The opinion of the court was delivered by: P. MICHAEL MAHONEY, Magistrate Judge
MEMORANDUM OPINION AND ORDER
Paul W. Thulen ("Plaintiff") seeks judicial review of the final
decision of the Commissioner of the Social Security
Administration ("Commissioner"). See 42 U.S.C. §§ 405(g),
1383(c)(3). The Commissioner's final decision denied Plaintiff's
application for Disability Insurance Benefits ("DIB") pursuant to
Title XVI of the Social Security Act (the "Act").
42 U.S.C. § 1381(a). This matter is before the Magistrate Judge pursuant to
consents filed by Plaintiff and Commissioner on December 3, 2003.
See 28 U.S.C. § 636(c); Fed.R. Civ. P. 73.
Plaintiff filed for DIB on September 5, 1997, alleging
disability on April 12, 1997. (Tr. 135). Plaintiffs application
for benefits was denied on January 12, 1998. (Tr. 86). Plaintiff
filed a request for reconsideration on January 29, 1998. (Tr.
90). Plaintiff's request for reconsideration was denied on March
13, 1998. (Tr. 91). Plaintiff then filed a request for a hearing
before an Administrative Law Judge ("ALJ") on May 13, 1998. (Tr.
94). Plaintiff appeared, with counsel, before an ALJ on March 15, 2001. (Tr.
38). In a decision dated April 25, 2001, the ALJ found that
Plaintiff was not entitled to DIB. (Tr. 26-33). On May 9, 2001,
Plaintiff requested a review of the ALJ's decision by the Appeals
Council. (Tr. 13). On June 17, 2001, the Appeals Council denied
Plaintiff's request for review. (Tr. 9).
Plaintiff was born on December 3, 1961, and was thirty-nine
years old at the time of his March 15, 2001, hearing before the
ALJ. (Tr. 135). Plaintiff graduated from high school. (Tr. 43).
At the time of the hearing, Plaintiff testified that he lived in
a house with his mother and three older siblings. (Tr. 42).
Plaintiff had a heart attack some time around April 12, 1997, and
suffers from coronary artery disease, high blood pressure,
shortness of breath, diabetes, and obesity. For these reasons,
and some others, Plaintiff claims to be disabled.
At the time of his hearing, Plaintiff's most recent and only
employment was with the Village of Savanna, Illinois. (Tr. 58).
Plaintiff testified that he worked 18 years for the Village of
Savanna as a "jack-of-all-trades" who would pick up garbage, fix
water leaks and sewers, and maintain walkways and
roadways.*fn1 (Tr. 58-59). This job was full-time. (Tr. 43).
While employed by the Village of Savanna, Plaintiff testified
that the most he had to lift was "a couple of hundred pounds" and
that he would frequently lift between 50 and 100 pounds. (Tr.
Plaintiff ended his full-time employment with the Village of
Savanna after his heart attack in April of 1997. (Tr. 43).
Plaintiff testified that he could not continue with his line of work because of feeling tired, fatigued, and not having "the wind
for it." (Id.) Plaintiff likewise did not pursue lighter jobs
because of feeling "tired all the time" in addition to
experiencing a painful back and not knowing how he will feel from
day to day. (Tr. 44).
On a typical day, Plaintiff testified that he sleeps and
watches TV at two hour intervals. (Tr. 54). Plaintiff stated that
he may make breakfast for himself "once in a while." (Id.)
Plaintiff testified that he does not clean, dust, vacuum, do
dishes or wash laundry for himself his 81-year-old mother does
the laundry, and someone else does the cleaning.*fn2 (Tr.
55). Plaintiff testified that he is able to make his own bed,
change his sheets, and bathe and dress himself. (Id.). Despite
his frequent, daily naps, Plaintiff told the ALJ that he always
feels tired. (Tr. 61). Plaintiff does not make trips to the
grocery store; he has someone else deliver his groceries. (Tr.
