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Jennifer Myers v. Michael J. Astrue

June 28, 2011


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


I. Introduction

Plaintiff, Jennifer Myers ("Plaintiff"), brought this action pursuant to 42 U.S.C. §§ 405(g) and 1383(c), for judicial review of the final determination of the Commissioner of Social Security ("Commissioner") which denied her application for disability insurance benefits ("DIB") and supplemental security income ("SSI") under Titles II and XVI of the Social Security Act ("Act"), 42 U.S.C. §§ 401-403; 1381-1383(f).

II. Background

A. Facts

Plaintiff was born on July 18, 1981 and was twenty-seven years old on the date of her administrative hearing, making her a "younger person" whose age does not affect her ability to adjust to other work pursuant to 20 C.F.R. § 416.963. She is a high school graduate, capable of communicating in English, with past relevant work experience as a dental assistant, assembler, and laborer. (R. 24, 25). A vocational expert ("VE") who testified at Plaintiff‟s administrative hearing described the job of dental assistant as light, skilled work, while assembler and laborer are classified as unskilled in nature and require medium-to-heavy exertional work. (R. 34).

Plaintiff went on medical leave from her employment on September 27, 2007, due to depression, anxiety, panic attacks, and syncope. (R. 124). Although she attempted to return to work on November 11, 2007, she stopped working again on January 9, 2008 because her condition had worsened. (R. 13, 25). The administrative law judge considered this an "unsuccessful work attempt," and found that Plaintiff had not engaged in substantial gainful work activity since her onset date. (R. 13, 25).

B. Plaintiff's Mental Health Treatment History

The record reflects that Plaintiff sought treatment at Brookville Hospital on May 29, 2007 experiencing epigastric discomfort. (R. 217). Following abdominal x-rays, which revealed no abnormalities, the attending physician administered a GI cocktail, recommended Prilosec, and instructed Plaintiff to consult her primary care physician, Barry Snyder, M.D., for a follow-up appointment. (R. 218, 220).

The following day, Plaintiff presented to Dr. Snyder, complaining of light-headedness, dizziness, and slight headaches. (R. 328). She underwent a title table study and a CT scan, both of which yielded normal results. (R. 178, 328). However, Plaintiff‟s symptoms persisted, and in early July 2007 she requested a note from Dr. Snyder excusing her from working on the "crating line" at the manufacturing plant where she was employed, which she complained made her feel dizzy. (R. 331). Dr. Snyder provided the note. (R. 332).

Plaintiff returned to Dr. Snyder‟s office on July 27, 2007 reporting that she felt better since starting on Prilosec. (R. 333). In Dr. Snyder‟s assessment, he noted that Plaintiff‟s depression was improved on Prozac; her vasodepressor syncope (normal tilt table study) was improved; and her GERD was controlled on Prilosec. (R. 333).

Office notes of Dr. Snyder reflect that he increased Plaintiff‟s Prozac dose to 40 milligrams on September 19, 2007 after Plaintiff called to report that the medication was not working at its previous level. (R. 336). Plaintiff followed up with Dr. Snyder on September 25, 2007 and complained of fatigue, depression, and difficulty sleeping. (R. 337). She also reported trouble concentrating at work, which led Dr. Snyder to note that "work is a major issue." (R. 337). Accordingly, Dr. Snyder wrote Plaintiff a note excusing her from work until at least October 18, 2007 and advised her to contact psychologist Albert DiGilarmo, Psy.D., to arrange mental health treatment. (R. 337, 339). In addition, Dr. Snyder discontinued Plaintiff‟s Prozac and prescribed a trial dose of Effexor. (R. 337).

Plaintiff‟s initial appointment with Dr. DiGilarmo was on October 1, 2007, at which time he noted that Plaintiff complained of depression and anxiety accompanied by panic attacks. (R. 229). Plaintiff further complained of exhaustion and difficulty sleeping.

(R. 331). Plaintiff stated that her symptoms began approximately ten years ago, but had worsened because of her "financial situation." (R. 332). Upon examination, Plaintiff was assessed with a current Global Assessment of Functioning*fn1 ("GAF") score of 48, with a past-year highest GAF score of 65. (R. 229).

Plaintiff next saw Dr. DiGilarmo on October 10, 2007. (R. 277). At that time she reported the same symptoms she conveyed to Dr. Snyder, namely sadness, depression, worthlessness, and anxiety along with panic. (R. 277). In his notes, Dr. DiGilarmo indicated that Plaintiff‟s depression and anxiety were creating increased obstacles to working. (R. 277). That same day, Dr. DiGilarmo completed a short-term disability insurance form for Plaintiff, opining that Plaintiff‟s "depression and anxiety is preventing her from working productively and safely" through November 15, 2007. (R. 280-82).

At a follow-up appointment with Dr. Snyder on October 18, 2007, Plaintiff‟s depression had improved, as Dr. Snyder‟s notes reflect that Plaintiff appeared more animated and less stressed. (R. 343). Dr. Snyder further noted that Plaintiff‟s GERD was stable on Prilosec, and that her near syncope was stable and no longer required medication. (R. 343).

