State Hearing Decision - Hearing Decisions and Administrative ...

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STATE HEARING DECISION CONTINUATION distress. Characteristic features are typical of the individual's long-term functioning and are not limited to discrete episodes of illness. The required level of severity for these disorders is met when the requirements in both A and B are satisfied. A. Deeply ingrained, maladaptive patterns of behavior associated with one of the following: AND 1. Seclusiveness or autistic thinking; or 2. Pathologically inappropriate suspiciousness or hostility; or 3. Oddities of thought, perception, speech and behavior; or 4. Persistent disturbances of mood or affect; or 5. Pathological dependence, passivity, or aggressivity; or 6. Intense and unstable interpersonal relationships and impulsive and damaging behavior; B. Resulting in at least two of the following: 1. Marked restriction of activities of daily living; or 2. Marked difficulties in maintaining social functioning; or 3. Marked difficulties in maintaining concentration, persistence, or pace; or 4. Repeated episodes of decompensation, each of extended duration. “Episodes of decompensation” are exacerbations or temporary increases in symptoms or signs accompanied by a loss of adaptive functioning, as manifested by difficulties in performing activities of daily living, maintaining social relationships, or maintaining concentration, persistence, or pace. Episodes of decompensation may be demonstrated by an exacerbation in symptoms or signs that would ordinarily require increased treatment or a less stressful situation (or a combination of the two). Episodes of decompensation may be inferred from medical records showing significant alteration in medication; or documentation of the need for a more structured psychological support system (e.g., hospitalizations, placement in a halfway house, or a highly structured and directing household); or other relevant information in the record about the existence, severity, and duration of the episode. Although the Agency only determined whether the Appellant met the criteria for listing 12.08, the evidence shows he does not meet the criteria for 12.04 either. The psychologist who Page 4 of 8
STATE HEARING DECISION CONTINUATION completed the Mental Functional Capacity Assessment found no marked restrictions, to meet part B of both listings. The DDA appeal summary stated the medical evidence found no inability to function outside the home or repeated episodes of decompensation to meet Part C. The Appellant did not report an inability to function outside the home either and testified that he could do some janitorial work between the hours of 3pm and 8pm. He explained that he hears voices in his head which led him to use drugs and alcohol. The Appellant does not meet the social security listing for either 12.04 or 12.08. The next step in the evaluation is the Appellant’s residual functional capacity assessment. The residual functional capacity is the most an individual can still do despite his or her limitations. If DDA finds that he or she cannot do his or her past relevant work (or he or she does not have any past relevant work), DDA will use the same assessment of the individual’s residual functional capacity at step five of the sequential evaluation process to decide if he or she can make an adjustment to any other work that exists in the national economy. 20 C.F.R. § 416.945. At this step, DDA will not use the assessment of the residual functional capacity alone to decide if the individual is disabled. DDA will consider the residual functional capacity assessment together with the information about the individual’s vocational background to make the disability determination or decision. 20 C.F.R. § 416.945. When DDA assess an individual’s physical abilities, it must first assess the nature and extent of his or her physical limitations and then determine his or her residual functional capacity for work activity on a regular and continuing basis. A limited ability to perform certain physical demands of work activity, such as sitting, standing, walking, lifting, carrying, pushing, pulling, or other physical functions (including manipulative or postural functions, such as reaching, handling, stooping or crouching), may reduce his or her ability to do past work and other work. 20 C.F.R. § 416.945. DDA found that his conditions only cause moderate limitations, and would still allow him to do routine tasks with minimal interpersonal contact. DDA found he could do some work in the national economy, such as janitorial work that does light cleaning and empties trash after hours when everyone is gone. The Appellant agreed that he could do this kind of job from 3pm to 8pm. He explained he would not be able to do early morning work because he is taking medicines to help him sleep and he is too groggy in the morning, and then he takes the medicines again at 8pm. He also indicated he is interested in taking computer classes because he does not know how to operate one. Based on the Appellant’s testimony, I find the DDA correctly determined he has the residual functional capacity to do light work in the national economy. As for the high blood pressure disability allegation, DDA was correct to deny this claim as it is not a disabling condition under social security. Although the Appellant experiences the affects of high blood pressure, such as headaches, it is not a disabling condition in and of itself. In conclusion, DDA correctly denied the Appellant’s disability claims because he did not meet the social security listings criteria, and he has the residual functional capacity assessment to do some light work in the national economy. Since the Appellant is not disabled, he is not eligible for Medicaid for the Disabled or DFA and the Agency correctly denied the applications. Therefore, these appeals should be overruled. Page 5 of 8
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