United States District Court, N.D. Ohio, Eastern Division
REPORT AND RECOMMENDATION
R. Knepp II United States Magistrate Judge.
Emely Camacho (“Plaintiff”) filed a Complaint
against the Commissioner of Social Security
(“Commissioner”) seeking judicial review of the
Commissioner's decision to deny supplemental security
income (“SSI”). (Doc. 1). The district court has
jurisdiction under 42 U.S.C. §§ 1383(c) and 405(g).
This matter has been referred to the undersigned for
preparation of a report and recommendation pursuant to Local
Rule 72.2. (Non-document entry dated February 3, 2017).
Following review, and for the reasons stated below, the
undersigned recommends the decision of the Commissioner be
reversed and remanded.
filed for SSI in January 2014, alleging a disability onset
date of August 1, 2009. (Tr. 127-37). Her claims were denied
initially and upon reconsideration. (Tr. 91-93, 99-100).
Plaintiff then requested a hearing before an administrative
law judge (“ALJ”). (Tr. 104). Plaintiff
(represented by counsel), and a vocational expert
(“VE”) testified at a hearing before the ALJ on
December 8, 2015. (Tr. 29-66). On February 3, 2016, the ALJ
found Plaintiff not disabled in a written decision. (Tr.
13-24). The Appeals Council denied Plaintiff's request
for review, making the hearing decision the final decision of
the Commissioner. (Tr. 1-7); see 20 C.F.R.
§§ 416.1455, 416.1481. Plaintiff timely filed the
instant action on February 3, 2017. (Doc. 1).
Background and Testimony
was born in January 1982 and was 31 years old on her
application date. (Tr. 22). Plaintiff's mother drove her
to the hearing. (Tr. 38). Plaintiff lived with her five
children, aged 17, 15, 14, 12, and 9. (Tr. 41). Her oldest
daughter and her mother, who lives nearby, helped her care
for her other children. Id. Plaintiff testified to
past work as a house cleaner. (Tr. 46).
described the reasons she believed she was unable to work:
It's very hard for me . . . to focus and to concentrate
on doing any type of work or any type of pay. . . . I feel
like everybody's, like, looking at me while I'm . . .
when I'm doing things. . . . I have severe tics, and
it's just . . . a problem. . . ., I distract everybody
from too much tics that I do.
(Tr. 38-39). Plaintiff had tics in her face, neck, arms, and
legs, “every day, like constantly.” (Tr. 39). The
tics increased in severity when Plaintiff was “more
stressed out.” Id. When questioned about an
inconsistency in the record where a provider observed no tics
until tics were mentioned, Plaintiff explained:
I always - - like, my tics are always - - I always have tics.
There's time periods where I could, like not have tics,
like for a time period, but not like - - like, for long time
periods. Like, it's just like - - I could - - like if
I'm relaxed, I could [have] tics but not as major. But I
always tend to have tics, like severely all the time every
(Tr. 40-41). Plaintiff testified the longest she could go
without having a tic was “a couple minutes” and
talking or thinking about tics made them worse. (Tr. 47).
time of the hearing, Plaintiff took Lamictal and Topamax.
(Tr. 41-42). The medications caused drowsiness and Plaintiff
slept a lot. (Tr. 44); see also Tr. 45 (“I
just sleep . . . almost . . . all day. Like, I'm
constantly tired all the time.”).
testified her mother and oldest daughter helped with house
cleaning. (Tr. 47-48). Plaintiff stated she could sweep or
mop, but “it just takes me more time to do it.”
(Tr. 48). Plaintiff testified it took her longer to do these
things than it used to, but acknowledged she had always had
tics. (Tr. 48-49). Plaintiff washed dishes, but worried she
might drop things, and had broken dishes before. (Tr. 50-51).
