United States District Court, E.D. Missouri, Southeastern Division
LEIGHANNE N. WELLER, Plaintiff,
CAROLYN W. COLVIN, Acting Commissioner of Social Security, Defendant.
MEMORANDUM AND ORDER
E. JACKSON UNITED STATES DISTRICT JUDGE.
matter is before the Court for review of an adverse ruling by
the Social Security Administration.
October 6, 2011, plaintiff Leighanne N. Weller filed an
application for supplemental security income, Title XVI, 42
U.S.C. §§ 1381, et seq.,  with an alleged
onset date of March 1, 2005. (Tr. 242-47) After
plaintiff's application was denied on initial
consideration, (Tr. 102-03, 110-14), she requested a hearing
from an Administrative Law Judge (ALJ). (Tr. 115-17)
Plaintiff and counsel appeared for hearings on May 16, 2013,
and January 13, 2014. (Tr. 31-92) The ALJ issued a decision
denying plaintiff's application on February 6, 2014. (Tr.
8-24) Plaintiff requested the Appeals Council reverse the
ALJ's decision and remand for a new hearing. (Tr. 6-7,
343-44) The Appeals Council denied plaintiff's request
for review on June 4, 2015. (Tr. 1-4) Accordingly, the
ALJ's decision stands as the Commissioner's final
Evidence Before the ALJ
plaintiff's allegedly disabling mental impairments are at
issue in this appeal. Consequently, the discussion below
primarily addresses the evidence of plaintiff's
psychological conditions and their attendant symptoms.
Disability Application Documents
was born on July 2, 1982. (Tr. 242) She graduated from high
school, and she was never placed in special education classes
or given an Individualized Education Program (IEP). (Tr. 275)
After graduating from high school, plaintiff began taking
college courses, but she “had to drop out due to
sickness while she was pregnant.” (Tr. 702)
was married at the time of her application, (Tr. 250), but
divorced by August 2013. (Tr. 338) Plaintiff had two
dependent children at the time of her application. (Tr. 251)
Following her separation and subsequent divorce, her children
no longer live with her. (Tr. 715) Though plaintiff has never
asserted trouble managing her own finances, she does not
presently have a bank account. (Tr. 251)
August 5, 2008, plaintiff completed a Function Report. (Tr.
281) She was then living with friends and her children.
Id. Her daily activities consisted of dressing
herself and her children, cooking, doing laundry, cleaning,
bathing herself and her children, playing with them, and
sleeping. Id. Plaintiff reported her conditions did
not affect her sleep or personal care, though she was
“clumsy.” (Tr. 282) She also did not need
reminders to take medications or to care for her personal
needs, or to perform her household chores. (Tr. 283)
left her apartment every day without assistance, and was able
to drive a car. (Tr. 284) She had no difficulty shopping.
Id. Her hobbies included watching television,
listening to music, and visiting with family and friends.
(Tr. 285) Plaintiff induced no problems in her familial
relationships or in her relationships with friends,
neighbors, and others. (Tr. 285-86) She visited and spoke
with her friends or family daily; her ability to socialize
had not been affected by the onset of her allegedly disabling
reported that her coordination, concentration, and memory
were affected by her mental impairments. (Tr. 286) However,
plaintiff also stated that she experienced no challenges
completing tasks, understanding, or following instructions.
Id. She also said that she does not finish what she
starts. Id. She could follow written instructions
well, and had a fair ability to follow spoken instructions.
Id. Plaintiff reported that she relates well to
authority figures. (Tr. 287) Though plaintiff wrote that she
experiences unquantified nervousness and anxiety, she also
reported a fair ability to handle both stress and changes to
her routine. Id.
August 12, 2008, Ginger Hanselman, a medical consultant,
completed a Physical Residual Functional Capacity Assessment
of plaintiff. (Tr. 95-99) Plaintiff's primary diagnosis
was “[h]eadaches, ” with other alleged
impairments of a neurological disorder and fatigue. (Tr. 95)
Plaintiff specifically alleged a “neurological
disorder, headaches, anxiety attacks, and fatigue.”
(Tr. 97) At that time, plaintiff had been treated by an
unidentified neurologist, who diagnosed plaintiff with
“tension headaches” and had prescribed her Elavil
(Amitriptyline), an antidepressant. Id.
to Henselman's report, plaintiff claimed that the
“headaches occur four times a week and can last all
day.” Id. Her MRI was “abnormal, ”
but examination revealed “no deficits.”
