Black was convicted of three counts of first degree murder and the jury sentenced him to death. On appeal, argued that he was ineligible for the death penalty due to mental retardation, under Atkins v. Virginia, 536 U.S. 304 (2002). Black's experts testified that his mental retardation was largely due to prenatal exposure to alcohol, but may have had other causes, as well, including lead exposure and head trauma from football injuries. The conclusions of the experts were based in part on brain imaging, including MRI and PET scans.

Tennessee law defines mental retardation by the presence of three factors: (1) sub-average intellectual functioning, evidenced by and IQ of 70 or below, (2) deficits in adaptive behavior, and (3) manifestation of the mental retardation by the age of 18.

Based on the evidence presented (including the fact that IQ tests administered to Black prior to the age of 18 all resulted in scores above 70; his score declined in later years), the court concluded that Black did not meet the third prong of Tennessee's definition of mental retardation.

As regards Black's prenatal exposure to alcohol, his sister testified that their mother drank alcohol during pregnancy, but the court noted that she "did not...testify as to the amount her mother drank while she was pregnant" (perhaps reflecting a mistaken impression that a certain level of alcohol exposure is required to result in damage or diagnosis). The court further noted that "it cannot be determined with certainty that the ingestion of alcohol during pregnancy will cause mental retardation." (It is not clear whether, if the court were convinced that Black's mental retardation was a result of his prenatal exposure to alcohol, that would have affected its conclusion as to whether his mental retardation manifested before he reached the age of 18.)

The court's opinion was based strictly on the state's statutory definition of mental retardation, and does not indicate whether FAS was otherwise presented as a mitigating factor during sentencing.