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Stephens v. Colvin

United States District Court, M.D. Pennsylvania

March 13, 2017


          KANE, JUDGE



         I. Procedural Background

         On February 27, 2012, Steve Stephens (“Plaintiff”) filed as a claimant for disability benefits under Title II and XVI of the Social Security Act, 42 U.S.C. §§ 401-433, 1382-1383 (“Act”) and Social Security Regulations, 20 C.F.R. §§ 404 et seq., 416 et seq., with a last insured date of September 30, 2014, [1] and claimed a disability onset date of April 25, 2011. (Administrative Transcript (hereinafter, “Tr.”), 13).

         After the claim was denied at the initial level of administrative review, the Administrative Law Judge (ALJ) held a hearing on January 29, 2014. (Tr. 33-57). On May 15, 2014, the ALJ found that Plaintiff was not disabled within the meaning of the Act. (Tr. 10-32). Plaintiff sought review of the unfavorable decision, which the Appeals Council denied on September 14, 2015, thereby affirming the decision of the ALJ as the “final decision” of the Commissioner. (Tr. 1-5).

         On October 14, 2015, Plaintiff filed the above-captioned action pursuant to 42 U.S.C. § 405(g) to appeal a decision of the Commissioner of the Social Security Administration (“SSA”) denying social security benefits. (Doc. 1). On December 22, 2015, the Commissioner (“Defendant”) filed an answer and an administrative transcript of proceedings. (Doc. 9, 10). On February 4, 2016, Plaintiff filed a brief in support of the appeal. (Doc. 13) (“Pl. Brief”)). On April 25, 2016, Defendant filed a brief in response. (Doc. 20 (“Def. Brief”)). On May 2, 2016, Plaintiff filed a reply brief. (Tr. 21 (“Reply”)). On November 8, 2016, the Court referred this case to the undersigned Magistrate Judge.

         II. Relevant Facts in the Record

         A. Education, Age, and Vocational History

         Plaintiff was born in August 1968 and classified by the Regulations as a younger individual at the time of the ALJ decision. (Tr. 26); 20 C.F.R. § 404.1563(c). He had a GED and past work experience as a dishwasher/kitchen helper, prep cook, painter, and laborer for a cemetery and for a grocery store. (Tr. 52, 174, 183-90, 227-31). Plaintiff asserts that he is disabled due to several impairments, including low back pain, bilateral knee problems, PTSD, depression, paranoia, suicidal ideation, and violent outbursts. (Tr. 173). Earnings reports demonstrate that he earned three to four quarters of coverage from 1988 to 1999, 1992 to 1998, 2000 to 2001, 2004 to 2009.[2] (Tr. 165).

         B. Relevant Treatment History and Medical Opinions

         1. Pinnacle Health

         On April 25, 2011, Plaintiff sought emergency room (ER) treatment for right knee and for low back pain after he was struck on the front side of his right knee by a car. (Tr. 250-58). X-rays of Plaintiff's right knee showed a small effusion with no fracture or dislocation. (Tr. 259). He was diagnosed with a right knee contusion. (Tr. 258).

         2. Orthopedic Institute of PA: William W. DeMuth, M.D.

         On August 24, 2011, Plaintiff went to Dr. DeMuth, an orthopedic surgeon, for complaints of radicular pain from his low back to his right knee. (Tr. 274). Plaintiff reported that he was struck by a vehicle while he was walking. (Tr. 274).

         Plaintiff was fully ambulatory. (Tr. 274). He walked with a decided limp and exhibited positive straight leg raising on the right. (Tr. 274). He did not have signs of myelopathy. (Tr. 274). Dr. DeMuth opined that Plaintiff had posttraumatic lower back pain with right leg sciatica. (Tr. 274). An MRI of Plaintiff lumbar spine dated August 30, 2011, showed lumbar spondylosis with a mild disc protrusion at ¶ 5-S1. (Tr. 396).

         On September 26, 2011, Plaintiff stated that his main problem was his right leg which, he claimed, gave way when he walked. (Tr. 273). Dr. DeMuth ordered an MRI of Plaintiff's right knee, which showed a medial meniscus tear. (Tr. 394). On November 18, 2011, Plaintiff underwent right knee arthroscopy to address a meniscus tear. (Tr. 271, 310).

