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Simpson v. Berryhill

United States District Court, N.D. Illinois, Eastern Division

May 16, 2018

NANCY A. BERRYHILL, Deputy Commissioner for Operations for the Social Security Administration, Defendant.


          Susan E. Cox, Magistrate Judge.

         Plaintiff 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.

         I. Background

         a. Procedural History and Plaintiff's Background[1]

         On 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.

         Plaintiff 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).

         Plaintiff 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. 415, 440).

         Plaintiff 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.

         On 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, 480).

         On 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).

         On July 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).

         On July 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, [2] 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.[3](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.[4], [5] Id.

         Plaintiff 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. 659).

         Plaintiff's 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. 647).

         On 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[6] 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.

         Plaintiff 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).

         On 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).

         At 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).

         However, 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).

         At his 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).

         On 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.

         Dr. 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).

         Plaintiff 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).

         Plaintiff returned to the Near South facility on February 4, 2015, but left without being seen.[7](R. 598).

         On 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).

         Plaintiff 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 follow-up.

         At the 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.[8] (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).

         Also at 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.

         Pam 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).

         At the 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).

         b. The ALJ's Decision

         The ALJ 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.

         At step 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.

         At step 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 level.” Id.

         The ALJ 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), [9] 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 ...

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