United States District Court, M.D. Pennsylvania
MICHAEL K. DORKOSKI, Plaintiff,
CAROLYN W. COLVIN, Acting Comissioner of Social Security, Defendant.
WILLIAM J. NEALON, District Judge.
On June 20, 2014, Plaintiff, Michael Dorkoski, filed this instant appeal under 42 U.S.C. § 405(g) for review of the decision of the Commissioner of the Social Security Administration ("SSA") denying his application for disability insurance benefits ("DIB") and supplemental security income ("SSI") under Titles II and XVI of the Social Security Act, 42 U.S.C. § 1461 et seq. and 42 U.S.C. § 1381 et seq., respectively. (Doc. 1). The parties have fully briefed the appeal. For the reasons set forth below, the decision of the Commissioner denying Plaintiff's applications for DIB and SSI will be affirmed.
Plaintiff protectively filed his applications for DIB and SSI on October 27, 2010 alleging disability beginning on December 16, 2008. (Tr. 15). The claim was initially denied by the Bureau of Disability Determination ("BDD") on April 1, 2011. (Tr. 15). On May 4, 2011, Plaintiff filed a written request for a hearing before an administrative law judge. (Tr. 15). A hearing was held on April 2, 2012 before administrative law judge Therese A. Hardiman ("ALJ"), at which Plaintiff an impartial vocational expert, Michele C. Giorgio ("VE"), and Plaintiff's mother, Alice Dorkoski, testified. (Tr. 15). On June 15, 2012, the ALJ issued a decision denying Plaintiff's claims because, as will be explained in more detail infra, Plaintiff could perform light work with limitations. (Tr. 22).
On February 4, 2014, Plaintiff filed a request for review with the Appeals Council. (Tr. 7). On April 29, 2014, the Appeals Council concluded that there was no basis upon which to grant Plaintiff's request for review. (Tr. 1-3). Thus, the ALJ's decision stood as the final decision of the Commissioner.
Plaintiff filed the instant complaint on June 20, 2014. (Doc. 1). On October 7, 2014, Defendant filed an answer and transcript from the SSA proceedings. (Docs. 9 and 10). Plaintiff filed a brief in support of his complaint on November 21, 2014. (Doc. 11). Defendant filed a brief in opposition on January 26, 2015. (Doc. 16). Plaintiff did not file a reply brief.
Plaintiff was born in the United States on February 21, 1963, and at all times relevant to this matter was considered a "younger individual." (Tr. 224). Plaintiff obtained college and masters degrees, and can communicate in English. (Tr. 238-239). His employment records indicate that he previously worked as a stockbroker, manufacturing engineer, business consultant, and a security guard. (Tr. 227). The records of the SSA reveal that Plaintiff had earnings in the years 1979 through 1981, 1987 through 1989, 1991 through 2006, and 2009. (Tr. 176). His annual earnings range from a low of no earnings from 1982 through 1986, and in 1990, 2007, 2008, 2010, and 2011, to a high of fifty-two thousand three hundred ninety-seven dollars and forty-six cents ($52, 397.46) in 2005. (Tr. 176). His total earnings during those thirty-two (32) years were five hundred thirty-eighth thousand two hundred ninety-nine dollars and fifty-six cents ($538, 299.56). (Tr. 176). Plaintiff's alleged disability onset date is December 16, 2008. (Tr. 224). The impetus for his claimed disability is "back problems." (Tr. 239).