         On December 2, 2011, Plaintiff sought follow-up treatment and reported feeling stiff and sore, but otherwise doing well. (Tr. 270). Dr. DeMuth observed that Plaintiff moved around with a slight limp, that his range of motion was stiff, but he was ambulating, and Plaintiff reported that his left side was also bothering him due to the accident. (Tr. 270). On January 16, 2012, Plaintiff reported back pain and suicidal thoughts and depression due to his inability to work and due to the stiffness in his knees. (Tr. 269). Dr. DeMuth noted that Plaintiff seemed to have stiffness with range of motion, and “seemed to have exaggerated discomfort for what the clinical exam suggested.” (Tr. 269). Dr. DeMuth diagnosed Plaintiff with mild degenerative joint disease of the knees and depression. (Tr. 269).

         On February 27, 2012, Plaintiff sought follow-up treatment for his right knee. (Tr. 268). Dr. DeMuth noted that Plaintiff seemed to have improved, had some stiffness in his leg, and that he did not find any physical reason to explain why Plaintiff's knee was locking. (Tr. 268). Dr. DeMuth opined that Plaintiff was unable to work until his knee symptoms resolve. (Tr. 268).

         On April 25, 2012, Dr. DeMuth stated that Plaintiff had some residual swelling of his right knee and was mildly numb in the anterior aspect of his leg. (Tr. 282). Plaintiff could otherwise flex his knee to 120 degrees and had full extension. (Tr. 282). Dr. DeMuth stated that “all in all [Plaintiff] was doing well.” (Tr. 282).

         On October 19, 2012, Dr. DeMuth observed Plaintiff limping possibly due to his right knee. (Tr. 386). Dr. DeMuth noted that Plaintiff seemed a “bit hyperactive” and did not appear to be as depressed as he had been on previous visits. (Tr. 386). Dr. DeMuth noted tenderness along his right knee, but no ligament instability. (Tr. 386). Plaintiff had full range of motion of his right shoulder, as well as his right hip. (Tr. 386). There were no signs of myelopathy. (Tr. 386). X-rays of Plaintiff's right knee showed “very mild” degenerative changes. (Tr. 386). X-rays of his right shoulder were normal. (Tr. 386). Dr.

         DeMuth injected Plaintiff's right knee and prescribed Ultram for pain relief. (Tr. 386). On November 7, 2012, Plaintiff had a normal range of motion for the neck and normal gait. (Tr. 372-73).

         On June 14, 2013, Plaintiff sought treatment for his right thumb and right knee. (Tr. 384). Dr. DeMuth observed full range of motion in the thumb with an intact neurovascular examination. (Tr. 384). Upon examination of Plaintiff's knee, Dr. DeMuth noted no ligament instability and did not note any remarkable findings. (Tr. 384). Dr. DeMuth assessed Plaintiff with chondromalacia and post-traumatic right hand pain. (Tr. 384).

         On August 7, 2013, Plaintiff reported ongoing right knee pain which caused difficulty going up and down steps. (Tr. 405). Plaintiff had pain with range of motion of his right knee, but no ligament instability. (Tr. 405). Dr. DeMuth noted minor right knee effusion was noted. (Tr. 405). X-rays of Plaintiff's knees showed no obvious arthritis and x-rays of Plaintiff's lumbar spine were normal. (Tr. 405). Dr. DeMuth injected Plaintiff's right knee and advised Plaintiff to follow up in one year. (Tr. 405).

         3. Tristan Associates

         A right lower extremity Venus Doppler, performed December 20, 2011, revealed normal compressibility of the femoral and popliteal veins, indicating absence of thrombus at the knee and above. (Tr. 311).

         4. Holy Spirit Hospital

         On April 27, 2011, Plaintiff reported lower back pain, bilateral leg pain, as well as shoulder and neck pain due to a recent auto-pedestrian collision. (Tr. 312-16). It was noted that he was ambulatory, had multiple contusions, and examination of Plaintiff's neck revealed that it was non-tender and demonstrated a painless range of motion. (Tr. 313, 315-16). An x-ray of Plaintiff's lumbar spine showed mild arthritic changes with no acute fracture. (Tr. 317). An x-ray of his cervical spine showed mild degenerative changes at ¶ 5-C6 and moderate spondylosis or possible skeletal hyperostosis in his lower cervical spine. (Tr. 317).

