Opinion
Civil No. 3:01cv0349AS
August 6, 2002
MEMORANDUM AND ORDER
George B. Timmons applied for and was denied child's insurance benefits (CIB) under Title II of the Social Security Act. Timmons now appeals the decision rendered by the Commissioner of the Social Security Administration below. Timmons argues that (1) the administrative law judge (ALJ) failed to consider evidence relating to his executory functioning in reaching her conclusion that his impairment did not prevent him from working prior to his twenty-second birthday and (2) the ALJ erred in failing to request a medical expert to provide a more complete understanding of the head injuries suffered by Timmons prior to his twenty-second birthday.
I. BACKGROUND
George B. Timmons was born on September 30, 1996 and was forty-two years of age on the date of his hearing. The record reveals that during his early years he was impatient, rebellious and bored with his studies. However, his mother considered him to be bright based upon various intelligence tests given to him in the seventh grade. R. at 226. Timmons had engaged in the consumption of alcohol beginning at the age of ten and that consumption increased with age. Timmons also began smoking marijuana around the age of fourteen. The record reveals that Timmons' grades in high school began in the average range but continued to slide downward during the 1971-1972 school year. R. at 208.
In 1973, at the age of seventeen, Timmons was involved in a tragic automobile accident. As a result of the accident, Timmons spent approximately eleven weeks in a coma at Parkview Hospital. He suffered a comminuted depressed left frontal temporal skull fracture with marked evidence of neurological damage. R. at 172 and 177. The brain injury was serious in nature and an electroencephalogram revealed the presence of severe brain damage in the left frontal and sylvian portions of his brain. R. at 222.
At the time of release from the hospital, in March 1974, the doctors were guarded with their prognosis for his recovery. R. at 172. Many of his reasoning and language skills were slightly impaired and it was noted that he had a short span of attention and was easily frustrated. R. at 173. However, it was noted that his behavior was generally good during therapy. R. at 174. Furthermore, Drs. Mann and Haas who examined Timmons to evaluate any changes in his personality determined that his current condition would not allow for an accurate evaluation with respect to his neurological functioning. R. at 172. They recommended that re-evaluation be done in six months. Id.
In July 1975, Timmons was seen by C. Joe Ottinger, M.D. for a neurological consultation. R. at 204-06. Dr. Ottinger noted that Timmons had made "a very fine recovery and had returned to school." Timmons' mother, Alberta Wamsley, noted that Timmons had poor impulse control upon his release from the hospital. However, Dr. Ottinger found that Timmons had improved with respect to these problems in the two years since the accident. At this particular evaluation, Timmons had commented that his coordination was not quite normal, but he stated that he was otherwise doing fairly well. Timmons was subjected to a modified Halstead-Reitan battery during the examination. Dr. Ottinger noted that this particular examination revealed little in the way of any abnormalities. R. at 206. Dr. Ottinger also noted that Timmons' speech was somewhat slurred and had some difficulty in saying words rapidly. Id. Otherwise, according to Dr. Ottinger, Timmons had made "a rather miraculous recovery considering the extent of his head injury and the length of time he was unconscious." Id.
After his release from the hospital, Timmons returned to high school. His grades continued at the lower end of the grade scale, but he nevertheless was able to eventually graduate in 1976. After graduation, Timmons attended Ivy Tech in Fort Wayne, Indiana for approximately one year. However, he did not return to the program for a variety of reasons after completing the first year.
Subsequently, Timmons commenced a vocational program at Cardinal Learning Center and performed various jobs including custodial work but never for any extended period of time. The record reveals that Timmons was unable to retain employment because he was disruptive to the other workers at his various places of employment. R. at 69-71. During this period, Timmons had recurring problems with alcohol. While intoxicated, he was involved in a moped accident on July 28, 1984. Subsequent to his accident, Timmons experienced seizure problems, but those problems were controlled through the use of various medications.
