United States District Court, D. Oregon
OPINION AND ORDER
HONORABLE PAUL PAPAK UNITED STATES MAGISTRATE JUDGE
Zak Borst ("Borst") filed this action January 29,
2016, seeking judicial review of the Commissioner of Social
Security's final decision denying his application for
disability insurance benefits ("DIB") and
Supplemental Security Income ("SSI") under Titles
II and XVI of the Social Security Act (the
"Act"). This court has jurisdiction over
Borst's action pursuant to 42 U.S.C. § 405(g) and
1383(c)(3). I have considered all of the patties' briefs
and all of the evidence in the administrative record. For the
reasons set forth below, the Commissioner's final
decision is REVERSED and REMANDED for the immediate payment
establish disability within the meaning of the Act, a
claimant must demonstrate an "inability to engage in any
substantial gainful activity by reason of any medically
determinable physical or mental impairment which can be
expected ... to last for a continuous period of not less than
12 months." 42 U.S.C. § 423(d)(1)(A). The
Commissioner has established a five-step sequential process
for determining whether a claimant has made the requisite
demonstration. See Bowen v. Yuckert, 482 U.S. 137,
140 (1987); see also 20 C.F.R. §§
404.1520(a)(4), 416.920(a)(4). At the first four steps of the
process, the burden of proof is on the claimant; only at the
fifth and final step does the burden of proof shift to the
Commissioner. See Tackett v. Apfel, 180 F.3d 1094,
1098 (9th Cir. 1999).
first step, the Administrative Law Judge ("ALJ")
considers the claimant's work activity, if any. See
Bowen, 482 U.S. at 140; see also 20 C.F.R.
§§ 404.1520(a)(4)(i), 416.920(a)(4)(i). If the ALJ
finds that the claimant is engaged in substantial gainful
activity, the claimant will be found not disabled. See
Bowen, 482 U.S. at 140; see also 20 C.F.R.
§§ 404.1520(a)(4)(i), 404.1520(b),
416.920(a)(4)(i), 416.920(b). Otherwise, the evaluation will
proceed to the second step.
second step, the ALJ considers the medical severity of the
claimant's impairments, See Bowen, 482 U.S. at
140-141; see also 20 C.F.R. §§
404.1520(a)(4)(h), 416.920(a)(4)(h). An impairment is
"severe" if it significantly limits the
claimant's ability to perform basic work activities and
is expected to persist for a period of twelve months or
longer. See Bowen, 482 U.S. at 141; see
also 20 C.F.R, §§ 404.1520(c), 416.920(c). The
ability to perform basic work activities is defined as
"the abilities and aptitudes necessaiy to do most
jobs." 20 C.F.R. §§ 404.1521(b), 416.921(b);
see also Bowen, 482 U.S. at 141. If the ALJ finds
that the claimant's impairments are not severe or do not
meet the duration requirement, the claimant will be found not
disabled. See Bowen, 482 U.S. at 141; see
also 20 C.F.R. §§ 404.1520(a)(4)(h),
404.1520(c), 416.920(a)(4)(h), 416.920(c). Nevertheless, it
is well established that "the step-two inquiry is a de
minimis screening device to dispose of groundless
claims." Smolen v. Chafer, 80 F.3d 1273, 1290
(9th Cir. 1996), citing Bowen, 482 U.S. at 153-154.
"An impairment or combination of impairments can be
found 'not severe' only if the evidence establishes a
slight abnormality that has 'no more than a minimal
effect on an individual[']s ability to work.'"
Id., quoting S.S.R. 85-28, 1985 SSR LEXIS 19 (1985).
claimant's impairments are severe, the evaluation will
proceed to the third step, at which the ALJ determines
whether the claimant's impairments meet or equal
"one of a number of listed impairments that the
[Commissioner] acknowledges are so severe as to preclude
substantial gainful activity." Bowen, 482 U.S.