Once while cooking, Plaintiff dropped a pot on the floor.
testified to having obsessive compulsive disorder symptoms
including repeatedly checking her door locks, her stove, and
whether her children were breathing. Id. She would
check the door and the stove three or four times a day, and
check her children's breathing whenever they were
sleeping. (Tr. 52). She also arranged her children's
shoes from smallest to biggest. (Tr. 51-52).
had trouble concentrating, and worried about others making
fun of her or being distracted by her. (Tr. 53). Plaintiff
testified she did not go anywhere, and did not like being
around people. Id. She clarified that she takes her
children to school with her oldest daughter, and goes grocery
shopping with her mother. (Tr. 54). She was teased due to her
tics, and had pain in her face and neck from the tics. (Tr.
testified she had been seeing Dr. Pandya for “maybe a
year or so”. (Tr. 42). Plaintiff testified that she saw
Dr. Pandya on the day she gave him a mental impairment
questionnaire in November 2015. (Tr. 43-44). Plaintiff did
not feel like she was getting better under Dr. Pandya's
treatment and she was “going to be seeing a new doctor
because Dr. Pandya is leaving”. (Tr. 55).
March 2011, Plaintiff saw Erick Kauffman, M.D., at
Neighborhood Family Practice, for bipolar disorder and
Tourette's disorder. (Tr. 264). She reported being off
all medications, but that Lamictal had previously helped make
her calmer, and Clonidine “helped [T]ourette[‘]s
a bit”. Id. On examination, Dr. Kauffman noted
normal: mood and affect, behavior, and thought content. (Tr.
265). He prescribed Lamictal and Klonopin for Plaintiff's
bipolar disorder and Clonidine for her Tourette's.
April 2011, Plaintiff complained of aching epigastric pain
with nausea and vomiting. (Tr. 262). Plaintiff reported
stopping the Lamictal, but it “was helping mood and
reactivity” and she wanted to restart it. Id.
Dr. Kauffman again noted normal: mood and affect, behavior,
and thought content. Id.
and August 2011, Plaintiff called to request a refill of,
inter alia, Klonopin (clonazepam). (Tr. 261). In
September 2011, Plaintiff called to request a psychiatric
referral, which Dr. Kauffman approved. (Tr. 260).
October 2011 visit with Dr. Kauffman, Plaintiff reported
anxiety, panic attacks, and poor sleep. (Tr. 258-59). Dr.
Kauffman noted plaintiff was nervous and anxious and had
insomnia. (Tr. 259). Dr. Kauffman prescribed Klonopin, and
citalopram (Celexa), and instructed Plaintiff to follow up
“with psych or me in one month”. Id.
December 2011, Plaintiff called requesting refills of
Lamictal and Klonopin. (Tr. 258). Plaintiff also reported she
had previously taken Seroquel and requested a refill.
Id. Plaintiff was informed Dr. Kauffman would
address these refills at her next office visit. Id.
next saw Julia Garcia, MA (in the same office as Dr.
Kauffman) later that month. (Tr. 257). Plaintiff reported
“[f]unctioning well when she is on lamictal”, but
she had “been off it for 2 weeks.” Id.
Plaintiff was prescribed Klonopin (clonazepam) and quetiapine
(Seroquel), and notes indicate “[w]ill work on psych
meds until she is seen by psych”. (Tr. 258). In
January, Plaintiff again called Dr. Kauffman for a refill of
Klonopin. (Tr. 256).
February 2012, Plaintiff saw psychiatrist Sara Stein, M.D.
(Tr. 255-56). Plaintiff reported she had been diagnosed with
bipolar disorder ten years prior, and had occasional suicidal
feeling and panic attacks. (Tr. 255). Plaintiff also reported
a previous diagnosis of Tourette's. Id.
Plaintiff reported she was taking Lamictal, never started
citalopram, and took clonazepam for anxiety. Id. On
examination, Plaintiff was anxious, had “obvious motor
tics” and her speech was pressured. (Tr. 256). Dr.
Stein assessed bipolar disorder, and Tourette's, and
assessed a Global Assessment of Functioning
(“GAF”) score of 60. Id. Dr. Stein
adjusted Plaintiff's medications (increasing her Lamictal
dosage, and adding trazodone). Id.
2012, Plaintiff returned to Dr. Kauffman for a
“medication review”. (Tr. 252). Plaintiff
reported she was pregnant, and had stopped taking her
Klonopin and Lamictal two weeks prior. Id. Dr.
Kauffman again noted normal: mood and affect, behavior, and
thought content. Id. Dr. Kauffman referred Plaintiff
to behavioral health. (Tr. 252-53). Later that month,
Plaintiff told Dr. Stein she had stopped all her medications
three weeks prior, and that she had racing thoughts and could
not sleep. (Tr. 251). Dr. Stein prescribed a low dose of
Haloperidol, noting it was safest for pregnancy. Id.
