United States District Court, N.D. Illinois, Eastern Division
MEMORANDUM OPINION AND ORDER
E. Cox, Magistrate Judge.
Terry Simpson (“Plaintiff”) appeals the decision
of the Commissioner of the Social Security Administration
(“Commissioner”) denying his disability insurance
benefits (“DIB”) under Title II and Title XVI of
the Social Security Act. The Parties have filed cross motions
for summary judgment. For the reasons detailed below, the
Commissioner's Motion for Summary Judgment (dkt. 17) is
granted and Plaintiff's motion (dkt. 12) is denied.
Procedural History and Plaintiff's
November 14, 2012, Plaintiff applied for Title II disability
insurance benefits and Title XVI supplemental security
income, alleging disability since June 15, 2007.
(Administrative Record (“R.”) 272-84).
Plaintiff's claim was denied initially and again at the
reconsideration stage. (R. 135-144; 1-6). Plaintiff timely
requested an administrative hearing, which was held on March
31, 2015 before Administrative Law Judge (“ALJ”)
Michael G Logan. (R. 148; 52-100). Plaintiff was represented
by counsel, and both a Medical Expert (“ME”) and
a Vocational Expert (“VE”) testified during the
hearing. (R. 52-100). On September 25, 2015, the ALJ issued a
written decision denying Plaintiff disability benefits and
supplemental security income. (R. 17-37). On January 19,
2017, the Appeals Council denied Plaintiff's appeal, and
the ALJ's decision became the final decision of the
Commissioner. (R. 1-6). Plaintiff filed the instant action on
March 27, 2017. (Dkt. 1). The record contains no medical
evidence prior to 2011.
was 55 years old at the onset date of disability, and did not
complete high school (he has no more than a ninth grade
education). (R. 55, 57, 665). He last worked in 2005, as a
box loader and machine operator and repairer. (R. 58).
first filed his application for benefits on November 14,
2012. Shortly thereafter, on November 30, 2012, he sought
treatment at Cook County's Near South facility
(“Near South”) alleging a myriad of physical
disorders but no mental health symptoms aside from a
diagnosis of alcoholism. (R. 415). Plaintiff next was seen on
January 7, 2013 for back and arthritis pain, where he
reported a past diagnosis of hypertension but noted that he
had been off hypertension medication for a year. (R. 438,
440). He was started on medication for his elevated blood
pressure on that occasion and his reports of the prior
diagnosis. (R. 20). He was referred for imaging based on
complaints of knee pain and back pain but results were
normal. (R. 20, 441). Notably, there is no suggestion of
mental health complaints or substance abuse at this time, nor
is there any suggestion of abnormal mental health
observations. (R. 415, 438-441). Although there is no work up
for asthma, Plaintiff's reports of a prior asthma
diagnosis are credited and he is prescribed an inhaler (R.
appeared for a consultative internal medicine examination on
January 10, 2013 with Liana Palacci, D.O. of Disability
Determination Services (“DDS”) (R. 421-25). At
this time, Plaintiff admitted to use of beer and whiskey, and
alleged that he quit use of marijuana and cocaine in 2012.
(R. 421). He acknowledged being in rehab for substance abuse
in the 1990's. Id. Plaintiff claimed he was
diagnosed with asthma and COPD in the 1980's, yet also
reported smoking 2½ packs of cigarettes per day for
the prior 40 years. (R. 421-22). He reported low back pain
since the age of 13 with numbness and weakness in the right
leg. (R. 422). He reported a stroke in 2001 with left sided
hemiparesis and reported attending of physical rehabilitation
for several months. Id. He also alleged experiencing
a “mild heart attack” in 1982 with chest pain for
the prior 3 months. Id. On examination,
Plaintiff's blood pressure was not remarkable.
Id. Lungs were clear. Id. His grip strength
was 4, and Dr. Palacci noted that this was due to poor
effort on Plaintiff's part. (R. 423). He presented with
some reduced range of motion but had negative straight leg
raise testing, no loss of sensation, and full 5/5 strength.
