Based on a comprehensive review of the evidence, including Claimant's testimony, the expert medical and vocational opinions and depositions, the medical records, and the Stipulation for Compromise Settlement between Claimant and Employer, as well as based on my personal observations of Claimant at hearing, I find:
1) Claimant is a 55-year-old, currently unemployed individual, who last worked for Lighthouse for the Blind (Employer) running labeling and filling machines for aerosol cans, until he was fired for having a bad attitude in November 2003. Claimant testified that his current source of income is Social Security Disability benefits of $\ 1,006.00 per month.
2) Claimant graduated from high school in 1973, but he testified that his grades were average or below average. He testified that he was regularly bullied by a classmate throughout his school career and he was often more worried about what was going on with him, than he was about school itself. He tried to attend college for a semester, but the schooling did not work for him. Claimant has had no other formal education or training.
3) Claimant testified that he turned to alcohol and over-drinking, partly because of his problems at school and partly because his sister was always an "angel" and he was never very good. He testified that he received beatings from his father at a young age for not listening, and so as he got older, turned to drinking. However, Claimant testified that he has stopped drinking and has been sober for approximately nine years now.
4) Claimant testified that in addition to his prior low back problems, which will be discussed in more detail below, he had prior problems with his heart. He testified that he had a stent surgically implanted for heart problems sometime prior to 2001. He admitted that prior to November 19, 2003, he was having symptoms of shortness of breath and chest pain that caused him difficulties at work. He said that he was receiving breathing treatments before the accident to deal with his shortness of breath. When he would suffer from chest pains or shortness of breath at work, he would have to sit down, take a break and try to relax. Claimant admitted that prior to November 19, 2003, he was insulin-dependent for diabetes. He was taking a pill in the morning and insulin at night to try to control his diabetes. He said that he notices problems with the diabetes in that if he eats anything in the morning with any amount of sugar in it, then he has to lie down because he gets immediately tired, and he has also passed out in his backyard from his sugar being too high. He also admitted that he has problems with his eyes, in that sometimes he can see fine, and other times things are fuzzy. Claimant testified that he also received treatment and medications for bipolar disorder prior to the work injury in 2003. Despite taking the medications, Claimant testified that he gets very frustrated and aggravated very easily. He believed the medications help, but do not control it totally.
5) Claimant testified that his work history shows he has had many different jobs that normally ended with his being fired. He said that he felt everyone had a problem with him, and when he felt that way, he would "get that bipolar coming out of me and I just want to argue..." He admitted that he has problems getting along with people and he especially does not like it when authority figures get demanding with him. He admitted also that his bipolar disorder was affected (worsened) by his parents' passing in 2001. He said that his mother used to do everything for him, and since she died he feels lost and that he cannot handle all of this himself. His medications had to be increased and he missed three to four weeks of work following her death. I observed Claimant break down in tears when discussing his mother's death and the effect it had on him.
6) In terms of other pre-existing injuries, Claimant testified that he had problems with his right hand. He said that he fell and crushed the ulnar nerve, and went through two surgeries, but he refused to have a third. He noted that his two fingers are crooked because of the injury and surgeries and he does not have the grip or hand coordination that he once had.
7) Medical treatment records from Dr. Somkietr Rojanasathit (Exhibit F) document treatment Claimant had with that physician beginning on February 19, 2003 and continuing after his work injury, until February 7, 2005. Throughout those records, there are office notes and laboratory tests showing that Claimant's diabetes was out of control at various points, both before and after the work injury that is the subject of this case. Additionally, those same notes and test reports show that his triglycerides were often extremely high. For instance, on February 19, 2003, the doctor reported that Claimant had uncontrolled diabetes because test results showed his glucose at 159 and his triglycerides at 216. Later on April 19, 2004, after the work injury of November 19, 2003, Claimant's glucose level was 146 and his triglycerides level was even higher than before at 564. Then, on December 6, 2004, his test results again seemed to worsen with a glucose level at 325 and a triglycerides level at 794.
8) Additionally, in these records from Dr. Somkietr Rojanasathit (Exhibit F) was an X-ray report from Christian Hospital (Exhibit F) for lumbar spine X-rays taken on May 30, 2003, which showed relatively marked degenerative changes in the lumbar spine with the most severe degenerative disc disease at the L5-S1 interspace. Then, there was the report from The Imaging Center (Exhibit F) dated June 13, 2003 for a lumbar spine MRI. The MRI revealed diffuse disc bulging and facet hypertrophy producing central and lateral stenosis most marked at L2-3, L3-4 and L4-5, as well as a focal disc herniation centrally at L5-S1, with extension of the disc material more prominently on the left side at this level.