In a document entitled "Function Report - Adult" filed with the SSA, Plaintiff indicated that he lived alone in a "HUD highrise." (Tr. 264). From the time he woke up until he went to bed, he made and drank his coffee, watched television, would be "up and down the [first] 3 hours or so to loosen up, " got dressed, took the elevator to his car, drove to Mount Carmel to pick up his son and his son's mother, drove them to Walmart, shopped with them in Walmart for about twenty (20) minutes, waited outside in the car until they were finished shopping, drove back to his son's house, unloaded the groceries, sat on the couch and watched television with his son, and then either went home or lied down in his son's bed for forty-five (45) minutes to two (2) hours when the "pain [had] increased [and] fatigue [had] set in." (Tr. 265-266). He indicated that he took care of his four (4) year old son, and sometimes his son's older brothers, which involved making quick meals. (Tr. 267). His son's mother's ex-husband helped take care of his son. (Tr. 267). His back pain affected his sleep. (Tr. 267). He was able to take care of his personal needs, albeit slowly. (Tr. 268). He prepared mainly frozen and microwave meals, did one (1) load of laundry per week, drove a car, and shopped for groceries. (Tr. 268-269). When asked to check items which his "illnesses, injuries, or conditions affect, " Plaintiff did not check hearing, seeing, or using his hands. (Tr. 271). He was able to walk about two hundred (200) yards before needing to stop and rest for about five (5) minutes. (Tr. 271). He indicated that he used a cane "all the time" because he needed it, and that he would "only get it prescribed if [he] wanted a [third] party to pay for it." (Tr. 272).
Regarding his concentration and memory, Plaintiff needed special reminders to take care of his personal needs and to take his medicine. (Tr. 268). He could count change, handle a savings account, and use a checkbook. (Tr. 269). He did not finish what he started, indicated that the questionnaire "lost [his] attention long ago, " stated that his ability to follow written and spoken instruction depended on his pain level, and handled changes in routine "ok." (Tr. 271-272).
Socially, Plaintiff left his apartment about five (5) days a week, and was able to go out alone. (Tr. 269). He saw his son daily. (Tr. 270). He had no hobbies or interests, and indicated that before his illnesses, injuries, and conditions began, he was "superman." (Tr. 270). He reported that he had problems getting along with family, friends, neighbors, or others due to pain which caused him to not want to be "bothered." (Tr. 271). Prior to the onset of his conditions, he was social. (Tr. 271). He could be "short" with authority figures, but was never fired or laid off from a job because of problems getting along with others. (Tr. 272).
In a Supplemental Questionnaire regarding fatigue, Plaintiff indicated that he began experiencing fatigue in 2005 when he started taking Vicodin, and that his fatigue had increased as his medication had been increased "over the years." (Tr. 274). His pain wore him out, and due to an increase, caused him to nap daily and to lie down several times a day. (Tr. 274).
In a Supplemental Questionnaire regarding pain, Plaintiff indicated that his pain began in 2005, and that it was stabbing, pinching, throbbing, aching, twisting, and tightening in nature. (Tr. 275). He stated that his pain was at a higher level more consistently than it was when it began. (Tr. 275). The location of his pain went from the base of his skull, down his back, into his hips, down into the ball of his left foot, and then sometimes into the toes of his left foot. (Tr. 275). He avoided any activities taking place below his waist, and weather changes increased his pain. (Tr. 275). His pain was worse in early mornings and when he pushed himself. (Tr. 275). It occurred all day, every day. (Tr. 275). His pain medication "took the edge off, " and caused drowsiness and fatigue. (Tr. 276). Plaintiff received epidurals and engaged in home physical therapy exercises to relieve his pain, but did not attend physical therapy because it was not covered by Medicaid. (Tr. 276).
At his hearing, Plaintiff indicated that he had two (2) children, a thirty-one (31) year old daughter, and a son who was five and a half (5 ½) years old. (Tr. 44). He got along well with his immediate family and with people in general. (Tr. 49). Regarding his educational and work history, Plaintiff testified that he obtained his degree in aeronautical engineering in 1986, and his MBA at Lehigh University in 1991. (Tr. 44). At the time of the hearing, he was receiving food stamps, had a medical access card, and was living in a HUD high-rise, but was not receiving cash assistance. (Tr. 45). He stated that, since his alleged onset date of December 16, 2008, he worked as a security guard at Knoebel's amusement park in the summer of 2009, but that the job aggravated his condition. (Tr. 45). He testified that pain, having to frequently switch positions, and being easily confused caused him to voluntarily leave his position at Bucknell University. (Tr. 55). He testified that he preferred to be still working at Bucknell, explaining that "who in their right mind would do this for six or eight years and learn complete poverty just for some kind of a chance to get a small check... I should be out there using my two degrees..." (Tr. 56).
