Dragon v. Commissioner of Social Security , 470 F. App'x 454 ( 2012 )


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  •                 NOT RECOMMENDED FOR FULL-TEXT PUBLICATION
    File Name: 12a0332n.06
    FILED
    No. 09-4489
    Mar 26, 2012
    UNITED STATES COURT OF APPEALS                        LEONARD GREEN, Clerk
    FOR THE SIXTH CIRCUIT
    ROSE DRAGON,                                          )
    )
    Plaintiff-Appellant,                           )
    )
    v.                                                    ) ON APPEAL FROM THE UNITED
    ) STATES DISTRICT COURT FOR THE
    COMMISSIONER OF SOCIAL                                ) SOUTHERN DISTRICT OF OHIO
    SECURITY,                                             )
    )
    Defendant-Appellee.                            )
    )
    Before: GUY, BOGGS, and GIBBONS, Circuit Judges.
    JULIA SMITH GIBBONS, Circuit Judge. Plaintiff–appellant Rose Dragon appeals the
    district court’s decision affirming the decision of Michael J. Astrue, Commissioner of Social
    Security, denying her supplemental security income under Title XVI of the Social Security Act. For
    the following reasons, we reverse the decision of the district court and remand to the administrative
    law judge for an immediate award of benefits.
    I.
    Rose Dragon (“Dragon”) was born on February 29, 1980. She is married and lives with her
    husband and daughter. She and her husband share the household tasks like grocery shopping, caring
    for her daughter, laundry, and dishes. She has a high school education (completed through special
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    Dragon v. Comm’r of Soc. Sec.
    education classes) and has attempted to work a number of jobs, including dishwasher, bagger at a
    grocery store, and fast-food worker. Her employment was always short-lived because, as she
    testified, she “got frustrated,” she “wasn’t fast enough,” or “if people made fun of [her], [she] would
    get discouraged.” In June 2004, Dragon applied for supplemental security income (“SSI”) under
    Title XVI of the Social Security Act alleging disability due to speech problems, learning difficulties,
    and asthma onset as of April 1, 2004. Upon denial of her claims she requested a hearing before an
    administrative law judge (“ALJ”).
    The ALJ reviewed records from Dragon’s schools from 1994 to 1998. These records note
    that, in 1992 at the age of 12, Dragon took the Wechsler Intelligence Scale for Children-Third
    Edition (“WISC-III”), and received a verbal scale I.Q. score of 65, a performance scale I.Q. score
    of 72, and a full scale I.Q. score of 66. The same records indicate that Dragon had a “mild
    articulation delay” and that “Rosanna qualifie[d] for a program for developmentally handicapped and
    for speech therapy.” The school placed Dragon on an individual education plan for the ‘93–‘94 and
    ‘94–‘95 school years. Dragon never passed any of the ninth grade proficiency tests and was
    exempted because she “[did] not have the necessary skills to pass.” Dragon was considered a 1998
    graduate after she completed her requirements during the summer. A 1998 assessment stated that
    Dragon was fairly successful in her classes, that she took a regular curriculum with study skills for
    support, and that she received work-study credits. Post-graduation, the record indicated that the
    “team [felt] that Rose [was] developing skills needed to live independently with some assistance.”
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    Dragon v. Comm’r of Soc. Sec.
    On July 23, 2004, clinical psychologist Dr. Paul Deardorff performed a consultative
    psychological evaluation of Dragon. Dr. Deardorff administered the Wechsler Adult Intelligence
    Scale-Third Edition (“WAIS-III”). Dragon received a verbal I.Q. score of 58, a performance scale
    I.Q. score of 51, and a full scale I.Q. score of 50, indicating that her current functioning was in the
    “moderately retarded range of intelligence or at least well less than the percentile for [her] age
    group.” In his report, Dr. Deardorff stated, “[Dragon’s] tested I.Q. is lower than would be expected
    on the basis of clinical presentation. Emotional and motivational factors may have interfered with
    performance on this measure as [she] appears to be of borderline intelligence.” In his multiaxial
    classification of Dragon, on Axis I he listed her clinical disorders as anxiety disorder and reading
    disorder; on Axis II rather than listing a level of mental retardation Dr. Deardorff classified Dragon
    as of “borderline intellectual functioning”; Dr. Deardorff listed no general medical conditions under
    Axis III; on Axis IV Dr. Deardorff listed Dragon’s psychosocial and environmental problems as
    occupational problems, problems interacting with social environment, problems with primary
    support group, and educational problems; and on Axis V he assessed a Global Assessment of
    Functioning (“GAF”) score of 55. In reaching Dragon’s GAF score, Dr. Deardorff noted Dragon’s
    anxiety and irritation. He observed that she “has few friends but sees them on a daily basis . . . [,]
    cares for her daughter and assists with household chores . . . [,] plays video games, listens to the
    radio[,] and likes to shop.” A GAF score of 55 indicates moderate symtomatology and difficulties
    in social, occupational, or school functioning.
    Regarding Dragon’s work-related mental abilities, Dr. Deardorff observed:
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    Dragon v. Comm’r of Soc. Sec.
    1.      The claimant’s mental ability to relate to others, including fellow workers and
    supervisors is moderately to seriously impaired by her emotional difficulties.
    She was somewhat uncomfortable dealing with this examiner and she stated
    that she believes others ridicule her. She very likely would have difficulty
    relating adequately to others in completing simple repetitive tasks.
