Marques v. Astrue (758 F. Supp. 2d 835, 2010)

ORDER DENYING PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT

ROBERT E. LARSEN, United States Magistrate Judge.

Plaintiff Donald Marques seeks review of the final decision of the Commissioner of Social Security denying plaintiffs application for disability benefits under Title II of the Social Security Act (“the Act”). Plaintiff argues that (1) the ALJ failed to give proper weight to the opinions of Dr. Farrow and Dr. Bhargava, (2) the ALJ improperly formulated plaintiffs residual functional capacity, and (3) the ALJ improperly evaluated plaintiffs credibility. I find that the substantial evidence in the record as a whole supports the AL J’s decision that plaintiff is not disabled. Therefore, plaintiffs motion for summary judgment will be denied and the decision of the Commissioner will be affirmed.

I. BACKGROUND

On August 5, 2005, plaintiff applied for disability benefits alleging that he had been disabled since April 5, 2005. Plaintiffs disability stems from compulsive disorder, depression and panic attacks. Plaintiffs application was denied on January 3, 2006. On June 24, 2008, a hearing was held before an Administrative Law Judge. On July 21, 2008, the ALJ found that plaintiff was not under a “disability” as defined in the Act. On December 31, 2009, the Appeals Council denied plaintiffs request for review. Therefore, the decision of the ALJ stands as the final decision of the Commissioner.

II. STANDARD FOR JUDICIAL REVIEW

Section 205(g) of the Act, 42 U.S.C. § 405(g), provides for judicial review of a “final decision” of the Commissioner. The standard for judicial review by the federal district court is whether the decision of the Commissioner was supported by substantial evidence. 42 U.S.C. § 405(g); Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971); Mittlestedt v. Apfel, 204 F.3d 847, 850-51 (8th Cir.2000); Johnson v. Chater, 108 F.3d 178, 179 (8th Cir.1997); Andler v. Chater, 100 F.3d 1389, 1392 (8th Cir.1996). The determination of whether the Commissioner’s decision is supported by substantial evidence requires review of the entire record, considering the evidence in support of and in opposition to the Commissioner’s decision. Universal Camera Corp. v. NLRB, 340 U.S. 474, 488, 71 S.Ct. 456, 95 L.Ed. 456 (1951); Thomas v. Sullivan, 876 F.2d 666, 669 (8th Cir.1989). “The Court must also take into consideration the weight of the evidence in the record and apply a balancing test to evidence which is contradictory.” Wilcutts v. Apfel, 143 F.3d 1134, 1136 (8th Cir.1998) (citing Steadman v. Securities & Exchange Commission, 450 U.S. 91, 99, 101 S.Ct. 999, 67 L.Ed.2d 69 (1981)).

Substantial evidence means “more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Richardson v. Perales, 402 U.S. at 401, 91 S.Ct. 1420; Jemigan v. Sullivan, 948 F.2d 1070, 1073 n. 5 (8th Cir.1991). However, the substantial-evidence standard presupposes a zone of choice within which the decision makers can go either way, without interference by the courts. “[A]n administrative decision is not subject to reversal merely because substantial evidence would have supported an opposite decision.” Id.; Clarke v. Bowen, 843 F.2d 271, 272-73 (8th Cir.1988).

III. BURDEN OF PROOF AND SEQUENTIAL EVALUATION PROCESS

An individual claiming disability benefits has the burden of proving he is unable to return to past relevant work by reason of a medically-determinable physical or mental impairment which has lasted or can be expected to last for a continuous period of not less than twelve months. 42 U.S.C. § 423(d)(1)(A). If the plaintiff establishes that he is unable to return to past relevant work because of the disability, the burden of persuasion shifts to the Commissioner to establish that there is some other type of substantial gainful activity in the national economy that the plaintiff can perform. Nevland v. Apfel, 204 F.3d 853, 857 (8th Cir.2000); Brock v. Apfel, 118 F.Supp.2d 974 (W.D.Mo.2000).

The Social Security Administration has promulgated detailed regulations setting out a sequential evaluation process to determine whether a claimant is disabled. These regulations are codified at 20 C.F.R. §§ 404.1501, et seq. The five-step sequential evaluation process used by the Commissioner is outlined in 20 C.F.R. § 404.1520 and is summarized as follows:

1. Is the claimant performing substantial gainful activity?

Yes = not disabled.

No = go to next step.

2. Does the claimant have a severe impairment or a combination of impairments which significantly limits his ability to do basic work activities?

No = not disabled.

Yes = go to next step.

3. Does the impairment meet or equal a listed impairment in Appendix 1?

Yes = disabled.

No = go to next step.

4. Does the impairment prevent the claimant from doing past relevant work?

No = not disabled.

Yes = go to next step where burden shifts to Commissioner.

5. Does the impairment prevent the claimant from doing any other work?

Yes = disabled.

No = not disabled.

IV. THE RECORD

The record consists of the testimony of plaintiff and vocational expert Sandra Schneider, in addition to documentary evidence admitted at the hearing.

A. ADMINISTRATIVE REPORTS

The record contains the following administrative reports:

Earnings Record

The record establishes that plaintiff earned the following income from 1976 through 2008:

Year Income Year Income

1976 $3,649.18 1993 $16,672.01

1977 2,767.21 1994 17,311.43

1978 5,936.95 1995 18,113.06

1979 8,379.95 1996 18,797.95

1980 6,233.16 1997 20,399.89

1981 6,068.63 1998 28,880.01

1982 17,929.91 1999 28,258.85

1983 21,514.62 2000 28,638.43

1984 14,023.37 2001 30,143.20

1985 26,078.79 2002 30,178.64

1986 28,859.04 2003 30,111.37

1987 25,295.29 2004 23,757.40

1988 10,010.18 2005 7,247.69

1989 2,457.31 2006 0.00

1990 13,524.87 2007 0.00

1991 16,434.62 2008 0.00

1992 17,311.43

(Tr. at 81).

Disability Report — Field Office

In a Disability Report completed on August 8, 2005, by Interviewer P. Davis Roberts of Disability Determinations, the Interviewer observed that plaintiff had difficulty understanding, concentrating, and answering (Tr. at 84-85). “The claimant cried many times during this interview, he came in to file an appeal but was outside his appeal time. He was in FI, and is in the middle of what he says is a very messy divorce. He was accompanied by his friend, who is also his contact person. The claimant had a lot of problems staying on task, wanted to discuss every intimate detail of what his soon to be ex wife has done to him ... He cried off and on through out [sic] the entire interview, which lasted 3+ hours. He was very hard to keep on track.” (Tr. at 85).

