United States District Court, E.D. Missouri, Eastern Division
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.
August 8, 2011, plaintiff Chris Pautler protectively filed an
application for supplemental security income with an alleged
onset date of January 16, 2010. (Tr. 118-19,
Plaintiff's application was denied on initial
consideration on December 22, 2011, (Tr. 56-64, 67-71), and
he requested a hearing from an Administrative Law Judge
(ALJ). (Tr. 74).
and counsel appeared for a hearing on July 22, 2013. (Tr. 10,
86). That same day, plaintiff amended the disability onset
date to February 16, 2011. (Tr. 143). The ALJ issued a
decision denying plaintiff's application on August 20,
2014. (Tr. 7-31). The Appeals Council denied plaintiff's
request for review on January 7, 2016. (Tr. 1-5).
Accordingly, the ALJ's decision stands as the
Commissioner's final decision.
Evidence Before the ALJ
Disability Application Documents
October 27, 2011, Disability Report (Tr. 146-54), plaintiff
listed his disabling conditions as severe depression, sleep
apnea, irritable bowel syndrome, anxiety, and low
testosterone levels. (Tr. 147). An updated report (Tr.
173-78) submitted on February 8, 2012, indicated that
beginning in February 2012, plaintiff experienced worsening
depression and anxiety, as well as signs of paranoia.
Plaintiff also noted worsened colitis and incontinence. (Tr.
173). Plaintiff stopped working on May 31, 2008, when he was
laid off. (Tr. 148). He then collected unemployment benefits
for some time before he “became disabled” on
January 15, 2011. Id. In the fifteen years prior to
the onset of his disability, plaintiff worked as a retail
manager. He stayed in that position until May 2008. (Tr.
149). To treat his health conditions, doctors
prescribed numerous medications including,
Adderall to regulate sleep, a supplement for a
vitamin B deficiency, testosterone injections for his
testosterone deficiency, and Zoloft for depression. (Tr. 150).
Plaintiff's updated disability report reflected the same
prescription medications, but did not include the vitamin
supplement. (Tr. 175). Additionally, the stated reasons for
medications changed: Adderall was reportedly prescribed for
ADHD and testosterone for managing chronic fatigue.
Function Report dated November 7, 2011, (Tr. 162-72),
plaintiff stated that he lived in a house with his family. In
response to a daily activities inquiry, plaintiff stated that
after waking up he took his medications and then returned to
bed for about an hour. (Tr. 162). After getting up again, he
sometimes took care of his personal needs. But, sometimes he
spent several consecutive days in bed, neglecting his
personal care. Id. He did not list any hobbies but
related that he spent most of his day watching television.
reported that his health conditions did not affect his
ability to dress and feed himself, and he could use the
toilet without assistance. (Tr. 163). He noted that sometimes
he failed to bathe and care for his hair and he seldom
shaved. Id. Plaintiff attributed these personal care
habits to his depression. Id. Plaintiff's mother
would “gently remind” him to care for his
personal hygiene and take his medications. (Tr.
once a week plaintiff “accomplish[ed] small
tasks” such as laundry, housework, and yardwork. He
needed encouragement to do so, due to low motivation. (Tr.
162, 164). On other days, plaintiff added, he might
“just go in circles.” (Tr. 162). When it came to
handling money, plaintiff could count change and use a
checkbook or money orders. (Tr. 165). He could not, however,
pay bills or handle a savings account, as he would become
“overwhelm[ed].” (Tr. 165). Plaintiff prepared
his own meals three or four times a week. (Tr. 164). He tried
to make meals quickly, rather than healthfully. Id.
Plaintiff left his home about two or three times each week;
he was able to walk and drive alone. (Tr. 165). He shopped
for clothes or groceries once every two weeks. He refrained
from shopping more frequently because of his depression.
reported that depression has also diminished his abilities to
concentrate, absorb information, and socialize, noting that
in the past he enjoyed sports and school. (Tr. 163, 166).
Plaintiff reported limited social interaction- whether in
person, on the phone, or on the computer. (Tr. 166). He has
had difficulty getting along with others, as he is
“easily annoyed and impatient.” (Tr. 167).
Plaintiff wrote that his “inability to
communicate” manifested in “poor job function,
” and his “eventual termination” from a
job. (Tr. 168). Plaintiff added that he experienced
hearing and memory difficulties, and that he
struggled to complete tasks, understand, and follow
instructions. (Tr. 167). He noted that his concentration,
which could only persist for about fifteen to twenty minutes,
limited his capacity to follow instructions. Id.