55). Plaintiff does not do any yard work including mowing the
lawn, raking leaves, or shoveling snow his younger brother
takes care of these tasks. (Tr. 55-56). Plaintiff testified that
he does, however, take small walks of up to 100 yards roughly
every other day. (Tr. 56). Plaintiff also testified that he is
able to change light bulbs or change batteries in a smoke
detector when needed. (Tr. 58).
Plaintiff does not have any hobbies, does not go out to eat or
to see movies, does not attend religious services, has not been
out of town for vacation or other reasons (for three years prior
to his hearing), and does not participate in social, church, or
volunteer activities. (Tr. 56-57). Plaintiff still has a valid
driver's license without any restrictions, and testified that he
drives two to three times per week through town or to see the
Mississippi River, which is just a two to three minute drive from
Plaintiff's home. (Tr. 43). With regard to family interactions,
Plaintiff testified that he talks to his mother but interacts with his
older siblings as minimally as possible because they are mentally
handicapped and he prefers to "avoid it." (Tr. 57-58).
At the hearing, Plaintiffs mother testified on his behalf. (Tr.
71). She stated that Plaintiff has "a lot of problems" including
his breathing and his high level of stress due to living with his
older siblings. (Tr. 72). She testified that Plaintiff sometimes
gets up during the day and makes himself some eggs before "just
[sitting] in his chair" because "that's about all he's able to
do." (Tr. 73). She added, however, that Plaintiff is able to
drive himself to the doctor because "the doctor is just uptown."
Vocational Expert, James Radke, also appeared before the ALJ
during Plaintiff's hearing on March 15, 2001. (Tr. 73). The
vocational expert testified that Plaintiff's position with the
Village of Savanna would be classified as "heavy in terms of
exertion and semi-skilled in terms of his [skill] level." (Tr.
The ALJ then presented the vocational expert with the following
If I would assume, on the basis of the record, an
individual who is 39-years-old has the work
experience and education of this claimant and has the
following exertional limitations: can sit for six
hours, stand and walk for six hours, can lift and
carry frequently up to 25 pounds, occasionally up to
50 pounds, and only can occasionally stoop, crawl,
and climb stairs and ramps, can never climb any
ladders, robes or scaffolds. Can only occasionally
crouch, kneel or balance. Further assuming someone
who must avoid concentrated exposure to activities
involving unprotected heights, being around moving
and hazardous machinery, and dust odors, fumes and
gases. [I should] assume such a person could not
perform the claimant's past work, is that correct?
(Tr. 74-75). The vocational expert stated that such a
hypothetical person could perform Plaintiff's past work as a
and could also perform work as a janitor,
cleaner, food preparation worker, and medium level packager or filler. (Tr.
75). The ALJ then added that the hypothetical person should
"avoid concentrated exposure to temperature extremes. (Tr. 75).
This modification did not change the vocational expert's answer
about what work the hypothetical person could perform. (Id.).
The ALJ further modified the hypothetical by changing the
exertional requirement to "light work, someone who can lift and
carry frequently just up to 10 pounds and occasionally up to 20
pounds." (Tr. 75-76). With these modifications, the vocational
expert opined that Plaintiff's past work as a truck driver would
be eliminated, but such a hypothetical person could still perform
packaging and filling positions, work in miscellaneous food prep
positions, or work as a cashier or assembler. (Tr. 76). The ALJ
proceeded to modify the hypothetical further by adding the
requirement that the hypothetical person be allowed to sit and
stand approximately every 45 minutes. (Id.). With this change,
the vocational expert stated that a hypothetical person with
these limitations could still work in some packaging, filling,
miscellaneous food preparation, and cashier positions. (Id.).
The vocational expert also determined that the individual would
be able to work in sedentary assembly and sorting occupations.
(Id.). According to the vocational expert, at the time of the
hearing, there were less than 1,000 packaging and filling
positions, about 7,000 miscellaneous food preparation positions,
and 24,300 cashier positions in the Northern Illinois area that
such a hypothetical person could perform. (Tr. 76).
