorrect.”

8
 No. 08-30783

tive requirements (“significantly subaverage intellectual functioning with defi-
cits in adaptive functioning”), the diagnostic description’s temporal requirement
(“initially manifested during the developmental period; i.e., the evidence demon-
strates or supports onset of the impairment before age 22”), 7 and the four severi-
ty criteria (paragraphs A, B, C, and D). We are presented with three markedly
different constructions to choose among. In the context of a claim under Listing
12.05(C), the possible constructions are as follows:
(1) An impairment satisfies Listing 12.05 if the claimant pres-
ently exhibits the severity criteria (IQ and limitation of function).
In this reading, the diagnostic description and temporal language
pose no independent requirements.

(2) An impairment satisfies Listing 12.05 if (a) the claimant
presently exhibits the severity criteria, and (b) the severity criteria
manifested during the developmental period. In this reading, the
diagnostic description’s substantive language poses no independent
requirement.

(3) An impairment satisfies Listing 12.05 if (a) the claimant
presently satisfies the diagnostic description’s substantive require-
ments, (b) the claimant shows that the impairment satisfying the di-
agnostic description’s substantive requirement manifested during
the developmental period, and (c) the claimant presently exhibits

7
The regulations contemplate the addition of specific temporal elements in § 404.1525:

Most of the listed impairments are permanent or expected to result in death.
For some listings, we state a specific period of time for which your impair-
ment(s) will meet the listing. For all others, the evidence must show that your
impairment(s) has lasted or can be expected to last for a continuous period of
at least 12 months.

20 C.F.R. § 404.1525(c)(4).

9
 No. 08-30783

the severity criteria.8

Randall argues for construction (2); the Commissioner, for (3).
Our circuit has yet to resolve this question. Our only opinion to address
it, Arce v. Barnhart, 185 F. App’x 437 (5th Cir. 2006), rejected a Listing 12.05C
claim by concluding, without elaboration, that “[b]ecause there is substantial evi-
dence that [the claimant] does not have deficits in adaptive functioning, there
is substantial evidence that she does not meet listing 12.05C.” Id. at 439. That
unpublished case does not have precedential effect. See 5 TH C IR. R. 47.5.4. In
Selders v. Sullivan, 914 F.2d 614 (5th Cir. 1990), we said that “Section 12.05(C)
defines an impairment to include a valid verbal, performance, or full scale I.Q.
score of 60-69 inclusive, and a physical or other mental impairment imposing
additional and significant work-related limitations of function;” we also opined
that “[a] claimant must prove both of these conditions in order to meet his bur-
den under step three.” Id. at 619. But because the Selders claimant failed to
establish the requisite IQ score, the court did not reach the issue of whether the

8
We need not address the question of whether the temporal requirement should extend
beyond the diagnostic description to the severity criteria, because the Commissioner does not
try to justify the ALJ’s decision on the ground that Randall failed to satisfy the temporal re-
quirement with respect to the paragraph C elements. Thus, we attend to the temporal re-
quirement only insofar as it extends to the diagnostic description’s substantive requirement.

Along similar lines, several circuits presume that an impairment was “initially mani-
fested during the developmental period” if the claimant establishes the requisite impairment
in the present . See Hodges v. Barnhart, 276 F.3d 1265, 1268-69 (11th Cir. 2001); Branham
v. Heckler, 775 F.2d 1271, 1274 (4th Cir. 1985) (applying the presumption to IQ scores). Oth-
ers refuse to erect such a presumption. See Markle v. Barnhart, 324 F.3d 182, 188 (3d Cir.
2003). Because we resolve Randall’s claim by evaluating only the present characteristics of
her alleged impairment, we need not opine on this issue.

