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Demacio v. Commissioner of Social Security

United States District Court, W.D. Pennsylvania

March 27, 2014

JILL M. DEMACIO, Plaintiff,


TERRANCE F. McVERRY, District Judge.


Jill M. Demacio ("Plaintiff") brings this action pursuant to 42 U.S.C. § 405(g), seeking review of the final determination of the Commissioner of Social Security ("Defendant" or "Commissioner") denying her application for Disability Insurance Benefits ("DIB") and Supplemental Security Income ("SSI") under Titles II and XVI of the Social Security Act, 42 U.S.C. §§ 401-433, 1381-1383f ("Act"). This matter comes before the Court on cross motions for summary judgment. (ECF Nos. 10, 14). The record has been developed at the administrative level. For the following reasons, Plaintiff's Motion for Summary Judgment will be GRANTED in part and DENIED in part.


Plaintiff filed for DIB and SSI with the Social Security Administration on August 5, 2009, claiming a disability onset of August 4, 2008. (R. at 123-34, 152-56).[1] She claimed that her inability to work was a result of functional limitation stemming from dizziness, panic attacks, fear, lack of bladder control, and issues with digestion. (R. at 158). Plaintiff was initially denied benefits on January 5, 2010. (R. at 89-98). A hearing was scheduled for March 1, 2011, and Plaintiff appeared to testify represented by counsel. (R. at 38-62). A vocational expert ("VE") also testified. (R. at 38-62). The Administrative Law Judge ("ALJ") issued his decision denying benefits to Plaintiff on May 27, 2011. (R. at 10-34). Plaintiff filed a request for review of the ALJ's decision by the Appeals Council, which request was denied on July 26, 2012, making the decision of the ALJ the final decision of the Commissioner. (R. at 1-5).

Plaintiff filed her Complaint in this Court on September 14, 2012. (ECF No. 3). Defendant filed an Answer on December 11, 2012. (ECF No. 4). Cross motions for summary judgment followed. The matter has been fully briefed and is ripe for disposition.


A. General Background

Plaintiff was born on December 3, 1983, was 25 years old at the time of her application for benefits, and 27 years old at the time of the ALJ's decision. (R. at 42). She resided in the home of her mother with a boyfriend, but at the time of application for benefits resided with her now-former spouse. (R. at 42, 170). Plaintiff graduated from high school, but was allegedly enrolled in special education classes with the exception of mathematics. (R. at 166). She was unable to complete attempted post-secondary education. (R. at 166). Plaintiff had a sporadic history of part-time work. (R. at 159). She indicated that she was not engaged with any type of vocational rehabilitation or other support services at the time of application for benefits. (R. at 167). She subsisted on cash assistance, and received medical benefits from the state. (R. at 43, 157).

In a self-report of daily activities completed at the time of her application for benefits, Plaintiff indicated that a typical day included feeding, walking, and playing with her pets; playing cards; watching television; talking on the telephone; using the computer; showering; and completing household chores such as laundry and cleaning. (R. at 170-72, 174). Plaintiff also stated that she would "sometimes" experience panic attacks and crying spells during the day. (R. at 170). She complained of difficulty sleeping. (R. at 171). She did not have physical difficulty with self-care, but hated shaving, forgot to shower, and did not like to undress due to issues with her self-image. (R. at 171). Plaintiff did not prepare her own meals because she "did not like cooking anymore." (R. at 172). While she left the house several times per week, she preferred not to do so alone due to fear of strange men, dogs, and the dark. (R. at 173). Plaintiff went grocery shopping once per month and to church once per week, but could not drive herself due to a history of blackouts. (R. at 173-74).

Plaintiff was capable of paying bills, handling a checking/savings account, and counting change. (R. at 173). She could walk for five minutes before needing ten minutes to rest. (R. at 175). Her attention span was only two minutes, she did not finish what she started, and she did not follow written or spoken instructions well. (R. at 175). Plaintiff did not like big crowds or new people, but got along well with authority figures and had never lost a job due to difficulties with others. (R. at 175-76). Plaintiff claimed that she did not handle stress or changes in routine well. (R. at 176).