Also in 1984, Timmons enrolled in the State Vocational Rehabilitation Program in Elkhart, Indiana. A counselor at that particular program referred Timmons to Melvin F. Funk Ph.D. for further evaluation. Dr. Funk administered the Wechsler Adult Intelligence Scale Revised examination to Timmons. On July 30, 1984, Dr. Funk reported that Timmons had a full scale IQ of 94, which placed him in the average range. R. at 228. Dr. Funk noted that his problems appeared to be "of immediate recall and performance skills being impaired." Id.
In his report Dr. Funk outlined his vocational assessment of Timmons as follows:
Based on the CAI he is highest in the Realistic theme. That is, his preference may be toward physically active occupations where use of hands and machines or tools would be involved.
Thus, he would probably be most satisfied in manual activities, skilled trades, possibly working out of doors in construction programs. He might also like working with machines and mechanical things. Since he has some accident related deficits in terms of his thinking as well as his emotional reactions, care would need to be taken to finding something that would not be too demanding in terms of intellectual requirements and also in terms of emotional stress. Apparently his work in the tire retread shop was reasonably successful till seizures contraindicated his working with dangerous equipment. R. at 231.
Finally, Dr. Funk noted that further neurological examinations would seem appropriate and that a rehabilitation program should be developed. R. at 231.
In August of 1984, Timmons was evaluated by Bruce Rector, M.A., a therapist. R. at 222-24. Mr. Rector noted that Timmons suffered from a long-standing drug and alcohol problem. Id. Mr. Rector opined that Timmons was probably dependent on both alcohol and cannabis and that a residential drug treatment program was recommended. He further recommended that Timmons continue with his present counseling.
Between February 25, 1985 and March 22, 1985, Timmons engaged in a vocational evaluation to determine his vocational capabilities at the Cardinal Center in Warsaw, Indiana. R. at 214. Norman L. Metzger, a certified vocational evaluator, performed the evaluation. Mr. Metzger noted that Timmons needed work adjustment training before he would be ready for competitive work. R. at 215. Further, Mr. Metzger noted that his lack of a driver's license and need to be seizure-free for one year would diminish the number of jobs available to Timmons. Id.
In January 1991, Timmons family physician, John Dick M.D., was asked to comment on his remaining functional capacity by the Social Security Administration. R. at 242. Dr. Dick recommended that Timmons not: (1) work in high places or use machinery; (2) work in a position that required a good deal of judgment; or (3) work in a position that would produce stress or anxiety. Id.
In March of 1991, Timmons was examined by Wayne J. VonBargen, Ph.D. R. at 245-46. Dr. VonBargen noted the presence of alcohol abuse by Timmons and seizure disorder. He then proceeded to perform several informal tests. Dr. VonBargen then opined that his cognitive functioning appeared to be basically intact. R. at 246.
Later, in November of 1991, Timmons was examined by a neuropsychologist, J. Courtney, PsyD. at the request of Dr. Dick. R. at 400-06. Dr. Courtney noted the presence of seizure disorders and the well documented instances of alcohol and drug abuse. Dr. Courtney performed several tests to evaluate Timmons' neuropsychological impairment including: the Halstead-Reitan Neuropsychological Test Battery; the Weschsler Adult Intelligence Scale Revised; Wechsler Memory Scale-Revised; and the California Verbal Learning Test. The results from the testing were mixed, but generally found that his impairment was in the mild to moderate range. Dr. Courtney concluded that the moderate level of impairment was a mixture of his two head injuries and ongoing substance abuse. R. at 405.
The Category Test of the Halstead-Reitan Battery revealed that Timmons demonstrated a severe level of impairment with respect to his ability to shift mental set and utilize environmental feedback to guide adaptive problem-solving. R. 403-04.
On June 4, 1995, Timmons was involved in another alcohol related motor vehicle accident. The attending physician, Mark A. Jensen, M.D. noted that Timmons had a good prognosis in recovering from his physical injuries, but a poor prognosis in terms of his continued abuse of alcohol. R. at 413.