Function Report

In a Function Report dated December 9, 2005, plaintiff said that his girl friend gives him his medicine and a drink, otherwise he will not take his medicine (Tr. at 96).

B. SUMMARY OF MEDICAL RECORDS

On April 7, 2003, plaintiff was seen at Access Healthcare for spitting up blood (Tr. at 200). He said he had relapsed and was abusing alcohol. Plaintiff was advised to stop drinking, and he was prescribed Lexapro.

Nine days later, on April 16, 2003, plaintiff was seen by Azzam Muftah, M.D., a gastroenterologist, for colon polyps (Tr. at 194). Plaintiff denied alcohol use.

On September 16, 2003, plaintiff was seen by a nurse at Access Healthcare due to splitting up blood (Tr. at 126, 193). Plaintiffs exam was normal. Plaintiff was assessed with alcohol abuse, depression, hemoptysis [coughing up blood] and sinusitis. He was advised to attend Alcoholics Anonymous and to restart Lexapro.

On November 10, 2003, plaintiff was seen by Nancy Franklin, a certified physician’s assistant, at Access Healthcare for cold symptoms (Tr. at 125, 192). Plaintiffs exam was normal except he had a hoarse voice. Ms. Franklin assessed alcohol use and advised plaintiff to go to Alcoholics Anonymous. She diagnosed depression and recommended that plaintiff restart Lexapro. In addition she assessed an upper respiratory infection for which he was prescribed an antibiotic.

On March 4, 2004, plaintiff was seen at Access Healthcare (Tr. at 191). Plaintiff was reported (by himself or his wife) to be angry and obsessive/compulsive. His wife brought pictures of their home showing that it looked like a junk yard. Plaintiff had discontinued his Lexapro. He refused counseling.

On April 8, 2004, plaintiff was seen at Access Healthcare (Tr. at 190). Plaintiff reported that he was doing better on his medication and that there was some improvement on his obsessive personality. Plaintiffs exam was normal. He was assessed with obsessive compulsive disorder. He was told to increase his Zoloft [antidepressant] to 50 mg twice a day.

On April 19, 2004, plaintiff was seen by Riqueza Cua, M.D. (Tr. at 133, 139). The record indicates diagnoses, but no observations, tests, or examinations. Plaintiff was assessed with obsessive-compulsive disorder, bipolar II disorder, and problems related to his social environment. His GAF was 50.

On April 23, 2004, plaintiff was seen at Access Healthcare (Tr. at 189). He said he felt fine, but his wife reported that he was hyper. Either plaintiff or his wife reported that he had trouble sleeping. Plaintiffs physical exam was normal. He was assessed with obsessive compulsive disorder.

On May 26, 2004, plaintiff was seen by Dr. Cua (Tr. at 131, 137). He was seen with his family. He reported missing his Zoloft at times. He said he stopped taking Geodon because it made him feel funny. He reported still exhibiting obsessive compulsive disorder behaviors. His mood was “less anxious.” He was assessed with obsessive-compulsive disorder, bipolar II disorder depressed moderate with atypical features with rapid cycling, attention-deficit/hyperactivity disorder, and problems related to his social environment. His GAF was 55. He was told to continue Zoloft and return in two to three months.

On August 27, 2004, plaintiff was seen by Dr. Cua (Tr. at 130, 136). Plaintiffs wife accompanied him. They reported that plaintiff was on vacation, that he gets easily distracted, that he “buys a lot of stuff,” was going to auctions, had 21 cars, had “loads of furniture,” and was compulsive. Dr. Cua observed that plaintiffs mood was pleasant, he was joking around, he “wants to find a nice girl,” he thought his wife was not helping out. He was assessed with obsessive-compulsive disorder, bipolar II disorder depressed moderate with atypical features with rapid cycling, and problems related to his social environment. His GAF was 55. He was started on Strattera and told to return in one month.

On October 1, 2004, plaintiff was seen by Dr. Cua (Tr. at 129, 135). Plaintiffs wife had called and reported that plaintiff was on a buying spree out of state. Plaintiff told Dr. Cua that he had been fixing a house in Kansas. He admitted that he had not taken his medication, he was anxious and depressed because his wife had served him with divorce papers, that he was stressed at work, that although he was doing a good job a supervisor was pressuring him, and that he was unable to function. He was anxious and tearful. His speech was logical and coherent; he had fair insight and judgment. He was assessed with obsessive-compulsive disorder, bipolar II disorder depressed moderate with atypical features with rapid cycling, attention-deficif/hyperactivity disorder, and problems related to his social environment. His GAF was 50. Dr. Cua referred plaintiff for therapy and told him to return in a week and to consider taking a mood stabilizer.

April 5, 2005, is plaintiffs alleged onset date.

On August 2, 2005, plaintiff was seen by Jeff Farrow, Ph.D., a clinical psychologist, for individual psychotherapy (Tr. at 248). Plaintiff was on time, was casually dressed and adequately groomed. His mood was mildly depressed. Plaintiff reported decreased sleep, racing and ruminating thoughts, increased irritability, and feeling helpless, restless, and hopeless. His GAF was 51-53.

On September 21, 2005, plaintiff was evaluated by Dr. Farrow (Tr. at 151-154, 244-247).

Informants: The information for this initial clinical assessment was provided by Mr. Marques. Mr. Marques appears to be a reliable informant. The information given for this initial clinical assessment appeared to be valid.

Chief Complaint: When asked why he was seeking services Mr. Marques stated, “I have depression, anxiety, Obsessive Compulsive Disorder and Bipolar. I think about the past a lot. These problems have been getting worse in the past month or so.”

History of Present Illness: According to Mr. Marques, “I worked in prisons for 20 years, most of my life and I don’t have anything to show for myself. I used to have lots of stuff when I lived in Florida. I had lots of cars and lots of other stuff. I used to like to go to yard sales and get stuff. Now I don’t get any work. My wife is selling everything. She sold my 1978 Camaro for like $1,400. I think she is just giving this stuff away. The stuff she is not giving away, she has had yard sales. It would either sale [sic] or she just throws it away. It is very upsetting to me that I didn’t get to bring all my stuff with me when I left Florida. I am at the point where I just don’t care anymore. I am not sleeping at night. I have lots of dreams. I can’t see my kids anymore. I have no self-esteem. The girlfriend I have here is not as understanding as I would like her to be. She doesn’t seem to understand my problems either. I used to be on some medicine but it was so old that I threw it out. I would like to talk to somebody about getting on some medicine.”