(R. 423-24). On mental status examination, Plaintiff was
alert and oriented. (R. 424). He had normal affect, knew who
the President was, and could perform simple arithmetic.
Id. Dr. Palacci's clinical impressions were that
Plaintiff had well-controlled asthma and COPD; complaints of
low back pain; history of stroke with no residual weakness;
and history of coronary artery disease with complaints of
chest pain that appear atypical. Id.
March 12, 2013, Plaintiff appeared at Near South for a
prescription medication follow-up. (R. 460-63). Plaintiff had
good grip strength on examination despite alleging numbness,
and there were no diagnostic findings supportive of
neuropathy. Id. Plaintiff reported chronic hand
numbness that comes and goes and has been present for several
months. (R. 479). Plaintiff's allegations of arm and hand
numbness were considered to possibly be related to neuropathy
from long-term alcoholism or a Vitamin B deficiency. (R. 461,
April 24, 2013, Plaintiff went to the Provident Hospital
outpatient clinic asking for a psychiatric referral. (R.
475-78). He claimed that he “sometimes hears
voices” and that he was on medication (presumably
psychiatric medication) a long time ago. (R. 475). He
reported “jumping muscles” in his arms and
occasional dizziness. Id. He also reported use of
hypertension medication. Id. Although Plaintiff
complained about his knees, back, and cervical spine, imaging
studies from around that time of the cervical spine and knees
were normal (R. 436-37, 478). The Plaintiff was given a
psychiatric referral at his request and advised to return in
one to two months. (R. 476, 478).
5, 2013, Plaintiff returned to Near South for a prescription
refill and also complained of right shoulder pain. (R.
482-84). It was noted that imaging studies (CT and x-ray)
taken within the prior 5-6 months were normal. Id.
Examination did not show any significant deficit and grip
strength was largely unimpacted. (R. 483-84). At his July 9,
2013 follow-up, Plaintiff again complained of right upper
extremity deficit, some chest pain, and instances of his legs
giving out, all without objective confirmation. (R. 485-491).
He was started on medication for neuropathic pain. (R. 487,
490). At this time, he also reported visual hallucinations at
night/seeing dead people; he conversed with them, but they
were not threatening or disturbing. (R. 487). He stated that
sometimes he feels held down to his bed. Id. He
further reported some non-threatening auditory hallucinations
during the day. Id. Despite the fact Plaintiff
claimed not to be using alcohol at this time, his doctor
opined, relative to Plaintiff's allegations of anxiety
and hallucinations, that Plaintiff's alcohol use was
likely worsening. (R. 487, 491). There was no mention of drug
use. (R. 485-491). Despite his contentions of no current
alcohol use, alcoholism remained an active diagnosis and
Plaintiff was advised to quit. (R. 490).
29, 2013, Plaintiff appeared before psychiatrist Regina
Hall-Ngorima (“Dr. Ngorima”) for a new patient
evaluation. (R. 661-66). Dr. Ngorima noted that
Plaintiff's last psychiatric visit was 10 years ago. (R.
662, 664). Plaintiff's living situation was somewhat
tenuous: he reported he had lost his apartment last year and
that he had been living with his daughter for the prior two
weeks. (R. 662, 665). Plaintiff alleged ongoing auditory and
visual hallucinations (reportedly since childhood but worse
as an adult), past suicidal attempt/ideation,  and paranoia but
mostly when he drinks. (R. 662-63). He reported feeling like
something was holding him down in bed, so he sleeps sitting
up. (R. 662). He reported that he is always fighting and
arguing and that he drinks to stay calm. Id. He
acknowledged daily drinking with occasional withdrawal
symptoms, and regular marijuana and occasional crack
use.(R. 665). He was given a diagnosis of
manic-depressive psychosis, but no diagnosis of substance
abuse (although alcoholism is listed on the “problem
list” as a past diagnosis). (R. 663, 665). He was
advised to continue with his previously prescribed
Notriptyline and he was started on started Risperdal nightly
for psychosis. Id. Based on this initial assessment,
Dr. Ngorima provided Plaintiff with a Global Assessment of
Functioning (“GAF”) score of 45, indicative of
serious symptoms.,  Id.
returned to Dr. Ngorima on August 26, 2013. (R. 655-60).