In September 1996, Timmons was awarded supplemental security income under Title XVI of the Social Security Act. At that time, Timmons was denied his CIB claim. In conjunction with his application to the Social Security Administration, Timmons was examined by Dr. Donald Kramer. Dr. Kramer described Timmons to be "somewhat vague and rambling in terms of describing his limitations and handicaps." R. at 466. Dr. Timmons noted further that "[Timmons] comes across during today's examination as functioning in the Dull Normal level of intelligence at best, although as indicated, previous intellectual examinations have actually indicated Average functioning." R. at 467. Specifically, Dr. Kramer found that Timmons' cognitive functioning was lower than expected given his average range of intelligence on the WAIS-R administered in 1991. The test results demonstrated that Timmons "continues to experience some organic brain dysfunction secondary to his past history of head trauma" R. at 470. Furthermore, the years of heavy drinking also contributed to his cognitive impairment. Id. Finally, Dr. Kramer summarized Timmons' cognitive problems as the source of a functional impairment and that "he certainly would have difficult maintaining appropriate and goal-directed behavior in most competitive employment situations." R. at 471.
At Timmons' administrative hearing, the administrative law judge raised the possibility as to whether his current claim for CIB was barred because of his prior claim for those same benefits in December of 1990 R. at 19. However, the current claim was found not to be precluded in light of State Agency's determination that res judicata did not bar Timmons' claim for CIB in June of 1996. R. at 281.
In 1998, Dr. Dick submitted a letter outlining his diagnosis of an organic mental disorder as confirmed by previous treating sources. R. at 473. Dr. Dick opined that there had been a deterioration in Timmons' mental functioning since 1991. Id. Furthermore, in a clinical note dated December 10, 1998, Dr. Dick explained that Timmons was unable to hold down any competitive employment without stress or that would require original thinking, despite being employed by a family member to help with various jobs. R. at 237.
Alberta Wamsley, Timmons' mother, observed that after the accident his physical health returned to normal, but that he began having problems with impulse control and his academic performance dropped. R. at 22. Furthermore, she observed that Timmons would become easily angered because of his condition and had unrealistic expectations of his capabilities to perform various tasks. R. at 29. Finally, she testified during the hearing that Timmons lacked the focus to perform even simple tasks dating back to the period prior to his twenty-second birthday.
B. PROCEDURAL BACKGROUND
Timmons applied for CIB under Title II of the Social Security Act, alleging a disability onset date of November 1, 1973. The application was denied both initially and on reconsideration. After a hearing, the ALJ determined that Timmons was not disabled within the meaning of the Social Security Act because he "retained the capacity on and before attaining age 22 years to make an adjustment to work which exists in significant numbers in the national economy." Timmons appealed the ALJ's decision. The Appeals Council denied his claim. This appeal followed.
II. STANDARD OF REVIEW
A reviewing court must sustain the findings of the final decision of the Commissioner so long as they are supported by substantial evidence. See 42 U.S.C. § 405(g); Scott v. Barnhart, (No. 01-3302 slip opinion at p. 7) ___ F.3d ___, 2002 WL 1608218 (7th Cir. Jul 22, 2002). Substantial evidence consists of "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 399-400 (1971). In making a substantial evidence determination, the court will review the record as a whole, but will not re-evaluate the facts, re-weigh the evidence or substitute its own judgment for that of the Commissioner. Scott, at slip opinion p. 8. With respect to credibility determinations, the ALJ is in the best position to observe the demeanor and veracity of the testifying witnesses. Grffth v. Callahan, 138 F.3d 1150, 1152 (7th Cir. 1998). The court will not disturb the ALJ's weighing of credibility so long as those determinations are based on some support in the record and are not "patently wrong." Id.; Herron v. Shalala, 19 F.3d 329, 333 (7th Cir. 1994). However, the district court is required to critically review the evidence and not simply rubber-stamp the Commissioner's decision. See Scott at p. 8; Cifford v. Apfel, 227 F.3d 863, 869 (7th Cir. 2000).