9) Claimant was employed by Employer from April 2003 until November 2003 running machines for labeling and filling aerosol cans. He explained that his job entailed setting up the machines and then pushing a button to start the run. Claimant testified that he thought he was being hired as a supervisor for Employer, but then they brought in someone else to be the supervisor and he was left to just running the machines. He noted that he "butted heads a lot" with Employer over this dispute concerning whether
he was supposed to be a supervisor or not. Claimant admitted that he was repeatedly disciplined by Employer for attitude problems and for not being able to get along with others, particularly his bosses. He was working full-time for Employer, eight hours per day, leading up to the time of his November 19, 2003 fall. Claimant testified that he earned approximately $\ 450.00 per week while working for Employer.
10) Claimant testified that on November 19, 2003, he was working for Employer in his usual job, when he fell over a pallet of cans onto his back. He testified that he reported the injury right away and they took him to the hospital, where he had an MRI taken of his low back. He began a course of treatment for his low back that included injections from Dr. Graham and eventually surgery on his low back performed by Dr. Wagner.
11) Claimant testified on direct examination that after his injury at work on November 19, 2003, he "had a lot of lower pain in my back. It was going down my right leg and my left leg." He admitted that he had had problems with his low back for many years leading up to the time of his November 19, 2003 injury, and that he had had an MRI taken of his low back four or five months prior to his injury because of "pain in my back and everything." He even admitted at trial that he had pain into his legs before the work injury, but it got more severe after the work injury. He testified that before his work injury, his low back caused problems at work with bending over and doing things, but after his injury and the surgery, which he believed made his condition worse, he now has problems performing any physical activities, including sitting, standing or even moving around. He said that he does not drive anymore, and he had a friend bring him to court for this hearing. He admitted that he was even having trouble before his work injury with the light lifting and bending required in his job for Employer. He admitted that he missed work prior to November 19, 2003 because of low back problems.
12) Medical treatment records from Christian Hospital Northeast/Northwest (Exhibit B) document Claimant's initial treatment following this injury on November 19, 2003. He was initially seen in the emergency room and then admitted to the hospital for treatment from November 19, 2003 through November 21, 2003. The records contain a consistent history of falling backwards over some cans onto a pallet at work and injuring his low back. He also struck his mid-back and head and was complaining of headache-type pain. The notes indicate a history of diabetes mellitus under good control, arteriosclerotic heart disease status post coronary artery stent placement, manic depressive illness and chronic obstructive pulmonary disease. In these records, Claimant specifically denies any radiation of pain, numbness, tingling or muscle weakness into the buttocks or lower extremities. An MRI of the lumbar spine taken on November 20, 2003, showed evidence of congenital short pedicle spinal stenosis throughout the lumbar spine, with broad-based, diffuse disc bulging at multiple levels, including L1-2, L2-3, L3-4, L4-5 and L5-S1, and a central disc prominence (potential central disc herniation) at L5-S1. Claimant was discharged on pain medications, given a follow-up appointment with the doctor and kept off work until December 1, 2003.
13) Claimant was next examined by the doctors at Concentra Medical Centers (Exhibit B) at the request of Employer on November 26, 2003. Claimant again provided a consistent history of injuring his low back when a can rolled off a pallet under his feet and he fell backwards over the pallet. He reported back pain but no radicular symptoms. He was diagnosed with a lumbar strain, spinal stenosis and a possible central disc herniation at L5-S1. Although Employer raised some issues with regard to whether this was a work-related event or not, when Dr. Catanzaro saw Claimant on December 3, 2003, he apparently believed that it was a compensable work injury, because he referred Claimant to an orthopedic surgeon for consultation on the MRI findings, and continued his same medications and modified activity restrictions.