Plaintiff reported continued symptoms and a negative reaction
to Risperdal; his mood was depressed and angry, but his
affect and thought process was normal. (R. 656, 659). He
reported that his daughter had kicked him out because he was
talking to himself and throwing things when angry. (R. 656).
Although Dr. Ngorima had diagnosed Plaintiff with
manic-depressive psychosis both in the month prior and on
this visit, she now suggested that he was previously
diagnosed with schizoaffective disorder bipolar type. (R.
656, 659, 665). In addition to previously prescribed
medications, Plaintiff was started on Seroquel and Quetipine
in place of the Risperdal. (R. 659-60). Plaintiff's
reported substance use remained unchanged. (R. 658). There
was still no diagnosis of substance abuse by Dr. Ngorima. (R.
next visit with Dr. Ngorima was on October 7, 2013. (R.
649-54). Plaintiff reported some decrease in symptoms but
that he was still “fussing and fighting” with
family members. (R. 650). He had been living at his
brother's house for the prior three weeks, but reported
that he would have to move soon due to a foreclosure.
Id. He still had some auditory and visual
hallucinations, but reported that he had them less now that
he was sleeping better. Id. He reported that
he'd had suicidal thoughts two weeks prior but did not
attempt to harm himself. Id. Alcohol is reported as
being used daily; there is no diagnosis of substance abuse
but it remained on the “problem list”. (R. 651,
653). The remainder of the notes related to this visit were
largely consistent with prior visit. (R. 649-54). At his
December 16, 2013 follow up, Plaintiff admitted that he last
filled meds in October and had been without medication for
six weeks, so he was restarted on medication including
Zoloft. (R. 644, 647). He reported some continued but
decreased hallucinations and was back to living with his
daughter. (R. 644). He described himself as stressed due to
lack of income and frequent moves. Id. There was no
change in reported substance use or substance use history,
nor was there a diagnosis of alcoholism by Dr. Ngorima. (R.
January 21, 2014, Plaintiff appeared as a new patient before
Dr. Chukwudozie Ezeokoli. (R. 499-503). Plaintiff again
complained of “jumping muscles” and spasms/cramps
in his right arm (R. 500). Plaintiff's neurological
findings were unremarkable. (R. 502). Although no abnormal
mental health findings were noted, Plaintiff appears to have
been credited with schizoaffective disorder/bipolar disorder
and advised to continue with previously prescribed
Sertraline and Seroquel. (R. 503). Despite the record
indicating that alcoholism was one of Plaintiff's chief
complaints on that day, Plaintiff contended that he had quit
using alcohol four months ago. (R. 499-500). This appears to
be Plaintiff's only visit with Dr. Ezeokoli.
continued to complain of varied physical upper extremity pain
and neuropathy at a Near South follow-up on February 20,
2014. (R. 491-96). However, Plaintiff's EMG results were
normal, showing “no electrophysiologic evidence of
peripheral neuropathy or cervical radiculopathy.” (R.
495). The record reflects two different notations about
Plaintiff's alcohol use on this visit: he told his doctor
both that he quit drinking alcohol, and that he drinks a 6-12
pack a day or two 20-oz beverages. (R. 494-96). Plaintiff did
not allege any mental health issues on this occasion, and
Plaintiff's doctor noted that Plaintiff's anxiety and
hallucinations were better on his current medications and his
reports of alcohol cessation. (R. 496).
March 10, 2014, Plaintiff returned to Dr. Ngorima with his
disability paperwork. (R. 638). He alleged on this occasion
that his medication was not working. Id. He reported
that he was living with a different daughter after getting
into a fight with the prior daughter's boyfriend.