         On December 26, 2012, Plaintiff sought treatment for injury for his right thumb and right knee. (Tr. 325-36). It was noted that Plaintiff was ambulatory. (Tr. 333). Examination of Plaintiff's back revealed no costovertebral angle (“CVA”) tenderness, and no vertebral tenderness. (Tr. 331). Examination of Plaintiff's neck revealed that it was non-tender and demonstrated a painless range of motion. (Tr. 331). Examination of Plaintiff's thumb revealed tenderness and mild swelling. (Tr. 331). An x-ray of Plaintiff's right thumb showed no abnormality. (Tr. 335). An x-ray of his right knee showed minimal degenerative changes. (Tr. 336).

         5. Pressley Ridge: Amy Saracino, D.O.

         In a psychiatric evaluation dated December 13, 2010, Plaintiff reported that he no prior inpatient or outpatient psychiatric history. (Tr. 339). Plaintiff reported no history of suicide attempts or any psychotropic drug trials. (Tr. 339). Plaintiff reported a history of head injuries and motor vehicle accidents, and reported that he currently was not taking any medication. (Tr. 339). Plaintiff reported taking criminal justice classes for an online university and planned to transfer the credits to a local community college. (Tr. 340). Plaintiff reported twice daily cannabis use and no alcohol use or recent use of drugs other than cannabis. (Tr. 340).

         Plaintiff reported that he had thought a lot about death as a result of things he had witnessed. (Tr. 338). Plaintiff reported that, at times, he thinks he sees faces in the carpet or in the concrete which are “evil.” (Tr. 338). Plaintiff reported that when he was young he witnessed a man get run over by a steamroller; prior work experience which involved cremating individuals; sharing a jail cell with a convicted murder who described, in detail, his killings, and; as a result of testifying against the convicted murderer, he was attacked by a taxi driver who attempted to poison him. (Tr. 338-39). Plaintiff reported some anxiety surrounding these intrusive thoughts and flashbacks including increased heart rate and chest pain. (Tr. 339). He reported feeling depressed more days than not in a given year. (Tr. 339). Plaintiff reported that he cries for no reason, experienced a reduced appetite and decreased energy, had ongoing trust issues, and was somewhat defensive. (Tr. 339). Plaintiff reported that he once intentionally burned himself to serve as a distraction from his feelings. (Tr. 339). Plaintiff denied any history consistent with manic episodes including periods of decreased need for sleep or increased energy, did not describe any clear grandiose delusions, and did not report any history of auditory hallucinations or clear delusions. (Tr. 339). Dr. Saracino noted that Plaintiff presented “with some unrealistic thoughts in discussing events that have happened to him.” (Tr. 339). Plaintiff also reported that when thinking of death or violent thoughts, it is easier to think of himself as someone he named “Jack.” (Tr. 339). Plaintiff acknowledged that there were not really two parts of him and Dr. Saracino posited that Plaintiff may have used “Jack” as a possible coping mechanism. (Tr. 339).

         Dr. Saracino noted that Plaintiff's recent and remote memory appeared grossly intact, was oriented x3, had normal speech, and broad affect. (Tr. 340-341). Dr. Saracino noted small healing burns on his bilateral hands and wrists. (Tr. 341). Plaintiff reported “possible hallucinations” which Dr. Saracino opined were “most likely illusions or a manifestation of anxiety or posttraumatic experiences including hypervigilance.” (Tr. 341). Dr. Saracino noted that Plaintiff sat in the chair and steadily looked at the carpet for a face which would be “atypical of an actual visual hallucination.” (Tr. 341). Dr. Saracino opined that there was no “evidence of clear delusional thinking at the time of the interview” and although Plaintiff described a certain amount of hypervigilance and paranoid thinking at times, such was not to the point of reaching the realm of paranoid delusions. (Tr. 341).

         Dr. Saracino noted that there was possibly obsessional thinking, however, Plaintiff did not describe any compulsive behaviors associated with these intrusive thoughts. (Tr. 341-342). Dr. Saracino diagnosed Plaintiff with: 1) dysthymic disorder; 2) rule out posttraumatic stress disorder, chronic type; 3) rule out obsessive compulsive disorder, and; 4) cannabis dependence. (Tr. 342). Dr. Saracino assessed Plaintiff with a GAF score of 55, [3] prescribed a trial of Prozac 20mg, recommended that Plaintiff abstain from drug use, and recommended individual therapy. (Tr. 342).