at 141; see also 20 C.F.R. §§
404.1520(a)(4)(iii), 404.1520(d), 416.920(a)(4)(iii),
416.920(d). If the claimant's impairments are equivalent
to one of the impairments enumerated in 20 C.F.R. § 404,
subpt. P, app. 1, the claimant will conclusively be found
disabled. See Bowen, 482 U.S. at 141; see
also 20 C.F.R. §§
claimant's impairments are not equivalent to one of the
enumerated impairments, between the third and the fourth
steps the ALJ is required to assess the claimant's
residual functional capacity ("RFC"), based on all
the relevant medical and other evidence in the claimant's
case record. See 20 C.F.R. §§ 404.1520(e),
416.920(e). The RFC is an estimate of the claimant's
capacity to perform sustained, work-related physical and/or
mental activities on a regular and continuing basis,
despite the limitations imposed by the claimant's
impairments. See 20 C.F.R. §§ 404.1545(a),
416.945(a); see also S.S.R. No. 96-8p, 1996 SSR
LEXIS 5 (July 2, 1996).
fourth step of the evaluation process, the ALJ considers the
RFC in relation to the claimant's past relevant work.
See Bowen, 482 U.S. at 141; see also 20
C.F.R. §§ 404.1520(a)(4)(iv), 416.920(a)(4)(iv).
If, in light of the claimant's RFC, the ALJ determines
that the claimant can still perform his or her past relevant
work, the claimant will be found not disabled. See
Bowen, 482 U.S. at 141; see also 20 C.F.R.
§§ 404.1520(a)(4)(iv), 404.1520(f),
416.920(a)(4)(iv), 416.920(f). In the event the claimant is
no longer capable of performing his or her past relevant
work, the evaluation will proceed to the fifth and final
step, at which the burden of proof shifts, for the first
time, to the Commissioner.
fifth step of the evaluation process, the ALJ considers the
RFC in relation to the claimant's age, education, and
work experience to determine whether a person with those
characteristics and RFC could perform any jobs that exist in
significant numbers in the national economy. See
Bowen, 482 U.S. at 142; see also 20 C.F.R.
§§ 404.1520(a)(4)(v), 404.1520(g), 404.1560(c),
404.1566, 416.920(a)(4)(v), 416.920(g), 416.960(c), 416.966.
If the Commissioner meets her burden to demonstrate the
existence in significant numbers in the national economy of
jobs capable of being performed by a person with the RFC
assessed by the ALJ between the third and fourth steps of the
five-step process, the claimant is found not to be disabled.
See Bowen, 482 U.S. at 142; see also 20
C.F.R. §§ 404.1520(a)(4)(v), 404.1520(g),
404.1560(c), 404.1566, 416.920(a)(4)(v), 416.920(g),
416.960(c), 416.966. A claimant will be found entitled to
benefits if the Commissioner fails to meet that burden at the
fifth step. See Bowen, 482 U.S. at 142; see
also 20 C.F.R. §§ 404.l520(a)(4)(v),
404.1520(g), 416.920(a)(4)(v), 416.920(g).
reviewing court must affirm an Administrative Law Judge's
decision if the ALJ applied proper legal standards and his or
her findings are supported by substantial evidence in the
record. See 42 U.S.C. § 405(g); see also
Batson v. Comm 'r of Soc. Sec. Admin., 359 F.3d
1190, 1193 (9th Cir. 2004). '"Substantial
evidence' means more than a mere scintilla, but less than
a preponderance; it is such relevant evidence as a reasonable
person might accept as adequate to support a
conclusion." Lingenfelter v. Astrue, 504 F.3d
1028, 1035 (9th Cir. 2007), citing Robbins v. Soc. Sec.
Admin., 466 F.3d 880, 882 (9th Cir. 2006).
court must review the record as a whole, "weighing both
the evidence that supports and the evidence that detracts
from the Commissioner's conclusion." Id.,
quoting Reddick v. Chafer, 157 F.3d 715, 720 (9th Cir.
1998). The court may not substitute its judgment for that of
the Commissioner. See id., citing Robbins, 466 F.3d
at 882; see also Edlimdv. Massanari, 253 F.3d 1152,
1156 (9th Cir. 2001). Moreover, the court may not rely upon
its own independent findings of fact in determining whether
the ALJ's findings are supported by substantial evidence
of record. See Connettv. Barnhart, 340 F.3d 871, 874
(9th Cir. 2003), citing SEC v. Chenery Corp., 332
U.S, 194, 196 (1947). If the ALJ's interpretation of the
evidence is rational, it is immaterial that the evidence may
be "susceptible to more than one rational
interpretation." Magallanes v. Bowen, 881 F.2d
747, 750 (9th Cir. 1989), citing Gallant v. Heckler,
753 F.2d 1450, 1453 (9th Cir. 1984).
OF ADMINISTRATIVE RECORD
was born on January 3, 1982. Tr. 114, 127, 144, 339, 341,
He graduated college, serves in the National Guard, and
speaks English. Tr. 94, 106-07, 155, 165, 167, 170, 427, 429.