Plaintiff also struggled handling stress and adapting to
changes in routine. (Tr. 168). In his narrative, plaintiff
attributed his disability to having been “born with the
[umbilical] cord wrapped around [his] neck.” (Tr. 169).
stated that he can walk a distance of only one block before
requiring a ten-minute rest period. (Tr. 167). He also
reported that sleep apnea reduced his daily coordination and
functioning and exacerbated his depression and anxiety. (Tr.
169). He also added that irritable bowel syndrome (IBS)
necessitated frequent bathroom visits. (Tr. 169).
Work History Report plaintiff provided a detailed description
of his prior work experience. (Tr. 155-61). Plaintiff worked
as a retail manager from an unknown date until May 2008. (Tr.
156). He worked for eight hours each day, and for seven days
each week, earning about $1, 200.00 weekly. Id. His
job responsibilities included “ordering and maintaining
sales records, ” “payroll, ” and managing
staff. Id. Moreover, his duties required that he
employ machines, tools, and equipment, as well as technical
knowledge or skills. (Tr. 156). He also wrote and completed
reports. Id. The daily physical requirements of
plaintiff's position involved about 5.5 hours of walking,
5 hours of standing, 3.5 hours of climbing, 2 hours of
stooping, 0.5 hours of kneeling, 1 hour of crouching, 6.5
hours of handling, grabbing, or grasping large objects, 2.5
hours of reaching, and 2 hours of writing, typing or handling
small objects. Id. On a daily basis he would lift
and carry boxes of stock and furniture for up to 1, 000 feet.
Id. He frequently lifted objects weighing about
fifty pounds or more. Id. Plaintiff supervised eight
other employees in his position, and had some responsibility
for hiring and firing.
Testimony at Hearing
testified that he lives with his 75 year old mother. He
testified that his employment issues began when his former
employer laid him off on May 31, 2008. (Tr. 36). He collected
unemployment until January 2011. (Tr. 36). By February 16,
2011, plaintiff had ceased looking for work and collecting
unemployment benefits. (Tr. 37). Plaintiff testified that he
was disabled due to persistent depression, anxiety, panic
attacks, chronic fatigue, and irritable bowel syndrome. (Tr.
testified that he used a continuous positive airway pressure
machine (CPAP) for sleep apnea. (Tr. 38). When asked about
medication compliance, plaintiff responded that he had
stopped taking Lipitor and was going to resume but his doctor was
on vacation. Plaintiff stated that he was given Lipitor while
in the hospital in May 2013 because doctors believed he
“might have had a mini stroke.” (Tr. 38).
testified that in high school he saw Jay Liss, M.D., “a
couple times” for treatment of depression. (Tr. 40).
Plaintiff did not see Dr. Liss for several years after that,
but resumed treatment “on and off” in the mid- to
late 1980's. Id. For about 2½ or 3 years
preceding the hearing, plaintiff had been keeping regular
appointments with Dr. Liss. (Tr. 40-41). Because of
depression, plaintiff testified that feels he doesn't
“have any way out” and that he doesn't
“have a purpose in life because [he is] tired all the
time.” (Tr. 41-42). He testified that depression had
caused his inability to concentrate and follow written
directions and his difficulty with reading comprehension.
Id. Plaintiff reported that he had become forgetful
and that lately his “memory isn't all that
good.” Id. As a further consequence of
depression, plaintiff testified that he does not have
“any social life anymore” and that he has
“lost contact with all [his] friends.” (Tr. 43).
Additionally, he has days when he does not “feel like
getting out of bed.” Id. Plaintiff testified
that “there might [be] three days in a row” when
he does not “get out of bed or take a shower or do
anything.” (Tr. 45).
testified that anxiety makes him feel overwhelmed at times.
(Tr. 46). He could not identify specific triggers for his
anxiety but he believed it sometimes arose from thinking
about his responsibilities. (Tr. 46, 47). He also attributed
anxiety to an incident several years earlier when he was shot
during an attempted robbery. Id. That experience led
to fear of leaving home and suspicion of strangers in public
places. (Tr. 48).
described how chronic fatigue made him “dizzy and
lightheaded.” (Tr. 46). He also complained of resulting
muscle aches and difficulties walking. Id. The onset
of the fatigue was generally unpredictable. Id.