    2.      The claimant’s mental ability to understand, remember, and follow
    instructions is moderately impaired by her emotional difficulties. She would
    have no difficulty understand [sic] simple instructions but her short term
    memory skills are weak and she may have difficulty retaining them. Further,
    her pace may be slowed by her depressive symptomatology.
    3.      The claimant’s mental ability to maintain attention, concentration,
    persistence, and pace is moderately impaired by her emotional difficulties.
    Her attention and concentration skills were not strong during this evaluation
    and may deteriorate over extended time periods, slowing her performance in
    completing simple repetitive tasks.
    4.      The claimant’s mental ability to withstand the stress and pressure associated
    with day-to-day work activities is moderately impaired by her emotional
    difficulties. Such stress may result in increased anxiety and decreased
    attention and concentration skills, and might also result in increased
    suspiciousness and misinterpretation of the behavior and statements of those
    around her.
    5.      Should she be granted disability compensation, she would have difficulty in
    managing funds prudently as her arithmetic skills are limited.
    On August 4, 2004, Dr. Douglas Pawlarczyk, a state agency psychologist, filled out a
    psychiatric review technique form (“PRTF”) reviewing Dragon’s record, which included her school
    records, Dragon’s contact with the Agency, and Dr. Deardorff’s examination. The PRTF largely
    consists of checked boxes indicating that Dr. Pawlarczyk found that medically determinable
    impairments were present but did not precisely satisfy the diagnostic criteria for mental retardation
    and anxiety-related disorders. He further checked that she had mild restriction of activities of daily
    living; moderate difficulties in maintaining social function and maintaining concentration,
    persistence, or pace; and no evidence of related episodes of decompensation of extended duration.
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    Dragon v. Comm’r of Soc. Sec.
    The last page of the PRTF contained a functional capacity assessment, the only portion of the PRTF
    actually written by Dr. Pawlarczyk. This largely reiterated Dr. Deardorff’s findings of Dragon’s
    functional capacity. Dr. Pawlarczyk did note, in particular, that “[Dr. Deardorff] felt that [Dragon’s
    I.Q. scores] may be an underestimate as [Dragon] clinically presented as more in the [borderline
    intellectual functioning] range. Those school age score [sic] are more likely an [sic] true estimate
    of her intellectual ability.” Alice, Psy.D., a state agency psychologist, stamped her approval on the
    PRTF on September 23, 2004.
    Dragon, her father, and a vocational expert (“VE”) testified at a hearing on April 17, 2006,
    before the ALJ. Dragon testified to her home life, her work experiences, and her general disabilities.
    The VE testified regarding the skill level of Dragon’s only durationally significant job at the Old
    Country Buffet: the dishwasher job rated as medium work and unskilled, the busser job as medium
    work and unskilled, and the attendant job as light work and unskilled. The VE noted that, similar
    to the dishwashing job, there are cleaning jobs at a medium level and a light level that are
    appropriate for an individual with a marginal education and who is able to perform only simple,
    routine tasks; can understand, remember, and carry out only short and simple instructions; can
    interact no more than occasionally with the general public; can make only simple work-related
    decisions; and cannot work at a rapid product rate pace. But upon examination by Dragon’s counsel,
    the VE revealed that Dragon’s problems interacting with others, keeping up with tasks, and inability
    to handle certain stresses might interfere with this kind of work.
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    Dragon v. Comm’r of Soc. Sec.
    On May 23, 2006, the ALJ issued an unfavorable decision in Dragon’s case, ultimately
    concluding that Dragon was not disabled, was able to perform past work, and thus was not entitled
    to SSI. In reaching this determination, the ALJ conducted the five-step evaluation pursuant to 
    20 C.F.R. § 416.920
    . After determining that Dragon had not been engaged in substantial gainful
    activity since April 1, 2004, the ALJ recognized that Dragon did indeed have some severe
    impairments. Among these severe impairments was borderline intellectual functioning, which the
    ALJ affirmatively found to exist. The ALJ determined, however, that Dragon failed on the third,
    fourth, and fifth steps of the analysis.
    As to the third step, the ALJ addressed Dragon’s severe impairments—specifically borderline
    intellectual functioning, a mild articulation delay, an anxiety disorder, and a reading disorder—but
    found that “the severity of [those] impairments, either singly or in combination, [did] not meet or
    equal the requirements of any listed impairment in Appendix 1 to Subpart P of 404, including
    Sections 12.05 and 12.06.” The ALJ again noted that Dragon is “of borderline intelligence and is
    not mentally retarded.” The ALJ specifically rejected a portion of Dr. Deardorff’s analysis: “The I.Q.
    scores obtained by Dr. Deardorff were felt to be underestimates of the claimant’s intellectual
    functioning and therefore are not valid.” The ALJ referenced I.Q. scores in the mid-60s obtained
    while Dragon was a child but failed to consider the scores because the testing “is not actually
    contained in the file to assess whether the results were considered to be valid.” The ALJ then went
    on to note that Dragon’s high school education was not consistent with mental retardation. The ALJ
    concluded his third step analysis as follows: “There is very little to no substantive indication that the
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    Dragon v. Comm’r of Soc. Sec.
    claimant has a history of deficits in adaptive functioning initially manifested during the
    developmental period to the attainment of age 22.”
