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Hinds v. Commissioner of Social Security

United States District Court, N.D. Ohio, Eastern Division

August 5, 2019

TYLER DOUGLAS HINDS, Plaintiff,
v.
COMMISSIONER OF SOCIAL SECURITY, Defendant.

          MEMORANDUM OPINION & ORDER

          Kathleen B. Burke United States Magistrate Judge

         Plaintiff Tyler Douglas Hinds (“Plaintiff” or “Hinds”) seeks judicial review of the final decision of Defendant Commissioner of Social Security (“Defendant” or “Commissioner”) denying his application for social security disability benefits. Doc. 1. This Court has jurisdiction pursuant to 42 U.S.C. § 405(g). This case is before the undersigned Magistrate Judge pursuant to the consent of the parties. Doc. 14. For the reasons explained herein, the Court AFFIRMS the Commissioner's decision.

         I. Procedural History

         On November 13, 2014, Hinds protectively filed[1] an application for supplemental security income (“SSI”). Tr. 17, 118, 201-206. Hinds alleged disability beginning on August 8, 2014. Tr. 17, 101, 253. He alleged disability due to depression, myotopic dystrophy, ADD, bipolar disorder, learning disorder, and low IQ. Tr. 101-102, 142, 152, 258. After initial denial by the state agency (Tr. 142-148) and denial upon reconsideration (Tr. 152-156), Hinds requested a hearing (Tr. 159-161). On May 23, 2017, a hearing was held before an Administrative Law Judge (“ALJ”). Tr. 35-74. On October 17, 2017, the ALJ issued an unfavorable decision, (Tr. 14-34), finding that Hinds had not been under a disability, as defined in the Social Security Act, since November 13, 2014, the date the application was filed (Tr. 18, 28).[2] Hinds requested review of the ALJ's decision by the Appeals Council. Tr. 196-198. On April 27, 2018, the Appeals Council denied Hinds' request for review, making the ALJ's October 17, 2017, decision the final decision of the Commissioner. Tr. 1-6.

         II. Evidence A. Personal, vocational and educational evidence

          Hinds was born in 1990. Tr. 27. At the time of the hearing, Hinds lived with his girlfriend in a house that his parents purchased for him. Tr. 44-45. His girlfriend was staying with him since she had moved out of one apartment and was waiting to move into a new apartment. Tr. 44-45. Hinds attended school through the twelfth grade and attended a technical college where he learned about auto-related technical skills. Tr. 42. Hinds was dismissed from the technical college in March 2010. Tr. 42, 424, 425. Hinds relayed that he had been suspended from the technical school due to the college feeling he was unable to learn. Tr. 42. A letter from Mr. Davis, department head at the technical college, noted that Hinds faced academic challenges and there were also issues of safety due to Hinds' difficulty in working with and handling equipment. Tr. 424. Hinds last worked in the summer of 2014 at Wal-Mart. Tr. 43, 679. Hinds had received assistance through the Ohio Bureau of Vocational Rehabilitation (“BVR”). Tr. 316-421, 679. BVR closed Hinds' case on April 16, 2015, for the following reasons “Refused Services or No. Further Services. Based on our discussion today, you have a desire to stabilize your health and explore Social Security, prior to considering working.” Tr. 317.

         B. Medical evidence

          1.Treatment history

         Physical Impairments

         On April 10, 2014, Hinds saw Michael W. Walker, M.D., an orthopedic physician at the Cleveland Clinic, for an opinion regarding cramping and spasms that Hinds was having in his hands and wrists. Tr. 560-561. Hinds' mother attended the appointment with him. Tr. 560. Hinds relayed that he was being treated for bipolar disorder and attention deficit disorder and he had been having the reported wrist and hand problems prior to being placed on medications for his psychiatric disorders. Tr. 560. Hinds denied pain, paresthesias, weakness, numbness or tingling. Tr. 560-561. The cramping and spasms occurred when Hinds tried to use his hands for manipulative activity, e.g., trying to open a jar. Tr. 561. During such activity, Hinds indicated his fingers and wrists cramped up. Tr. 561. Hinds denied any other joint involvement or neck pain or neck trauma. Tr. 561. Hand x-rays showed no significant abnormalities involving the fingers or carpal bones. Tr. 561. During a physical examination, Dr. Walker observed that Hinds had some difficulty unbuttoning the sleeve on his shirt and he seemed to have lost some dexterity in his hands. Tr. 561. There was no swelling with regard to range of motion of Hinds' fingers, thumb, wrist or elbows and there was no triggering of the flexor tendons. Tr. 561. Dr. Walker diagnosed spasticity of the hands bilaterally. Tr. 561. Dr. Walker did not see any obvious orthopedic issues to explain Hinds' issues and recommended a neurological consultation. Tr. 561.

