The opinion of the court was delivered by: Nora Barry Fischer U.S. District Court
Erika Bryant Sargent ("Plaintiff") brings this 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 ("Commissioner") denying her application for disability insurance benefits ("DIB") and supplemental security income ("SSI") benefits under Titles II and XVI of the Social Security Act ("Act"). 42 U.S.C. §§ 401--433, 1381--1383(f). The record has been developed at the administrative level. For the following reasons, the Court finds that the decision of the Administrative Law Judge ("ALJ") is supported by substantial evidence. Therefore, the Commissioner's Motion for Summary Judgment (Docket No. 11) is GRANTED and the Plaintiff's Motion for Summary Judgment (Docket No. 6) is DENIED.
Plaintiff filed for DIB and SSI benefits with the Social Security Administration on January 5, 2009, claiming an inability to work due to disability as of May 15, 2007. (R. at 13)*fn1 .
Plaintiff was initially denied benefits on March 23, 2009. (R. at 13). A hearing was scheduled for August 13, 2009, and Plaintiff appeared to testify represented by counsel. (R. at 13). A vocational expert also testified. (R. at 13). The Administrative Law Judge ("ALJ") issued a decision denying benefits to Plaintiff on September 14, 2009. (R. at 13‒22). Plaintiff filed a request for review of the ALJ's decision by the Appeals Council, which was denied on January 19, 2011, thereby making the decision of the ALJ the final decision of the Commissioner. (R. at 6‒8).
Plaintiff filed her Complaint in this Court on February 10, 2011. (Docket No. 1). Defendant filed his Answer on April 15, 2011. (Docket No. 2). Cross motions for summary judgment followed. (Docket Nos. 6, 11).
Plaintiff was born on March 8, 1987, making her 20 years old at the alleged onset date (May 15, 2007) and 22 years old at the time of her hearing before the ALJ (August 13, 2009). (R. at 13). She was born in Washington, Pennsylvania and raised in Richeyville, Pennsylvania. (R. at 111). Her parents divorced around 2008. (Id.). Plaintiff‟s mother reportedly has bipolar disorder with depression and her brother has substance abuse issues. (Id.). When Plaintiff was 11 years old she was sexually abused by a man (her current husband‟s cousin) while baby-sitting his children; this abuse reportedly continued for a year and a half until it was discovered. (Id.). Plaintiff completed the 10th grade and has not earned a GED. (R. at 323). She last worked in May 2007 as a nursing assistant. (Id.). Plaintiff married in October 2008. (R. at 111). Her husband worked at a steel mill but was laid off in December 2008. (Id.). He began receiving $1,420 monthly in unemployment compensation in January 2009. (R. at 314).
B. Plaintiff's Medical Background
In Plaintiff‟s Disability Report form, she claims disability due to hepatitis C, history of drug abuse, depression, and methadone maintenance. (R. at 57). She claimed that she stopped working "because of [her] condition," although she testified before the ALJ that she stopped working in May 2007 because of her pregnancy. (R. at 57, 323). In her Supplemental Function Questionnaire, Plaintiff reported that her fatigue "has been progressing over the last 2 years" and that she is fatigued "all day long." (R. at 75). She described pain "in my lower back, legs, and right side," that has progressively worsened and continues throughout the day. (R. at 76). Plaintiff associated this pain with her hepatitis C. (Id.).
On April 12, 2007, Plaintiff saw Dr. Dawson Lim in Monongahela, PA. (R. at 252). Dr. Lim documented that approximately a year earlier Plaintiff had been diagnosed with hepatitis C*fn2 by a doctor in Uniontown, but that Plaintiff had not received follow-up treatment. (Id.). Dr. Lim noted that Plaintiff complained of "easy fatiguing and weakness, sometimes profound" during the previous four to five months. (Id.). He assessed that "these symptoms may or may not be related to her hepatitis C," and he recommended further workup. (Id.).
