United States District Court, M.D. Pennsylvania
JOHN E. JONES, III, District Judge.
Plaintiff Tiffany Arnold has filed this action seeking review of a decision of the Commissioner of Social Security ("Commissioner") denying Arnold's claim for supplemental security income benefits.
Arnold protectively filed her application for supplemental security income benefits on June 18, 2009, alleging that she became disabled on January 31, 2007. Tr. 18. Arnold has been diagnosed with several impairments, including: bipolar disorder, an anxiety-related disorder, borderline personality disorder, Hepatitis C, Lyme disease, bilateral shoulder impingement status post-surgical correction, and a history of polysubstance abuse and dependence. Tr. 20-21. On January 4, 2010, Arnold's application was initially denied by the Bureau of Disability Determination. Tr. 100.
Hearings were conducted by an administrative law judge ("ALJ") on November 10, 2010 and June 16, 2011, where Arnold was represented by counsel. Tr. 43-69, 72-97. On June 22, 2011, the ALJ issued a decision denying Arnold's application. Tr. 18-34. On July 26, 2013, the Appeals Council declined to grant review. Tr. 1. Arnold filed a complaint before this Court on August 20, 2013. Supporting and opposing briefs were submitted and this case became ripe for disposition on March 2, 2014 when Arnold filed a reply brief.
Arnold appeals the ALJ's determination on four grounds: (1) the ALJ erred in finding that borderline personality disorder was not a medically determinable impairment, (2) the ALJ violated regulations concerning the analysis of substance abuse disorders, (3) the ALJ did not properly evaluate the available medical opinions, and (4) the vocational expert's testimony did not constitute substantial evidence at step five. For the reasons set forth below, the decision of the Commissioner is affirmed.
Statement of Relevant Facts
Arnold was twenty-eight years of age on the date the ALJ rendered his decision; she has a high school education, and is able to read, write, speak, and understand the English language. Tr. 46, 49, 249. The ALJ found that Arnold did not have any past relevant work. Tr. 32.
A. Arnold's Mental Impairments
On January 8, 2007, just prior to the relevant period, Arnold presented to Girard Medical Center for inpatient mental health treatment. Tr. 312. Arnold complained of insomnia, intermittent suicidal ideation without intent, and anxiety attacks. Tr. 315. Upon admission, Arnold was cooperative and fully oriented, had good eye contact, a goal-direct thought process, and no hallucinations. Tr. 316. She had an anxious affect, as well as adequate memory and insight, but poor judgment. Id . Arnold had a GAF score of 20-30. Tr. 317. She was discharged from inpatient treatment on January 24, 2007. Tr. 312. At discharge, Arnold was diagnosed with major depressive disorder and borderline personality disorder, and was assigned a GAF score of 35-40. Tr. 312, 318.
After receiving little treatment for her mental illnesses for a period of more than two years, on May 16, 2009, Arnold voluntarily presented for inpatient mental health treatment. Tr. 342. Arnold reported increased depression and suicidal thoughts following several stressful events, including her grandfather's suicide, the death of a friend, and being fired from her job. Tr. 342-43. Arnold also reported relapsing on drugs that month after being sober for a significant amount of time; she was assigned a GAF score of 30. Tr. 342-43. Upon discharge on May 18, 2009, Arnold's affect was "somewhat" restricted and her mood was variable. Id . She was diagnosed with bipolar disorder without psychotic features, panic disorder, heroin abuse, and cocaine abuse. Tr. 342. Arnold's GAF score had improved to 50. Tr. 343.
Arnold returned to inpatient treatment on May 19, 2009 with continuing suicidal thoughts. Tr. 349. On admission, Arnold had poor insight and judgment, as well as paranoid thoughts and tactile hallucinations although a full mental status examination was not possible due to her sedated state. Tr. 350. It was noted that Arnold was abusing benzodiazepines. Id . Arnold was discharged on June 1, 2009 with a "somewhat constricted" affect, a "somewhat anxious" mood, and no suicidal or homicidal ideation. Tr. 351. Arnold's GAF score was 49. Tr. 349.
On June 1, 2009 after being discharged from inpatient treatment, Arnold was admitted to Bowling Green Brandywine for substance abuse treatment. Tr. 1121-1131. At that time, Arnold was cooperative with an appropriate affect and calm mood; she had normal motor activity and no memory problems. Tr. 1125. Arnold was alert and oriented, had relevant speech, moderate insight into her problems, and adequate judgment. Id . Her thought content and processes were within normal limits, and she denied hallucinations or delusions. Id.