Past Psychiatric History: Mr. Marques states he was treated on an outpatient basis while residing in Florida. He did not remember the name of the clinic. He denied any other psychiatric history on an inpatient or outpatient basis. He also denied any previous drug or alcohol treatment either on an inpatient or outpatient basis.

Medical History: ... His current medical problems include allergies, frequent headaches and intermittent migraines. He states he has no family physician and is not currently taking any prescription medications.... Mr. Marques states his last physical examination was “a long time ago”.... Mr. Marques states he is not currently experiencing any type of pain and feels that his medical needs are being met at this time. “I’m not sick.”

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Addictive Behavior/Dependence: Mr. Marques stated he had his first alcoholic drink around the age of 18. He drank on a heavy basis until the age of 26. “Now I just drink on very rare occasions. The last time was probably a month ago. I pretty much quit when I got married.” Mr. Marques reported using marijuana while in high school. He denied any other types of addictive behavior.

Psychosocial History: ... Mr. Marques appeared to be more than capable of attending to his activities of daily living.... Mr. Marques reports being broke.... He states he has been unemployed for the past couple of years.

The form notes that a mental status examination was performed and says, “See attached Mental Status Examination sheet”; however, there is no Mental Status Examination sheet attached to this report. Dr. Farrow diagnosed the following:

Axis I: Bipolar I Disorder, Most Recent Episode Mixed to Moderate Obsessive Compulsive Disorder

Axis II: Diagnosis deferred.

Axis III: Allergies, frequent headaches, and intermittent migraines, all by client’s report

Axis IV: Limited support system, unemployed, financial stress.

Axis V: GAF current 50-60. Past year 60-70.

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Formulation and Recommendations:

Rationale for Diagnosis — Mr. Marques meets the diagnostic criteria for Bipolar I Disorder, Most Recent Episode Mixed to Moderate. Mr. Marques reports a history of experiencing both manic and depressive episodes. His manic episodes were described as distinct periods of persistently elevated, expansive or irritable mood. During this period of mood disturbance he has gone up to one week with only sleeping three or four hours a night. He experiences mood swings, flight of ideas, is easily distracted, has increased irritability, an increase in goal-directed behavior and pressured speech. He also reports experiencing depressive episodes during which he has depressed mood, decreased sleep, up and down appetite, decreased energy, intermittent crying spells, being easily distracted, experiencing racing and ruminating thoughts, having increased irritability “at times” and experiencing moderate experiences of anhedonia. Mr. Marques’s obsessive compulsive symptoms include having recurrent persistent thoughts and impulses. These thoughts and impulses are not particularly excessive. He worries about real life problems. Mr. Marques attempts to ignore or suppress his thoughts. He recognizes that the obsessive thoughts are produced by his own mind. His repetitive behaviors include collecting “things” at yard sales, out of ditches, and estate sales. This behavior is aimed at preventing or reducing distress caused by the thought process.

Client’s Strengths — Mr. Marques has good verbal skills and appears to be of average intelligence, although formalized intelligence testing was not conducted.

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Treatment Recommendations/initial Treatment Plan — Mr. Marques will participate in individual psychotherapy to work on issues surrounding his Bipolar Disorder and Obsessive Compulsive Disorder. He will work on decreasing his depressive and anxiety symptoms while increasing his coping skills, problem solving skills, and decision making skills.

On October 19, 2005, plaintiff saw Elizabeth Bhargava, M.D., a psychiatrist (Tr. at 155-156, 242-243).

Identifying Information: The patient is a 46-year-old married but separated, unemployed, Caucasian male who lives in Willow Springs with his girlfriend.

Presenting Complaint: “Dr. Farrow thinks I need medications.”

History of Present Illness: The patient was evaluated by Dr. Farrow on 09/21/05.... He states that he was diagnosed with Bipolar Disorder by Dr. [Cua] in Florida. He used to be treated with medication, which included Strattera, Zoloft, and Restoril. He has not been on medications for a couple of years. He reports not being able to sleep. He goes to sleep at times between 2:00 a.m. and 4:00 a.m. He has been depressed. One of his stressors include his relationship with his ex-wife, who apparently was unfaithful to him, and had him kicked out of the house on a restraining order, went to court and lied about him, and got his 13 cars as well as his house and left him with nothing. Apparently, she alleged that he was abusive. The patient is accompanied by his girlfriend, Cathy. He, himself, is a rather poor historian due to him being very circumstantial. He tells me he starts projects in the middle of the night, such as tearing down a wall of the house, repairing things, and usually does not complete the project and jumps onto a new one. He tends to dwell in the past, and there have been times when he bursts out crying. He does acknowledge passive suicidal ideation at times. He used to enjoy working on cars, but has not been doing so lately. He denies any auditory or visual hallucinations. He does acknowledge some mild paranoia. He does have some mild memory problems. He tends to be disorganized. He does have obsessive compulsive symptoms, his hoarding. She tells me he cannot bear throwing things away. He goes into dumpsters to pull out stuff and restore them. They have a lot of garbage that they do not need. Although there is some baseline disorganization, he does have bursts of energy with decreased need for sleep and increased goal-directed activities.

Past Psychiatric History: It seems that apparently he has not been very compliant with medications. There have been no prior hospitalizations or suicide attempts....

Substance Abuse History: He reports an eight to ten year period of drinking heavily, up to a six pack a night on a daily basis. However, he quit that, and currently drinks an occasional beer. He quit smoking....

Multiaxial Psychiatric Diagnosis:

Axis I: Bipolar Disorder, current episode mixed

Rule out Attention Deficit Hyperactivity Disorder

Rule out Obsessive Compulsive Disorder

Axis II: Deferred

Axis III: Arthritis; migraines

Axis IV: Unemployed; Issues with ex-wife.

Axis V: Global Assessment of Functioning of 44.

On November 9, 2005, plaintiff saw Dr. Farrow for individual psychotherapy (Tr. at 241). Plaintiff was on time, was casually dressed and adequately groomed. His mood was normal. Plaintiff reported disrupted sleep, mild racing and ruminating thoughts, increased frustration level and feeling helpless. “Focal issue for today’s session was setting boundaries in interpersonal relationships.” Plaintiffs GAF was 51-53.

On November 16, 2005, plaintiff was evaluated by Dr. Farrow in connection with his disability application (Tr. at 147-150).

GENERAL OBSERVATIONS: Mr. Marques ... presented on time for the scheduled appointment and stated he drove himself to this appointment. Mr. Marques was casually groomed. He was neat and clean in appearance. His mood was mildly anxious and depressed and his affect was appropriate to content. He was alert and oriented. His speech was logical and goal-directed. His eye contact was good. His affective expression as observed during today interview would be described as mildly depressed and mildly anxious.

