United States District Court, M.D. Pennsylvania
RICHARD P. CONABOY UNITED STATES DISTRICT JUDGE
before the Court is Plaintiff's appeal from the
Commissioner's denial of Disability Insurance Benefits
(“DIB”) under Title II of the Social Security Act
and Supplemental Security Income (“SSI”) under
Title XVI. (Doc. 1.) Plaintiff filed applications for
benefits on December 31, 2013, alleging a disability onset
date of March 19, 2013. (R. 21.) After she appealed the
initial denial of the claims, a hearing was held on July 24,
2015, and Administrative Law Judge (“ALJ”) Jarrod
Tranguch issued his Decision on December 21, 2015, concluding
that Plaintiff had not been under a disability during the
relevant time period. (R. 21, 32.) Plaintiff requested review
of the ALJ's decision which the Appeals Council denied on
January 4, 2017. (R. 1-6, 16-17.) In doing so, the ALJ's
decision became the decision of the Acting Commissioner. (R.
filed this action on March 7, 2017. (Doc. 1.) She asserts in
her supporting brief that the Acting Commissioner's
determination is error for the following reasons: 1) his
determination that Plaintiff's knee arthritis and anxiety
were not severe impairments was error; and 2) he erred in
rejecting the opinions of Plaintiff's treating
psychiatrist, Dr. Matthew Berger. (Doc. 14 at 3.) After
careful review of the record and the parties' filings,
the Court concludes this appeal is properly granted.
was born on April 13, 1961, and was fifty-two years old on
the alleged disability onset date. (R. 31.) She has a high
school education and past relevant work as a food service
supervisor, food service coordinator, and telemarketer.
(Id.) Plaintiff alleges she is unable to work on a
competitive full-time basis due to right knee arthritis,
bipolar disorder, and anxiety disorder with panic attacks.
(Doc. 14 at 2.)
Right Knee Arthritis
primary care visit on September 30, 2013, Plaintiff
complained of right knee pain and stiffness. (R. 373.) At the
request of her primary care provider, Leocadia T. Prawdzik,
M.D., Plaintiff had x-rays indicated by right knee pain at
Hazleton General Hospital on October 11, 2013. (R. 315.) The
“Impression” was no acute fracture or
dislocation, mild degenerative joint changes, and small joint
October 14, 2013, upon Plaintiff's request, Dr. Prawdzik
referred Plaintiff for an orthopedic consultation because she
reported in a telephone contact that nothing was helping her
right knee pain. (R. 372.) Plaintiff reported that her pain
was getting worse at her October 16th office
visit. (R. 371.) Examination showed that she had pain in the
posterior and medial aspects of the right knee with mild
swelling, gait dysfunction, and mild right leg swelling.
saw James E. Murphy, M.D., for an orthopedic consultation on
October 22, 2013. (R. 387.) Dr. Murphy informed Dr. Prawdzik
that Plaintiff reported a four-week history of right knee
pain that “started out of the blue” and bothered
her when she was walking on flat ground and bending her knee
to go up steps. (Id.) Dr. Murphy found that x-rays
did not show any significant abnormalities but he thought
they showed some mild osteoarthritis. (Id.) He also
found that Plaintiff's clinical examination was
consistent with “pes tendinitis as she is quite tender
right over the spot of the tendon insertion.”
(Id.) Dr. Murphy recommended avoidance of
aggravating activities, nonsteroidal antiinflammatories, and
physical therapy for evaluation. (Id.) He noted that
she would follow up with him on an as-needed basis.
January 8, 2014, Plaintiff reported that naproxin was helping
her right knee pain. (R. 368, 473.)
15, 2015, Plaintiff reported that she had knee pain and the
right knee was giving out three times per week. (R. 471.) She
said it was worse when walking and she had increased pain
when doing steps and standing up from a sitting position.
10, 2015, Dr. Prawdzik noted that Plaintiff had no
complaints, and musculoskeletal pain and stiffness were much
better with Naproxen. (R. 469.) His diagnoses included
degenerative joint disease of the right knee. (Id.)
Anxiety and Depression
December 17, 2012, Dr. Prawdzik's diagnoses included
anxiety and depression. (R. 378.) In August 2013 Dr. Prawdzik
did not make any notation in the ROS “Psych”
section and examination findings included that
Plaintiff's mental status was within normal limits. (R.
374-75.) He continued to include anxiety and depression in
his diagnoses. (R. 375.) In September, Plaintiff continued to
report a lot of anxiety. (R. 373.)
January 8, 2014, Plaintiff told Dr. Prawdzik she was
experiencing increased anxiety which included palpitations
and shortness of breath during anxiety attacks. (R. 368,
473.) On May 15, 2015, Plaintiff reported increased anxiety
and said she was seeing a therapist and psychiatrist. (R.
471.) Dr. Prawdzik noted that Plaintiff had no complaints in
June 2015 but his diagnoses included anxiety and depression.
Mental Health Treatment
treating psychiatrist has been Matthew Berger, M.D., who
began treating her in February 2013 upon referral from her
primary care provider. (R. 420.) At the initial visit, Dr.
Berger recorded that Plaintiff reported symptoms of bipolar
disorder, eating disorder, and substance abuse.
(Id.) Objectively, Dr. Berger assessed
Plaintiff's mood as anxious and depressed with an affect
appropriate to that mood. (R. 422.) Otherwise no problems
were noted with Plaintiff's psychiatric examination.
(Id.) Dr. Berger diagnosed Alcohol Abuse in
Remission, Bipolar I Disorder Current Mixed NOS, Eating
Disorder Other. (Id.) He assessed a current GAF
score of 49. (Id.) Dr. Berger adjusted
Plaintiff's medication regimen and scheduled Plaintiff to
see a therapist. (R. 423.)