    With regard to the remaining two steps, the ALJ set forth the following residual functional
    capacity (“RFC”):
    [D]ue to her severe impairments, the [ALJ] finds that [Dragon] can perform only
    simple, routine tasks and is able to understand, remember, and carry out only short
    and simple instructions. She cannot interact with the general public more than
    occasionally. She cannot work at a rapid production-rate pace. She is able to make
    only simple work-related decisions. Any job should not require the ability to make
    change, or reading or writing skills above the third grade level. The job should not
    require more than very simple math. [Dragon] has no exertional limitations.
    Relying on the VE’s assessment, the ALJ concluded that Dragon “retains the ability to perform her
    past relevant dishwasher work and other cleaner jobs despite her impairments,” thus failing to
    establish a disability under the fourth and fifth steps of the analysis. The ALJ ultimately denied
    Dragon’s claim for SSI.
    Dragon filed suit in the United States District Court for the Southern District of Ohio, seeking
    judicial review of the ALJ’s decision. On January 18, 2009, a magistrate judge issued a Report and
    Recommendation (“R&R”), recommending that the case be reversed and remanded for an immediate
    award of benefits. The Commissioner filed an objection to the R&R, and Dragon filed a response.
    The district court declined to adopt the magistrate’s R&R and affirmed the ALJ’s decision. Dragon
    now appeals on the ground that substantial evidence did not support the ALJ’s finding that she was
    not disabled and therefore not entitled to SSI.
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    Dragon v. Comm’r of Soc. Sec.
    II.
    We review the district court’s conclusion in a social security case de novo. Valley v. Comm’r
    of Soc. Sec., 
    427 F.3d 388
    , 390 (6th Cir. 2005). We review the underlying ALJ’s findings to
    determine whether they are supported by substantial evidence. 
    Id.
     (citing 
    42 U.S.C. § 405
    (g)).
    “Substantial evidence is more than a scintilla of evidence but less than a preponderance; it is such
    relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Cutlip
    v. Sec’y of Health & Human Servs., 
    25 F.3d 284
    , 286 (6th Cir. 1994). If there is such support, those
    findings are conclusive, and this court may not reverse even if it would have arrived at a different
    conclusion. Valley, 
    427 F.3d at 391
    .
    III.
    Under the Social Security Act, “disability” is defined as the inability “to engage in any
    substantial gainful activity by reason of any medically determinable physical or mental impairment
    which can be expected to result in death or which has lasted or can be expected to last for a
    continuous period of not less than 12 months.” 
    42 U.S.C. §§ 423
    (d)(1)(A), 1382c(a)(3)(A). Dragon
    has the burden of establishing that she meets this definition. 
    42 U.S.C. §§ 423
    (d)(5)(A). The
    evaluation is a five-step, sequential process, and if the ALJ finds disability or lack of disability at any
    step, the determination is made without proceeding to the next step. 
    20 C.F.R. § 416.920
    (4). The
    steps are as follows:
    (i) At the first step, we consider your work activity, if any. If you are doing
    substantial gainful activity, we will find that you are not disabled. . . .
    (ii) At the second step, we consider the medical severity of your impairment(s). If
    you do not have a severe medically determinable physical impairment that meets the
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    Dragon v. Comm’r of Soc. Sec.
    duration requirement . . ., or a combination of impairments that is severe and meets
    the duration requirement, we will find that you are not disabled. . . .
    (iii) At the third step, we also consider the medical severity of your impairment(s).
    If you have an impairment(s) that meets or equals one of our listings in appendix 1
    to subpart P of Part 404 of this chapter and meets the duration requirement, we will
    find that you are disabled. . . .
    (iv) At the fourth step, we consider our assessment of your residual functional
    capacity and your past relevant work. If you can still do your past relevant work, we
    will find that you are not disabled. . . .
    (v) At the fifth and last step, we consider our assessment of your residual functional
    capacity and your age, education, and work experience to see if you can make an
    adjustment to other work. If you can make an adjustment to other work, we will find
    you are not disabled. If you cannot make an adjustment to other work, we will find
    that you are disabled.
    
    Id.
     § 416.920(a)(4)(i)–(v).
    According to the ALJ, Dragon met her burden in steps 1 and 2, but failed on steps 3, 4, and
    5. We disagree. We conclude that the ALJ’s decision to reject the evidence in the record supporting
    Dragon’s claims of impairment and to affirmatively find that Dragon was of borderline intellectual
    functioning as opposed to mentally retarded was not supported by substantial evidence. Our
    discussion will elaborate on why the ALJ erred in finding that Dragon failed to develop her disability
    on steps 3, 4, and 5.
    A.
    The third step requires an examination of the medical severity of Dragon’s impairments and
    a determination of whether they meet one of the listings found in appendix 1. Dragon argues that
    she meets the listing for mental retardation, specifically Listing 12.05C, which has three
    requirements: (1) “significantly subaverage general intellectual functioning with deficits in adaptive
    functioning initially manifested during the developmental period; i.e., the evidence demonstrates or
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    Dragon v. Comm’r of Soc. Sec.
    supports onset of the impairment before age 22”; (2) “[a] valid verbal, performance, or full scale IQ
    of 60 through 70”; and (3) “a physical or other mental impairment imposing an additional and
    significant work-related limitation of function.” 20 C.F.R. Pt. 404, Subpt. P, App. 1, § 12.05C.1 The
    ALJ determined that Dragon failed to meet this listing because of his affirmative finding that Dragon
    “is of borderline intelligence and not mentally retarded.” The ALJ ignored the wealth of evidence
    in support of Dragon’s claims and affirmatively found otherwise.
    i.