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PRESENT ILLNESS: ... When asked about his history and current symptoms Mr. Marques stated, “I haven’t been working. I worked in prisons both in New York and Florida for most of my life, at least twenty years of it. I’ve been diagnosed with bipolar and obsessive compulsions. I used to collect things. I guess I still do, but my girlfriend is helping me with that. I used to get stuff from yard sales. My garage and porch got full. I had 21 cars. I guess my ex-wife is selling them now. That really bothers me. I spent a lot of time and money getting that stuff and now she has it. We’re getting divorced after twenty years of being together. I’ve gotten to where I didn’t care about anything. I don’t have nothing to show for my life. My ex-wife has it all. I’m not sleeping at night. I’m only sleeping three or four hours per day. I have two kids and I can’t see either one of them. My self-esteem is gone. My present girlfriend isn’t as understanding as I’d like her to be. She’s a good person and has been helping me, but there are things I feel I just have to have. I’m back on some medicine now. I hadn’t been on any medicine in over a year. I’m taking Zoloft and Seroquel. I guess they’re working.”

Mr. Marques meets the diagnostic criteria for Bipolar I Disorder, most recent episode mixed, moderate. Mr. Marques reported experiencing both manic and depressive episodes. His manic episodes were described as being distinct periods of persistently elevated, expansive, or irritable mood during which he has gone up to one week with only sleeping three or four hours per night. He experiences mood swings, flight ideas, is easily distracted, has increased irritability, pressured speech and an increase in goal directed behavior. Mr. Marques reported he is currently in a depressive episode. His depressive episodes include depressed mood, decreased sleep, up and down appetite, decreased energy, crying spells “most of the time,” being easily distracted, experiencing racing and ruminating thoughts, increased irritability “at times,” and moderate symptoms of anhedonia. He also reported feeling helpless “at times,” feeling hopeless, feeling restless and worthless. Mr. Marques also meets the diagnostic criteria for Obsessive Compulsive Disorder. He reported experiencing both obsessive thoughts and compulsive behavior. His obsessive thoughts were defined as being recurrent and persistent thoughts, impulses or images that are experienced sometime during the day. These are intrusive and inappropriate. They cause marked anxiety and distress. The thoughts and impulses are not simply excessive worries about real life problems. Mr. Castillo [sic] reported he tries to suppress and ignore these thoughts or images. He reported experiencing repetitive behavior in the form of mental acts or compulsions he does counting with his fingers, tapping, etc. These types of behavior and mental acts are aimed at preventing or reducing distress or preventing some dreaded event/situation from happening. Mr. Castillo [sic] reported he recognizes the obsessions and compulsions are excessive and unreasonable, but he cannot control them. When the obsession and compulsions are present they cause marked distress and are excessively time consuming. This has caused him to have significant interference in his daily routine including occupational functioning and social activities. At the time of this evaluation, Mr. Marques denied any current or previous auditory or visual hallucinations and no delusional thought processes were noted. He denied having any unexpected panic attacks. During this evaluation, Mr. Marques’ mood was mildly depressed and mildly anxious. His affect was appropriate to content. His insight appeared to be poor and his judgment appeared to be fair. He denied any current suicidal or homicidal ideation, plans or intent.

PAST HISTORY OF MENTAL DISORDERS: When asked about previous psychiatric treatment Mr. Marques reported he is currently receiving treatment at Ozarks Medical Center Behavioral Healthcare. In the past, he was treated on an outpatient basis in Florida. He denied any other history of either inpatient or outpatient psychiatric treatment. He also denied any previous drug or alcohol treatment.

When asked about his own alcohol and illicit substance use history Mr. Marques reported he had his first alcoholic drink around the age of 18. He reported he drank on a heavy basis until the age of 26, “When I got married.” He reported only drinking on rare occasions now. The last time was approximately one month ago. When asked about illicit substance use, Mr. Marques reported he used marijuana “when I was in high school.” Mr. Marques denied any current legal difficulties.

INTELLECTUAL FUNCTIONING AND SENSORIUM: ... Memory for immediate information was rated as poor in that Mr. Marques was able to repeat five digits forward and only two digits backward. He evidenced intact remote memory functioning in that he could relate the events of his life in a logical, coherent and consistent fashion. Mr. Marques’ functional memory would be rated as fair.

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DIAGNOSIS: The following diagnostic impressions are based on Mr. Marques’ clinical presentation as well as his reported history and symptoms.

Axis I 296.89 Bipolar I Disorder, most recent episode mixed, moderate.

303.3 Obsessive Compulsive Disorder.

Axis II Diagnosis deferred.

Axis III Allergies. Frequent headaches. Intermittent migraines, (all per client’s report)

Axis IV Limited support system. Unemployed. Financial stress.

Axis V GAF Current 50-60, past year 60-70.

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A. Understand and remember instructions. Mr. Marques did not demonstrate any difficulties in his ability to understand and remember simple instructions, moderately complex level instructions, or complex level instructions. If Mr. Marques’ Bipolar I Disorder and his OCD symptoms are exacerbated, it is believed he would have difficulties remembering complex level instructions.

B. Sustain concentration and persistence in tasks. Mr. Marques was able to sustain concentration and persistence on simple tasks, moderately complex level tasks, and complex level tasks during this evaluation. Again, it is felt if his bi-polar or OCD symptoms are exacerbated, he will have difficulties with his ability to concentrate on complex level tasks.

C. Interact socially and adapt to his environment. Mr. Marques’ ability to consistently appropriately interact with others (i.e., the general public, coworkers, or work supervisors) and adapt to changes in his environment in a safe manner would be greatly enhanced if in an environment with limited contact with the public and few inherent hazards.

On November 28, 2005, plaintiff saw Dr. Bhargava (Tr. at 157, 240). “The patient tells me he is doing better with taking the Seroquel; however, he has cut down from the 200 mg because he was running out of his medications and has been taking only 100 mg at bedtime. He does acknowledge a couple of episodes where he does get more depressed and preoccupied with all of his losses much easier. He is sleeping better. He is significantly less circumstantial this interview. He is accompanied to this visit by his girlfriend, who tells me that he is doing better in terms of his mood swings as well as his sleep.” Dr. Bhargava observed that plaintiff was casually dressed, his mood was less depressed, his thought process was coherent. She assessed him with “significant improvement.”

On December 8, 2005, plaintiff saw Dr. Farrow for individual psychotherapy (Tr. at 239). Plaintiff was on time, casually dressed and adequately groomed. Plaintiff reported up-and-down sleep pattern, mild racing and ruminating thoughts, and feeling helpless. “Focal issue for today’s session was coping with the holidays and being medication complaint.” Plaintiffs GAF was 54-57.