B. Educational Records

Plaintiff attended Langley High School in Pittsburgh, Pennsylvania, from 1998 until 2002, when she graduated. (R. at 183). Plaintiff's cumulative grade point average was 2.327, and her class rank was 86 of 112. (R. at 183). The record here, however, contained no more than a single-page academic transcript. (R. at 183). There is no indication that she was enrolled in special education courses or programs, or that she received additional assistance or instruction during her time in school. (R. at 183). There is no indication that an individualized educational program was in place. (R. at 183).

C. Treatment History

Plaintiff received treatment from a primary care physician at Ambridge Area Healthcare beginning in January 2008. (R. at 211-21). At her initial visit, Plaintiff was noted to complain of poor sleep and migraine headaches. (R. at 221). Her orientation, memory, mood, and affect were indicated to be normal. (R. at 221). At a follow-up visit in March 2008, however, Plaintiff also complained of depression, bipolar disorder, constipation, dizziness, knee problems, swollen hands, back pain, car sickness, sweating, and urinary incontinence when sneezing or laughing. (R. at 220). An MRI and EEG were ordered for the dizziness, and Celexa was prescribed for depression. (R. at 219). Trazadone was prescribed for sleep. (R. at 219). Plaintiff's orientation, memory, mood, and affect were still indicated as normal. (R. at 219). In September 2008, Plaintiff complained of continuing dizziness and poor sleep. (R. at 215). She had also just been married, and complained of increased anxiety and panic attacks. (R. at 215). Plaintiff's prescriptions were adjusted, and her mood and affect were observed to be blunted. (R. at 215). She was advised to undergo an MRI for her dizziness, as she had not yet done so. (R. at 215). Plaintiff's complaints to her primary care physician remained generally the same through November 2008. (R. at 211-14).

Beginning in August 2008, Plaintiff began counseling at the Staunton Clinic in Sewickley, Pennsylvania. (R. at 241-46). Plaintiff reported living with her husband, who received SSI for mental retardation. (R. at 241). She had no other income. (R. at 241). Plaintiff described being raped and beaten at age fifteen by an ex-boyfriend, having a verbally abusive father, having flashbacks of past trauma, having panic attacks, hitting her husband, and passing out and blacking out almost daily. (R. at 241, 246). Plaintiff's sleep was poor, as was her concentration. (R. at 241). She endorsed experiencing anhedonia, hopelessness, excessive worry, irritability, and poor self-esteem. (R. at 241, 246). Plaintiff denied any physical pain or treatment for such. (R. at 245).

Plaintiff was observed by her counselor to be well-groomed and cooperative, with normal motor activity and behavior, normal speech, alertness, good eye contact, appropriate affect, logical thought, normal thought content, and intact memory. (R. at 242). Yet her judgment and insight were indicated to be poor, her intelligence was below average, and her mood was sad, anxious, and fearful. (R. at 242). She was recommended for individual therapy and a psychiatric evaluation. (R. at 243). Initial diagnoses included post-traumatic stress disorder ("PTSD"), major depressive disorder, and possible anxiety disorder, panic disorder, and mental retardation. (R. at 245). She was assigned a global assessment of functioning score ("GAF") of 52.[2] (R. at 245).

On September 8, 2008, Plaintiff underwent an MRI of the brain, the results of which were relatively unremarkable with the exception of an abnormal signal indicating a possible focus of demyelination. (R. at 202). Follow-up for clinical study was recommended. (R. at 202).

On September 10, 2008, Plaintiff was again seen for individual therapy at the Staunton Clinic. (R. at 247). She complained of traumatic flashbacks. (R. at 247). Her therapist noted her affect, mood, physical appearance, speech, thought organization, orientation, impulse control, insight, and judgment to be unremarkable. (R. at 247). A GAF score of 52 was assigned, and Plaintiff was noted to "brighten at times." (R. at 247). Ongoing therapy sessions in September, October, November, and December 2008 included similar objective observations by treating specialists and similar complaints by Plaintiff, albeit with noted general improvement in symptoms and GAF scores. (R. at 237-40, 248-49, 364). By December, Plaintiff reported that she was "doing great!" (R. at 364). She had no panic, no flashbacks, and no issues being around others. (R. at 364).

