United States District Court, D. Connecticut
JOHN K. WALLACE
NANCY A. BERRYHILL, ACTING COMMISSIONER OF SOCIAL SECURITY
RULING ON THE PLAINTIFF'S MOTION TO REVERSE THE
DECISION OF THE COMMISSIONER AND ON THE DEFENDANT'S
MOTION FOR AN ORDER AFFIRMING THE DECISION OF THE
M. SPECTOR UNITED STATES MAGISTRATE JUDGE.
action, filed under § 205(g) of the Social Security Act,
42 U.S.C. § 405(g), seeks review of a final decision by
the Commissioner of Social Security [“SSA”]
denying the plaintiff Disability Insurance benefits
[“DIB”] and Supplemental Security Income benefits
about December 6, 2010, the plaintiff filed an application
for DIB and SSI benefits claiming he has been disabled since
January 15, 2008, due to manic depression and bipolar
disorder. (Certified Transcript of Administrative
Proceedings, dated June 6, 2017 [“Tr.”] 344-56,
411). The plaintiff's application was denied initially
(Tr. 234-41; see Tr. 242-45) and upon
reconsideration. (Tr. 246-51). On January 19, 2012, the
plaintiff requested a hearing before an Administrative Law
Judge [“ALJ”] (Tr. 252-58), and on November 14,
2012, a hearing was held before ALJ Ronald J. Thomas, at
which the plaintiff and the plaintiff's mother testified.
(Tr. 44- 74). On December 27, 2012, ALJ Thomas issued an
unfavorable decision denying the plaintiff's claims for
benefits. (Tr. 206-28). On February 15, 2013, the plaintiff
submitted a request for review of the hearing decision (Tr.
433-34), and on March 28, 2014, the Appeals Council granted
the plaintiff's request, vacating the December 27, 2012
decision, and remanding the matter for subsequent
proceedings. (Tr. 229-33).
second hearing was held before ALJ Thomas on June 26, 2015,
at which the plaintiff, his treating physician, Dr. John
Nowicki, and Howard Steinberg, a vocational expert,
testified. (Tr. 75-132). On October 27, 2015, ALJ Thomas
issued an unfavorable decision denying the plaintiff's
claim for benefits. (Tr. 9-43). The same day, the plaintiff
requested review of the hearing decision (Tr. 7), and, on
February 24, 2017, the Appeals Council denied the
plaintiff's request for review, thereby rendering the
ALJ's decision the final decision of the Commissioner.
April 24, 2017, the plaintiff filed his complaint in this
pending action (Doc. No. 1), and on June 26, 2017, the
defendant filed her answer and administrative transcript,
dated June 6, 2017. (Doc. No. 12). On July 12, 2017, the
parties consented to the jurisdiction of a United States
Magistrate Judge; the case was transferred to Magistrate
Judge Joan G. Margolis. (Doc. No. 17). On January 8, 2018,
the plaintiff filed his Motion to Reverse the Decision of the
Commissioner (Doc. No. 21), and brief in support (Doc. No.
21-2 [“Pl.'s Mem.”]),  and on April 6,
2018, the defendant filed her Motion to Affirm (Doc. No. 29),
and brief in support (Doc. No. 29-1 [“Def.'s
Mem.”]). On May 1, 2018, this case was reassigned to
this Magistrate Judge. (Doc. No. 30).
reasons stated below, the plaintiff's Motion to Reverse
the Decision of the Commissioner (Doc. No. 21) is granted
such that the matter is remanded for further proceedings
consistent with this Ruling, and the defendant's
Motion to Affirm (Doc. No. 29) is denied.
date of his second hearing, the plaintiff was fifty years old
and living with his mother. (Tr. 79). The plaintiff has lived
with his mother since he moved back to Connecticut from Los
Angeles in 2009. (Tr. 80). The plaintiff has an MBA from
DePaul University in Chicago and worked as an accountant in
Los Angeles before he stopped working in 2007. (Tr. 81-82). The
plaintiff testified that his last long-term employment ended
in 2006 when he was laid off; he started having panic attacks
and was “so stressed out it was ridiculous.” (Tr.