According to the evidence of record, prior to his disability
onset date of January 23, 2014, Borst worked as an attendant
at a children's institution, volunteer information clerk,
clinical counselor, body guard, artillery or naval gun fire
observer, and sales clerk. Tr. 93-94, 105-06, 108.
earliest medical evidence in the administrative record is
from April 16, 2012, when Borst received treatment from
Michael Drager, D.P.M., for discomfort in both of his feet.
Tr. 602. Borst reported that his feet become more
uncomfortable with increased activity, and had he tried
different shoes and insoles without success, Id.
Upon examination, Dr. Drager found no swelling or
discoloration, and noted that Borst's feet were warm to
the touch, that his light touch and gross sensation were
normal, and he had a "relatively stable gait with only
mild pronation and not medical column collapse."
Id. Dr. Drager diagnosed mechanical foot pain with
intrinsic tendonitis, placed Borst in orthotics, and
prescribed the use of Ibuprofen twice a day with icing and
14, 2012, Borst had a follow-up appointment with Dr. Drager
where he reported wearing the orthotics "most all of the
time, " and only noticing pain when he runs. Tr. 603.
Dr. Drager found Borst's "neurovascular status is
grossly intact, " and there was "no edema,
erythema, or discoloration, " and "no discomfort in
the interspaces with palpation and compression, " or
discomfort around the tarsal tunnel area. Id. He
scheduled a follow-up appointment for Borst for the next week
to consider an injection for Borst's foot pain.
21, 2012, Borst returned for his one-week follow-up
appointment with Dr. Drager where Dr, Drager noted mild foot
discomfort in Borst's "area of the 3rd interspace
near the metatarsal heads and into the adjacent aspects of
the toes." Tr. 603. Dr. Drager injected Borst with
Kenalog and Marcaine and in a separate note from that same
day wrote that Borst "must run at own pace to tolerance
until issues are resolved." Tr. 601, 734.
4, 2012, Borst failed to show up for his scheduled
appointment with Dr. Drager, but was seen on June 18, 2012.
Tr. 603, 604. On June 18, Dr. Drager found "no real
change" since his last appointment, but noted that Borst
complained of "general weakness and muscle pain, "
explaining that sometimes he cannot get out of bed, move, and
has a hard time lifting his arms above his shoulders. Tr.
604. Borst also reported having "some strange sensations
in his legs and feet, " and that he "is very tired
and can sleep 14 plus hours per day." Id. Upon
examination, Dr. Drager found Borst's sensation was
intact, there was no edema, erythema, or discoloration, and
his muscle strength was normal and symmetrical. Id.
16, 2012, Borst underwent a sleep study, and the following
day results were interpreted by Dr. David Ramey. Tr. 554,
716. Borst was found to suffer from "profound daytime
somnolence requiring multiple over-the-counter stimulant
medications, " and was diagnosed with "very mild
obstructive sleep apnea." Id.
December 1, 2012, an Officer Evaluation Report was completed
on Borst's behalf. Tr. 566-70, 710-13. The report
indicated that Borst was able to carry and fire his assigned
weapon, evade direct and indirect fire, ride in a military
vehicle for 12 hours in a day, wear a helmet and body armor
for at least 12 hours in a day, wear load bearing equipment
or military boots and uniform for 12 hours a day, and wear a
protective mask for at least 2 continuous hours in a day. Tr.
569, 712, He was unable to move 40ibs while wearing
protective gear, or live in an austere environment without
worsening his medical condition. Id.
January 14, 2013, Borst had a follow-up appointment with Dr.
Ramey, where he noted that Borst had "a history of
hypersomnolence with a relatively unremarkable diagnostic
polysomnogram, " Tr. 615, 623. Dr. Ramey noted that
Borst was taking Adderall twice daily, which "has
resulted in dramatic improvement of his daytime symptoms,
" and he "is not having any problems tolerating
it." Id. Dr. Ramey also noted Borst's
history of "diffuse shooting pains in both his arms and
his legs" noting that Borst had an electromyography and
nerve conduction studies done, which returned normal results.