Regarding his mental health impairments, Plaintiff testified that he had initially been seeing a psychiatrist, Dr. Singh, weekly, and at time of the hearing, was seeing him monthly. (Tr. 46). He was also attending counseling and Alcoholics Anonymous ("AA"). (Tr. 46-47). He admitted that he had been having auditory hallucinations. (Tr. 59). He also described that during the time when he drank alcohol years prior, he would see "all these random black cats going in front of [him], " but that when he stopped drinking, the cats appeared less and less. (Tr. 60). He also explained that he equated the black cats with bad signs. (Tr. 60).
Regarding his physical limitations, Plaintiff testified that he took care of his personal needs such as bathing, grooming, and dressing every couple of days. (Tr. 48). He "barely [did] anything" in terms of household chores, and doing any activity from the "waist down [was] nearly impossible." (Tr. 48). He was able to read the news, watch movies, and use the computer. (Tr. 48). He also was able to fish, with his last fishing trip being the day before the hearing, but fished in a spot close to his car because he had trouble walking far distances. (Tr. 49). He shopped at Walmart, but was only able to "go to the back of the store once and  back to the front." (Tr. 49). He testified that the last item he picked up off the floor was a piece of paper. (Tr. 50). In a seated position, he was able to straighten his legs out and put them down, but it caused strain and pain in his lower lumbar area. (Tr. 50). On average, he was able to stand for about ten (10) to fifteen (15) minutes before needing to sit or lay down, and the best he could do was forty-five (45) minutes. (Tr. 51). On average, he was able to sit in a seat for twenty (20) to forty (40) minutes. (Tr. 51). He could walk about two (2) blocks, but some days was able to walk five (5) blocks. (Tr. 52-53). He was able to reach overhead. (Tr. 50). Activities that aggravated his symptoms included walking too much, lifting anything, standing too long, sitting in a certain position for too long, and driving too far. (Tr. 53). He stated that before his pain began, he worked out five (5) days a week. (Tr. 56).
In terms of daily routine, he typically woke up at about seven o'clock in the morning (7:00 a.m.), and would go to bed anytime between eight thirty in the evening (8:30 p.m.) and two thirty in the morning (2:30 a.m.). (Tr. 50). He testified that the amount of time he slept varied due to medication changes, but that at the time of his hearing, he slept about eight (8) to nine (9) hours a night, and then would get very tired in the afternoon when he would take a three (3) to four (4) hour nap. (Tr. 50-51).
With respect to medication, Plaintiff indicated that he was taking Vicodin, Gabapentine, Flexeril, Celexa, the Fentanyl Patch, Hydroxyzine, and Risperidone. (Tr. 52-53). He testified that his medications were not very effective, but that without them, he would "kill [himself]." (Tr. 52). In terms of side effects, Plaintiff experienced a low sex drive, dry mouth, headaches, and short-term memory loss. (Tr. 52, 54). He testified that the narcotics helped his back pain, but did not help the buzzing electric-like pain in his legs; however, the Gabapentin did help the buzzing sensations. (Tr. 53). Physical therapy did not help. (Tr. 58). Plaintiff walked with a cane most of the time. (Tr. 58). The hearing concluded with a clarification for the record made by Plaintiff's attorney that, during the hearing, Plaintiff had been kneeling on the floor and leaning against the wall and behind a chair. (Tr. 60).
Plaintiff's relevant medical records will be reviewed, including those from his alleged onset date of December 16, 2008, through the date last insured of December 31, 2012.