Id. Plaintiff's “partially credible”
symptoms included the headaches and feeling tired and
nervous. (Tr. 99) She provided all of the care for her
children, cooked, cleaned, shopped, socialized, and managed
her own finances. Id. Though plaintiff's
coordination was not “very good, ” she alleged
“no memory problems.” Id. The Social
Security Administration listed plaintiff's diagnosis as,
“Other Disorders of the Nervous System.” (Tr.
completed another Disability Report sometime in early October
2011, following the instant application for supplemental
security income. (Tr. 292) She was experiencing a
neurological disorder, headaches, anxiety attacks, fatigue, a
back condition, and depression, the conditions for which she
is presently requesting benefits. (Tr. 103, 110, 296)
Plaintiff was interviewed by an employee of the Social
Security Administration, who remarked that plaintiff appeared
to have difficulty answering questions. (Tr. 293) For
example, plaintiff “guessed at a lot of dates.”
(Tr. 294) At the same time, however, she did not appear to
have difficulty understanding, concentrating, or talking.
time, plaintiff had prescriptions for Ambien (Zolpidem), an
anti-insomnia medication; Hydrocodone, an analgesic;
Trazadone, a sleep aid; Xanax (Alprazolam), an anti-anxiety
and anti-depressant medication; and vitamin B-12 injections.
(Tr. 299) She was being treated by Jim Pang Jr., M.D. (Tr.
300-01) She occasionally also sought treatment from Dennis
Reed, M.D., for “bad migraines or whenever” she
could not “get in to see” other physicians. (Tr.
301) Plaintiff additionally recalled having been treated by
licensed clinical social worker John Hunter, M.A., L.P.C.,
from 2008 until 2011 for “mental problems” and
“threatening suicide.” (Tr. 304) Following a
suicide attempt in 2008, plaintiff indicated she had begun
receiving her present medications, with additional
counseling. (Tr. 304-05)
remained able to drive. (Tr. 309) She completed a Function
Report in which she wrote that she lived with friends. (Tr.
311) She would awake at 8:00 a.m., eat breakfast, shower,
watch television, and then go to bed at 9:00 p.m.
Id. Yet, she claimed to suffer from insomnia. (Tr.
312) When asked to describe how her conditions affect her
ability to function. plaintiff wrote: “Not sure
[be]cause I've had problems since I was 8 [years
October 2011 Function Report plaintiff reported that she had
no difficulty with personal care and grooming. (Tr. 312-13)
She also did not need reminders to groom herself or take her
medications. Id. Plaintiff also prepared her own
meals, cleaned, and did her own laundry. (Tr. 313) However,
she sometimes required a “push to do” those
activities, because she does not “always feel
good.” Id. She also described herself as
“clumsy.” (Tr. 314)
had no problems managing her own finances. Id. Her
daily routine included socializing with friends, which she
retained the capacity to do without difficulty. (Tr. 315)
Plaintiff also reported that she found it difficult to get
along with family, friends, neighbors, and others whenever
“people have a problem getting along with” her.
(Tr. 316) She attributed this to being “too nice and
believe[ing] people too eas[ily].” Id.
same report, plaintiff was asked whether she had any memory
deficits or challenges completing tasks. Id. She
identified none. Id. Nor did she mention any
difficulty understanding or following instructions.
Id. She related well to authority figures.
Id. She also attested to having some unspecified
difficulty maintain concentration, though she had a good
ability to follow written instructions and a fair ability to
follow spoken instructions. (Tr. 316-17) Plaintiff wrote that
she does not handle stress or changes in her routine very
well. (Tr. 317) In contrast to the 2008 Function Report, in
which plaintiff reported experiencing nervousness and
anxiety, she did not mention these conditions when asked in
the 2011 Function Report. Id.
