L.D.R. v. Nancy Berryhill

In the
United States Court of Appeals
For the Seventh Circuit
____________________
No. 18-1763
L.D.R., a minor by his mother and
guardian, ROSHONDA R. WAGNER,
Plaintiff-Appellant,
v.
NANCY A. BERRYHILL,
Acting Commissioner of Social Security,
Defendant-Appellee.
____________________
Appeal from the United States District Court for the
Northern District of Indiana, South Bend Division.
No. 3:16-CV-829 JD — Jon E. DeGuilio, Judge.
____________________
ARGUED MARCH 26, 2019 — DECIDED APRIL 15, 2019
____________________
Before BAUER, ROVNER, and BRENNAN, Circuit Judges.
BRENNAN, Circuit Judge. A mother contests the decision
that her minor son (whom we refer to as L.D.R.) did not qual-
ify for social security disability benefits until second grade.
She also seeks retroactive payments for the first year of
L.D.R.’s life, before she applied for assistance, challenging the
2 No. 18-1763
constitutionality of social security laws that bar benefits be-
fore application.
We conclude that the administrative law judge’s opinion
was properly reasoned and well supported by substantial ev-
idence. We also reject the mother’s constitutional challenge to
the social security laws and agree with the district court’s re-
view of the ALJ’s opinion. So we affirm.
I.
The Social Security Administration determined that L.D.R.
was disabled as of August 1, 2015, just before he enrolled in
second grade. Our opinion focuses on events leading up to
that date.
A.
L.D.R. has had several health problems since he was born
in March 2008. While an exhaustive tour through L.D.R.’s
medical history is not necessary to resolve this case, a sketch
of his medical history shows a child with various health con-
ditions, at times improving, at others deteriorating. He has
consistently received medical care in the fields of pediatrics,
otolaryngology (ear, nose, and throat, or “ENT”), pulmonol-
ogy, psychology, and speech pathology. We will discuss
L.D.R.’s care in each of these fields.
When L.D.R. was about 18 months old, his family physi-
cian saw signs of asthma and diagnosed him with an inflam-
matory disease of the middle ear for which ear tubes were in-
serted. Around the same time, a speech pathologist concluded
his language skills may be delayed. A clinical psychologist
also diagnosed delays in L.D.R.’s social-emotional and adap-
tive behavioral development.
No. 18-1763 3
By age three, L.D.R.’s pediatric ENT confirmed that
L.D.R.’s receptive and expressive language skills were
delayed. Ear tubes were inserted and that doctor reported im-
provements in the boy’s speech and hearing. A few months
later, L.D.R.’s pediatrician concluded that L.D.R. had met sev-
eral developmental milestones, his asthma was doing well,
and if any behavioral problems persisted he should see a psy-
chologist. At nearly age four, a clinical psychologist con-
cluded L.D.R. had met developmental milestones and that his
full-scale IQ score was in the “low-average” range.
By age four, L.D.R.’s mother reported him being hyperac-
tive and defiant. While not in therapy, he took medication for
his behavioral problems. L.D.R.’s mother also alleges her son
began to exhibit sleep disturbances, which resulted in day-
time drowsiness. A sleep study showed mildly reduced sleep
efficiency and moderate sleep apnea. L.D.R.’s tonsils and
adenoids were removed, and his snoring and sleep disor-
dered breathing improved. He remained on respiratory med-
ications, but by age five his pulmonologist found that they
were exacerbating his behavior issues.
When L.D.R. was almost five, his pediatrician concluded
L.D.R.’s health had made a “dramatic turn” downward. He
suffered from moderate asthma, sleep apnea, hearing loss
from chronic ear infections, and attention deficit hyperactive
disorder. Nine months later, the same pediatrician concluded
L.D.R. was not able to function as a normal five-year old. At
age five and one-half, in a mental status exam, L.D.R. passed
some tests, but not others. Even so, L.D.R.’s kindergarten
teacher observed his functional limitations to be neither seri-
ous nor very serious.
4 No. 18-1763
About age six, the speech pathologist concluded L.D.R.
had moderative receptive delay and low average expressive
language skills, but a good potential to reach age appropriate
language skills. L.D.R.’s pediatrician also reduced his behav-
ioral medication. By March 2015, six months before L.D.R.
was deemed disabled, another clinical psychologist diag-
nosed him with significant attention deficits and impulsive
behaviors. While L.D.R.’s communication abilities and intelli-
gence were judged “good” and he had begun kindergarten in
general education classes, he had difficulty getting along with
his peers and was later slotted to attend special education
classes. This same psychologist concluded L.D.R. was “quite
able to perform age-appropriate daily activities and behave in
an age appropriate manner when taking meds.”