14) As a result of the referral from Concentra, Claimant came under the care of Dr. John Wagner (Exhibit B) for his low back injury on December 16, 2003. Claimant again provided a consistent history of the injury at work, and also mentioned a prior history of low back problems from working with concrete when he was 20 years old, but he denied any other pre-existing low back problems leading up to this accident at work. He did not report to Dr. Wagner that he had X-rays and an MRI of the low back taken only approximately six months prior to this examination, and prior to his work injury. He complained of back pain to Dr. Wagner, but no radicular symptoms in his legs. Dr. Wagner noted that the MRI showed a herniated disc at L5-S1 on the right, as well as marked degenerative disc disease throughout the lumbar spine. Dr. Wagner found that Claimant had severe osteoarthritis at a very young age, and also had some residual complaints from his fall at work. He recommended physical therapy, medication, light duty work and re-evaluation in four weeks. The notes indicate the physical therapy aggravated Claimant's low back complaints.
15) Dr. Wagner recommended epidural steroid injections for Claimant's continuing back complaints, which were administered by Dr. John Graham (Exhibit B), and seemed to provide some relief of his pain. Dr. Graham's report dated February 4, 2004 is the first indication I can find in the medical treatment records where Claimant complained of any pain in his legs, following his accident at work. Continued physical therapy also seemed to be providing improvement in his functioning and decreasing his complaints. However, in early April 2004, Claimant was performing vigorous exercises with both lower extremities, when he noticed a gradual increase in right lower extremity pain from the lateral thigh to the lateral calf that resulted in an emergency room visit to Christian Hospital on April 17, 2004. By April 22, 2004, Dr. Wagner found that Claimant had a limp on the right side with obvious discomfort on weight bearing. He ordered an EMG/nerve conduction study that was performed by Dr. Ravi Yadava (Exhibit B) on April 27, 2004. It showed findings compatible with a right-sided lumbar radiculitis affecting the L5 and S1 myotomes. When Claimant returned to see Dr. Wagner on April 29, 2004, Dr. Wagner indicated a new MRI showed no change in the herniated disc found on the prior MRI, but the EMG showed nerve root involvement that corresponded to the L5-S1 disc herniation. He discussed surgical treatment options with Claimant, but noted the increased risks associated with his diabetes and weight. Dr. Wagner indicated that unless something dramatic occurred, with Claimant's back problems and the herniated disc, he did not think there was much of a chance of Claimant returning to a lifting occupation. By May 6, 2004,
Dr. Wagner notes that he again discussed surgery with Claimant, and surgery for excision of the herniated disc was to be scheduled at Claimant's convenience.
16) Dr. John Wagner took Claimant to surgery at Missouri Baptist Medical Center (Exhibit B) on June 1, 2004 and performed an excision of the herniated disc at L5-S1 on the right.
17) As Claimant continued to follow up with Dr. Wagner after his surgery, he initially reported some improvement in his back symptoms, but he still reported some back pain and posterior knee pain. Dr. Wagner thought the residual symptoms were due to the degenerative disc disease since he found no continued radicular signs. Claimant was sent for physical therapy, but in Dr. Wagner's notes, he comments that Claimant does not seem to be progressing in therapy at all. He encourages Claimant to get out of the house, be active, walk and go to therapy, but he questions, based on the lack of progress, if Claimant is actually performing any of the home exercises he is supposed to be doing. Claimant had a Functional Capacity Evaluation performed at PRORehab (Exhibit B) on December 7, 2004. The report indicates that Claimant was employable on a full-time basis in the heavy work demand level. It also noted that he failed 6 out of 11 of the validity criteria, raising questions about possible symptom magnification and not giving maximal effort in the test.
18) When Claimant saw Dr. Wagner on December 14, 2004, Dr. Wagner reviewed the results of the Functional Capacity Evaluation with him. He opined that because of the degenerative joint disease that pre-existed Claimant's injury, he thought it would be more appropriate to place Claimant at the medium demand duty level with a lifting restriction of 35 pounds on a regular basis and 50 pounds occasionally. Dr. Wagner discharged Claimant from care at that point. He opined that Claimant had 17.5\% permanent partial disability of the lumbar spine, of which 7.5 % was due to his preexisting degenerative disease and 10 % was due to his herniated disc.
19) On May 19, 2006, Dr. John Wagner (Exhibit B) wrote another letter to Employer's attorney after he reviewed some additional pre-existing medical records, showing an emergency room visit for back pain five months before his injury and an MRI of the lumbar spine from June 12, 2003 that also showed a focal disc herniation centrally at L5-S1. Claimant had apparently not reported these prior problems and the prior MRI to Dr. Wagner. Based on this new information, Dr. Wagner concluded that the disc protrusion at L5-S1 existed prior to the November 19, 2003 accident. He opined that the radiologists who read the individual MRI's were basically expressing the same finding that he saw during his physical examination. He opined that the injury of November 19, 2003 resulted in a significant sprain to the back, with pre-existing degenerative disease, stenosis and a central disc at L5-S1. With this new information, he also amended his rating of disability. He still opined that Claimant had 17.5\% permanent partial disability of the lumbar spine overall, but he further opined that 12.5 % was pre-existing (related to the degenerative disease and herniated disc) and 5 % was related to the significant sprain of the back related to the November 19, 2003 injury.