Four days later Plaintiff returned to Dr. DiGilarmo. (R. 274). Following a mental status examination, Dr. DiGilarmo noted that Plaintiff had poor concentration and moderately impaired self-esteem; however, she exhibited no significant abnormalities. (R. 274). Similarly, at her next appointment, on November 5, 2007, a mental status evaluation revealed moderately decreased motor activity, moderate social withdrawal, and moderate limitations in mood, affect, thought content, and perception. (R. 271). Plaintiff also reported having trouble sleeping. (R. 274). Following the appointment, Dr. DiGilarmo contacted Dr. Snyder to discuss Plaintiff‟s sleep issues, and Dr. Snyder subsequently prescribed Ativan to Plaintiff.

(R. 345). Two weeks later, Plaintiff called Dr. Snyder reporting recurrences of lightheadedness, for which Dr. Snyder again prescribed Atenolol. (R. 346).

On December 13, 2007, Plaintiff presented to Dr. Snyder complaining of pain in her lower abdomen. (R. 356). She was diagnosed with an abscess, for which she was prescribed new medications and granted a five-day medical leave of absence from work. (R. 349, 351-60). Dr. Snyder also indicated that Plaintiff‟s depression had "substantially improved," but that she continued to experience some panic attacks. (R. 356).

At Plaintiff‟s next session with Dr. DiGilarmo, on January 10, 2008, she was assessed as having poor concentration; moderately limited mood, affect, thought content, and perception; and moderate hostility. (R. 260). Dr. DiGilarmo noted that Plaintiff‟s depression and anxiety had worsened. (R. 260). She was also experiencing increased work-related stress. (R. 260). Dr. DiGilarmo indicated that Plaintiff needed a medication re-check, for which he referred her back to Dr. Snyder. (R. 260, 266).

Plaintiff followed up with Dr. Snyder on January 15, 2008 complaining that her depression had not significantly improved despite her medications. (R. 362). Although Dr. Snyder noted that Dr. DiGilarmo felt Plaintiff had suicidal ideation, her mental status examination was normal. (R. 362-63). Dr. Snyder‟s impression was that while Plaintiff‟s depression was not currently controlled, she had shown some improvement since the prior week. (R. 363). He nonetheless increased Plaintiff‟s Trazodone dose and noted that she should be off work. (R. 363). In addition, he recommended exercise to improve Plaintiff‟s mood and weight. (R. 364). Two days later, Dr. DiGilarmo completed a second short-term disability form for Plaintiff, in which he noted that her significant depression, anxiety, and panic attacks continued to prevent her from working. (R. 258-59).

On January 29, 2008, Plaintiff presented to both Dr. Snyder and Dr. DiGilarmo with complaints of stomach pain and fatigue; however, her depression was reportedly better since she stopped working. (R. 257, 367). Dr. Snyder‟s psychological examination of Plaintiff was normal, but he decreased her dose of Effexor and directed her to stay off Trazodone to correct some side effects. (R. 367-68). Two weeks later, Dr. Snyder recorded in his notes that Plaintiff was "off all of her depression medications except Effexor." (R. 374). At a February 21, 2008 follow-up appointment with Dr. Snyder, Plaintiff reported that she was feeling "ok" on her lower dose of Effexor. (R. 396). In addition, she had not experienced any fainting spells and reportedly felt less tired since her last appointment. (R. 396). Thus, Dr. Snyder found that Plaintiff‟s depression was under reasonable control and maintained the levels of her medications. (R. 396). After Plaintiff‟s next appointment, on March 5, 2008, Dr. Snyder indicated that Plaintiff‟s depression was "getting better," but that she remained a "little irritable." (R. 376). As a result, Dr. Snyder adjusted her dose of Effexor. (R. 376). In addition, he indicated that Plaintiff was less fatigued after she discontinued her Atenolol. (R. 376).

On March 10, 2008, Dr. DiGilarmo completed another short-term disability form for Liberty Mutual, in which he assessed a current GAF score of 52. (R. 254). He noted that Plaintiff appeared sad and that her affect was constricted. (R. 252). However, she was well-groomed, well-developed, alert, oriented, and demonstrated good hygiene. (R. 252). Dr. DiGilarmo also noted that Plaintiff‟s immediate memory was poor, but her short-term memory and long-term memory were both good. (R. 252). While Dr. DiGilarmo indicated that he was not familiar with Plaintiff‟s job responsibilities and could not comment on what work-related tasks she could perform, he nonetheless opined that "Plaintiff is currently experiencing depression and anxiety with panic that does interfere with job duties." (R. 253).

During appointments with Dr. DiGilarmo in late March and early April 2008, Plaintiff again reported improvements in her condition. (R. 244-45). Specifically, she indicated that she felt less anxious and less depressed. (R. 244). However, she continued to complain of difficulty sleeping. (R. 244-45).

The next month, on May 27, 2008, Plaintiff returned to Dr. DiGilarmo, reportedly experiencing increased anxiety, depression, and stress. (R. 239). She also related feeling fatigue and vertigo. (R. 239). That same day, in a questionnaire for the state agency, Dr. DiGilarmo indicated that he had been seeing Plaintiff once every two weeks since October 2007 and that her symptoms of depression and anxiety had recently intensified. (R. 291). Dr. DiGilarmo‚Äüs mental status examination of Plaintiff revealed poor concentration, poor short-and long-term memory, a somewhat dysthymic mood and flat affect, somewhat decreased social judgment, diminished insight, and concerns about employability. (R. 291-93). However, Plaintiff had a neat appearance, normal behavior, clear and fluent speech, no hallucinations or ...

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