United States District Court, N.D. Ohio, Eastern Division
A. Barker, Judge.
REPORT AND RECOMMENDATION
R. Knepp, II United States Magistrate Judge
Beverly Chapman (“Plaintiff”) filed a Complaint
against the Commissioner of Social Security
(“Commissioner”) seeking judicial review of the
Commissioner's decision to deny disability insurance
benefits (“DIB”). (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 July 13, 2018).
Following review, and for the reasons stated below, the
undersigned recommends the decision of the Commissioner be
filed for DIB in May 2015, alleging a disability onset date
of July 3, 2012. (Tr. 173). Her claims were denied initially
and upon reconsideration. (Tr. 121-24, 127-29). Plaintiff
then requested a hearing before an administrative law judge
(“ALJ”). (Tr. 134-35). Plaintiff (represented by
counsel), and a vocational expert (“VE”)
testified at a hearing before the ALJ on May 17, 2017. (Tr.
34-85). On October 4, 2017, the ALJ found Plaintiff not
disabled in a written decision. (Tr. 15-25). The Appeals
Council denied Plaintiff's request for review, making the
hearing decision the final decision of the Commissioner. (Tr.
1-3); see 20 C.F.R. §§ 404.955, 404.981.
Plaintiff timely filed the instant action on July 13, 2018.
Background and Testimony
was born in 1962, making her 54 years old at the hearing.
See Tr. 40. She had a bachelor's degree in
communications (Tr. 46), and past work in the corporate
training industry (Tr. 48-49).
was terminated from her last job due to “erratic
behavior” in the workplace. (Tr. 46). She was not
“dealing with clients and colleagues well”, and
experienced auditory and visual hallucinations,
“sobbing episodes”, and mood swings. Id.
She noted her behavioral and mental health problems had
“progressed a lot” since 2012. (Tr. 55).
Plaintiff denied that a single traumatic event caused a
decline, but instead she gradually “started having
reactions that [she] knew weren't normal”.
experienced visual hallucinations, seeing and conversing with
people who “look as real to me as you look to me right
now.” (Tr. 56). She had become familiar with certain
people by voice and appearance, describing them as
“motorcycle people”. (Tr. 57). Plaintiff noted
the people were supportive, offered consolation, and provided
positive affirmations. (Tr. 58). Sometimes Plaintiff only
heard voices and did not see faces. Id. These
hallucinations mostly occurred at home, but sometimes in
public. (Tr. 59). Since she started treatment,
Plaintiff's hallucinations were less frequent.
also described mood swings. (Tr. 59-60). Occasionally she
woke in the morning feeling depressed - a feeling which
sometimes lasted a week and sometimes lasted only the day.
(Tr. 60). She had “blow-up episodes” where she
overreacted, or otherwise reacted inappropriately, to
something that made her angry. Id. Plaintiff also
experienced panic attacks where she felt sweaty, shook, had
weak legs, and fled whatever setting she was in. (Tr. 60-61).
She had approximately three panic attacks per week which
lasted fifteen to twenty minutes each. (Tr. 62).
lived with her elderly mother (Tr. 41), who she testified was
the only person with whom she got along. (Tr. 66). She was
estranged from her father and only sibling. Id.
Plaintiff did not grocery shop and did not participate in
household chores due to concentration problems. (Tr. 66-67).
She did not have any hobbies and slept most of the day. (Tr.
67-68). Plaintiff was afraid to leave her home due to
“agoraphobic tendencies”. (Tr. 69).
treated with her primary care physician Richard McBurney,
M.D., and a nurse practitioner within his office, a total of
three times between 2013 and 2015. See Tr. 266-79,
289-92. Dr. McBurney treated Plaintiff for panic disorder
without agoraphobia and generalized anxiety disorder. (Tr.