Although plaintiff could still drive, fatigue sometimes
interfered and he would have to pull over until it passed.
testified that he had sleeping difficulties for which he took
Ambien.(Tr. 49). Nevertheless, he still struggled
to fall asleep due to racing thoughts and uncomfortable
positioning to accommodate his CPAP machine. (Tr. 49-50). He
woke up frequently throughout the night, preventing him from
getting adequate rest. Id. As a result, he might not
hear an alarm and might not get out of bed until anywhere
between 10:00 a.m. and 2:00 p.m. (Tr. 50, 51).
typical day, plaintiff began by taking his medication-two
Adderall, one Zoloft, and aspirin. Id. Because he
was often still tired, he would go back to bed for another
hour. Id. Upon arising, he might take a shower or
take vitamin supplements or Metamucil. Id. During
the afternoon and evening plaintiff cooked or ate meals. (Tr.
52). Plaintiff did not have any hobbies. Id.
Instead, on a typical day he watched television or did chores
such as cleaning, laundry, or mowing the lawn. Id.
On occasion he shopped for groceries. Id. Plaintiff
told the ALJ that he does not participate in any social
activities or groups. However, in the two years preceding the
hearing, he and his mother traveled to the Lake of the Ozarks
several times and plaintiff went fishing there. (Tr. 43,
Vocational Specialist Interrogatories
the administrative hearing, the ALJ propounded
interrogatories to vocational specialist Gerald Belchick.
(Tr. 198-202). The ALJ asked whether an individual born on
July 25, 1962, with at least a high school education, who can
communicate in English, with work experience as a retail
sales manager, and who has the residual functional capacity
(RFC) to perform a full range of work at all exertional
levels but has nonexertional limitations of (1) routine
repetitive tasks (SVP not to exceed 2), (2) occasional
interaction with the public, and (3) occasional to frequent
interaction with co-workers and supervisors, could perform
prior past jobs and could perform any unskilled occupations
with jobs that exist in the national economy. (Tr. 199-200).
Belchick responded that the individual did have work
experience within the past fifteen years but he could no
longer perform the same position. (Tr. 198-99). He also
opined that the individual could perform unskilled
occupations in the national economy. (Tr. 200). Specifically,
he noted that “there are a number of unskilled jobs
that are simple, routine and repetitive and that do not
involve frequent interaction with the public, co-workers or
supervisors.” (Tr. 202). Such positions included
warehouse worker, commercial laundry worker, and cleaner.
Mental Health Records
Liss, M.D., met with plaintiff on March 19, 2009. (Tr. 220).
Dr. Liss diagnosed plaintiff with depression and attention
deficit disorder (ADD). Id. He wrote that
plaintiff's medications included Zoloft and Adderall.
Id. During that session, plaintiff told Dr. Liss
that he was sleeping less. Id. Notes from June 10,
2009, reflect similar findings; but Dr. Liss added that
plaintiff suffered from anxiety. (Tr. 219). On July 9, 2010,
Dr. Liss wrote that plaintiff maintained the same dosage of
Adderall and Zoloft and had a GAF of 60. (Tr. 218). Dr. Liss
diagnosed plaintiff with ADD. Id. He further noted
that plaintiff had to go to court due to a trespassing
charge. Id. Records also indicate that plaintiff
discussed his unemployment. Id. In his next set of
meeting notes, Dr. Liss clarified that the trespassing
charges were civil in nature. (Tr. 217). He also found a GAF
of 60 and wrote that plaintiff had ADD and still held
prescriptions for Adderall and Zoloft. Id
a physical exam at Barnes Jewish Hospital on November 24,
2010, plaintiff reported that he took antidepressants and
Adderall (for daytime fatigue). (Tr. 231). Scott D. Groesch,
M.D. wrote of plaintiff's depression that he
“seem[ed] stable on current medications.” (Tr.
Mental Health Records
March 9, 2011, plaintiff again saw Dr. Groesch. (Tr. 229-30).
He noted that plaintiff presented with “normal sleep,
mood, energy, sense of well-being and memory.” (Tr.
229). He further wrote that plaintiff's depression was
“stable on the above listed medications”
(Adderall and Sertraline HCl). (Tr. 229-30). Dr. Groesch
reported similar findings during a visit on March 30, 2011.
