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Cremens v. Commissioner of Social Security Administration

United States District Court, N.D. Ohio, Eastern Division

August 5, 2019



          James R. Knepp II United States Magistrate Judge.


         Plaintiff Cynthia Cremens[1] (“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”) and supplemental security income (“SSI”). (Doc. 1). The district court has jurisdiction under 42 U.S.C. §§ 1383(c) and 405(g). The parties consented to the undersigned's exercise of jurisdiction in accordance with 28 U.S.C. § 636(c) and Civil Rule 73. (Doc. 11). For the reasons stated below, the undersigned affirms the decision of the Commissioner.

         Procedural Background

         Plaintiff filed for DIB and SSI in September 2014, alleging a disability onset date of August 5, 2010. (Tr. 210-11). Her claims were denied initially and upon reconsideration. (Tr. 126-43). Plaintiff then requested a hearing before an administrative law judge (“ALJ”). (Tr. 145). Plaintiff (represented by counsel), and a vocational expert (“VE”) testified at a hearing before the ALJ on February 22, 2017. (Tr. 27-55). On June 20, 2017, the ALJ found Plaintiff not disabled in a written decision. (Tr. 11-21). The Appeals Council denied Plaintiff's request for review, making the hearing decision the final decision of the Commissioner. (Tr. 1-6); see 20 C.F.R. §§ 404.955, 404.981, 416.1455, 416.1481. Plaintiff timely filed the instant action on May 1, 2018. (Doc. 1).

         Factual Background[2]

         Personal Background and Testimony

         Born in 1970, Plaintiff was 40 years old on her alleged onset date. See Tr. 20, 210. Plaintiff had an eighth-grade education, and stated she could do basic math and read. (Tr. 45). She also reported past work at a radio station. (Tr. 31-32). Plaintiff lost her job after an August 2010 involuntary inpatient psychiatric hospital stay. (Tr. 33-34). Plaintiff also had another psychiatric inpatient admission in the 1990s. (Tr. 35).

         At the time of the hearing, Plaintiff received mental health treatment from the Charak[3]Treatment Center for depression, insomnia, mood swings, rage, “[e]pisodes where [she] tear[s] stuff up”, and blackouts. (Tr. 34-35). Plaintiff testified to feeling “down” more than “up”. (Tr. 35). During a down cycle - which could last “from a couple of days to over a month.” (Tr. 35), Plaintiff did not get out of bed, and ate less (Tr. 36). Plaintiff also testified to rage episodes where she would “get so mad [she] can't remember what [she] do[es]”. (Tr. 36). During such episodes, she had hit her kids, torn up things in her house, and poured a gallon of paint over “everything in [her] house.” (Tr. 36-37). Plaintiff was arrested based on her behavior in the past. (Tr. 37-38).

         Plaintiff had auditory hallucinations of music, talking, or people calling her name. (Tr. 38). Plaintiff testified she had been on psychiatric medication “[o]n and off since the early 90s”. (Tr. 39). She saw Dr. Ranjan[4] “[o]n and off” for about two and a half years. (Tr. 40). She believed that her mental condition was “a lot worse” the past couple of years. Id. She had a “hard time concentrating and remembering”. (Tr. 45).

         Relevant Medical Evidence

         In August 2010, Plaintiff was involuntarily admitted to River Point Behavioral Health for three days after making statements about suicide. (Tr. 309). On discharge, Plaintiff was assessed with bipolar disorder (“seemingly Type II, most recent episode Hypomanic without Psychotic Features in acute exacerbation, now in discrete remission”), alcohol abuse, not otherwise specified, and “[n]ormal grieving (?)”. (Tr. 498). Treatment notes reference the unexpected death of Plaintiff's father. (Tr. 499). Plaintiff was discharged into her family's custody to attend her father's funeral and was noted to be “normally grieving her father's unexpected death”, and at that time manifested no suicidal ideations. Id.