On December 8, 2005, Dr. Farrow wrote a letter to whom it may concern:

This letter is being written on a request, from Donald Marques, regarding information about his current level of emotional/mental functioning. Mr. Marques has been a client here at Ozarks Medical Center Behavioral Healthcare, since 09-21-2005. At the time of admission, Mr. Marques’ symptoms met the diagnostic criteria for Bipolar I Disorder, most recent episode, mixed, moderate and Obsessive Compulsive Disorder. Mr. Marques is participating in both medication services and individual psychotherapy. Mr. Marques’ response to antidepressant medications has been reported to be in a positive direction.

At the time of his last appointment, on 12-08-2005, Mr. Marques was continuing to report experiencing the following depressive symptoms: depressed mood, decreased sleep, “but it is more on the medication,” decreased energy, experiencing racing thoughts, increased irritability “at times,” is easily distracted, having difficulties with his concentration and memory, and symptoms of anhedonia. Mr. Marques also continues to experience obsessive thoughts, “but my compulsion to collect junk has gone down on my medication.” Mr. Marques’ current mental health symptoms will affect his ability to be gainfully employed for at least the next twelve mouths, if not longer.

(Tr. at 159,160).

On January 3, 2006, Kenneth Burstin, Ph.D., completed a Psychiatric Review Technique (Tr. at 165-178). He found that plaintiff suffers from bipolar disorder. He noted that plaintiff has a diagnosis of obsessive compulsive disorder which is “not fully supported by objective findings.” He determined that plaintiff suffers from mild restriction of activities of daily living; moderate difficulties in maintaining social functioning; mild difficulties in maintaining concentration, persistence, or pace; and has had no episodes of decompensation. Dr. Burstin noted that Dr. Farrow’s opinion that plaintiff could not work for at least twelve months was subjective and based on only a few visits and that the notes indicated plaintiff had improved with treatment. Dr. Burstin also noted that plaintiff alleged panic attacks but had not complained of panic attacks to his doctors.

That same day, Dr. Burstin completed a Mental Residual Functional Capacity Assessment (Tr. at 179-182). He found that plaintiff was moderately limited in his ability to interact appropriately with the general public but that he was not significantly limited in any other area. “Claimant retains the capacity to acquire, retain, perform and sustain complex tasks. Claimant can interact in environments that do not require frequent public contact. Claimant can adapt to changes in routine work environments.”

On January 6, 2006, plaintiff saw Dr. Farrow for individual psychotherapy (Tr. at 238). Plaintiff was on time, casually dressed and adequately groomed. Plaintiff reported an up-and-down sleep pattern, mild racing and ruminating thoughts, and feeling helpless. Plaintiff was assessed with a GAF of 54-57.

On January 17, 2006, plaintiffs girl friend accompanied him to his appointment with Dr. Bhargava (Tr. at 237). They both reported that plaintiff gets irritable over “silly things. There have been no real anger episodes. He has been sleeping well. His mood is fairly good.” He was assessed with, “Mild symptoms.” She continued his Zoloft and increased his Seroquel to 250 mg at bedtime “to help with the irritability and circumstantiality. He is also complaining of being distractible.”

On January 30, 2006, plaintiff saw Dr. Bhargava (Tr. at 236). Plaintiff reported continuing to get irritable off and on. He was sleeping well. “He talked to me about how well he cooks. He does get upset at his girlfriend for not being able to do as much over the last one month, but apparently she had an accident in which she hit her head, which may have contributed to this. I asked him to be patient.” Plaintiff complained about his upcoming divorce and about not wanting to participate in mediation. Dr. Bhargava observed that plaintiff was mildly depressed, his thought process was coherent, he was not suicidal or psychotic. She increased his Seroquel to 25 mg every morning and 250 mg at bedtime and continued his Zoloft.

On February 13, 2006, plaintiff saw Dr. Farrow for individual psychotherapy (Tr. at 234-235). Plaintiff was on time, he was casually dressed and adequately groomed. Plaintiff reported racing thoughts, memory difficulties, being mildly withdrawn. “Focal issue for today’s session was dealing with financial stressors and medication compliance.” Plaintiff was assessed with a GAF of 54-57.

On March 9, 2006, plaintiff saw Dr. Bhargava (Tr. at 232). “Mr. Marques reports that he and his girlfriend sent a letter to the attorney in Florida stating that they would not be able to go for court because they could not afford it. He has been quite upset over the fact that he has no contacts with his daughter and son. He tells me his ex-wife put his 13-year-old daughter out into foster care with the state. Both he and his girlfriend are hoping to be able to track her down and have her come to stay with them. His girlfriend tells me that Seroquel is making him tired, especially when taken in the morning. It does help him with sleeping at night, but sometimes makes him oversedated.” Dr. Bhargava decreased plaintiffs Seroquel to 100 mg at bedtime and started Ability. She suggested he contact the Division of Family Services in Florida as well as his attorney.

On March 17, 2006, plaintiff saw Dr. Farrow for individual psychotherapy (Tr. at 230). Plaintiff was on time, he was casually dressed and adequately groomed. Plaintiff reported nervousness, racing thoughts, memory difficulties. “Focal issue for today’s session was dealing with divorce, division of property, [and] legal problems.” Plaintiff was assessed with a GAF of 54-57.

On March 22, 2006, plaintiff was seen at Access Healthcare for a “consult” (Tr. at 124, 188). Plaintiffs “wife” stated that he had obsessive-compulsive disorder. She reported radical changes in his behavior, said he collects junk constantly and gets upset at the drop of a hat. A physical exam was performed which was normal. Plaintiff was diagnosed with obsessive-compulsive disorder and personality disorder. He was started on Zoloft and referred to a psychiatrist.

On April 4, 2006, plaintiff saw Dr. Farrow for individual psychotherapy (Tr. at 228). Plaintiff was late. He was casually dressed and adequately groomed. Symptoms reported included mildly expansive mood, racing thoughts, mild pressured speech, and increased frustration. “Focal issue for today’s session was coping with on-going legal problems.” Plaintiff was assessed with a GAF of 54-57.

On April 20, 2006, plaintiff saw Dr. Bhargava (Tr. at 226). “Mr. Marques states he does get irritable, otherwise he rates his depression as a three of ten. He comes in with his girlfriend and they both complain about each other. However, their issues and reactions that they describe do not appear to be more than what one would expect in a co-habitating couple. I helped them understand that the medications are not going to take away all their problems.” Plaintiffs mood was “fairly good,” his affect was reactive and appropriate, his thought process was coherent, and his speech was normal in rate and volume. Under assessment, Dr. Bhargava wrote, “Doing better.” His GAF was assessed at 55. Dr. Bhargava continued plaintiffs Zoloft, increased his Abilify to 15 mg and discontinued Seroquel.