On January 15, 2009, Plaintiff had an appointment with Hussain Abdul-Al, M.D. at Medical House, P.C., with the request that Dr. Abdul-Al fill out disability forms. (Tr. 382). Plaintiff stated that he could not work due to back pain, and that he wanted to receive more injections as they gave him relief for several weeks at a time. (Tr. 382). His medications list at this appointment included Fish Oil, Celexa, Flexeril, and Vicodin. (Tr. 382). Dr. Abdul-Al's plan was for Plaintiff to continue on these medications, and Dr. Abdul-Al completed the disability paperwork. (Tr. 382).
On January 26, 2009, Plaintiff visited the emergency room ("ER") at Shamokin Area Community Hospital for back pain after a car accident. (Tr. 308). He underwent an x-ray of his cervical spine, which showed degenerative disc disease ("DDD") with disc space narrowing at the C5-C6 and C6-C7 levels and straightening of the normal cervical lordosis. (Tr. 310). He was diagnosed with degenerative disc disease at the C5-C6 and C6-C7 levels in the mid to lower lumbar area. (Tr. 310-311).
On January 27, 2009, Plaintiff had a follow-up visit with Dr. Abdul-Al after his car accident a day earlier. (Tr. 384). Plaintiff stated that he had bilateral hip pain, lower back pain, groin pain, and numbness in his legs while he was at the ER. (Tr. 384). Plaintiff was told to keep taking the Fish Oil, Celexa, Flexeril, and Vicodin, and was not scheduled for a follow-up visit. (Tr. 384).
On February 4, 2009, Plaintiff had an appointment with David Martin at Medical House, P.C., for complaints of back pain. (Tr. 386). It was noted that he had a long-standing history of low back pain related to DDD that was complicated by the recent car accident in January of 2009. (Tr. 386). It was also noted that Plaintiff had prior successful visits to Pain Management at GMC, and, as a result, requested an evaluation and treatment at this location. (Tr. 386). His exam revealed diffuse tenderness over his right and left lumbar paraspinal areas with guarding and bilateral diminished patellar reflexes. (Tr. 386). An MRI of Plaintiff's lumbar spine was ordered, and Plaintiff was scheduled for a caudal epidural injection at the Pain Management Center at GMC. (Tr. 386).
On February 13, 2009, Plaintiff underwent an MRI of his lumbar spine. (Tr. 363). His diagnosis was DDD with mild central canal stenosis at the L3-4 level, degenerative changes at the L4-5 level with previous left laminectomy, a left paramedial to lateral disc protrusion narrowing the left lateral recess and potentially impinging the left L5 nerve root, and mild bilateral neural foraminal narrowing at the L4-5 level. (Tr. 363).
On February 26, 2009, Plaintiff had an appointment with David Martin for depression. (Tr. 388). It was noted that Plaintiff had been seeing Dr. Newton who wanted to start him on Lamictal, and that Plaintiff felt that the Celexa does was not as effective as it once was. (Tr. 388). Plaintiff's Celexa dosage was increased, bloodwork was ordered, and Plaintiff was instructed to schedule an appointment with Dr. Newton at his earliest convenience. (Tr. 388-389).
On March 4, 2009, Plaintiff had an appointment with Shaik Mohd Ahmed, MD for pain in his low back and his knees. (Tr. 314). It was noted that he recently had a repeat MRI which showed "changes at L3-4, L4-5" and DDD at L5-S1. (Tr. 314). Plaintiff completed a pain scale survey, indicating that on a scale of zero (0) to ten (10), his present pain that day was a three (3), and that he experienced: (1) a four (4) for back pain; (2) a two (2) for right leg pain; (3) a three (3) for neck pain; and (4) a zero for right arm pain. (Tr. 317). Plaintiff indicated that he had little interest or pleasure in any activity. (Tr. 318). On a scale of zero (0) to ten (10), he rated his overall back pain intensity at a two (2), his pain during personal care activities at a one (1), pain during lifting, walking, sitting, standing, and sleeping at a two (2), and pain with social life and traveling at a three (3). (Tr. 318). He rated his neck pain on a scale of zero (0) to ten (10) at a three (3) for pain intensity, a one (1) with personal care, a two (2) with lifting, reading, concentration, driving, sleeping, and recreation, and a three (3) for headaches and while working. (Tr. 318). His problems list included the following: (1) major depressive disorder; (2) anxiety; (3) insomnia; (4) post laminectomy lumbar problems; (5) lumbosacral neuritis; (6) lumbosacral DDD; and (7) lumbosacral disc displacement. (Tr. 320). His outpatient medications included Flexeril, Vicodin, Celexa, Hydrocodone-Acetaminophen, and Fentanyl. (Tr. 320). Dr. Ahmed recommended a lumbar epidural steroid injection, and Plaintiff agreed to receive this treatment. (Tr. 314). The indications for the injection were "spinal stenosis-lumbar, degenerative disc disease, and neuropathic pain." (Tr. 314). Plaintiff received the injection at this appointment, and was scheduled for a follow-up visit in two (2) months. (Tr. 315).