Id. Overall, Dr. Ramey found Borst was "doing
well on Adderall, " and planned to refer Borst to
rheumatology for his diffuse pain complaints. Tr. 616, 624.
March 5, 2013, Borst presented at Kootenai Rheumatology and
Internal Medicine to establish care and was seen by Dr.
Andrea Dinning. Tr. 661. Borst was noted to have narcolepsy,
chronic fatigue syndrome, and caipal tunnel and reported
taking Adderall and Provigil for his narcolepsy and chronic
fatigue syndrome, but reported Provigil caused stiffness in
his back. Id. Borst was also noted to suffer from
connective tissue disease, for which he received a steroid
shot, which "helped a lot." Id. Dr
.Dinning increased his Adderall dosage to treat his chronic
fatigue syndrome. Tr. 663.
October 24, 2013, Borst had a follow-up appointment with Dr.
Dinning to clarify his previous diagnosis of connective
tissue disorder. Tr. 656. Borst also complained of depression
and anxiety, and expressed interest in receiving prescription
medications for this. Id. Upon examination, he was
found positive for depression, anxiety, fatigue, back pain,
joint pain, and neck pain, and was started on Lexapro for his
depression, Tr. 657-58.
October 28, 2013, Borst had a appointment with Mr. Thomas
Byrne, PA-C, to establish care. Tr. 611-14. Borst complained
of pain and fatigue symptoms and reported that he experiences
pain daily, with occasional flares which he described as
feeling like "his joints are being pulled apart."
Tr. 611. Borst reported taking Prednisone for pain flare-ups
and Tramadol and Ibuprofen for daily pain management.
Id. Mr. Byrne diagnosed Borst with a sleep disorder
and chronic pain, which was described as "stable, "
and prescribed Mobic, Minocycline, Lexapro,
hydroxychloroquine, and Tramadol. Tr. 613.
November 26, 2013, Borst had an appointment with Dr.Dinning
to discuss his medications and disability paperwork where she
noted that Borst was taking Adderall for narcolepsy, Lexapro
for depression, and Plaquenil and Ultram for his connective
tissue disorder. Tr. 653. Dr. Dinning also noted that Borst
had recently seen a counselor who "thinks he has PTSD,
" Id. Dr. Dinning increased Borst's
Adderall, continued his Lexapro, Plaquenil and Ultram, and
encouraged him to see Dr. Dustin Dinning for an appointment
to discuss switching medication for his connective tissue
disorder after reporting that he was "not doing
well." Tr. 654.
December 16, 2013, Dustin Dinning, D.O., wrote a letter
noting that he had been treating Borst for chronic fatigue,
chronic pain, and fibromyalgia syndrome since February 28,
2013. Tr. 562, 735. Dr. Dinning noted that Borst's
fatigue and musculoskeletal pain persisted despite the use of
medications, and wrote he "foresee[s] these problems
being persistent and refractory to medical treatment."
Id. Overall, Dr. Dinning concluded that "[a]t
this time, due to the severity of his symptoms, I don't
think he can work any job." Tr. 735.
following day, on December 17, 2013, Dr. Dustin Dinning wrote
a letter noting that he would no longer serve as Borst's
physician due to "frequent no shows" for his
scheduled appointments. Tr. 563, 736.
January 7, 2014, Borst had a follow-up appointment with Dr.
Ramey for idiopathic hypersomnia. Tr. 556, 729. Dr, Ramey
noted that Adderall was "now having decreased
effectiveness, " so he switched Borst back to Provigil.
Tr. 558, 731. Dr. Ramey also noted that Borst was diagnosed
with fibromyalgia and placed on Gabapentin by the
rheumatology department, but was not tolerating the
prescription well due to increased somnolence. Tr. 556, 729.
Dr. Ramey suggested that Borst speak with Dr. Dustin Dinning
for an alternative medication for his fibromyalgia pain. Tr.
January 8, 2014, Dr. Ramey completed a Narcolepsy Disability
Benefits Questionnaire where he diagnosed Borst with
idiopathic hypersomnia. Tr. 751-63. Dr. Ramey wrote that
Borst complained of excessive daytime sleepiness,
"despite adequate total sleep time, " and overall
noted that Borst's narcolepsy affected his ability to
work. Tr. 751-52.
February 26, 2014, Borst had a follow-up appointment with Dr.