to plaintiff, on December 1, 2011, her conditions became
worse because she could not “go to the doctors, ”
as she lacked funds or insurance, and she therefore could not
obtain her prescription medications. (Tr. 321) On December
13, 2011, the Social Security Administration determined
plaintiff had a primary diagnosis of discogenic and
degenerative disorder of the back, with a secondary diagnosis
of migraines. (Tr. 102) In her February 16, 2012, request for
a hearing, plaintiff wrote that her “back hurts all the
time” and she gets very “nervous around people
and situations.” (Tr. 115) Plaintiff subsequently
completed an undated Disability Report. (Tr. 321-26) Though
she had worked for three days, (Tr. 254-55), she had been
fired for unspecified reasons on January 31, 2012. (Tr. 325)
1, 2013, plaintiff's father, James C. Ramsey, filed an
affidavit in support of her claim. (Tr. 328-32) According to
Ramsey, plaintiff's “emotions fluctuate almost
daily from being happy or even elated to being depressed[, ]
to having feelings of low self esteem.” (Tr. 330) He
also remarked that plaintiff is “clumsy, ”
sometimes dropping objects, and she has trouble
concentrating, with additional unspecified “personality
abnormalities.” (Tr. 330-31) Ramsey attests plaintiff
is very childlike and can easily be persuaded. (Tr. 331)
May 16, 2013 Hearing
16, 2013, an ALJ held a hearing, which plaintiff and her
counsel attended. (Tr. 31-43) At the hearing, plaintiff's
counsel characterized the medical condition she had suffered
at age 8 as a “traumatic brain injury.” (Tr. 34)
As a result of that injury, she received Social Security
benefits from age 8 until approximately age 23. Id.
That injury stemmed from a routine appendectomy, during which
an anesthetic error caused her to suffer “brain damage,
” resulting in eight months of hospitalization to treat
her physical and mental symptoms. (Tr. 34-35) According to
plaintiff's counsel, her brain injury is a
“permanent condition.” (Tr. 36) Counsel also
noted that plaintiff “does not explain” her
condition well. Id.
counsel also maintained that none “of the treating
sources that the Social Security Administration” had
examine plaintiff “even kn[e]w that she . . . has [a]
traumatic brain injury.” (Tr. 38) The attorney stated
that plaintiff's treating physicians were “not
treating her for” a traumatic brain injury, but whether
“they know she has it or not is a different
question.” Id. The ALJ responded that at least
some of plaintiff's treating physicians must have been
aware of plaintiff's condition, because it is documented
in her medical records. Id. Counsel requested an
evaluation of the condition, and the ALJ ordered a
psychological consultative examination, with cognitive
testing. (Tr. 37, 39) The ALJ recessed the hearing to
accommodate that testing and to allow further development of
the evidentiary record. (Tr. 36-41)
January 13, 2014 Hearing
January 13, 2014, a different ALJ held a second hearing,
which plaintiff and her counsel also attended. (Tr. 44-92)
Plaintiff had been under the care of Pavin Palepu, M.D., a
psychiatrist, since May 2013. (Tr. 47) Because Dr. Palepu had
not yet responded to counsel's request for an assessment
of plaintiff's psychiatric functioning, counsel asked
that the record be kept open “for approximately ten
days to see if” counsel could obtain that report.
Id. The ALJ agreed. Id. But Dr. Palepu did
not submit his report, a Mental Impairment Questionnaire,
until February 21, after the ALJ's decision was issued.
Karl Manders, a medical expert, testified at the hearing
based on his review of plaintiff's medical records; he
had not treated or examined plaintiff. (Tr. 49-50) Dr.
Manders opined that plaintiff has “significant problems
from a psychological area and possibly for a cognitive
area.” (Tr. 51) According to Dr. Manders,
plaintiff's brain injury could be categorized as a
“stroke.” Id. It was “unbelievable
that she recovered as well as she did, but it appear[ed]
that[, ] from a contemporary standpoint[, ] her primary
problem is psychiatric, and is not on a neurological
basis.” (Tr. 51, 54) Dr. Manders also remarked that
plaintiff “does have apparently, or did have[, ] some
residual of her neurological deficit” from the stroke.
“a functional standpoint, ” however, plaintiff
has “pretty well recovered from” that
neurological deficit. Id. Plaintiff's medical
records, Dr. Manders explained, showed “at times that
she had some neurological abnormalities, but they did not
translate into an impairment or a listing.”
Id. Dr. Manders opined as to plaintiff's
physical condition, but remarked that her “primary
problem” is “psychological.” (Tr. 53)
headaches, according to Dr. Manders, would be expected to be,
“many times[, ] in a situation like this, ” based
on “psychological problems.” (Tr. 53-54) Dr.
Manders also noted that a November 28, 2011, CT scan of
plaintiff's brain showed “prominent bilateral basal
ganglia paravascular spaces versus encephalomalacia, ”
which is the “shrinkage of the brain” that is
“secondary to the stroke.” (Tr. 56) Dr. Manders
remarked that plaintiff's brain shrinkage is “not
in itself a cause of” her headaches, but is a
“significant neurological finding[, ] obviously.”
