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Shreve v. Astrue

January 20, 2009


The opinion of the court was delivered by: Sean J. McLAUGHLIN, J.


Plaintiff, Thomas B. Shreve, commenced the instant action pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3), seeking judicial review of the final decision of the Commissioner of Social Security, who found that he was not entitled to supplemental security income ("SSI") under Title XVI of the Social Security Act, 42 U.S.C. §§ 1381-1383f. Plaintiff filed an application for SSI on September 9, 2005, alleging that he was disabled since May 31, 2004 due to anxiety and depression (Administrative Record, hereinafter "AR", at 40-42; 69). His application was denied and Plaintiff requested a hearing before an administrative law judge ("ALJ") (AR 34-39). A hearing was held on October 19, 2007 and following this hearing, the ALJ found that Plaintiff was not disabled at any time through the date of his decision and therefore was not eligible for SSI benefits (AR 16-29; 293-311). Plaintiff's request for review by the Appeals Council was denied (AR 5-8), rendering the Commissioner's decision final under 42 U.S.C. § 405(g). The instant action challenges the ALJ's decision. Presently pending before the Court are cross-motions for summary judgment. For the reasons set forth below, we will deny the Plaintiff's motion and grant the Defendant's motion.


Plaintiff was born on August 29, 1975 and was 32 years old at the time of the ALJ's decision (AR 20). He graduated from Clarion University in 2002 with a degree in fine arts with a major in graphic design (AR 193-194). Since graduation, he has worked for periods of several months as a barista, a gallery assistant and as a graphic designer for a newspaper (AR 70).

Plaintiff's medical records reflect a history of psychiatric treatment and/or hospitalizations due to depression and alcohol abuse. He was treated by Roberta Kahler, M.D. for his complaints of depression who prescribed medication (AR 131-136). On July 14, 2004, Plaintiff reported by telephone that the Prozac prescribed by Dr. Kahler was not working (AR 136).

On July 19, 2004, Plaintiff was evaluated at the Venango County Mental Health Center (AR 193). He reported a two or three year history of depression, stating that "many of his issues" were related to the fact he had a college degree and was unable to locate employment in the area (AR 193). He indicated that it was difficult to find a job and he was receiving Department of Public Welfare funds (AR 193). Plaintiff admitted that he abused alcohol and reportedly began drinking in 2000 when his wife left him (AR 194). He stated that he last used alcohol in May 2004, prior to undergoing detoxification at Turning Point Chemical Dependency Treatment Center and had recently begun attending Intensive Outpatient (IOP) sessions for substance abuse (AR 193-194). Plaintiff complained of mild panic attacks, poor concentration, mood swings and feeling emotionally distanced from people (AR 194). He reported suicidal ideation but no plan and stated that his self-esteem fluctuated with his moods (AR 194). Plaintiff reported that he took Prozac as prescribed by Dr. Kahler, who suggested he seek psychiatric counseling for his anxiety and depression (AR 194). Plaintiff was scheduled for outpatient counseling (AR 195).

Plaintiff underwent a psychiatric evaluation at the Regional Counseling Center on September 14, 2004 performed by Caryn Dudinsky, P.A. (AR 265-267). He complained of depression and increased anxiety due to moving back home and unemployment in his chosen field (AR 265). Plaintiff reported that he discontinued taking Zoloft as prescribed by Dr. Kahler and did not find Prozac to be helpful (AR 265). He admitted to a past history of alcohol abuse and undergoing drug and alcohol treatment, but claimed he had been sober since May 2004 (AR 265). Plaintiff reported that living with his parents was better than being homeless and that he was contemplating applying for disability in the hopes of being able to live on his own (AR 266). On mental status examination, Ms. Dudinsky noted that Plaintiff's mood was depressed, his affect was eythymic, although he was able to smile and laugh a bit at times (AR 266). His thought processes were linear and coherent and his intelligence was above average (AR 266).

Ms. Dudinski diagnosed him with general anxiety disorder, dysthymia, major depressive disorder episode in the past and alcohol dependence in early remission (AR 266). She assigned him a Global Assessment of Functioning ("GAF") score of 50*fn1 and prescribed a trial of Gabitril and Wellbutrin (AR 267).