269-70, 272-73, 289-90). He prescribed Lexapro and clonazepam
(Tr. 271, 273, 290), noted her symptoms were “well
controlled” on the medications (Tr. 269), and helped
her symptoms “considerably” (Tr. 289). Dr.
McBurney also found Plaintiff's affect appropriate to her
mood. See Tr. 271, 291.
underwent a consultative examination with psychologist
Charles Misja, Ph.D., in June 2014. (Tr. 255-61). Plaintiff
reported living in a “continual state of dread
expecting the worst”, and that worrying
“overwhelm[ed]” her. (Tr. 256). She expressed
difficulty maintaining personal relationships and dealing
with workplace stress. Id. Plaintiff told Dr. Misja
she was terminated from a job as a software applications
trainer because she walked out of meetings, hungup on
conference calls, and could not get along with supervisors or
coworkers. (Tr. 257). She did not belong to any social groups
or organizations and did not have any hobbies or interests.
(Tr. 258). Plaintiff had a “close” relationship
to her brother. Id. She showered every two to three
days, managed her own finances, cooked for herself, and did
her laundry once per month. Id. On a typical day,
Plaintiff woke at noon, had coffee, took her medication, and
watched television most of the day. Id.
examination, Dr. Misja found Plaintiff dressed appropriately,
was adequately groomed, made good eye contact, and did not
appear to exaggerate her symptoms. Id. He found she
was direct in her conversation with good flow and was verbose
and articulate. Id. Plaintiff had a constricted
affect and depressed and stable mood. Id. She rated
her depression as a “six”, but added it recently
was “as high as eight”. Id. She did not
have any suicidal thoughts. Id. Plaintiff reported
that her depression “never stopped her from functioning
and even now  has no difficulty getting out of bed for the
day.” Id. She reported a “drastic”
change in her quality of life because she lived with her
parents, including her father who was “difficult to
cope with.” Id. Plaintiff had no anger towards
herself, but was angry with others due to “anticipated
mistreatment”. (Tr. 259). She rated her anxiety as a
“ten” but stated, “I'm able to
function”. Id. Plaintiff was fine by herself,
but did not have interest in social settings. Id.
Dr. Misja found no evidence of visual or auditory
hallucinations or delusions. Id. She was oriented
with no sign of grandiosity, religious or sexual
preoccupations, suspiciousness, or aggression. Id.
Dr. Misja found Plaintiff functioned in the average range of
intelligence. Id. She had good insight and fair
judgment. (Tr. 260). He diagnosed major depression
(moderate), generalized anxiety disorder, and personality
disorder (not otherwise specified). Id.
August 2015, Plaintiff underwent a second consultative
examination with psychologist Alison Flowers, Psy.D. (Tr.
294-301). Plaintiff reported losing three jobs due to
psychological problems. (Tr. 294-96). She noted that she was
easily annoyed, could not focus, and could not get along with
her coworkers. (Tr. 296). Plaintiff reported that she took
her prescribed medications (Lexapro and clonazepam) daily
(Tr. 295), and they helped “somewhat” (Tr. 296).
Plaintiff described her typical mood as “sad and
depressed”. (Tr. 297). She further reported panic
attacks, difficulty concentrating, dysphoric moods, loss of
usual interests, a diminished sense of pleasure,
irritability, and social withdrawal. Id. Plaintiff
reported that she could dress, bathe, and groom
independently. Id. She could not cook or prepare
food due to an inability to concentrate. Id. She did
“a little” cleaning and shopped for herself in
“small stores” such as Walgreens. Id.
Plaintiff reported that she was unable to manage her own
finances, and was going through bankruptcy. Id. She
drove independently. Id.
examination, Dr. Flowers found Plaintiff had an open demeanor
with appropriate social skills. (Tr. 298). She was
appropriately dressed, well-groomed, and had appropriate eye
contact. Id. Plaintiff had fluent speech, a clear
voice, coherent thought process, and goal-directed thoughts
with no evidence of hallucinations, delusions, or paranoia.
