FINDINGS OF FACT AND CONCLUSIONS OF LAW
After careful consideration of the entire record, the undersigned makes the following findings:1. The claimant has not engaged in substantial gainful activity since June 21, 2007, the application date (20 CFR 416.971 et seq.).
2. The claimant has the following sever impairments: schwannoma tumor in the jugular foramen, visual disorder, dysthymia, and depression (20 CFR 416.920(e)).
The above impairments cause significant limitations in the claimant’s ability to perform basic work activities.
3. The claimant does not have an impairment or combination of impairments that meets or medically equals one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1 (20 CFR 416.920(d), 416.925 and 416.926).
The undersigned considered listing 2.02 governing the loss of visual acuity. In order to meet Listing 2.02, the claimant must have remaining vision in the better eye after best correction of 20/200 or less. There is no evidence in the medical record to suggest that the claimant’s visual acuity in the better eye has deteriorated to satisfy the requirements of Listing 2.02.
The undersigned also considered listing 2.04 governing the loss of visual efficiency. In order to meet Listing 2.04, the claimant must have a visual efficiency of 20 percent or less as determined by kinetic perimetry. The claimant argues that he meets 2.04 and that his doctor has determined that he met Listing 2.04. However, upon review of the medical record of evidence, the claimant’s doctor reported that the claimant’s visual efficiency was 72 % in his right eye and 57% in his left eye which is far from meeting the criteria in Listing 2.04 (Exhibit 15F/1).
*I don't understand any of this or what my doctor wrote. But, apparently, having major blind spots in my central vision isn't a big enough deal. I guess as long as I might see part of something in front of me, that's good enough. I wonder if he'd want me to drive next to him since my vision is, by his standards, within the BMV requirements.
The claimant’s mental impairments, considered singly and in combination, do not meet or medically equal the criteria of listing 12.04. In making this finding, the undersigned has considered whether the "paragraph B" criteria are satisfied. To satisfy the "paragraph B" criteria, the mental impairments must result in 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 extended duration. A marked limitation means more than moderate but less than extreme. Repeated episodes of decompensation, each of extended duration, means three episodes within l year, or an average of once every 4 months, each lasting for at least 2 weeks.
In evaluating the claimant’s psychological impairments, the undersigned utilized the technique set forth at 20 CFR 404.1520a and 416.920a. The claimant’s depression causes no more than mild restrictions in activities of daily living, mild difficulties in the ability to maintain social functioning, or moderate deficiencies of concentration, persistence or pace. The claimant is able to maintain personal hygiene and grooming, he lives with his parents, does the laundry, cooks, watches television, pursues social networking on the computer, goes out with friends to watch sporting events at bars, and regularly attends basketball games. The claimant reads, although he tires easily while reading. Based on this, the mental condition fails to satisfy the A and B criteria. Moreover, there is no evidence that even a minimal increase in mental demands or change in the environment would be predicted to cause the claimant to decompensate. Additionally, there is no history of an inability to function outside a highly supportive living arrangement. Finally, there is no evidence that he is completely unable to function outside the area of his home environment. Consequently, the A and C criteria are not at listing level severity.
*I don't know about specific legal definitions or guidelines, but it seems to me that because I'm not a total slob and can shower somewhat regularly (though often not when I want to), that I live with my parents (as opposed to what?), that I do laundry (I have enough clothes to last me awhile, but I still can't always do it when I want to--for instance, I'd prefer to wash my bedding once a week, but that doesn't ever happen), that I feed myself (rarely what I want--I often settle for something simple like a sandwich instead of cooking something more elaborate), that I watch TV (really?!?!), that I'm do social networking online (reading what you're up to and posting a little about my life makes me less sick?), that I go somewhere else to watch TV (well, if watching TV at home is too much...), and going to Fever games in the summer (even if I'm just sitting there, which happens a lot, despite my inclinations to cheer), and because I read, apparently at all (wow), I'm not disabled. Basically, because I function AT ALL, I'm not depressed enough. To hell with feeling hopeless and suicidal (in the past), wondering what the point of doing anything is, and, when I have the tears, crying to myself so sick of the nothingness that my life has become. Fuck it, I can watch TV, I must be alright.