         On March 1, 2011, Plaintiff was discharged from Pressley Ridge for refusal to comply with attendance requirements. (Tr. 410-412). He was diagnosed with dysthymic disorder and assessed with a GAF score of 55. (Tr. 411). On November 5, 2013, Plaintiff reported he would like to stop seeing the images of dead people. (Tr. 408). Plaintiff was diagnosed with dysthymic disorder and assessed with a GAF score of 50. (Tr. 408). On November 12, 2013, he was discharged due to his return to jail based on a parole violation. (Tr. 406-07). He was assessed with a GAF score of 50 and it was noted that minimal progress was made toward reaching the treatment goals. (Tr. 406).

         6. Pinnacle Health: Mary Bonar, D.O.; Lance Hildrew, D.O.; Joseph Benaknin, D.O.; Chris Delong, R.N.

         On November 7, 2012, Plaintiff sought treatment for ear pain. (Tr. 372-73). During examination, Mr. Delong noted that Plaintiff had a normal range of motion for the neck, normal gait, normal affect, and presented with a minimal risk for suicide. (Tr. 372-73).

         On February 26, 2013, Plaintiff sought ER treatment for hematuria and reported vague symptoms of abdominal pain. (Tr. 364-69). Plaintiff denied back pain or injury, denied neck pain, but reported a history of myalgias. (Tr. 364). Plaintiff denied a history of alcohol abuse, anxiety, depression, or drug abuse. (Tr. 364). Plaintiff's gait was normal. (Tr. 365). Upon examination, Dr. Benaknin observed that Plaintiff had a normal range of motion in his neck, normal range of motion for his back with no costovertebral tenderness, and a normal range of motion in the upper and lower extremities. (Tr. 365). Dr. Benaknin noted that Plaintiff presented with a normal affect and judgment. (Tr. 365). Plaintiff was diagnosed with kidney stones and abdominal pain. (Tr. 364, 368).

         On March 28, 2013, Plaintiff sought treatment for severe pain related to kidney stones. (Tr. 357-58). Plaintiff reported a history of chronic pain of eight out of ten where ten indicated the greatest amount of pain. (Tr. 358). Plaintiff stated that he took Tylenol #3 to treat his pain because someone accused him of being addicted to Vicodin. (Tr. 358). He was anxious and alleged suicidal ideation and auditory hallucinations, however, Dr. Hildrew noted that Plaintiff presented as a minimal suicide risk. (Tr. 358).

         On June 5, 2013, Plaintiff sought follow-up treatment for kidney stones. (Tr. 350). Dr. Bonar noted that Plaintiff was ambulatory with a steady gait. (Tr. 352). Plaintiff reported experiencing pain for four months and missed his last urology appointment do to incarceration. (Tr. 350). Plaintiff reported a current pain of ten out of ten and that his pain had been constant for three days, however, he had not taken any medication to address his pain. (Tr. 350). Plaintiff reported that although he had previously been taking Tylenol #3 for his knee pain, he had not been taking pain medication for a period of time. (Tr. 350). Plaintiff reported that he smoked marijuana at times. (Tr. 350). Upon examination, Dr. Bonar noted that Plaintiff's: 1) musculoskeletal examination was unremarkable; 2) psychiatric examination revealed normal affect and judgement; 3) neck examination demonstrated a normal range of motion, and; 4) back examination demonstrated costovertebral tenderness on the left. (Tr. 350-51). Dr. Bonar recommended that Plaintiff follow up with an urologist and noted that Plaintiff could take over-the-counter medications to address pain. (Tr. 351).

         7. Medical Records during Incarceration

         On June 18, 2012, Plaintiff reported “seeing” the people that he cremated during his prior employment. (Tr. 499, 529). He was diagnosed with PTSD by history. (Tr. 529). In records on June 15, 2012, June 18, 2012, April 25, 2013, and May 17, 2013, Plaintiff generally was alert and oriented x3 and exhibited no signs of depression. (Tr. 413-16, 428). Plaintiff reported that he was worried about his car, girlfriend, rent, and his knee. (Tr. 415, 427). The form indicated that Plaintiff's mobility was not restricted in any way. (Tr. 418). Plaintiff reported that he never had a head injury and that Plaintiff indicated that he would need to see a psychologist. (Tr. 420). Plaintiff indicated that he had joint problems and surgery in the right knee. (Tr. 422). Norco and prednisone were listed as his medication. (Tr. 423). It was noted that Plaintiff's lower right knee had a well healed surgical scar and demonstrated pain with slight touch. (Tr. 425). Plaintiff reported that he had PTSD. (Tr. 433).