Andrea Dinning where she noted that his De Quervain's
tenosynovitis was doing "much better, " and
Adderall and Flexeril were working well for his chronic
fatigue and insomnia, respectively. Tr. 651. Borst was noted
to be taking Venlafaxine for depression, but admitted to
still having a depressed mood, so Dr. Dinning increased his
Venlafaxine dosage. Id.
March 26, 2014, Borst had a follow-up appointment with Dr.
Andrea Dinning for his chronic fatigue syndrome and
narcolepsy. Tr. 649-50. Dr. Dinning noted that Borst
struggled daily with fatigue, but had a normal sleep study.
Tr. 649. Borst was referred to Dr. Craig Weisenhutter for his
fibromyalgia and told to continue with Adderall and
Venflaxine for chronic fatigue syndrome and depression
respectively. Tr. 649-50.
following month, on April 22, 2014, Borst had another
follow-up appointment with Dr. Andrea Dinning for his chronic
fatigue syndrome and fibromyalgia. Tr. 647-48. Borst
complained of dizziness, seeing spots, and occasional
confusion, and that taking Provigil and Adderall together was
making him "too sleepy." Tr. 647. Dr. Dinning
ordered an MRI for Borst's confusion and dizziness. Tr.
April 29, 2014, Borst had an MRI taken of his brain. Tr. 665.
Imaging results showed "[n]egative enhanced and
unenhanced MRI of the brain" with results that were
unremarkable, with no abnormal findings. Tr. 665, 667.
21, 2014, Borst had an appointment with Dr. Andrea Dinning
for questions concerning his fibromyalgia. Tr. 644-46. Borst
reported pain that "comes and goes" in his
shoulders, wrist, and low back, and that he had taken a
Hydrocodone which had helped. Tr, 644. He also requested a
prescription of Paxil for his depression after reporting that
his wife uses it and it had worked for him. Id. Dr.
Dinning gave Borst a referral to Dr. Michael Coats for
chronic fatigue syndrome, prescribed him Paxil for
depression, and scheduled neurocognitive testing. Tr. 645.
same day, Borst was referred to Dr. Daryl MacCarter for a
second opinion and further evaluation of "migratory
joint complaints and myalgias." Tr. 685-87. Dr.
MacCarter wrote that Borst reported fatigue, somnolence, and
low back pain, and was previously diagnosed with
fibromyalgia. Tr. 685. Upon physical examination, Dr.
MacCarter found Borst had "no tender points on joint
exam suggestive of fibromyalgia, " mild tenderness in
both wrists, normal range of motion in his elbows and
shoulders with mild range of motion in the right shoulder,
mild loss of flexion in his lumbar spine, and tenderness in
his low back and the sacroiliac joints. Tr. 686. Dr.
MacCarter assessed Borst with probable rheumatoid arthritis
and associated Sjogren's syndrome, and ordered x-rays and
consideration of an MRI to check for bone marrow edema. Tr.
29, 2014, Borst returned for a follow-up appointment with Dr.
Ramey where he found on examination that Borst "still
has no other symptoms suggestive of narcolepsy including
cataplexy, sleep paralysis, or hypnagogic/hypnopompic
hallucinations." Tr. 620-22, 628-30. Dr. Ramey wrote
that Borst suffers from idiopathic hypersomnia, but noted
that whether Borst "has another coexisting condition
such as chronic fatigue syndrome is not entirely clear,
" and that he would not be able to make that diagnosis.
Tr. 621, 629. Dr. Ramey also wrote that Borst had
"seemed to develop a tolerance" to Adderall, which
he was currently treating with. Tr. 620, 628.
19, 2014, Borst had an follow-up appointment with Amy
Ellsworth, PA-C for his migratory myalgias, arthralgias, and
extreme fatigue. Tr. 641-43. Borst reported using Pro vigil
and Adderall, but noted that Provigil caused extreme fatigue
and the Adderall was no longer as effective as before. Tr.
641. Borst also presented with questions regarding exposure
to polyhydrocarbons, and wondered if they were related to his
symptoms. Id. Ms. Ellsworth prescribed Cymbalta for
Borst's fibromyalgia, chronic fatigue syndrome, and
depression and told Borst to stop taking Paxil. Tr. 643. Ms.
Ellsworth also wrote that she would inquire about testing for
polyhydrocarbon exposure after Borst was found to be positive
for anti-nuclear antibody (ANA). Id.