Plaintiff returned to the Regional Counseling Center on November 10, 2004 and reported that he was without medication for approximately one month since he lost his medical access card (AR 264). He indicated that Wellbutrin helped his mood and the Gabitril was very helpful for his anxiety (AR 264). Ms. Dudinsky noted that his mood was fair, his affect was appropriate, his eye contact was good and his thoughts were coherent (AR 264). She assessed Plaintiff with a history of generalized anxiety disorder, dysthymia, major depressive disorder and alcohol dependence (AR 264). She continued his current medication regime since he seemed to be doing fairly well (AR 264).

When seen by Ms. Dudinsky on December 22, 2004, Plaintiff reported that he continued to do well overall in terms of his anxiety but was more depressed (AR 263). His mood was fair, somewhat more downcast, but his thoughts were coherent (AR 263). Her assessment remained the same and she added Lexapro to his medication regime (AR 263).

Plaintiff was apparently again admitted to Turning Point on July 31, 2005 and was discharged on August 16, 2005 after successfully completing the program (AR 137).

In August 2005, Dr. Kahler completed a Pennsylvania Department of Public Welfare Employability Assessment Form stating that Plaintiff was temporarily disabled from February 20, 2005 until February 20, 2006 due to severe depression (AR 139). Dr. Kahler also completed a Health-Sustaining Medication Assessment Form on August 23, 2005 and indicated that Plaintiff suffered from severe depression, was taking Wellbutrin and was incapacitated when not on medication (AR 138).

On October 5, 2005, Plaintiff returned to the Regional Counseling Center for a medication management visit and was seen by Janis Pastorius, PA-C (AR 262). He complained of depression and increased anxiety, but was not taking his medications because he was "out of his Medicaid [c]ard" (AR 262). Plaintiff claimed that his primary care physician gave him medication samples but they did not alleviate his symptoms (AR 262). On mental status examination, Ms. Pastorius reported that his eye contact was good, his mood was depressed with his affect appropriate to his mood, and his thoughts were logical and well organized (AR 262). Ms. Pastorius assessed Plaintiff with a history of generalized anxiety disorder, dysthymia, major depressive disorder and alcohol dependence (AR 262). She started him on Seroquel and Paxil and he was given a coupon for free medications (AR 262).

When seen by Ms. Pastorius on November 30, 2005, he reported an improvement in his anxiety since beginning the Paxil (AR 261). He was able to leave home and appear in public places, and he reportedly held an art show at a local coffee shop and sold a painting (AR 261). He reported no depressive symptoms and was sleeping and eating well (AR 261). On mental status examination, Plaintiff exhibited good eye contact, his speech was clear and coherent, his mood was less anxious, with his affect appropriate to his mood, and his thoughts were logical and well organized (AR 261). Ms. Pastorius' assessment remained unchanged and she increased his Paxil dosage and continued him on Seroquel (AR 261).

On December 18, 2005, Plaintiff presented to the UPMC Northwest Hospital for voluntary admission due to depression (AR 147). He complained of sleep disturbance, poor appetite, low energy level, feeling tired, hopeless, helpless and poor concentration (AR 147). He reported taking Paxil and Seroquel with poor response (AR 147). His alcohol level was 140 mg/dl upon admission (AR 147). He reported a history of DUI's and blackouts following alcohol consumption and indicated that he typically drank 20 beers and usually passed out once every few weeks from drinking (AR 162). It was recommended that he work with a counselor to address his drug and alcohol problem and attend Alcoholics Anonymous meetings (AR 164). Plaintiff was treated with Effexor and Seroquel and gradually improved during his four-day hospitalization (AR 147). His diagnosis on discharge was major depressive disorder recurrent and alcohol dependence (AR 146). Plaintiff's GAF score upon discharge was 50 (AR 146).

On January 27, 2006, Plaintiff underwent a clinical psychological disability evaluation performed by Robert P. Craig, Ph.D. pursuant to the request of the Commissioner (AR 168-171). Plaintiff claimed disability based on anxiety and depression (AR 168). Dr. Craig reported that he was attentive, cooperative and alert during the evaluation (AR 168). Plaintiff reported that he was "let go" from his job at the newspaper because he was not fast enough and when things became stressful he "shut down" (AR 169). He stated that he had recently been hospitalized for about five days at Northwest Behavioral Health Center, had been undergoing counseling at the Regional County Counseling Center since June 2004 and was on Effexor and Seroquel (AR 169).