III. DISCUSSION
In order for Timmons to qualify for the receipt of CIB based on the income of a parent wage earner, he must (1) file an application for child's benefits, (2) at the time of filing, be unmarried and (3) be eighteen years or older and have a disability that began before age twenty-two years old. See 20 C.F.R. § 404.350; Maher v. Secretary of Health and Human Services, 898 F.2d 1106, 1108 (6th Cir. 1989). In addition, Timmons must demonstrate that he was disabled, meaning a medically determinable physical or mental impairment that can be expected to result in death, or can be expected to last for a continuous period of not less than twelve months. 42 U.S.C. § 423(d)(1)(A); see also Lieberman v. Califano, 592 F.2d 986, 987 (7th Cir. 1979). The particular physical or mental impairment must prevent him from engaging in any substantial gainful activity. Lieberman, 592 F.2d at 989. Here the ALJ determined that Timmons failed to demonstrate that he had a mental impairment that would prevent him from performing competitive work prior to reaching the age of twenty-two and therefore did not meet the requirements for CIB.
A. EVALUATION OF MENTAL IMPAIRMENT
The regulations that coincide with the social security statute provide a detailed format to evaluate a claimant's mental impairment. In conjunction with 20 C.F.R. § 404.1520a, the Social Security Administration has devised a listing of mental impairments to assist those making an evaluation and determine the extent of the mental impairment. See 20 C.F.R. Part 404, Subpart P, Appendix 1, 12.01 et seq. (2002). Timmons' particular type of impairment would fall under Listing 12.02 in the appendix. That particular listing first requires that a claimant demonstrate one of the following:
20 C.F.R. § 404.1520a Evaluation of mental impairments.
(a) General. The steps outlined in § 404.1520 apply to the evaluation of physical and mental impairments. In addition, when we evaluate the severity of mental impairments for adults (persons age 18 and over) and in persons under age 18 when Part A of the Listing of Impairments is used, we must follow a special technique at each level in the administrative review process. we describe this special technique in paragraphs (b) through (e) of this section. Using the technique helps us:
(1) Identify the need for additional evidence to determine impairment severity;
(2) Consider and evaluate functional consequences of the mental disorder(s) relevant to your ability to work; and
(3) Organize and present our findings in a clear, concise, and consistent manner.
(1) disorientation to time and place; or (2) memory impairment, either short-term (inability to learn new information), intermediate, or long-term (inability to remember information that was known sometime in the past); or (3) perceptual or thinking disturbances (e.g., hallucinations, delusions); or (4) change in personality; or (5) disturbance in mood; or (6) emotional lability (e.g., explosive temper outbursts, sudden crying, etc.) and impairment in impulse control; or (7) loss of measured intellectual ability of at least 15 I.Q. points from premorbid levels or overall impairment index clearly within the severely impaired range on neuropsychological testing, e.g., the Luria-Nebraska, Halstead-Reitan, etc.;
See 20 C.F.R. Part 404, Subpart P, Appendix 1, 12.02 (Part A). Once the claimant has demonstrated one of the above seven factors, he must then demonstrate that those factors resulted in at least two of the following restriction or difficulty criteria:
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; Appendix 1 at 12.02 (Part B)
As noted in her opinion, the ALJ determined that Timmons did not satisfy the requisite showing of Part B of Listing 12.02. See R. at 25.
B. Whether Timmons' impairment satisfied Part B of Listing 12.02 prior to Age 22
Timmons contends that the ALJ erred in determining that his mental condition was not so severe as to prevent him from performing any substantial gainful activity prior to reaching age twenty-two. Timmons assigns two primary points of error below: (1) the ALJ failed to build an accurate bridge between the evidence and her conclusion because she failed to recognize Timmons' executive functioning limitations in reaching her determination that his impairment did not meet or equal in severity a listed impairment; and (2) that the ALJ should have requested a medical expert to more fully understand the limitations accompanying the type of traumatic brain injury sustained by him in 1973 because of the growth and development in the understanding of his particular mental impairment.
