United States District Court, E.D. Missouri, Southeastern 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.
7, 2013, plaintiff Marjorie Young 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 October 17, 2011. (Tr. 233-38, 239-45). After
plaintiff's applications were denied on initial
consideration (Tr. 164-68), she requested a hearing from an
Administrative Law Judge (ALJ). (Tr. 172-23, 174-76).
hearing was held on September 19, 2014. (Tr. 74-128). The ALJ
issued a decision denying plaintiff's applications on
December 8, 2014. (Tr. 11-30). The Appeals Council denied
plaintiff's request for review on February 16, 2016. (Tr.
1-6). Accordingly, the ALJ's decision stands as the
Commissioner's final decision.
Evidence Before the ALJ
Disability Application Documents
Disability Report dated June 7, 2013 (Tr. 275-83), plaintiff
reported that she had stopped working on October 7, 2012 and
was unable to work due to the following conditions:
post-traumatic stress disorder (PTSD), severe depression,
panic attacks, bad vision, ulcer in right eye, three
concussions in 2006, negative neck curvature, scoliosis, torn
sheath of the left chest muscle, lumbar disk displacement,
neck and back spasms, “degloving” damage to the
left hand and arm, diabetes, high cholesterol, elevated blood
pressure during episodes of psychosis, broken teeth, toenail
fungus, weak bladder, periodic chest pains, pain and limited
movement of the right thumb, plantar wart, sore hip joints,
possible sleep apnea, insomnia, and nerve damage in the arch
of the left foot. She completed three years of college and
was trained as a licensed manicurist. She had worked as a
substance abuse technician, a heavy equipment operator, a
limousine driver, a pipeline oiler, and a phone clerk.
Plaintiff was prescribed the antidepressant citalopram.
Function Report dated June 20, 2013, (Tr. 284-94), plaintiff
reported that she lived alone in an apartment. In response to
a question about her daily activities, plaintiff stated that
she engaged in prayer and meditation, ate meals, attended to
her personal hygiene, washed dishes, and took a short walk or
tended to errands with family members. Her sleep was
disturbed by anxiety and pain in her hips, back, and neck.
Each week, she prepared two complete meals which she
supplemented with sandwiches, canned soups, and frozen foods.
She cleaned her kitchen and bathroom, swept floors, and did
laundry. At the time she completed the report, she could read
for 15 minutes before her eyes began to hurt. She was able to
watch television without limitation. She visited with family
at home or while doing errands. She walked to church with a
neighbor three times a week.
stated that she had previously been a heavy equipment
operator but was no longer able to climb, sit, stand or lift.
She had limited use of her left arm and hand and suffered
pain in her right thumb due to overuse. She felt unable to
cope with her anxiety and PTSD. She had difficulty
communicating and calming herself. She had no energy, her
reactions were dulled, and she could not concentrate. She
complained of an inability to see clearly. She had difficulty
sleeping due to pain, a frequent need to urinate, and
disturbing thoughts. She was able to pay bills, count change,
and manage a checkbook, money orders, and a savings account.
Plaintiff had difficulties with lifting, squatting, bending,
standing, reaching, walking, sitting, kneeling, talking,
hearing, climbing stairs, seeing, remembering, completing
tasks, concentrating, following instructions, using her
hands, and getting along with others. She was able to walk
about 150 yards before she needed to return home, due to
pain. She could generally follow written instructions, but
often needed clarification of spoken instructions. She did
not always get along with police officers but had never been
fired because of conflict with others. She liked to plan
things out and sudden changes in routine caused a great deal
of tension. She described an extensive history of sexual,
physical, and emotional abuse, as well as a pattern of tense
interactions in the workplace.
record contains a letter from plaintiff's older sister,
who reported that plaintiff was sexually and physically
abused by their grandfather, between the ages of 4 and 7.
(Tr. 312-14). Plaintiff had a lot of conflict with her
mother, leading her to move to Missouri to live with her
father when she was 14. When she was 18, she was held up at
gunpoint while working in a clothing store. When she was 28
years old, she was admitted to a treatment center where she
was diagnosed with depression and PTSD. She was unable to
maintain employment, due to physical and psychiatric issues,
and had married and divorced five times. Plaintiff's
sister reported that plaintiff's ability to cope had
deteriorated in the preceding four years, leading her to give
away her belongings in order to reduce her stress.
