United States District Court, M.D. Pennsylvania
MEMORANDUM Docs. 1, 6, 7, 10, 11.
GERALD B. COHN, Magistrate Judge.
I. Procedural Background
On August 17, 2010, Denise Marconi ("Plaintiff") protectively filed an application as a claimant for disability insurance benefits, with an alleged disability onset of July 23, 2010. (Administrative Transcript, hereinafter, "Tr." at 12, 142-43). After Plaintiff's claim was denied at the initial level of administrative review, at Plaintiff's request, on December 5, 2011, an administrative law judge ("ALJ") held a hearing at which Plaintiff, who was represented by an attorney, and a vocational expert ("VE") appeared and testified. (Tr. 24-78). On January 23, 2012, the ALJ found that Plaintiff was not disabled and not entitled to benefits. (Tr. 12-23). On March 26, 2012, Plaintiff filed a request for review with the Appeals Council (Tr. 6-8), which the Appeals Council denied on August 9, 2013, thereby affirming the decision of the ALJ as the "final decision" of the Commissioner. (Tr. 1-5).
On October 8, 2013, Plaintiff filed the above-captioned action pursuant to 42 U.S.C. § 405(g) and pursuant to 42 U.S.C. § 1383(c)(3), to appeal a decision of the Commissioner of the Social Security Administration denying social security benefits. Doc. 1. On December 18, 2013, the Commissioner ("Defendant") filed an answer and an administrative transcript of proceedings. Doc. 6, 7. On February 20, 2014, Plaintiff filed a brief in support of the appeal ("Pl. Brief"). Doc. 10. On March 26, 2014, Defendant filed a brief in response ("Def. Brief"). Doc. 11. On April 29, 2014, the Court referred this case to the undersigned Magistrate Judge.
II. Relevant Facts in the Record
Plaintiff was born on October 7, 1968, and thus was classified by the regulations as a younger person through the date of the ALJ decision on January 23, 2012. (Tr. 22); 20 C.F.R. § 404.1563(c). Plaintiff completed the ninth grade and obtained a GED in May 1999. (Tr. 161). At the time relevant to the proceedings, Plaintiff was married and lived with her husband and minor child. (Tr. 30).
A. Relevant Treatment History and Medical Opinions
1. Hospitalizations and inpatient treatment
On July 30, 2010, Plaintiff sought in-patient psychiatric treatment at Community Medical Center ("CMC") that lasted until August 9, 2010. (Tr. 18, 304, 309). Plaintiff had "thoughts of her killing herself and her son, but she [said] they were just thoughts; she would not do it." (Tr. 18, 310-11). Plaintiff said her son's behavior caused her increased stress. (Tr. 18, 312). Plaintiff stated that she had more than twenty prior psychiatric hospitalizations. (Tr. 18, 310). She also reported that "[s]he just quit one week ago being a janitor" (Tr. 18, 310). At admission, Plaintiff was cooperative, accessible and she maintained spontaneous and coherent conversation. (Tr. 298). Plaintiff's speech was normal, and she showed no evidence of loosening associations, hallucinations, or delusions. (Tr. 19, 298). Plaintiff had an inappropriate affect because "she smiled very easily." (Tr. 298). She expressed suicidal and homicidal ideation while displaying fair judgment and partial insight. (Tr. 298-99). Plaintiff was oriented and had adequate memory. (Tr. 299). Doctors assigned her a Global Assessment of Functioning ("GAF") score of 30. (Tr. 310).
In the discharge report dated August 9, 2010, doctors described Plaintiff as being "in an improved state with no homicidal or suicidal ideation." (Tr. 309). Plaintiff had shown "gradual, but continued improvement." (Tr. 309). Plaintiff's GAF score improved to 65. (Tr. 18, 309).
