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Prasnikar v. Colvin

United States District Court, M.D. Pennsylvania

September 24, 2014

CAROLYN W. COLVIN, Acting Commissioner of Social Security, Defendant.


MARTIN C. CARLSON, Magistrate Judge.


This is an action brought by Joseph Prasnikar ("Prasnikar" or "the plaintiff"), a claimant for supplemental social security income (SSI) benefits under Title XVI of the Social Security Act (Act), 42 U.S.C. §§ 1381-1383f. An administrative law judge (ALJ) presided over a hearing on Prasnikar's claims, and reviewed Prasnikar's medical and opinion evidence offered in support of his application for benefits. Following that review, the ALJ issued an adverse decision, finding that Prasnikar was not totally disabled as a result of a combination of physical and mental limitations, and, therefore, denied his claim for SSI benefits. In this action, Prasnikar seeks review of this decision pursuant to 42 U.S.C. § 405(g) and 1383(c)(3). Because we find that the ALJ's decision was supported by substantial evidence, and because there is no basis to remand this decision for further consideration, Prasnikar's claims will be denied.


The plaintiff sought disability benefits in 2011 after having had little work experience as an adult, due in large part to the fact that he was incarcerated for much of his adult life. Prasnikar spent 16 years, between 1988 and 2004, incarcerated in Massachusetts as the result of an undisclosed sexual crime. (Doc. 8, Transcript and Exhibits ("Tr.") 1089.) Since his release from custody, it appears that Prasnikar has lived in or around Tuscarora, Pennsylvania, where he has held two jobs, working briefly as a telemarketer between 2006-2007, and as a laborer with a temporary employment service between 2004 and December 2009.

In October 2009, Prasnikar suffered a heart attack while working as a temporary worker at a turkey farm, and was life-flighted to Lehigh Valley Hospital, where he was diagnosed with a non-ST elevation myocardial infarction, coronary artery disease status post drug-eluting stent to the right coronary, pneumonia, tobacco use, hypertension and hyperlipidemia. Prasnikar was discharged on October 8, 2009, in stable condition, with multiple discharge medications, and without recurring chest pain or arrhythmia, after doctors "had a long discussion" with him regarding the need for him to stop smoking and the health risks associated with living with a roommate who smokes cigarettes.[1] (Tr. 223.) Prasnikar continued to smoke immediately after he was discharged, was readmitted to the hospital on October 8, 2009, after experiencing chest pain, and was catheterized. On October 10, 2009, he reported himself to be pain-free and asymptomatic and was deemed stable for discharge. (Tr. 255.)

After the heart attack, Prasnikar returned to his job at the turkey farm, but found he could no longer perform his prior work there as a turkey handler, and was unable even to perform lighter duty tasks such as folding boxes, notwithstanding that he was taking tablets of nitroglycerin on average twice a week to help him cope with chest pain, ventricular contractions and burning sensations that he claims to have experienced four to five times a week.[2]

Believing that he was no longer capable of engaging in any substantial gainful employment, Prasnikar protectively filed an application for SSI benefits on March 22, 2010, alleging a disability onset date of October 6, 2009, the day of his heart attack. A hearing was held on June 24, 2010, in Pottsville, Pennsylvania before the Honorable Michelle Wolfe, an administrative law judge. During the hearing, Prasnikar testified, as did his girlfriend, Hallie Gerber, and Gerald Keating, an impartial vocational expert. On August 17, 2011, the ALJ issued an unfavorable decision denying Prasnikar's claims for SSI benefits. (Tr. 61-78.)

Prasnikar was 43 years old at the time of the ALJ's adverse decision, and, therefore, considered a "younger individual" under Social Security Regulations (Tr. 16). 20 C.F.R. § 416.963(c). He has a GED, and can speak, understand, read, and write English. (Tr. 18, 165.) Prasnikar lives in an apartment with his girlfriend, Hallie Gerber, a woman sometimes identified in the record documents as Prasnikar's fiance. (Tr. 17.) In this action, Prasnikar claims that he is totally disabled based upon heart disease, chronic obstructive pulmonary disorder (COPD), depression, and post-traumatic stress disorder (PTSD) relating to his long-term incarceration. (Tr. 36, 166.) In addition to these asserted impairments, Prasnikar claims that he sleeps poorly, suffers from back pain, has volatile moods, is frequently defensive and aggressive, and experiences violent dreams about prison that sometimes result in him unconsciously lashing out at his girlfriend in the middle of the night.