10
 No. 08-30783

diagnostic paragraph imposes any additional requirement. Id.9
The SSA provides the touchstone for our analysis, because Listing 12.05
represents the Commissioner’s effort to determine which impairments meet the
statutory definition of disability. Section 423(d)’s definition of “disability” in-
cludes two limiting elements: a definition of impairment and a severity require-
ment.
To qualify as a “physical or mental impairment,” the condition must be “an
impairment that results from anatomical, physiological, or psychological abnor-
malities which are demonstrable by medically acceptable clinical and laboratory
diagnostic techniques.” § 423(d)(3). To meet the severity requirement, the im-
pairment must be “of such severity that he is not only unable to do his previous
work but cannot, considering his age, education, and work experience, engage
in any other kind of substantial gainful work.” § 423(d)(2)(A). This distinction
between an impairment’s existence and its severity is fundamental to an under-
standing of Listing 12.05.
Like the statute, the Secretary’s disability-determination regulations sepa-
rate the question of the impairment’s existence from the question of its severity.
After reciting the statutory definition of disability, see 20 C.F.R. § 404.1505(a),
section 404.1508 addresses the means by which claimants must prove the exis-

9
In Hamilton v. Shalala, No. 94-30218, 1994 WL 612289 (5th Cir. Oct. 17, 1994) (un-
published), we stated that “Listing 12.05 provides that a person is classified as mentally re-
tarded and qualifies for benefits if that person has ‘a valid verbal, performance, or full scale
IQ of 60 through 70 and a physical or other mental impairment imposing additional and signif-
icant work-related limitation of function.’” Id. at *1. Because, however, the claimant in Ham-
ilton failed to show the requisite severity, the court did not confront the issue we face today.
See id. at *2 (“Since the Secretary found that Hamilton did not have a valid verbal, perfor-
mance, or full scale IQ of 60 through 70, the Secretary did not have to assess whether Hamil-
ton’s impairments were imposing a significant work-related limitation.”).

11
 No. 08-30783

tence of an impairment:
If you are not doing substantial gainful activity, we always look first
at your physical or mental impairment(s) to determine whether you
are disabled or blind. Your impairment must result from anatomi-
cal, physiological, or psychological abnormalities which can be
shown by medically acceptable clinical and laboratory diagnostic
techniques. A physical or mental impairment must be established
by medical evidence consisting of signs, symptoms, and laboratory
findings, not only by your statement of symptoms.

§ 404.1508 (emphasis added). Several other sections make it plain that the two
inquiries are distinct. The section addressing evidence requires that applicants
“provide medical evidence showing that you have an impairment(s) and how se-
vere it is during the time you say that you are disabled.”10
Additional evidence of the separation’s importance comes from § 404.-
1520a, which describes the “special technique” of mental impairment evalua-
tions: “Under the special technique, we must first evaluate your pertinent symp-
toms, signs, and laboratory findings to determine whether you have a medically
determinable mental impairment(s).” § 404.1520a(b)(1). After identifying an
impairment, the Commission attempts to “rate the degree of functional limita-
tion resulting from the impairment(s),” § 404.1520a(b)(2), and only then does the
Commission address severity, see § 404.1520a(d) (“After we rate the degree of
functional limitation resulting from your impairment(s), we will determine the

10
§ 404.1512(c) (emphasis added); see also § 404.1520(c) (distinguishing an “impair-
ment” from a qualifying “severe impairment”); § 404.1513(a) (“We need evidence from accept-
able medical sources to establish whether you have a medically determinable impairment(s).”);
Sullivan v. Zebley, 493 U.S. 521, 530 (1990) (“For a claimant to show that his impairment
matches a listing, it must meet all of the specified medical criteria.”

12
 No. 08-30783

severity of your mental impairment(s).”).11
Finally, we come to the Listing of Impairments, which provides an intro-
duction and set of specific listings for each of various body systems. See C.F.R.
Listing; 20 C.F.R. § 404.1525(c)(1). Listing 12 addresses nine specific mental
disorders and begins with a set of introductory instructions, see C.F.R. Listing
12; the Listing’s introductory instructions are no less mandatory than is Listing
12.05 itself, see 20 C.F.R. § 404.1525(c)(2). Accordingly, every mental disorder
listing includes two independent components: a diagnostic description of the dis-
order and specific criteria measuring the disorder’s severity.12
After an introductory paragraph sets out a diagnostic description, most of
the listings include the following text: “The required level of severity for these
disorders is met when the requirements in both A and B are satisfied, or when
the requirements in C are satisfied.” E.g., C.F.R. Listing 12.02. If the Listings
were our only text, this provision—particularly the “is met” command—might
tempt us to construe the diagnostic description’s substantive language as a mere
precatory introduction to the binding requirements enumerated in paragraphs
A through D. But the Listings do not stand alone; the surrounding statutes and
regulations take care to distinguish the severity inquiry from the threshold de-