On March 9, 2009, Plaintiff had an appointment with David Martin for neck pain. (Tr. 390). An MRI of the cervical spine was ordered, and physical therapy, along with a continuation of the medications Plaintiff had already been taking, including Fish Oil, Celexa, Flexeril, and Vicodin, was prescribed. (Tr. 390). Plaintiff was scheduled for a follow-up appointment in one (1) month. (Tr. 390).
On March 24, 2009, Plaintiff had an appointment with David Martin with a request of an increase in his Vicodin dosage. (Tr. 392). In the "History of Present Illness" section, it was noted that Plaintiff had been seen by Martin for low back pain that had been causing numbness in his bilateral lumbar spine area with radiation to both hips and legs. (Tr. 392). Plaintiff stated that when he sat still for about forty-five (45) minutes, he would develop numbness in his bilateral hip area with radiation down along his sciatic nerves to his bilateral heels. (Tr. 392). It was noted that Plaintiff was enrolled in physical therapy and was awaiting approval for an MRI of his lumbar spine and bilateral hip areas. (Tr. 392).
On April 22, 2009, Plaintiff had a follow-up appointment for his neck and back pain with David Martin. (Tr. 394). It was noted that Plaintiff could not attend physical therapy "because of insurance problems, " but Plaintiff had been exercising on his own and noted an improvement in his general condition. (Tr. 394). His medications list at this appointment included Vicodin, Celexa, Fish Oil, and Flexeril, but Plaintiff indicated that he had been using his pain medications on a "downscale" and did not need any refills at that time. (Tr. 394). Plaintiff had a full range of motion in his neck, and was told to follow-up as needed. (Tr. 394).
On June 5, 2009, Plaintiff received a caudal epidural steroid injection performed by Dr. Ahmed for his lumbar spinal stenosis and DDD, lumbosacral neuritis, and neuropathic pain. (Tr. 327). More specifically, Plaintiff indicated that his pain was located in his lower back bilaterally with radiation into his buttocks bilaterally, rated this pain at a three (3) out of ten (10), and described it as constant in nature. (Tr. 328). It was also noted that Plaintiff received good temporary pain relief of his hip pain from the March 4, 2009 lumbar epidural steroid injection. (Tr. 328). Plaintiff tolerated the injection, and was scheduled for a follow-up in three (3) months. (Tr. 328).
On July 2, 2009, Plaintiff had an appointment with David Martin for refills of his pain medication. (Tr. 396). It was noted that he had a caudal epidural block done in June that did not help as well as it had in the past and that his condition had recently been aggravated by sleeping on the ground during a camping trip. (Tr. 396). His neck had a full range of motion, and an exam of his spine revealed bilateral lumbar tenderness with negative straight leg lift pain. (Tr. 396). Plaintiff was told to continue on Celexa, Fish Oil, and Flexeril, was prescribed a new medication called Duragesic, and was scheduled for a follow-up appointment in three (3) months. (Tr. 396).
