United States District Court, W.D. Pennsylvania
TERRENCE F. McVERRY, District Judge.
Mary Elizabeth Harrison ("Plaintiff") brought this action under 42 U.S.C. § 405(g) for judicial review of the decision of the Commissioner of Social Security ("Commissioner"), which denied her application for supplemental security income ("SSI") under Title XVI of the Social Security Act ("Act"), 42 U.S.C. §§ 1381 et seq. The parties have filed cross-motions for summary judgment, which have been fully briefed and are ripe for disposition. (ECF Nos. 8-11). For the following reasons, the Commissioner's motion will be GRANTED, and Plaintiff's motion will be DENIED.
Plaintiff filed for SSI on December 10, 2012, alleging that she has been disabled since October 13, 2012, due to a number of physical and mental impairments. (R. 183). As of the date of the hearing, Plaintiff was a 42-year-old high school graduate who previously worked as a grocery store bagger. (R. 37). However, she stopped working in 2006 because of transportation issues and has not worked since. (R. 312).
Plaintiff has a history of depression and anxiety that predates her alleged onset date. She has been prescribed a number of different anti-depressants and anti-anxiety drugs from a psychiatrist at Wesley Spectrum Services, where she received care for some time prior to filing for SSI. (R. 235, 287, 291). Plaintiff testified that she believes that her depression precludes her from working, as she is afraid that she'll "have a breakdown" while on the job. (R. 42). She testified that when she has a "breakdown, " she cries a lot and isolates herself. (R. 43). Plaintiff is also morbidly obese and has difficulty standing and walking for long periods of time because she has "trouble with [her] ankles." (R. 40, 235). Nevertheless, she testified that she does all of the housework, laundry, and grocery shopping for herself and her boyfriend, with whom she has lived on-and-off during the past several years, and she also testified that she has no issues taking care of herself. (R. 38). Moreover, she testified that she likes to crochet, go shopping, visit with friends, and play with her pet dog. (R. 42).
Plaintiff's SSI claim was precipitated by a serious "breakdown" on October 12, 2012. (R. 287). She had a bad breakup with her boyfriend, with whom she was living at the time (and with whom she continued to live after the two apparently reunited). (R. 43). After the incident, she "was to the point where [she] was about ready to cut [her] wrist, " so she called 911. (R. 43). She was initially taken to Westmoreland Hospital, but the next day, she was voluntarily admitted to Washington Hospital. (R. 43). On admission, Plaintiff said that she still felt suicidal, her affect was restricted, and her insight and judgment appeared to be poor. (R. 289). She was also concerned about what her living situation would be after she left the hospital since she did not believe that she could move back in with her erstwhile boyfriend. (R. 289). However, her speech was fluent and articulate; she was well-oriented to person, place, time, and situation; and she was not delusional. (R. 289). Plaintiff was diagnosed with major depressive disorder, which was described as "severe without any psychotic features" but with suicidal thoughts. (R. 290). In addition, she was assessed with a global assessment of functioning ("GAF") score of 25. (R. 290). During Plaintiff's hospitalization, her dosages of Buspar (an anti-depressant) and Citalopram (an anti-anxiety medication) were increased, and within 48 hours, doctors reported that she "was brighter[, ] not suicidal, had no thoughts to harm herself, and began to look better with regard to hygiene." (R. 287). Plaintiff was discharged on October 18, and by then, her condition had "[g]realty improved, " though she was still assessed a GAF score of 45, which is indicative of serious symptoms or "serious impairment in social, occupation, or school functioning." DSM-IV, at 34 (4th ed. 2000). Because of the issues with her boyfriend, arrangements were made for her to stay in a shelter until more permanent housing could be found. (R. 287-88).
After her hospitalization, Plaintiff continued to see a psychiatrist at Wesley Spectrum for routine medication management. (R. 323-33). In January, Plaintiff's psychiatrist, Dr. Kira Kirvy, noted that Plaintiff's mood had been down, though she denied having suicidal thoughts. (R. 333). Later that month, Dr. Krivy completed a Medical Source Statement on behalf of Plaintiff. (R. 300). Dr. Krivy opined that Plaintiff's ability to understand, remember, and carry out instructions was not affected by her impairments. (R. 300). Nor was Plaintiff's ability to interact appropriately with supervisors, co-workers, and the public and to respond to changes in the routine work setting so affected. (R. 300). Dr. Krivy did, however, note that Plaintiff had "difficulty handling stressful situations and making decisions" and had "required psychiatric hospitalization after stressful life events, most recently in late 2012." (R. 301). In addition, she noted that Plaintiff "struggled with anxiety related to making decisions about making changes in her life." (R. 301).