         On May 8, 2014, Hinds saw neurologist Sheila Rubin, M.D., at the Cleveland Clinic for a consultation regarding his hands locking up. Tr. 559-560. Hinds relayed that he had had problems with his hands locking up his entire life. Tr. 559. The problems had not gotten worse but his father noticed the problem and suggested that Hinds have the problem looked at. Tr. 559. Hinds explained that his hands “ball up” when using them to cook or grip something tightly; he was unable to do pull ups; he shook his hands to unlock them; his symptoms were not painful; he did not have problems while eating, shaving or writing; and cold weather made his symptoms much worse. Tr. 559. Hinds indicated that he slept well and his energy level was “terrific.” Tr. 559. Hinds reported always having a “speech impediment.” Tr. 559. He denied shortness of breath, chest pain, fever/chills, headaches, neck and back pain, or memory problems. Tr. 559. Dr. Rubin's impression was probable myotonic dystrophy type I, noting that Hinds exhibited temporal balding, facial weakness, slurred speech, and myotonia. Tr. 560. Dr. Rubin ordered an EMG/NCV, EKG and cardiology and ophthalmology consults. Tr. 560. Dr. Rubin noted that she was unable to order genetic testing; Hinds would need to be referred to a genetics counselor for such testing. Tr. 560.

         On May 15, 2014, Hinds saw Abdul R. Wattar, M.D., F.A.C.C., a cardiologist at the Cleveland Clinic, to rule out myotonic dystrophy associated cardiac abnormality. Tr. 556-559. Dr. Wattar ordered a cardiac MRI. Tr. 558. Hinds denied any current active cardiac symptoms. Tr. 558. Dr. Wattar's physical examination findings were unremarkable. Tr. 557-558. Hinds' cardiac MRI was performed on May 29, 2014. Tr. 562, 564-569. Hinds saw Dr. Wattar on June 12, 2014, for follow up. Tr. 552-555. Dr. Wattar reviewed the cardiac MRI test results, indicating that the MRI showed that the left ventricle was normal in size, shape, and low normal function, EF 54%; there were prominent trabeculations along the distal apical walls and significant thinning of the mid-distal lateral walls of the left ventricle, measuring 4-5 mm; there were no segmental wall motion abnormalities; there were no findings to suggest prior ischemic damage or an infiltrative process; and there was normal aortic, mitral and tricuspid valve function. Tr. 554. Hinds denied any current active cardiac symptoms but noted occasional shortness of breath. Tr. 554. Dr. Wattar offered to have a chest x-ray performed but Hinds' mother declined and indicated that Hinds would follow up with his primary care physician. Tr. 555. Dr. Wattar advised Hinds to stop smoking. Tr. 555.

         On December 4, 2014, Hinds saw Kristen A. Smith, M.D., at Associates in Neurology, Inc. with complaints of his hands locking up on him for several years. Tr. 609-610. Hinds noted that he had been seeing Dr. Rubin but she did not take his insurance. Tr. 609. Hinds' mother accompanied him to the appointment. Tr. 609. They relayed that Hinds had been seen at the Cleveland Clinic and had been diagnosed with possible myotonic dystrophy. Tr. 609. Hinds indicated that if he balled his hands into fists they stayed that way. Tr. 609. Also, he indicated that his mouth stayed open like a fish. Tr. 609. Hinds' mother relayed that Hinds had breathing problems as a baby; he had learning disabilities; his speech was unclear; and he did not notice myotonic features in his feet or larger muscle groups. Tr. 609. Hinds' mother indicated that Hinds was looking for a job and she felt that he should be employable. Tr. 609. On physical examination, Dr. Smith observed that Hinds had “the typical gaping mouth and narrow face, ” his speech was slightly slurred; he exhibited involuntary movements, i.e., tonic maintenance following muscle tension was observed, especially in the hands and bilateral upper extremities; there were no tremors; muscle atrophy was noted throughout; and diffuse weakness with tonic maintenance of effort was observed. Tr. 609-610. Dr. Smith ordered EMG testing of the extremities and indicated that she would see Hinds for follow up after the testing was completed. Tr. 609.

