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Knuth v. Colvin

United States District Court, E.D. Missouri, Eastern Division

September 2, 2016

CAROLYN W. COLVIN, Acting Commissioner of Social Security, Defendant.



         This matter is before the Court for review of an adverse ruling by the Social Security Administration.

         I. Procedural History

         On May 29, 2009, plaintiff Robert Allen Knuth filed applications for a period of disability, disability insurance benefits, Title II, 42 U.S.C. §§ 401 et seq., and for supplemental security income, Title XVI, 42 U.S.C. §§ 1381 et seq., with an alleged onset date of June 1, 2008. (Tr. 243-46, 247-50). After plaintiff's applications were denied on initial consideration (Tr. 100, 101), and reconsideration (Tr. 102, 103), he requested a hearing from an Administrative Law Judge (ALJ). Following a hearing on June 7, 2011, (Tr. 30-52), the ALJ issued a decision denying plaintiff's applications on August 24, 2011. (Tr. 107-16). On October 5, 2012, the Appeals Council vacated the hearing decision and remanded plaintiff's case to the ALJ with instructions to “obtain additional evidence . . . includ[ing] a consultative mental examination with psychological testing and medical source statements;” evaluate third-party evidence; further evaluate plaintiff's subjective complaints and mental impairments; and obtain additional evidence if necessary. (Tr. 122-24). Plaintiff and counsel appeared for an additional hearing conducted by video on February 14, 2014. (Tr. 53-99). The ALJ again denied plaintiff's applications on March 13, 2014. (Tr. 14-23). The Appeals Council denied plaintiff's request for review on June 25, 2015. (Tr. 1-4). Accordingly, the ALJ's decision stands as the Commissioner's final decision.

         II. Evidence Before the ALJ

         A. Disability Application Documents

         Plaintiff completed a Disability Report on June 9, 2009, listing his disabling conditions as fetal alcohol syndrome, learning disabilities, and mental health problems. (Tr. 319-25). He reported that he had been placed in special education services and that he had difficulty with reading, writing, and math. He had previously worked as a janitor, stopping on June 1, 2008, due to his conditions. Plaintiff did not list any medications in his Disability Report.

         The record contains Function Reports completed in May and June 2009 by plaintiff and a friend, Linda Burnett. In his report, plaintiff reported that he lived with friends. (Tr. 326-23). Plaintiff woke up about 5:00 in the morning. On days when he felt able to do so, he went out to look for work; otherwise, he avoided other people. He prepared sandwiches and pizza for himself and, with reminders, did his own laundry and washed dishes. Ms. Burnett reported that plaintiff also did mowing and raking. Plaintiff wrote that he sometimes shopped for food, but had to work up his nerve to go in stores. Ms. Burnett reported that plaintiff occasionally shopped for leather and beads for Indian crafts. Plaintiff wrote that he was unable to pay bills, count change or handle bank accounts, while Ms. Burnett stated that plaintiff was able to count change and could pay bills when reminded to do so. Plaintiff identified his hobbies as going to schools to talk about Native Americans. Ms. Burnett additionally wrote that plaintiff's activities included watching television, visiting friends, walking in the woods, and working to protect the environment and Indian gravesites. Plaintiff regularly attended Alcoholics Anonymous (AA) meetings and spoke at treatment centers about drug and alcohol abuse. He tried to avoid authority figures and generally preferred doing things on his own because it was “just easier.” With respect to his ability to work with others, plaintiff's learning disabilities exposed him to name calling or termination. He responded to stress and changes in routine with anger or severe depression. He had problems with talking, memory, completing tasks, concentration, understanding, following instructions, and getting along with others. Although he had trouble following written instructions, he could follow clear spoken instructions. In a brief narrative statement, plaintiff wrote that he thought he was able to talk about Native Americans and other things he knows well. He had been sober for fourteen years. Ms. Burnett noted that plaintiff had two daughters and a stepdaughter for whom he provided support when able. (Tr. 315).

         The record includes three additional reports from Ms. Burnett. On November 20, 2009, she reported that plaintiff had been struggling with depression and suicidal thoughts following the death of his mentor in September. (Tr. 338-44). He could not take antidepressants because they caused dangerously strong suicidal urges. Ms. Burnett described plaintiff as unable to care for himself and reliant on friends for housing, food, and general support. He had been unable to find work despite applying for jobs within a 30-mile radius of his home. Ms. Burnett opined that plaintiff had attention deficit disorder and needed frequent reminders “before taking action.” A separate undated report adds that plaintiff struggled in the workplace because other employees harassed him until he became angry and managers generally did not support him when he reported harassment. (Tr. 366-67). In another letter dated February 14, 2014, Ms. Burnett stated that plaintiff displayed unpredictable “bouts of anger” that took hours or days to dissipate. (Tr. 393).