    Regarding the first requirement, the ALJ stated that “[t]here is very little to no substantive
    indication that [Dragon] has a history of deficits in adaptive functioning initially manifested during
    the developmental period prior to the attainment of age 22.” “Adaptive functioning includes a
    claimant’s effectiveness in areas such as social skills, communication, and daily living skills. West
    v. Comm’r Soc. Sec, 240 F. App’x 692, 698 (6th Cir. 2007) (citing Heller v. Doe by Doe, 
    509 U.S. 312
    , 329 (1993)). Dragon, however, did present significant evidence to the contrary, including a set
    of I.Q. scores obtained in 1992 when she was 12-years old. This testing resulted in a verbal I.Q.
    score of 65, a performance I.Q. score of 72, and a full scale I.Q. score of 66. The ALJ disregarded
    1
    To meet the requirements of Listing 12.05B, Dragon needed to establish manifestation of
    deficits in adaptive functioning prior to the age of 22 and a valid verbal, performance, or full scale
    I.Q. score of 59 or less. 20 C.F.R. Pt. 404, Subpt. P, App. 1, § 12.05B. To meet the requirements
    of Listing 12.05D, Dragon needed to establish manifestation of deficits in adaptive functioning prior
    to the age of 22, a valid I.Q. of 60 through 70, and at least two of the following: marked restriction
    of activities of daily living; marked difficulties in maintaining social functioning; marked difficulties
    in maintaining concentration, persistence, or pace; or repeated episodes of decompensation, each of
    an extended duration. Id. § 12.05D.
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    Dragon v. Comm’r of Soc. Sec.
    these scores because “this testing was 14 years ago and occurred while [Dragon] was a child.”2
    Disregarding the scores on this ground misconstrues the relevance of the scores; indeed, an older
    score was relevant to establish the manifestation of Dragon’s impairment before the age of 22. Cf.
    West, 240 F. App’x at 698 (“While the claimant may use a qualifying IQ score before the age of 22
    to demonstrate that his subaverage intellectual functioning initially manifested during his
    developmental period, . . . a claimant is by no means required to produce an IQ score obtained prior
    to age 22.”).
    The ALJ also disregarded these scores because they were “only referenced in the file and
    [were] not actually contained in the file to assess whether the results were considered to be valid.”
    Nothing in the school records suggests that the scores were invalid, whether or not the actual testing
    was contained in the file. The scores and school records indicating that Dragon was to proceed in
    a separate educational program suggest the manifestation of Dragon’s impairment before the age of
    22. Moreover, the records indicate that she had a “mild articulation delay,” qualified for a program
    “for developmentally handicapped and for speech therapy,” and did not have the skills to pass her
    ninth grade proficiency tests. The I.Q. scores were consistent with the evidence in the school records
    and were valid to prove one of the necessary elements of her disability claim—that her deficits in
    2
    Seemingly in support of this finding, the Commissioner cites an Appendix 1 Listing for the
    proposition that test results must be sufficiently current, and I.Q. tests obtained before the age of 16
    are not necessarily reliable. The provision cited deals specifically with mental retardation under
    Listing 112.05, regarding mental disorders for children under age 18. See 20 C.F.R. Pt. 404, Subpt.
    P, App. 1 § 112.00D(10) (stating that I.Q. scores “must . . . be sufficiently current for accurate
    assessment under 112.05” and that “[g]enerally, the results of IQ tests tend to stabilize by the age of
    16”). But Dragon’s claim has been made under Listing 12.05, not under Listing 112.05.
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    Dragon v. Comm’r of Soc. Sec.
    adaptive functioning manifested prior to the age of 22. For those reasons, we find that the ALJ
    lacked substantial evidence to determine that Dragon’s childhood I.Q. scores were invalid and lacked
    substantial evidence to conclude that Dragon had failed to establish “significantly subaverage general
    intellectual functioning with deficits in adaptive functioning initially manifested during the
    developmental period.”
    ii.
    The second requirement under Listing 12.05C is “[a] valid verbal, performance, or full scale
    I.Q. of 60 through 70.” To establish this, Dragon submitted the set of I.Q. scores obtained by Dr.
    Deardorff, in which Dragon scored a verbal scale I.Q. of 58, performance scale I.Q. of 51, and full
    scale I.Q. of 50 on the WAIS-III. The ALJ concluded that these scores were not valid because “[t]he
    I.Q. scores obtained by Dr. Deardorff were felt to be underestimates of [Dragon’s] intellectual
    functioning.” This conclusion was based on Dr. Deardorff’s Axis II categorization of “borderline
    intellectual functioning” and Dr. Deardorff’s statement that Dragon’s “tested I.Q. [was] lower than
    would be expected on the basis of clinical presentation,” but that “[e]motional and motivational
    factors may have interfered with performance on this measure as [Dragon] appear[ed] to be of
    borderline intelligence.” An affirmative finding of borderline intellectual functioning is usually
    associated with I.Q. scores of at least 70.
