Apparently when he didn't take his meds he twitched uncontrollably... When Natale accused Mikey Lance and him of being the shooters in the Turra hit and made him and Lance stand up in court he was apparently twitching uncontrollably and the defense was like yeah how could this guy be an effective hit man? Natale's response was he didn't twitch like that when he was on his meds he didn't twitch at all. It sounds to me like he might not have been a factor in Nicky Sr's day but for whatever reason Merlino took him and as mentioned used him in hits supposedly... Whether Merlino was just taking advantage of/using a guy who was starved for acceptance or if Merlino legitimately was accepting of him is up for debate I suppose?