11
See also § 404.1529(b) (“Your symptoms, such as pain, fatigue, shortness of breath,
weakness, or nervousness, will not be found to affect your ability to do basic work activities
unless medical signs or laboratory findings show that a medically determinable impairment(s)
is present.”); § 404.1529(c)(1) (“When the medical signs or laboratory findings show that you
have a medically determinable impairment(s) that could reasonably be expected to produce
your symptoms, such as pain, we must then evaluate the intensity and persistence of your
symptoms so that we can determine how your symptoms limit your capacity for work.”).
12
C.F.R. Listing 12.00(A)-(C) (separating “documentation of a medically determinable
impairment[]” from “consideration of the degree of limitation such impairment(s) may im-
pose”).

13
 No. 08-30783

termination of whether an impairment exists.
More importantly, Listing 12 specifically rejects this construction. To en-
sure that the severity determination is not confused with the predicate deter-
mination of impairment, 12.00(A) separates the requirements and requires satis-
faction of both: “We will find that you have a listed impairment if the diagnostic
description in the introductory paragraph and the criteria of both paragraphs
A and B (or A and C, when appropriate) of the listed impairment are satisfied.”13
It is certainly true that “[t]he structure of the listing for mental retarda-
tion (12.05) is different from that of the other mental disorders listings.” C.F.R.
Listing 12.00(A). Listing 12.05 employs four enumerated paragraphs instead of
the typical three to describe the severity criteria, and only one paragraph must
be met instead of a combination of two. Those differences do nothing, however,
to relieve claimants of the initial burden of demonstrating that their impairment
satisfies the introductory paragraph’s diagnostic description.
The statutory and regulatory context informs Listing 12.05 just as much
as it does every other mental disability listing, and Listing 12.05 does nothing
to disclaim the distinction between an impairment’s existence and an impair-
ment’s severity. Like its counterparts, Listing 12.05 says that “[t]he required
level of severity for this disorder is met when the requirements in A, B, C, or D
are satisfied.” C.F.R. Listing 12.05. But again the regulations give a specific in-
struction that reiterates the need to satisfy both the diagnostic description and
the severity criteria: “If your impairment satisfies the diagnostic description in
the introductory paragraph and any one of the four sets of criteria, we will find

13
C.F.R. Listing 12.00(A) (emphasis added); see also § 404.1525(c)(3) (“We will find that
your impairment(s) meets the requirements of a listing when it satisfies all of the criteria of
that listing, including any relevant criteria in the introduction . . . .”).

14
 No. 08-30783

that your impairment meets the listing.” 14 Without a challenge to this regula-
tion’s legitimacy, we must give it effect.
For similar reasons, we find no principled basis for giving effect to only
part of the diagnostic description. That is, nothing in Listing 12.05 suggests that
the temporal language is any more binding than is the substantive portion of
that very same sentence. This is particularly so given that the respective phras-
esSSthe language of the diagnostic description’s substantive requirement and the
15
language of the severity paragraphsSScarry such different meanings.
Accordingly, the ALJ did not err in construing Listing 12.05 to require an
independent showing of “significantly subaverage general intellectual function-
ing with deficits in adaptive functioning initially manifested during the devel-
opmental period; that is to say, the evidence demonstrates or supports onset of
the impairment before age 22.”

2.
Our construction of Listing 12.05 accords with the published holdings of

14
C.F.R. Listing 12.00(A) (emphasis added). As promulgated in 1985, Listing 12 includ-
ed no such provision. Federal Old-Age, Survivors, and Disability Insurance; Listing of Impair-
mentsSSMental Disorders, 50 Fed. Reg. 35038, 35066-70 (Aug. 28, 1985). The agency added
the instructions in its 2000 revisions. Revised Medical Criteria for Evaluating Mental Disor-
ders and Traumatic Brain Injury, 65 Fed. Reg. 50746, 50776 (Aug. 21, 2000).
15
Compare C.F.R. Listing 12.00(C)(1) (defining “adaptive activities” to include “clean-
ing, shopping, cooking, taking public transportation, paying bills, maintaining a residence, car-
ing appropriately for your grooming and hygiene, using telephones and directories, and using
a post office”) with C.F.R. Listing 12.05(A)-(D) (defining severity in terms of I.Q.). Where two
terms within the same sentence carry such distinct denotations, it is not our role to decide
which is of sufficient import to deserve enforcement. Although, under this construction of the
regulation, some claimants may satisfy the specific severity criteria but not the general diag-
nostic description, where, as here, the regulation accords with the statute, our role in constru-
ing the regulation is not to second-guess the agency’s policies but only to construe its words.