2013, Plaintiff reported that she was doing well and that
seeing the therapist had been very helpful. (R. 416.)
Plaintiff continued to report symptoms of bipolar disorder
and said she was taking her medications as prescribed but
felt worse compared to her previous visit. (Id.) She
also reported symptoms of eating disorder and substance abuse
including binge eating, body dysmorphia, self-induced
vomiting, infrequent diuretic use, and recent alcohol
consumption. (Id.) Dr. Berger noted that Plaintiff
displayed depression during the encounter and otherwise her
psychiatric examination was unremarkable. (R. 418.) Dr.
Berger noted that Plaintiff's bipolar illness and eating
disorder were ongoing, and her substance abuse was episodic.
(R. 418.) His diagnosis remained the same and his GAF score
was assessed to be 50. (Id.)
Berger's assessments in July, August, and October
indicate that Plaintiff's bipolar disorder and eating
disorder were improving or stable, and her alcohol abuse was
episodic or in remission. (R. 402, 406, 410, 414.) GAF scores
of 54-56 were recorded. (Id.) He also noted that
Plaintiff had been taking her medication as prescribed. (R.
400, 404, 408, 412.)
January 2014, Plaintiff reported a lot of daytime anxiety and
rated her mood as 2/10. (R. 396.) She also reported an
increase in many bipolar disorder symptoms and said she felt
worse compared to her previous visit. (Id.) She said
she had not taken all prescribed medications for a one-month
period due to insurance problems. (Id.) Plaintiff
continued to report symptoms of eating disorder and said she
had used alcohol in October. (Id.) Dr. Berger found
Plaintiff's affect to be depressed and labile but her
psychiatric examination was otherwise normal. (R. 398.) He
concluded Plaintiff's bipolar illness was increasing, her
eating disorder was stable, and her alcohol abuse was in
remission. (R. 398.) He assessed a GAF score of
February 2014, Plaintiff reported to Dr. Berger that she was
“terrible” and her mood had been like a
“roller coaster.” (R. 392.) She reported
increased bipolar disorder symptoms, some improvement with
eating disorder symptoms, and no new episodes of alcohol use.
(Id.) Dr. Berger found Plaintiff to be anxious with
an affect appropriate to her mood. (R. 394.) He noted that
Plaintiff's speech was overproductive and tearful and her
judgment and insight were fair. (Id.) Dr. Berger
again assessed Plaintiff's bipolar illness to be
increasing, her eating disorder to be stable, her alcohol
abuse was in remission, and her GAF score was 44.
March 2014, Plaintiff reported to Teresa Clark, CRNP, that
she was “a little better, ” and she felt that her
medication adjustment had helped. (R. 434.) She continued to
report symptoms of bipolar disorder and eating disorder.
(Id.) Ms. Clark noted that Plaintiff's speech
was overproductive and tearful, and her judgment and insight
were fair. (R. 436.) She assessed that Plaintiff's
bipolar disorder was increasing, her eating disorder was
stable, and her alcohol abuse was in remission.
(Id.) She recorded a GAF score of 44.
4, 2014, Plaintiff reported to Ms. Clark that she had started
drinking again and she been under increased stress due to
financial concerns and pressure to take a job managing a
small bakery that she knew would be too much for her. (R.
438.) She expressed experiencing symptoms related to bipolar
disorder and eating disorder. (Id.) Ms. Clark noted
that Plaintiff's mood was subdued with related affect.
(R. 440.) She also noted that Plaintiff's speech was
overproductive and tearful, her judgment was impulsive, and
her insight was lacking. (Id.) She assessed that
Plaintiff's bipolar illness was ongoing, her eating
disorder was stable, and her alcohol abuse was episodic.
(Id.) Ms. Clark again recorded a GAF score of 44.
30, 2014, Plaintiff told Ms. Clark that she had decided not
to take the job and she was feeling less overwhelmed since
making the decision. (R. 442.) Plaintiff continued to report
symptoms of bipolar disorder, eating disorder, and alcohol
abuse. (Id.) Plaintiff's examination and
assessments were the same as earlier in the month except that
she was not tearful. (R. 440, 444.)
October 2014, Plaintiff reported to Ms. Clark that she had
taken a part-time job and she was doing craft shows with
baked goods which was keeping her busy. (R. 446.) She
continued to report symptoms of bipolar disorder with a
decrease in some symptoms, and she reported a decrease in
eating disorder symptoms. (Id.) Ms. Clark again
found Plaintiff's mood subdued with her affect
appropriate to her mood. (R. 448.) She assessed ongoing
bipolar illness, stable eating disorder, episodic alcohol
abuse, and a GAF score of 48. (Id.)
February 2015, Plaintiff reported an improvement in her mood
and Ms. Clark noted that Plaintiff's affect was
appropriate to her mood. (R. 452.) Ms. Clark continued to
find that Plaintiff's judgment was impulsive and her
insight was lacking. (Id.) She assessed that
Plaintiff's bipolar illness was improving, her eating
disorder was stable, her alcohol abuse was episodic, and her
GAF score was 50. (Id.)
again reported improvement to Ms. Clark in April 2015,
stating that she knew she took on too much at times and was
trying to keep things in perspective. (R. 454.) She also
reported that she was busy baking for weekend craft shows,
and she was working six to nine hours a week which helped
with the bills. (Id.) Plaintiff continued to express
that she had symptoms of bipolar disorder but stated they had
decreased, as had her symptoms of eating disorder.
(Id.) Ms. Clark recorded that Plaintiff's mood
was euthymic and her affect was appropriate but her judgment
continued to be impulsive and her insight was lacking. ...