97). However, it was not until January 2008 that the
plaintiff “realized [he] had a problem” because
he was “in denial before that.” (Tr. 98). In
2010, the plaintiff was treated for cardiac heart failure
(Tr. 99), after which he suffered from “severe
depression[.]” (Tr. 100). At the time of the hearing,
the plaintiff reported that he had been sober for the past
year (Tr. 84), and that he attended Alcoholics Anonymous
meetings three times a week. (Tr. 85). According to the
plaintiff, he suffers from panic attacks, which are
“just as bad” now that he is sober, even with
“the [fourteen] pills” he takes each day. (Tr.
plaintiff testified that he does aqua classes three times a
week and walks his dog “about a block” to keep
his “heart going.” (Tr. 87, 89). According to the
plaintiff, he is “bad” with hygiene. (Tr. 91). He
makes simple meals and is not allowed to use the stove, and
he gets “bored” or loses interest when doing
chores. (Tr. 91; see also Tr. 103 (mows the lawn in
“pieces and parts”)). He drives to the gym and
grocery store, but he always uses a GPS because
“[s]ometimes” he forgets where he is going. (Tr.
92). According to the plaintiff, he is “horrific in
groups . . . [; he is] afraid of them.” (Tr. 94). He
does not answer his phone; he tries “to avoid social
interaction.” (Tr. 106). The plaintiff described his
writing as “so horrific[, ]” “like,
scribble[;]” he cannot complete tasks[;] he
“screw[s] up with everything[, ]” and his
short-term memory is “shot.” (Tr. 103-06).
John Nowicki, who is the plaintiff's mother's first
cousin, testified that he has been the plaintiff's
primary care physician since 2008. (Tr. 109-10). Dr. Nowicki
testified that the plaintiff has marked depression that
“worsened after his hospitalization in February
2010” and “became bipolar.” (Tr. 111).
According to Dr. Nowicki, the plaintiff has frequent panic
attacks that affect his ability to function. (Tr. 111). As of
result of his hospitalization in February 2010, during which
he suffered from cerebral anoxia, he has suffered from a
“decrease in his cognitive function, ” and his
IQ decreased by 40 points. (Tr. 111-14, 116). Additionally,
Dr. Nowicki opined that the plaintiff's psychiatric
treatment “seems to be somewhat successful, but not
fully successful[, ]” as the plaintiff has
“developed bipolar disorder” (Tr. 114), and he
has difficulty concentrating and “following
through.” (Tr. 116). According to Dr. Nowicki, the
plaintiff has marked restrictions in activities of daily
living, social functioning, and concentration, persistence,
or pace, and the plaintiff's mental impairment meets
Listing 12.03. (Tr. 118-19).
vocational expert testified that a person of the
plaintiff's age, education, and work experience who is
limited to the light exertional level of work could
occasionally bend and balance, twist, climb, crawl, kneel,
and squat; could sustain routine, simple, repetitive tasks
not requiring teamwork or working closely with the public;
could engage in occasional interaction with the public,
supervisors, and coworkers; and could perform the following
light, unskilled jobs: office helper with approximately 207,
000 jobs in the national economy; hotel housekeeper with
approximately 137, 000 jobs in the national economy; and mail
clerk with approximately 122, 000 jobs in the national
economy. (Tr. 121-23).
August 4, 2008, the plaintiff was admitted at California
Pacific Medical Center after presenting to the emergency room
with reports of a seizure. (Tr. 755; see Tr.
755-57). He stated that he previously had a seizure in March,
but attributed it to anxiety and did not seek medical
attention. (Tr. 755). The plaintiff “actively denied
any significant use of alcohol or any other drugs throughout
the course of his hospital stay[, ]” and his partner,
who accompanied him, reported that the plaintiff was
“clearly minimizing his alcohol use.” (Tr. 755).
Testing in the emergency room confirmed a blood alcohol level
and the presence of cocaine. (Tr. 755). The plaintiff's
seizure symptoms were diagnosed as “most consistent
with alcohol withdrawal.” (Tr. 756). He was also
diagnosed with alcoholic hepatitis and hypertension. (Tr.
756). The plaintiff was treated for alcohol withdrawal, but
despite ongoing symptoms, by August 8, he was discharged upon
request, as he was not considered “a candidate for
hold” given that he was appropriately oriented. (Tr.