         B. Medical Records

         On February 23, 2009, plaintiff sought treatment at the Earlham Medical Clinic, in Earlham, Iowa, for depression, with complaints of decreased appetite and sleep disturbance. (Tr. 395). He reported that he was going through a divorce. After many years of alcohol and drug use, he had been “clean and sober” for 17 years. He had a long history of depression and several siblings had committed suicide. Although he was not actively suicidal at the time, he expressed concern about “following the same path.” The examiner noted that plaintiff was fully oriented, his memory was intact, he displayed normal judgment and insight, and his mood was neutral. Plaintiff was prescribed Citalopram, to start at 20 mg for a week before increasing to 40 mg. He was given a referral for psychological treatment.

         On March 23, 2009, Timothy P. Olson, M.D., completed an evaluation of plaintiff's depression. (Tr. 398-99). Plaintiff reported that his depression began several months earlier when his wife of nine years requested a divorce. Plaintiff reported that he had felt confused for several months. He returned to the reservation in South Dakota but felt uncomfortable there and left. He was currently living with friends in Earlham. Plaintiff reported that he had abused alcohol and other substances in his teens and early twenties but had stopped about 16 years earlier. He still attended substance abuse meetings and wanted to become a drug and alcohol counselor. His depressive symptoms included insomnia and withdrawal. He was unable to tolerate the higher dose of Citalopram. Nonetheless, he reported that his sleep had improved and he felt more outgoing and optimistic. He hoped to find work and get his own place to live. He did not work outside the home during his marriage. He had previously worked in housekeeping. On mental status examination, plaintiff was cooperative and oriented, his mood was neutral or slightly depressed with appropriate affect, and he had good insight. His intelligence was estimated to be in the normal or dull normal range. Plaintiff was directed to continue taking 20 mg of Citalopram and return in two months. Dr. Olson diagnosed plaintiff with Major Depression, single episode, versus Adjustment Disorder with Depressed Mood; Mixed Substance Dependence, in remission. Plaintiff was assigned a score of 58 on the Global Assessment of Functioning (GAF) scale.[1]On June 26, 2009, Dr. Olson reported to the disability examiner that plaintiff had not returned after his initial evaluation. Based on his single visit, Dr. Olson opined that plaintiff would have no more than mild limitations in work-related abilities and was capable of handling cash benefits. (Tr. 397).

         On August 26, 2009, Arthur H. Konar, Ph.D., completed a consultative psychological evaluation. (Tr. 400-03). Plaintiff had previously worked in janitorial and “basic services” jobs. His last job had been as a motel bellman. He stated that there were times “socially when I don't want to be a janitor.” He had no savings and was struggling to pay some overdue credit cards. He received food stamps and medical assistance. Plaintiff showed Dr. Konar a newspaper article reporting on his childhood abandonment, his mother's alcohol abuse, and his current fight against a development that threatened ancient burial grounds. He was placed in special education throughout his schooling and reported that he was better at math than reading. He had been sober for 17 years until a single relapse, weeks before the evaluation, when he drank until he blacked out. Plaintiff's depressive symptoms included sleep disturbance, self-doubt, isolation, poor focus, impaired concentration, tracking problems, and mood swings with anger and crying. He described himself as feeling abandoned and stupid, and “a little piece of junk” to be “kicked around.” He recently had suicidal thoughts and inclinations, but he did not want to act on these thoughts. He did not display overt anxiety.

         On examination, Dr. Konar described plaintiff as friendly and cooperative. Plaintiff had a calm demeanor and made good eye contact but appeared “down and out.” His speech was flowing but somewhat slowed. He “may have some cognitive processing issues, ” although he displayed a sense of humor and approached the testing with good motivation. His performance on structured tasks showed “some” impairment in concentration and tracking, “marginal” memory functioning, below average verbal abstraction, and questionable judgment. Dr. Konar concluded that there were “strong indications of borderline intellectual functioning, and/or learning disabilities, ” possibly due to fetal alcohol syndrome or alcohol abuse. Dr. Konar diagnosed plaintiff with Major Depression, recurrent, moderate; Alcohol Dependence in long-term remission with recent relapse; and possible Reading Disorder and Borderline Intellectual Functioning. Dr. Konar assigned a GAF score of 45-50.[2] With respect to work-related abilities, Dr. Konar opined that plaintiff was cognitively able to remember and understand instructions, procedures, and locations. However, his depression and cognitive issues impaired his abilities to carry out instructions and maintain attention and concentration. As a result of his “depressed posture” in combination with possible cognitive processing issues, he was “a diffuse and somewhat unreliable communicator.” Thus, he was “only variably able” to interact appropriately with others in a work setting, use good judgment, or respond appropriately to changes in the work place. (Tr. 403)