Id. He again reported suicidal ideation via a gun,
but claimed the gun was taken away. Id. He described
himself as more irritable, more depressed, and getting little
sleep. Id. Although he appeared angry and depressed
on examination, Dr. Ngorima found no objective evidence of
delusions or behavioral abnormality and he was considered to
be relaxed, cooperative and stable. (R. 641). His diagnosis
was listed as manic depressive psychosis with antisocial
traits and both his Seroquel and Zoloft were increased in
dosage. (R. 641-42). There was no change to his substance
abuse history or suicide attempt history. (R. 641). There was
no diagnosis of alcoholism by Dr. Ngorima, although it
remained on the “problem list.” (R. 640-41).
Plaintiff's June 2014 follow-up at Near South, Plaintiff
reported he stopped drinking alcohol six months prior. (R.
559). This record makes no mention of Plaintiff's drug
use. (R. 558-66). His mood was considered to be more stable
and although he reported some nighttime visual hallucinations
and daytime auditory hallucinations, they were not
threatening but he sometimes felt held down to his bed. (R.
559). Physical examination was again largely unremarkable,
and the record again reflects that his mental health symptoms
had improved with his current medication regimen. (R. 565).
at his June 2, 2014 follow up with Dr. Ngorima, Plaintiff
alleged continued mental health symptomology, including
violent behavior, despite reporting that he was compliant
with medication (R. 631). Plaintiff's medication dosage
was increased again. (R. 636). Alcoholism remained on the
“problem list” but was still not a current
diagnosis, yet Plaintiff's alcohol and drug usage report
remained unchanged from his first appointment with Dr.
Ngorima (i.e., a pint and a 6-pack of alcohol daily;
occasional crack use; marijuana use 3 days a week). (R. 632,
634, 636). Plaintiff's objective examination was largely
consistent with prior findings. (R. 630-36).
August 11, 2014 psychiatric follow up, Plaintiff reported
that he was drinking a couple times each week, having about
two beers each occasion; he had not used marijuana in months;
and he had not used crack cocaine “recently, ” as
his daughter did not allow it in the house. (R. 625).
Plaintiff reported continued mental health symptoms, such as
fighting with family, not sleeping well, and hallucinations.
Id. Plaintiff also reported that he thinks of
suicide often; he reported that he took a large amount of
pills two weeks prior and his daughter made him throw them
up. Id. Despite this, Dr. Ngorima made no change to
Plaintiff's suicide attempt history. (R. 628; see
also, fn. 2, supra). Plaintiff's
prescription for Zoloft, however, was increased due to his
depression. (R. 629).
December 4, 2014, Plaintiff appeared for a consultative
psychological assessment with State agency consultant Mark
Langgut, Ph.D. (R. 569-72). On the date of the assessment,
Plaintiff had been without medication for at least two
months, but did not report this to Dr. Langgut. (R. 618;
570). Dr. Langgut noted that Plaintiff “had an agenda
and was only fairly cooperative in responding to questions
during examination.” (R. 571). Plaintiff claimed he was
“seeing, hearing things…people talking to me. I
can't stand small spaces.” (R. 569). Plaintiff
traveled to the testing site independently, but he reported
that he did not know the directions taken to the site. (R.
569, 571). Plaintiff suggested that he could not remember his
age, and could not remember if he had siblings; Plaintiff
claimed to have eleven children (but could not recall their
names or ages, despite elsewhere indicating he was in recent
contact with five of them and had recently lived with 3 of
them, including currently living with one of his daughters).
(R. 570-71). He admitted to watching television and going out
walking during the day. (R. 570). He further suggested he
essentially allows others to complete most activities of
daily living that he benefits from, such as cooking,
cleaning, etc. Id. Plaintiff's emotional
presentation was variable throughout the interview, and he
often displayed emotions inappropriate to the situation; he
reported that he easily becomes mildly angered, and Dr.
Langgut found him to have poor coping skills. (R. 571).