On January 15, 2010, after he had discontinued working at the turkey farm, Prasnikar had a follow-up medical appointment to assess his heart condition. A radiology report produced at that time showed that he had no active cardiovascular disease in his chest, his lungs were found to be clear, and his heart was a normal size. (Tr. 286.)

On March 12, 2010, Prasnikar again sought treatment for chest pain and chronic asthma; the doctor who saw him was Carolyn Houk, M.D. (Tr. 561.) During this medical appointment, it was noted that the plaintiff had not followed up on his medical appointments for several months, yet was now requesting that the doctor help him obtain disability benefits. (Tr. 562.) The nursing intake notes indicate that the plaintiff was claiming to have daily aching chest pain provoked by stress, and claimed that he felt chronically fatigued and demoralized that he could no longer work.

During his exam, Prasnikar was found to be alert, healthy, and in no distress, though it was difficult to get a good lung exam because he would not or could not comply with directions to take deep breaths. (Tr. 564.) The plaintiff's heart rate and rhythm were normal with no unusual sounds like clicks, murmurs, rubs or gallops. (Tr. 564.) In her notes from the appointment, Dr. Houk observed that "[d]espite him feeling chest pain, sob and fatigue, he has not sought medical attention within the last 5 months and is instead asking for disability which is odd." (Tr. 564.) Dr. Houk could not do a complete assessment for a variety of reasons, and after noting that the plaintiff needed to improve medically before further assessment was possible, she stated that "I cannot rule out depression." (Tr. 564.) Dr. Houk also noted that the plaintiff was noncompliant with his medications and continued to smoke, something she "strongly urged" him to stop doing given his asthma and its effect upon his health. (Tr. 564.)[3]

Dr. Houk saw the plaintiff again on March 29, 2010. During this visit, his heart rate and rhythm were once again found to be regular with no unusual sounds. (Tr. 1095.) During this visit, the plaintiff exhibited some bilateral wheezing in his lungs, but it was noted that he had a better airway than was previously observed. (Tr. 1095.) Dr. Houk's notes indicate that cardiologists did not believe that the plaintiff's chest pain was related to active ischemia, and he had a normal ejection fraction, which is a measurement of the percentage of blood leaving the heart after it contracts. (Tr. 1096.) It was also noted that the plaintiff continued to smoke, despite being strongly advised to quit, and that his asthma had not improved since his last visit. (Tr. 1096.)

On May 5, 2010, the plaintiff was seen by Larry Jacobs, M.D. for complaints of chest pain. (Tr. 582.) Dr. Jacobs noted that the plaintiff's chest pain was atypical, and that his heart rhythm was regular with no unusual sounds. (Tr. 583.) Dr. Jacobs found that most of the plaintiff's symptoms, which included shortness of breath, were related to or due to his COPD. (Tr. 583.) Like Dr. Houk, Dr. Jacobs recommended that the plaintiff quit smoking. (Tr. 583.)

On May 24, 2010, the plaintiff underwent cardiac stress testing and was found to have a normal resting electrocardiogram (ECG), with no abnormal changes when exercising. (Tr. 960.) During this examination, the plaintiff exhibited normal ventricular function and normal myocardial contractions at rest and during periods of exercise. (Tr. 960.) When at his maximum exercise level, the plaintiff reported experiencing some mild chest pain. (Tr. 960.)

Two days later, the plaintiff was again seen by Dr. Houk. At this appointment, the plaintiff's heart rate was found to be regular and exhibited no unusual sounds. (Tr. 1113.) The plaintiff did still have some slight wheezing in his lungs, but it was noted that this had improved since his prior visit. (Tr. 1113.) Dr. Houk again emphasized the need for the plaintiff to stop smoking, and told him that his asthma would not improve unless he did so. (Tr. 1113.) At this visit, Dr. Houk noted that the plaintiff was seeing a physical therapist for a lumbar disc displacement issue. (Tr. 1114.) Dr. Houk made similar notes during follow-up appointments in the coming months. (Tr. 1124, 1133, 1135-36, 1150, 1152.)