On May 4, 2006, plaintiff saw Dr. Farrow for individual psychotherapy (Tr. at 224-225). Plaintiff was on time for his appointment, was casually dressed and adequately groomed. The focus of the session was processing how to let go of the past in order to move forward. On a scale of zero to ten with zero being no measurable progress, five being goal partially met, and ten being goal achieved, Dr. Farrow ranked plaintiff a six. His GAF was 54-57. Plaintiff was advised to return in four to six weeks for supportive therapy.

On May 19, 2006, plaintiff was seen by Dr. Bhargava (Tr. at 223). “Mr. Marques says he is doing fairly well. He has been stressed because he will have to go to Florida for the court hearing regarding division of property related to the divorce. He is anxious about that.... He has been sleeping fairly well. Occasionally he doe[s] get irritable but nothing out of the way.” Dr. Bhargava observed that plaintiffs mood was fair, his affect was reactive and appropriate. She concluded, “Fairly stable in spite of stressors” and assessed a GAF of 60. He was continued on his same medications and was encouraged to diet and exercise.

On June 7, 2006, plaintiff saw Dr. Farrow for individual psychotherapy (Tr. at 221-222). Plaintiff was on time for his appointment and was adequately groomed. Plaintiff reported mild racing thoughts, mild pressured speech, ruminating thoughts. The focus of the session was making decisions related to his divorce proceedings. On a scale of zero to ten with zero being no measurable progress, five being goal partially met, and ten being goal achieved, Dr. Farrow ranked plaintiff a six. His GAF was 56-58. Plaintiff was advised to return in four to six weeks for supportive therapy.

On June 16, 2006, plaintiff saw Dr. Bhargava (Tr. at 219). Plaintiff said he was anxious about having to go to Florida the next month but “otherwise he has been doing fairly well.” He had had no significant episodes of irritability. “His girlfriend tells me he keeps himself really busy.” He had not yet signed up for the Solutions to Wellness program. Plaintiffs thought process was coherent. His mood was mildly anxious. He was assessed as “fairly stable” with a GAF of 60. He was told to continue on his same medications and return in four to six weeks.

On July 5, 2006, plaintiff was seen by Dr. Farrow for individual psychotherapy (Tr. at 217-218). Plaintiff reported increased appetite, decreased energy, ruminating and obsessive thoughts. Dr. Farrow and plaintiff worked on decreasing anxiety symptoms while increasing mood stabilization, coping with increased anxiety and weight gain. On a scale of zero to ten with zero being no measurable progress, five being goal partially met, and ten being goal achieved, Dr. Farrow ranked plaintiff a six. His GAF was 53-55. Plaintiff was advised to return in four to six weeks for supportive therapy.

On July 21, 2006, plaintiff saw Dr. Bhargava (Tr. at 215). “Mr. Marques says he did not have to go to Florida after all. The attorney settled the whole matter over the phone. He is going to get about $46,000. He does get depressed occasionally thinking about his children. He continues to gain weight. It does not appear that he has been working on his diet or exercise. He complains that it is to [sic] hot.” Plaintiff was casually groomed, his mood was “fairly good,” affect was “bright.” His thought process was coherent.

“Assessment:

1. Continues to be fairly stable.

2. Global Assessment of Functioning Score of 64.”

Dr. Bhargava recommended plaintiff continue with 100 mg of Zoloft daily, 156 mg. of Ability every morning, 20 mg of Levitra as needed, and return in six to eight weeks.

On August 2, 2006, plaintiff saw Dr. Farrow for individual psychotherapy (Tr. at 213-214). Plaintiff was on time and was adequately groomed. Plaintiff reported decreased sleep, increased energy, ruminating and obsessive thoughts. “Focal issue for today’s session was coping with financial problems and finalizing a divorce.” Dr. Farrow and plaintiff worked on decreasing anxiety symptoms while increasing mood stabilization. On a scale of zero to ten with zero being no measurable progress, five being goal partially met, and ten being goal achieved, Dr. Farrow ranked plaintiff a six. His GAF was 53-55. Plaintiff was advised to return in four to six weeks for supportive therapy.

On August 2, 2006, Dr. Farrow completed a Medical Source Statement Mental (Tr. at 207-209). He wrote that plaintiff does not have a history of alcohol abuse. He found that plaintiff was not significantly limited in the following:

• The ability to understand and remember very short and simple instructions

• The ability to carry out very short and simple instructions

• The ability to ask simple questions or request assistance

• The ability to maintain socially appropriate behavior and to adhere to basic standards of neatness and cleanliness

He found that plaintiff was moderately limited in the following:

• The ability to remember locations and work-like procedures

• The ability to understand and remember detailed instructions

• The ability to perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances

• The ability to sustain an ordinary routine without special supervision

• The ability to make simple work-related decisions

• The ability to interact appropriately with the general public

• The ability to be aware of normal hazards and take appropriate precautions

• The ability to travel in unfamiliar places or use public transportation

He found that plaintiff was markedly limited in the following:

• The ability to carry out detailed instructions

• The ability to maintain attention and concentration for extended periods

• The ability to work in coordination with or proximity to others without being distracted by them

• The ability to complete a normal workday and workweek without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods

• The ability to accept instructions and respond appropriately to criticism from supervisors

• The ability to get along with coworkers or peers without distracting them or exhibiting behavioral extremes

• The ability to respond appropriately to changes in the work setting

• The ability to set realistic goals or make plans independently of others

On September 13, 2006, plaintiff saw Dr. Farrow for individual psychotherapy (Tr. at 211-212). Plaintiff was on time for his appointment, he was casually dressed and adequately groomed. He said he was relieved his divorce was final but he continued to obsess on the material items he had to give up and the fact that he hadn’t gotten to talk to his son in three years. Dr. Farrow and plaintiff worked on decreasing anxiety symptoms while increasing mood stabilization. On a scale of zero to ten with zero being no measurable progress, five being goal partially met, and ten being goal achieved, Dr. Farrow ranked plaintiff a seven. His GAF was 55-58. Plaintiff was advised to return in four to six weeks.

