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Weller v. Colvin

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

September 9, 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 October 6, 2011, plaintiff Leighanne N. Weller filed an application for supplemental security income, Title XVI, 42 U.S.C. §§ 1381, et seq., [1] 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 decision.

         II. Evidence Before the ALJ

         Only 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.

         A. Disability Application Documents

         Plaintiff 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)

         Plaintiff 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)

         On 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)

         Plaintiff 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 conditions. Id.

         Plaintiff 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.

         On 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.

         According 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. 100)

         Plaintiff 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. (Tr. 293)

         At that 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)

         Plaintiff 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 old].” Id.

         In the 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)

         Plaintiff 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.

         In that 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.

         According 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)

         On July 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)

         B. May 16, 2013 Hearing

         On May 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.

         Plaintiff's 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)

         C. January 13, 2014 Hearing

         On 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. (Tr. 783-88)

         Dr. 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. (Tr. 52)

         From “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)

         Plaintiff's 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.

         Based 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.

         Further, 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)

         Dr. 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.

         As to 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.

         Further, 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 symptoms.

         According 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 pre-hearing memorandum.

         Referring 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)

         Dr. 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.

         Dr. 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.

         Dr. 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.

         Further, 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.

         As 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.

         Plaintiff's 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 about it.

         As Dr. 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.

         Plaintiff 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)

         Plaintiff 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)

         Plaintiff 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.

         Plaintiff 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. Id.

         Plaintiff 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)

         Plaintiff 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.

         As to 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.

         Plaintiff 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)

         Plaintiff 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)

         Plaintiff 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.

         Plaintiff 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.

         The 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)

         As 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. Id.

         Dr. 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 ...

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