By age seven, L.D.R.’s pediatrician found that his middle
ear inflammation had improved, his physical exam was nor-
mal, medications had managed his mild persistent asthma,
and his behavioral problems were stable.
B.
Specific administrative regulations control the disability
decision. A child is disabled under social security income
rules if the child has a “medically determinable physical or
mental impairment, which results in marked and severe func-
tional limitations” that “has lasted or can be expected to last
for a continuous period of not less than 12 months.” 42 U.S.C.
§ 1382c(a)(3)(C)(i).
A three-step sequential evaluation governs whether a mi-
nor is disabled according to social security regulations. Step
one asks if the minor has worked (per the regulation “sub-
stantial gainful activity”), which L.D.R. has not. 20 C.F.R.
No. 18-1763 5
§ 416.924(b). In step two, the ALJ determines whether the mi-
nor has a medically determinable impairment (or combina-
tion of impairments) that is “severe.” 20 C.F.R. § 416.924(c).
For a minor, an impairment is not severe if it is a slight abnor-
mality (or combination of slight abnormalities) that causes no
more than minimal functional limitations. 20 C.F.R.
§ 416.924(c). Absent a severe impairment, the minor is not dis-
abled.
In step three, if the impairment is severe, the ALJ deter-
mines whether the minor has an impairment (or combination
of impairments) that meets or medically equals the severity of
a “listing.” The listing in the social security regulations spec-
ify the criteria for those impairments considered presump-
tively disabling. 20 C.F.R. § 404.1525(a). A claimant may be
eligible for benefits if an impairment meets or equals an im-
pairment found in the listing of impairments. 20 C.F.R.
§ 404.1520(d); 20 C.F.R. Pt. 404 P., App. 1. The ALJ must con-
sider the combined effect of all medically determinable im-
pairments, even those not severe. 20 C.F.R. §§ 416.923,
416.924a(b)(4), and 416.926a(a) and (c). If the minor has an im-
pairment or combination of impairments that meets or medi-
cally equals the severity of the listings, and it has lasted at
least 12 months, the minor is presumed to be disabled. If not,
the minor is not disabled. 20 C.F.R. § 416.924(d).
In determining whether an impairment (or combination of
impairments) of a child functionally equals a listing, the ALJ
considers six “domains“ of functioning: (1) acquiring and us-
ing information; (2) attending to and completing tasks; (3) in-
teracting with and relating to other people; (4) moving about
and manipulating objects; (5) caring for oneself; and (6) health
and physical well-being. 20 C.F.R. § 416.926a(b)(1); see Sanchez
6 No. 18-1763
v. Barnhart, 467 F.3d 1081, 1082 (quoting Keys v. Barnhart, 347
F.3d 990, 991 (7th Cir. 2003)).
C.
L.D.R.’s mother has consistently applied for social security
disability benefits throughout her son’s life. She first applied
when L.D.R. was age one. Her application, then and now, re-
quests back payments for the first year of L.D.R.’s life, even
though supplemental security income regulations preclude
benefits pre-dating the application.
In 2012, an administrative law judge denied the benefits
application for L.D.R. on the basis that his various problems
did not functionally equal a listing under the regulations.
L.D.R.’s mother appealed that decision to the district court,
which found that the ALJ had not described in specific
enough detail the weighing of certain medical evidence, so
the court vacated and remanded the case. In the meantime,
L.D.R.’s mother had filed another benefits application, which
was consolidated on remand and a new ALJ considered both
applications.
In a thorough and extensive 28-page single-spaced deci-
sion, the ALJ’s findings of fact and conclusions of law
included that L.D.R. has severe conditions resulting in more
than mild limitation in age-appropriate functioning, among
them asthma, trouble understanding language, and attention
deficit hyperactivity disorder manifesting in a behavior disor-
der. In the key portion of her opinion (App. 31–45), the ALJ
reviewed L.D.R.’s conditions under the six functional equiva-
lence domains listed above. She set out the social security
rules for different time frames of a child’s life (“older infant
or toddler (i.e. a child age 1 to … age 3)”; “a preschooler (i.e.
No. 18-1763 7
a child age 3 to … age 6)”; “a school-age child (i.e. a child age
6 to … age 12),”and made factual findings, generally and for
different time periods of L.D.R.’s life.