         In November 2014, Plaintiff underwent an intake evaluation with psychologist Charel Khol, with Affiliates in Behavioral Health. (Tr. 398-401). Plaintiff reported having moved to Cleveland in June 2014 after living in Florida. (Tr. 398). She reported past diagnoses of bipolar disorder, panic attacks, and agoraphobia. Id. Plaintiff reported no psychiatric medication for the prior three years. Id. On mental status examination, Plaintiff's general appearance/behavior was appropriate, cooperative, open, alert, oriented, and confused, with good eye contact. (Tr. 400). Her speech was clear, coherent, relevant, and spontaneous. Id. Her cognitive functioning was noted to be within normal limits, but she had immediate memory problems. Id. She had below average intellect and fair insight/judgment. Id. Dr. Khol offered diagnoses of 296.80 (bipolar disorder) and 300.01 (panic disorder).[5] (Tr. 401). He assigned a “[c]urrent” Global Assessment of Functioning (“GAF”) score of 52, and a “[p]ast [y]ear” score of 57.[6] Id. Dr. Khol commented that Plaintiff had a history of mood swings and agoraphobia and had “[n]ever had treatment that is required to manage bipolar.” Id.

         One week later, Plaintiff underwent a psychological consultative examination with Amber L. Hill, Ph.D. (Tr. 341-51). Plaintiff reported she was “off [her] medication” and was applying for disability in part because she was “bipolar, manic depress[ive], borderline suicidal.” (Tr. 341). On examination, Dr. Hill noted Plaintiff was dressed appropriately and was well-groomed. (Tr. 346). She had normal motor behavior and maintained appropriate eye contact. Id. Plaintiff had a coherent thought process and fluent, clear speech. Id. There was no evidence of hallucinations, delusions, or paranoia. Id. Plaintiff's affect was full and appropriate, and mood was “only slightly dysthymic.” (Tr. 347). Dr. Hill did not observe any anxiety in the interview, or in the waiting room. Id. Plaintiff was oriented and her attention, concentration, and recent/remote memory “appeared intact”. Id. Dr. Hill opined Plaintiff's overall intellectual functioning to be “within a below average range”. Id. Dr. Hill assessed persistent depressive disorder (early onset, mild), agoraphobia, and alcohol use disorder (moderate). Id. Dr. Hill opined Plaintiff's prognosis was “guarded” because she was “not currently engaged in any mental health treatment related to her reported mental health concerns and states that she has not had treatment for the past one to two years.” (Tr. 348).

         The following month - December 2014 - Shura Hegde, M.D. (also at Affiliates in Behavioral Health), completed an intake evaluation of Plaintiff. (Tr. 395-96). Plaintiff reported taking Lamictal, for one month, but “ha[d] not been taking it on a regular basis”. (Tr. 395). Plaintiff had mood swings, fatigue, depression, and decreased motivation; she also reported financial stress and not wanting to be around people. Id. Dr. Hegde observed Plaintiff was “in no apparent distress” and reported her mood “was fine”. (Tr. 396). She had an appropriate affect, normal speech, linear thought process, and normal thought content. Id. She denied hallucinations, had intact memory, and limited judgment. Id. Dr. Hegde assessed a history of type two bipolar disorder, severe alcohol use disorder in remission, marijuana use disorder, rule out substance abuse, mood disorder. Id. She assessed a GAF score of “[a]bout 52 to 55”. Id. Dr. Hegde prescribed Seroquel and Brintellix and instructed Plaintiff to follow up with counseling. Id.

         In February 2015, Dr. Khol completed a brief mental status examination form. (Tr. 394). In it, she noted Plaintiff was disheveled, with dirty clothes. Id. Plaintiff had a calm and cooperative attitude, normal speech, and behavior. Id. Her affect was flat and blunted, and her mood was irritable, anxious, and depressed. Id. Her thought processes were disorganized; she did not have suicidal or homicidal ideations, but had fears of leaving home and being around others. Id. She had no perceptual disturbances, and was oriented. Id. She had “some disruption in thoughts”. Id. At the same time, Dr. Khol completed a daily activities questionnaire. (Tr. 392-93). In it, she noted Plaintiff lived with her disabled spouse, and children (ages 22 and 15). (Tr. 392). She noted Plaintiff had difficulty getting along with family and neighbors, but her sister-in-law drove her to appointments. Id. She noted Plaintiff reported that she did not get along with former employers, supervisors, and coworkers because “she's always argumentative and some[times] aggressive.” Id. When asked for examples that might prevent work activities, Dr. Khol noted Plaintiff was easily stressed out, had blacked out at times, had poor concentration and restlessness, did not get out of bed some days, had mood swings, depression, and anxiety, and would not be able to be safe around equipment. Id. She also noted Plaintiff rarely engaged in food preparation (“doesn't pay attention [and] burns meal”) or shopping (“can ‘run in' for a few things w[ith] someone with her”). Id. She observed Plaintiff's personal hygiene was poor. Id. She did not drive and was afraid of public transportation. Id. Dr. Khol described Plaintiff's current treatment as once per month for psychotherapy, and noted Plaintiff saw Dr. Hegde for psychiatric medication. Id.