15
 No. 08-30783

at least three (and perhaps four) other circuits. Soon after the 2000 revisions,
the Sixth Circuit held that claimants must satisfy the diagnostic description’s
substantive requirements independently of the severity criteria:

A claimant must demonstrate that her impairment satisfies
the diagnostic description for the listed impairment in order to be
found disabled thereunder. As the Commissioner has pointed out,
recent amendments to the regulations further clarify that a claim-
ant will meet the listing for mental retardation only “[i]f [the claim-
ant’s] impairment satisfies the diagnostic description in the intro-
ductory paragraph and any one of the four sets of criteria . . . .”

Foster v. Halter, 279 F.3d 348, 354–55 (6th Cir. 2001) (citations omitted).16
There is substantial evidence to support the ALJ’s conclusion that Randall
does not meet the listing for mental retardation. First, the evidence does not
demonstrate or support onset of the “significantly subaverage general intellec-
tual functioning with deficits in adaptive functioning” before age 22. . . . More-
over, the evidence does not demonstrate or support onset of “deficits in adaptive
functioning” before age 22.
In Wall v. Astrue, 561 F.3d 1048 (10th Cir. 2009), the court adhered to the
same construction, concluding that “[t]o come within the scope of listing 12.05,
a claimant must satisfy that listing’s [diagnostic] definition.” Id. at 1062. “Part

16
Accord West v. Comm’r Soc. Sec. Admin., 240 F. App’x 692, 697-98 (6th Cir. 2007);
Cooper v. Comm’r of Soc. Sec., 217 F. App’x 450, 452 (6th Cir. 2007); Carmack v. Barnhart, 147
F. App’x 557, 560 (6th Cir. 2005); Daniels v. Comm’r of Soc. Sec., 70 F. App’x 868, 872 & n.1
(6th Cir. 2003).

16
 No. 08-30783

of listing 12.05’s [diagnostic] definition is the requirement that a claimant exhib-
it subaverage general intellectual functioning before the age of twenty-two.”
Id.17 The Seventh Circuit’s position was once uncertian,18 but it now utilizes the
construction that we adopt: In Novy v. Astrue, 497 F.3d 708, 709 (7th Cir. 2007),
it required that its Listing 12.05(C) claimant satisfy the description’s definition
of mental retardation “in addition to” the severity criteria. An IQ between 60
and 70 “is insufficient, even with the presence of some impairment, to establish
disability per se on grounds of mental retardation.” Id. Rather, “[t]he key term
in the introductory paragraph of section 12.05 of the regulation, so far as bears
on this case, is ‘deficits in adaptive functioning.’” Id. at 710.
The Eighth Circuit’s opinions are best read as agreeing. In Maresh v.
Barnhart, 438 F.3d 897 (8th Cir. 2006), the only Eighth Circuit decision to con-
front the text of 12.00(A), the Commissioner argued that “the introductory para-
graph of the Listing requires that the deficits in adaptive functioning are ini-
tially manifested before age 22,” and the court “agree[d] with the Commissioner
that the requirements in the introductory paragraph are mandatory.” Id. at 899.
Although Maresh did not use explicit language to embrace the imposition of the
diagnostic paragraph’s substantive requirement, it seems to have done so im-
pliedly when it said that “this court disagrees with the Commissioner that the
Listing’s introductory paragraph requires a formal diagnosis of mental retarda-

17
See also Lax v. Astrue, 489 F.3d 1080, 1085 (10th Cir. 2007) (“In addition to meeting
this [diagnostic] definition, a claimant must also meet one of the four severity prongs for men-
tal retardation as listed in the regulations” (emphasis added).). Accord Barnes v. Barnhart,
116 F. App’x 934, 938-39 (10th Cir. 2004).
18
See Fischer v. Barnhart, 129 F. App’x 297, 301-02 (7th Cir. 2005); Mendez v. Barn-
hart, 439 F.3d 360, 361-62 (7th Cir. 2006); Griffin v. Barnhart, 198 F. App’x 561, 564 (7th Cir.
2006); Adkins v. Astrue, 226 F. App’x 600, 604-05 (7th Cir. 2007).

