Unreported / Non-Citable
Background
Lavoria Ausborne sought judicial review of the Commissioner's final decision denying Supplemental Security Income (SSI) benefits on behalf of her minor daughter, L.A., under Title XVI of the Social Security Act. L.A. was initially found disabled due to low birth weight and later continued to be disabled based on Listing 102.02 for a retinal disorder, blindness, and/or low vision. On September 9, 2020, the SSA determined that L.A., then 13 years old, was no longer disabled as of September 1, 2020. That determination was upheld on reconsideration, and Ausborne requested a hearing before an Administrative Law Judge (ALJ).
At the September 5, 2023 hearing, Ausborne appeared without counsel and without her daughter, who was then 16. Ausborne testified that L.A. was a high school sophomore taking some special education classes with below-average but passing grades, wore glasses all the time, could read sheet music with glasses, and enjoyed drawing and painting. After the hearing, the ALJ obtained additional school and medical records and a medical expert opinion via interrogatory from Dr. Grettel Donahue, a pediatrician with over 20 years of experience. The ALJ upheld the cessation determination, finding L.A.'s disability ended as of September 1, 2020 and that she had not become disabled again since that date.
The Court’s Holding
The court denied Ausborne's motion for summary judgment and granted the Commissioner's cross-motion for summary judgment. The court found that the ALJ satisfied the requirement under Howard ex rel. Wolff v. Barnhart and Acquiescence Ruling 04-1(9) to make reasonable efforts to obtain a case evaluation from a pediatrician or appropriate specialist. Dr. Donahue, a pediatrician, evaluated the entire record and found L.A.'s impairments did not meet the Listings, including Listing 102.02 for vision. Ausborne conceded Dr. Donahue reviewed the entire record but argued an ophthalmologist was required; the court held the statute and ruling require only a pediatrician or other appropriate specialist, not a specific subspecialist.
Substantial evidence supported the ALJ's finding of medical improvement as of September 1, 2020. The ALJ relied on consultative examinations by optometrists Liann Griffiths, O.D., Terry Isbill, O.D., and pediatrician Dr. Shahid Ali, M.D. Dr. Griffiths found L.A. did not meet criteria for legal blindness, saw well with corrective lenses, and had good peripheral vision with corrected acuity of 20/30-2 and 20/25+1. Multiple examiners documented full confrontational visual fields. The ALJ also noted L.A. did not put forth best efforts on testing and her mother failed to inform a school psychologist that L.A. wore prescription glasses. Dr. Donahue confirmed the vision impairment did not meet Listing 102.02.
The court found Ausborne's argument that the ALJ failed to consider lay evidence was inadequately presented for review. Her brief offered only a vague assertion and a string cite to approximately 100 pages of the administrative record without identifying specific evidence or its relevance. Under the party presentation principle, courts rely on parties to frame issues. To the extent the argument challenged the ALJ's handling of subjective symptom testimony, the court found evidence of malingering provided clear and convincing reasons to discount it. Dr. Ali found L.A.'s mother magnified symptoms and L.A. was uncooperative with the eye exam; a speech pathologist noted suspicion of malingering; and a psychoeducational assessment noted the mother was not forthcoming about L.A.'s glasses. The ALJ's evaluation of Dr. Donahue's opinion was sufficiently articulated and supported by the record.
Key Takeaways
- An ALJ satisfies the statutory requirement for a specialist evaluation in a childhood disability case by obtaining a case review from a pediatrician; a subspecialist such as an ophthalmologist is not required.
- Medical improvement in a continuing disability review can be established through consultative examination findings of near-normal corrected visual acuity and full visual fields, even if the claimant previously met a Listing for blindness or low vision.
- A party challenging an ALJ's decision must specifically identify alleged errors and the evidence supporting them; vague assertions with voluminous record citations are insufficient to preserve issues for judicial review.
- Evidence of malingering or symptom exaggeration—including from consultative examiners, school psychologists, and therapists—constitutes a clear and convincing reason for an ALJ to discount subjective symptom testimony.
- The substantial evidence standard is deferential: the court will uphold the Commissioner's decision if supported by relevant evidence a reasonable mind might accept as adequate, even if the evidence could support a different conclusion.
Why It Matters
This decision reinforces the deferential substantial evidence standard in Social Security disability appeals and clarifies that the statutory requirement for a 'qualified pediatrician or other individual who specializes in a field of medicine appropriate to the disability' does not mandate a subspecialist matching the specific impairment. The court's refusal to sift through 100 pages of record to find unconsidered lay evidence underscores the party presentation principle and the obligation of counsel to frame specific arguments. The ruling also illustrates how evidence of poor effort on testing and parental magnification of symptoms can support an ALJ's credibility determination and finding of medical improvement in a childhood SSI cessation case.