         Plaintiff saw Rakesh Ranjan, M.D., and Michelle Steele, L.P.N., at the Charak Center for Health and Wellness for a medication review visit in January 2016. (Tr. 447-52). Plaintiff rated her depression as 8/10 and attributed this to the “extra stress” of the holidays, and being off her medication. (Tr. 447). She reported missing an appointment and running out of medication. Id. She reported her symptoms had worsened, with daily panic attacks, poor sleep, and no appetite. Id. She also, however, reported bathing regularly and keeping up with her activities of daily living. Id. She wanted to get back on medication to help with her anxiety, depression, and sleep. Id. On mental status examination, she was noted to be well-groomed, with average eye contact and motor activity. (Tr. 449). Her demeanor was cooperative, and her speech was normal. Id. Her thought content contained no delusions, but she reported auditory and visual hallucinations. Id. Her mood was euthymic and her affect constricted. (Tr. 450). She was oriented, her reasoning ability was intact, and her memory was normal. Id. She was noted to have average insight, fair judgment, normal impulse control, and moderately impaired energy and concentration. Id. Dr. Ranjan continued Plaintiff's medications (Seroquel XR, Lamotrigine, Abilify, and Klonopin). (Tr. 451). She was instructed to continue individual therapy sessions to identify coping mechanisms and stress reduction techniques. Id.

         Opinion Evidence

         At her November 2014 consultative examination, Dr. Hill offered an opinion regarding Plaintiff's limitations. (Tr. 349-51). She opined Plaintiff appeared able to understand, remember, and carry out instructions and that there “does not appear to be any significant limitation in this area.” (Tr. 349). She noted Plaintiff appeared able to maintain attention and concentration and perform simple and multi-step tasks “as evidenced by her presentation within the clinical interview setting, her performance on the mental status exam tasks, and her reported daily functioning, in which she completes numerous multi-step tasks independently[.]” Id. She noted Plaintiff “may have some limitation in maintaining persistence and pace” due to her depression symptoms, but noted that she “might have improvements in this area if she were to engage in mental health treatment, such as counseling and therapy or medical for possibly symptom control or relief.” Id. Dr. Hill also opined Plaintiff appeared able to respond appropriately to supervisors and coworkers in a work setting based on her conduct during the interview, and her “report of positive socialization in her life”. (Tr. 350). She acknowledged Plaintiff's self-reported agoraphobia, “which could possibly cause difficulty in this area”, but noted she had not observed such symptoms in the interview or the waiting area, and that it was “difficult to determine” whether mental health treatment” would help with this. Id. Finally, Dr. Hill opined Plaintiff “may have some difficulty” responding appropriately to work pressures in a work setting based on her reported agoraphobia and alcohol use. Id. Dr. Hill continued:

Having said that, the claimant's reported concerns with anxiety related symptomatology of agoraphobia were not observed within the clinical interview setting. Further, the claimant did not report any difficulty in this area in her reported work history. It is possible if the claimant were to engage in mental health treatment, such as counseling and therapy or medication, that she could have positive benefit, including symptom control or relief in this area.

(Tr. 350-51).