Id. However, plaintiff had “really remarkable
recovery” from the stroke, considering that, shortly
after the stroke “she occasionally would fall down
going down steps, and occasionally” would “lose
her train of thought.” Id. As Dr. Manders
explained, “because of the stroke, ”
plaintiff's “brain shr[ank] a little bit” due
to “some damage to the tissue, ” and “the
shrinkage of the brain is a normal finding after the brain
has been injured.” Id.
on those findings, Dr. Manders was asked to explain the
long-term symptoms of plaintiff's brain injury. (Tr. 57)
He opined that plaintiff's symptoms included
“occasionally” falling, tripping, or losing
“her train of thought.” Id. However, the
records showed “she was a C plus average student or a B
[student], so intellectually she did pretty darn well.”
Id. According to the records, plaintiff also
“complained of dizzy spells” and “had a
little trouble with speech, ” specifically
“dysarthria, ” which is a “little
slowness” in her speech pattern. Id.
plaintiff suffered from a “slight weakness on the right
side” of her body, with “dystonia, ” an
“abnormal movement in the right foot and ankle.”
Id. Dr. Manders inquired of the ALJ whether
plaintiff had a neuropsychological evaluation, because, he
testified, an MRI or a CAT scan would not necessarily show
the damage to plaintiff's brain. (Tr. 57-58)
Specifically, such testing might show “evidence of some
difficulty secondary to the stroke, ” but it would not
“describe how the brain is working.” Id.
Consequently, whether plaintiff's “present
difficulty” was “related to that” brain
injury “would have to be determined by a neuro
psychologist doing extensive neuro consultative work-ups,
” from which it could be “discover[ed] whether
the problem is” on a “organic or structural
basis[, ] versus more of a psychological one.” (Tr. 58)
Charles D. Auvenshine, a medical expert, also testified at
the hearing. Id. As with Dr. Manders, Dr. Auvenshine
had never examined or treated plaintiff. (Tr. 59) According
to Dr. Auvenshine, plaintiff suffers from five categories of
“mental impairments” recognized by the Social
Security Administration: 12.02 organic; 12.04, affective
disorder; an anxiety-related disorder; 12.08, personality
disorder; and 12.09, substance addiction disorder. (Tr. 60)
Dr. Auvenshine opined that plaintiff's mental impairments
taken “individually” do not meet a listing.
Id. He did not opine as to the cumulative effects of
those five conditions.
the symptoms of those conditions, Dr. Auvenshine highlighted
that plaintiff had on one occasion denied “agitation
anxiety and depression, ” suicidal ideation, and
judgment abnormality, and that in that instance memory
impairments were “not detected.” (Tr. 60-61)
However, the report Dr. Auvenshine referenced is from October
21, 2002, before plaintiff's alleged onset date. (Tr.
404) In addition, that report details plaintiff's
treatment at a clinic for a urinary tract infection, not
treatment by a psychiatrist. Id.
in that same report, the treating physician, William Bryant,
M.D., indicated that plaintiff denied having symptoms of any
kind. Id. In the same report in which Dr. Bryant
wrote that plaintiff suffered from a urinary tract infection,
he also wrote that plaintiff did not have a recent infection.
Id. Dr. Bryant also noted that plaintiff denied
nocturia (waking at night to urinate), noting at the same
time that plaintiff's “chief complaint”
included “nocturia.” Id. Additionally,
Dr. Bryant wrote that plaintiff complained of “some
nausea, ” but he noted, “[n]ausea denied.”
Id. Even though Dr. Bryant had remarked just one
month earlier that plaintiff's right leg is longer than
her left leg, (Tr. 405), he wrote on October 21 that he
detected no such physical abnormality. (Tr. 404) Dr.
Auvenshine offered no testimony to explain his reliance on
the report from 2002 as proof that, beginning three years
later in 2005, plaintiff suffered no serious mental health
to Dr. Auvenshine, plaintiff had remarked that her physical
impairments kept her from working because of her depression,
but she also denied any limitation “secondary to the
depression.” (Tr. 61) To the contrary, however, the
exhibit Dr. Auvenshine referenced, which is a pre-hearing
memorandum written by plaintiff's counsel, specifically
notes plaintiff's “long history of depression with
suicidal thoughts, ” two in-patient psychiatric
hospitalizations following suicidal ideation, bipolar
disorder, major depressive disorder, which plaintiff
described as “severe, ” borderline personality
disorder, and concentration difficulties. (Tr. 336- 42) Dr.
