the request of the Secretary. Dr. Behar diagnosed mild mental retardation and a "Dysthmic Disorder," observing a "shallow, narrow" affect and that Ortiz's "mood looks depressed." (R. 262). He also felt that Ortiz was in need of supervision "to prevent him from making any dangerous mistakes and hurting himself." Id. In a "Psychiatric Activities Assessment," Dr. Behar opined that Ortiz was completely dependent on his wife for all household chores, isolates himself socially, does not participate in any group activities besides Sunday mass, forgets instructions easily, loses track easily when attempting to complete a task, requires constant prompting in order to sustain a routine, is unable to perform at a consistent pace for more than ten minutes at a time, gets anxious and confused in response to change, withdraws from conflict, and has no concern for his personal safety. (R. 267-270).
In a March 10 "Medical Assessment of Ability to do Work-Related Activities (Mental)," Dr. Behar stated that Ortiz had a "fair ability" (defined as "seriously limited but not precluded") to follow work rules, relate to co-workers, deal with the public, interact with supervisors, deal with work stresses, maintain attention and concentration, behave in an emotionally stable manner, relate predictably in social situations, or demonstrate reliability. (R. 263-640). He felt that Ortiz had no ability to use judgment or function independently.
Ortiz told neither Dr. Goodman nor Dr. Behar about his sexual dysfunction. However, his testimony at the October 5, 1992 hearing reveals that much of the depression was caused by his medical condition and the resulting impotence. He stated that he was depressed because he very much wanted children and would now be unable to impregnate his wife. This testimony is corroborated by that of his wife, Onelia Ortiz, who testified at both the December 9, 1991 and the October 5, 1992 hearings. Mrs. Ortiz testified that her husband's depression began just after his first surgery in April, 1990 and that from then on "he has been going in . . . and out of depression." (R. 38). She stated that "Very many times he has told me he wants to . . . disappear, he gets very depressed." She testified that his depression manifests itself through anger and hyperactivity and added that she doesn't know "what to do with him, all I can do is pray. But he . . . wants to [have a] . . . family and I have the awful feeling sometimes that he wants to commit suicide." She also said that when he is depressed he stops eating, isolates himself, and refuses to talk to anyone. (R.64).
Ortiz and his wife also testified as to the ongoing physical conditions upon which Ortiz bases disability, specifically pain in his waist and legs, bleeding upon urination, impotence, swelling of the legs and testicles, constipation, urinary incontinence, diarrhea, recurring hemorrhoids ad pain with sitting, walking, and standing. He testified that his sleeping habits are "awful" because he cannot lie on his stomach due to pain and because he has to get up every two hours to use the bathroom. (R. 55). He wears adult diapers to bed because he wets the bed at least three times a week and "pus comes out." (R. 60-61). He also testified that he suffers from diarrhea three to four days a week, forcing him to use the bathroom approximately seven times a day for half an hour each time. If he is unable to use the bathroom every two hours, it becomes very painful. Finally, Ortiz and his wife testified that he is unable to dress himself because of difficulty bending over, that he can help his wife with shopping for groceries only for short periods of time, but that he helps wash the dishes.
Vocational Expert ("VE") Mark Lukas testified at the hearing. His role was to identify whether an individual with a work, education and medical history similar to that of Ortiz could perform any substantial gainful activity and, if so, whether those positions were available in significant numbers in the national and regional economy. Lukas characterized Ortiz's past relevant work as a machine operator and material handler as unskilled, at the medium to heavy exertional level and his work as a welder as skilled to semi-skilled, at a medium exertional level. In response to a hypothetical from Judge Yatron, Lukas testified that if Ortiz was required to urinate every two hours and/or had diarrhea three times a week which required him to use the bathroom approximately seven times a day for half an hour each time, these absences from the work station would be an "adverse vocational factor." (R. 71-72). If a worker were required to leave his or her work station for even three half hour intervals, "that would be intolerable" because it would "not even allow for a full day of work activity." Combined with medication that causes drowsiness, such as that being taken by Ortiz, this would be another "negative vocational factor." No hypotheticals were posed involving the totality of Ortiz's mental and physical limitations.
STANDARD OF REVIEW
Review of the final decision of the Secretary is limited to a determination of whether that decision is supported by substantial evidence. Brown v. Bowen, 845 F.2d 1211 (3d Cir. 1988). Substantial evidence has been defined as "such evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401, 28 L. Ed. 2d 842, 91 S. Ct. 1420 (1971) (quoting Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229, 83 L. Ed. 126, 59 S. Ct. 206 (1938)). Substantial evidence is "more than a mere scintilla, but may be less than a preponderance." Woody v. Secretary of Health and Human Services, 859 F.2d 1156, 1159 (3d Cir. 1988).
Additionally, the third circuit has held that an ALJ's findings "should be as comprehensive and analytical as feasible and, where appropriate, should include a statement of subordinate factual foundations on which ultimate factual conclusions are based, so that a reviewing court may know the basis of the decision." Cotter v. Harris, 642 F.2d 700, 705 (3d Cir. 1981). In addition to evidence supporting the result, it is essential that the ALJ's statement include "some indication of the evidence which was rejected." Id. There is a particularly acute need for explanation when relevant evidence has been rejected or when there is conflicting evidence in the record. Id. at 706. The third circuit requires that an ALJ do more than simply state ultimate factual conclusions. Stewart v. Secretary of Health, Education & Welfare, 714 F.2d 287 (3d Cir. 1985).
In a decision dated May 21, 1993, the ALJ concluded that Ortiz's depression and anxiety were accompanied by clinical findings sufficient to meet the requirements of § 12.04(A) of the Listing of Impairments, in that he suffered from an Adjustment Disorder, but were insufficient to meet the criteria of § 12.02(B).
The ALJ found that while Ortiz suffered from severe impairments, he retained the residual functional capacity to perform a limited range of work and that there were a significant number of jobs in the national and regional economy available. He added that Ortiz's ability to perform at a job is "reduced by restrictions on constant standing or walking, deep bending, exposure to temperature extremes or tolerance of job complexity or stress." (R. 19). Furthermore, he found that
The claimant's statements regarding the nature and severity of his impairments and the extent of his functional limitations are credible, and are consistent with objective medical findings, except to the extent that he alleges that his symptoms of abdominal, testicular, and leg pain, along with urinary frequency and diarrhea, prevent him from performing all substantial gainful activity . . . .
Regarding Ortiz's mental condition, the ALJ rejected the results of the IQ test given by Dr. Goodman, believing it invalid because it was administered though his wife as interpreter. However, he cited her observations regarding his anxiety and depression, as well as the "substantial restrictions on concentration and task persistence and on adaptation to stressful circumstances, and significant restrictions on activities of daily living and social functioning . . . ." (R. 16). The ALJ summarized Dr. Behar's findings as being that "the claimant has a fair ability to make occupational, performance, and personal/social adjustments, could understand, remember, and carry out simple job instructions well." Id. Overall, the ALJ concluded that Ortiz has "difficulty coping with pain, impotence and urinary frequency, and he should avoid complex or detailed job tasks and work environments involving high levels of stress," (R. 17), but that jobs existed in the national or regional economy that he could perform.
In determining whether an individual is entitled to disability benefits, the Secretary must consider the following factors, in order:
1. Whether the plaintiff is working;
2. Whether the plaintiff has a serious impairment;