As to the fourth domain (moving about and manipulating
objects), the ALJ found that L.D.R. had no limitation before
August 2015. As to the other five domains, she found that
L.D.R. had various early limitations, but that their severity
was “less than marked.” She determined that L.D.R.’s condi-
tions did not functionally equal a listing and that L.D.R. did
not qualify as disabled. But, the ALJ found that since August
2015 L.D.R.’s worsening behavioral issues, and his limitations
in the third (interacting and relating with others) and fifth
(caring for one’s self) domains had become “marked.” The
ALJ ultimately concluded that L.D.R. became disabled in Au-
gust 2015 before he started second grade.
The district court affirmed the ALJ’s decision. The court
found that substantial evidence supported all the ALJ’s find-
ings and that L.D.R. had not presented any argument war-
ranting remand. L.D.R. also challenged the constitutionality
of statutes and regulations barring retroactive payments for
time before a disability application, which the district court
likewise rejected. L.D.R. appeals on both grounds.
II.
An appeal from denial of social security benefits has layers
of review. We review de novo the district court’s considera-
tion of the ALJ’s decision. Skinner v. Astrue, 478 F.3d 836, 841
(7th Cir. 2007). We will uphold an ALJ’s final decision if the
correct legal standards were applied and supported with sub-
stantial evidence. 42 U.S.C. § 405(g); Jelinek v. Astrue, 662 F.3d
805, 811 (7th Cir. 2011). “Substantial evidence is ‘such relevant
8 No. 18-1763
evidence as a reasonable mind might accept as adequate to
support a conclusion.’ Our review is deferential; we will not
reweigh the evidence or substitute our judgment for that of
the ALJ.” Summers v. Berryhill, 864 F.3d 523, 526 (7th Cir. 2017)
(quoting Castile v. Astrue, 617 F.3d 923, 926 (7th Cir. 2010)). We
also do not resolve conflicts or decide questions of credibility.
Lopez ex rel. Lopez v. Barnhart, 336 F.3d 535, 539 (7th Cir. 2003).
Where substantial evidence supports the ALJ’s disability de-
termination, we must affirm the decision even if “reasonable
minds could differ concerning whether [the claimant] is disa-
bled.” Elder v. Astrue, 529 F.3d 408, 413 (7th Cir. 2008).
L.D.R.’s mother argues first that the ALJ failed to properly
analyze and make findings for all six functional equivalence
domains specific to each age gradation L.D.R. fell within. An
ALJ is to evaluate a child’s functioning as compared to other
children their age. 20 C.F.R. §§ 416.924b, 416.926a(b). But as
the district court noted, the regulations do not require the ALJ
to make separate findings within different age groups, so long
as relevant evidence from each age group is considered. The
regulations identify the age categories as examples of appro-
priate functioning at different ages. They do not require, or
even suggest, that an ALJ must articulate findings separately
for each category. 20 C.F.R. § 416.926a(g)-(k). L.D.R.’s mother
has not cited any authority (nor did we find any) in which this
court (or any other) requires each of the six domains to be as-
sessed separately for each age gradation. Instead, she argues
that such particular findings are “necessary for meaningful
district court review.”
The ALJ compared L.D.R.’s functions to typical children of
his age without impairments, see 20 CFR § 416.926a(f)(1), by
describing the typical functioning of children in each of the
No. 18-1763 9
three age categories applicable to L.D.R. for every domain.
(App. 31-44) The ALJ’s decision considered in particular de-
tail L.D.R.’s various conditions, their history, the treatments
he received, and L.D.R.’s reactions to these treatments. The
ALJ decision cites evidence during the entire time span from
the first application for benefits for L.D.R. in 2009 to his being
found disabled effective August 1, 2015. Even if the ALJ’s de-
cision did not delineate age gradations under each domain,
evidence was presented, and conflicting opinions resolved, in
each of the relevant age ranges. This was sufficient to meet
regulatory requirements.
L.D.R.’s mother also disputes the ALJ’s consideration of
the medical evidence, including how L.D.R. was treated for
middle ear inflammation, asthma, and sleep apnea. This goes
to the sixth domain of “health and physical well-being.”
L.D.R.’s mother contends the ALJ “minimized” L.D.R.’s mul-
tiple impairments and their impact on his functioning. But the
comprehensive and detailed discussion in the ALJ’s decision
of each of these impairments does not square with this asser-
tion.