         EMG testing of the right upper and lower extremities was completed on January 10, 2015. Tr. 611-613. The testing showed evidence consistent with myotonic dystrophy type I. Tr. 613. Also, it was noted that there may be superimposed mild median mononeuropathy at the wrist, i.e., carpal tunnel syndrome. Tr. 613, 614.

         Hinds saw Dr. Smith on February 12, 2015, for follow up regarding his myotonic dystrophy and for review of the EMG. Tr. 615-616. Hinds reported problems with heartburn and that he occasionally noticed skipped heartbeats. Tr. 615. Hinds' mother reported that Hinds' IQ was measured at 79. Tr. 615. During a physical examination, Dr. Smith observed that Hinds was alert and in no acute distress; he exhibited the typical gaping mouth and narrow face; he had mild impairment of cognitive functions; his speech was slightly slurred; he exhibited tonic maintenance following muscle tension - especially of the bilateral hands and upper extremities; there were no tremors; there was muscle atrophy throughout; and there was diffuse weakness with tonic maintenance of effort. Tr. 615-616. Dr. Smith assessed myotonic dystrophy (primary) and mental retardation. Tr. 615. Dr. Smith referred Hinds to Dr. Goldstein a cardiologist and Hinds was encouraged to continue with psych. Tr. 615.

         Upon Dr. Smith's referral, on May 21, 2015, Hinds saw Robert N. Goldstein, M.D., at LakeHealth Electrophysiology. Tr. 629-630. Dr. Goldstein noted the following general comments regarding the history of Hinds' present illness - Hinds had a history of myotonic dystrophy along with a variety of psychiatric problems, including depression, bipolar disorder, and low IQ; he had episodes of palpitations on occasion but no frank syncope for the prior six years; he had heartburn; Hinds was fairly active with no exertional symptoms; he had no orthopnea or dyspnea with exertion; and Hinds had not had a cardiac work-up. Tr. 629. On physical examination, Dr. Goldstein observed that Hinds was a markedly thin male in no acute distress; his affect was appropriate; and his mood was pleasant. Tr. 629. Hinds' heart sounds were normal, there were no murmurs, gallops or rubs. Tr. 629. Hinds exhibited normal peripheral pulses bilaterally in the extremities and there was no edema. Tr. 629. Neurological findings were “grossly normal: intact, no abnormalities.” Tr. 629. An EKG was performed that same day and it showed normal sinus rhythm; moderate voltage criteria for LVH that may represent a normal variant in light of Hinds' thin body habitus; and early repolarization abnormality. Tr. 630, 649. Dr. Goldstein assessed myotonic dystrophy (primary) and palpitations and he recommended an echocardiogram and a 2-week event monitor to further assess for arrhythmia. Tr. 629-630. The two-week event monitor findings showed a minimum heartrate of 43 bpm, a maximum heartrate of 181 bpm, and an average heartrate of 86 bpm. Tr. 631-640. An echocardiogram was performed on June 25, 2015. Tr. 660-662. The impression from that testing was that global left ventricular wall motion and contractility were within normal limits, there was an estimated ejection fraction of > 60% and there was a trace of mitral regurgitation. Tr. 662, 668-672.

         On October 1, 2015, Hinds saw Dr. Smith for follow up regarding his myotonic dystrophy and complaints of problems swallowing that Hinds had been having for about a month. Tr. 703-704. Dr. Smith's physical examination findings (Tr. 703-704) were similar to the findings from February 2015 (Tr. 615-616). Dr. Smith referred Hinds to SLP[3] for evaluation. Tr. 703.