2012, Plaintiff called Dr. Kauffman to request a Lamictal
refill. (Tr. 250). Plaintiff also reported she was no longer
pregnant and had an appointment with Dr. Stein the following
day. (Tr. 250-51). Plaintiff did not show up for her
appointment with Dr. Stein, and Dr. Stein requested a staff
member call her to request she come into the office. (Tr.
October 2012, Plaintiff saw Dr. Stein, reporting a lost
pregnancy, difficulty sleeping, “[b]ad tics”, and
racing thoughts. (Tr. 248). Dr. Stein adjusted
Plaintiff's medications (restarting Lamictal, increasing
haloperidol, and adding vitamin B6). Id.
reflect prescription refills from both Dr. Stein and Dr.
Kauffman from January through June 2013. (Tr. 247). In June
2013, Plaintiff called Dr. Kauffman requesting a Klonopin
refill, and was instructed to make an appointment.
Id. Plaintiff saw Dr. Kauffman later that month,
reporting stress from relationship issues, caring for her
children alone, and wanting to get back on medications. (Tr.
245-46). Dr. Kauffman noted Plaintiff was depressed, nervous,
and anxious. (Tr. 246). Dr. Kauffman restarted
Plaintiff's medications (adding Doxepin), and referred
Plaintiff to counseling. Id.
called Dr. Kauffman later in June and again in July,
reporting the Doxepin dosage was too strong and made her
sleepy. (Tr. 244-45). Plaintiff was instructed to take half a
tablet, and later given a prescription for a lower dose. (Tr.
December 2013, Plaintiff called Dr. Kauffman's office
requesting refills of Lamictal and Klonopin until her
appointment in January. (Tr. 244).
January 2014, Plaintiff saw Dr. Kauffman for a physical, and
reported she continued to suffer from depression and
insomnia. (Tr. 242). She also reported the Doxepin
“makes her too drowsy.” Id. On
examination, Dr. Kauffman noted Plaintiff was
“[p]ositive for depression”, and was
“nervous/anxious and ha[d] insomnia.”
Id. She was, however, noted to have a normal mood
and affect. (Tr. 243). Dr. Kauffman prescribed Elavil. (Tr.
240-41). She called two weeks later, requesting a refill of
Doxepin, and stating the Elavil was not helping with sleep.
Id. The following day, Plaintiff called back,
stating the prescribed Doxepin dose was too strong. (Tr.
240). Dr. Kauffman's office also recommended Plaintiff
“set up an intake time with behavioral health”.
January 2014, Plaintiff began treatment with Jane Harris,
L.I.S.W. (Tr. 287). Plaintiff reported suffering from
Tourette's since age 12, anxiety, depression, and OCD.
Id. She reported symptoms of aggressive behavior,
agitation/irritability, crying spells, distressed mood,
distractibility, hypervigilance, general anxiety,
hyperactivity, impaired memory, lack of interest in
activities, low energy, nightmares, obsessions/compulsions,
paranoia, phobias, poor concentration, poor impulse control,
racing thoughts, sleep disturbances, and thoughts of death.
(Tr. 287-93). Plaintiff reported previously taking several
medications for her mental health problems, but had
discontinued several due to ineffectiveness or side effects.
(Tr. 296-304). She was currently taking Doxepin for sleep and
depression (though it made her sleepy during the day) (Tr.
297), Klonopin for anxiety, and Lamictal for depression (Tr.
299). Ms. Harris noted Plaintiff had trouble concentrating,
and was “not prepared to spend the time
required”, but “was cooperative and
engaged.” (Tr. 313). Ms. Harris noted Plaintiff yawned
throughout the session, and had facial tics. Id.
Plaintiff failed to attend two sessions in February, and
cancelled one. (Tr. 314-16).
saw Ms. Harris three times in March 2014. (Tr. 318-20).
Plaintiff reported anxiety and depression increasing after
the death of a family member, and Ms. Harris noted Plaintiff
was doing “[w]orse.” (Tr. 318). Ms. Harris noted
Plaintiff reported medication compliance, but “then
admitted she was partially med compliant off and on.”
Id. Ms. Harris encouraged Plaintiff to address her
diet, medication compliance, and caffeine and nicotine
intake. (Tr. 320). In April 2014, Plaintiff saw Ms. Harris to
discuss anxiety and ...