20) Medical treatment records from Dr. Garry Vickar (Exhibit H) span the period of time of March 19, 2003 through April 2004. Although these appear to be psychiatric treatment records, since I believe there is a reference to a diagnosis of major depression on March 19, 2003, they are extremely difficult to decipher and it is not at all clear to me what exactly the doctor was recording in the majority of these notes.
21) Claimant and Employer entered into an agreement to resolve their portion of the November 19, 2003 claim (Injury No. 03-120199) by Stipulation for Compromise Settlement (Exhibit A) for $\ 21,039.20 or 17.5 % permanent partial disability of the body as a whole referable to the lumbar spine. According to the Stipulation, Employer paid medical benefits totaling $\ 36,140.23 and temporary total disability benefits of $\ 14,502.21, for a period of $482 / 7$ weeks. The Second Injury Fund portion of the case was left open on the Stipulation for Compromise Settlement. The Stipulation was approved by Administrative Law Judge John Percy on July 10, 2006.
22) The medical treatment records from Dr. Frank Calandrino (Exhibit G) span the period of time of November 14, 2002 through July 30, 2009. These records confirm that going back to November 14, 2002, Claimant was diagnosed with mild-tomoderate emphysema, and then in 2004 he was diagnosed with moderate COPD. He received numerous breathing tests, treatments and medications for his breathing condition throughout this period of time.
23) The deposition of Dr. Mark Lichtenfeld (Exhibit C) was taken by Claimant on June 26, 2009 to make his opinions in this case admissible at trial. Dr. Lichtenfeld is a board certified family physician and medical examiner. He examined Claimant on one occasion, September 14, 2006, at the request of Claimant's attorney, and he authored one report dated September 26, 2006. He took a history from Claimant, reviewed medical treatment records and performed a physical examination of Claimant. Dr. Lichtenfeld's report contains not only the history provided by Claimant, the results of the physical examination and a review of the medical treatment records, but also approximately a page-long diatribe on his views of functional capacity evaluations, the reasons he does not believe they are accurate or useful, and especially disparaging remarks about Mr. David Abkemeier, who performed the functional capacity evaluation in this case. Dr. Lichtenfeld opined that as a direct result of the injury on November 19, 2003, Claimant had the following diagnoses: Cervical spine strain, resolved; concussion; chronic lumbosacral spine strain; incitation, exacerbation and acceleration of pre-existing degenerative changes; left nerve root impingement at L5; status post inferior laminectomy at L5 and superior laminectomy at S1; status post L5-S1 discectomy; right L5 and S1 radiculopathy; and left L4 and L5 radiculopathy. He opined that while Claimant had similar findings on the MRI scan in June 2003, Claimant was asymptomatic with respect to nerve root encroachment and the herniated disc before November 2003, so that is why he believes these diagnoses are the direct result of the workplace injury in November 2003. He opined that the work injury was responsible for causing the radicular complaints from the herniated disc that, in turn, necessitated the low back surgery. Although his report contained no specific opinion on an amount of permanent partial disability referable to the November 2003 injury, in his deposition, Dr. Lichtenfeld
testified that Claimant had 37.5 % permanent partial disability of the body as a whole referable to the November 19, 2003 injury. Although his report, again, contained no rating of disability for the pre-existing low back condition, he also rated Claimant as having 25 % permanent partial disability of the body as a whole referable to the low back regarding his pre-existing degenerative changes and the herniated disc at L5-S1. However, later in the deposition, Dr. Lichtenfeld testified that Claimant had 20\% permanent partial disability of the low back, pre-existing the November 2003 injury. Since there was no rating in that respect contained in the report, it is impossible to tell which one of these was the error.