756). The plaintiff returned to the emergency room the next
day for readmission; the attending doctor noted that when the
plaintiff left the hospital the day prior, he “clearly
went out and drank.” (Tr. 758-59). He was discharged
with a diagnosis of alcohol withdrawal, a prescription for
Ativan, and a referral for inpatient detoxification. (Tr.
the plaintiff was admitted for rehabilitation from September
10 to 24, 2008. (Tr. 451-56). He was discharged with the
following diagnoses: alcohol dependence, anxiety not
otherwise specified, and rule out panic disorder; he was
prescribed medication for anxiety and hypertension. (Tr.
451-53). The plaintiff also had elevated liver function
tests, seizures, sleep apnea, hypertension, and anemia. (Tr.
452). The plaintiff was directed to follow-up with a
psychiatrist within two weeks. (Tr. 452).
6, 2009, the plaintiff was treated at St. Vincent's
Medical Center after he “was found down at the
Bridgeport Train Station.” (Tr. 622, 1373-75; see
generally Tr. 629-35 (normal x-rays, CT chest scan, CT
head scan, CT abdominal scan)). After treatment of abrasions,
the plaintiff was assessed as ready to be discharged
“when he sobers up.” (Tr. 1374).
August 31, 2009, the plaintiff was admitted for residential
treatment for chemical dependence relapse at Ocean Hills
Recovery, where he was treated by Martin Pennington, Psy.D.
(Tr. 470-73; see Tr. 463). Dr. Pennington, a
psychologist, observed on a mental status examination that
the plaintiff was of high intelligence with an intact memory,
without thought disorder, and without delusions or
hallucinations. (Tr. 470). The only diagnosis that Dr.
Pennington noted was alcohol dependence. (Tr. 470).
plaintiff met with Dr. Pennington on a weekly basis for the
month of September, starting on September 2, 2009. (Tr.
474). The plaintiff reported that, at that time,
he was “working on his C.P.A[, ]” and that he
worked for Warner Brother's music “doing accounting
and finance” when he lived in Los Angeles. (Tr. 474).
According to the plaintiff, he underwent intensive outpatient
treatment for alcohol dependence once before, for two weeks,
following which he “stayed sober for a couple of months
and then started binging.” (Tr. 474). A mental status
examination was unremarkable, and the plaintiff was clean and
appropriately dressed. (Tr. 474). He was cooperative; he had
good eye contact and normal speech; his mood was happy; his
memory was intact; his insight was good; his judgment was
fair; and, his thought process was coherent. (Tr. 474). Dr.
Pennington noted that the plaintiff had above average
intelligence, and good attention and concentration. (Tr.
474). The plaintiff's goal was to “stop his binge
drinking and stop drinking completely so that he can truly
live his life.” (Tr. 474). By September 28, 2009, he
was looking for a job and planning to return to California.
(Tr. 469). He was discharged on October 1, 2009, in good
condition, but Dr. Pennington noted his concern that the
plaintiff needed thirty more days of treatment and had not
fully accepted his alcoholism. (Tr. 463).
February 26 to March 6, 2010, the plaintiff was admitted to
Western Medical Center in California. (See Tr.
477-571). The plaintiff presented with shortness of breath
and heart palpitations; he was diagnosed with bilateral
pneumonia (Tr. 479 (“septic pneumonia”)), then
with cardiomegaly and cardiogenic shock. (Tr. 477). He was
found to have major arterial blockages that required
stenting. (Tr. 481). The plaintiff reported a history of
anxiety disorder, and was noted to be “very
anxious“ upon admission. (Tr. 481).
his cardiology consult, Dr. Arthur Selvan noted that an
echocardiogram “revealed an enlarged left ventricle
with severe generalized hypokinesis and markedly reduced
indices of systolic performance: Estimated ejection fraction
approximately 18-20%.” (Tr. 484-85). Dr. Selvan
diagnosed “severe cardiomyopathy of unknown etiology
with markedly diminished indices of left ventricular systolic
performance . . . . Shock syndrome: probably cardiogenic;
respiratory failure with bilateral infiltrates: probably
congestive heart failure . . . .” (Tr. 485) (emphasis
omitted). He assessed the plaintiff's prognosis as
“[v]ery poor.” (Tr. 485). On February 28, 2010,
Dr. Selvan inserted a Swan-Ganz thermodilution catheter and
arterial line, and while hospitalized, the plaintiff
underwent a catheterization and the insertion of stents. (Tr.
