The opinion of the court was delivered by: McLAUGHLIN, Sean J., District Judge.
Plaintiff, Lucretia Pulos ("Plaintiff"), 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 denying her claims for disability insurance benefits ("DIB") and supplemental security income ("SSI") under Titles II and XVI of the Social Security Act, 42 U.S.C. § 401 et seq, and § 1381 et seq. Plaintiff filed applications for DIB and SSI on March 4, 2005, alleging disability since February 10, 2001 due to obsessive compulsive disorder, depression, asthma, back and knee pain and endometriosis (Administrative Record, hereinafter "AR", 68-70; 94).*fn1
Her applications were denied and she requested a hearing before an administrative law judge ("ALJ") (AR 59-64). A hearing was held before an administrative law judge ("ALJ") on May 27, 2007 and following this hearing, the ALJ concluded that the Plaintiff was not entitled to a period of disability, DIB or SSI under the Act (AR 12-20). Her request for review by the Appeals Council was denied (AR 4-7), 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, the Defendant's motion will be denied and the Plaintiff's motion will be granted only to the extent she seeks a remand for further consideration.
Plaintiff was thirty-three years old on the date of the ALJ's decision (AR 91). She is a high school graduate but attended special education classes while in high school (AR 100). She has past relevant work experience as a home health care attendant and fast food cashier (AR 102).
Plaintiff was seen on July 25, 2003 at Community Integration, Inc. for medication management and was reportedly working three jobs at that time (AR 224).*fn2 Plaintiff further indicated that she was "doing well," her moods were more stable and she denied any suicidal thoughts (AR 224). On mental status examination, her mood, affect and cognition were reported as normal, and she was pleasant and cooperative (AR 224). She was assessed with a Global Assessment of Functioning ("GAF") score of 55 (AR 165).*fn3
Plaintiff presented to Millcreek Community Hospital on August 15, 2003 complaining of suicidal thoughts related to child custody issues, health problems and a recent rape (AR 152-155). She was transferred to the Stairways, Inc. residential unit where she spent three days undergoing counseling and was prescribed Zoloft (AR 155-160). She was subsequently discharged on August 18, 2003 in stable condition free of suicidal thoughts (AR 155).
Community Integration medication progress notes dated September 11, 2003 show that the Plaintiff complained of anxiety and depression on that date (AR 223). On mental status examination, her mood was depressed, her affect was anxious and she denied any suicidal thoughts (AR 223). She was assigned a GAF score of 50 and her medication regimen stayed the same (AR 223).*fn4
On November 18, 2003, Plaintiff reported to Community Integration that she was recently promoted at work (AR 222). Her mood and affect were reported as normal and she was pleasant and cooperative (AR 222). Plaintiff had no acute complaints and it was noted she was "doing well" on Zoloft (AR 222). She was assessed a GAF score of 55 (AR 222).
When seen on April 12, 2004, Plaintiff requested a psychiatric evaluation (AR 221). It was noted that she had no acute depressive symptoms, but "admit[ted]" to unspecified obsessive compulsive behavior (AR 221). Her mood, affect and behavior were all within normal limits, yet she was assessed a GAF score of 50 (AR 221).
Plaintiff subsequently underwent a psychiatric evaluation on April 28, 2004 conducted by Jaime Ayala, M.D. at Safe Harbor Behavioral Health (AR 219-220). Dr. Ayala noted that the Plaintiff had been diagnosed with major depressive disorder, recurrent (AR 219). It was further noted that the Plaintiff had attended individual and group therapy sessions in earlier years but became "disenchanted" with those services (AR 219). Dr. Ayala indicated that the Plaintiff was quite active with both of her children who were doing very well in school, and also assisted her sister with one of her children (AR 219). Plaintiff stated that she was not able to work beyond 15 hours per week because she lacked daycare services for her children (AR 219). Dr. Ayala reported that the Plaintiff managed to do well despite her depressive outlook of a "dysthymic nature" (AR 219).
In Dr. Ayala's mental status examination of the Plaintiff, he noted that she was dysphoric*fn5 and preoccupied with ensuring an adequate support system for her children (AR 219). She denied suffering from any sleep disorder or having suicidal thoughts (AR 219). She acknowledged irritability and at times being short-tempered with her children, but recognized this as a sign of stress (AR 219). Dr. Ayala reported that the Plaintiff appeared "motivated for vocational rehabilitation" (AR 219). He diagnosed the Plaintiff with "[m]ajor [d]epression, recurrent, in partial remission, [r]ule out [d]ysthymic [d]isorder," and assigned her a GAF score of 50 (AR 220). Dr. Ayala recommended that her medications remain at the same level and that she consider a referral to vocational rehabilitation (AR 220). He characterized her prognosis as "favorable" (AR 220).