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tion.” Id. Had the Maresh court intended to impose only the temporal aspect of
the diagnostic description, the distinction between diagnosed and undiagnosed
cases of mental retardation would have been unnecessary.19
Unpublished opinions from three other circuits support our construction.
Even before the 2000 amendments, the Eleventh Circuit had held that the diag-
nostic description imposed more than just temporal requirements: “To be consid-
ered for disability benefits under section 12.05, a claimant must at least (1) have
significantly subaverage general intellectual functioning; (2) have deficits in
adaptive behavior; and (3) have manifested deficits in adaptive behavior before
age 22.” Crayton v. Callahan, 120 F.3d 1217, 1119 (11th Cir. 1997). Although
Crayton did not explicitly distinguish these requirements from the severity cri-
teria, later unpublished decisions did.20
In Morales v. Comm’r of Soc. Sec., 2 F. App’x 34 (1st Cir. 2001), the court
rejected a claim made under 12.05(C) by citing the diagnostic description, not the
severity criteria.21 In Brooks v. Barnhart, 167 F. App’x 598 (9th Cir. 2006), the
court relied on the “significantly subaverage general intellectual functioning”

19
Cf. Johnson v. Barnhart, 390 F.3d 1067, 1071 (8th Cir. 2004) (rejecting a Listing
12.05(C) claim where the claimant “did not display the significant limitations in adaptive func-
tioning that 12.05 requires.”).
20
For example, Pettus v. Astrue, 226 F. App’x 946 (11th Cir. 2007), cited the standard
from Crayton, then added, “In addition, for presumptive disability under 12.05C, the claimant
must have (1) a valid IQ score of 60 through 70 inclusive, and (2) an additional mental or phys-
ical impairment significantly affecting the claimant’s ability to work.” Id. at 948. Accord
Humphries v. Barnhart, 183 F. App’x 887, 889 (11th Cir. 2006); Burt v. Barnhart, 151 F. App’x
817, 820 n.2 (11th Cir. 2005).
21
Morales, 2 F. App’x at 37 (“The problem with claimant’s argument is that there sim-
ply is no evidence in the record that claimant had any ‘deficits in adaptive behavior initially
manifested . . . before age 22.’”).

18
 No. 08-30783

requirement to deny a Listing 12.05(C) claim.22
Since the 2000 revision to Listing 12, some circuits have continued to re-
quire only the severity criteria and temporal requirement (but not the diagnostic
description’s separate substantive requirement) without discussion of the textual
change. See Grant v. Astrue, 255 F. App’x 374, 374 (11th Cir. 2007)23 ; Bailey v.
Apfel, 230 F.3d 1063, 1065-66 (8th Cir. 2000).24 Dictum from another circuit does
so as well.25

22
Brooks, 167 F. App’x at 599-600 (“To establish that she meets either listing, the
claimant must show that she has: ‘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.’ In addition,
she must establish that she has a valid IQ score within the ranges set forth in paragraph B
or C. Paragraph C further requires an additional severe mental or physical impairment that
imposes ‘an additional and significant work-related limitation of function.’” (citations omit-
ted)).
23
But see Garrett v. Astrue, 244 F. App’x 937, 938 (11th Cir. 2007) (rejecting a Listing
12.05(C) claim where “the ALJ found that [the claimant] did not have the required deficits in
adaptive functioning”).
24
Other recitations of that interpretation came before the 2000 revisions, and often as
dicta in cases in which the decision rested on satisfaction (or not) of another requirement. See,
e.g., Flowers v. U.S. Dep’t of Health & Human Servs., 904 F.2d 211, 213-14 (4th Cir. 1990)
(awarding benefits after recognizing that “the narrow question before us is whether there is
substantial evidence to support the decision that [the claimant] did not meet the second part
of [Listing 12.05(C)].”).
25
See Markle v. Barnhart, 324 F.3d 182, 187 (3d Cir. 2003) (“To meet the requirements
of § 12.05C a claimant must i) have a valid verbal, performance or full scale IQ of 60 through
70, ii) have a physical or other mental impairment imposing additional and significant work-
related limitations of function, and iii) show that the mental retardation was initially mani-
fested during the developmental period (before age 22).”). In Markle, the ALJ’s denial of the
SSI claim rested upon the claimant’s failure to satisfy the severity criteria’s IQ threshold. Id.
at 187-89. As a result, the court remanded to the ALJ and avoided the question whether the
claimant met “the third element of a § 12.05(C) listed impairment, namely, whether his retar-
dation commenced before age 22.” Id. at 189. In Vivaritas v. Comm’r of Soc. Sec., 264 F. App’x
155 (3d Cir. 2008), the court quoted Markle’s recitation of the Listing 12.05(C) requirements
(continued...)