492, 494; see also Tr. 496-97).
his hospitalization, the plaintiff was very anxious, had
chronic essential tremors, and was given medication for
iron-deficiency due to anemia. (Tr. 477). In a psychiatric
consultation subsequent to his cardiac surgery, the plaintiff
reported that he had “always been a nervous, anxious
guy, ” that he did not “drink that much anymore,
” and that he was “binge drinking but . . . was
still able to work 60 hours a week.” (Tr. 486). The
plaintiff denied ever having a psychiatric diagnosis or
seeing a psychiatrist or psychologist other than for alcohol
dependence, and he noted that he has “always been very
functional throughout his life despite the alcoholism.”
(Tr. 486-87). According to the plaintiff, he was “in
between jobs secondary to the economy and frequent moving
back and forth between the East Coast and different cities on
the West Coast.” (Tr. 488). The plaintiff reported that
he was currently drinking a few glasses of wine once or twice
a week (Tr. 486), although at other points during the
admission, the plaintiff said that he was drinking vodka.
(Tr. 481, 490). The plaintiff stated that he had a brief
period of panic attacks driving or going over bridges, for
which he took Xanax, but that “this resolved[,
]”and although the consulting psychiatrist advised the
plaintiff that he could receive psychological follow-up after
discharge, the plaintiff saw “no need for psychiatric
follow[-]up.” (Tr. 487-88).
plaintiff subsequently returned to Connecticut and began
treatment at Cardiac Specialists, P.C., primarily under the
care of Dr. Steven Kunkes. (See Tr. 678-87,
943-45). On March 30, 2010, the plaintiff reported
to Dr. Kunkes that he “now feels well - no [chest
pain]” and that epigastric discomfort, which he had
experienced, was “now better.” (Tr. 678).
14, 2010, the plaintiff presented to the emergency room for
complaints of palpitations and pulsing in his veins lasting
one day. (Tr. 577-82, 699-700). The plaintiff denied chest
pain, shortness of breath, or nausea, but reported some
lightheadedness. (Tr. 577, 699). He smelled of alcohol and
had a breath level reading of 0.34. (Tr. 577, 699). Emergency
room personnel noted that the “[plaintiff] appears to
be an alcoholic[.] Mother tends to be confrontive [sic] and
[intrusive].” (Tr. 588). The plaintiff reported that he
was not working “because he is grieving the deaths of
[two] friends.” (Tr. 588).
examination, the cardiologist felt that there was no cardiac
indication for an admission (Tr. 573, 578, 1291, 129); the
plaintiff was admitted, however, for alcohol detoxification.
(Tr. 572-74, 1290-93; see Tr. 589-608). He reported
that he had been binge drinking since college “to
‘self-medicate' for his high anxiety level, which
he has suffered since childhood.” (Tr. 572). He also
reported a long history of major depression, decreased
appetite, anhedonia, and substance abuse. (Tr. 572). The
plaintiff was treated for alcohol withdrawal, given Lexapro
for depression, and was discharged three days later with
instructions to see APRN Robert Krause for follow-up. (Tr.
plaintiff was seen at Cardiac Specialists on June 21, 2010;
the plaintiff's coronary artery disease was noted as
“stable.” (Tr. 684). The plaintiff's blood
pressure was 80/60 sitting and 70/60 standing; medications
were ordered and the plaintiff was instructed to “take
salt.” (Tr. 684). The following day, the plaintiff
returned with complaints of esophageal discomfort and a
feeling of “pulsations” in the veins of his arm.
(Tr. 683). In a letter dated the same day, Dr. Kunkes
informed Dr. Nowicki that the plaintiff's “current
problems” were anemia, abnormal liver tests
“which may be due to alcohol, and an elevated
creatinine that may be due to dehydration.” (Tr. 751).