         On June 15, 2012, and April 25, 2013, it was noted that Plaintiff would get new intake opiate detox checks over a period of days. (Tr. 487-512). From June 18, 2012, to September 18, 2012, and starting April 26, 2013, Plaintiff was placed on gym and work restrictions and lower bunk bed assignment. (Tr. 454, 469-70).

         On April 25, 2013, Plaintiff reported that joint problems which included bilateral knee surgery in addition to hip pain. (Tr. 435). Plaintiff reported a history of depression, hypervigilance, and PTSD symptoms. (Tr. 437). Plaintiff's gait was within normal limits and right knee demonstrated full range of motion with discomfort, positive McMurray's sign and positive left Costovertebral angle tenderness. (Tr. 439). Plaintiff was cleared to perform prison work from an infection disease standpoint. (Tr. 439).

         On April 26, 2013, it was noted that Plaintiff had no mental health restrictions and he refused to take the prescribed Prozac because he did not like the way it made him feel. (Tr. 530). During the examination, Plaintiff denied suicidal thoughts, denied hallucinations, and presented with appropriate conversation, normal speech, and euthymic mood. (Tr. 530). On April 29, 2013, it was noted that although he was prescribed Prozac, Plaintiff refused his medication. (Tr. 515).

         On May 1, 2013, it was noted that Plaintiff demonstrated mildly anxious mood and affect. (Tr. 530). On May 3, 2013, physical findings were within normal limits, Plaintiff denied experiencing any pain and stated that he wanted to work. (Tr. 471, 515). After the examination, medical restrictions were discontinued for the gym, work, and lower bunk bed. (Tr. 471).

         On May 17, 2013, Plaintiff reported that he saw faces on walls and floors and sometimes heard voices. (Tr. 531). It was noted that Plaintiff was alert and oriented x4, presented with an intense mood, normal speech, and preoccupation with death. (Tr. 531). In another document dated May 17, 2013, it was noted that Plaintiff's exhibited paranoid and delusional thoughts which included auditory hallucinations. (Tr. 440-41). It was noted that Plaintiff's judgement was impaired but insight regarding awareness of his disorder was intact. (Tr. 441). He was assessed with psychotic disorder, NOS (possible delusional disorder) and personality disorder, NOS. (Tr. 441). Plaintiff was released from prison on May 27, 2013. (Tr. 520).

         During the intake process on November 11, 2013, Plaintiff denied experiencing any depression or suicidal ideation. (Tr. 536, 548). He also did not appear overly anxious, panicked, afraid, or angry. (Tr. 548). Plaintiff reported a history of pain and use of pain medications. (Tr. 547).

         On January 2, 2014, Plaintiff underwent a psychological evaluation. (Tr. 550). Plaintiff reported feeling hopeless and angry, crying all the time, reliving past events, seeing things, and hearing voices. (Tr. 550). It was noted that Plaintiff was restless, had a labile affect, tangential thought process and a depressed, angry, and irritable mood. (Tr. 550). It was noted that Plaintiff's thought content included delusions and Plaintiff reported auditory and visual hallucinations. (Tr. 550). The examiner noted, however, that Plaintiff was not responding to internal stimuli and that his thoughts and anger were toward the public in general. (Tr. 550). The examiner diagnosed Plaintiff with PTSD, intermittent explosive disorder, and personality disorder. (Tr. 550). The examiner assessed Plaintiff with a GAF of 40 and recommended a mood stabilizer, i.e., VPA (Valproic Acid), for treatment. (Tr. 550).

         On January 16, 2014, Plaintiff reported that the psychiatric medication kept him out of conflict and made him feel calmer. (Tr. 549). It was noted that Plaintiff had an appropriate affect, anxious mood, coherent thought process, normal thought content, and intact memory. (Tr. 549). Plaintiff was reported to have occasional auditory hallucinations. (Tr. 549). His thought process was coherent and his thought content was normal. (Tr. 549). It was noted that he continued to relive his past. (Tr. 549). Plaintiff's medication dosage was increased. (Tr. 549).

         On January 21, 2014, Plaintiff reported upset stomach. (Tr. 547). On January 22, 2014, and January 29, 2014, Plaintiff had a follow-up visits to evaluate for pain. (Tr. 547).

