Providence County Superior Court PC 13-5928
For Plaintiff: Gretchen M. Bath, Esq.
For Defendant: Gail A. Theriault, Esq.
Before this Court is an appeal from a decision of the Rhode Island Department of Human Services (DHS), denying Medical Assistance (MA) disability benefits to Appellant William Gelinas (Appellant). Jurisdiction is pursuant to G.L. 1956 § 42-35-15.
Facts and Travel
On May 23, 2013, Appellant submitted an Application for Medical Assistance (Application) to DHS (DHS R. Ex. 4, AP-65, July 19, 2013). The Appellant, who is fifty-two years old, possesses a GED and was a foundry worker for approximately twenty years. (DHS R. Ex. 6, AP-70, May 23, 2013.) His medical records reveal that he has degenerative disc disease and moderate facet joint osteoarthritis at L5/S1. (DHS R. Ex. 9, X-Ray Report.) His medical records additionally reveal that Appellant has been diagnosed with a mood disorder with depressive features due to a general medical condition. (DHS R. Ex. 7, Thundermist Medical Records.)
The Medical Assistance Review Team (MART) reviewed Appellant's Application and issued its decision that he was not disabled on July 26, 2013. (DHS R. Ex. 3, MA Letter of Denial.) MART also notified Appellant of his right to appeal and his right to have legal counsel. Id On July 29, 2013, Appellant timely appealed and a duly noticed hearing was conducted on November 7, 2013. (DHS R. Ex. 2, Hearing Appointment Letter.) Hearing Officer Carol J. Ouellette (Hearing Officer) conducted the hearing.
At the hearing, Appellant appeared pro se, and he offered into evidence:
• Physician Report (Agency Form MA-63), dated May 27, 2013, and signed by Jennifer Hopgood, FNP (Family Nurse Practitioner) (DHS R. Ex. 5.)
• Physician Report (Agency Form MA-63), dated October 7, 2013, and signed by Eric Paesano, LICSW (Licensed Social Worker) on October 7, 2013 and by Sapna Chowdhry, M.D. on October 9, 2013 (DHS R. Ex.12.)
• Information for Determination of Disability (Agency Form AP-70), dated May 23, 2013, and signed by Appellant (DHS R. Ex. 6.)
• Medical records from Ms. Hopgood, Mr. Paesano, and Jennifer Breslaw, PMHNP (Psychiatric and Mental Health Nurse Practitioner) (DHS R. Ex. 7.)
• Rhode Island Medical Imaging X-Ray Report, dated April 1, 2013. (DHS R. Ex. 9.)
• Consultative examination by J. Scott Toder, M.D., dated April 8, 2013. (DHS R. Ex. 8.)
• Consultative examination by psychologist Wendy Schwartz, Ph.D. (DHS R. Ex. 10.)
The Appellant, pro se, testified at the hearing. Sandra Brohen, a social worker and member of the MART, testified on behalf of DHS.
The Report of Jennifer Hopgood, FNP
Ms. Hopgood became Appellant's primary care provider in April of 2013, and she diagnosed him with back pain and a mood disorder with depressive features due to his general medical condition. (DHS R. Ex. 7, Thundermist Medical Records.) Ms. Hopgood suggested that Appellant take Motrin for his back pain, but he told her he could not afford it. Id. The Appellant told Ms. Hopgood that he had been living day-to-day with the pain, but that it prevented him from being able to work and that his back pain worsened with bad weather. Id.
Ms. Hopgood reported that Appellant suffered from a musculoskeletal disorder and a mental disorder. (DHS R., Ex. 5, MA-63, May 27, 2013.) She stated that Appellant's back pain originated in 1997, and that an x-ray of his spine showed severe arthritis. Id. Apparently, however, an MRI could not be conducted due to the presence of metal shrapnel in Appellant's eyes. Id. Additionally, Ms. Hopgood noted that Appellant reported that his back pain was worsened as a result of sleeping on the floor of the shelter where he was staying. Id. Ms. Hopgood documented Appellant's mood disorder, and noted that she had referred him for behavioral health treatment. Id.
Ms. Hopgood reported that, on any given eight-hour workday, (1) Appellant was able to walk and stand for less than two hours; (2) that he could sit four out of eight hours; (3) that he could reach occasionally; (4) that he could bend occasionally; (5) that he was able to lift/carry up to five pounds; (6) that he could bend/stoop occasionally as needed; and (7) that he could push/pull occasionally. Id. With respect to Appellant's mental activities, Ms. Hopgood found that his ability to remember and carry out simple instructions was slightly limited, and that his ability to maintain attention and concentration in order to complete tasks in a timely manner was moderately limited. Id. She additionally reported that Appellant was moderately limited in his ability to (a) make simple work-related decisions; (b) to interact appropriately with co-workers and supervisors; (c) work at a consistent pace without extraordinary supervision; and (d) respond appropriately to changes in work routine or environment. Id.
The Report of Eric Paesano, LICSW
Mr. Paesano began treating Appellant in May of 2013 as part of his behavioral health follow-up. (DHS R. Ex. 7, Thundermist Medical Records.) Mr. Paesano found Appellant to be suffering from suicide ideation, but without a plan. Id. Later in the year, however, Appellant was no longer suffering from suicide ideation. Id. Mr. Paesano found that Appellant's speech was articulate, his memory was not impaired, his attention was focused, and his insight and judgment were good; however, his self-esteem was low. Id.
Mr. Paesano reported that Appellant suffered from a mood disorder with depressive features due to his general medical condition, including depression, sadness, hopelessness, insomnia, lack of interest. (DHS R. Ex. 12, MA-63, Oct. 9, 2013.) He also reported that Appellant suffered from body aches and pain. Id. Although Mr. Paesano did not complete the form section regarding physical activities, he did fill out the mental activities section. Id. There he reported Appellant to be moderately limited in his ability to remember and carry out simple instructions; maintain attention/concentration necessary to complete tasks in a timely manner; make simple work-related decisions; interact appropriately with co-workers and supervisors; and respond appropriately to changes in work routine or environment. Id. Mr. Paesano also reported that Appellant was only slightly limited in his ...