4. After careful consideration of the entire record, the undersigned finds that the claimant has the residual functional capacity to perform light work as defined in 20 CFR 416.967(b) except the claimant is limited to occasional postural activities with no climbing of ladders, ropes, or scaffolds. He must avoid all hazards and can engage in activity only requiring occasional visual functioning (i.e. occasional near and far acuity, field of vision, peripheral acuity, depth perception, and nighttime vision). The claimant is also limited to perform simple and repetitive tasks.
*Standing up is a hazard. "Occasional visual functioning???" So I can do stuff that I only need to see part of the time? What am I suppose to do when I'm unable to see?
In making this finding, the undersigned has considered all symptoms and the extent to which these symptoms can reasonably be accepted as consistent with the objective medical evidence and other evidence, based on the requirements of 20 CFR 416.929 and SSRS 96-4p and 96-7p. The undersigned has also considered opinion evidence in accordance with the requirements of 20 CFR 416.927 and SSRS 96-2p, 96-Sp, 96-6p and 06-3p.
In considering the claimant’s symptoms, the undersigned must follow a two-step process in which it must first be determined whether there is an underlying medically determinable physical or mental impairment--i.e., an impairment that can be shown by medically acceptable clinical and laboratory diagnostic techniques--that could reasonably be expected to produce the claimant's pain or other symptoms. Second, once an underlying physical or mental impairment that could reasonably be expected to produce the claimant's pain or other symptoms has been shown and because a claimant’s symptoms can sometimes suggest a greater level of severity of impairment than can be shown by the objective medical evidence alone, the undersigned must consider in addition to the objective medical evidence when assessing the credibility of the claimant's statements:
1. The claimant's daily activities;
*Next to nothing--little of significance
2. The location, duration, frequency, and intensity of the claimant's pain or other symptoms;
*CONSTANT WOOZINESS/BLINDNESS
3. Factors that precipitate and aggravate the symptoms;
*Being active, looking up/down, bending over, stress
4. The type, dosage, effectiveness, and side effects of any medication the claimant takes or has taken to alleviate pain or other symptoms;
*Nothing really helps the wooziness
5. Treatment, other than medication, the claimant receives or has received for relief of pain or other symptoms;
6. Any measures other than treatment the claimant uses or has used to relieve pain or other symptoms (e.g., lying flat on his or her back, standing for 15 to 20 minutes every hour, or sleeping on a board); and
*Ceasing activity, lying down, NOT BEING ACTIVE
7. Any other factors concerning the claimant's functional limitations and restrictions due to pain or other symptoms (SSR 96-7p).
For this purpose, whenever statements about the intensity, persistence, or functionally limiting effects of pain or other symptoms are not substantiated by objective medical evidence, the undersigned must make a finding on the credibility of the statements based on a. consideration of the entire case record.
This 31 year old claimant alleged that he has macular serpiginous choroiditis, depression, asthma, lightheadedness, and dizziness. He claims that his eyes are sensitive to light and that he is depressed due to his poor health. He claims that he is unable to concentrate and that he rarely does anything physical because he is always disoriented.
After careful consideration of the evidence, the undersigned finds that the claimant’s medically determinable impairments could reasonably be expected to cause the alleged symptoms; however, the claimant’s statements concerning the intensity, persistence and limiting effects of these symptoms are not credible to the extent. They are inconsistent with the above residual functional capacity assessment.
*So I'm only visually impaired part of the time? CONSTANT wooziness isn't that bad? What, exactly, isn't credible about my 'claims?'
