United States District Court, E.D. Missouri, Eastern Division
RHONDA L. FLEMING, Plaintiff,
CAROLYN W. COLVIN, Acting Commissioner of Social Security, Defendant.
SHIRLEY PADMORE MENSAH UNITED STATES MAGISTRATE JUDGE
an action under 42 U.S.C. §§ 405(g) and 1383(c)(3)
for judicial review of the final decision of Defendant
Carolyn W. Colvin, the Acting Commissioner of Social
Security, denying the application of Plaintiff Rhonda L.
Fleming (“Plaintiff”) for Disability Insurance
Benefits (“DIB”) under Title II of the Social
Security Act, 42 U.S.C. §§ 401 et seq.,
and for Supplemental Security Income (“SSI”)
under Title XVI of the Social Security Act, 42 U.S.C.
§§ 1381, et seq. (the “Act”).
The parties consented to the jurisdiction of the undersigned
magistrate judge pursuant to 28 U.S.C. § 636(c). (Doc.
8). Because I find the decision denying benefits complies
with the relevant legal requirements and is supported by
substantial evidence, I will affirm the Commissioner's
denial of Plaintiff's application.
19, 2012, Plaintiff applied for DIB and SSI, alleging that
she had been unable to work since January 28, 2011, due to
glaucoma, emphysema, and depression. (Tr. 124-36, 154). Her
applications were initially denied. (Tr. 52-67). On March 5,
2013, after a hearing, the Administrative Law Judge
(“ALJ”) issued an unfavorable decision on
Plaintiff's claims. (Tr. 10-16). Plaintiff requested
review by the Social Security Administration's Appeals
Council, but on June 15, 2015, the Appeals Counsel denied the
request for review. (Tr. 1-3). Plaintiff has exhausted all
administrative remedies, and the decision of the ALJ stands
as the final decision of the Commissioner of the Social
FACTUAL BACKGROUND 
Plaintiff's Testimony Before the ALJ
was 54 years old as of the date of the hearing before the
ALJ. (Tr. 26). Her last job involved part-time work doing
home health care, and she testified that she was laid off due
to lack of work. However, she also testified that it was
getting hard to work because the patients were mean and she
could not deal with that with her depression. (Tr. 28). She
testified to several physical problems that prevent her from
working, including her emphysema making her out of breath;
trouble standing some days; a need to sit down to catch her
breath when doing anything physical; inability to walk more
than half a block without sitting down; problems with her
left wrist; and vision problems related to glaucoma. (Tr.
29-31, 49-51). She also testified that she has a hard time
trying to concentrate; that she has depression that causes
crying spells almost every day; that she has anxiety that
makes her heart beat faster and her hands get shaky, which is
when she has trouble trying to concentrate; that she has
panic attacks a couple of times a month; and that she has bad
days about ten times a month when she does not leave the
house at all and does not do anything. (Tr. 41-47). On a
typical day, she gets up, watches the news, makes her bed,
and tries to clean; it takes her a day to clean a room. (Tr.
36). Aside from going to doctors and to the grocery store
once a month, she rarely goes out. (Tr. 36, 45).
Plaintiff's Medical Records
February 14, 2011, Plaintiff saw her primary care physician,
Dr. Sanjay Sharma, D.O., and reported symptoms of sweating,
shaking, nausea, and blurred vision. She reported
“significant anxiety.” It was noted that she was
already taking Prozac, and she was started on Ativan. (Tr.
225-27). Plaintiff reported that she exercised by walking and
using weights and an exercise ball. (Tr. 235). She reported a
general ability to do usual activities. (Tr. 236).
March 22, 2011, Plaintiff returned to Dr. Sharma. She was in
tears and reported living with a gentleman who she said was
very manipulative and had a lot of control issues. She
reported sweats coming in from nowhere and poor sleep. (Tr.
260). Her mood was sad, but her mental status examination was
otherwise normal. Dr. Sharma diagnosed adjustment disorder
with mixed anxiety and depressed mood, started her on Xanax,
and referred her to a psychiatrist. (Tr. 261).
April 11, 2011, Plaintiff returned to Dr. Sharma and reported
that she had been feeling much better since she had been on
Xanax. Dr. Sharma noted that Plaintiff still felt like seeing
a psychiatrist because of ongoing issues, but “all in
all she is doing much better.” Also, he noted that
“most of her issues revolve around her controlling
partner.” (Tr. 258).