(Tr. 227-28). He specifically stated that plaintiff's
“depression is much improved and is followed by
psychiatry.” (Tr. 227). Moreover, he reported that
plaintiff was “improving” and
“well-controlled on current regimen.” (Tr.
attended a psychiatric appointment with Dr. Liss on May 20,
2011. Dr. Liss's notes indicate that the two discussed
plaintiff's attorneys, as well as his medications. Dr.
Liss found on Axis I that plaintiff had ADD. His GAF
assignment on Axis V is indecipherable. (Tr. 216). When
plaintiff returned on September 16, 2011, Dr. Liss wrote that
he was “feeling more depressed” and had night and
day “mixed up.” (Tr. 263). In addition he wrote
that plaintiff felt “worried about his mother.”
Id. Again, Liss diagnosed plaintiff with ADD.
Id. Plaintiff's prescription medications
remained the same. Id.
a November 17, 2011, visit to Dr. Groesch, plaintiff
complained of “ongoing depression.” (Tr. 225). At
that time plaintiff maintained the same prescription regimen
for his depression (Setraline HCl), but also had
prescriptions for Adderall, Lipitor, and Depo-Testosterone
December 5, 2011, Lenora V. Brown, Ph. D., conducted
plaintiff's psychological evaluation. (Tr. 246-50). Dr.
Brown reported that she reviewed plaintiff's medical
records prior to the examination and noted that his chief
complaints were severe depression, sleep apnea, IBS, anxiety,
and low testosterone levels. (Tr. 246). Dr. Brown began by
describing each of plaintiff's presenting issues. She
first noted that plaintiff had no knowledge of a diagnosis of
ADD, despite its repeated mention in medical records.
Id. Plaintiff reported constant symptoms of
depression including “fatigue, irritability, sense of
worthlessness, sadness, lack of interest in engaging in
social activities, decreased concentration, ” low
self-esteem, guilt about being a burden, disturbed sleep, and
increased appetite with fluctuating weight. (Tr. 247).
Plaintiff also told Dr. Brown that he had struggled with
anxiety since high school and depression since childhood.
Id. He denied any suicidal attempts, excessive
alcohol consumption, drug use, or inpatient admissions.
Id. His medications at the time were Straline 100
mg, once daily; Adderall 30 mg, twice daily; and testosterone
Brown reported that plaintiff's grooming and hygiene
appeared within normal limits. (Tr. 248). She did not observe
“unusual motor activity or disturbance in gait.”
Id. With respect to plaintiff's ability to
relate, Dr. Brown noticed that although his eye contact was
poor, he succeeded in generating “some spontaneous
conversation.” Id. Plaintiff's cooperation
with the examiner seemed fair and “no problems were
noted in either receptive or expressive language
domains.” Id. Generally, plaintiff's
speech was normal and Dr. Brown related that his rate,
rhythm, and volume fell within normal limits. Id.
Dr. Brown further opined that while plaintiff's affect
appeared within normal limits, he reported that he felt
“sort of closed in.” Id. Dr. Brown's
assessment of plaintiff's thought process found it
generally normal-he denied paranoid ideation, as well as
auditory or visual hallucinations. Id. Also,
“[d]uring the evaluation he was coherent and his
conversation was relevant and logical.” Id. In
the sensory tests, plaintiff successfully repeated five
digits forward, named the current president and governor,
named the past four presidents, and identified his
birthplace, birthdate, and social security number.
Id. He could not name the current mayor.
Id. On a series of tests involving judgment (how to
react to various scenarios), calculation (performing simple
calculations and a serial threes task), proverb
interpretation, and similarities and differences questions,
plaintiff successfully answered all questions, and Dr. Brown
rated him as “fair” in each category; he
completed calculations without difficulty. (Tr. 248-49).
Dr. Brown evaluated plaintiff's level of daily
functioning. (Tr. 249). She reported that plaintiff told her
he can pay bills and has a bank account. Id. He also
stated that he can cook, use a microwave, and make a
sandwich. Id. He shops for groceries once a week,
and was able to perform basic chores such as laundry,
vacuuming, and cleaning the bathroom. Id. Plaintiff
told Dr. Brown that “[o]n average” he is
“capable of doing things about once a week.”