    The ALJ ignored Dr. Deardorff’s earlier observation that Dragon “did not appear to
    exaggerate or minimize her difficulties . . . [and] was adequately motivated.” In spite of his
    “borderline intellectual functioning” classification and high expectations, Dr. Deardorff
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    Dragon v. Comm’r of Soc. Sec.
    acknowledged that Dragon’s I.Q. scores suggested that her performance falls “moderately below the
    average range” on tasks calling for the comprehension of words, abstract verbal reasoning abilities,
    a fund of information, or common-sense reasoning abilities. He further observed that she falls “well
    below average limits” in her perceptual-organizational or non-verbal problem-solving abilities,
    arithmetic reasoning skills, and short-term memory skills. Dr. Deardorff also discussed his
    administration of the Wechsler Memory Scale-Form III. Dragon’s memory abilities and attention
    and concentration skills fall within the moderately retarded range—“at well less than the 1st
    percentile for her age group”—and her reading abilities fall in the mildly retarded range—“at about
    the 1st percentile for her age group.” Dragon’s “[w]ord recognition abilities fall at the third grade
    level but her reading comprehension abilities are very likely not as well developed as her meager
    word recognition abilities.” Dr. Deardorff also assessed Dragon with a GAF of 55, indicating
    moderate symptomatology.
    Notwitstanding the general consistency of Dragon’s test results, the ALJ placed great
    emphasis on the statement that Dragon’s tested I.Q. was lower than expected and found that Dr.
    Deardorff’s statement on this point completely invalidated the I.Q. scores. This conclusion is not
    supported by substantial evidence. Dr. Deardorff apparently did expect Dragon to perform better
    on the I.Q. test based on her presentation. Yet, in order to actually test as of borderline intelligence,
    Dragon would have had to achieve an I.Q. score of 70, twenty points higher than she actually scored.
    Moreover, Dr. Pawlarczyk surmised that Dragon’s “school age score [sic] are more likely an [sic]
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    Dragon v. Comm’r of Soc. Sec.
    true estimate of her intellectual ability.” Dragon’s school age scores placed her below the range of
    borderline intellectual functioning.
    The remainder of Dr. Deardorff’s report details Dragon’s substantial limitations, including
    poor attention, concentration, arithmetic, reading, and reasoning skills. The ALJ may choose to
    disregard I.Q. scores that would normally lead to a finding of disability when those scores were
    undermined by a doctor’s full evaluation. See Daniels v. Comm’r of Soc. Sec., 70 F. App’x 868, 869,
    872 (6th Cir. 2003) (finding that substantial evidence supported the ALJ’s finding that claimant was
    not mentally retarded although claimant had a performance I.Q. of 67 because the examining doctor
    also found claimant to be within the “borderline range of intelligence” and clinically “appeared to
    function in the dull-normal range of intelligence”). But that was not the case here. The ALJ
    disregarded Dr. Deardorff’s full evaluation, which served to reinforce the I.Q. scores, rather than
    undermine them.
    Further in support of his decision to reject the I.Q. scores, the ALJ stated, “[T]he fact that
    [Dragon] was able to graduate from high school, albeit with an individualized education plan, is not
    consistent with mental retardation. She is married and has a six year old daughter who she appears
    to do a good job taking care of.” The regulations permit the ALJ to question the validity of test
    results in conjunction with other factors.      “In assessing the validity of a claimant’s I.Q.,
    ‘[i]nformation from both medical and nonmedical sources may be used to obtain detailed
    descriptions of the individual’s activities of daily living; social functioning; concentration,
    persistence and pace; or ability to tolerate increased medical demands (stress).’” Brown v. Sec’y of
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    Dragon v. Comm’r of Soc. Sec.
    Health & Human Servs., 
    948 F.2d 268
    , 269 (6th Cir. 1991) (quoting 20 C.F.R. Pt. 404, Subpt. P,
    App. 1, § 12.00D). Nonetheless, the Sixth Circuit has found that certain activities are not necessarily
    “inconsistent with a valid test I.Q. of 68”—use of public transit, making change at a grocery story,
    doing laundry (but with strong body odor), cleaning, limited reading comprehension (equivalent to
    a third-grade education), or the ability to keep records of work activity. Id. at 270. But see West, 240
    F. App’x at 698 (citing claimant’s ability “to drive a garbage truck on a part-time basis, to care for
    his daily needs, to pay bills, to shop for groceries, to interact with friends and families, and to engage
    in numerous other daily activities” as evidence that claimant was not deficient in adaptive
    functioning).
    In this case, the ALJ reasoned that, because Dragon was a high school graduate and a mother,
    her I.Q. scores were invalid. Given the record here, these things cannot be held against her. See 
    20 C.F.R. § 416.920
    (d) (“If you have an impairment(s) which . . . is listed in Appendix 1, we will find
    you disabled without considering your age, education, and work experience.”). She graduated from
    high school on an individual education plan and never passed her ninth grade proficiency tests.
    Although she has a good relationship with her daughter, all the while she has been living with
    another parental figure—first her daughter’s father and now her new husband. Because Dragon’s
    activities are not inconsistent with her tested I.Q. scores and Dragon’s performance during Dr.
    Deardorff’s evaluation was not inconsistent with her tested I.Q. scores, the ALJ’s decision to
    invalidate the I.Q. scores was not supported by substantial evidence.
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    iii.
    The third requirement for meeting Listing 12.05C is a physical or other mental impairment
    imposing an additional and significant work-related limitation of function. The ALJ appeared to
    reject the evidence presented by Dragon on this point by relying on the findings of Dr. Pawlarcyzk.