Plaintiff told Dr. Langgut he has had hallucinations of mild
intensity all his life, and that they were auditory, visual,
olfactory, tactile, and gustatory in nature. (R. 572).
Plaintiff reported moderate depression, indicating that he
was upset that he did not have his own place, yet he claimed
he did not know when he first became depressed. (R. 751). Dr.
Langgut found no behavioral abnormalities, and no indications
of mania or anxiety. Id.
Langgut noted Plaintiff's history of chronic alcoholism,
with recent reported remission, which was described by Dr.
Langgut as a “tenuous state of abstinence from
substances.” (R. 570, 572). Plaintiff reported to Dr.
Langgut that he was drinking daily by the age of 20, yet had
stopped five or six months earlier due to headaches. (R.
570). Plaintiff does not attend AA meetings. Id. He
also admitted to drug abuse from the age of 15 onward using
“anything there was” (primarily cocaine and
marijuana), but he suggested that he stopped two years
earlier, for unclear reasons. Id. He also claimed to
be down to smoking only five to ten cigarettes daily (prior
reports by Plaintiff were rather consistently at 1-2 packs a
day). Id. Ultimately, Dr. Langgut diagnosed
Plaintiff with: Alcohol Abuse - in recent remission;
Polysubstance Abuse - in recent remission; and
Substance-Induced Mood Disorder, N.O.S. (R. 572).
returned to Dr. Ngorima for follow-up on December 29, 2014,
where he reported continued mental health symptoms but also
admitted that he had been without medication for three
months. (R. 618). He denied current drug or alcohol use (yet
elsewhere this record indicates Plaintiff was drinking 1-2
beers twice weekly with occasional withdrawal symptoms). (R.
618, 621). He was restarted on medication. (R. 622).
returned to the Near South facility on February 4, 2015, but
left without being seen.(R. 598).
February 9, 2015, Plaintiff attended a second consultative
internal examination, this one by Dr. Joseph Youkhana. (R.
580-89). Plaintiff now denied any prior heart attack and
failed to allege stroke, but did claim hypertension, right
arm numbness, and back pain secondary to a childhood injury.
(R. 580). Plaintiff told Dr. Youkhana that he only
occasionally drank alcohol in the last year, despite being a
heavy drinker in the past for many years. (R. 581). He told
Dr. Youkhana he had not used drugs in the last year, but
prior to that he used marijuana and cocaine. Id.
Plaintiff reported a history of asthma with inhaler use and
also reported continued cigarette smoking, at 4 cigarettes
per day. (R. 580- 81). Lung examination showed only mild
decrease in breath sounds with no wheezing or rattling
sounds. (R. 581). Grip strength in both hands was 5/5 with
normal ability in both fine and gross movements. Id.
Bilateral knee flexion was 130/150. (R. 588). Range of motion
in the lumbar spine was mildly limited, but all other joints
had normal range of motion. Subsequent spirometry testing
showed mild restriction. (R. 594-97). Similarly, x-ray
examination showed only mild degenerative joint disease of
the left knee and lumbar spine. (R. 592-93). On mental status
examination, Plaintiff showed increased math capacity, recall
of past presidents, and provided the names of some children.
(R. 582). Dr. Youkhana diagnosed Plaintiff with: hypertension
(blood pressure of 150/96, advised to see primary care doctor
for better blood pressure control); history of asthma with
shortness of breath; chronic back pain; and mental illness
(unspecified). (R. 583).
had routine follow up with Dr. Ngorima on April 20, 2015. (R.
611-16). Plaintiff alleged that he did not feel his
medication was working because he was still irritable and
unable to sleep some nights, yet reported sleeping 7-8 hours
most nights. (R. 612). Plaintiff's judgment and thought
processes were appropriate, and he was not found to be
depressed. (R. 615). He again denied drug or alcohol use, but
this record also indicates Plaintiff was drinking 1-2 beers
twice weekly with occasional withdrawal symptoms. (R. 612,
614). Dr. Ngorima added a trial of Depakote for mood
stabilization to Plaintiff's previously prescribed
medications. (R. 616). There is no evidence of subsequent
March 31, 2015 administrative hearing, Plaintiff testified,
inter alia, that he does not know the year his
alleged stroke took place, but that he was normal and
suffered no consequences from the stroke. (R. 76-68, 70).