August 4, 2010, the plaintiff presented to the emergency room
for complaints of right shoulder pain after he “ran
into a door frame by accident.” (Tr. 640, 763, 1331;
see Tr. 640-53, 763-68, 1131-36). He suffered a
right shoulder fracture. (Tr. 642-44, 765-67).
plaintiff was seen for an orthopedic consultation for the
shoulder fracture by Dr. David J. Martin on August 5, 2010;
the plaintiff reported that he was “in fairly good
health otherwise.” (Tr. 663-64; see Tr. 675).
Dr. Martin recommended surgery pending cardiology clearance.
(Tr. 664; see Tr. 665). In a Cardiac Specialists
visit on August 10, 2010 for surgical clearance, the
plaintiff smelled heavily of alcohol and had slurred speech.
(Tr. 681). The plaintiff underwent the right shoulder
surgical procedure on August 18, 2010. (Tr. 636-38, 674-76,
760-62, 1347, 1371-72; see Tr. 666-73).
September 3, 2010 appointment with Cardiac Specialists, the
plaintiff reported that he felt well. (Tr. 680). Two months
later, on November 12, 2010, the plaintiff reported to Dr.
Martin that he still had difficulty fully elevating his arm,
but he was “trying to do a lot of things including
playing football and raking leaves.” (Tr. 669). Dr.
Martin advised the plaintiff to be patient, work daily on
stretching, and “[n]o football.” (Tr. 669). On
November 29, 2010, the plaintiff told Dr. Martin that he fell
over the weekend and landed on his lower back and right
elbow. (Tr. 670). Two weeks later, on December 13, 2010, the
plaintiff reported that his back felt better, and there was
no mention of his right elbow. (Tr. 672). The plaintiff
reported, however, that he broke a rib while snowboarding a
year ago and that recently, his rib pain was re-aggravated.
(Tr. 672). He also reported increased shoulder pain. (Tr.
672). Dr. Martin observed that, on x-rays, the
plaintiff's shoulder looked healed, but recommended a
computed tomography scan of the shoulder to “make sure
that we are not dealing with non-union.” (Tr. 672). He
recommended that the plaintiff restrict his activities. (Tr.
672). The plaintiff was seen on the same day at Cardiac
Specialists, where he reported that he stopped drinking
alcohol. (Tr. 678). On December 17, 2010, the plaintiff
underwent imaging of his right shoulder which revealed
“[r]ight plueral effusion” for which
“further investigation [was] warranted.” (Tr.
710, 732, 853).
the plaintiff returned to Cardiac Specialists on January 17,
2011, he mentioned being active in an exercise program, and
that he felt better and was less depressed. (Tr. 724). On
February 9, 2011, the plaintiff was seen for a neurological
consultation with Dr. Philip Barasch for complaints of memory
difficulties, most of which were brought to his attention by
his mother, who told him that he did not pay attention and
did not remember tasks he needed to do. (Tr. 706). His mother
reported that the plaintiff had increased anger at home and
that he had “not been the same person that he was
previously.” (Tr. 706). She reported that he was also
drinking alcohol too much, but the plaintiff denied this and
said he only drank once a week. (Tr. 706). According to his
mother, the plaintiff was somewhat “disinhibited[,
]” at times “delusional, ” and that he had
not been telling her the “truth.” (Tr. 706). On
examination, the plaintiff had intact language function,
attention span, recall and concentration, and during
conversational speech, the plaintiff “appeared quite
tangential.” (Tr. 706). Dr. Barasch assessed the
plaintiff as having “had a behavioral change, ”
and it was unclear whether this represented a psychiatric
disorder or “a possible neurological problem such as
frontotemporal dementia given that he has not been working
for at least the past five years for unclear reasons or
alcohol abuse.” (Tr. 707). Dr. Barasch performed an
electroencephalography, which was normal. (Tr. 705). He
recommended a neuropsychological examination. (Tr. 707).
Martin observed on February 15, 2011, that the plaintiff was
doing better and had no pain. (Tr. 851). He advised the
plaintiff to continue use of an Exogen stimulator and could
resume a strengthening program including pulleys, but not to
play football or “contact sports obviously.” (Tr.
March 31, 2011, the plaintiff presented to the emergency room
with complaints of ringing in the left ear for the past three
weeks which became worse that night when he was drinking
alcohol. (Tr. 769, 1342; see Tr. 769-72, 1342-45).