The claimant has a long history of having serpiginous choroiditis, an inflammatory condition of the eye. His physician noted in a letter in October of 1998 that the claimant had a moderate visual impairment due to this condition and that he had photophobia and decreased vision in certain light conditions (Exhibit 15F/62). In May of 2009, the claimant had his vision evaluated and his doctor reported that the claimant’s visual acuity was 20/40 in the right eye and 20/50 in the left eye, uncorrected, with a corrected visual acuity of 20/25 and 20/40 respectively (Exhibit 15F/70). Although the claimant’s doctor in September of 2009 noted that the claimant met Listing 2.04, the doctor reported that the claimant’s visual efficiency was as 72% in his right eye and 57% in his left eye which was far from meeting the criteria in Listing 2.04 (Exhibit 15F/1).
*Classifying it as "an inflammatory condition of the eye" is underselling it a bit. I have scar tissue on my retinas, which causes blind spots. That means that I CANNOT SEE where those spots are. I guess compared to being completely blind, I have "moderate visual impairment," but I have TOTAL VISUAL IMPAIRMENT where the scarring is, and it is significant. And to get the 20/40 and 20/50 acuities, I have to move my eyes/head around to try to catch things peripherally. I can't just look at something and see it since my central vision is so compromised by the scarring. And lighting is a HUGE factor with my sight. If it's too bright, my functional vision, beyond being able to get around, is nil. Why does everything get so understated?
The claimant also had a long history of dizziness and lightheadedness. In January of 2009, the claimant underwent a biopsy of his jugular foremen which demonstrated that the claimant had a schwannoma tumor (Exhibit 14F/28). He underwent surgery to remove the tumor; however, during the surgery, the claimant’s blood pressure and pulse dropped at a dramatic rate and the surgeon was unable to remove the schwannoma tumor (Exhibit 14F/1). During a follow-up examination, his physician noted that the majority of the tumor, approximately 75-90%, still remained (Exhibit 14F/3). In August of 2009, the claimant’s physician noted that the claimant continued to have occasional dizziness (Exhibit 14F/1). The physician also noted that the claimant’s strength was 5 out of 5 and that his reflexes were symmetric (Exhibit 14F/1).
*So 822 characters sums up my tumor? Being forced to leave 75-90% of a huge ass lesion in my head is not significant? The "occasional dizziness" meant occasional INCREASED dizziness that's on top of the wooziness I CONSTANTLY feel. What the fuck does my strength and reflexes have to do with being woozy? I guess I'm strong enough to survive a fall and my leg will kick out if I land on my knee just right?
The claimant was also diagnosed with Dysthymic Disorder in September of 2005 (Exhibit SF), and depression in July of 2007 (Exhibit 11F). His psychologist noted that the claimant felt that his depression would remain as long as he remained physically impaired and dependent on others (Exhibit 11F). In August of 2007, the claimant reported that his concentration was “o.k.” and that he was often bored (Exhibit 11F). In January of 2008, the claimant’s case manager at the community mental health center noted that the claimant was only mildly depressed; however, he still had feelings of hopelessness and low energy (Exhibit 11F). The claimant underwent a consultative examination in September of 2007. At that time, the state agency's consultant noted that the claimant’s muscle tone and strength was 5 out of 5 in all extremities with no muscle wasting (Exhibit 5F/5). The consultant also noted that the claimant’s gait was normal and that his station was normal (Exhibit 5F/5 ). The claimant was also able to walk on his heels and toes and squat and rise from a squatted position without difficulty (Exhibit 5F/ 5).
*Again, we have incomplete and understated information. Too, what does my strength or gait or ability to walk on my toes/heels, etc. have to do with being depressed? Or wooziness? Or blindness?