6, 2011, Dr. Sharma noted that Plaintiff “has been
doing well and has no complaints.” Dr. Sharma noted
that Plaintiff “is doing better except when she is not
on Xanax her anxiety is worse” and stated, “Most
of her anxiety is associated with issues related to her
fiancé.” It was noted that she did exercise by
walking and using weights and an exercise ball. (Tr. 256).
Her mood was anxious but her mental status examination was
otherwise normal. (Tr. 257).
October 3, 2011, Plaintiff returned to Dr. Sharma for follow
up, but no mental symptoms were discussed; her Xanax
prescription was refilled. (Tr. 252-53).
April 9, 2012, Plaintiff returned for follow-up and reported
“going through some significant stress in life which is
related to her family cabin that burned down, ” as well
as issues with her boyfriend and finances. She reported
anxiety. (Tr. 251). She was out of Xanax, and Dr. Sharma
prescribed some. (Tr. 250-51).
4, 2012, Plaintiff went to Dr. Sharma to have disability
paperwork filled out. She reported not doing well with her
depression. Dr. Sharma noted that she had stress with her
boyfriend, as well as financial stress. Dr. Sharma noted that
Plaintiff complained of anxiety, depression, crying spells,
irritability, insomnia, depressed mood, lack of interest in
pleasurable things every day for more than several months,
fatigue, concentration issues, and irritability all the time.
She was in tears and had a depressed mood, and Dr. Sharma
diagnosed major depressive disorder, single episode,
moderate. Dr. Sharma recommended a psychiatric consult. (Tr.
13, 2012, James W. Morgan, Ph.D., reviewed Plaintiff's
records and found that Plaintiff had a medically determinable
impairment of anxiety that resulted in no restriction in
activities of daily living, mild difficulty in social
functioning, mild difficulty in concentration, persistence or
pace, and no episodes of decompensation. (Tr. 55-56, 63-64).
August 9, 2012, Plaintiff saw Dr. C.J. Jos, M.D., for an
initial psychiatric evaluation. Dr. Jos noted that Plaintiff
reported a history of depression on and off for the last 20
years, consisting of depressed mood, crying spells,
occasional suicidal thoughts, constant anxiety, and being
nervous and anxious. (Tr. 293). He noted that Plaintiff had a
“quite anxious” mood and affect and had
“fair” concentration; her mental status
examination was otherwise normal. (Tr. 293-94). He diagnosed
generalized anxiety disorder, major depression (recurrent),
and personality disorder with compulsive traits; he assigned
Plaintiff a Global Assessment of Functioning
(“GAF”) score of 65; he prescribed Xanax, Elavil,
and Prozac; and he told Plaintiff to follow up in one month.
September 7, 2012, Plaintiff reported to Dr. Jos that overall
she was doing better and using her medications responsibly;
Dr. Jos noted a fair mood and affect; assigned a GAF of 65;
continued her medications; and advised Plaintiff to come back
in three months and call if any issues came up before that.
October 8, 2012, Plaintiff returned to Dr. Sharma and
reported that she had seen a psychiatrist, that he continued
her medications, and that she was feeling better. She
reported being able to do usual activities, being in a good
general state of health, and having no fatigue or weakness.
She reported exercising using weights and walking. (Tr. 305).
November 15, 2012, Plaintiff saw Dr. Jos and “reported
she was having a lot of stress related to her boyfriend,
” but that the medications were helping her (Tr. 289).
Her mood and affect were fair, and her GAF was 65. She was
advised to come back in three months but to call before then
if needed. (Tr. 288).
February 7, 2013, Plaintiff returned to Dr. Jos, with her
chief complaint being depression. Dr. Jos noted that
Plaintiff “reported she was still under a lot of stress
related to her boyfriend whom she thought was taking
advantage of her” and that she “also felt her
daughter was taking advantage of her.” (Tr. 287). She
was taking her medications responsibly and denied any side
effects. Her mood and affect were depressed and she had
“mild ideas of hopelessness and helplessness.”
She did not want a follow-up appointment with a counselor,
but preferred to have a number to call in case there ...