Auvenshine did not clarify his testimony regarding the
to medical records from January 1, 2005, onward, Dr.
Auvenshine noted that plaintiff had been “diagnosed
with depression, ” which her physicians described as
“severe” and “recurrent.” (Tr. 61,
528-55) As Dr. Auvenshine admitted, (Tr. 61), those records
show plaintiff also was diagnosed with “generalized
anxiety disorder, ” “substance abuse, ” and
a “personality disorder, ” with
“narcissistic histrionic traits.” (Tr. 528-55)
However, Dr. Auvenshine said, during that same period
plaintiff's mental status was remarked to have been
normal on several occasions, with normal mental status
examinations. (Tr. 61)
Auvenshine additionally examined the records of the
neuropsychological examination Stephen Jordan, Ph.D.,
performed on plaintiff on July 30, 2013. (Tr. 61, 742-50) As
Dr. Auvenshine noted, plaintiff was diagnosed with
depression, bipolar disorder, and substance abuse, which was
in remission. (Tr. 61-62) Though plaintiff had no Axis II or
Axis III diagnoses, a “history of abusive
relationships” qualified as an Axis IV environmental
factor affecting her conditions. (Tr. 62) On Axis V,
plaintiff's Global Assessment of Functioning (GAF) was
65, and a previous GAF was 76. Id.
Auvenshine testified that plaintiff's medical records
show she had “overdosed” on medications on April
27, 2012, for which she had been admitted to the hospital for
psychiatric care until May 4, 2012. Id. Based on Dr.
Auvenshine's “summary of” the “findings
in the record, ” plaintiff had not experienced
hallucinations, was “not psychotic, ” and was
“thought to be of average intelligence” at the
time of her hospitalization. Id.
Auvenshine opined that plaintiff's “substance
problem” with drugs and alcohol was not material.
Id. Additionally, Dr. Auvenshine opined that
plaintiff's activities of daily living were mildly
limited, her social limitations were mild, and her
concentration, persistence, and pace were mildly limited.
Id. The doctor also determined that the records
showed plaintiff had experienced “no actual outright
episodes of decompensation.” Id. As just
mentioned, however, Dr. Auvenshine recognized that plaintiff
had been placed in emergency, in-patient psychiatric care for
suicidal ideation. To use his parlance, that hospitalization
is an “outright episode of decompensation.”
Id. Dr. Auvenshine did not clarify that discrepancy
in his testimony.
of course, Dr. Auvenshine had not reviewed Dr. Palepu's
assessment of plaintiff's mental conditions and symptoms,
because that report had not yet been submitted. (Tr. 63) In
addition, Dr. Auvenshine admitted that he could not read
“some” unspecified records from plaintiff's
counseling sessions from April 27, 2012, until the date of
the hearing. Id. The ALJ did not inquire about Dr.
Auvenshine's admission that certain unidentified records
were not considered when he formed his opinions.
plaintiff's counsel then noted, her treatment records
from December 28, 2013, show she was experiencing a
“delusional thought process.” Id. In
response, Dr. Auvenshine testified that particular record was
“marginal in terms of not being able to read it.”
(Tr. 63-64) He then went on to explain that he could see what
the attorney was asking about, because checkboxes on that
form were marked for both delusions and paranoia.
Id. Dr. Auvenshine again did not explain the
discrepancy between his opinion testimony and the records he
purportedly relied on to form that opinion.
counsel additionally highlighted that records showing
“some delusional thought process” were
“counter-indicative of what” Dr. Auvenshine had
“testified to.” (Tr. 64) Specifically, counsel
inquired about the discrepancy between Dr. Auvenshine's
testimony that there was no evidence plaintiff experienced
“any psychotic episodes” and the noted delusional
thought processes, which “would show at least one
instance” of such an episode. Id. Dr.
Auvenshine responded, “yes, and what I cited came from
the record.” Id. But Dr. Auvenshine then did
not explain the inconsistency, and the ALJ did not inquire
Auvenshine admitted, the notation that plaintiff was
delusional and experiencing paranoia “was recorded by
the examining specialist” who treated plaintiff.