Although the claimant has described daily activities which are fairly limited, two factors weigh against considering these allegations to be strong evidence in favor of finding the claimant disabled. First, allegedly limited daily activities cannot be objectively verified with any reasonable degree of certainty. Secondly, even if the claimant’s daily activities are truly as limited as alleged, it is difficult to attribute that degree of limitation to the claimant’s medical condition, as opposed to other reasons, in view of the relatively weak medical evidence and other factors discussed in this decision. The undersigned noted that there are facts and inconsistencies in the record which detract from the credibility of the claimant’s allegations. In the claimant’s disability report, he stated that he was unable to do much and that he considered himself lucky if he could stand up. However, the claimant testified that he took care of his personal hygiene, did the laundry, cleaned his room, watched television, pursued social networking on his computer, attended sporting events, and went out socially with fiends to watch sporting events. Further, although the claimant claimed limited activities of daily living, his mother reported in a 3rd party report that he had no problem taking care of his hygiene and that he watched movies and worked on his computer (Exhibit 9E). She also reported that the claimant needed to be more active (Exhibit 9E). Although the inconsistent information provided by the claimant may not be the result of a conscious intention to mislead, nevertheless the inconsistencies suggest that the information provided by the claimant generally may not be entirely reliable.
*If my "allegedly limited daily activities cannot be objectively verified with any reasonable degree of certainty," then what am I supposed to do? My situation is my situation. I don't choose my symptoms or limitations. Weak medical evidence? A golf ball sized tumor in my head that they were unable to remove much of because I almost died when they were working on it is weak? Scars on my retinas is weak? Not being able to see is week? And all of those activities that I apparently do...it's really not that much. Showering makes me able-bodied? Watching TV? REALLY? Getting out of the house once in awhile, if just for my own sanity (literally) is that much? And the stuff from my mom. I only asked her to fill that out because no one else would. I should have left it blank. She didn't believe I was sick then (they hadn't found the tumor yet). But because my mom said my hygiene was fine (maybe I should stink more) and because I can watch movies (SERIOUSLY??) and mess around on my computer some, I'm OK? What is inconsistent? Yes, I do stuff sometimes when I feel good enough to do it. Most of the time, though, I just sit around and try not to fall over. Sometimes I'm successful.
In accordance with Social Security Ruling 96-6p, the undersigned considered the administrative findings of fact made by the state agency medical physicians and other consultants and weighed these opinions as statements from non-examining expert sources. The residual functional capacity conclusions reached by the physicians employed by the State Disability Determination Services also supported a finding of "not disabled." Although those physicians were non-examining, and therefore their opinions do not as a general matter deserve as much weight as those of examining or treating physicians, those opinions do deserve some weight, particularly in a case like this in which there exist a number of other reasons to reach similar conclusions.
*It doesn't seem he took anything that my doctors said about me being as bad off as I am into any consideration. And based on how the hearing went, it didn't seem like he talked to any doctors. And "in a case like this in which there exist a number of other reasons to reach similar conclusions" is to mean what, exactly? Both my eye condition AND the tumor are extremely rare. My situation is not at all common.
In light of the claimant’s alleged impairments and giving the claimant every benefit of the doubt regarding his allegations of dizziness and lightheadedness, as well as his visual disorder, the undersigned finds, therefore, the claimant is limited to light work. Because of his alleged symptoms, the claimant is limited to perform work which only requires occasional postural activities with no climbing of ladders, ropes, or scaffolds. He must avoid all hazards and can engage in activity only requiring occasional visual functioning (i.e. occasional near and far acuity, field of vision, peripheral acuity, depth perception, and nighttime vision). Because of the claimant’s depression and dysthymia, he is limited the performance of only simple and repetitive tasks.
*"Every benefit of the doubt????" I don't need any benefit of the doubt, I just need someone with some common sense to look at my case. And, again, what can I do that only requires me to be able to see some of the time, that's simple and repetitive? This makes no sense!
In summary, based on a review of the medical evidence of record, as sell as the claimant’s testimony at the hearing and the record as a whole, the undersigned finds the evidence contained in the record does not support the claimant's allegations of totally incapacitating symptoms. He has retained the capacity to perform light work, with minor postural, environmental and non-exertional limitations, throughout the period under consideration. The claimant has not demonstrated that the medical evidence supports greater limitation than in the RFC above, and the undersigned gives the claimant all benefit of reasonable doubt.
