United States District Court, W.D. Pennsylvania
TERRENCE F. McVERRY, Senior District Judge.
Patricia Ann Grek ("Plaintiff") has filed this action for judicial review of the decision of the Acting Commissioner of Social Security, which denied her applications for disability insurance benefits ("DIB") and supplemental security income ("SSI") under Titles II and XVI of the Social Security Act ("Act"), 42 U.S.C. §§ 401-403, 1381-1383. Pending before the Court are the parties' cross-motions for summary judgment. ECF Nos. 6, 10. The motions have been fully briefed and are ripe for disposition. ECF Nos. 7, 11. For the reasons that follow, the Acting Commissioner's motion will be GRANTED, and Plaintiff's motion will be DENIED.
Plaintiff was born on May 8, 1964. (R. 76). She is a high school graduate, with past relevant work experience as a home healthcare aide, housekeeper, laundry folder, and assembly worker. (R. 77, 99). However, she has not worked since June 1, 2008. (R. 79). She initially alleged disability as of that date due to anxiety, depression, and bipolar disorder. (R. 138, 298). At the hearing, though, she agreed to amend her alleged onset date to January 12, 2011. (R. 50, 326). Plaintiff met the insured-status requirement through December 31, 2011. (R. 52).
A. Treatment Records
Plaintiff has a long history of mental health issues, including diagnoses of bipolar disorder, depression, and borderline personality disorder. She has been hospitalized on several occasions, dating back to several years before her alleged onset date. She also has a history of alcohol abuse, though she has been sober for several years.
Around the time she stopped working, Plaintiff was seeing Joan Rowland, C.R.N.P., and the staff at Safe Harbor Behavioral Health ("Safe Harbor") to manage her psychotropic medications, which at the time included Wellbutrin, Seroquel, Zoloft, and Vistaril. (R. 341-363). She was reported to be doing well throughout 2008, with her GAF consistently assessed at 75. (R. 352-60). Her mental status examinations were also within normal limits. (R. 352-60). Plaintiff started to see a counselor at Safe Harbor in February 2009. (R. 351-55). During her intake interview, she told the counselor that she struggled with depression and had a history of negative experiences with mental health treatment. (R. 351-55). Her depression and anxiety continued throughout the remainder of 2009, and she continued to receive routine treatment from Safe Harbor. (R. 342-48). All the while, although Plaintiff reported that she had "stopped looking for a real job, '" she was cleaning houses to make some extra money. (R. 342). Throughout 2009, her GAF remained at 55. (R. 342-48).
Plaintiff was admitted to Millcreek Community Hospital ("Millcreek") on January 12, 2011, for a psychiatric evaluation. (R. 379). At intake, she reported that her dosage of Seroquel needed to be adjusted. (R. 379). She had reportedly been taking her medication improperly for about 10 days. (R. 379). Plaintiff was diagnosed with mood disorder, not otherwise specified, and assessed a GAF of 26. (R. 380-81). She was voluntarily admitted to the psych unit, where she spent the next seven days. (R. 381). By the time of her discharge, Plaintiff's mood had improved, and she did not display any evidence of psychosis or delusions. (R. 377). She also denied experiencing hallucinations, anxiety, depression, thoughts of self-destructive behavior, suicidal ideation, and/or homicidal ideation. (R. 377). Her GAF score was 60. (R. 378). She was advised to continue seeking outpatient treatment after her discharge. (R. 378).
On February 14, 2011, Plaintiff underwent a psychiatric evaluation at Stairways Behavioral Health ("Stairways"). (R. 383-85). She recounted her lengthy history of psychiatric problems, but noted that her condition had been stabilized with Seroquel. (R. 384). Although Plaintiff still reported "occasional paranoia, " she "admit[ted] that [her condition] had improved" with medication. (R. 384). She noted that she was still working part-time cleaning houses. (R. 385). Upon examination, she was alert and oriented, pleasant, and cooperative. (R. 385). Her thought process was organized and relevant, and she denied suicidal and homicidal ideations, as well as hallucinations. (R. 385). Although she did not appear delusional, she did show some signs of paranoia and splitting behavior. (R. 385). Otherwise, she displayed average intelligence without any significant cognitive or memory impairment, and her mood was stable. (R. 385). Diagnoses of bipolar disorder and borderline personality disorder were confirmed, and she was assessed a GAF of 60. (R. 385).
