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Coronary Artery Disease Patient also Suffering from Obesity, Major Depressive Disorder...

Coronary Artery Disease Patient also Suffering from Obesity, Major Depressive Disorder, Post-Traumatic Stress Disorder, Alcohol Abuse in Reported Remission, Uncontrolled Diabetes Mellitus and Panic Disorder: Fully Favorable Social Security Disability Decision

Disabilities: coronary artery disease, obesity, major depressive disorder, post-traumatic stress disorder, alcohol abuse in reported remission, uncontrolled diabetes mellitus and panic disorder

Notice of Decision: Fully Favorable

Office of Disability Adjudication and Review (ODAR): Manchester, New Hampshire

FINDINGS OF FACT AND CONCLUSIONS OF LAW

After careful consideration of the entire record, the undersigned makes the following findings:

1. The claimant's date last insured is December 31, 2013.

2. The claimant has not engaged in substantial gainful activity since September 1, 2009, the amended alleged onset date (20 CFR 404.1520(b) and 404.1571 et seq.).

3. The claimant has the severe combination of impairments consisting of coronary artery disease status post coronary artery bypass grafting, obesity, major depressive disorder, post-traumatic stress disorder, alcohol abuse in reported remission, uncontrolled diabetes mellitus and panic disorder with partial agoraphobia (20 CFR 404.1520(c)).

The claimant's medically determinable impairments of hypertension and hyperlipidemia do not cause more than minimal limitation in the claimant's ability to perform basic work activities and are therefore nonsevere.

4. 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 404.1520(d), 404.1525 and 404.1526).

The claimant has such the degree of limitation in the broad areas of mental functioning set out in the disability regulations for evaluating mental disorders and in the mental disorders listings in 20 CFR., Part 404, Subpart P, Appendix I as moderate restriction in activities of daily living, moderate difficulties in maintaining social functioning, moderate difficulties in maintaining concentration, persistence or pace, and one to two episodes of decompensation, each of extended duration (Exhibit 11F).

5. The claimant has the residual functional capacity to perform sedentary work as
defined in 20 CFR 404.1567(a) except that he can only occasionally lift and carry 10 pounds and can walk for 2 hours in an 8-hour workday and sit for 6 hours in an 8 hour workday. Further, the claimant can rarely climb stairs and cannot climb ladders, cannot balance, stoop, kneel, crouch or crawl, must avoid even moderate exposure to hazardous machinery and heights, can understand and remember only 2 to 3 step instructions of a routine nature, can sustain attention and concentration for routine tasks of a nonsocial nature and maintain effort for extended periods over the course of a normal work day or week within acceptable pace and persistence standards, is capable of brief superficial interactions with the general public on an individual and infrequent basis and participate in typical interactions with co-workers and supervisors while completing routine tasks of a nonsocial nature, can tolerate stress in a routine work setting, can adapt to minor changes in routine and is capable of independent goal directed behavior while completing routine tasks.

In making this finding, the undersigned 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 404.1529 and SSRs 96-4p and 96-7p. The undersigned has also considered opinion evidence in accordance with the requirements of 20 CFR 404.1527 and SSRs 96-2p, 96-6p and 06-3p.

The medical evidence of record sufficiently documents findings that support and explain a residual functional capacity for a significantly restricted range of sedentary work. Treatment progress notes from treating ... documents follow-up in March 2010 for coronary artery bypass grafting for known coronary disease status post previous myocardial infarction recently manifested by chest pain with exertion. Also documented in these treatment progress notes are medical problems including depression, anxiety, diabetes mellitus, and significant weight gain (Exhibit 14F). Psychological treatment notes also documents alcohol dependence in remission and subjective complaints of symptoms consistent with depression and post-traumatic stress disorder (Exhibit 13F).

After considering the evidence of record, the undersigned finds that the claimant's medically determinable impairments could reasonably be expected to produce the alleged symptoms, and that the claimant's statements concerning the intensity, persistence and limiting effects of these symptoms are generally credible.

The State agency medical consultant's physical assessment for a significant range of light work (Exhibit 6F) is given little weight because evidence viewed at the hearing level shows that the claimant is exertionally more limited than determined by the State agency consultant. Furthermore, the State agency consultant did not adequately consider the combined effect of the claimant's impairments. However, the State agency psychological consultant's mental assessment for moderate limitation of function (Exhibits 11F & 12F) is given significant weight because it is consistent with the record as a whole.

6. The claimant is unable to perform any past relevant work (20 CFR 404.1565).

The demands of the claimant's past relevant work exceed the residual functional capacity.

7. The claimant was an individual closely approaching advanced age on the established disability onset date (20 CFR 404.1563).

8. The claimant has a limited education and is able to communicate in English (20 CFR 404.1564).

9. Transferability of job skills is not an issue in this case because the claimant's past
relevant work is unskilled (20 CFR 404.1568).

10. Considering the claimant's age, education, work experience, and residual functional capacity, there are no jobs that exist in significant numbers in the national economy that the claimant can perform (20 CFR 404.1560(c) and 404.1566).

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 (SSR 83-11).

Even if the claimant had the residual functional capacity for the full range of sedentary work, considering the claimant's age, education, and work experience, a finding of "disabled" would be directed by Medical-Vocational Rule 201.09.

11. The claimant has been under a disability as defined in the Social Security Act since September 1, 2009, the amended alleged onset date of disability (20 CFR 404.1520(g)).

12. The claimant's substance use disorder(s) is not a contributing factor material to the determination of disability (20 CFR 404.1535).

Alcohol abuse in remission is not a factor material to the finding of disability, as the evidence of record in its entirety establishes the existence of other impairments, separate and apart from alcohol abuse in remission that limits the claimant's ability to perform a full range of sedentary work. Therefore, disability may be established without reference to alcohol abuse in remission.

DECISION

Based on the application for a period of disability and disability insurance benefits filed on July 14, 2009, the claimant has been disabled under sections 216(i) and 223(d) of the Social Security Act since September 1, 2009.