         Mental Impairments

         On February 6, 2014, Hinds saw Jeffery Turell, M.D., at Premier Behavioral Health Services. Tr. 596-597. Dr. Turell noted he had last seen Hinds in October 2013. Tr. 596. Hinds reported that he broke his thumb punching a punching bag hard. Tr. 596. Hinds was drinking regularly but did not see that alcohol was a problem in his life. Tr. 596. He noted, however, that his friends had conducted an “intervention” with him about his alcohol use and he had received a citation for disorderly conduct while intoxicated about two months prior - he was walking home after drinking. Tr. 596. Hinds reported that Adderall helped him focus. Tr. 596. He had reduced the amount of Trazadone that he was taking because it was too sedating. Tr. 596. Hinds had been doing some work at his mother's apartment building - cleaning and painting. Tr. 596. Also, he was doing some interior construction type work with some friends to help them out - he was not getting paid. Tr. 596. Dr. Turell noted that Hinds was continuing to see Dr. Bruder[4] for counseling. Tr. 596. Hinds denied a depressed mood or anxiety symptoms and indicated his sleep and appetite were fine. Tr. 596. Dr. Turell observed Hinds to be casually dressed; he was cooperative; he was clam; his speech was fluent, spontaneous, and low; his thought process was concrete; he denied suicidal ideation; his cognition was grossly average to below average; his insight was limited; and his judgment was poor. Tr. 597. Dr. Turell's assessment was that Hinds continued to make poor decisions; he was in denial about the problems alcohol was causing in his life; his mood was stable; Adderall was helping with concentration; he had not yet obtained IQ testing; and he had stumbled upon types of work that he might do well in rather than jobs he had applied for in the past that he did not do well in. Tr. 597. Dr. Turell diagnosed bipolar II disorder, ADHD combined type, alcohol abuse and a reading disorder. Tr. 597. Dr. Turell reduced Hinds' Trazadone and recommended that Hinds cut down on his drinking and complete IQ testing. Tr. 597.

         During a May 8, 2014, visit with Dr. Turell, Hinds stated he was a loser and people did not give him a chance. Tr. 598. Adderall was continuing to help with his concentration; his appetite was the same; and he was not drinking as often. Tr. 598. Hinds was unemployed and living with his parents. Tr. 598. Dr. Turell's assessment was depressed/poor self-worth based on life circumstances and medical problems. Tr. 598. Diagnoses included bipolar II disorder, ADHD combined type, alcohol abuse; adjustment disorder with anxiety; and reading disorder. Tr. 598.

         Hinds saw Dr. Turell again on August 7, 2014. Tr. 599. Hinds had a job at Walmart. Tr. 599. Hinds was interested in increasing his Adderall to help with his concentration due to the increased demands of work. Tr. 599. Hinds had a girlfriend. Tr. 599. Diagnoses included bipolar II disorder, ADHD combined type, alcohol abuse; anxiety disorder, NOS; and reading disorder. Tr. 598. Dr. Turell continued to recommend cognitive testing. Tr. 599. Hinds had not been able to schedule the testing due to conflicts. Tr. 599. Dr. Turell increased Hinds' Adderall and continued his other medications. Tr. 599.

         Hinds saw Dr. Turell on January 8, 2015. Tr. 600. Hinds had been fired from Walmart after a cart had hit a car. Tr. 600. Hinds had a job interview scheduled for January 12, 2015. Tr. 600. Hinds was going snowboarding. Tr. 600. Hinds had neuropsychological testing performed on October 9, 2014.[5] Tr. 600. Hinds reported inconsistent medication compliance. Tr. 600. Hinds indicated that periods of sadness lasted about an hour and then faded. Tr. 600. His up moods lasted longer - “for days, weeks.” Tr. 600. On mental examination, Dr. Turell observed that Hinds' mood was better than usual. Tr. 600. He was cooperative. Tr. 600. His affect was flat. Tr. 600. His speech was fluent, spontaneous, increased and his tone was low. Tr. 600. His thought process was circumstantial; his cognition was diminished; his insight was partial; and his judgment was poor. Tr. 600. Diagnoses were bipolar II disorder, ADHD combined type, alcohol abuse; anxiety disorder, NOS; reading disorder; and borderline intellectual functioning. Tr. 600. Dr. Turell encouraged good sleep hygiene and he made some modifications to Hinds' medications. Tr. 600. Hinds denied medication side effects. Tr. 600.

         When Hinds saw Dr. Turell on June 25, 2015, he relayed that he had been denied social security disability. Tr. 643. Hinds was planning on appealing. Tr. 643. Hinds was living with a roommate in a house. Tr. 643. Hinds reported inconsistent medication compliance, noting he had probably missed a few days. Tr. 643. Hinds reported being irritable but he denied a depressed mood, anxiety, elevated mood or psychosis. Tr. 643. He was frustrated with myotonic dystrophy and social security. Tr. 643. On mental examination, Hinds' affect was frustrated; his mood was congruent; his speech was fluent, spontaneous, increased but at a slow rate, with a low tone, and his voice was gravelly; his thought process was circumstantial, concrete, and he perseverated; his cognition was average and grossly intact; his insight was partial and his judgment was poor. Tr. 643. Dr. Turell assessed Hinds as being stable, noting he had been denied social security disability and was unable to hold a job. Tr. 643. Dr. Turell continued to diagnose bipolar II disorder, ADHD combined type, alcohol abuse; anxiety disorder, NOS; reading disorder; and borderline intellectual functioning. Tr. 643. Dr. Turell recommended that Hinds continue with his current treatment and he encouraged regular exercise and Hinds' appeal of the social security decision. Tr. 643.