    The ALJ stated, “With specific regard to the . . . criteria pertaining to the claimant’s mental
    impairments, the [ALJ] agrees with the findings of Dr. Pawlarcyzk that [Dragon] has a mild
    restriction of activities of daily living, moderate difficulties in maintaining concentration, persistence
    or pace, and no episodes of decompensation.”3 This reliance appears to have affected the ALJ’s
    finding that the severity of Dragon’s impairments did not meet Listing 12.05C as well as the ALJ’s
    finding of her RFC, which affects the fourth step of the analysis.
    Dr. Deardorff performed a consultative psychological evaluation of Dragon on July 13, 2004.
    On August 4, 2004, Dr. Pawlarczyk performed a psychiatric review of the record (the PRTF), which
    included Dragon’s school records and Dr. Deardorff’s evaluation. In weighing medical opinions,
    generally, a treating source is to be given more weight than an examining source and an examining
    source (Dr. Deardorff) more weight than a non-examining source (Dr. Pawlarcyzk). 
    20 C.F.R. § 404.1527
    (d)(1)–(2).4 This is not a bright-line rule. See Lyons v. Soc. Sec. Admin., 19 F. App’x 294,
    3
    The language of these criteria do not specifically pertain to Listing 12.05C (the criteria
    appear in Listing 12.05D and others), but this statement implies a reliance on Dr. Pawlarcyzk’s
    evaluation rather than Dr. Deardorff’s in concluding that Dragon did not meet any of the listings.
    4
    The “treating-physician doctrine” is inapplicable in this case. The testimony of a treating
    physician is entitled to substantial deference, but in this case Dr. Deardorff was merely an examining
    physician, performing an evaluation at the expense of the Social Security Administration. See
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    No. 09-4489
    Dragon v. Comm’r of Soc. Sec.
    302 (6th Cir. 2001) (“A non-examining physician’s opinion may be accepted over that of an
    examining physician when the non-examining physician clearly states the reasons that his opinions
    differ from those of the examining physicians.”). Whether an opinion is consistent with the record
    as a whole or supported by relevant evidence will also factor into the evaluation of medical opinions.
    
    20 C.F.R. § 404.1527
    (d)(3)–(4). The weight of non-examining sources will be given weight
    dependant on the “degree to which they provide supporting explanations for their opinions.” 
    20 C.F.R. § 404.1527
    (d)(3).
    In this case, Dr. Pawlarcyzk’s evaluation consisted almost entirely of checked boxes and a
    regurgitation of some of Dr. Deardorff’s findings. He provided little explanation or support for his
    conclusion that Dragon did not satisfy the diagnostic criteria of mental retardation and anxiety-
    related disorders. Dr. Deardorff’s analysis, however, was quite detailed and supported not only by
    his own evaluation, but also by the rest of the record. Dragon was able to graduate from high school
    but only with an individual education plan and regardless of her inability to complete some basic
    requirements. Additionally, Dragon has proved that she is not unemployed for lack of trying. Prior
    to applying for SSI, Dragon has attempted many jobs for short time periods but has been unable to
    maintain consistent employment. Dragon testified that she had difficulty keeping up, that she was
    made fun of, that she was slower than others, and that she would get discouraged and frustrated at
    her various jobs.    Dr. Deardorff’s analysis confirmed her difficulties in relating to others,
    remembering instructions, keeping pace, maintaining attention, and withstanding stress and pressure.
    Barker v. Shalala, 
    40 F.3d 789
    , 794 (6th Cir. 1994).
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    No. 09-4489
    Dragon v. Comm’r of Soc. Sec.
    He determined that she suffered from anxiety disorder, reading disorder, borderline intellectual
    functioning, occupational problems, problems interacting with social environment, problems with
    primary support group, and educational problems. His assessment was consistent with a finding of
    mental retardation under 12.05C, which requires a finding of “a physical or other mental impairment
    imposing an additional and significant work-related limitation of function.”5 Substantial evidence
    did not support the ALJ’s decision to disregard Dragon’s examining doctor’s evaluation in favor of
    a form with little substantive information. Dr. Deardorff’s more complete evaluation demonstrated
    that Dragon met her burden of establishing that she met Listing 12.05C.
    For the foregoing reasons, we conclude that the ALJ’s determination that Dragon failed to
    meet a listing in Appendix 1 was not supported by substantial evidence. The regulations suggest that
    the analysis may end here: “If we can find that [Dragon is] disabled or not disabled at a step, we
    make our determination or decision and we do not go on to the next step.” 
    20 C.F.R. § 416.920
    (a)(4). Nevertheless, we will continue with our evaluation of the ALJ’s decision to fully
    conclude that it was not supported by substantial evidence.
    5
    Furthermore, Dragon can likely establish disability under Listing 12.05B or 12.05D as well.
    Listing 12.05B requires “a valid verbal, performance, or full scale IQ of 59 or less,” which was
    precisely found by Dr. Deardorff. Listing 12.05D requires “a valid verbal, performance, or full scale
    IQ of 60 through 70, resulting in at least two of the following: 1. Marked restriction of activities of
    daily living; or 2. Marked difficulties in maintaining social function; or 3. Marked difficulties in
    maintaining concentration, persistence, or pace; or 4. Repeated episodes of decompensation, each
    of extended duration.” Dr. Deardorff’s evaluation demonstrates this as well.