When seen for medication management on July 12, 2004, the Plaintiff was pleasant and cooperative, and her mood, affect and cognition were within normal limits (AR 218). It was noted that she was doing well on Zoloft and she was assessed a GAF score of 55 (AR 218).
On October 12, 2004, Plaintiff reported that her depression continued and she was currently homeless but staying with friends (AR 217). It was noted that she was pleasant and cooperative and exhibited a "good attitude" (AR 217). Her mood, affect and cognition were within normal limits (AR 217). No acute psychotic or depressive state was observed or reported, and the Plaintiff was stable with a GAF score of 50 (AR 217). She was encouraged to stay on her medication and return for follow up in three months (AR 217).
When seen at Safe Harbor Behavioral Health on January 5, 2005, Plaintiff reported that she was "overwhelmed" and homeless, and complained of increased depression, anxiety and confusion (AR 216). She further reported she was in a shelter with no income and was unable to work (AR 216). Her mood was reported as depressed, she exhibited an anxious affect and displayed evidence of "thought blocking"*fn6 (AR 216). She was assessed a GAF score of 45 and encouraged to apply for temporary disability (AR 216).
When she returned on February 24, 2005, Plaintiff presented as depressed, anxious and irritable but there was no evidence of thought blocking (AR 215). She continued to complain of depression and was distressed about her current living situation (AR 215). Plaintiff reported increased mood swings, but denied suffering from any suicidal or homicidal thoughts (AR 215). Her Zoloft dosage was decreased, Wellbutrin was added for depression and Topamax for mood stability (AR 215). She was assessed with a GAF score of 45 to 50 (AR 215).
On April 20, 2005, Plaintiff underwent a psychological evaluation performed by Isis Kuczaj, Clinical Psychology Intern, at Saint Vincent Outpatient Behavioral Services, who noted that the Plaintiff began treatment at the facility in February 2005 for depression and a "lying disorder" (AR 229). Plaintiff reportedly told a friend she had cancer and was undergoing chemotherapy in order to induce the friend to offer her a place to stay (AR 236). She indicated that her dishonesty had "gotten her into trouble" almost causing her to lose custody of her children (AR 229). Ms. Kuczaj reported that the Plaintiff was pleasant and cooperative and her thought processes were "connected and organized" (AR 230). Ms. Kuczaj noted that the Plaintiff showed "few signs of remorse" for her actions (AR 230).
Ms. Kuczaj administered the Minnesota Multiphasic Personality Inventory-2 ("MMPI-2"), and concluded that the results were invalid because, in her view, the Plaintiff answered items in such a way as to present herself with severe psychopathology (AR 230). She noted that the Plaintiff's production of a "fake-bad" MMPI-2 profile was consistent with her compulsive lying problem (AR 230). Ms. Kuczaj found that the Plaintiff's problems would be difficult to address in treatment because the Plaintiff felt compelled to exaggerate her condition to therapists (AR 230). Due to the production of what she considered to be an invalid profile, Ms. Kuczaj did not render a diagnostic impression (AR 230).
On May 23, 2005, Gloria Kieffer, M.A., a psychologist at Saint Vincent, reported that the Plaintiff had been in outpatient counseling since January 2005 for depression and by the Plaintiff's definition, a "lying disorder" (AR 232). According to Ms. Kieffer, the Plaintiff seemed remorseful for her pattern of dishonesty and its consequences (AR 232). It was noted that the Plaintiff had a documented history of extensive childhood abuse and numerous foster placements (AR 232). Ms. Kieffer reported that the Plaintiff's treatment had been sporadic with "very inconsistent involvement" and that she had only kept 9 out of 16 scheduled appointments (AR 232). She indicated that the Plaintiff was a poor candidate for ongoing treatment due to her non-compliance with Saint Vincent's "no show" policy (AR 232). Ms. Kieffer diagnosed the Plaintiff with major depressive disorder, in partial remission, post traumatic stress disorder and personality disorder, not otherwise specified (AR 232). She assigned her a GAF score of 60 (AR 232).
On July 8, 2005, Ray Milke, Ph.D., a state agency reviewing psychologist, completed a Mental Residual Functional Capacity Assessment form, and found that the Plaintiff was not significantly limited in a number of areas, but was moderately limited in her ability to understand, remember and carry out detailed instructions; maintain attention and concentration for extended periods; perform activities within a schedule, maintain regular attendance and maintain punctuality; and complete a normal workday/workweek without interruptions from psychologically based symptoms (AR 279-280). Dr. Milke also concluded that she was moderately limited in her ability to interact appropriately with the general public; accept instructions and respond ...