         Hinds saw Dr. Turell again on October 15, 2015. Tr. 713. Hinds reported being compliant with his medication. Tr. 713. However, he did relay that he has taken his girlfriend's medication one time. Tr. 713. Hinds' kitten had died which was causing him to feel down. Tr. 713. Hinds' quality of sleep was terrible. Tr. 713. Trazadone was no longer helping Hinds' sleep. Tr. 713. Hinds reported anxiety regarding his girlfriend's health. Tr. 713. On mental examination, Dr. Turell observed Hinds' mood was sad; his affect was down; his voice was gravelly with fluent, spontaneous and increased speech with a low tone; his thought process was circumstantial and concrete; his cognition was limited; his insight was partial and his judgment was poor. Tr. 713. Dr. Turell discontinued Trazadone, added melatonin, and continued all other treatment. Tr. 713. Dr. Turell continued to encourage regular exercise and advised him not to take someone else's medication. Tr. 713.

         Hinds continued to see Dr. Turell from January 27, 2016, through January 12, 2017. Tr. 719-724, 726-730, 736-740, 747-749, 754-756. During a January 17, 2016, visit, Hinds reported that he was doing “pretty good” since his last visit in October. Tr. 724. He was a little more depressed - he was waiting for his girlfriend to get out of the hospital. Tr. 724. Hinds' concentration was fine on Adderall. Tr. 724. Hinds had gotten a place in Eastlake. Tr. 724. He had been with his girlfriend for six months. Tr. 724. Dr. Turell continued Hinds' current treatment and encouraged regular exercise. Tr. 723.

         During an April 21, 2016, visit, Dr. Turell's assessment was that Hinds reported mild irritability; he was living a disorganized life but at his baseline. Tr. 721. Dr. Turell made some medication adjustments. Tr. 721. He recommended that Hinds engage in daily physical activity; he should use Adderall regularly, not just on the days/times he thinks he needs to, and he should see a speech pathologist for his swallowing difficulties. Tr. 721.

         On June 16, 2016, Hinds complained of poor concentration, anxiety regarding his future health, ADHD symptoms, pain in his hands, and frustration and irritability. Tr. 736. He denied a depressed mood. Tr. 736. Hinds had run out of Adderall on June 5. Tr. 736. Dr. Turell restarted Adderall and continued Abilify and Lamictal. Tr. 739. Dr. Turell indicated that Hinds had “a clear and convincing burden of physical and mental conditions affecting his ability to work.” Tr. 738.

         During a September 22, 2016, visit, Hinds reported that he did not like how his medication made him feel. Tr. 726. Hinds felt he was more depressed on Abilify and Lamictal. Tr. 726. He reported a better mood since getting back with his girlfriend - they were living together. Tr. 726. His mother and girlfriend were at the visit with him. Tr. 726. Hinds had stopped drinking. Tr. 726. He continued to smoke about a pack of cigarettes per day. Tr. 726. Dr. Turell discontinued Abilify and Lamictal, continued Adderall and added Depakote. Tr. 727. Dr. Turell noted he was going to write a letter for disability. Tr. 727.

         During a December 8, 2016, visit with Dr. Turell, Hinds requested standardized psychological testing and a letter describing his problems and situation. Tr. 747. Hinds was very angry at the judge. Tr. 747. On mental examination, Hinds' speech was fluent and spontaneous; his thought process was tangential, concrete, and he perseverated; his affect was angry/frustrated; he was cooperative but animated; and he reported having interesting dreams. Tr. 747. Hinds was not drinking but he continued to smoke. Tr. 747. Dr. Turell increased Hinds' Depakote and continued Adderall. Tr. 748. Dr. Turell noted that Hinds was still impulsive and clearly unable to work and that Hinds' plans to apply for disability were appropriate. Tr. 749.