         On September 15, 2009, David Beeman, Ph.D., completed a Psychiatric Review Technique. (Tr. 409-22). Based on the record, Dr. Beeman concluded that plaintiff met the criteria for affective disorders (depressive syndrome) and substance addiction disorders (alcohol dependence in overall remission with one relapse). In a Mental Residual Functional Capacity Assessment, (Tr. 405-08), Dr. Beeman found that plaintiff was moderately limited in the abilities to carry out detailed instructions; maintain attention and concentration for extended periods; complete a normal workday and workweek without interruptions and perform at a consistent pace without an unreasonable number and length of rest periods; and respond appropriately to changes in the work setting. In support of his conclusions, Dr. Beeman noted that plaintiff had quit work due to depression arising from his divorce. Plaintiff had not been psychiatrically hospitalized and there was no evidence of a period of decompensation. Dr. Beeman noted that Dr. Konar suggested possible borderline intellectual functioning while Dr. Olson had estimated plaintiff's intelligence as average to low average. Plaintiff's participation in a project defeating a development project and talks to school children regarding Native American culture suggested grossly intact intellectual and social skills. In addition, plaintiff's self-report of daily activities was sufficiently detailed and coherent, although academic limitations were evident. His memory was fair, he was able to drive, and generally capable of managing his affairs. Dr. Beeman concluded that plaintiff retained the ability to perform simple, routine, and repetitive work functions when motivated to do so.[3]

         The record contains no evidence that plaintiff sought further treatment until May 2011 when he returned to the Earlham Medical Clinic with complaints of depression. (Tr. 429-34). On May 2, 2011, plaintiff complained to Eve Harris, P.A., of decreased appetite, lack of enjoyment, a desire to sleep, and he was planning suicide. He reported that a previous trial of Citalopram caused shaking and racing thoughts. Ms. Harris prescribed Prozac. (Tr. 430). On May 16, 2011, plaintiff reported that he had discontinued the Prozac because it made him too irritable. (Tr. 431-32). He was still experiencing significant insomnia, sadness, hopelessness, immense fatigue, and lack of appetite and interest. He reported that he had participated in outpatient counseling for six or seven months several years earlier and found it unhelpful. He believed that he would be happy if he could live alone in the woods and survive off the land. He continued to experience suicidal thoughts, especially after two other people in town committed suicide. He agreed not to act on his feelings. He was anxious about an upcoming disability hearing. (Tr. 429). On examination, Ms. Harris reported that plaintiff was cooperative, depressed and unkempt, but not in acute distress. His judgment in social situations was inappropriate. He had impaired concentration and problem-solving. He recalled his past history, had an appropriate fund of knowledge and appropriate vocabulary, but was unaware of current events. He was started on Paroxetine and told to return in two weeks.

         There is no evidence that plaintiff returned to see Ms. Harris until August 15, 2011, when he sought treatment for a skin rash on his arm that he acquired after getting a tattoo and then exposing the area to poison ivy while doing yard work. (Tr. 433-34).

         On January 26, 2013, consultative psychologist Michael P. Baker, Ph.D., administered the Weschler Adult Intelligence Scale - 4th edition (WAIS-IV) and completed a psychodiagnostic mental status evaluation. (Tr. 435-38). Plaintiff reported that his longest period of employment was two years in 1989 when he worked road construction. He also worked for Goodwill for two years in the early 1990s. In 2007, he worked as a school janitor for a year and a half and, in 2012, he worked for a farmer for three months. Plaintiff reported that he was in three chemical dependency treatment programs through 1991 and that he had not used mood-altering substances for the past five years. He had stopped attending 12-step programs in 2011. He had resided with his sponsor for the past two years. Plaintiff did most of the cooking, housekeeping and laundry. He did not like to do the grocery shopping because there were too many people in the stores. His driver's license was suspended due to unpaid child support.

         Plaintiff's scores on the WAIS-IV resulted in a Verbal IQ score of 91, a Performance IQ score of 81, and a Full Scale IQ score of 78, which placed him in the borderline range of intellectual functioning. He had significant weaknesses in indices for Working Memory and Processing Speed and displayed a great deal of variability across subscales, some of which could be attributed to a reading disability. Plaintiff's vocabulary and general fund of information were in the average range which might create an unrealistic expectation of his overall intellectual functioning. On mental status examination, plaintiff was cooperative, made good eye contact, and displayed normal speech patterns. His affect was somewhat restricted but not inappropriate. He was able to recall four out of four items after a four-minute delay and could subtract serial threes from 20 but could not subtract serial sevens from 100. He correctly spelled “world” backwards.

         Dr. Baker gave plaintiff diagnoses of Major Depressive Disorder, moderate; Alcohol Dependence in reported long-term remission; and Borderline Intellectual Functioning. He assigned plaintiff a GAF score of 45.[4] In a Medical Source Statement, Dr. Baker opined that plaintiff had no restrictions in the abilities to understand, remember, and carry out simple instructions or make judgments on simple work-related decisions. He had mild restrictions in the abilities to understand and remember complex instructions, interact appropriately with others in the workplace, and respond appropriately to usual work situations and to changes in a routine work setting. Finally, Dr. Baker opined that plaintiff had moderate restrictions in the abilities to carry out complex and to make judgments on complex work-related decisions. (Tr. 440-42).

         C. Testimony at June 7, 2011 Hearing

         Plaintiff was 43 years old at the time of the hearing. (Tr. 37). He was placed in special education throughout his entire schooling and was not taught to read and write. (Tr. 35). He acquired limited reading skills as an adult but was still unable to do any math. Plaintiff spent about three years working on and learning about Native American burial sites ...

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