AR 93-1(4) (Rescinded 8/21/2000, effective 9/20/2000)

EFFECTIVE DATE: 4/29/93

AR 93-1(4): Branham v. Heckler, 775 F.2d 1271 (4th Cir. 1985); Flowers v. U.S. Department of Health and Human Services, 904 F.2d 211 (4th Cir. 1990) -- What constitutes an additional and significant work-related limitation of function -- Titles II and XVI of the Social Security Act.

Issue

Whether a claimant for disability insurance benefits or for supplemental security income benefits based on disability who has an IQ score in the range covered by Listing 12.05C and who cannot perform his or her past relevant work because of a physical or other mental impairment has per se established the additional and significant work-related limitation of function requirement of Regulations 20 CFR Part 404, Subpart P, Appendix 1, section 12.05C.

Statute/Regulation/Ruling Citation

Sections 223(d)(2)(A) and 1614(a)(3)(B) of the Social Security Act (42 U.S.C. 423(d)(2)(A) and 1382c(a)(3)(B); 20 CFR Part 404, Subpart P, Appendix 1, section 12.05C.

Circuit

Fourth (Maryland, North Carolina, South Carolina, Virginia, West Virginia);

Branham v. Heckler, 775 F.2d 1271 (4th Cir. 1985); Flowers v. U.S. Department of Health and Human Services, 904 F.2d 211 (4th Cir. 1990).

Applicability of Ruling

This ruling applies to determinations or decisions at all administrative levels (i.e., initial, reconsideration, administrative law judge (ALJ) hearing and Appeals Council).

Description of Case

Branham

The plaintiff, Larry R. Branham, filed his claim for disability benefits following a work-related injury allegedly sustained in October 1979, for which he received Workers' Compensation benefits. Mr. Branham claimed great back, hip, and neck pain associated with the injury; and he also complained of chest pain, disorientation, and bronchitis. The plaintiff had also been diagnosed as having a generalized anxiety disorder. He was taking medication for all of his ailments.

Mr. Branham's claim for disability benefits was denied initially and on reconsideration. After a hearing, the ALJ found that although the plaintiff could not return to his past relevant work, he had the ability to engage in light work and thus was not disabled. The ALJ therefore denied his request for benefits and the Appeals Council upheld the denial.

Upon review by the district court, the plaintiff submitted and the court accepted additional evidence of his emotional problems and vocational abilities, including the results of a test indicating an IQ of 63. The court remanded the case for further proceedings.

On remand, a second ALJ heard the plaintiff's claim and granted Mr. Branham benefits under section 12.05C of Appendix 1 of 20 CFR Part 404, subpart P. The ALJ found that Mr. Branham's IQ fit within this section, but referring to the finding of the first ALJ, held that the plaintiff's physical problems held no significant work-related limitation of function since Mr. Branham had the ability to do light work. The second ALJ did find, however, that Mr. Branham's psychotic disorder, agoraphobia, significantly limited his ability to work and was a mental impairment within section 12.05C. The ALJ consequently decided that the plaintiff was disabled as of January 15, 1983, the date the ALJ found the plaintiff's agoraphobia began. The Appeals Council adopted the decision of the second ALJ, awarding benefits on the basis of the plaintiff's IQ and mental impairment.

On review, the district court modified the Secretary's decision, changing the onset date of the plaintiff's disability from January 15, 1983 to December 17, 1982, the date the claimant took his first IQ test. The court found that Mr. Branham satisfied the physical impairment requirement of section 12.05C on account of the 1979 back injury which led to the termination of his employment and said that the claimant's inability to perform his past relevant work as a laborer constituted a significant work-related limitation of function. Mr. Branham appealed the onset date of disability set by the district court, alleging that he met the IQ requirement of section 12.05C prior to the time that he took his first IQ test.

Holding

The Court of Appeals held that the plaintiff's inability to do his past relevant work established the additional and significant work-related limitation of function required by the regulation and determined the onset of disability to be October 1979, the date of the injury to Mr. Branham's back.

The court stated that the additional and significant work- related limitation of function specified in section 12.05C need not be disabling in and of itself, reasoning that if the claimant's physical impairment were required to be independently disabling, section 12.05C would be rendered meaningless. The court affirmed the finding of the lower court that the plaintiff's back impairment was a significant work-related limitation of function and remanded the case for an award of benefits. The court cited for support an earlier decision, Rainey v. Heckler, 770 F.2d 408 (4th Cir. 1985).

Flowers

The plaintiff, Stroun A. Flowers, Jr., was born August 4, 1944. He completed the seventh grade. From 1970 to 1971, he worked as a flag man for a construction company and for the next seven years was a timberjack driver. He had not worked since July 15, 1978. Mr. Flowers filed a claim for supplemental security income payments. He alleged that he was disabled due to seizures and a hip problem and that he met the requirements of section 12.05C. The plaintiff had a verbal IQ of 72, a performance IQ of 66, and a full scale IQ of 68. Following the denial of his claim at the initial and reconsideration levels, the plaintiff requested and received a hearing before an ALJ. The ALJ agreed that the plaintiff met the first part of Listing 12.05C, i.e., he had an IQ between 60 and 69;[1] that the plaintiff's seizure disorder did not satisfy the "significant work-related limitation of function" element. The ALJ also found that the plaintiff's low IQ and seizure disorder did not prevent him from performing his former work and, therefore, denied the plaintiff's request for supplemental security income. The denial was upheld by the district court.

Holding

The Court of Appeals held that the ALJ's finding that the plaintiff's seizure disorder did not prevent him from performing his former work was not supported by substantial evidence. In its holding, the Court of Appeals stated that it was following the Fourth Circuit rule announced in Branham that if a claimant cannot return to his past relevant work, he has established a work-related limitation of function that meets the requirement of section 12.05C. Accordingly, the court vacated the decision of the district court and remanded the case for an award of benefits.

Statement as to How Branham and Flowers Differ From Social Security Policy

At issue in Branham and in Flowers is the meaning of the term "additional and significant work-related limitation of function," as contained in section 12.05C. What constitutes a significant work-related limitation of function is not defined in the Secretary's regulations. Agency policy is that the adjudicator in each case decides whether an impairment constitutes a significant work-related limitation of function based on all evidence, including the requirements of a claimant's past work. The fact that a mentally retarded claimant has an IQ in the range specified in section 12.05C of the Listing of Impairments and is also unable to perform his or her past relevant work may or may not mean that the claimant is disabled. It depends upon the facts of the particular case. In the Fourth Circuit, the rule has evolved that an inability to do one's past relevant work due to the additional impairment meets the "additional and significant work-related limitation of function" requirement of section 12.05C of the regulations.

Explanation of How SSA Will Apply Branham and Flowers Within The Fourth Circuit

This ruling applies only where the claimant resides in Maryland, North Carolina, South Carolina, Virginia or West Virginia at the time of the determination or decision at any level of administrative review, i.e., initial, reconsideration, ALJ hearing or Appeals Council review.

A claimant who is mentally retarded and has a valid verbal, performance, or full scale IQ in the range specified by section 12.05C of the Listing of Impairments and also has a physical or other mental impairment which prevents him or her from performing his or her past relevant work will be considered to have established the requirements of section 12.05C of the Listing of Impairments.


[1] At the time the ALJ issued his decision, Listing 12.05C was applicable to claimants with IQ scores of 60 to 69 inclusive.

[1] At the time the ALJ issued his decision, Listing 12.05C was applicable to claimants with IQ scores of 60 to 69 inclusive.


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