Id. She had a restricted affect and appeared anxious
throughout the appointment. Id. Plaintiff had a
neutral mood and euthymic affect. Id. She was
oriented to person, place, and time and had “mildly
impaired” attention and concentration. Id.
Plaintiff had good insight, fair judgment, and was in the
average range of intelligence. (Tr. 299). Dr. Flowers
diagnosed generalized anxiety disorder, panic disorder, and
unspecific depressive disorder. Id. Further, Dr.
Flowers offered a “guarded” prognosis because
Plaintiff reported problems related to anxiety and depression
and she was not receiving mental health treatment for those
symptoms. Id. She opined that Plaintiff's
prognosis might improve with treatment. Id.
began treating with counselor Andrea Brown, LPC, in December
2015. See Tr. 305. At her initial visit, Plaintiff
reported anxiety symptoms and mood changes. (Tr. 306). On
examination, Plaintiff's mood and affect were within
normal limits; she made steady eye contact, was oriented, had
normal speech, intact memory, average intellect, fair
judgment, and a normal thought process. (Tr. 305). Ms. Brown
diagnosed major depressive disorder, single episode. (Tr.
attended several counseling visits with Ms. Brown in January
and February 2016. (Tr. 323-65). During the visits Plaintiff
reported anxiety symptoms (Tr. 323, 332, 336, 340, 348, 356,
364-65), depression symptoms (Tr. 336, 344), and difficulties
with social situations (Tr. 323, 332, 364-65). On
examination, Ms. Brown consistently found Plaintiff had an
anxious mood, appropriate affect, good concentration, and
good or fair judgment. (Tr. 330, 334, 338, 342, 346, 350,
354, 358, 362).
in January 2016, Plaintiff underwent a third consultative
examination with psychologist Amber Hill, Ph.D. (Tr. 310-19).
Plaintiff reported a family history of psychiatric concerns,
describing her father as having “rages”. (Tr.
311). She got along with her mother, but had a strained
relationship with her father, and was estranged from her
brother. Id. Plaintiff had no other socialization
and no hobbies or interests. Id. She spent the
majority of her day watching television and attending
doctor's appointments. Id. If she arrived at an
appointment early, she would stop and get a cup of coffee
close to the building. Id. Plaintiff reported taking
Lexapro and clonazepam, id., and described the
medication as “helpful” (Tr. 312). She was
terminated from her last job because she had difficulty
getting along with her coworkers. Id. Plaintiff
reported feeling “very, very sad” most days. (Tr.
313). Plaintiff suggested that she had symptoms of mania,
detailing “spending binges” during periods of
happiness. Id. She reported three panic attacks per
week and that she only left the house to attend appointments.
(Tr. 314). Plaintiff was able to dress, bathe, and groom
herself but did so infrequently. Id. She did not
cook or prepare simple meals, instead relying on her
mother's friend to bring over take-out meals. (Tr.
314-15). She reported that she was able to manage her own
finances. (Tr. 315).
examination, Dr. Hill found Plaintiff appropriately dressed
and well groomed. Id. She noted Plaintiff
demonstrated normal posture and motor behavior with
appropriate eye contact, but visibly shook during most of the
session. Id. Plaintiff had fluent speech and a clear
voice with coherent goal-directed thoughts. Id.
There was no evidence of hallucinations, delusions, or
paranoia. Id. Dr. Hill found Plaintiff had a
restricted and flat affect with a dysthymic mood.
Id. Plaintiff was anxious throughout the session.
Id. Her concentration and attention appeared mildly
impaired, as did her recent and remote memory skills. (Tr.
