Opinion ID: 2831704
Heading Depth: 3
Heading Rank: 2

Heading: Consultative Reports and Medical Opinions

Text: On October 9, 2010, consulting psychologist, Dr. Mayra Miro, examined Perez and performed a General Clinical Evaluation with Mental Status Functioning. Dr. Miro observed Perez (1) maintained good eye contact, (2) was well groomed and appropriately dressed, (3) ambulated without gait disturbance or apparent difficulty, (4) had clear and understandable speech, and (5) had an open and straightforward self demeanor but seemed somewhat anxious. Perez reported being completely independent in her self-care, including grooming, dressing, bathing, and eating. She reported, however, loss of desire for social activities. 6 Case: 14-14671 Date Filed: 08/27/2015 Page: 7 of 32 Testing results showed Perez had “consistent difficulties in concentration tasks,” but her persistence was adequate. R. at 313. Dr. Miro also noted Perez’s thought process was coherent, goal oriented, and organized. Dr. Miro further found Perez “showed clinical symptoms of depression that seemed situational and associated to her difficulties in coping with changes in physical functioning.” R. at 313. Dr. Miro opined Perez was “likely to experience limitations in carrying out complex instructions and achieving satisfactory work performance,” but her “overall results suggested that [she] ha[d] a good potential for a return-to-work in a suitable type of occupation with appropriate supportive interventions and treatment follow-up.” R. at 313. Although Dr. Miro stated Perez appeared to be competent to manage her funds, Dr. Miro also recommended she be supervised in her financial management, given her difficulties in attention and concentration. In an October 26, 2010, Report of Contact, agency reviewer, Sandra Forbes, reported having a telephone conversation with Perez. In that conversation, Perez reported being completely independent in grooming, dressing, bathing, and eating. Perez cooked dinner for her family most days and drove her ten-year-old daughter to and from school. She oversaw her daughter’s homework to ensure her daughter completed it but was limited, because of her difficulties with English. On November 8, 2010, agency medical consultant, Dr. Catherine Nunez, completed a Mental Residual Functional Capacity (“RFC”) Assessment and a 7 Case: 14-14671 Date Filed: 08/27/2015 Page: 8 of 32 Psychiatric Review Technique. Dr. Nunez opined Perez was moderately limited in her abilities to (1) understand and remember detailed instructions, (2) carry out detailed instructions, and (3) maintain attention and concentration for extended periods. Dr. Nunez found Perez not to be significantly limited in any other areas. She further opined Perez could follow instructions and persist on simple tasks on a regular basis, but she had some limitations associated with both mental and physical impairments affecting her motivation and desire to complete tasks. Dr. Nunez determined Perez was “socially appropriate and capable of adequate communication with others,” but she was best suited to a setting with low social demand. R. at 326. Dr. Nunez found Perez “would be able to adapt to the environmental demands of a work-like setting,” and her overall functioning was not significantly restricted. R. at 326. On February 1, 2011, state agency consultant, Dr. Hector Meruelo, performed a physical examination and noted Perez reported she had had four strokes, suffered from high-blood pressure, and had a heart murmur. Perez also reported she could bathe, dress, write, eat using a knife and fork, open door knobs and jar lids, and button blouses. Dr. Meruelo determined Perez had no impairment to dexterity, and her gait was normal. Perez could (1) get in and out of a chair and on and off the examining table by herself without difficulty and (2) walk on heels and toes. 8 Case: 14-14671 Date Filed: 08/27/2015 Page: 9 of 32 Dr. Meruelo found no edema, cyanosis, trophic changes, varicose veins, or venous insufficiency in Perez’s lower extremities. Perez’s joints were all normal; there was no evidence of inflammatory or deforming arthritis or arthropathy, motor or sensory deficits, or pathological reflexes. According to Dr. Meruelo, Perez’s strength was: arms “5/5”; lower right extremity “4+/5”; and lower left extremity “1+/5.” R. at 346. Dr. Meruelo opined: “There could be considerably very mild weakness of the right lower extremity but [this] is not a striking finding.” R. at 346. Dr. Meruelo determined Perez’s hypertension was well controlled, and she had no other hypertensive complications after her stroke a year prior to the examination. Although Perez complained of some heaviness in her right lower extremity, Dr. Meruelo found “no specific detectable neurological impairment.” R. at 346. On February 14, 2011, state agency reviewer, Marta Sanchez, completed a Physical RFC Assessment. Sanchez opined Perez (1) occasionally could lift or carry up to 20 pounds, (2) frequently could lift or carry up to 10 pounds, (3) could stand, walk, or sit approximately 6 hours in an 8-hour workday, and (4) had an unlimited ability to push and pull. Sanchez determined Perez had no postural, manipulative, visual, communicative, or environmental limitations. Sanchez referenced previous findings Perez did not limp and could walk on her heels and 9 Case: 14-14671 Date Filed: 08/27/2015 Page: 10 of 32 toes. She also noted Dr. Meruelo’s findings that Perez exhibited arm strength of 5/5 and any weakness in her right lower extremity was not striking.