On September 22, 2006, plaintiff saw Dr. Bhargava (Tr. at 267-268). Plaintiff reported feeling more depressed. He said he had stopped cooking, which he previously enjoyed. He was sleeping about 14 hours per night. Dr. Bhargava observed that plaintiffs mood was depressed, his affect restricted, thought process coherent. He was not suicidal or psychotic. She assessed,

1. Increased symptoms

2. Global Assessment of Functioning Score of 50.

She increased his Zoloft to 150 mg. daily, decreased his Abilify to 10 mg every morning, and prescribed Topamax for mood stabilization “to decrease weight gain.”

On September 22, 2006, Elizabeth Bhargava, M.D., completed a Medical Source Statement Mental (Tr. at 250-252). She found that plaintiff is not significantly limited in the following:

• The ability to understand and remember very short and simple instructions

• The ability to interact appropriately with the general public

• The ability to ask simple questions or request assistance

• The ability to maintain socially appropriate behavior and to adhere to basic standards of neatness and cleanliness

• The ability to be aware of normal hazards and take appropriate precautions

She found that plaintiff was moderately limited in the following:

• The ability to remember locations and work-like procedures

• The ability to carry out very short and simple instructions

• The ability to perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances

• The ability to sustain an ordinary routine without special supervision

• The ability to work in coordination with or proximity to others without being distracted by them

• The ability to make simple work-related decisions

• The ability to complete a normal workday and workweek without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods

• The ability to accept instructions and respond appropriately to criticism from supervisors

• The ability to get along with coworkers or peers without distracting them or exhibiting behavioral extremes

• The ability to respond appropriately to changes in the work setting

• The ability to travel in unfamiliar places or use public transportation

• The ability to set realistic goals or make plans independently of others

She found that plaintiff was markedly limited in the following:

• The ability to understand and remember detailed instructions

• The ability to carry out detailed instructions

• The ability to maintain attention and concentration for extended periods

On October 31, 2006, plaintiff saw Dr. Bhargava and stated he was “doing better” (Tr. at 265-266). Plaintiff reported feeling tired during the day, but said he was having no problems with the Topamax. “He has obtained some settlement with the divorce. However, due to the money that he got he might lose his Medicaid and this has been worrying him.” Dr. Bhargava observed that plaintiff was “casually groomed. His mood was less depressed and affect brighter. Thought process was coherent. He was not suicidal or psychotic.” She assessed

1. Doing better

2. Global Assessment of Functioning 60.

She continued his Zoloft, discontinued the Ability, and increased his Topamax.

On November 15, 2006, plaintiff saw Dr. Farrow for individual psychotherapy (Tr. at 263-264). Plaintiff was on time, casually dressed and adequately groomed. Plaintiff reported hypervigilence, ruminating thoughts, easily distracted, increased obsessive thoughts. “Mr. Marques’ significant other is very frustrated with his behaviors and lack of focus on the relationship. He has been obsessing about buying cars at the cost of ignoring other aspects of his life.” On a scale of zero to ten with zero being no measurable progress, five being goal partially met, and ten being goal achieved, Dr. Farrow ranked plaintiff a seven. His GAF was 55-58.

On January 12, 2007, plaintiff saw Thomas Nixon, a licensed clinical social worker, at Behavioral Health Care (Tr. at 261-262). Plaintiff arrived early for his appointment and was adequately groomed. This was the first time plaintiff saw Mr. Nixon after Dr. Farrow passed away. Plaintiff reported depression and feelings of hopelessness. Plaintiff talked about hoarding and how it began when he was a child and was not allowed in the refrigerator-he began keeping a drawer full of candy in his room. “He repeatedly discussed his ex-wife not appreciating him, discarding his things and depleting his finances. He was tearful through most of the session today.” Plaintiffs GAF was 54-57.

On April 18, 2007, plaintiff saw Thomas Nixon at Behavioral Health Care for a clinical assessment (Tr. at 258-260). Plaintiff reported mood swings, concentration problems, loss of interest, and feeling numb and nervous. Plaintiff said he has to has things and will sometimes stop to pick something up off the side of the road.

Changes in past year:

Personal: “Like in conversations sometimes, like my opinion don’t mean nothing, and I feel like a piece of crap.” He reports that he has been having some problems with some of his friends. “It’s like they use you. They borrow things and stuff like that. I was really upset when Dr. Farrow died. That was really painful.”

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Treatment: Since 2005 Donald had been seeing Jeff Farrow, Psy.D. for psychotherapy and Elizabeth Bhargava, M.D., for pharmacotherapy. Dr. Farrow passed away in December 2006. Donald had last seen him in November 2006. He saw this therapist in January 2007 and did not return till today’s date. He blames his wife for this stating that she was having problems and didn’t keep up with his appointments. He can-celled appointments for medication and therapy in February and no showed an appointment for medications last week.

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Assessment of Pain: Current Pain: Yes. Location: Lower left side. Duration: Off and on for about a year. Frequency: 2 or 3 times a week.... “His wife notes that he seems to get the pain after he drinks beer.

Plaintiff was adequately groomed, his thought flow and associations were within normal limits, his thought content was primarily concrete with some ability for abstract reasoning. His mood was anxious, he reported sleeping fine, he denied hallucinations and delusions. He was fully oriented, and his memory was within normal limits. Plaintiff was assessed with obsessive compulsive disorder, bipolar disorder type I, and a GAF of 48-50.

On May 30, 2007, plaintiff saw Thomas Nixon at Behavioral Health Care for individual psychotherapy (Tr. at 256-257). Plaintiff was on time, was casually dressed and well groomed. Plaintiff reported anxiety and recent depression. “He stated he had been upset with a friend who was supposed to buy a ear and then didn’t make payments to him. He discussed wanting to buy a 1974 Ford Maverick but not having the money.” Plaintiffs GAF was 58-60.

On June 13, 2007, plaintiff saw Thomas Nixon at Behavioral Health Care for individual psychotherapy (Tr. at 254-255). Plaintiff was on time, he was casually dressed and adequately groomed. His mood was amdous. Plaintiff reported feeling frustrated, anxious, having mood swings, loss of interest and sleep problems. “He stated that he was so upset he couldn’t sleep because he traded 2 cars to a man for a truck and the man took one of the cars to a scrap yard and junked it. He was upset that the man would destroy a car in good running condition, angry and thinking that he wanted to have nothing else to do with the man. He frequently switched subjects during interview today and seemed to have difficulty staying on track.” On a scale of zero to ten with zero being no measurable progress, five being goal partially met, and ten being goal achieved, Mr. Nixon ranked plaintiff a five. His GAF was 58-60.