On April 13, 1997, Plaintiff was taken to the Emergency
Department of the Samaritan Health System in Clinton, Iowa, via
ambulance. (Tr. 228). Plaintiff had been coughing up blood for a
couple of days before seeking treatment, and started experiencing
severe left back and rib pain which worsened with breathing and coughing. (Id.) The
History and Physical Report, by J. Gondwe, M.D., noted that
Plaintiff "[smoked] quite a bit and apparently [had] been
drinking quite a bit lately." (Tr. 230). Dr. Gondwe's physical
exam indicated Plaintiff had a "density in the left breast, maybe
pneumonia." (Id.). Dr. Gondwe's impression of Plaintiff at that
time indicated that Plaintiff suffered from pleurisy,*fn4
had an abnormal electrocardiogram*fn5 suggesting a
myocardial infarction, was obese, and had problems with nicotine
addiction and alcoholism. (Id.). Plaintiff was treated with
penicillin and heparin, and laboratory tests were ordered.
Plaintiff was admitted to the Samaritan Health System, and
underwent further testing and consultation examinations. (Tr.
226-268). At the time of a consultative examination by Q.
Rasheed, M.D., F.A.C.C., also on April 13, 1997, Plaintiff was
alert and oriented, and appeared in mild respiratory distress.
(Tr. 232). Dr. Rasheed determined that Plaintiff experienced an
acute pulmonary embolism,*fn6 had an abnormal
electrocardiogram with evidence of inferior*fn7 and
anterolateral*fn8 myocardial infarction, used tobacco, and
used alcohol with probable dependence. (Id.). With regard to
Plaintiff's tobacco use, Dr. Rasheed noted that Plaintiff smoked
two packs of cigarettes per day for fifteen years. (Id.). Dr.
Rasheed agreed with Dr. Gondwe's decision to heparinize*fn9 Plaintiff, and ordered further tests to
assess Plaintiff's cardiac functioning. (Id.). Dr. Rasheed
noted that Plaintiff was "critical at [that] time and without
treatment the potential for morbidity and mortality [was] high."
On April 14, 1997, during Plaintiff's hospitalization, he
underwent a consultative examination by Nidal Harb, M.D., who was
asked to assume Plaintiff's cardiac care. (Tr. 234). At the
beginning of the consultation notes, Dr. Harb stated that "the
patient is a poor historian and has been somewhat noncompliant
with doctor's visits." (Id.). Dr. Harb indicated that
Plaintiff's cardiac risk factors included obesity,
hypertension,*fn10 his gender,
hypercholesterolemia,*fn11 family history for coronary
artery disease, and smoking. (Id.). Dr. Harb also indicated
that Plaintiff denied affliction with diabetes mellitus. (Id.).
Dr. Harb's impression of Plaintiff was similar to the impressions
of Drs. Gondwe and Rasheed; Dr. Harb noted that Plaintiff had a
pulmonary embolus, suffered from coronary artery disease, was
morbidly obese, had hyperlipedemia,*fn12 and was addicted to
nicotine. (Id.). Dr. Harb recommended that Plaintiff continue
with heparin treatment until switching later to warfarin therapy,
and that Plaintiff use topical nitrates if his condition
permitted. (Id.). Dr. Harb also discussed with Plaintiff the
need to modify Plaintiff's cardiac risk factors, the nature of
coronary artery disease, and the possible modalities of
treatment. (Id.). Plaintiff remained hospitalized through April 21, 1997, when he
was discharged to home. (Tr. 226). Dr. Gondwe's discharge summary
of Plaintiff's hospitalization reported a final diagnosis of (1)
pulmonary embolism, (2) deep venous thrombosis involving the left
lower extremity, (3) pneumonia involving the left lower and right
middle lobes of the lungs, (4) coronary vascular disease with a
history of subacute myocardial infarction, (5) history of tobacco
abuse, (6) obesity, and (7) pleurisy caused by a pulmonary
embolus. (Id.). Dr. Gondwe commented that Plaintiff's chest
x-rays showed improvement of the lung tissue, and that
Plaintiff's echocardiogram was "technically a very difficult
study with enlargement of the left ventricle." (Id.). Further,
Dr. Gondwe stated that Plaintiff was not to work for two months
after hospitalization, should try to quit smoking, and should
follow-up with him and with Dr. Harb as scheduled. (Id.). Dr.