Plaintiff testified that he stopped/reduced his alcohol
consumption because he “got tired of it” within
the prior 12 months. (R. 73-75). When asked to quantify his
prior drinking, Plaintiff testified that for
“years” he used to drink a half gallon of gin and
a 12-pack of beer per day. (R. 73-74). Plaintiff testified
that he drinks alcoholic beverages only on holidays now. (R.
75-76). Plaintiff testified that snorting cocaine was his
drug of choice and he would consume one or two “dime
bags” a week. (R. 75-76). He used to go to AA, but
doesn't anymore. (R. 74-75). Plaintiff stated that his
sleep was “restless, ” but when questioned
further on this topic, Plaintiff stated that he slept all of
the hours between bedtime and waking (from around 9:00
p.m./9:30 p.m. to 7:00 a.m.) and that he felt rested in the
morning. (R. 83-84).
the administrative hearing, the ME, Dr. James McKenna, M.D.,
who is board certified in internal medicine and pulmonary
disease, testified that Plaintiff has a history of
alcoholism, nicotine dependence, and although he has been
prescribed an inhaler, asthma is not established in
Plaintiff's medical records. (R. 86-94). Dr. McKenna
noted that the results of a pulmonary function test in the
record were inconsistent and that the Plaintiff gave poor
effort during the test. Id. He noted that Plaintiff
had been diagnosed with hypertension in the past but was not
receiving medication at that time. Id. Dr. McKenna
testified that x-rays of the Plaintiff's right shoulder
and cervical spine, as well as a CT scan of the brain were
largely normal. Id. There was some atrophy, but Dr.
McKenna noted that this is not inconsistent with
Plaintiff's high levels of alcohol consumption.
Id. Dr. McKenna opined that Plaintiff's positive
straight leg raise at his most recent internal medicine
consultative examination did not correlate with his
extensions, minimal decreases in range of motion demonstrated
spinal range of motion, nor did decreased range of motion in
the shoulder not correlate with any medically determinable
impairment. Id. When questioned about
Plaintiff's reported poor grip strength at his initial
consultative examination, Dr. McKenna noted that poor effort
on the part of the Plaintiff undermines the results. Dr.
McKenna ultimately opined that Plaintiff has no severe
physical impairment. Id.
Tucker, the VE at the administrative hearing, testified, in
significant part, that an individual in the competitive
workforce cannot be off task for more than 15% of the
workday. (R. 95). She testified, based on the hypothetical
limitations provided by the ALJ, that not only could
Plaintiff return to either of his former occupations of
Cleaner or Machine Operator, but that the jobs of Packer,
Machine Feeder, and Lunch Worker also existed in significant
numbers in the national economy and could be performed by
Plaintiff. (R. 96-97).
conclusion of the hearing, the ALJ held the record open to
allow for submission of outstanding mental health records.
These records demonstrated a substantial prior history of
drug and alcohol abuse, including every other day crack
cocaine ingestion that Plaintiff did not acknowledge at the
administrative hearing. (R. 31).
The ALJ's Decision
issued a written decision on September 25, 2015. (R. 17-37).
The ALJ found that Plaintiff met the insured status
requirements of the Act through December 31, 2007. (R. 19).