On July 10, 2009, Plaintiff had a follow-up appointment with David Martin to discuss the newly prescribed Duragesic patch for pain control. (Tr. 398). He reported that he still had been having pain with using only the patch for pain control, but the Vicodin in combination with the patch gave him better relief. (Tr. 398). His exam revealed a full range of motion in his neck and bilateral lumbar pain radiating to his bilateral hips. (Tr. 398). He was scheduled with GMC Pain Management in the upcoming weeks. (Tr. 398).
On July 30, 2009, Plaintiff had an appointment with David Martin. (Tr. 400). Plaintiff was advised to use Duragesic as his main pain management control and that Vicodin should only be used for breakthrough symptoms. (Tr. 400).
On September 8, 2009, Plaintiff presented to Dr. Ahmed for a caudal epidural steroid injection for lumbar spinal stenosis and DDD, lumbosacral neuritis, and neuropathic pain. (Tr. 337). He indicated he had been experiencing pain in his lower back, hips, and legs, and rated his pain at a four (4) out of ten (10). (Tr. 339). Plaintiff tolerated the procedure well, and was scheduled for a follow-up visit in three (3) months. (Tr. 338).
On September 8, 2009, Dr. Hussain Abdul-Al filled out a Clinical Assessment of Pain form. (Tr. 346). Dr. Abdul-Al opined the following: (1) Plaintiff's pain was present to such an extent as to be distracting to adequate performance of daily activities and/or work; (2) Plaintiff experienced greatly increased pain in relation to physical activities such as walking, standing, bending, stooping, and moving of extremities to such a degree as to cause distraction from or total abandonment of a task; (3) Plaintiff's medications could be expected to cause some mildly troublesome side effects; (4) Plaintiff's pain and/or prescribed medication would present some limitations on his ability to perform his previous work, but not to such a degree as to create serious problems in most instances; (5) Plaintiff's pain would remain a significant element in his life, although it may lessen in intensity or frequency in the future; and (6) treatments for his pain had no appreciable effect or have only briefly altered the level of pain. (Tr. 346-348).
On September 28, 2009, Plaintiff had an appointment with David Martin due to numbness on the bottom of his left foot that had been occurring for six (6) weeks and was associated with standing and walking a lot while working at the amusement park. (Tr. 404). He reported that the epidural he received three (3) weeks earlier at GMC resulted in a slight improvement, and that he had obtained fairly adequate pain relief of his lower back with the prescription medications. (Tr. 404). Upon examination, Plaintiff had a full range of motion in his neck, and his feet and lower extremities were normal to inspection and palpation. (Tr. 404). Plaintiff was instructed to continue on his medications, including Duragesic, Colase, Vicodin, Celexa, Fish Oil, and Celexa. (Tr. 404).
On October 19, 2009, Plaintiff had an appointment with Dr. Abdul-Al for "cascading pain" through the left side of his body, increasing lower back pain that radiated into his left foot and leg, and bilateral groin pain. (Tr. 406). It was noted that he was "concerned about the future of his back, and the effect of this on his work ability..." (Tr. 406). In the comments section of the medical record from this appointment, it was stated that Plaintiff had been seen by Dr. Lin at "sun ortho" who had suggested surgery, and was also seen by Dr. Andrychack who offered him surgery for DDD, but Plaintiff declined. (Tr. 406). Plaintiff had been previously treated with Neurontin and Cymbalta, but he "could not work with both of them..." (Tr. 406). Dr. Abdul-Al suggested that Plaintiff not be involved in physical kind of work, but that he would be able to do sedentary work. (Tr. 406).
On December 15, 2009, Plaintiff had a follow-up appointment with Dr. Abdul-Al. (Tr. 408). Plaintiff indicated that he had not been taking Neurontin, that his back pain was stable with some days worse than others, that he continued to have numbness in his left foot, and that he was feeling depressed, but not taking his Celexa. (Tr. 408). His examination revealed that he had a full range of motion in his neck, and that his extremities did not show any clubbing, cyanosis, or edema. (Tr. 408). His Assessment Diagnoses included DDD and Depressive Disorder. (Tr. 408). He was instructed to continue taking his medications, including Colace, Flexeril, Neurontin, Medrol, Fish Oil, Cialis, Vicodin, Duragesic, and Celexa, and was scheduled for a follow-up visit in six (6) months. (Tr. 408-409).