The next month, Plaintiff underwent a consultative mental health exam with Dr. Joel Last at the request of the state agency. (R. 312-18). Like the other doctors with whom Plaintiff had treated, Dr. Last diagnosed Plaintiff with major depression, which he noted was "recurrent, moderate, [and] appears to be in remission." (R. 313). He also concluded that Plaintiff had personality disorder and assessed a current GAF score of 45, with a past year high of 45. (R. 313).
In the months that followed, Plaintiff made steady progress, as she began to experience fewer depressive episodes and anxiety attacks. (R. 330, 331, 332). By March, she was reporting to Dr. Krivy that she "ha[d] seen much improvement in anxiety and mood since starting [to take Effexor (an anti-depressant)]" in February. (R. 331). She also consistently denied having suicidal thoughts. (R. 330, 331, 332). In June 2013, Plaintiff began seeing a new psychiatrist, Dr. Robert Algaier, who remarked in the notes from his initial appointment with Plaintiff that she "report[ed] feeling better." (R. 326). In particular, she "rate[d] her depression as an average of 6, which seems to be mostly associated with situations and not constant in her life and her anxiety "as an average of 4." (R. 326). Moreover, she told Dr. Algaier that she felt her medications were helpful. (R. 326).
In addition to the routine medication management appointments, Plaintiff testified that she also attended therapy sessions four days a week: individual therapy once a week at Wesley Spectrum and some form of group therapy three times a week at a facility called Westmoreland Psych Rehab, where, according to her testimony, she had been going for "maybe four or five years." (R. 41, 45, 48). There is nothing in the record from Westmoreland Psych Rehab to confirm Plaintiff's treatment there (and as will be discussed later, Plaintiff submits that the ALJ is to blame for this purported gap in the record and that the matter should be remanded so that the record can be further developed). Records from Wesley Spectrum do, however, make reference to "Psych Rehab" at various points and confirm that Plaintiff "had been attending regular outpatient sessions and weekly group therapy for a long time." (R. 324, 325).
Plaintiff also met weekly with an individual named Mr. Unkefer,  whom the ALJ referred to as a "peer specialist" in his decision. (R. 44). Plaintiff testified that she was connected to Mr. Unkefer through Westmoreland Psych Rehab. (R. 43-45). As Plaintiff points out, though, it is not clear from the record what Mr. Unkefer's actual title is (more on this later, too). Plaintiff testified that Mr. Unkefer helped her with activities of daily living (e.g., paying bills, managing money, driving her to appointments, and assisting with grocery shopping) and also helped her with socializing and learning different ways to deal with her depression. (R. 44-45).
Plaintiff's claim was denied at the initial level of review, so she requested a hearing, which was held before Administrative Law Judge ("ALJ") Charles Pankow in November 2013. Plaintiff was represented by counsel and testified at the hearing, as did a vocational expert ("VE"). (R. 33). Mr. Unkefer was also present at the hearing, but he did not testify. (R. 43). On December 17, 2013, the ALJ issued an unfavorable decision to Plaintiff. (R. 29). In his decision, the ALJ found that although Plaintiff has a number of severe impairments (major depressive disorder, personality disorder, severe obesity, depression, and anxiety), she could still perform light, unskilled work with occasional postural maneuvers in a low stress environment and with only occasional social interaction. (R. 21, 24). Then, relying on the testimony of the VE, the ALJ concluded that a significant number of jobs existed in the national economy that Plaintiff could perform even with those limitations: inspector hand packer, electrical equipment inspector, and jewelry stinger. (R. 28). Therefore, the ALJ found at Step 5 of the sequential evaluation that Plaintiff is not disabled as that term is defined in the Act. (R. 29).
After the Appeals Council upheld the ALJ's decision, Plaintiff filed a Complaint in this Court. The parties' cross-motions for summary judgment followed soon thereafter. In her motion, Plaintiff contends that the ALJ made two errors that require this Court to either award benefits or remand the case to the ALJ for further proceedings. First, she argues that the ALJ failed to sufficiently develop the record because he never sought records from Plaintiff's therapy sessions with Westmoreland Psych Rehab or inquired about the specific nature of the services provided by Mr. Unkefer or determined what his actual title is. Second, she argues that the ALJ erred in failing to address her GAF scores of 45 in his decision, the first of which was assessed in October 2012 following her discharge from Washington ...