United States District Court, N.D. Ohio, Eastern Division
MARGARET A. MANCHOOK, Plaintiff,
COMMISSIONER OF SOCIAL SECURITY Defendant.
S. GWIN JUDGE
REPORT & RECOMMENDATION
M. PARKER UNITED STATES MAGISTRATE JUDGE
Margaret A. Manchook, seeks judicial review of the final
decision of the Commissioner of Social Security denying her
application for disability insurance benefits
(“DIB”) and supplemental security income
(“SSI”) under Titles II and XVI of the Social
Security Act. Because the ALJ failed to adequately explain
his consideration of a treating physician's opinion, I
recommend that the final decision of the Commissioner be
VACATED, and the matter be REMANDED for further proceedings
consistent with this report.
A. Manchook applied for DIB and SSI on April 7, 2015 and
April 9, 2015. (Tr. 745-749). She alleged a disability onset
date of February 15, 2015. (Tr. 745). Her application was
denied initially on September 3, 2015 (Tr. 650-656) and on
reconsideration on December 21, 2015. (Tr. 660-671). Manchook
requested a hearing (Tr. 672) and Administrative Law Judge
(“ALJ”) Joseph Vallowe heard the case on July 19,
2017. (Tr. 523-573). On December 28, 2017, the ALJ issued a
decision finding that Manchook was not disabled. (Tr.
485-511). On May 16, 2018, the Appeals Council denied
Manchook's request for further review, rendering the
ALJ's conclusion the final decision of the Commissioner.
(Tr. 1-4). On July 12, 2018, Manchook filed this action to
challenge the Commissioner's denial of her claim. ECF
Relevant Medical Evidence 
was born on January 7, 1981 and was 36 years old on the day
of her hearing. (Tr. 745). She had past relevant work as a
state tested nurse assistant (“STNA”), a parts
assembler and a fast food worker. (Tr. 538, 565).
began suffering from depression and mental health issues when
she was fifteen years old. (Tr. 2163). Starting in October
2012, she was attending medication management sessions with
nurse practitioner, Bernard Nosanchuk. Manchook complained of
depression and anxiety. However, Mr. Nosanchuk often observed
a full-range of affect; that Manchook was friendly, talkative
and smiled appropriately; and that she did not appear to be
in any emotional distress. (Tr. 2211, 2218, 2225, 2233). Mr.
Nosanchuk consistently assigned a Global Assessment of
Functioning “GAF” score of 60, indicating
moderate symptoms of functioning. (Tr. 2165-2255). Manchook
was able to work until February 2015.
began attending an intensive outpatient partial
hospitalization program (“PHP”) in March 2015.
She attended group therapy five days per week from 9:00 a.m.
to 12:00 p.m. (Tr. 2275). Progress notes show that she
reported feeling anxious, hopeless, and overwhelmed at times,
but she was generally alert, taking her medications, and
participating in the group. (Tr. 2275, 2280, 2282, 2284,
2286, 2287, 2289, 2290, 2292, 2294, 2296, 2304, 2360, 2370).
She continued through August 2015. She had two panic attacks
during group therapy. (Tr. 2406, 2410).
March 10, 2015, Manchook told her case worker, Leslie Green,
that she had increased anxiety since her surgery and quitting
her job. She was frustrated with her lack of motivation and
had been sleeping a lot more lately. (Tr. 1367-1368). On
March 23, 2015, Ms. Green noted that Manchook was coping well
with her anxiety and attributed her reduction of symptoms to
accepting things the way they are presented. (Tr. 1366). On
April 13, 2015, Ms. Green noted that Manchook had added art
therapy to motivate her toward change and resolution.
Manchook reported feeling low energy, having crying spells,
and isolating from the outside world. She felt increased
frustration and helplessness. (Tr. 1362).
was discharged from services at Ohio Guidestone in June 2015
when she “abruptly declined services after two and a
half years of treatment.” Ms. Green noted that Manchook
had been consistent with her appointments but was very
resistant and in denial about resolving issues. She avoided
at times and blamed others in addition to feeling
inappropriately guilty toward circumstantial stress. Ms.
Green opined that Manchook continued to need intensive
services in an outpatient setting including partial
hospitalization, individual counseling and medication
services. (Tr. 1443). Manchook received counseling several
times a week from August 2014 to November 2015. (Tr.
September 9 to September 24, 2015, Manchook was hospitalized
for depression and suicidal ideations. She reported a loss of
interest in doing things, low energy levels, poor
concentration, and feeling hopeless, helpless, and worthless.
(Tr. 1546). She reported suicidal thoughts with no specific
plan. She complained of symptoms of anxiety, having
difficulty with interactions with other people, being out in
public in common areas, and in front of groups of people.
(Tr. 1546). Her mental status examination showed that she was
conscious, alert in all spheres, and cooperative. Her memory
was intact, and her attention and concentration were fair.
