Opinion ID: 2831704
Heading Depth: 3
Heading Rank: 1

Heading: Physical Impairments and Assessments

Text: Perez, a resident of Miami-Dade County, Florida, entered the emergency room at Kendall Regional Medical Center on November 23, 2009, with complaints of nausea, vomiting, and dizziness. A magnetic resonance imaging scan of her brain showed she had suffered a stroke. She also had high-blood pressure. When she was discharged on November 26, 2009, Perez was diagnosed with a stroke, hypertensive crisis, and high cholesterol. On March 2, 2010, Perez returned to the emergency room at Kendall Regional after a doctor’s appointment in which she was found to have elevated 2 Case: 14-14671 Date Filed: 08/27/2015 Page: 3 of 32 blood pressure. She also reported anxiety and panic attacks. Her consultation report stated she had malignant hypertension and a history of cerebrovascular accident. On March 11, 2010, Perez saw Dr. Basilio Garcia-Sellek and complained of constipation and fatigue from her blood-pressure medication. Dr. Garcia-Sellek diagnosed her with hypertension, status post-stroke, and referred her to a cardiologist. Perez saw Dr. Rene Hasbun on January 5, February 17, and May 11, 2012, for abdominal pain, nausea, melena (black or tarry stool), heartburn, and difficulty walking. In January and February, Dr. Hasbun reported Perez had a diminished range of motion, but she had exhibited a full range of motion in May. Dr. Hasbun diagnosed Perez with abdominal pain, gastro-esophageal reflux disease, and hypertension. Dr. Hasbun further concluded Perez had a malignancy of multiple myelomas (cancer of plasma cells) and recommended she see an oncologist. On May 10, 2012, Dr. Hasbun completed a Medical Assessment of Ability to do Work-Related Activities (Physical). He opined Perez had generalized pain from multiple myelomas and was unable to lift or carry 10 pounds. Dr. Hasbun concluded Perez was able to (1) sit, stand, or walk for one hour in an eight-hour workday, but not without interruption; (2) occasionally use her hands for simple grasping and fine manipulation; (3) occasionally use her right foot; and (4) frequently use her left foot. According to Dr. Hasbun, Perez could (1) never 3 Case: 14-14671 Date Filed: 08/27/2015 Page: 4 of 32 climb, balance, stoop, crouch, kneel, crawl, or push and pull; (2) occasionally reach or handle; (3) frequently feel; and (4) continuously hear or speak. Dr. Hasbun noted Perez would be environmentally restricted in all areas, because of an unsteady gait and impaired balance. The treatment notes of Dr. Fernando Mendez-Villamil, Perez’s psychiatrist, provided a description of Perez’s psychological symptoms. According to a June 2002 initial Psychiatric Evaluation Form, Perez reported hearing voices and was noted as having paranoid delusions and poor social functioning. Dr. MendezVillamil found Perez was calm and cooperative, had good eye contact, and had a coherent and relevant thought process. He diagnosed Perez with major depressive disorder, which was recurrent and severe with psychotic features. Dr. Mendez-Villamil saw Perez several times between February 11, 2010, and May 1, 2012. In most visits, Dr. Mendez-Villamil noted Perez had a disheveled appearance, retarded psychomotor activity, fair eye contact, a depressed and anxious mood, blunt affect, alert demeanor, poor immediate and recent memory, impaired concentration, thought blocking, and impoverished thought process, but no suicidal or homicidal thoughts or delusions. Additionally, Dr. Mendez-Villamil noted in approximately half the visits Perez reported auditory hallucinations. Perez frequently reported during her visits with Dr. MendezVillamil she was depressed; she experienced poor sleep, decreased energy, and 4 Case: 14-14671 Date Filed: 08/27/2015 Page: 5 of 32 motivation; and she was not stable on medications. Dr. Mendez-Villamil repeatedly diagnosed Perez with major depressive disorder, which was recurrent and severe with psychotic features. On July 29, 2011, Dr. Mendez-Villamil completed a Medical Assessment of Ability to do Work-Related Activities (Mental) and found Perez had no useful ability to follow work rules; relate to coworkers; deal with the public or with work stress; maintain attention or concentration; understand, remember, and carry out complex or detailed job instructions; maintain her personal appearance; behave in an emotionally stable manner; relate predictably in social situations; or demonstrate reliability. Dr. Mendez-Villamil determined Perez had a poor ability to interact with supervisors; function independently; and understand, remember, and perform simple job instructions. Dr. Mendez-Villamil opined Perez’s illness had affected her concentration and attention span. She had “no ability to deal with [the] public because of her instability.” R. at 370. Dr. Mendez-Villamil further stated Perez’s illness had affected her “capacity to remember even simple job instructions,” and her social skills in that “she doesn’t shower, and gets irritable.” R. at 371. Dr. Mendez-Villamil concluded Perez was “[u]nable to work at all due to the severity of her illness, poor concentration, [and] poor energy.” R. at 371. On May 7, 2012, Dr. Mendez-Villamil completed a second Medical Assessment of Ability to do Work-Related Activities (Mental) and found Perez had 5 Case: 14-14671 Date Filed: 08/27/2015 Page: 6 of 32 a poor ability to follow work rules; relate to coworkers; deal with the public and work stress; interact with supervisors; maintain attention or concentration; understand, remember, and carry out complex, detailed, or simple job instructions; maintain her personal appearance; behave in an emotionally stable manner; relate predictably in social situations; and demonstrate reliability. Dr. Mendez-Villamil opined Perez’s illness had “affected her concentration and social skills,” and she had “lost all ability to deal with any stressors.” R. at 386. Dr. Mendez-Villamil further opined Perez’s illness had affected her energy, concentration, emotional stability, and reliability. Dr. Mendez-Villamil determined Perez was unable to manage benefits in her own best interest and unable to work, because of her poor concentration, energy level, and decreased ability to deal with stressors.