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    Dragon v. Comm’r of Soc. Sec.
    B.
    If Dragon had failed to demonstrate her disability under the third step, the court would then
    move to the fourth step—an assessment of Dragon’s RFC and her past relevant work. In reaching
    a claimant’s RFC, the ALJ is to assess the claimant’s physical abilities, mental abilities, other
    abilities affected by impairments, and total limiting effects. 
    20 C.F.R. § 404.1545
    (b)–(e). The RFC
    is based on medical evidence but also statements made by the claimant on what she can do.
    Additionally, the ALJ will “consider descriptions and observations of [the claimant’s] limitations
    from [her] impairment . . . provided by [the claimant], [the claimant’s family], neighbors, friends,
    or other persons.” 
    Id.
     § 404.1545(a)(3). Dragon argues that, for the same reasons discussed above,
    the ALJ erred in relying on Dr. Pawlarcyzk’s evaluation alone. We agree.
    If the ALJ had given any credence to Dr. Deardorff’s evaluation, the RFC would have looked
    quite different. The ALJ’s RFC stated that Dragon “cannot interact with the general public more
    than occasionally,” while Dr. Deardorff’s more thorough analysis added that Dragon’s “mental
    ability to relate to others, including fellow workers and supervisors is moderately to seriously
    impaired by her emotional difficulties. . . . She very likely would have difficulty relating adequately
    to others in completing simple repetitive tasks.” Consistent with Dr. Deardorff, the ALJ found that
    Dragon “can perform only simple, routine tasks and is able to understand, remember, and carry out
    only short and simple instructions.” The ALJ, however, ignored Dr. Deardorff’s statement that
    Dragon’s “pace may be slowed by her depressive symptomatology.” The ALJ determined that
    Dragon “cannot work at a rapid production-rate pace” and “is able to make only simple work-related
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    No. 09-4489
    Dragon v. Comm’r of Soc. Sec.
    decisions.” Dr. Deardorff viewed Dragon as even more limited, noting that Dragon’s “attention and
    concentration skills were not strong during this evaluation and may deteriorate over extended time
    periods, slowing her performance in completing simple repetitive tasks.” Furthermore, the ALJ
    completely ignored Dr. Deardorff’s assessment that Dragon’s mental ability to withstand stress and
    pressure of day-to-day work activities is moderately impaired by her emotional difficulties. He
    noted, “Such stress may result in increased anxiety and decreased attention and concentration skills,
    and might also result in creased suspiciousness and misinterpretation of the behavior and statements
    of those around her.” The ALJ and Dr. Deardorff agreed that Dragon’s reading and arithmetic skills
    are limited. We conclude that the ALJ’s RFC was not supported by substantial evidence.
    Additionally, the ALJ’s incomplete RFC was insufficient to elicit apt testimony from the VE
    regarding Dragon’s ability to perform her past relevant work. The VE testified that Dragon’s
    previous work has ranged from medium to light work, all unskilled. The VE also testified that the
    education described by the ALJ was not a functionally limited education, but rather Dragon’s
    education would be considered “marginal.” Given the ALJ’s assessment of Dragon’s RFC, the VE
    testified that Dragon could perform her past work as a dishwasher. Based on this testimony, the ALJ
    remained confident that Dragon would be able to work—“despite her history of academic problems
    and some unsuccessful work attempts.” The ALJ understood the VE’s testimony to say that “despite
    the[] limitations stemming from [Dragon’s] severe impairments, [Dragon] could perform her
    composite job as a dishwasher, both as actually performed and as customarily performed in the
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    No. 09-4489
    Dragon v. Comm’r of Soc. Sec.
    national economy.” We conclude that this is simply not the case. Had the VE been presented with
    a more accurate picture of Dragon’s limitations, the VE’s testimony could have easily differed.
    Furthermore, Dragon has clearly put forth the effort to find work; she attempted and failed
    to work as a dishwasher at Old Country Buffet. In assessing a claimant’s RFC, the ALJ will consider
    her statements about what she can do. 
    20 C.F.R. § 404.1545
    (a)(3). And in assessing a claimant’s
    ability to perform past relevant work, the claimant is to provide information about work done in the
    past. 
    Id.
     § 404.1560(b)(2). Then the ALJ may look to others who may know about the claimant’s
    work as well as to vocational experts. Id. Dragon provided information regarding her past relevant
    work and testified that she quit her job at Old Country Buffet for a number of reasons:
    [T]hey told me if I didn’t quit there, I would have got fired because they found out
    that I was pregnant and then I couldn’t keep up and like I was sick a lot and they told
    me they were going to fire me and they said I was also too slow.
    Dragon also testified as to why she believes she is unable to work in general:
    I’m unable because any job I tried in the past, I couldn’t keep up because I’m slower
    than others and like say if people made fun of me, I would get discouraged and that
    holds me like I can’t do it and I feel like, basically, I feel I’m too dumb to do it, like
    any kind of job.
    The ALJ found Dragon’s testimony “credible to the extent that such testimony is consistent with the
    above [RFC] assessment.6 To the extent that any such testimony was reflective of a greater degree
    of limitations, such testimony was not found to be credible due to a lack of objective medical
    6
    Dragon argues that the ALJ erred in discrediting her father’s testimony rather than her own,
    but we find more significant error in the ALJ’s quick dismissal of Dragon’s own assessment of her
    limitations.