         During his January 12, 2017, visit with Dr. Turell, Hinds reported doing “pretty good.” Tr. 754. He was applying for social security disability for the sixth time and was very angry at the judges. Tr. 754. He denied a depressed mood but had anxiety over losing his girlfriend. Tr. 754. Hinds' affect was described as amused and animated. Tr. 755. He denied suicidal ideation but indicated he had thoughts of judges committing suicide. Tr. 755. He relayed homicidal ideation towards a woman in North Carolina but noted he would never see her again. Tr. 755. In his assessment, Dr. Turell indicated that Hinds was stable but he still displayed poor judgment and anger and he made vague threatening statements but did not act on them. Tr. 755.

         2. Opinion evidence

         Physical Impairments

         Treating

         On December 22, 2015, Dr. Smith completed a functional capacity evaluation.[6] Tr. 713-714. Dr. Smith opined that Hinds was limited to rarely lifting/carrying 5-10 pounds; standing/walking a total of 1-2 hours in an 8-hour workday; and he could never climb, balance, stoop, crouch, kneel or crawl. Tr. 714. Also, Dr. Smith opined that Hinds' impairment affected his ability to be around temperature extremes or vibration because Hinds' muscle weakness was likely worse in the cold and with vibration. Tr. 714. Dr. Smith opined that she would expect Hinds to miss more than 4 days per month of work and would be off task more than 20% of the time due to pain or fatigue. Tr. 715. If Hinds was working a sedentary job, Dr. Smith opined that Hinds would need to lie down 2 hours or more during an 8-hour workday. Tr. 715. Dr.

         Smith opined that Hinds would be able to use his hands less than 10% of the time during an 8hour workday. Tr. 715. Dr. Smith opined that Hinds would need to take unscheduled breaks more than 4 times per day (beyond normal morning, lunch, and afternoon breaks). Tr. 715. Dr. Smith explained her opinions, stating Hinds “has myotonic dystrophy, which is a condition marked by progressive muscle impairment, difficulty releasing muscle contraction, and frequently, cardiomyopathy.” Tr. 715. Dr. Smith stated further, “Myotonic dystrophy is progressively disabling and results in death [and] he is unable to be employed in any setting on a long-term basis.” Tr. 715.

         Reviewing

         On May 7, 2015, state agency reviewing physician William Bolz, M.D., completed a physical RFC assessment. Tr. 111-114. Dr. Bolz opined that Hinds had the RFC to lift and/or carry 20 pounds occasionally and 10 pounds frequently; he could stand and/or walk for a total of about 6 hours in an 8-hour workday and sit for a total of about 6 hours in an 8-hour workday; he had limited ability to push and/or pull with his upper extremities bilaterally - limited to frequently using hand controls due to myotonic dystrophy; he could never climb ladders/ropes/scaffolds due to myotonic dystrophy; he was limited to frequent bilateral handling and fingering; and he would have to avoid all exposure to hazards - machinery and unprotected heights - due to myotonic dystrophy. Tr. 111-113.

         Upon reconsideration, on August 26, 2015, state agency reviewing physician Paul Morton, M.D., reached the same conclusions as Dr. Bolz. Tr. 129-131.

         Mental Impairments

         Treating

         Dr. Turell

         On January 5, 2016, Dr. Turell completed a Mental Source Assessment (Mental) wherein he rated Hinds' functional abilities in 20 work-related tasks related to understanding and memory; sustained concentration and persistence; social interaction; and adaptation. Tr. 716-718. Dr. Turell found that Hinds was unable to perform of 13 of the 20 tasks; he would have noticeable difficulty performing 1 of the tasks more than 20% of the workday or workweek; he would have noticeable difficulty performing 2 of the tasks 11-20% of the workday or workweek; and he would have noticeable difficulty performing 4 of the tasks no more than 10% of the workday or workweek. Tr. 716-717. Dr. Turell opined that Hinds would likely be absent from work about 4 days per month; he would be off task 20% of the time during the workday; and he would need to take unscheduled 15-minutes breaks beyond the normal breaks and lunch period more than 4 times per day. Tr. 717. Dr. Turell explained that his opinions were supported by neuropsychological testing completed by Dr. Mekota, an associate in his office, which showed a full-scale IQ in the borderline range, low average attention/processing speed, calculation, concentration with impairment of inhibitory control. Tr. 718. Dr. Turell added further comments, indicating:

Given Tyler's consistent history of difficulty with applying for jobs, limited success being offered an interview, and short duration of holding a job before getting fired, Tyler has not shown the ability to maintain full-time employment which also fits with a history of poor decision-making.
The difficulty he faces as a result is that “trouble finds Tyler, ” meaning due to deficits in executive function, intellectual function, and social skills, he invariably performs or behaves in way that results in dismissal/termination of employment.