At a psychiatric evaluation on June 3, 2009, Arnold reported manic states, racing thoughts, irritability, and poor sleep. Tr. 1132. Arnold's behavior was "highly med-seeking" and she was an unreliable historian, though she had fair recent memory. Tr. 1132-33. Arnold made good eye contact, had slightly pressured speech, a depressed mood, an irritable affect, and her thought processes were "linear but slightly circumstantial." Tr. 1132. She had poor insight and judgment, and was diagnosed with opiate dependence, cocaine abuse, and mood disorder with a GAF score of 60. Tr. 1133.
On January 20, 2009, Arnold presented to Anne Dall, M.D. for a psychiatric evaluation. Tr. 645-47. Arnold reported anhedonia, anxiety, and panic symptoms; she denied suicidal or homicidal ideation, and denied feelings of hopelessness or helplessness. Tr. 645. Arnold reported being "clean" from drugs, but also admitted that she was not taking any of her medications except for Seroquel. Tr. 646. She was cooperative, oriented, neatly groomed and dressed, and made good eye contact. Id . Arnold's affect was constricted, but she had no psychomotor agitation or retardation. Id.
Dr. Dall noted that Arnold's immediate and short term memory was "intact to register" and she was able to recall three out of three words after one minute, and again after five minutes. Id . However, Arnold's remote memory for life events "was patchy in places." Id . Dr. Dall found that Arnold's concentration was intact; she was able to spell "world" backwards and forwards, and was able to subtract serial 7's backward from one hundred to seventy-nine without error. Id . Arnold's abstract thinking was intact, she had good insight, fair impulse control, and intact judgment. Id . Dr. Dall diagnosed Arnold with bipolar II disorder and polysubstance abuse in remission, and assigned a GAF score of 53. Tr. 647.
Arnold returned to Dr. Dall on May 14, 2010 and reported that she had stopped taking her medications "because they were not helpful." Tr. 1048. Arnold had a "rather angry" affect, but made good eye contact, had an organized thought process, intact cognition, and normal speech. Id . Her GAF score remained 53. Id . By July 20, 2010, Arnold's affect had improved and become "fairly bright." Tr. 1046. She reported mood swings and depression, but a mental status examination was normal. Id . Her GAF score improved to 55, and Dr. Dall diagnosed Arnold with bipolar disorder and polysubstance abuse in remission. Id.
On August 28, 2010, Arnold presented to the White Deer Run Behavioral Health System for drug rehabilitation, where she remained until September 30, 2010. Tr. 1055. During her treatment, Arnold complained of depression and bipolar disorder, and it was noted that her mental impairment symptoms were present even during periods of sobriety. Tr. 1068. Arnold was calm and cooperative, she had an appropriate affect, relevant speech, and had normal motor activity and no memory problems. Tr. 1069. She had moderate insight into her problems, no hallucinations or delusions, adequate judgment, and her thought content and processes were within normal limits. Id . Arnold was diagnosed with opioid dependence, cannabis dependence, generalized anxiety disorder, depressive disorder, and a history of post-traumatic stress disorder. Tr. 1056. During her treatment, Arnold was assessed a GAF score of 45-51. Tr. 1086.
After her discharge from White Deer Run, Arnold returned to Dr. Dall on October 5, 2010. Tr. 1097. Arnold complained of ongoing anxiety, poor motivation and energy, and mood swings. Id . Arnold had a bright affect and her mental status examination was normal. Id . Dr. Dall listed Arnold's polysubstance dependence as no longer being in remission, and assigned a GAF score of 54. Id . On November 22, 2010, Arnold reported that she had begun using lamictal and felt her mood was becoming more stable. Tr. 1142. Arnold's mental status examination was normal and she had a bright affect. Id . Dr. Dall diagnosed Arnold's polysubstance dependence as being in remission and assessed a GAF score of 55. Id.
On December 29, 2010, Arnold reported that her mood remained stable since beginning lamictal. Tr. 1144. Her mental status examination remained unchanged, as did her diagnoses. Id . Dr. Dall assigned a GAF score of 57. Id . On April 11, 2011, Arnold reported to Dr. Dall for the final appointment contained within the administrative record. Tr. 1184. Arnold complained of anxiety, racing thoughts, and difficulty sleeping. Id . She did note that her depression was "improving a little bit, " but admitted that she ...