1.
Timmons does not dispute that the ALJ considered the correct Listing under the SSA regulations, specifically Listing 12.02 — organic mental disorder. Rather, his first assignment of error is that the ALJ failed to consider the evidence that the damage to Timmons' brain resulted in significant loss to his executory functioning capabilities and thus prevented him from performing any substantial gainful activity. It is important to note that Timmons is not asserting that the ALJ did not address a specific line of evidence or reference the critical listing. See Scott, slip opinion at p. 11-13. Rather, his assignment of error centers upon the weight and sufficiency given by the ALJ to the various medical evidence in the record in reaching the decision.
Under Listing 12.02 a claimant must meet one category A criteria and two category B criteria, or one category C criterion. Here the focus is placed on whether substantial evidence supports the ALJ's determination that Timmons impairment did not satisfy category B.R. at 26. The ALJ's opinion comprehensively outlines the medical reports of Dr. Ottinger, Dr. Dick, Dr. Funk, and Dr. Courtney. The testimony and statements of Timmons' family members were also considered in reaching the decision. Most importantly, the decision rested upon the results of the various psychological testing performed on Timmons in 1975, 1984, and 1991 which would give the most accurate picture as to his mental status during the disability period at issue.
First, the ALJ found that Timmons did not demonstrate marked restrictions of his daily activities under Part B(1). The record demonstrates that Timmons was able to care for his personal needs and again was able to regularly attend high school after the accident. Furthermore, he was able to perform various tasks such as cooking, laundry, shopping and gardening. Timmons does not specifically reject this finding in his brief and therefore the court finds that substantial evidence supports the ALJ's determination that the record as a whole does not show marked restrictions in this particular area.
In assessing Part B(2) under Listing 12.02, the ALJ noted that the record did not demonstrate any marked difficulties in maintaining social functioning. However, Timmons points to his aggressive and over-friendly characteristics as presenting the necessary marked difficulty in this area. However, a 1985 vocation evaluation revealed that Timmons initiated conversation with the evaluator and other clients and seemed to gain acceptance with others. Indeed, the record reveals very few incidents of aggression and anger toward others (outside of family) in various social settings. In that vocation evaluation, Timmons was listed as "generally a cooperative worker." R. at 218. Thus, there is substantial evidence in the record for the ALJ's determination that Timmons did not demonstrate any marked difficulties in maintaining social functioning under Part B(2).
Next, counsel for Timmons points to certain instances of problems with his concentration and attention and some social problems with friendliness and some aggression. (P's Brief at pp. 27-29). The ALJ, however, in assessing the entire record determined that Timmons did not suffer from marked restrictions of concentration and attention. Specifically, in addressing Part B(3), the ALJ noted that claimant was able to sustain adequate attendance and perform his course work in completing high school. R. at 26. Although Timmons points to the fact that he received barely passing grades, he nevertheless was able to attend classes regularly and receive his diploma. Further, the record reflects that his grades began downward prior to his accident in 1973.
Furthermore, testing under the digit span subtest revealed average range in measuring attention. Id. Finally, the ALJ opined that the claimant was able to do one thing at a time and follow simple instructions. See Goose v. Apfel, 238 F.3d 981, 983 (8th Cir. 2001); (claimant demonstrated ability to complete simple tasks such as making the bed, playing cards and performing odd jobs). Therefore, the ALJ's determination under Part B(3) was supported by substantial evidence in the record.
Timmons spends much of his brief addressing his condition between the years of 1991 to 1996. While it is true that Timmons was awarded SSI benefits in 1996, the ALJ determined based upon a review of the record that Timmons' condition had worsened over the years because of his sustained substance abuse and later accidents. The record clearly shows that Timmons ongoing alcohol abuse added to the level of his impairment. R. at 403. In 1996, Dr. Courtney specifically noted that his impairment was "an admixture of two reasonably significant head injuries as well as a history of ongoing substance abuse." R. at 405. Therefore, the ALJ was entitled to find that the later testing reflected a diminished capacity that was not present prior to Timmons' last date of disability for purposes of CIB.