2. Scranton Counseling Center (SCC)
Throughout the progress notes with SCC, Plaintiff reported fluctuating progress and exacerbation of anxiety and depression while generally: denying any suicidal or homicidal ideation and demonstrating an affect, concentration, attention, and mental status that were unremarkable. (Tr. 384-411). On August 16, 2010, Plaintiff reported some improvement in her symptoms. (Tr. 18, 341). She had an anxious mood, but was alert, friendly, and cooperative with appropriate affect. (Tr. 341). Plaintiff appeared oriented and had non-psychotic thoughts. (Tr. 341). She denied suicidal or homicidal ideation. (Tr. 341). September 20, 2010, the SCC staff assigned Plaintiff a GAF score of 60. (Tr. 411). On October 13, Plaintiff reported "doing well on meds." (Tr. 409). Plaintiff acknowledged some "bad" thoughts, but said she would not act on them. (Tr. 409). She appeared calm and pleasant. (Tr. 409).
On November 1, 2010, Plaintiff complained of "intense" anxiety and described that it felt like "having a heart attack." (Tr. 407). Otherwise, the staff physician indicated that Plaintiff maintained an appropriate affect and "ok" concentration and attention, made check marks indicating that Plaintiff had a non-psychotic mental status, and no suicidal or homicidal thoughts. (Tr. 407). On November 8, 2010, Plaintiff reported that she was falling into a depressive state. (Tr. 406). On December 27, 2010, Plaintiff reported feeling "good" and complained of being tired and sleeping from four in the afternoon until three in the morning. (Tr. 404). The report indicated that Plaintiff had an alert, cooperative mood, an appropriate affect, and her concentration and attention remained okay, and otherwise unremarkable. (Tr. 404).
On February 9, 2011, Plaintiff felt more depressed and reported that her husband has to remind her to bathe. (Tr. 403). On February 15, 2011, she reported a stable mood and with a good response to medication. (Tr. 401). The report indicated that Plaintiff's concentration and attention remained okay. (Tr. 401). On February 23, 2011, Plaintiff reported that her mood would not change until her son's behavior changed and also reported that her son had not physically attacked her in a month. (Tr. 400). On February 24, 2011, Plaintiff complained of increased anxiety and situational stress. (Tr. 398).
On April 5, 2011, Plaintiff reported that she wanted to isolate herself. (Tr. 397). Plaintiff again reported anxiety and situational stress. (Tr. 395). Her mood remained "fairly stable." (Tr. 395). On April 19, Plaintiff reported that she still prefers being by herself and that her son had been attacking her again. (Tr. 394). Plaintiff also reported that she was able to take a shower on her own initiative and dine out twice with her husband. (Tr. 394). On May 12, 2011, Plaintiff was in tears due to continued issues with her son. (Tr. 393). Plaintiff reported that she was "getting out more." (Tr. 393). The stated goal was for her to continue grocery shopping and couponing. (Tr. 393). It was also noted that she started going shopping with a friend. (Tr. 393).
Two months later, on July 5, 2011, Plaintiff reported experiencing some episodic depression, but was feeling okay overall. (Tr. 391). Her GAF score was 68. (Tr. 392). On July 7, 2011, Plaintiff reported continued depressive symptoms with decreased motivation, but characterized her mood swings as stable. (Tr. 390). She continued to get out more and grocery shopped to relax. (Tr. 390). Plaintiff also reported that her son was doing better. (Tr. 390).
On August 30, 2011, Plaintiff reported continued depressive symptoms and that her son had recently been diagnosed with autism. (Tr. 389). On September 20, 2011, despite anxiety and mood swings, Plaintiff reported feeling "good." (Tr. 410). On September 27, 2011, Plaintiff reported some depression and mild mood swings. (Tr. 387). The staff assigned her a GAF score of 68. (Tr. 388).
3. Antoinette Hamidian, Psy.D. CCC-SLP, Treating Psychologist
On September 10, 2010, Dr. Hamidian completed a Medical Source Statement-Mental. (Tr. 347-49). Dr. Hamidian opined that Plaintiff had many marked or extreme limitations in her abilities to understand, remember, and carry out instructions; and to respond appropriately to supervisors, co-workers, and work pressures. (Tr. 347). Dr. Hamidian held that the Plaintiff was at great risk of self-harm and neglect of family because her medication was unregulated. (Tr. 347). Dr. Hamidian further noted that the Plaintiff suffered from paranoid ideation, increases in aggression when agitated, rapid cycling mood swings, with an inability to work due to repeated mental decompensation. (Tr. 347). Dr. Hamidian noted that the Plaintiff left her last job and wandered aimlessly around town for hours. (Tr. 347). Dr. Hamidian wrote that Plaintiff seemingly "disassociates becomes another personality." (Tr. 349). On February 20, 2011, Dr. Hamidian opined that Plaintiff was permanently disabled. (Tr. 423-24).