19
 No. 08-30783

No matter what Listing 12.05 required before 2000, the clarifying revisions
best evince the relationship between the diagnostic description’s components and
the severity criteria. Accordingly, we join those circuits that pay close attention
to that change.

B.
Having determined that the ALJ applied the proper legal standard, we
address the question whether substantial evidence supports her factual findings.
“Substantial evidence is more than a scintilla, less than a preponderance, and
is such that a reasonable mind might accept it as adequate to support a conclu-
sion.” Randall v. Sullivan, 956 F.2d 105, 109 (5th Cir. 1992) (citing Richardson
v. Perales, 402 U.S. 389, 401 (1971)). “We may not reweigh the evidence or sub-
stitute our judgment for that of the Commissioner.” Audler v. Astrue, 501 F.3d
446, 447 (5th Cir. 2007).
The ALJ, by relying on various kinds of evidence, including the Buxton
and Klusman reports, in particular, concluded that Randall failed to exhibit “sig-
nificantly subaverage general intellectual functioning with deficits in adaptive
functioning.” After reviewing the record that was before the ALJ, we agree that
her ultimate finding as to Randall’s adaptive functioning was backed by substan-
tial evidence. In particular, the ALJ was entitled to rely on the clinical psycholo-

25
(...continued)
and said that “[a] claimant seeking benefits pursuant to listed impairment 12.05(C) has the
burden of providing evidence showing that the claimed impairment commenced during the de-
velopmental period” but did not make plain whether the proof of the “claimed impairment”
would refer to the diagnostic description or the severity criteria. See id. at 160-61 (“Here, as
was true of the claimant in Markle, [the claimant] produced evidence suggesting that her
claimed mental impairment had an onset before she reached the age of 22.”).

20
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gists’ specific analysis of Randall’s physical and mental capabilities, including
the determination that she suffered from only “mild/borderline” adaptive retar-
dation and that her impairments “would not preclude gainful competitive em-
ployment.” See, e.g., Domingue v. Barnhart, 388 F.3d 462, 463 (5th Cir. 2004).
Randall does not contend otherwise. Instead, her only argument is that
we cannot affirm the ALJ’s decision on this ground (Randall’s failure to satisfy
the diagnostic description’s adaptive functioning element), because the district
court rejected this argument and affirmed on another ground: Randall’s failure
to establish 12.05(C)’s “additional and significant work-related limitation of func-
tion.” It is well established, however, that even though the case comes to us on
appeal from a final judgment of the district court, we focus our review not on the
district court’s decisional process but on the ALJ’s. See, e.g., Ward v. Celebrezze,
311 F.2d 115, 116 (5th Cir. 1962). The district court’s rejection of the diagnostic-
definition argument does not prevent the Commissioner from reasserting that
argument here and prevailing thereby.26

III.
In summary, Randall has failed to demonstrate that the ALJ applied an
erroneous legal standard or to show that the ALJ’s conclusions are supported by
less than substantial evidence. As a result, there is no reversible error in the
ALJ’s denial of Randall’s claim. The judgment is AFFIRMED.

26
See also Flournoy v. Century Fin. Co. (In re Henderson), 577 F.2d 997, 1002 n.5 (5th
Cir. 1978) (“An appellate court may consider alternative bases offered by appellees for uphold-
ing the judgment below, even though they were not relied on by the district court and appel-
lees have not filed a formal cross appeal.”).

21