Timmons argues, primarily, that the ALJ's reliance on the neurological testing performed by Dr. Ottinger should not have been afforded any weight because he administered the "modified" Halstead-Reitan battery which revealed very little in the way of abnormalities. However, the ALJ not only relied upon this examination by Dr. Ottinger, but also the later WAIS-R exam which revealed a full-scale score of 94. R. at 228. The ALJ considered these examinations in conjunction with Dr. Ottinger's opinion of Timmons' mildly diminished intellectual functioning and some compromised judgment and insight in determining whether Timmons was disabled prior to reaching age twenty-two. R. at 22. In attempting to analyze the medical evidence most relevant to the disability period in question, the ALJ found significant that these early examinations did not demonstrate significant limitations due to his head injury from the 1973 accident. R. at 24.
However, the ALJ went further in attempting to ascertain the degree to which his 1973 accident limited his functioning by analyzing later testing performed by Dr. Courtney. In 1991, Dr. Courtney performed the "full" Halstead-Reitan battery. Although the full test given in 1991 revealed a moderate level of neuropsychological impairment, Dr. Courtney noted that his impairment was an "admixture of two reasonably significant head injuries as well as a history of ongoing substance abuse." R. at 405. The ALJ noted that his WAIS-R exam results were consistent with those given in 1984. With respect to his problems of concentration and sustained attention, the test results revealed mild to moderate levels of impairment. R. at 404.
Counsel for Timmons does not address how the failure of the ALJ to account for the inability to perform executive functioning tasks leads to a determination that a Listing 12.02 impairment was warranted. There is no specific correlative discussion with respect to that particular evidence as it relates to the required level of severity under Listing 12.02. Specifically, Part B requires the presence of two of the four enumerated restrictions or difficulties before a claimant's impairment will be found to be disabling. See Goose, 238 F.3d at 983
More importantly, the inability to perform executive functioning tasks was not listed by any of the reviewing physicians or psychologists in the medical record as a severe limitation in Timmons' functioning that could be expected to prevent him from performing substantial gainful activity. Rather, the various medical sources appear to find, with various restrictions, that Timmons could have made a transition to some form of substantial gainful activity despite his limitations. In assessing his functional capacity in 1991, Dr. Dick did not opine that Timmons could not perform substantial gainful activity based upon his impairments; rather he set out the limitations with respect to what types of work that he could not perform (must take his anti-convulsant medication properly; avoid jobs requiring a good deal of judgment and avoid hazards). See R. at 28 242. However, it is unknown to what extent Timmons' functional capacity was further diminished by his long-standing and well documented substance abuse problems that occurred after his 1973 accident. It is undisputed that the various medical sources believed that his condition only worsened because of these problems.
Timmons also disagrees with the ALJ's assessment of the report issued by the Cardinal Center. This particular assessment was conducted in 1985. The report was intended to identify Timmons' skills and limitations. Timmons asserts that the ALJ misinterpreted the report in concluding that he would be capable of working after going through a twelve week period of work skills. Pl's Brief at p. 31. However, the ALJ merely opined that "It was thought that the claimant would be capable of working after going through a period of work skills training." R. at 24. The ALJ's finding was not a misrepresentation of the report; rather this interpretation was reasonable in light of the recommendations made. Specifically, the report identified jobs within the Elemental Work/Industrial (06.04) II as being particularly well suited for Timmons. R. at 215. Although the report identified several weaknesses in Timmons' ability to perform various work related tasks, a reasonable reading of the report indicates that with proper training Timmons could make a transition to some types of work activities.