315-16). Dr. Hill found Plaintiff's intellectual
functioning to be normal. (Tr. 316). She diagnosed panic
disorder, generalized anxiety disorder, and persistent
depressive disorder and offered a “guarded”
prognosis due to Plaintiff's lack of full symptom control
or relief. (Tr. 316-17) (“Although the claimant
suggests that she has some good benefit from her mental
health medication prescribed by her primary care provider for
the past seven years, the claimant does not have full symptom
control or relief.”).
began treating with psychiatrist Thomas Thysseril, M.D., in
April 2016. See 385-90. At her initial visit,
Plaintiff reported a variety of symptoms including: nocturnal
sleep habits, rapid speech, road rage, trust issues,
fluctuating mood, and distractibility. (Tr. 385). She
reported staying at home most of the day; she did not
participate in chores or cooking, and showered approximately
once per week. Id. Plaintiff also noted that she
angered easily. Id. Dr. Thysseril noted Plaintiff
had no active hallucinations. Id. On examination,
Plaintiff was cooperative, made good eye contact, and
appeared casually dressed with “improved”
hygiene. (Tr. 388). She had a mixed mood and a labile,
guarded, affect. Id. Plaintiff had fair impulse
control, judgment, and insight. Id. Dr. Thysseril
diagnosed bipolar disorder (mixed, moderate), anxiety
disorder, and assigned a Global Assessment of Functioning
(“GAF”) score of 60. (Tr. 389). He adjusted
Plaintiff's medications. Id.
saw Dr. Thysseril from April to November 2016. (Tr. 391-425,
454-77). Throughout this period, Plaintiff's reported
symptoms included anger (Tr. 391, 396), anxiety (Tr. 454,
464), depression (Tr. 411), and paranoia (Tr. 401, 459).
Plaintiff reported a visual hallucination of a man on a
bicycle in September 2016 (Tr. 459), and auditory
hallucinations in November 2016 (Tr. 474). On a few
occasions, Dr. Thysseril described Plaintiff as being
“calmer” than usual (Tr. 406, 464, 469) or less
paranoid (Tr. 406, 416, 421). On examination, Plaintiff's
mood varied from “mixed” (Tr. 393, 398),
“expansive” (Tr. 418, 461, 476), and depressed
(Tr. 413) to “calmer” (Tr. 408, 423, 456, 471)
and “less depressed” (Tr. 403). Plaintiff's
affect also varied from “guarded” (Tr. 393, 398),
“restricted” (Tr. 418, 423, 456, 471),
“tearful” (Tr. 413), and “labile”
(Tr. 461, 466, 476) to “less guarded” (Tr. 403,
408). Dr. Thysseril consistently described Plaintiff as
“cooperative” with good eye contact, but noted
psychomotor retardation was also present. (Tr. 393, 398, 403,
408, 413, 423, 456, 461, 476). He found Plaintiff's
recent and remote memory intact and consistently noted
Plaintiff had fair impulse control, insight, and judgment; he
maintained a diagnosis of bipolar disorder, anxiety disorder,
and consistently assigned a GAF score of 60 or 65. (Tr. 394,
399, 404, 409, 414, 418-19, 424, 457, 462, 467, 472, 477).
underwent a battery of cognitive testing in August 2016 with
consultative examiners Matthew Liptensky, M.A., P.C. (a
counselor) and Deborah Koricke, Ph.D (a psychologist). (Tr.
427-30). Wechsler Adult Intelligence Scale testing revealed
Plaintiff fell in the low average range of overall mental
abilities. (Tr. 427-28). She was in the low average range in
the area of verbal comprehension; borderline in perceptual
reasoning; and low average in the area of attention and
concentration. (Tr. 428). Plaintiff's processing speed
fell within the average range. Id. Plaintiff also
underwent Integrated Visual and Auditory Continuous
Performance Testing (“IVA-CPT”) to assess her
overall attention and concentration. (Tr. 429). Results
indicated Plaintiff fell within the “impaired”
range in all areas of functioning related to attention
consistent with someone suffering from attention deficit
hyperactivity disorder (“ADHD”). Id.