The ALJ’s assessment of L.D.R.’s ear infections (including
behavior problems secondary to them) noted how L.D.R.’s
mother in 2011 had reported to an ENT physician that her
son’s speech improved after he received placement of ear
tubes, how his audiometric tests were normal, and that a later
period of inflammation had resolved. The same is true for the
ALJ’s evaluation of the evidence of L.D.R.’s asthma. The ALJ
considered all pulmonary treatment notes and records, in-
cluding school records which did not support the alleged
number of asthma-related symptoms. And the ALJ provided
the same thorough analysis of L.D.R.’s sleep apnea. No
10 No. 18-1763
evidence was presented that L.D.R.’s sleep apnea was disa-
bling; to the contrary, the ALJ discussed evidence of L.D.R.’s
sleep improvements. The ALJ’s conclusion is supported by
the results of the sleep study done on L.D.R., his improvement
after the surgery to remove the tonsils and adenoids, and the
records showing periods of time without sleep issues.
The August 1, 2015 disability date is also well supported
in the ALJ’s decision. In second grade, L.D.R.’s conditions
worsened markedly. School reports, counseling records, and
a report from L.D.R.’s second grade teacher all show that his
condition had deteriorated. Records confirm L.D.R. visited
the nurse approximately 25 times for illness and injuries (in-
cluding self-injury), and that the school social worker re-
quested an Individualized Education Plan 1 to address
L.D.R.’s behavioral and emotional problems. Also at that
time, L.D.R.’s second-grade teacher reported he had serious
to very serious problems in four functional areas.
Whether as to particular illnesses, or as to the disability
date, this appeal effectively asks us to reweigh the evidence
the ALJ considered and to come to a different decision based
on the facts. That is not our role. “Our review is deferential;
we will not reweigh the evidence or substitute our judgment
for that of the ALJ.” Summers v. Berryhill, 864 F.3d 523, 526 (7th
Cir. 2017).
III.
L.D.R.’s mother also challenges the constitutionality of the
social security statute and regulations as applied, to the extent
1
20 U.S.C. § 1414(d)(1)(A) and (d)(6) (statutory authority for IEP); 34
C.F.R. § 300.320 (definition of IEP).
No. 18-1763 11
they prohibit the retroactive award of benefits before L.D.R.’s
benefits application was filed. 2 She argues this violates the
equal protection component of the Due Process Clause of the
Fifth Amendment because it “den[ies] benefits to otherwise
eligible, i.e. poor and disabled, children for months from the
onset of disability to the application filing date.” 3 She claims
this punishes young, poor children for the tardiness of their
parents, or alternatively forces parents with potentially disa-
bled children to apply for benefits before they are even certain
such disability exists. The district court rejected this argu-
ment, and we review de novo a constitutional challenge like
this to federal statutes. See, e.g., United States v. Leach, 639 F.3d
769, 772 (7th Cir. 2011).
Rational basis scrutiny applies to equal protection dis-
crimination claims on the basis of age and wealth. See San
Antonio Ind. Sch. District v. Rodriguez, 411 U.S. 1, 54–55 (1973)
(applying rational basis scrutiny to the question of wealth dis-
crimination against children). Here, the district court identi-
fied several rational bases for not providing disability benefits
retroactively before application. For example, social security
benefits are means-tested monthly, 42 U.S.C. § 1382(c), so ret-
rospective determinations before an application is filed would
present proof difficulties and create administrative burdens.
Another rational basis is that the current rule incentivizes
prompt applications, which serves the law’s purpose of
2 The earliest a claimant can receive social security benefits is the
month after the month of application. 42 U.S.C. § 1382(c)(7); 20 C.F.R.
§ 416.335.
3The equal protection analysis in the Fifth Amendment as it applies
to the federal government is the same as that under the Fourteenth
Amendment. See Bolling v. Sharpe, 347 U.S. 497, 500 (1954).
12 No. 18-1763
helping people meet their basic food, clothing, and shelter
needs. Because the challenged statute and regulation prohib-
iting retroactive benefits pass the rational basis test, they do
not violate the constitutional guarantee of equal protection.
IV.
As L.D.R.’s counsel noted at oral argument before this
court, if the ALJ’s decision can be meaningfully reviewed,
then L.D.R. does not prevail. The ALJ’s comprehensive deci-
sion, as well as the district court’s review, provided more than
enough evidence and analysis for our court to review. After
that review, we find no error, so we AFFIRM.