12, 2014, Borst had an appointment with Douglas Dero, D.O.
for concerns regarding upper extremity symptoms. Tr. 631-32.
Dr, Dero noted that Borst complained of tingling and pain,
yet EMG results were negative. Tr. 631. Borst reported that
he had "taken himself off all medications" and
"was wondering if that was causing some problems."
Id., Upon physical examination, Dr. Dero found that
Borst's neck was unremarkable, he had no bony prominence
tenderness, no muscle weakness by individual testing, and his
upper extremities were neurovascularly intact. Id.
Dr. Dero's impression was that Borst suffered from
paresthesias and pain of both upper extremities and gave
Borst a dose of Prednisone. Id. Dr. Dero did not
recommend any other diagnostic tests, but did discuss having
Borst get another MRI. Id.
17, 2014, Borst had an appointment with Ms. Ellsworth, PA-C
for follow-up care relating to an emergency room visit he
made for tingling and numbness of his bilateral upper
extremities. Tr. 637-40. Borst reported experiencing tingling
in his fingers that morning, which became worst when lying
down, and blurry vision. Tr. 637. Borst also reported that
his memory problems "have worsened" and he needs to
set reminders in order to remember to take his medication,
Id. Borst requested a letter requesting supervision
while at work and the ability to "access bed rest as
needed for flare ups." Id. Ms. Ellsworth noted
that Borst had recently ran out of Adderall and was using
Hydroxycut to stay awake, which she discouraged and
recommended that Borst continue to use Adderall. Tr. 637,
639. She wrote that Borst's stress could be contributing
to his fatigue and noted that the paresthesia of his hand
"appear[ed] to be improving, " but she would
schedule an MRI, per Borst's request, if the paresthesia
continued. Tr. 639.
28, 2014, Borst filed applications for Disability Insurance
Benefits and Supplemental Security Income alleging disability
beginning January 23, 20124. Tr. 339-40, 341-50.
August 13, 2014, Borst had an appointment with Ms. Ellsworth
with complaints of dizziness for two weeks, confusion, left
arm pain, and chronic fatigue. Tr. 633-36. Borst described
his dizziness as mild, and his confusion as "spontaneous
and longstanding, " and indicated he was worse during
the last two weeks with "confusion, dizziness,
headaches, paresthesia, and tingling." Tr. 633.
Additionally, Borst described his pain as "aching and
electrical, " and was aggravated by lifting.
Id. Borst noted that he had experienced a pain
flare-up the week prior, which he tried to relieve with
ibuprofen, ice, heat, and rest, but reported "little
relief." Id. He requested pain medication for
these pain flare-ups, Id. Ms. Ellsworth examined
Borst and found no edema, normal memory, cranial nerves that
were grossly intact, that he had an appropriate mood and
affect, and was oriented to time, place, person, and
situation. Tr. 635. She assessed Borst with dizziness, which
she noted was resolved and had an unknown etiology; chronic
fatigue syndrome, which was under "fair control with
AdderaU" and noted that stress may be adding to this;
and addressed Borst's left arm pain, noting that it had
resolved and she prescribed Norco and encouraged massage
therapy. Tr. 635-36.
September 18, 2014, Borst completed an Adult Function Report.
Tr. 444-51. Borst wrote that his illnesses, injuries, or
conditions affect his ability to work because he is unable to
stay awake due to "narcoleptic symptoms caused by
idiopathic hypersomnolence, " and is unable to attend
recovery "due to 'flare-up' symptoms, diffuse
pain, [and] weakness associated with chronic fatigue
syndrome." Tr. 444. Borst also wrote that he cares for
his wife and children, cooks one meal a week, drives his
children to school, completes "1-4 chores a day, "
including laundry, dishes, and vacuuming, yet noted that his
wife helps care for their children when he "can't
stay awake." Tr, 445. Borst reported being able to drive
when his "meds are working" and gets out of the
house by walking or driving. Tr. 447. Borst reported being
able to shop in stores and online for food and household
items, but was unable to pay bills, count change, handle a
savings account, or use a checkbook because he
"forget[s] things and misunderstands instructions,
" and had "double paid bills in the past."
Id., Borst reported spending time with others,
occasionally needing someone to accompany him when he goes
places, and always having someone to help if he "ha[s]
both kids with him." Tr. 448. He also reported having