Tr. 718.

         On April 20, 2017, Dr. Turell completed another Mental Source Assessment (Mental) wherein he again rated Hinds' functional abilities in 20 work-related tasks related to understanding and memory; sustained concentration and persistence; social interaction; and adaptation. Tr. 763-764. Dr. Turell found that Hinds was unable to perform of 13 of the 20 tasks; he would have noticeable difficulty performing 1 of the tasks more than 20% of the workday or workweek; he would have noticeable difficulty performing 3 of the tasks no more than 10% of the workday or workweek; and no problem performing 2 of the tasks. Tr. 763-764. Dr. Turell opined that Hinds would likely be absent from work about 3 days per month; he would be off task over 20% of the time during the workday; and he would need to take unscheduled 15-20-minute breaks beyond the normal breaks and lunch period about 4 times per day. Tr. 764. When asked to state the medical findings that supported his opinions, Dr. Turell stated:

Tyler suffers from ADHD, bipolar disorder, and myotonic dystrophy. These conditions affected his academic trajectory, for which he had an IEP in school. Tyler has an easygoing nature but is plagued by poor decision-making and poor concentration resulting in difficulty obtaining and maintaining employment. Tyler has tried many jobs, but has been fired from all of them after only a short time. Trouble always seems to find Tyler, and in the workplace this results in termination of his employment.

Tr. 764-765.

         Dr. Turell further commented that “Tyler is truly incapable of full-time employment. Aside from his issues with poor concentration, it is his poor executive function and decision making that render him unemployable.” Tr. 765.

         Dr. Brunner

         On August 20, 2015, Rick Brunner, Ph.D., M.S.W., authored a “To Whom It May Concern” letter, wherein he expressed his sincere and full support for Hinds' application for disability benefits. Tr. 701. Dr. Brunner stated he had been meeting with Hinds (and his mother) since 2009 for approximately 50 therapy sessions. Tr. 701. During that therapy, Dr. Brunner indicated he had encouraged Hinds to find employment and had referred him to BVR because of the difficulties he was having finding work. Tr. 701. Dr. Brunner indicated that BVR had recently closed Hinds' case and suggested that he apply for disability. Tr. 701. Dr. Brunner relayed that Hinds had been diagnosed with ADHD and bipolar disorder and, despite taking prescribed medications, he continued to struggle with focus, poor decision making, impulsivity, and mood swings. Tr. 701. Dr. Brunner stated further that Hinds would love to work but “due to his psychiatric struggles and now his battle with Myotonic Dystrophy, he is often full of despair regarding his future.” Tr. 701.

         On May 3, 2017, Dr. Brunner completed a Mental Source Assessment (Mental) wherein he rated Hinds' functional abilities in 20 work-related tasks related to understanding and memory; sustained concentration and persistence; social interaction; and adaptation. Tr. 821-823. Dr. Brunner found that Hinds was unable to perform 8 of the 20 tasks; he would have noticeable difficulty performing 11 of the tasks more than 20% of the workday or workweek; and he would have noticeable difficulty performing 1 of the tasks 11-20% of the workday or workweek. Tr. 821. Dr. Brunner opined that Hinds would likely be absent from work more than 4 days per month; he would be off task over 20% of the time during the workday; and he would need to take unscheduled 15-minutes breaks beyond the normal breaks and lunch period about 4 times per day. Tr. 822. When asked to state the medical findings that supported his opinions, Dr. Brunner indicated “ongoing ADHD, bi-polar & borderline I.Q.” Tr. 822. Dr. Brunner commented further that Hinds had not been able to maintain full-time employment in the past even with the ongoing assistance and supervision of a job coach. Tr. 822.

         On May 12, 2017, Dr. Brunner provided another letter wherein he stated that he fully supported Hinds' applying for disability benefits. Tr. 825-826. Dr. Brunner offered his opinion as to why he believed that Hinds' impairments fell within Listings 12.04 and 12.05. Tr. 825. In his letter, Dr. Brunner characterized Hinds' impairments as having a marked or extreme effect on his ability to function in his daily life. Tr. 825.

         Examining

         Drs. Mekota ...


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