    -21-
    No. 09-4489
    Dragon v. Comm’r of Soc. Sec.
    support.” This reasoning is circular. The ALJ found Dragon’s testimony credible to the extent it
    confirmed the ALJ’s own conclusion. Thus, it appears the ALJ afforded Dragon’s testimony no
    weight at all because the ALJ had come to its conclusion independent of the information from her
    testimony.
    But Dragon’s testimony was consistent, both internally and with the record provided to the
    ALJ, especially Dr. Deardorff’s analysis. Consistency tends to support credibility, see Rogers
    Comm’n of Soc. Sec., 
    486 F.3d 234
    , 248 (6th Cir. 2007), and Dragon consistently presented that she
    was unable to keep up at her previous jobs, including her job as a dishwasher. Dr. Deardorff noted
    that Dragon has held “a lot” of jobs, which she has left due to relocation, ridicule, and inability.
    Dragon has demonstrated that she wanted to work and persistently attempted to find work. She has
    been unable to do so, and to conclude that she is able to perform previous work at which she
    earnestly failed is contrary to the record. Thus, we conclude that the ALJ’s RFC and the
    determination that Dragon was able to perform her past relevant work given that RFC were not
    supported by substantial evidence.
    C.
    The fifth step asks whether Dragon is capable of adjusting to other work. Regarding this
    step, the ALJ understood the VE’s testimony to suggest that Dragon “could perform the jobs of
    unskilled medium cleaner . . . and unskilled light cleaner . . . despite the above limitations.” Indeed,
    when presented with the ALJ’s perception of Dragon’s RFC and her education and past work, the
    VE testified that Dragon would also be able to perform other unskilled work such as light cleaning
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    No. 09-4489
    Dragon v. Comm’r of Soc. Sec.
    jobs including cleaning hotel rooms. For the reasons provided above, we find that the ALJ’s
    assessment of Dragon’s RFC lacked the support of substantial evidence. We conclude, thus, that the
    VE’s testimony is not supported by the record as the VE was not presented with the full assessment
    of Dragon’s abilities.
    IV.
    In this case, we find not only that the ALJ’s decision lacked a foundation in substantial
    evidence, but also that the evidence of Dragon’s disability is so substantial that she is entitled to an
    immediate award of benefits. Dragon has established significantly subaverage general intellectual
    functioning with deficits in adaptive functioning before the age of 22, a valid I.Q. score between 60
    and 70, and a physical or other mental impairment imposing an additional and significant work-
    related limitation of function. See 20 C.F.R. Pt. 404, Subpt. P, App. 1, § 12.05C. Furthermore, we
    find that substantial evidence did not support the ALJ’s conclusions that Dragon was of borderline
    intellectual functioning, able to perform past relevant work, and able to perform other work. In this
    case, we find that all factual issues have been resolved and that the record adequately establishes
    Dragon’s entitlement to benefits. See Faucher v. Sec’y of Health & Human Servs., 
    17 F.3d 171
    , 176
    (6th Cir. 1994).
    For the foregoing reasons, we reverse the decision of the district court and remand to the ALJ
    for an immediate award of benefits.
    -23-
    No. 09-4489
    Dragon v. Comm’r of Soc. Sec.
    DANNY J. BOGGS, Circuit Judge, Concurring in part and Dissenting in part.
    Although the majority provides an extensive and persuasive indication as to why the administrative
    law judge should have awarded benefits to Mrs. Dragon, I cannot agree that we are able to make that
    determination conclusively as an appellate court, and I therefore respectfully dissent from the
    conclusion that “the evidence of Dragon’s disability is so substantial that she is entitled to an
    immediate award of benefits.” While the ALJ may have erred in placing more weight on Dr.
    Pawlarsyck, a non-examining source, than Dr. Deardorff, an examining source, the difference
    between the two sources is not so great as to conclusively reverse the ALJ’s determination. In
    particular, his reliance on Dragon’s various past work efforts, which frequently had a productive
    beginning but ultimately failed because she was simply “slow” rather than totally unable to perform
    work, also seems within the ALJ’s fact-finding discretion.
    Further, to the extent that the decision turns on whether Dragon was “of borderline
    intellectual functioning as opposed to mentally retarded” (page 9), I agree that it is a close and
    contested issue. Dr. Deardorff’s testing was somewhat contradictory in that he did find IQ scores
    at quite a low level, but also found her to have “borderline intellectual functioning and a general
    ability to function at a higher level than her test scores indicated.” Dr. Pawlarsyck’s evaluation was
    more emphatic in support of a higher functioning level, but broadly consistent with an ability to
    function at a higher level than her exact scores. This is somewhat consistent with her being able to
    graduate from high school, albeit with an individualized education plan. Contrary to the implication
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    Dragon v. Comm’r of Soc. Sec.
    at page 14, it is not that “these things [are being] held against her,” so much as it is that they do
    indicate conflicting evidence.
    While the majority has pointed out deficiencies in the ALJ’s opinion that might well be
    sufficient to remand for further proceedings, I simply do not see that the evidence is sufficiently
    compelling for the additional step of ordering the ALJ to award benefits, rather that reevaluating the
    evidence in light of the majority’s lucid statement of the principles.
    I therefore dissent from the portion of the opinion that requires an immediate award of
    benefits.
    -25-