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Eligibility for SSI Benefits Based on Intellectual Disability in Pennsylvania

Pennsylvania residents with intellectual disabilities (previously known as “mental retardation”) may be eligible for SSI or SSDI. However, an intellectual disability doesn’t automatically qualify one for either type of federal benefit. In SSI cases, an administrative law judge will consider whether a claimant has certain limitations before awarding benefits.

A recent case illustrates certain aspects of a Social Security claim based on intellectual disability. In the case, a 52-year-old Pennsylvania plaintiff’s application for Supplemental Social Security Income based on his lack of intellectual functioning was denied.

The plaintiff’s history was mixed. He had gotten IQ scores of 76, 72, and 64 as a child and teenager and had to go to special education classes. In 2009, a psychiatrist noted he had marked limitations with respect to intellectual functioning. In 2010, he was diagnosed with mild mental retardation. Another psychologist noted he could meet basic mental demands in spite of his limitations.

Despite these limitations, the man had worked as an assembly worker, landscaper, and in retail maintenance and management, among other things. He had also gotten a GED, served in the army, had a driver’s license and had no problems with personal care or handling his finances.

After his SSI application was denied, the man requested a review by the Appeals Council, but no review was granted. Accordingly, he filed for a review by a Pennsylvania district court. He argued that the administrative law judge (ALJ) erred in assessing the plaintiff’s intellectual functioning by failing to consider the requirements of the Agency’s disability listing (12.05(c)) for intellectual impairments.

12.05 defines mental retardation or intellectual impairment as “subaverage general intellectual functioning” and “deficits in adaptive functioning” that appear before age 22. A claimant who claims an intellectual impairment must also show severe problems with one of four criteria. When there are multiple IQ scores, as in this case, the lowest score should be considered and must fall between 60-70. An ALJ can reject a test score, if there is substantial evidence in the record that the score is invalid.

In this case, the ALJ and their SSI disability lawyers, found that the plaintiff had severe depression and anxiety in addition to intellectual limitations. However, he had a limited analysis of the plaintiff’s intellectual functioning, stating that the plaintiff’s IQ scores taken when he was young were inconsistent with mild mental retardation. He also noted that there was no evidence to support limitations in the man’s daily activities.

The district court explained that, arguably, the plaintiff met Listing 12.05. The court explained that the ALJ didn’t offer a sufficient explanation about whether the IQ score was in the right range for 12.05. The ALJ did not, for example, find the score of 64 invalid or inconsistent with the rest of the record.

The district court noted that the plaintiff had been enrolled in special education classes before the age of 22 and that he had other severe impairments. It also explained that the plaintiff’s driver’s license, work history and ability to do basic activities were not inconsistent with mild mental retardation. The Social Security Administration’s counsel had speculated the ALJ was relying on the plaintiff’s normal thought process, speech and behavior, but since the ALJ had not specified any of that, the ALJ’s decision was insufficient. The district court remanded the case for the ALJ to assess the plaintiff’s intellectual functioning and Listing 12.05.

If you are seriously disabled and unable to work, you may be entitled to Social Security benefits. Our experienced Pennsylvania Social Security Disability lawyers can evaluate your case. If appropriate, we can file a workers’ compensation claim as well as a civil lawsuit to get you the compensation you deserve. Contact the attorneys at Needle Law Firm at 570-344-1266 or via our online form for a free consultation.

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