Plaintiff began seeing Dr. Hossam Kandil, MD at the University of Pittsburgh Medical Center on November 23, 2007 for hepatitis C, genotype 1.*fn3 (R. at 90, 94‒95). At this visit, Dr. Kandil noted that Plaintiff complained of "occasional nausea and occasional vomiting. Otherwise, [she] denies any symptoms." (Id.). Plaintiff was 32-weeks pregnant at this visit, and Dr. Kandil recommended delaying hepatitis C treatment until after delivery. (Id.).
On June 2, 2008 Plaintiff followed up with Dr. Kandil. (R. at 90). He noted that they chose to wait until Plaintiff‟s son was two years old before starting hepatitis C treatment because of her current childcare demands. (Id.). At this visit, Plaintiff was "overall doing well" and "denie[d] any symptoms." (Id.). When Plaintiff saw Dr. Kandil again on December 9, 2008, she complained of "extreme fatigue and lack of sleep because of her childcare [demands] and occasional [.] fainting." (R. at 86). She also described stress at home related to her husband losing his job. (Id.). Dr. Kandil assessed that these symptoms were probably caused by poor sleep, inadequate dietary intake, and stress, rather than by hepatitis C. (R. at 87).
On January 20, 2009, Plaintiff began seeing Dr. R. Fraser Stokes, MD and his associates at Southwestern Gastrointestinal Specialists, P.C. for her hepatitis C treatment. (R. at 133). Dr. Stokes explained that Plaintiff moved her care from Dr. Kandil because she felt that Dr. Kandil ""kept her in the dark.‟" (Id.). At this visit, Plaintiff reported fatigue. (Id.). An ultrasound on January 26, 2009 showed that Plaintiff‟s liver was "normal other than limited evaluation of the pancreatic tail." (R. at 232). On February 24, 2009, Dr. Stokes and Plaintiff decided to start active hepatitis treatment. (Id. at 135). On March 13, 2009, Plaintiff began treatment, including Pegasys (Interferon)*fn4 injections of 180 mg weekly and ribavarin*fn5 twice daily. (Id. at 137). She experienced "significant flu-like symptoms" during her first week of treatment but continued to take the medications. (R. at 138).
On March 16 and March 20, 2009, Plaintiff asked Dr. Stokes for documentation of her hepatitis treatment to provide to her husband‟s employer so that he could take a leave from work. (Id.). Plaintiff expressed concerns about caring for her 14-month old baby because of the side effects she was experiencing as a result of her treatment. (Id.). Dr. Stokes declined to provide this documentation unless Plaintiff "would become disabled from the side effects which is rare." (Id.).
During her subsequent appointments with Dr. Stokes‟s colleague, Dr.
Frederick W. Ruthardt, M.D. on April 10, 2009 and May 8, 2009,
Plaintiff continued complaining of flu-like symptoms, including
dizziness, fatigue, nausea, and decreased appetite. (R. at 139‒143).
Plaintiff also began complaining of blurred vision, heartburn, burning
of the tongue, and anxiety attacks, with which Plaintiff reported
chest pain, shortness of breath, and sweaty palms. (R. at
139, 141--142). Dr. Ruthardt prescribed 20 mg Omeprazole*fn6
daily to treat the heartburn and 0.25 mg Xanax*fn7
every eight hours as needed to treat the anxiety. (R. at
141-143). After four weeks of treatment, Plaintiff‟s viral load was
"undetectable . . . which is an excellent prognostic indicator," and
the hepatitis treatment continued. (R. at 141). Dr. Ruthardt suspected
that some of Plaintiff‟s symptoms were caused by anemia and referred
her to a hematologist, Dr. Peracha for evaluation. (R. at 141--142).
On June 1, 2009, Plaintiff saw Dr. Sajid M. Peracha, M.D. at UPMC Cancer Centers in Uniontown for an anemia work-up. (R. at 276--278). He prescribed for Plaintiff injections of Aranesp*fn8 200 mcg every two weeks. (R. at 276, 278). On August 6, 2009, Plaintiff complained of right upper quadrant tenderness, which Dr. Peracha assessed may be caused by an infection. (Id.). He documented that Plaintiff "is tired to the point where she cannot even help her son get ready without taking a break." (Id.). Finding that Plaintiff‟s hemoglobin level remained low, Dr. Peracha increased the Aranesp dose to 300 mcg. (Id.).