Gondwe offered Plaintiff nicotine patches, but reported that
Plaintiff had not committed himself to quitting smoking yet.
(Id.). Dr. Gondwe documented his concern that Plaintiff could
"force more damage to the heart" if he smoked while using
nicotine patches. (Id.).
Plaintiff followed up with Dr. Harb on May 6, 1997. (Tr. 279).
At that time, Plaintiff denied chest pain, shortness of breath,
dizziness or loss of consciousness. (Id.). Plaintiff had
dyspnea*fn13 on exertion and some palpitations,*fn14
but reported feeling "much better." (Id.). Dr. Harb noted that
Plaintiff was "rather noncompliant" and continued to smoke very
heavily. (Id.). Dr. Harb's examination of Plaintiff revealed a
morbidly obese individual with stable vital signs, clear lungs, a heart beating at a regular rate and rhythm, and no
edema*fn15 in the extremities. (Id.). Dr. Harb "strongly
advised [Plaintiff] to stop smoking and modify other risk
On May 8, 1997, Plaintiff saw Dr. Harb for a second follow-up
visit. (Tr. 278). According to Dr. Harb
. . . [Plaintiff] presented after [medical staff]
called him for follow-up and evaluation. [Staff
called] the [Plaintiff in the] evening and during the
night to have him follow-up . . . and  were not
able to get a hold of him until today.
(Tr. 278). Plaintiff's health status was relatively unchanged
compared to his May 6, 1997 examination. (Id.). Dr. Harb again
reported that Plaintiff continued to smoke heavily, in spite of
being instructed to stop smoking and modify other risk factors.
Handwritten medical records reveal that Plaintiff was seen on
May 16, 1997. (Tr. 277). The assessment and plan from this
appointment are largely illegible, and the signature of the
treating practitioner cannot be deciphered. (Id.).
Plaintiff's next medical appointment was on May 19, 1997, with
Dr. Harb. (Tr. 276). At that time, Dr. Harb dictated that
somewhat of a poor historian and difficult to assess.
He appears to have some denial problems. He is
asymptomatic at this time. The patient does feel
better since he was started on [a beta-blocker].
(Id.). Because Plaintiff continued to smoke heavily, and
because an electrophysiologist apparently documented certain
findings which Dr. Harb wanted to follow-up on, Dr. Harb switched
Plaintiff's anticoagulant medication, and advised cardiac
catheterization for that day.*fn16
declined admission at that time, and arranged admission for
cardiac catheterization at a later time. (Id.). Dr Harb again advised
Plaintiff to stop smoking and modify his other risk factors.
On May 20, 1997, Plaintiff was evaluated for admission to the
Samaritan Health System for cardiac evaluation and management.
(Tr. 293). At the time of Plaintiff's "History & Physical"
examination by Dr. Harb, Plaintiff was asymptomatic and appeared
to be in no acute distress. (Id.). Again, Dr. Harb noted that
Plaintiff was difficult to assess because he provided a poor
history of his situation and appeared to have denial problems.
(Id.). Dr. Harb's discharge summary for this hospitalization
reported the following final diagnoses:
(1) Coronary artery disease . . . on the basis of his
clinical presentation (at that time patient did not
seek medical attention) with atypical angina which
appears to be stable.
(2) Pulmonary embolism per ventilation-perfusion lung
scan in April 1997.
(3) Morbid Obesity.
(5) Nicotine Addiction.
(6) Accelerated intraventricular rhythm on Holter
monitor which [has] now improved after treatment.
(7) Latent congestive heart failure, ejection