ALJ Grants 12.05C Claim

January 21, 2010

Author: Catherine M. Callery (Kate)| Louise M. Tarantino

How frustrating is it to be almost certain that your client has an IQ within the mentally retarded range, but there are no IQ scores available to prove your suspicions? Laura Weekly of the Legal Services of Central New York in Syracuse got those IQ scores by convincing the ALJ to send her client to a consultative examiner (CE) for intelligence testing, which revealed a Full Scale IQ score of 61.

Laura’s client was a 59 year old woman with diabetes, osteoarthritis, right thumb tendonitis, and bilateral carpal tunnel. She had filed her current application in March 2007.  She had had past work experience as a housekeeper, but was only insured for Title benefits through December 2001.  She had alleged an onset date of January 2001.

Although Laura was unable to obtain school records or statements from family members verifying that the claimant was always intellectually limited, the ALJ nonetheless found that the claimant met listing 12.05C.  The ALJ held that:

[w]hile the record does not contain results from intelligence tests administered to the claimant prior to the age of 22, her history of very low income from simple, unskilled work along with her history of special education in high school, her inability to read and her inability to take the GED despite five years of preparation, indicates that her mental retardation manifested during the developmental period.  Moreover, the record does not show an intervening medical cause for the claimant's cognitive limitations and she exhibits sufficient deficits in adaptive functioning to support the diagnosis of mental retardation.

The ALJ credited the claimant’s testimony as evidence that her past jobs involved only simple tasks “not inconsistent with her cognitive limitations.”  He also held that:

Although the record may indicate the claimant has not been aggressively pursuing treatment for any of her medical conditions, this does not undermine her allegations because the record shows that she has been uninsured at various times. Moreover, due to her mild mental retardation she may not recognize the importance of proper follow up treatment.

The ALJ also reopened the claimant’s prior 2003, 2004 and 2005 initial denials, citing the IQ test as new evidence establishing mild mental retardation, adding “the claimant lacked the mental capacity to understand the procedures for requesting review due to her mental retardation and inability to read and write.”  He found her disabled back to March 31, 1998, thus ensuring her entitlement to Title II as well as SSI benefits.

Sounds like the decision of our dreams. Congratulations to Laura for making it reality!