On June 24, 2010, Candelaria Legaspi, M.D., conducted a physical residual functional capacity (RFC) assessment of the plaintiff based upon her review of his health records. (Tr. 658.) She concluded that the plaintiff could occasionally lift or carry 20 pounds and frequent lift or carry ten pounds. (Tr. 658.) She found that he had no limitation on his ability to push or pull, and that he had the ability to stand, walk or sit for six hours during an eight-hour workday. (Tr. 658.) The plaintiff was found to have no postural, manipulative, visual, communicative or environmental limitations. (Tr. 659-60.) As part of her assessment, Dr. Legaspi found that the medical evidence indicated that the plaintiff had coronary artery disease, COPD, back pain, and a disc bulge at L4-L5. (Tr. 662.) With respect to the plaintiff's heart condition, Dr. Legaspi found that the plaintiff experienced no episodes of angina or congestive heart failure, his ejection fracture of 60% was normal, and he had not sought or undergone aggressive pain treatments for his back symptoms. (Tr. 662.) Based on her review of the plaintiff's records, and finding that the plaintiff had been able to control his pain symptoms, Dr. Legaspi concluded that the plaintiff was capable of engaging in light work. (Tr. 663.)

In October 2010, the plaintiff again presented at Lehigh Valley Hospital with complaints of chest pain. (Tr. 964.) During that visit, the plaintiff had x-rays taken that showed that he had no acute cardiopulmonary disease, and his heart rate and rhythm were normal. (Tr. 973, 977.) An ECG was negative for ischemia. (Tr. 979.) During a follow-up appointment, the plaintiff told medical providers that his COPD symptoms were controlled. (Tr. 993.) An x-ray taken in late October 2010 showed that the plaintiff's heart was normal. (Tr. 1196.) The following spring, in March 2011, a radiology report showed that the plaintiff had no active heart disease, and exhibited no signs of respiratory distress. (Tr. 1067, 1073.) Nevertheless, despite these apparently neutral or positive findings throughout the fall of 2010 and spring of 2011, in April 2011, Dr. Houk opined in a Pennsylvania Department of Welfare form that the plaintiff was permanently disabled as a result of coronary artery disease, COPD and hyperlipidemia. (Tr. 1082.)

In addition to his alleged physical limitations, Prasnikar has also experienced certain mental impairments or challenges. Thus, on April 8, 2010, the plaintiff underwent a mental status examination in which he was diagnosed with adjustment disorder and depressive disorder, and was assigned a Global Assessment of Functioning (GAF) score of 45, suggesting a serious impairment.[4] (Tr. 647-48.) At the time of this assessment, the plaintiff appeared anxious and depressed, but was neat, with good hygiene, made good eye contact, and demonstrated logical and coherent thinking. (Tr. 646.)

On June 4, 2010, Peter Garito, Ph.D., conducted a mental RFC assessment based upon his review of the plaintiff's health records. (Tr. 623.) Following his review, Dr. Garito opined that the plaintiff was moderately limited in his ability to understand and remember detailed instructions, carry out detailed instructions, and maintain attention and concentration for extended periods. (Tr. 623.) Dr. Garito further opined that the plaintiff was moderately limited in his ability to interact appropriately with members of the general public, to get along with co-workers or peers without distracting them or even exhibiting behavioral extremes, and to respond appropriately to changes in the work environment. (Tr. 624.) Dr. Garito concluded that the evidence demonstrated medically determinable impairments of depression, adjustment disorder, and PTSD. (Tr. 625.) Nevertheless, Dr. Garito also found that the plaintiff had the ability to engage in most activities of daily living, including driving, making meals, shopping and managing finances. (Tr. 625.) Dr. Garito found that there were limits in the plaintiff's social activity, but that he was able to relate to family members and others with whom he interacted. (Tr. 625.) Based on his observations, Dr. Garito found that the plaintiff was capable of making simple decisions, carrying out short and simple instructions, maintaining regular attendance, and performing simple and routine tasks in a job setting. (Tr. 625.) Likewise, Dr. Garito concluded that the plaintiff was able to satisfy the basic ...

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