24) Dr. Lichtenfeld continued in his report and testimony to also diagnose and rate Claimant's alleged pre-existing conditions and disabilities. Dr. Lichtenfeld diagnosed and rated the followed pre-existing conditions, all of which he believed were hindrances or obstacles to Claimant obtaining employment or re-employment:
15\% of the body as a whole for tinnitus (ringing in the ears);
An unquantified percentage for hearing loss;
An unquantified percentage for bipolar affective disorder;
20 % of the body as a whole for peptic ulcer disease and a hiatal hernia;
60 % of the right fourth MCP joint;
50 % of the right fifth MCP joint;
A 15 % loading factor for the combination of the MCP joint disabilities;
20 % of the right wrist for contracture of the fourth and fifth fingers;
27.5 % of the right elbow for right cubital tunnel syndrome;
35 % of the right elbow for a right elbow fracture;
30 % of the body as a whole for hypertension ( 35 % in his testimony);
35 % of the body as a whole for COPD;
40 % of the body as a whole for diabetes; and
32.5 % of the body as a whole for coronary artery disease.
Dr. Lichtenfeld opined that these disabilities combine with each other and the disability from the November 19, 2003 injury to generate an overall disability greater than the simple sum of the disabilities when added together. He finally opined that when considering Claimant's educational background and vocational history, as well as the primary and pre-existing disabilities, Claimant is totally and permanently disabled and unable to compete in the open labor market. He admitted, though, that he was not a vocational expert and would defer to a vocational expert if one could find a job for Claimant within the restrictions he imposed on Claimant.
25) The deposition of Dr. Jay Liss (Exhibit D) was taken by Claimant on July 17, 2009 to make his opinions in this case admissible at trial. Dr. Liss is board certified in psychiatry and neurology. He examined Claimant on one occasion, November 15, 2007, at the request of Claimant's attorney, and issued his report with that same date. He provided no treatment to Claimant in this case. Dr. Liss testified that the psychiatric evaluation he conducted of Claimant consisted of a history evaluation, review of available medical records, providing the patient with self-reporting questionnaires, and a mental status examination. Dr. Liss diagnosed Claimant with bipolar disorder and chemical dependency to alcohol. Taking into account Claimant's work history and chronology, as well as the extent of his illness, Dr. Liss opined that
Claimant would have at least 40 % permanent partial disability of the body as a whole. He further opined that this disability pre-existed the November 2003 injury, since Claimant had been diagnosed and treated for this condition prior to that injury. He admitted that he had no medical treatment records to review regarding any prior treatment. Therefore, he had to rely on what the patient and his wife told him, as well as gleaning information from his other medical records. He testified that he agreed with Dr. Lichtenfeld's diagnosis of bipolar affective disorder, as well as his opinions on the combination of the disabilities and Claimant's being unemployable in the open labor market. Dr. Liss testified that Claimant had a GAF of less than 50, which means the psychiatric illness is severe.
26) On cross-examination, Dr. Liss was specifically questioned about some of the parts of his report dated November 15, 2007. In that report, Dr. Liss notes that the "purpose of this psychiatric evaluation is to document psychiatric illness prior to the accident for the Second Injury Fund." Dr. Liss admitted that the only medical record he reviewed that mentioned a psychiatric disease prior to the accident was Dr. Mark Lichtenfeld's report of September 26, 2006, prepared as a part of the workmen's compensation claim. Dr. Liss admitted that in formulating his opinions and conclusions in this case, he relied on what Claimant told him and the reference in Dr. Lichtenfeld's report. However, in his report (and confirmed in his testimony), Dr. Liss admitted that Claimant was not a reliable source of information, nor really was his wife, and Claimant even disagreed with Dr. Vickar's diagnosis of him. However, he believed Claimant had a list of complaints compatible with the diagnosis. Dr. Liss concluded his report by writing, "Mr. Jezich has a psychiatric diagnosis which was diagnosed and treated prior to his accident of 2003. He worked in mainly labor jobs. So it is very difficult to document the extent of disability of the person as a whole. Judging the affects of bi-polar illness on any patient it can be rated that he has a permanent/partial disability of 40 % caused by the bi-polar illness." Dr. Liss explained this conclusion and rating by testifying that although Claimant had a poor work history, considering his potential, background, opportunities and socioeconomic environment, he could have or should have done better. He further testified that the 40 % rating he assigned could at least be a base rating for any patient with a bipolar diagnosis.