The plaintiff thought that he may have been injured while
“playing sports[.]” (Tr. 770). He denied
significant alcohol intake or having a drinking problem, but
his mother and brother reported that he had been very
intoxicated each day for at least a week. (Tr. 770). The
plaintiff's mother reported that the plaintiff told her
to kill him and gave her a knife, and she demanded that he
“be sent to detox because he is mentally
imbalanced.” (Tr. 770). The plaintiff did not want to
go to detox, and when his mother continued to demand
admission, the plaintiff became angry and “got up and
went straight to the door and left, no unsteady gait, clear
intent, very aware of his action. He was calm and cooperative
during his stay, was very clear in expressing his
preferences. Mom was aggressive, somewhat belligerent and
threatening.” (Tr. 771). The plaintiff's mother was
advised that a person who was alert and oriented could not be
forced into detox, but she repeatedly stated that the
plaintiff was unbalanced and mentally unwell and should not
be allowed to make his own decisions. (Tr. 771).
April 7, 2011, the plaintiff presented for a
neuropsychological evaluation with Dr. Michelle Bobulinski.
(Tr. 773-78). Dr. Bobulinski assessed the plaintiff as
having “[m]ild subcortical neurocognitive weaknesses,
in the setting of a significant history of cardiovascular
disease, psychological and emotional difficulties, and
alcohol dependence.” (Tr. 773). A review of the
plaintiff's records indicated that he left his corporate
finance or accounting job to travel, but then could not find
a job for the next one or two years. (Tr. 773). The plaintiff
reported that he was laid off. (Tr. 773). He also noted,
“He and his family are concerned that some of his
personality changes may have resulted or been exacerbated by
his cardiac condition, as he reportedly was deprived of
oxygen for two days when he had congestive heart failure and
was treated for pneumonia instead.” (Tr. 774). He
admitted to using alcohol increasingly after he stopped
working, and his family observed that his personality was
significantly different and that he had been drinking alcohol
in excess. (Tr. 774). He could go for a week or longer
without using alcohol, but would then be triggered by
something and have excessive use including periods of
blacking out. (Tr. 774). The plaintiff reported that
“[o]nce every two months, approximately, he experiences
symptoms of vertigo[.]” (Tr. 774). Over the past year,
the plaintiff had been independent in his daily living
activities, however, he is “relatively isolated.”
(Tr. 774). The plaintiff was recovering from a shoulder
injury, and hoped to resume regular exercise. (Tr. 774). He
was not aware of any obvious cognitive changes, but reported
that his lifestyle changed so dramatically it was difficult
for him to tell. (Tr. 774). He reported being increasingly
depressed due to missing his friends and former lifestyle,
and not having a job. (Tr. 774). The plaintiff stated that
finding a job was his top priority, but he was “feeling
some trepidation with respect to returning to work and
question[ed] whether he [would] able to handle the same pace
and lifestyle as before. Reportedly, he enjoyed his work
lifestyle, which also included an intense 70 hour work week,
including socializing for business.” (Tr. 774). The
plaintiff reported a somewhat disturbed sleep routine,
staying awake until four in the morning due to some
depression and some anxious ruminations. (Tr. 774).
Bobulinski noted the plaintiff's tremor and that he had a
mildly anxious and depressed mood. (Tr. 775). The plaintiff
recalled events with no apparent difficulty, and he had no
observable evidence of thought disorder or psychosis. (Tr.
775). Testing results showed overall mild subcortical
cognitive weaknesses, and Dr. Bobulinski noted that, given
the plaintiff's estimated premorbid intellectual
functioning, the current results “may actually
represent a more significant change or dampening of
neurocognitive functioning.” (Tr. 776). The
plaintiff's self-reports of psychological functioning and
personality showed a profile similar to individuals
indicating somatic complaints and behavioral dysfunction.