         In February 2015, Dr. Khol completed a mental status questionnaire. (Tr. 389-91). Dr. Khol noted she first saw Plaintiff on November 18, 2014, and had last seen her on February 16, 2015 (the date on the questionnaire). (Tr. 389). Dr. Khol observed Plaintiff was disheveled, with a depressed, anxious, and irritated mood, and a flat and blunted affect. (Tr. 389). She noted Plaintiff cried when anxious and did not like to be around others or leave her home. Id. Dr. Khol observed Plaintiff's concentration was very poor and it was difficult for her to focus on one topic. Id. (“mind wanders during sessions”). Further, Dr. Khol noted Plaintiff reported throwing things at home, or sometimes “black[ed]” out (not from alcohol) and did not remember her actions. Id. Dr. Khol opined Plaintiff could remember, understand, and follow directions “[i]f written down” due to memory problems. (Tr. 390). She opined Plaintiff had a “poor” ability to maintain attention because she “tends to jump to other areas” or “turn off if a problem or conflict” arises. Id. Dr. Khol also opined Plaintiff could not sustain concentration, persist at tasks, or complete them in a timely fashion, observing: “takes long time to complete tasks - problems with organizing thoughts and plan[ning] ahead.” Id. Dr. Khol also observed Plaintiff had “great difficulty” in social interaction and stayed away from others, noting by way of example that she did not shop for many things, but sent family members instead. Id. Dr. Khol also opined Plaintiff would not be able to make adjustments to work pressures because she is “extremely anxious in situations that she perceives as unknown and trapped”. Id.

         Also in February 2015, state agency reviewing psychologist Juliette Savitscus, Ph.D., reviewed Plaintiff's records and opined Plaintiff was moderately limited in social functioning and maintaining concentration, persistence or pace, and mildly limited in activities of daily living. (Tr. 64). Dr. Savitscus opined Plaintiff was moderately limited in her ability to work in coordination with or in proximity to others without being distracted and moderately limited in her ability to complete a normal workday and workweek without interruptions from psychologically based symptoms and to perform at a consistent pace. (Tr. 67-68). She opined Plaintiff could “perform simple and moderately complex tasks (1-4 steps) in a work environment without fast-paced production standards.” (Tr. 68). Dr. Savitscus also opined Plaintiff was moderately limited in her ability to interact with the general public, but “retain[ed] the ability to work in a setting requiring infrequent and superficial interactions with the public.” (Tr. 68-69). Finally, she opined Plaintiff was moderately limited in her ability to respond appropriately to changes in the work setting, but “retain[ed] the ability to function in an environment with infrequent changes that can be explained in advance.” (Tr. 69).Within her opinion, Dr. Savitscus noted where her opinion diverged from Dr. Khol's opinion. See Tr. 65, 67-69.

         In May 2015, the State agency sent Affiliates in Behavioral Health a Mental Status Questionnaire and Daily Activities Questionnaire forms. (Tr. 404-09). The forms were returned with a handwritten note: “Was seen by physician only 1 time this year. Dr. will not fill out!!!” (Tr. 405).

         In August 2015, Paul Tangeman, Ph.D., affirmed Dr. Savitscus's opinion. (Tr. 102-04).

         In September 2015, Dr. Ranjan and Kelly Stevenson, LISW, completed a form entitled “Medical Source Statement: Patient's Mental Capacity”. (Tr. 440-41). In it, they opined Plaintiff could rarely: use judgment, maintain attention and concentration for extended periods of 2 hour segments, maintain regular attendance and be punctual, deal with the public, interact with supervisors, function independently without redirection, work in coordination with or proximity to others without being distracted, complete a normal workday and workweek without interruption from psychologically based symptoms and perform at a consistent pace without an unreasonable number and length of rest periods, understand, remember, and carry out complex job instructions, relate predictably in social situations, and manage funds/schedules. Id. Plaintiff could occasionally: follow work rules, respond appropriately to changes in routine settings, relate to coworkers, work in coordination with or proximity to others without being distracted, deal with work stress, understand, remember and carry out simple or complex job instructions, socialize, behave in an emotionally stable manner, and leave home on her own. Id. She could frequently maintain her appearance. (Tr. 441). As the diagnoses and symptoms to support the assessment, they noted:

(1) bipolar [disorder] 1, mixed, severe with psychotic features - sad mood, anhedonia, low energy, low self-esteem, poor focus, sleep disturbance, auditory hallucinations, impulsive spending, psychomotor agitation, racing thoughts, pressured speech, (2) panic [disorder] [with] agoraphobia. Severe panic attacks every 2 mo[nths] or so, minor ...

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