Plaintiff began substance abuse treatment at Addiction Specialists, Inc. ("A.S.I.") in August 2006, when she was 14 years old. (R. at 103). She reported first using opiates at age 12 and that heroin was her drug of choice. (R. at 106). The staff reported that Plaintiff "is aware of her addiction. [She] came to A.S.I. to live a clean and structured life style." (R. at 102). The clinicians and Plaintiff agreed that she would begin attending NA groups for support. (Id.). Plaintiff has also been admitted to Twin Lakes for 6 days because of her addiction, although the record does not contain further documentation of this treatment. (R. at 110).
Plaintiff received ongoing methadone*fn9 treatment at A.S.I. (R. at 99‒101). Records from May 2008 through December 2008 show that the methadone dosages fluctuated, with Plaintiff requesting a reduced dose in May‒August 2008, but requesting an increased dose beginning in December 2008 because of increased pain. (R. at 101). Her treatment plan dated January 7, 2009 states that Plaintiff‟s long-term goal was to decrease and eventually stop methadone. (R. at 99). Her methadone dose at this time was 75 mg daily. (R. at 100). According to records from Dr. Stokes, the methadone dose was again increased in March 2009 to 85 mg daily. (R. at 138).
4. Psychiatric Conditions
Plaintiff began psychiatric treatment at Chestnut Ridge Counseling Services, Inc. in January 2009. (R. at 110‒115). On January 30, 2009, Nurse Practitioner Bonita Roche, CRNP conducted an initial psychiatric evaluation. (R. at 110‒113). Ms. Roche noted that the hepatitis C medication Plaintiff was prescribed may increase depression.*fn10 (R. at 110). She reported that Plaintiff was diagnosed with depression at age 14 and started on an antidepressant, but stopped the medication because of side effects and did not follow-up with treatment. (Id.). At this visit, Plaintiff complained of "severe depression," describing fatigue, frequent crying, isolation, poor energy, lack of interest, and severe anxiety attacks. (Id.).
Upon examination, Ms. Roche assessed Plaintiff as fully oriented, with
good memory and an average fund of knowledge. (R. at 112). However,
Plaintiff‟s concentration and attention were poor, and her impulse
control, judgment, and insight were impaired. (Id.). Ms. Roche
diagnosed Plaintiff with Major Depressive Disorder,*fn11
Rule-out Bipolar Disorder,*fn12 History of
Heroin Abuse,*fn13 "moderately severe" psychosocial
stressors,*fn14 and a Global Assessment of
Functioning ("GAF") score of 52.*fn15 (Id.). Plaintiff
was prescribed Lithium,*fn16 starting at 150mg each
night, and Seroquel,*fn17 50mg each night. (Id.).
On February 24, 2009, Plaintiff reported to Dr. Stokes that she was taking Celexa*fn18 and was "tolerating the [psychiatric] treatment well and feels it is working to control her depression."
(R. at 135). On March 20, 2009, Plaintiff saw Dr. Stokes about the adverse physical reactions she experienced after starting hepatitis treatment, but Plaintiff reported that her mental health remained stable. (R. at 138).
5. Other Medical Conditions
On March 18, 2008, Plaintiff went to Monongahela Valley Hospital Emergency Room complaining of pain after falling while carrying her child. (R. at 255). She was discharged from the ER that day with an ace wrap and pain medication. (R. at 260). An MRI of her elbow on May 23, 2008 was normal other than subtle irregularities that indicated a bone injury. (R. at 264). An MRI of her lower back on November 18, 2008 was normal. (R. at 261).
6. Residual Functional Capacity Assessment
On March 17, 2009 Dr. Richard A. Heil, Ph.D. reviewed Plaintiff‟s file
and completed a Psychiatric Review Technique Form. (R. at 116‒128). He
diagnosed Plaintiff with Major Depressive Disorder, PTSD,*fn19
Panic Disorder,*fn20 and Polysubstance
Abuse.*fn21 (R. at 119, 121, 124). He reported that
Plaintiff has "mild" restrictions in her activities of daily living,
has "moderate" difficulties in maintaining social ...