On November 29, 2011, Dr. Hamidian completed a Psychological Evaluation. (Tr. 420-22). She noted that Plaintiff's current medications helped reduce her paranoid thinking, increased her clarity of thought, and kept her out of the hospital. (Tr. 421). Dr. Hamidian noted that Plaintiff's husband brought her to the evaluation, Plaintiff was cooperative with a calm mood, and she had good hygiene. (Tr. 421). Plaintiff "graduated in 1992 with regular education." (Tr. 421). Dr. Hamidian noted that Plaintiff believed "that her developmental history is within normal limits, but she reported that she always had trouble concentrating and understanding verbal and written academic information." (Tr. 421). Dr. Hamidian also observed that:
[Plaintiff] has had an extensive mental health history from young adulthood. She has had two inpatient hositalizations due to mental health issues. She has been in treatment with Dr. Chandragiri and Antoinette Hamidian, Psy.D since 2008 for bipolar disorder symptoms. She has been tried on numerous courses of psychotropic medications such as Lithium, Paxi!, Zoloft and Adderall with poor results. She is currently [sic] prescribed Lamotrigine 150 mg. 2 × day; Clonazepam 0.5 mg 3 × day; Sertraline 100 mg 2 @bedtime; Geodon 80 mg 2 × day; Buspirone 10 mg 2 in the evening and 2 @bedtime; Simvastatin 40 mg 1 per day which have been helpful in reducing paranoid thinking and increasing clarity of thought and keeping her out of the hospital.
During the evaluation, Plaintiff's facial expression was appropriate with good eye contact and she was oriented "x 3." (Tr. 421). Dr. Hamidian found Plaintiff to be cooperative and have a calm mood. (Tr. 421). Dr. Hamidian opined that Plaintiff's memory was "clearly impaired, " noting that Plaintiff had "a difficult time providing a medical, psychiatric, and personal history.... Dates and times, along with facts and a continum [sic] of events is impaired." (Tr. 421). She had below average cognitive skills. (Tr. 421). Dr. Hamidian assigned her a GAF score of 55. (Tr. 422). Dr. Hamidian concluded that Plaintiff could not live independently. (Tr. 422). She further stated that Plaintiff would be homeless without her husband's support. (Tr. 422). She described Plaintiff as a candidate for a partial hospitalization program. (Tr. 422).
4. Thomas P. Smith, Psy.D., Consultative Examination
On October 29, 2010, Dr. Smith examined Plaintiff. (Tr. 360-66). For employment history Plaintiff reported that her first job was at the age of 19 doing the factory work for approximately two years, then as a dancer for approximately eight years, followed by approximately one year of more factory work where she hurt her back and then did factory work for approximately one more year. (Tr. 363).
During the October 2010 examination, Plaintiff reported experiencing anxiety and paranoia. (Tr. 360-61). She reported her in-patient treatment at CMC and the Horsham Clinic, and that "she [had] been in and out of psychiatric hospitals since her teen years." (Tr. 361). Regarding her daily activities, Plaintiff stated that she prepared breakfast, readied her son for school, cleaned the house, possibly napped, watched television, and waited for her son to come home to care for him. (Tr. 363). According to Plaintiff, her husband handled the remainder of the household chores and set out her medications. (Tr. 363).
Dr. Smith observed that Plaintiff was alert and oriented and had a below average fund of knowledge and vocabulary. (Tr. 363). Dr. Smith noted that Plaintiff had a depressed/variable mood and a labile affect with her mood and affect appearing normal and appropriate. (Tr. 363-64). Plaintiff had difficulty with long-term memory, but her short-term memory remained intact. (Tr. 364). She reported difficulty concentrating and her cognitive processes remained normal. (Tr. 364). Plaintiff retained fair insight, judgment, and impulse control. (Tr. 364). She ...