Id. But, according to Dr. Auvenshine, there were
“areas of suspiciousness that would fall within the
normal range, ” which are “sometimes quoted as
paranoia.” Id. Yet, Dr. Auvenshine did not
explain whether he believed, or had evidence to support the
assertion, that was so in this instance. Further, Dr.
Auvenshine admitted that he did not “know how severe
this paranoia is or whether” plaintiff was
“marginally psychotic or maybe totally
documented” as psychotic. Id. Following Dr.
Auvenshine's concession that his opinion did not
incorporate an understanding of the severity of
plaintiff's paranoia, or whether she was marginally or
totally psychotic, the ALJ did not inquire further.
testified at the second hearing. (Tr. 65) She was at that
time 31 years old, and divorced. (Tr. 66) She was living with
her boyfriend, while her children lived with their father.
(Tr. 67) She had no income. (Tr. 68)
last worked in 2008, at a fast food restaurant. (Tr. 70) She
“quit” that job after two days because it
“was too hard taking those orders.” Id.
She testified that the job required her “to push
buttons and stuff, and [she] got confused real easy.”
Id. At some point years ago, plaintiff testified,
she had also worked for a week and a half cleaning an elderly
person's home. Id. She had no other work
experience. Id. Her alleged onset date, March 1,
2005, is the same day she last received childhood Social
Security benefits. (Tr. 70-71)
had no difficulty reading or writing. (Tr. 69) However, she
testified that she is not a frequent reader and that she
spends most of her leisure time watching television and
movies. (Tr. 73) As to her activities of daily living,
plaintiff stated that she wakes inconsistently between 6:00
a.m. and noon, and then typically makes coffee and cereal or
oatmeal. (Tr. 71) “On a good day, ” she will
“do some light housework, ” including placing
dishes in the dishwasher or sweeping. Id. But
because she gets tired very easily, she has to “keep it
pretty mild” and also take naps during the day.
Id. She also cooks, but not very often. Id.
Plaintiff no longer does her own laundry. (Tr. 72) She avoids
vacuuming and mopping because it hurts her back. Id.
She does her own grocery shopping and is able to carry her
bags. Id. The ALJ noted that in her application she
had also reported that she drove, prepared her own meals, did
her own laundry, and managed her own finances. (Tr. 73)
Plaintiff testified that by the time of the second hearing
she no longer engaged in those activities. Id.
However, she retains the ability to drive. Id.
does “[n]ot really” have friends; she does not
“mess with a lot of people, ” to avoid
“trouble.” Id. She has discontinued
contact with her former friends, because she considers them a
bad influence. (Tr. 74) Plaintiff described her relationship
with her boyfriend as, “pretty good.” (Tr. 72-73)
She also relates well to her children and her father, but not
her mother. (Tr. 73) She is not active in any civic
organizations, but attends religious services occasionally.
also admitted to using methamphetamine, crack cocaine, and
marijuana. (Tr. 74-75) By the hearing date, she testified,
she had abstained from all drugs for at least six months.
(Tr. 75) She occasionally smokes cigarettes when she is
nervous, though she is attempting to quit. (Tr. 75-76) She
testified that she has never had a drinking problem, and no
longer drinks alcohol. (Tr. 76)
had discontinued taking Ambien, Hydrocodone, Xanax, and
vitamin B-12 injections. Id. She was still using
Trazodone to treat her sleep disorder. Id. Plaintiff
was also taking prescription Abilify (aripiprazole), an
antipsychotic medication used to treat her bipolar disorder
and depression; Trileptal (oxcarbazepine), a medication for
bipolar disorder; and Vistaril (hydroxyzine), to treat her
anxiety. (Tr. 76-77) Weight gain is a side effect of the
medications, according to plaintiff. (Tr. 78) Because of the
weight gain, plaintiff ceases taking her prescribed
medications “about once a month.” Id.
However, she consistently resumes the medications because,
after “a week or so, ” she will not “feel
like” herself without them. Id.
her symptoms both on and off of those medications, plaintiff
testified to feeling depressed, which includes being
“really sensitive” and experiencing frequent
crying spells. (Tr. 78) She also testified to suffering from
anxiety, including experiencing anxiety or panic attacks.
(Tr. 78-79) However, because she is taking medication for
those conditions, it had been “a while” since she
had an attack. Id. When an anxiety attack occurs,
she seeks relief by breathing deeply and trying “to get
somewhere where [she] can be calm.” Id.
also described suffering from what she believes is bipolar
disorder, manifesting mood swings that “normally run
from being really happy to being really sad, ”
depending on the day. (Tr. 79) She admitted to not
experiencing auditory or visual hallucinations. Id.
