Dr. Castiglione indicated that the key to outpatient treatment was weight loss and compliance with a good diet. (R. 243.)
On September 25, 1990, Dr. Bosse stated that diabetes could be better controlled if claimant followed the prescribed diet. (R. 263-71.) There was no evidence of any end organ damage. (R. 270.) Claimant did smoke which caused some chronic obstructive pulmonary disease, but the lungs were clear on examination. (R. 270.) She had not been referred to a mental health facility. Appearance and hygiene were good, she related appropriately to Dr. Bosse and his staff, she was able to care for personal needs independently, there was no evidence of dementia or psychotic behavior, and she could understand directions for the use of medications. (R. 270-71.) On October 1, 1990, a report of contact with the Pittsburgh Cardiovascular Institute indicated that claimant was seen be Dr. Caminos on May 1, 1990 for a stress test, which was negative for ischemia, angina, arrhythmia, or chest pain; there was good aerobic function. (R. 272.)
On November 9, 1990, Dr. Bosse stated that he had seen claimant on October 23, 1990. (R. 273-83.) He said that he prescribed Valium on occasion for nerves and that claimant had shortness of breath accompanied by wheezing. (R. 276-77, 274.) On January 23, 1991, Dr. Bosse stated that claimant had complained of intermittent nervous tension, and complained of shortness of breath when seen in October. She had a history of diabetes. (R. 285.)
On September 17, 1992, Jose B. Caballe, M.D. conducted a consultative examination. (R. 299-301.) Claimant reported that she had quit drinking and smoking. (R. 300.) Examination revealed no abnormal findings; the lungs were clear, there were no wheezes, pulmonary status appeared to be stable and there was no evidence of bronchospasm. (R. 300-01.) Claimant stated that she could walk the entire length of a shopping mall before having to rest. His impression was diabetes treated with insulin, history of bronchial asthma and chronic bronchitis, history of chest pain and gastritis, and obesity. (R. 301.)
On October 12, 1992, Dr. Caballe estimated that claimant was able to lift and carry up to ten pounds occasionally, stand and walk three hours a day. (R. 303.) She was limited in pushing and pulling by shortness of breath, but could balance frequently, climb, stoop, crouch, kneel and crawl occasionally. (R. 304.) She had environmental limitations of temperature extremes, dust, fumes and humidity, but no limitations in the ability to reach, handle, feel, see, hear or speak. (R. 304.) On May 10, 1993, Dr. Bosse stated that because he had seen claimant only irregularly, he could express no opinion on her disability. (R. 332.)
On August 4, 1993, Frank Meacci, Jr., Ph.D. interviewed claimant at the request of her attorney and administered the Minnesota Multiphasic Personality Inventory (MMPI). (R. 340-45.) Claimant stated that she heard and saw a brother who had died of diabetes, had feelings of hopelessness about her physical condition, and had episodes of irritability with her adult children. (R. 341.) Dr. Meacci stated that the test results, combined with the interview information, indicated a "mentally disordered" condition; he classified it as major depression, recurrent, with psychotic features. (R. 343.) Claimant reported the following symptoms: shortness of breath when she walked up ten steps, fatigue if she walked over two to three blocks, sleep disturbance in one-hour intervals, disruption of her daily diet which resulted in the loss of twenty pounds in two months, feelings of hopelessness and helplessness that her condition would ever improve, episodes of agitation and irritability usually focused on the children, isolation and withdrawal, flat affect, episodes of crying, auditory and visual hallucinations relating to a brother who had died of diabetes years before. (R. 343.) He indicated that she had a present Global Assessment of Functioning (GAF) of 25, and that her highest GAF in the past year had been 35. (R. 343.)
At the hearing, claimant stated that she takes Apent for asthma, Zantac for an ulcer, Valium for nerves and insulin for diabetes. (R. 54, 56-57, 54.) She has crying spells and gets irritable (R. 58-59), and she has feelings of hopelessness about her condition and occasionally has dreams about her deceased brother. (R. 59.) She has trouble sleeping and has to rest during the day. (R. 60.) She lives with her son in an apartment, takes care of her home, cooks, cleans (but relies upon her son for help), shops, handles her own money, plays bingo several times a month, visits family and friends during the week, bowls once a month, and attends church. (R. 56-66, 120, 125, 131.) She does not attend a mental health clinic. (R. 68.)
Samuel E. Edelmann, M.Ed., a vocational expert (R. 336-38), testified that, assuming that an individual of claimant's age, education and lack of work experience could perform light work in an environment free of temperature extremes, chemical fumes, dust and humidity, there were numerous jobs that such an individual would be qualified to perform, such as small parts assembler, security guard, and clerical worker. (R. 69-74.) Assuming further that there were periods of depression from time to time over a year with intact memory and judgment average concentration, the expert stated that this condition would not preclude the jobs identified. (R. 74.) If her GAF was 35, he thought that she would not be able to work. (R. 72.)
After considering the testimony of the claimant and the vocational expert and the medical evidence presented at the hearing, the ALJ made the following pertinent findings:
2. The medical evidence establishes that the claimant suffers from diabetes, controlled, gastritis, small hiatal hernia, chronic obstructive pulmonary disease, "history of alcohol abuse, history of chest pain, uncertain etiology, obesity, and major depression, recurrent. However, she does not have an impairment or combination of impairments listed in or medically equal to one listed in Appendix 1, Subpart P, Regulations No. 4.
3. Considering the claimant's allegations of disability under the criteria set out in Social Security Ruling 88-13, these are not of the frequency or duration as to prevent the claimant from functioning vocationally.