These providers also administered the Minnesota Multiphasic
Personality Inventory -2- Revised Format
(“MMPI-2-RF”) to assess psychopathology and
maladaptive personality functioning. (Tr. 430).
Plaintiff's score was indicative of someone likely
exaggerating their symptoms; it was thus likely invalid.
Id. Mr. Liptensky and Dr. Koricke noted, however,
that Plaintiff “was not perceived to be attempting to
feign an illness and appeared to be attempting to put forth a
consistent effort.” Id.
reported to the emergency room in January 2017 for suicidal
thoughts (Tr. 582, 588); she was admitted (Tr. 590). On
examination, Plaintiff was actively engaged in her interview,
was pleasant and courteous, and came across as “open
and unguarded”. (Tr. 592). Her speech was somewhat
rapid. Id. Plaintiff's mood was mildly hypomanic
and her affect congruent. Id. She had fair insight
and judgment, was somewhat distracted by racing thoughts, and
had “excellent” recent and remote recall.
Id. Providers diagnosed bipolar mood disorder,
hypomanic. Id.; see also Tr. 594 (discharge
Thysseril completed a medical source statement in March 2017.
(Tr. 948-53). In it, he listed Plaintiff's diagnosis as
bipolar disorder with a GAF score of 65. (Tr. 948). He
also listed Plaintiff's symptoms and medications. (Tr.
948-49). Dr. Thysseril opined Plaintiff had unlimited ability
to adhere to basic standards of neatness and cleanliness.
(Tr. 952). When asked his opinion on Plaintiff's ability
to ask simple questions or request assistance, Dr. Thysseril
checked two boxes indicating that she was both
“unlimited or very good” and “unable to
meet competitive standards” in her ability to ask
simple questions or request assistance. See Tr. 950.
He found she was “limited but
satisfactory” in her ability to maintain regular and
punctual attendance; make simple work-related decisions;
perform at a consistent pace without an unreasonable number
of rest periods; and set realistic goals or make plans
independently of others. (Tr. 950, 952). Dr. Thysseril found
Plaintiff “seriously limited” in her ability to
carry out very short and simple instructions; accept
instructions and respond appropriately to criticism from
supervisors; respond appropriately to changes in a routine
work setting, understand, remember, and carry out detailed
instructions; interact appropriately with the public;
maintain socially appropriate behavior; and travel in
unfamiliar places. Id. He found she was
“unable to meet competitive
standards” in her ability to maintain attention for a
two-hour segment; work in coordination with or proximity to
others without being distracted; and complete a normal
workday (or workweek) without interruptions from
psychologically based symptoms. (Tr. 950). When asked to
explain these limitations, including the medical/clinical
findings in support, Dr. Thysseril left the questions blank.
(Tr. 950, 952). Dr. Thysseril opined Plaintiff had a mild
limitation in her ability to understand, remember, or apply
information. (Tr. 951). He found a moderate limitation in her
ability to interact with others and maintain attention,
concentration, persistence, or pace. Id. Dr.
Thysseril found a marked limitation in Plaintiff's
ability to adapt or manage herself. Id. He did not
offer an opinion on absenteeism (Tr. 951) and left blank a
question which asked “[i]f stress tolerance is an
issue, what demands of work does this patient find
stressful?” (Tr. 953). Finally, Dr. Thysseril did not
answer when asked if Plaintiff impairment lasted (or could be
expected to last) at least twelve months. (Tr. 951).
2014, Dr. Misja opined Plaintiff functioned in the average
range of intelligence and would be able to understand and
implement ordinary instructions. (Tr. 261). She would have
“minimal” problems in her ability to maintain
attention and concentration, maintain persistence and pace,
and perform simple and multi-step tasks. Id. He
opined Plaintiff would have “severe” problems
responding appropriately to supervision and coworkers due to
a “significant personality disorder”.