On June 28, 2007, plaintiff saw Dr. Bhargava (Tr. at 314-315). This was plaintiffs first visit with Dr. Bhargava since the previous October. He told her he could not come in for the medication because he lost his Medicaid because of the money he got from his divorce. “He is now on the Department of Mental Health.” Plaintiffs girl friend described him as unbearable to live with. “He has mood swings, he has problems with focusing, he acknowledges periods of depression. He is easily distractible.” Dr. Bhargava observed that plaintiff was talkative, his mood was “fairly good today”, his affect was bright, his thought process was somewhat circumstantial. She assessed him as mildly hypo-manic with a GAF of 60. She reinstated Topamax and Wellbutrin.

On July 18, 2007, plaintiff saw Thomas Nixon for individual psychotherapy (Tr. at 312-313). He was on time, casually dressed, and adequately groomed. His mood was depressed and anxious. Plaintiff reported problems with concentration, sleep, and mood swings. He said he was worried that he let a man have two cars without getting the money first and the man skipped town. Plaintiffs girl friend reported that he is up every time the dogs bark for fear someone is bothering his cars. “He appeared almost child like in his presentation, frequently asking questions, having problems comprehending answers____ He has applied for disability, but apparently is having problems following through with some of the things he needs to do. His wife works and cannot walk him through the steps he needs to take and he seems to have difficulty understanding what he needs to do.... Therapist has difficulty seeing this client having worked as a prison guard for 20 years when he has such a trusting inocense [sic] and naivete about him.” Plaintiffs GAF was 51-53. He was told to return in two to four weeks.

On July 25, 2007, plaintiff saw Dr. Bhargava (Tr. at 310-311). Plaintiff and his girl friend reported that plaintiff recently purchased two cars which he later determined were not worth the money he paid for them, and that made him depressed. He reported binge drinking and drinking excessively when his friends come around. He reported overeating to the point of throwing up whenever he goes to a buffet. He reported loneliness now that his girl friend was working. Dr. Bhargava noted that plaintiff had lost five pounds. His mood was depressed and his affect was tearful. His thought process was coherent. She assessed him with “increased symptoms” and a GAF of 55. She increased his Topamax and Wellbutrin and encouraged him to go to Dual Diagnosis Group.

On September 5, 2007, plaintiff saw Thomas Nixon for individual psychotherapy (Tr. at 308-309). Plaintiff was on time, was causally dressed, and adequately groomed. “Donald states that he has not come to the Dual Diagnosis group because he has been preoccupied with some problems. He denies that he has been drinking excessively and reports that he has cut back his drinking. He was upset about having allowed a young couple, the daughter of a friend and her boyfriend, [to] move into his trailer on 14 highway. The deal was that they would fix the place up in exchange for no rent for a couple of months. Instead, they never switched the electric to their names, and stole items from off the property. He is now having to deal with the legalities of eviction and having to press charges.” Plaintiffs GAF was 51-53. He was told to return in two to four weeks.

On September 12, 2007, plaintiff saw Thomas Nixon for individual psychotherapy (Tr. at 306-307). Plaintiff was on time, was casually dressed and adequately groomed. Plaintiff did not think his medication was working because he was having trouble sleeping. He complained that the people he rented to were stealing from him, that neighbors were complaining to him, and that his wife got fired. Mr. Nixon told plaintiff that other people going through things like this would have trouble sleeping and would feel anxious. “Therapist suggested that it may not be that his medications are not working but that his current level of stress is over loading the medications a bit and that he needs to be taking other actions to deal with his stress.” Plaintiffs GAF was 48-50. He was told to return in two to five weeks.

On October 11, 2007, plaintiff saw Dr. Bhargava (Tr. at 304-305). “Mr. Marques states he has been doing all right. His girlfriend indicates he has been irritable at times. He does not like taking his medication. He tells me he does not feel like he needs to take the Trazodone on days when he is tired. He does a lot of the cooking and cleaning at the home. His girlfriend is currently dealing with severe back pain.” Dr. Bhargava observed that plaintiffs mood was fair, his affect was reactive and appropriate, thought process was coherent. “He does have some degree of impulsivity and tends to butt in on his girlfriend’s conversation.” The assessment is listed' as, “Doing fairly [sic]. GAF 60.”

On October 25, 2007, plaintiff had a psychological assessment done by Stacy Bray, Psy.D., at the request of Dr. Bhargava (Tr. at 298-301). Dr. Bray administered the Wechsler Adult Intelligent Scale 3rd and a Neurobehavioral Cognitive Status Examination (“cognistat”).

Mr. Marques worked in corrections for 20 years being promoted to the rank of Sergeant. He reported no particular problems during employment until he left. He reported he went through a difficult divorce, developed a mood disorder and was no longer able to work. He reported emotional difficulties since that time. He now collects and occasionally sells cars. He receives disability.

He reported no abuse or dependence to alcohol or drugs. His chart indicates a pattern of binge drinking.

He is currently living with his wife whom he relies on to help with his memory, concentration, and daily functioning.

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BEHAVIORAL OBSERVATIONS

Mr. Marques was alert and oriented to everything except time. During the interview, he was highly distractible and had difficulty maintaining the focus of the interview easily drifting off to unrelated topics. During the interview, he required a lot of redirection.... He was cooperative with the testing process and required less direction to remain on task than in the interview.... His mood was good.... Multiple times he became tearful and his voice tone expressed emotion. This happened both with interviewing him and when performing tasks. He lacked frustration tolerance. He talked himself through many of the performance tasks often criticizing his own performance. On the performance subtests, he often evidenced no problems with the tasks until the tasks became more complex either with color or design. When this happened, he seemed overwhelmed with the tasks and evidenced immediate difficulty with completion of the task. At one point, when overwhelmed, he asked for a bathroom break. He was encouraged to complete the task, and did so, before taking a break. Although, he voiced self-criticism, when asked his perception of his performance, he responded he thought he performed “probably not too bad.” RESULTS

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Full Scale IQ = 74 with a 95% confidence level that his true IQ falls within the range of 70-79.

Verbal = 72; Performance IQ = 79 This places Mr. Marques in the borderline range of intellectual functioning between low average and mild mental retardation.

Relative strengths are determined from comparing the individual’s performance within itself rather than to a normative population. He evidenced relative strengths in common sense and visual reasoningddsual problem-solving. He performed significantly] better in these areas than others assessed.

Cognistat

Mr. Marquesas] performance on the cognistat indieate[s] average performance in the cognitive areas of language including comprehending language, expressing language, and naming; construction ability; calculations; and reasoning including abstract thinking and judgment.

His performance in attention and memory were quite different. He performed in the moderate to severe range of impairment for attention and the severe range of impairment for memory.

As with the first test, he became overwhelmed when the tasks became more complex and was not able to complete the task