Finally, Timmons asserts that the ALJ failed to adequately consider the testimony of Alberta Wamsley, Timmons' mother, in assessing the level of his impairment. Specifically, Timmons asserts that the ALJ should have paid more attention to her testimony concerning his inability to perform executive functioning tasks. However, a careful review of the ALJ's decision reveals that her testimony was not overlooked. For example, the ALJ noted Wamsely's testimony with respect to her claim that he could not even perform the simplest of tasks dating back to September 1978. However, the ALJ determined that this specific testimony was contradicted by the 1985 evaluation at the Cardinal Center which noted that he could perform certain tasks if they were simple instructions and especially if it was demonstrated to him how they task was to be performed. More importantly, the ALJ was entitled to base her decision on the documented medical evidence in the record in general and particularly the medical evidence during the period of disability in question.
The ALJ was presented with a daunting task in trying to adequately assess the level of severity of Timmons' impairment. Fortunately, there was a fair amount of evidence that could be reviewed by way of Dr. Ottinger's 1975 evaluation. While Timmons is entitled to disagree with the opinions given in that particular document, the ALJ was free to give that report particular weight given the fact that it was the most contemporaneous analysis during the period in question rather than lay testimony of Timmons' mother which attempts to characterize his condition almost twenty years later. Therefore, the ALJ was entitled to afford her testimony little weight as it related to the severity of his impairment prior to reaching age twenty-two, especially his inability to perform simple tasks. Thus, based upon a review of the relevant evidence supplied to the ALJ, it is clear that the decision was supported by substantial evidence.
2.
Timmons next asserts that the ALJ should have enlisted the services of a medical expert to (1) ascertain whether the limitations that were later found to support the award of SSI benefits had occurred prior to his date of last insured in September 1978 and (2) to provide useful insight into the recent advancements in the diagnosis and treatment of the particular neuropsychological impairment documented in this case. Timmons cites to Social Security Ruling 83-20 in support of his argument that a medical expert should have been called to determine whether his condition prior to age twenty-two rendered him disabled.
SSR 83-20 was issued to provide guidance in determining the onset of disability in Title II and XVI cases. This particular regulation provides, inter alia, when an ALJ should call upon a medical advisor to help with determining when the onset of disability date has occurred and whether that determination is based upon a "legitimate medical basis." Grebenick v. Chater, 121 F.3d 1193, 1201, (8th Cir. 1997) citing SSR 83-20. Under SSR 83-20, a medical advisor is necessary when there is no contemporaneous medical documentation and the medical evidence is ambiguous. Grebenick at 1201. Here the ALJ relied upon the contemporaneous medical evaluation of Dr. Ottinger. The testing performed by Dr. Ottinger in 1975 during the period of disability as well as the testing done in 1984 and 1991 outside of the period of disability revealed that Timmons' impairments did not show significant limitations. R. at 23-24. While Timmons may take issue with the extent of the testing performed by Dr. Ottinger, Timmons fails to demonstrate that the specific findings made by Dr. Ottinger in 1975 were somehow inherently flawed or not supported by the objective criteria as outlined in Dr. Ottinger' s report. Therefore, the ALJ was entitled to rely heavily upon this examination in reaching her conclusion in light of the fact that it was the most relevant medical evidence during the period in question.
20 C.F.R. § 404.1527(f)(2)(iii) also provides that an "ALJ may also ask for and consider opinions from medical experts on the nature and severity of your impairment." (emphasis supplied). Under this particular social security regulation there is no mandatory obligation placed upon the ALJ to call a medical expert; rather that particular regulation merely provides that an ALJ may ask for such an expert. It is not for this court to dictate to the dedicated individuals who serve as administrative law judges when they should exercise their discretion in determining when further medical expertise is needed and when it is not. Those individuals deal with complex medical cases on a regular basis and therefore are in the best position to determine, based upon a case by case analysis, whether additional medical analysis by an expert is needed.
IV. CONCLUSION
Based upon the foregoing reasons, the court finds that the decision below was supported by substantial evidence in the record. Therefore, the decision of the Commissioner is AFFIRMED. IT IS SO ORDERED.