Plaintiff followed-up at Stairways for medication checks throughout the rest of 2011. (R. 386-397). Mental status examinations were unremarkable during this period. (R. 386-397). Her mood was, for the most part, stable, but she did continue to experience depression. (R. 393). Also, at times she reported that Seroquel was making her tired. (R. 386-397). In April 2011, she was taken off Zoloft and prescribed Prozac. (R. 393). At her next appointment, Plaintiff reported that Prozac seemed to help her mood, but she wanted to try a higher dose. (R. 394). Two months later, however, she reported no improvement in her depression. (R. 395). She also reported poor motivation and indicated that she had been isolating herself at times. (R. 395). As a result, her Prozac dose was increased. (R. 395). The next month, she reported depression, anxiety, poor energy, and low motivation, and she was prescribed Effexor, in place of Prozac. (R. 397).
Over the next few months, Plaintiff was described as "stable" on her medications and continued on the same regimen. (R. 421-24). By April 2012, however, Plaintiff reported that she was feeling "pretty low, " and her mood was very unstable. (R. 425). She also reportedly felt irritable and lacked motivation. (R. 425). According to Plaintiff, Effexor was not working as well as it had been when it was first prescribed. (R. 425). At her next visit in late May 2012, though, Plaintiff reported that her mood improved. (R. 426). She also reported that she had been sleeping better. (R. 426). Her condition remained stable throughout the summer of 2012, and in August, she reported that her then-current medications had been helpful. (R. 427). Plaintiff underwent a psychiatric evaluation at Stairways on October 1, 2012. (R. 463). Her symptoms included paranoia, insomnia, and depression. (R. 463). She also reported feeling stressed because of her separation from her husband. (R. 463). Upon examination, Plaintiff's speech was fast, her thought process was tangential and slightly elevated, her mood was elevated, her judgment was fair to poor, and she displayed slight psychomotor agitation. (R. 464). Otherwise, the findings of the examination were normal. (R. 464).
On October 9, 2012, Plaintiff was voluntarily admitted to Millcreek. (R. 434). She had apparently stopped taking her medications and reported that she was feeling "extremely paranoid" and "seeing demons." (R. 434). She was assessed a GAF score of 28 during her intake interview. (R. 437). During her hospitalization, Plaintiff did not require any periods of seclusion or restraint, but she did require frequent redirection. (R. 432). By October 10, her doctors noted that it had "become apparent that her psychotic symptomology was beginning to diminish...." (R. 432). Two days later, Plaintiff indicated that she was ready to be discharged. (R. 432). Her doctors confirmed that "she was no longer psychotic and was not expressing any desire to harm herself or to harm others. (R. 432). Whenever she was discharged, she was instructed to follow up with her Stairways counselor and see her psychiatrist, Sean Su, M.D. (R. 433). Her GAF was assessed at 60 upon her discharge. (R. 433).
Approximately one week later, Plaintiff was readmitted to Millcreek's behavioral health unit - this time involuntarily. (R. 441). According to the 302 petition completed by the police, Plaintiff was found sitting on the railroad tracks with a train approaching her. (R. 441). She jumped off the tracks when the train was just five feet away. (R. 441). When Plaintiff was taken into custody, police found pictures of her dogs and a suicide note in her possession. (R. 441). Plaintiff remained in Millcreek until November 9, 2012. (R. 437). During her stay, she displayed extreme paranoia toward the hospital's staff and her doctors. (R. 438). At one point, she became delusional. (R. 438). She also harassed other patients. (R. 438). Eventually, however, she started to respond to her medication regimen and became more cooperative with staff, doctors, and her fellow patients. (R. 438). By the time of her discharge on November 9, she was alert and oriented times three and was pleasant and cooperative. (R. 439). She did not display suicidal or homicidal ideation, hallucinations, or paranoia; her mood ...