Id. Dr. Misja also found Plaintiff would have
“severe” problems in her ability to respond
appropriately to work pressures, depending on the particulars
of the job. Id. By way of example, he noted that if
Plaintiff traveled for work (as she did in the past) that she
may “be able to hide her problem”. Id.
Finally, Dr. Misja opined Plaintiff could manage her own
finances. (Tr. 260).
August 2015, Dr. Flowers opined Plaintiff would have some
limits in her ability to understand and carry out
instructions based on the observation that Plaintiff required
repetition of some instructions during the examination. (Tr.
300). Dr. Flowers opined Plaintiff was likely limited in her
ability to perform multi-step tasks. Id. She noted
that, although Plaintiff appeared to be able to sustain
attention and concentration during the appointment, there
were some deficits in this area on examination. Id.
She further noted that Plaintiff reported difficulty
performing multi-step tasks at work in recent years.
Id. She observed Plaintiff appeared anxious during
the appointment and noted this might impact Plaintiff's
ability to respond appropriately to pressures in a work
setting. (Tr. 301). In considering Plaintiff's ability to
respond appropriately to supervisors or coworkers in a work
setting, Dr. Flowers described Plaintiff's subjective
reports of anger and irritability in social settings, but
also found that, during the exam, she was able to interact
appropriately. Id. Further, she pointed out that
Plaintiff's reporting of her socialization abilities was
“somewhat inconsistent”, and she drove with a
friend to her appointment that day. Id.
January 2016, Dr. Hill opined Plaintiff had mild impairment
in her ability to understand, remember, and carry out
instructions due to her impaired remote memory skills and
self-reported difficulties in carrying out instructions. (Tr.
318). She found Plaintiff limited in her ability to maintain
attention and concentration and persistence and pace, as well
as to perform some multi-step instructions, due to her
self-reported distress with her anxiety and depression
symptoms. Id. She opined Plaintiff could perform
simple tasks, and some multi-step tasks. Id. Dr.
Hill further found Plaintiff limited in her ability to
respond appropriately to supervision and coworkers. (Tr.
319). In support, she cited of Plaintiff's depression and
anxiety related symptoms as well as their interactions within
the clinical setting. Id. Finally, Dr. Hill found
Plaintiff limited in her ability to respond appropriately to
work pressures in a work setting due to her observed and
reported symptoms of anxiety and depression. Id.
appeared and testified at the hearing before the ALJ.
See Tr. 77-84. The ALJ asked the VE to consider a
person with Plaintiff's age, education, and vocational
background who was physically and mentally limited in the way
in which the ALJ determined Plaintiff to be. See Tr.
78-80. The VE opined such an individual could not perform
Plaintiff's past work, but could perform other jobs such
as an industrial cleaner, linen room attendant, and a
hospital cleaner. (Tr. 78-81). ALJ Decision In a
written decision dated October 4, 2017, the ALJ found
Plaintiff met the insured status requirements for DIB through
September 30, 2019 and had not engaged in substantial gainful
activity from since her alleged onset date (July 3, 2012).
(Tr. 17). He concluded Plaintiff had severe impairments of:
depression, anxiety, personality disorder, ADHD, degenerative
disc disease, fibroids, and ovarian cysts, but found these
impairments (alone or in combination) did not meet or
medically equal the severity of a listed impairment. (Tr.
18). The ALJ then found Plaintiff had the residual functional
to perform medium work as defined in 20 CFR 404.1567(c)
except for the following limitations. The claimant can
perform occasional left overhead reaching. The claimant
cannot climb ladders, ropes, or scaffolds. The claimant can
have no exposure to hazards such as unprotected heights or
moving mechanical parts. The claimant must avoid concentrated
exposure to dust, odors, fumes, and pulmonary irritants. The
claimant cannot perform work involving fast paced or high
production quota standards. The claimant can have occasional
and superficial interaction with supervisors and coworkers,
meaning no arbitration, mediation, confrontation,
negotiations, supervising ...