Plaintiff testified to having difficulty concentrating, and
“maybe” having trouble getting her
“thoughts together.” Id. Among other
physical symptoms, plaintiff testified that she is
“real clumsy” and will “drop stuff a
lot.” (Tr. 77)
also testified that she has “always” experienced
headaches approximately once every week or two weeks. (Tr.
84-85) The headaches manifest in her temples and sometimes
develop into migraines. For relief, plaintiff will “lay
down and get in a dark room or in the bathtub.” (Tr.
85) The headaches last from a “couple hours” to a
“couple days.” Id. Plaintiff had sought
treatment for the headaches, which, she testified, would not
subside absent medical intervention. But by the time of the
hearing she was no longer receiving the treatment.
Id. Plaintiff was unsure about the medications she
had acquired or been prescribed for headaches, though she
recalled at some point having taken Phenergan (promethazine),
an anti-nausea medication for migraines, and receiving
injections. (Tr. 85-86)
admitted she had used drugs as a teenager and then stopped
for about ten years, until 2011, when she was “mixed up
with the wrong people, ” her former friends. (Tr. 81)
She initially used methamphetamine and crack cocaine
“every day” after separating from her husband.
(Tr. 81-83) But, she clarified, she ceased daily use
approximately five months later when she moved in with her
mother, at which point she “might go weeks without it,
” but then would use again. (Tr. 82) Plaintiff
reiterated that she discontinued using all illegal drugs
between six and seven months before the second hearing. (Tr.
83) She admitted that she had told Dr. Jordan she had
“very limited periods of sobriety.” Id.
However, plaintiff testified that she did not know what that
meant when she said it. Id.
also testified that she could not “make any sense
of” her three previous separations from her ex-husband,
or her behaviors that preceded them, because it “was
like there was someone else in [her] body doing” it;
she “had no control over it.” Id.
Describing what precipitated her two prior in-patient
hospitalizations for suicidal ideation, plaintiff averred
that after she left her husband, she “felt like”
she “didn't see” or “have a
point” in “living.” (Tr. 86) She
“felt like [she] was worthless and nothing, ”
which made her “really depressed, ” emotions she
“still struggle[s] with.” Id.
“[A]t times, ” plaintiff “feel[s] like
maybe” she “need[s] to go back to the hospital,
” but she will instead speak to her father for
“positive reinforcement.” Id.
first time plaintiff had been hospitalized, she had used
methamphetamine or crack cocaine “a week prior.”
Id. But, according to plaintiff, she had not
recently used any illegal drugs preceding her second
hospitalization. Id. Additionally, as plaintiff
explained-and as the medical records show, contrary to Dr.
Auvenshine's description of those records-she had not
overdosed on drugs in either instance. (Tr. 86-87) Rather,
plaintiff had been experiencing thoughts that she could not
control, after which she threatened to, but did not, overdose
on her medications. Id. Her mention of suicide and a
specific plan prompted Dr. Palepu to suggest plaintiff seek
in-patient treatment, which she did. (Tr. 87)
noted, Dr. Palepu was plaintiff's treating psychiatrist.
(Tr. 84) According to plaintiff, however, Dr. Palepu did not
“really give [her] any advice.” Id. He
would “just ask” plaintiff “questions and
see how” she was “doing, ” and he would
then provide her renewed prescriptions for her medications.
Id. Plaintiff was also “supposed to” see
a counselor during her visits to Dr. Palepu's office, but
doing so costs $15.00 per visit, which she could not afford.
Carla F. Watts, a vocational expert, provided testimony
regarding the employment opportunities for an individual of
plaintiff's age, education, and with no past relevant
work, who retains the capacity to perform the exertional
demands of light work, with some physical restrictions. (Tr.
87-89) Specifically, according to the ALJ's hypothetical,
such an individual could lift twenty pounds occasionally, ten
pounds frequently, and could sit, stand, or walk for six
hours out of an eight hour workday, for a total of eight
hours in an eight hour workday. Id. That
hypothetical individual, who has no transferable work skills,
also would be limited to occasionally climbing, balancing,
stooping, crouching, kneeling, or crawling, and to only
occasionally being exposed to ladders, ropes, or ...