On September 15, 2008, Plaintiff was evaluated by a psychiatrist at the Staunton Clinic for medication management. (R. at 231-36). Plaintiff had a history of taking Celexa and Trazadone for mental health treatment. (R. at 231). Plaintiff was observed to be well-groomed and cooperative, with normal motor activity and behavior, normal speech, alertness, good eye contact, logical and organized thought, normal perception, normal impulse control, intact memory, fair insight, fair judgment, and average intelligence. (R. at 232). However, while her affective expression was appropriate and full, it was also anxious, and Plaintiff's mood was sad, anxious, and fearful. (R. at 232). She experienced paranoid ideation. (R. at 232). The psychiatrist diagnosed mood disorder, PTSD, and possible anxiety disorder. (R. at 235). Plaintiff was assigned a GAF score of 51. (R. at 235).

In October 2008, Plaintiff was examined by James Pilla, D.O., for complaints of episodic nausea and vomiting over the prior one-and-one-half months. (R. at 205-06). It was primarily experienced after meals and taking medications, and included heartburn and acid regurgitation. (R. at 205-06). Plaintiff claimed to have lost 11 pounds in the intervening period but denied any lower gastrointestinal issues except for occasional constipation. (R. at 205-06). Plaintiff did not complain of pain, weakness, headache, or significant mental disturbance, and was observed to be alert, oriented, and in no acute distress. (R. at 205-06). Imaging of the abdomen and blood test results were negative for abnormalities. (R. at 205-06). An esophageal biopsy was also negative. (R. at 205-06). Dr. Pilla prescribed Prevacid for suspected gastroesophageal reflux disease ("GERD"). A solid phase gastric emptying study was recommended, (R. at 205-06), the results of which were ultimately consistent with a diagnosis of gastroparesis. (R. at 324).

At a medication check with her psychiatrist at the Staunton Clinic on October 13, 2008, Plaintiff reported "doing much better, " being less emotional, and having less panic. (R. at 228). She was observed to be well-groomed and in a "better mood." (R. at 228). She was prescribed Abilify, Celexa, and Seroquel. (R. at 229).

On November 4, 2008 Plaintiff was evaluated by a neurologist at Allegheny Neurological Associates in Pittsburgh, Pennsylvania. (R. at 224-25). She complained of dizziness, blackouts, and staring spells. (R. at 224). Plaintiff claimed that she had experienced dizziness for nine years. (R. at 224). Sometimes she passed out and would fall, particularly when it was hot. (R. at 224). The neurologist recorded a history of attention deficit hyperactivity disorder, migraines, and insomnia. (R. at 224). Plaintiff was observed to have normal orientation, memory, attention, concentration, language, and fund of knowledge. (R. at 225). She had normal motor movement, normal muscle tone, and no muscle atrophy. (R. at 225). Coordination, sensation, and gait were all normal. (R. at 225). The neurologist considered the results of Plaintiff's brain MRI to be unremarkable. (R. at 225). Seizures and syncope were suspected. (R. at 225). An EEG was recommended, as was a work-up for syncope. (R. at 225).

At a medication check with her psychiatrist at the Staunton Clinic on November 10, 2008, Plaintiff indicated that she was "doing pretty well" and that she "feels better" overall, despite also feeling sedated on her dosage of Seroquel. (R. at 230). The psychiatrist observed Plaintiff to be well-groomed, in a "better mood, " and exhibiting a "brighter affect." (R. at 230). Her Seroquel dosage was reduced. (R. at 229).

At a visit to her primary care physician at Ambridge Area Healthcare on January 7, 2009, Plaintiff exhibited a good mood. (R. at 399). She had normal orientation, memory, mood, and affect. (R. at 399). Plaintiff's migraines had a "good ...

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