On mental status examination, Dr. Craig reported that Plaintiff "presented well" and his behavior and psychomotor activities were within normal limits, although he slowed somewhat as the interview progressed (AR 169). His impulse was good, there were no significant indicators of acting out behaviors and no indications of any homicidal or suicidal ideations (AR 169). Plaintiff reported that he experienced free-floating anxiety but had no feelings of depersonalization or derealization (AR 170). He stated that he "bundled up" his anger and sometimes "worr[ied] about the future" (AR 170). He reported that his medication helped him become more active and he was able to do things around the house and manage his finances (AR 170). Dr. Craig reported that he was able to answer a variety of similarities easily, perform serial 7's and perform simple multiplication and division (AR 170). Plaintiff described his remote and long-term memory as "pretty good" and his recent past memory and recent memory was good (AR 170). In general, Plaintiff's decision making skills were in the fair to average range (AR 170). Dr. Craig diagnosed Plaintiff with adjustment disorder with depression, rule out depressive disorder not otherwise specified and assigned him a GAF score of 59*fn2 (AR 170-171). Dr. Craig did not impose any work-related limitations (AR 172-173).

On March 3, 2006, Douglas Schiller, Ph.D., a state agency reviewing psychologist, reviewed the evidence of record and found that Plaintiff was mildly limited in his daily activities, moderately limited in social functioning and in concentration, persistence and pace, and had experienced one to two episodes of decompensation (AR 184). Dr. Schiller completed a Mental Residual Functional Capacity Assessment form and opined that Plaintiff was "not significantly limited" or only "moderately limited" in all areas of mental work functioning (AR 188-189). He considered Plaintiff's medically determinable impairments as depression and alcoholism (AR 190). Dr. Schiller considered Dr. Craig's report and accorded his opinions great weight (AR 190). Dr. Schiller concluded that Plaintiff was able to carry out very short, simple instructions and had no restrictions in his abilities with regards to basic understanding and memory (AR 190). He found that Plaintiff appeared to be able to meet the basic demands of competitive work on a sustained basis despite the limitations resulting from his impairments (AR 190).

Plaintiff returned to the Regional Counseling Center on March 13, 2006 and relayed the circumstances of his previous hospitalization in December 2005 for severe depression (AR 259). He reported that at the time of his admission he was self medicating with alcohol, but claimed that he had not had any alcohol since his discharge from the hospital (AR 259). He reported that he continued to have depression and anxiety symptoms (AR 259). He claimed that while the Effexor was helping, it wore off during the day (AR 259). Plaintiff requested a reduction in his Seroquel dosage stating it caused over sedation the following day (AR 259). He reported continued financial stresses, stating that he had hoped to use Social Security benefits, which were recently denied, to move out on his own and continue his art work (AR 259). On mental status examination, Ms. Pastorius reported that Plaintiff had good eye contact, clear and coherent speech, a fair mood and logical and well organized thoughts (AR 259). He denied any suicidal or homicidal ideations, intent or plan (AR 259). Ms. Pastorius assessed him with generalized anxiety disorder, dysthymic disorder, major depressive disorder and continuous alcohol dependence (AR 259). Plaintiff was referred to the partial hospitalization program for drug and alcohol treatment but refused (AR 259). He also refused both inpatient rehabilitation and outpatient drug and alcohol counseling (AR 259). Ms. Pastorius advised him to abstain from alcohol, increased his Effexor dosage and reduce his Seroquel dosage (AR 259).

Plaintiff again presented to the UPMC Northwest Hospital for voluntary admission on March 13, 2006 due to depression (AR 216-246). He complained of increased sadness, depression, poor sleep and "binge drinking" (AR 216; 231). He also reported "huffing" the past month (AR 218). Plaintiff's blood alcohol level on arrival was 300 mg/dl and he expressed suicidal ideations (AR 231). Yogesh D. Maru, M.D., reported that Plaintiff's hospital course was significant for gradual improvement in his mood, symptoms, thinking and affect with biopsychosocial interventions (AR 231). His Effexor was increased and his Seroquel dosage was reduced (AR 231). Dr. Maru reported that Plaintiff participated in psychological and social services, learning extra skills to cope with stress, and his alcohol dependence issues were addressed (AR 231). His discharge diagnosis was major depressive disorder, recurrent and alcohol dependence (AR 232). Dr. Maru reported that on discharge, Plaintiff had a stable affect, his mood was pleasant and good, his thought process was goal directed and he denied any suicidal ...

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