As there was no medical evidence prior to Plaintiff's
date last insured (“DLI”) of December 31, 2007,
the ALJ found insufficient evidence of a disability prior to
the DLI and denied Plaintiff's request for Title II
disability benefits. (R. 20). The remainder of the ALJ's
opinion dealt with Plaintiff's request for Title XVI
supplemental security income benefits. Id.
one, the ALJ found Plaintiff had not engaged in substantial
gainful activity from the alleged onset date of June 15, 2007
through his DLI. Id. At step two, the ALJ concluded
that Plaintiff had the severe impairments of: history of drug
and alcohol abuse; depression; and substance-induced mood
disorder. Id. In addition to these severe
impairments, hypertension, mild degenerative disk disease,
and mild left knee arthritis were determined to be
non-severe. (R. 25). The ALJ also determined that
Plaintiff's allegations of asthma, COPD, low back pain,
shoulder arthritis, history of stroke, and history of
coronary artery disease did not correspond with medically
determinable impairments, as there were no abnormalities
related to these allegations shown by medically acceptable
clinical and laboratory diagnostic techniques. Id.
three, the ALJ concluded Plaintiff did have an impairment,
including substance use disorders, that met Listings 12.04
and 12.09. Id. The ALJ found that Plaintiff
satisfied the “Paragraph A” criteria because
Plaintiff had medically documented persistence of depressive
syndrome characterized by sleep disturbance, psychomotor
agitation, difficulty concentrating, and hallucinations, and
he had been variously diagnosed with bipolar syndrome.
Id. The ALJ found that Plaintiff satisfied the
“Paragraph B” criteria because Plaintiff's
mental impairments, including substance use disorders, caused
at least two “marked” limitations in
Plaintiff's life, those marked limitations being in
social functioning and concentration, persistence, or pace.
(R. 26). The ALJ also noted that although Plaintiff
“provided innumerable conflicting statements regarding
the frequency and duration of his alcohol and drug use as
well as varied claims regarding when he reportedly stopped
use…medical evidence shows ongoing use in conjunction
with increased symptomology.” Id. Ultimately,
the ALJ found that “when [Plaintiff] is using drugs,
his condition is deteriorated such that he meets listing
then detailed the weight he gave to the medical opinions in
this matter, and his reasoning for such weight, as follows:
• The ALJ gave good weight to the opinion of
Plaintiff's treating psychiatrist, Dr. Ngorima, as her
opinion addressed Plaintiff's functioning in conjunction
with ongoing substance abuse. (R. 26-27). Although Dr.
Ngorima failed to acknowledge Plaintiff's ongoing
substance abuse at the time of her assessment (instead
crediting the non-credible statements of Plaintiff denying
use),  her opinion showing marked deficits in
functioning supported the finding that Plaintiff is disabled
and ultimately satisfied Listing severity in conjunction with
his substance abuse; the ALJ noted that this was demonstrated
by other medical evidence during the relevant time period.
Id. However, the ALJ gave slight weight to Dr.
Ngorima's finding as it pertains to Plaintiff's
functioning in the absence of substance abuse as the record
did not detail credible substance abstinence during periods
of increased symptomology. (R. 34). The ALJ noted that
“[a]lthough there are periods in which substance abuse
is not reflected and [Plaintiff's] functioning is
improved, suggestions of hallucinations and psychosis occur
in conjunction with extended substance use (and in the
absence of demonstrated abstinence).” Id. The
ALJ highlighted that Plaintiff's reported symptoms were
all made in the context of Plaintiff pursuing his disability
claim after his claim was denied initially. Id.
Moreover, as Plaintiff's mental allegations were
“primarily in the context of rampant daily ingestion of
street drugs and alcohol, ” the ALJ gave only good
weight to the GAF score of 45 as it pertained only to
Plaintiff's functioning in conjunction with substance use
and was not consistent with the longitudinal record (nor was
the GAF score ever reassessed). (R. 22, 34).
• The ALJ gave moderate weight to the medical source
statement of Dr. Langgut, as it related to the
Plaintiff's functioning in conjunction with substance
use. (R. 27, 34). Although Dr. Langgut's opinion was not
clearly indicative of disabling restriction, the ALJ
determined that his opinion showed several extreme and marked
deficits and his diagnosis all reflected substance related
conditions/restrictions. (R. 27). The ALJ held that because
Dr. Langgut's deficits were based on the diagnosis of