(Tr. 776). Assuming that physical origins of the
plaintiff's reported neurological and gastrointestinal
symptoms could be ruled out, the results suggested a
potential somatoform disorder, although
“alcohol/substance abuse also remains a significant
area of concern, ” which further “increases risk
to the patient's cognition and overall health and
well-being, including vascular disease and potential
progressive cognitive decline.” (Tr. 776). The
plaintiff admitted to getting drunk at least once a week, as
well as taking drugs or sleeping pills not prescribed by a
doctor. (Tr. 776-77). Dr. Bobulinski had several
recommendations, including an MRI of the plaintiff's
brain, psychiatric evaluation, and psychotherapy, but Dr.
Bobulinski also noted that the plaintiff's acting-out
tendencies could result in treatment noncompliance. (Tr.
plaintiff returned to Dr. Barasch on April 19, 2011. (Tr.
780-81). He stated that he ceased drinking alcohol and had
been applying for work. (Tr. 781). He reported an improved
memory and no major behavioral issues. (Tr. 781). The
plaintiff's mother, who was interviewed separately, said
that the plaintiff was “constantly lying” and
that he continued to drink. (Tr. 781). After reviewing Dr.
Bobulinski's evaluation, Dr. Barasch ordered an MRI which
was done on April 28, 2011; the results revealed mild
cerebral atrophy. (Tr. 779, 782).
plaintiff returned to Dr. Martin for his shoulder on April
27, 2011; he reported doing really well, with no pain. (Tr.
852). Dr. Martin recommended that the plaintiff return in a
year and that he “can essentially do whatever he can
tolerate.” (Tr. 852).
plaintiff's visits with Dr. Nowicki throughout 2011
focused on alcohol use (Tr. 935-37), and in late May, the
plaintiff mentioned that he was exercising four times a week.
26, 2011, the plaintiff began treatment at the Pride
Institute for “alcohol use, and depression”
(Tr. 787); his admitting diagnosis was alcohol dependence.
(Tr. 803-04). He was admitted for residential treatment until
discharge on July 20, 2011. (Tr. 787-804). He reported that
he had been heavily binging on alcohol three times a week for
the past six months. (Tr. 808; see Tr. 794, 800). On
July 2 and 6, his mood and affect were “neutral to
positive” (Tr. 790-91), and, in his mental health
consultation on July 4, 2011, the plaintiff's
“[p]resenting [p]roblem” was that he
“can't stop drinking.” (Tr. 792). On July 6,
2011, it was noted that his tremor was improving as was his
insight and judgment. (Tr. 790; see also Tr. 806
(July 13, 2011, plaintiff reported tremor “is
better”)). He also admitted to occasional cocaine use.
(Tr. 792). When asked if he had mental health concerns, the
plaintiff stated that he had regrets about a former
relationship. (Tr. 792). His discharge diagnosis was alcohol
dependence (Tr. 798; see also Tr. 793), although, in
the discharge summary, the plaintiff reported “symptoms
of depression and panic attacks.” (Tr. 794).
29, 2011, Dr. Kunkes informed Dr. Nowicki that the plaintiff
had complaints of fatigue and was taking three different
medications of the same type, which were adjusted. (Tr. 942).
The plaintiff returned to Cardiac Specialists on December 8,
2011, at which time he reported that he was active, but not
exercising. (Tr. 809). He complained of dizziness with
vertigo and vomiting. (Tr. 809). His blood pressure
medications were adjusted. (Tr. 809). His coronary artery
disease was stable. (Tr. 809). On December 11, 2011, Dr.
Kunkes wrote a letter to Dr. Nowicki to inform him that the
plaintiff “has been adjusting his own
medications” and consequently had relatively high blood
pressure and elevated cholesterol, and his medications were
being adjusted. (Tr. 940).
December 16, 2011, the plaintiff underwent a consultative
evaluation with Bina Roginsky, Psy.D. (Tr.
814-17). The plaintiff's mother reported that
he had major changes in his cognition after his cardiac
event, which she described as resulting in loss of oxygen to
the brain. (Tr. 814). The plaintiff and his mother reported
that he had not had any alcohol since he attended
rehabilitation sometime in the last year. (Tr. 814). Dr.
Roginsky observed that the plaintiff was detached and
passive, many times was unable to provide details and
frequently gave contradictory and illogical answers. (Tr.
815). The plaintiff was “difficult to understand, and
he had trouble with speaking only English.” (Tr. 815).
He often repeated words, ...