On December 16, 2009, Plaintiff had an appointment with licensed professional counselor Gene Brosius at Mount Carmel Mental Health Center. (Tr. 665). It was noted that Plaintiff had made some progress with improving his coping skills, following his medication prescriptions, and improving his relationship with his partner. (Tr. 665). His exam revealed the following: a depressed mood, a normal and appropriate affect, a normal mental status, that Plaintiff was active and eager to participate in his treatment, and that his response to treatment was as expected. (Tr. 665). In the "Other Observations/Evaluations" section, it was noted that Plaintiff returned as a patient after two (2) years, that he was depressed, that occupational and relationship issues continued to be a point of focus, and that he continued to seek help with employment. (Tr. 665). He was scheduled for a weekly follow-up. (Tr. 665).
On January 12, 2010, Plaintiff had an appointment with Dr. Abdul-Al for increasing neck problems. (Tr. 410). He stated that he had been experiencing numbness in his upper extremities that was affecting his sleep because his "whole arm [was] numb" when he went to bed, but the numbness went away in the morning when he woke up and shook his hands. (Tr. 410). His exam revealed that he had no motor dysfunction in his upper extremities. (Tr. 410).
On January 13, 2010, Plaintiff had an appointment with Gene Brosius at Mount Carmel Mental Health Center. (Tr. 666). It was noted that Plaintiff had made some progress with improving his coping skills, following his medication prescriptions, and improving his relationship with his partner. (Tr. 666). His exam revealed the following: a normal/euthymic mood, a normal and appropriate affect, a normal mental status, that Plaintiff was active and eager to participate in his treatment, and that his response to treatment was as expected. (Tr. 666). In the "Other Observations/Evaluations" section, it was noted that Plaintiff continued to have occupational and relationship issues, and that he had applied for a part-time position with a bus company. (Tr. 666). He was scheduled for a bi-weekly follow-up. (Tr. 666).
On January 27, 2010, Plaintiff had an appointment with Gene Brosius at Mount Carmel Mental Heath Center. (Tr. 667). It was noted that Plaintiff had made some progress with improving his coping skills, following his medication prescriptions, and improving his relationship with his partner. (Tr. 667). His exam revealed the following: a depressed mood, a normal and appropriate affect, a normal mental status, that Plaintiff was active and eager to participate in his treatment, and that his response to treatment was as expected. (Tr. 667). In the "Other Observations/Evaluations" section, it was noted that Plaintiff was depressed. (Tr. 667). He was scheduled for a bi-weekly follow-up. (Tr. 667).
On February 5, 2010, Plaintiff underwent an MRI of his cervical spine. (Tr. 365). The report noted that there were anterior osteophytes at the C5-6 and T3-4 levels, a broad-based bulge with a right paracentral protrusion at C5-6 with stenosis of the canal and neural foramina, a disc bulge eccentric to the left at C7-T1 that extended into the lateral recess on the left, and left paracentral herniations at the T2-3 and T3-4 levels. (Tr. 365). The impression was that Plaintiff had cervical spondylosis with findings most significant at the C5-6 and C7-T1 levels. (Tr. 365).
On March 5, 2010, Plaintiff underwent an EMG Electrodiagnostic Study performed by Glen A. Marino, M.D. for arm and hand numbness and pain. (Tr. 349). The test concluded that Plaintiff had bilateral median neuropathy of the wrist, otherwise known as Carpal Tunnel Syndrome, with very mild demyelination on the left and early moderate demyelination on the right, and had chronic cervical radiculopathy at the C7-C8 distribution on the left with normalization of the cervical paraspinal muscles and borderline suggestion of a similar pattern developing on the right. (Tr. 350). The "Discussion" section of the report noted that Plaintiff already had known lumbar degenerative disc disease, and that the EMG test suggested cervical disc disease with ...