         8. Consultative Examination: Stanley E. Schneider, Ed.D.

         On May 24, 2012, Plaintiff underwent a psychological examination by Dr. Schneider. (Tr. 286-295). Dr. Schneider noted that Plaintiff walked with a noticeable limp, but he was able to ambulate without a cane. (Tr. 287). Plaintiff stated that he usually walked with a cane, but was not using a cane on the day of the examination because he did not want to depend on it. (Tr. 287). Plaintiff reported that if he sits for too long his leg feels numb and if he stands too long he loses feeling in his right knee. (Tr. 287). Dr. Schneider observed that Plaintiff stood up to alleviate his symptoms and used another chair to elevate his leg. (Tr. 287, 290). Dr. Schneider noted that Plaintiff talked continuously in a rambling fashion. (Tr. 287, 289). When discussing his work history, Plaintiff stated that he could cook, paint, landscape, and cremate people. (Tr. 287). Plaintiff stated that he had ten jobs in his lifetime, but was fired from all of them because of his anger and arguing with others. (Tr. 288-89). He stated that he did not relate much with coworkers, but was okay with supervisors generally. (Tr. 289). He described a criminal history since age 16 and he was last jailed in 2009. (Tr. 288). Plaintiff reported a history of substance abuse, denied alcohol use, and stated that he used marijuana “every now and then.” (Tr. 288). Dr. Schneider noted that Plaintiff had never been hospitalized for psychiatric symptoms but Plaintiff reported that he believed that he received outpatient treatment approximately two years prior from Children and Family Services. (Tr. 288). Although Plaintiff reported that he had another angry personality whom he referenced in the third-person, Dr. Schneider opined that it did not appear to be “any full-blown Dissociative Identity Disorder.” (Tr. 289). When asked about his depression, he said that he feels bad that he is always in pain and reported that he had crying spells. (Tr. 289). Dr. Schneider noted that while Plaintiff was taking hydrocodone and an anti-inflammatory to treat his physical symptoms, he was not currently taking any psychotropic medications and was previously on Prozac. (Tr. 288).

         On examination, Plaintiff became dysphoric as he recalled his past. (Tr. 290). His mood was depressed and Plaintiff was somewhat paranoid inasmuch as he thought he would get shot or run over. (Tr. 290). He reported having sensory experiences that people were touching his head or holding his arms. (Tr. 290). He was obsessed about death. (Tr. 290). He admitted to recurrent suicidal ideation, but no current intent. (Tr. 290). He had no memory deficits and his attention and concentration were good. (Tr. 291). He admitted to impulsively losing his temper. (Tr. 291). His judgment was acceptable, but his insight was limited. (Tr. 291).

         Although opining that Plaintiff was “fairly reliable, ” Dr. Schneider “strongly suggested that confirmatory data . . . be obtained to support some of the statements” that Plaintiff made concerning what he witnessed in the past. (Tr. 291). With regard to daily activities, Dr. Schneider stated that “[t]he only impairments, restrictions, limitations concerning activities of daily living are mainly physical.” (Tr. 291). Dr. Schneider noted that Plaintiff did serial 5's acceptably, was concrete in his attempts to interpret simple proverbs, did not appear to have any significant memory deficits, was able to correctly repeat four digits forward and backward, was able to maintain attention and concentration, his judgment was acceptable, and his insight was limited. (Tr. 292). Plaintiff admitted to helping clean “now and then, ” and being able to cook. (Tr. 291-92). He knew how to shop and he reported no problems with personal care or hygiene. (Tr. 292). Dr. Schneider stated that socially, Plaintiff tended to be a loner and that his concentration and persistence would vary and his pace was fast. (Tr. 292). Dr. Schneider diagnosed Plaintiff with PTSD, depressive disorder, paranoid disorder with possible psychotic features, marijuana abuse, and possibly a personality disorder with antisocial features. (Tr. 292).

         Dr. Schneider assessed Plaintiff as having a marked to extreme limitation in the ability to: 1) respond appropriately to work pressures in a usual work setting; 2) respond appropriately to changes in a routine work setting; and, 3) interact appropriately with the public, supervisors and coworkers. (Tr. 294). Dr. Schneider opined that Plaintiff had a slight limitation in: 1) understanding, remembering, and carrying out short and simple instructions; 2) understanding, remembering, and carrying out detailed instructions, and; 3) making judgments on simple work- related decisions. (Tr. 294). In support of his opinion, Dr. Schneider ...

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