5. The claimant is unable to perform any past relevant work (20 CFR 416.965).
The claimant has past relevant work as a door to door sales representative, cashier II, and cashier checker. The vocational expert testified that the work requirements of these jobs exceeded the residual functional capacity provided for this claimant. Accordingly, the claimant is unable to perform past relevant work.
6. The claimant was horn on November 21, 1978 and was 28 years old, which is defined as a younger individual age 18-49, on the date the application was filed (20 CFR 416.963).
7. The claimant has at least a high school education and is able to communicate in English (20 CFR 416.964).
8. Transferability of job skills is not material to the determination of disability because using the Medical-Vocational Rules as a framework supports a finding that the claimant is "not disabled," whether or not the claimant has transferable job skills (See SSR 82-41 and 20 CFR Part 404, Subpart P, Appendix 2).
9. Considering the claimant's age, education, work experience, and residual functional capacity, there are jobs that exist in significant numbers in the national economy that the claimant can perform (20 CFR 416.969 and 416.969(a)).
In determining whether a successful adjustment to other work can be made, the undersigned must consider the claimant's residual functional capacity, age, education, and work experience in conjunction with the Medical-Vocational Guidelines, 20 CFR Part 404, Subpart P, Appendix 2. If the claimant can perform all or substantially all of the exertional demands at a given level of exertion, the medical-vocational rules direct a conclusion of either "disabled" or "not disabled" depending upon the claimant's specific vocational profile (S SR 83-l 1). When the claimant cannot perform substantially all of the exertional demands of work at a given level of exertion and/or has nonexertional limitations, the medical-vocational rules are used as a framework for decision-making unless there is a rule that directs a conclusion of "disabled" without considering the additional exertional and/or nonexertional limitations (SSRS 83-12 and 83-14). If the claimant has solely nonexertional limitations, section 204.00 in the Medical-Vocational Guidelines provides a framework for decision-making (SSR 85-15).
If the claimant had the residual functional capacity to perform the full range of light work, a finding of "not disabled" would be directed by Medical-Vocational Rule 202.21. However, the claimant's ability to perform all or substantially all of the requirements of this level of work has been impeded by additional limitations. To determine the extent to which these limitations erode the unskilled light occupational base, the Administrative Law Judge asked the vocational expert whether jobs exist in the national economy for an individual with the claimant's age, education, work experience, and residual functional capacity. The vocational expert testified that given all of these factors the individual would be able to perform the requirements of representative occupations such as maid, housekeeping cleaner, with 5,975 jobs available in regional economy and 364,640 in the national economy and sales attendant, with 1,685 jobs available in the regional economy and 87,500 jobs available in the national economy.
*What do my age, education, work experience, or RPC have to do with me not being able to see or feeling like I'm going to pass out? If my body doesn't function, how am I supposed to work? And my past work experience is supposedly moot, according to #5. I could be a maid? So I can only so stuff when I only need to see some of the time, and that wouldn't affect cleaning work? Plus, bending over, looking up and down, and all that make me feel worse. A maid doesn't do any of that, right? And a sales attendant? What would I sell? Presumably, I'd have to know about what I'm selling, which would involve research, which would mean at least some reading. And who would hire me knowing that I couldn't commit to working any set schedule? Also, if all of these jobs are available in my area, why is unemployment so high? REALLY?! I could be a maid or a salesman? *ROLLS EYES*
Pursuant to SSR 00-4p, the vocational expert's testimony is consistent with the information contained in the Dictionary of Occupational Titles.
Based on the testimony of the vocational expert, the undersigned concludes that, considering the claimant's age, education, work experience, and residual functional capacity, the claimant is capable of making a successful adjustment to other work that exists in significant numbers in the national economy. A finding of "not disabled" is therefore appropriate under the framework of the above-cited rule.
10. The claimant has not been under a disability, as defined in the Social Security Act, since June 21, 2007, the date the application was filed (20 CFR 416.920(g)).
DECISION
Based on the application for supplemental security income protectively filed on June 21, 2007, the claimant is not disabled under section l6l4(a)(3)(A) of the Social Security Act.
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