27) The deposition of Mr. James England (Exhibit E) was taken by Claimant on July 29, 2009 to make his opinions in this case admissible at trial. Mr. England is a board certified vocational rehabilitation counselor. He met with and evaluated Claimant on one occasion, May 19, 2008, at the request of Claimant's attorney, and he authored one report with that same date. As a part of his evaluation, he interviewed Claimant, reviewed medical records and reports, and performed vocational testing. Relying on Claimant's history and the reports of Drs. Lichtenfeld and Liss, as well as the medical treatment records, Mr. England concluded that the combination of Claimant's various problems would negate his ability to compete for or sustain work activity in the open labor market. He testified that the combination of the physical problems alone would limit Claimant to less than a full range of sedentary employment, but then once the psychological problems were added in, the overall combination would render Claimant permanently and totally disabled.
28) On cross-examination, Mr. England agreed that Claimant's psychological problems and his GAF score of less than 50 from Dr. Liss, would prevent Claimant from handling sedentary-to-light types of employment, and, then, it would prevent him from handling medium-to-heavy types of employment as well. Therefore, Mr. England agreed on cross-examination, that with a GAF score of less than 50, Claimant's psychological problems alone would prevent him from being able to handle the whole spectrum of employment, from sedentary-to-heavy work. On redirect examination, Mr. England explained that since Claimant was functioning with the mental problems up until the point of the primary injury, he believed Claimant's mental functioning and emotional difficulties worsened after the primary injury and associated with it. He believed that was what Dr. Liss was suggesting in his report regarding causation.
29) At the request of the Attorney General's Office on behalf of the Second Injury Fund, Dr. Russell Cantrell (Exhibit SIF I) performed a records review and issued his report dated December 2, 2009. Dr. Cantrell is board certified in physical medicine and rehabilitation. Dr. Cantrell did not perform a physical examination of Claimant. He reviewed medical records including the pre-existing low back MRI from June 12, 2003 and the records for the treatment Claimant received following the November 19, 2003 injury at work. Dr. Cantrell focused on the similarities in the findings on the multiple MRIs and the fact that the medical records following the November 19, 2003 fall did not report an acute radiculopathy immediately after the fall, to support his ultimate opinion that Claimant's lumbar symptoms and need for surgery was related to the progression of his degenerative disc and joint disease, and not the fall at work on November 19, 2003. Upon comparing the various diagnostic imaging studies, he specifically found that there was no significant change between the MRIs from June 2003 and November 2003. He suggests that Claimant may have sustained a low back strain or contusion as a result of the fall. Dr. Cantrell notes that symptoms from degenerative osteoarthritis wax and wane in severity. He opines that the objective medical findings in the months following the alleged injury in November 2003 do not support the development of an acute radiculopathy. Other than opining that the complaints and need for surgery were not related to the November 2003 fall, Dr. Cantrell does not provide any further opinions on Claimant's permanent partial disability or ability to work.
30) Claimant described his daily routine at the current time. He said that he gets up in the morning and his friend will have coffee made for him. He sits on the couch and watches television. Then his friend will make something for them to eat. Depending on his blood sugar and what time it is, he will go back to bed, and then not get back up until three or four o'clock in the afternoon. He will get up, eat, go outside for a half an hour or so, sit around, come in and then go back to bed.
31) During the trial, I observed that Claimant was shifting around in the witness chair constantly. Within minutes of beginning, he was already standing up. I also observed that at times during his testimony, if he was challenged with questions, he became
loud and agitated, even admitting that his "bipolar is coming out" because he did not know where the questioning was leading.
32) On cross-examination, Claimant was completely inconsistent and contradictory with regard to when the pain and complaints started going down his legs. Although he earlier admitted that he had leg complaints before the November 19, 2003 accident, on cross-examination he testified that he had no complaints in the legs prior to November 19, 2003. Claimant, then, variously testified that the leg complaints started in December 2003, then not until immediately after the surgery by Dr. Wagner, then prior to the February 4, 2004 injection by Dr. Graham.
33) On cross-examination, Claimant was taken through his employment history and it seemed as though he regularly lost his job because of attitude problems and conflicts with co-workers or supervisors. Claimant admitted that even if he did not have any physical problems, and just had his attitude and bipolar disorder, he did not believe he would be able to work currently based on the affect of the bipolar disorder and his attitude problems alone. Claimant again admitted on redirect examination that considering just the bipolar disorder, he did not think he would be able to work at all. In response to questioning from his attorney, he admitted that his bipolar again worsened after December 2009 when his wife died, just as it worsened after his mother died.