Id. In terms of his social functioning, plaintiff
“reported a history of problems getting along with
others in a work setting and acknowledged being terminated
twice.” Id. He also noted some friction with
his mother. Id. Furthermore, he only reported
television as a leisure and recreation activity. Plaintiff
reported that he does not always care for his personal needs
due to fatigue. Id. Finally, Dr. Brown observed that
plaintiff's “concentration, persistence, and pace
were fair during the duration” of the evaluation.
Brown concluded that plaintiff's ability to perform
activities of daily living and personal grooming were mildly
impaired. Next, she found that his levels of social
functioning and occupational functioning (ability to remember
and carry out simple tasks, concentrate, persist for a normal
period of time, and adapt to a normal workplace) were
moderately impaired. (Tr. 250). She diagnosed plaintiff with
depressive disorder, not otherwise specified, and assigned a
GAF of 65. Id.
January 11, 2012, Dr. Liss took notes on plaintiff's
various conditions- depression, chronic fatigue, sleep apnea,
low testosterone, and ADD. (Tr. 262). He also wrote that
plaintiff had been denied disability benefits. Id.
Dr. Liss indicated a GAF of 45. Id.
February 1, 2012, Dr. Liss noted that plaintiff was applying
for disability benefits. (Tr. 261). He also reported that
plaintiff complained of “memory trouble” and
stress. Id. Plaintiff received a GAF evaluation of
50 and a diagnosis of ADD. Id. In his April 4, 2012,
evaluation, Dr. Liss reported diagnoses of ADD and
depression. (Tr. 260). The notes also reflect that plaintiff
discussed various legal issues with Dr. Liss during that
appointment. (Tr. 260). Dr. Liss assigned a GAF of 40.
presented to Barnes Jewish Hospital on February 3, 2012, for
a physical exam, during which he discussed his mental health
complaints. (Tr. 273- 74). Plaintiff told Dr. Groesch that he
had long-standing depression, for which he was seeing a
psychiatrist. He noted that he took Adderall for daytime
fatigue, as well as antidepressants. (Tr. 273). Of
plaintiff's depression, Dr. Groesch wrote that it
“seems stable on current medications, ” and
associated depression treatment with improving
plaintiff's generalized fatigue. (Tr. 274).
met with Dr. Liss on May 31, 2012, at which time Dr. Liss
diagnosed him with ADD and a thought disorder. (Tr. 259). Dr.
Liss recorded several observations relating to
plaintiff's ADD including “(1) poor attention,
” “(2) poor sustainability”, “(3)
doesn't listen well, ” “(4) poor follow
through, ” “(5) poor organization, ” and
“(6) loses thought.” (Tr. 259). These notes
appear to be copied from later meeting records taken on
August 15, 2012. (Tr. 257). There was also some conversation
about plaintiff's legal issues. Id. Dr. Liss
assigned plaintiff a GAF of 50. Id.
29, 2012, Dr. Liss wrote that plaintiff was “at the
lake” and diagnosed plaintiff with ADD and a thought
disorder. (Tr. 258). He noted a GAF of 40. Plaintiff's
prescriptions were unchanged. Id.
from August 15, 2012, mirror those from May 31 noted above.
(Tr. 257). Dr. Liss found that plaintiff had ADD and a GAF of
40. Id. Dr. Liss recorded the same GAF and ADD
diagnosis on October 1, 2012. (Tr. 256). Topics of discussion
included plaintiff's siblings and use of the CPAP
machine. Id. Dr. Liss's diagnoses remained
consistent on November 14, 2012. (Tr. 255).
visited Barnes Jewish Hospital to follow up regarding his
fatigue. (Tr. 271-74). Dr. Groesch noted that plaintiff
“has some depression symptoms, ” which “are
partially improved with use of the testosterone
supplements.” (Tr. 271). Psychiatric evaluation also
included findings of “normal sleep, mood, energy, sense
of well-being and memory.” (Tr. 272). The assessment of
plaintiff's psychiatric state concluded that he
“seems stable on current medications, ” and will
follow-up with a psychiatrist. Id.
December 19, 2012, plaintiff and Dr. Liss discussed
plaintiff's sleep issues and weight loss. (Tr. 254). Dr.
Liss found that plaintiff had ADD and a GAF of 40.
Id. This assessment remained unchanged at the
appointment on January 23, 2013. (Tr. 253).
told Dr. Liss about his sleep apnea and overeating issues on
February 1, 2013. (Tr. 252). He concluded that plaintiff had
ADD and a GAF of 50. (Tr. 252). Notes from ...