Her thought process was linear and concrete and her thought
content had no specific paranoia. Her insight was fair. She
was diagnosed with bipolar disorder, current episode
depressed, severe, without psychotic features; and anxiety
disorder, not otherwise specified. (Tr. 1547). During her
hospitalization, she underwent five electroconvulsive therapy
(“ECT”) sessions. (Tr. 1545-1603). At discharge,
she was sleeping better, eating better, was more social, not
suicidal and was taking her medications. (Tr. 1599).
her hospitalization, Manchook continued to attend intensive
outpatient therapy in a PHP at Signature Health four days a
week from 9:00 a.m. to 12:00 p.m. (Tr. 265). Her progress
notes show that she continued to struggle with anxiety and
frustration, but was alert, an active participant, responded
well to feedback, denied any problems with her medication and
denied suicidal ideation. (Tr. 2420, 2422, 2424, 2426, 2450,
September 25, 2015, Manchook went to the emergency room with
tremors that began three days earlier. She reported that her
tremors began after ECT. (Tr. 1606). Physical examination was
normal and she did not have any tremors while at the
hospital. (Tr. 1608). She was instructed to follow up with a
neurologist and her psychiatrist. (Tr. 1608). Manchook
returned to the emergency room on September 26, 2015 with
similar complaints. The physician opined that the tremors
were caused by increased serotonin and were secondary to the
ECT. Manchook was advised to reduce her dosage of sertraline.
returned to the emergency room on October 1, 2015. She
complained of somnolence and memory loss following an AA
meeting; she may have passed out but was not sure. Her
physical examination was negative for any acute medical cause
for her symptoms. (Tr. 1643). On November 2, 2015, Manchook
told her family physician that her episode of amnesia may
have been caused by the electroconvulsive therapy. (Tr.
October 2015, after Mr. Nosanchuk left the practice, Manchook
began treating with Dr. Adella Wasserstein. (Tr. 2163). Dr.
Wasserstein assessed anxiety and episodic mood disorder
(mostly depressed with good control of mania.) At her first
visit, Manchook kept nodding off and Dr. Wasserstein sent her
to the emergency room. (Tr. 2164).
November 2015, Manchook was less sleepy and no longer dozing
off. (Tr. 2272). Her mental status examination showed that
she was alert and oriented, withdrawn, but pleasant; her
attention and concentration were within normal limits; her
mood and affect were euthymic; her speech was regular; her
thought process was goal oriented; and her associations and
thought content were within normal limits; her recent and
remote memory were grossly intact; her judgment and insight
were fair. (Tr. 2268). Her mental examination returned
similar results on December 1, 2015. (Tr. 2606). Manchook
reported that group therapy was the only place she fell
asleep. (Tr. 2612).
received counseling on a weekly basis from January 2016 to
May 2017. (Tr. 2791-3120, 3170-3311, 3487-3510, 3550-3693).
Dr. Wassertein occasionally noted a depressed and anxious
mood, but many of her mental status examinations were normal.
Dr. Wasserstein repeatedly assigned a GAF score of 60. (Tr.
2603-2623, 2747-2789, 3133-3167, 3479-3510).
January 2016, Manchook was evaluated by neurology for
potential seizure. A prolonged EEG was normal, both awake and
asleep. (Tr. 2646).
February 2, 2016, Dr. Wasserstein's findings were similar
except that Manchook's mood was “euthymic to
upset.” (Tr. 2750). Dr. Wasserstein noted that PHP
ended on February 8, 2016, that dialectical behavior therapy
(“DBT”) was to start on February 10, and that art
therapy was to start on February 9. However, Manchook missed
therapy because she was ill. (Tr. 2755). Her mood and anxiety
were okay with medications despite stressors related to her
daughter. She did not feel ready to take possession of her
yet because she was too newly on her own. (Tr. 2755).
February 23, 2016, she told Dr. Joshua Sunshine that she was
doing well and had no complaints; she felt less depressed.
(Tr. 2633). On March 14, 2016, Manchook's mood and affect
returned to euthymic and her mental status examination was
unremarkable. (Tr. 2760). She had custody of her daughter
again and was unable to go to DBT and group therapy but had
been attending appointments. (Tr. 2766).
April 2016, she had a depressed and anxious mood and affect
but otherwise a normal mental examination. (Tr. 2771).
Manchook reported anxiety and difficulty feeling motivated
over the past two weeks. She was not interested in going
anywhere and was sleeping about six hours. (Tr. 2777). On May
9, 2016, Manchook's mood was euthymic to overwhelmed and
her affect was euthymic. Her mental status examination was
normal. (Tr. 2782).
2016, Manchook reported an increase in depression to her
therapist, Kaitlyn Baker. She was staying home and not
feeling motivated to complete daily tasks. (Tr. 3081). Later
in June, Manchook reported that she was feeling more
optimistic; she was modelling positive healthy behavior for
herself and her two daughters. (Tr. 3094).
August 12, 2016, Manchook reported that she was not feeling
depressed or hopeless to her primary care physician. (Tr.
3122). When she met with Dr. Wasserstein on August 22, 2016,
she had a depressed to anxious mood, but euthymic affect.
Otherwise, her mental examination was normal. (Tr.
3133-3134). Manchook reported that she had stopped taking all
her medications two weeks ago at the instruction of her
counselor, Ms. Baker. She had actually been instructed to
stop taking supplements that were causing diarrhea and had
decided to stop all of her medications. Three days before her
appointment, she had started taking all her medications again
except Gabapentin. Dr. Wasserstein continued her medications
and prescribed a lower dose of Gabapentin. (Tr. 3136).
status examination was the same in September 2016. She told
Dr. Wasserstein that she continued to feel tired and
depressed but was not hopeless or suicidal. (Tr. 3142). In
October 2016, Manchook complained of feeling depressed,
isolative, having low appetite, intermittent waking and
suicidal ideation. She had gone to the emergency room with
suicidal ideation but did not require hospitalization. She
was attending PHP every day. Dr. Wasserstein did not note any
changes to her status examination. (Tr. 3149).
November 2016, Manchook reported sleeping more during the day
because she was only attending group therapy two times a
week. She was still having suicidal ideation and had called
the crisis hotline the night before. (Tr. 3156). In December
2016, she continued to complain of occasional passive
suicidal ideation. She reported depressive symptoms of