Participating in a two-way conversation
“derailed” plaintiff and caused her great
frustration. Her behavior had changed to the extent that her
sister wondered if she suffered from schizophrenia.
record also includes a letter from a participant in the
Piedmont Family Counseling Center day treatment program that
plaintiff attended. (Tr. 311). The letter writer reported
that plaintiff displayed anxiety in a number of
circumstances, such as being instructed by staff members or
participating in the weekly trips organized by the counseling
center. In addition, plaintiff became “nervous”
unless everything “was in its place.”
received unemployment benefits from the State of Nevada for
the third quarter of 2012 through the second quarter of 2013.
Testimony at September 19, 2014 Hearing
was 52 years old at the time of the hearing. (Tr. 82). She
lived alone in an apartment in what she described as
disability housing. (Tr. 106-07). She had a driver's
license but did not have a car. She used a scooter to ride to
the store near her home and, occasionally, to a grocery store
22 miles away.
completed three years of college and earned a
manicurist's license. She started working as a heavy
equipment operator in 1991, driving trucks in the gold
mines. The “jarring” she sustained
while driving caused compression fractures in her spine. (Tr.
83-84). She stopped working in October 2011 when her
depression and PTSD worsened. At first these conditions
forced her to leave work early, but ultimately they caused
her to be unable to get up to go to work. Plaintiff was
exhausted and was not “clear minded.” (Tr. 88).
attended the Piedmont Family Counseling Center in Kennett,
Missouri, four days a week. She was paid to do light cleaning
for two hours each week. When asked whether she would be able
to perform such work on a fulltime basis, she testified that
her physical and psychiatric conditions would prevent her
from meeting her commitments. (Tr. 90). She identified her
fear of making mistakes - a component of her PTSD - as the
most significant barrier to maintaining employment. She also
had panic attacks, during which her body felt tense and
vibrated, she became choked up, and she was unable to breathe
or speak. These panic attacks could be caused by a change in
the topic of conversation. Plaintiff met with a case manager
once a week to help her stay focused on her treatment plan
and cope with her constant fears of making a mistake or
getting into trouble. (Tr. 93). She took medication to treat
PTSD and severe depression and a sleep aid to deal with
nightmares and insomnia. (Tr. 95). The medications had
reduced the nightmares, but she continued to experience
flashbacks. She testified that she just didn't seem to be
able to function anymore and that her family and children
could not “handle” her. (Tr. 113).
testified that she generally slept three or four hours a
night. When she was working, she struggled to stay awake and
not nod off. A recent sleep study revealed that she had
obstructive sleep apnea. She had an appointment for another
sleep study and to be fitted for a CPAP mask. (Tr. 111-12).
January 2014, plaintiff began taking medication for diabetes.
Although her condition had stabilized with medication and an
alteration in her diet, she experienced daily episodes of
flushing and poor vision. She testified that she had a
service dog to alert her when her blood sugar was out of
balance. (Tr. 97-99).
sustained a traumatic injury in 2009 when she fell off a
horse. The reins wrapped around her left bicep, causing a
violent jerking of her arm and injury to the brachial plexus.
The reins then wrapped around her wrist and
“degloved” a portion of her left hand. (Tr.
100-101). Her arm was paralyzed for three months. She had
physical therapy for 6 months following the accident, but her
left arm remained weaker and smaller than her right arm and
she had a very weak grip. After a nerve conduction study in
early 2014, her primary care physician told her that her
“muscles were not getting the communication they
need.” (Tr. 102-03). She testified that she had
constant back pain due to her prior injuries and muscle
spasms. The pain fluctuated in intensity between 3 and 10 on
a 10-point scale. Her pain was aggravated by holding her arms
out in front, such as when washing dishes, sitting or
standing too long, and sleeping. (Tr. 99-100).
identified other physical pains: She had severe bunions which
caused pain if she wore a closed shoe. She also had a growth
on one foot that required lancing once a month. (Tr. 103-04).
On occasion a rib moved out of place, causing severe pain.
(Tr. 105-06). She experienced “big chest pains”
that radiated into her shoulders and jaw and which caused her
to worry that she was having a heart attack. (Tr. 106).
Riding the scooter caused unspecified pain. (Tr. 107).
testified that when she awoke in the morning, she walked her
dog, ate her breakfast, and then got ready for the day. The
van from the Family Counseling Center picked her up by 8:30
a.m. four days a week. While there, she attended groups. Over
time she had learned to cope with the other people in the
groups. (Tr. 110-11).
testified that she was took Metformin and Victoza for
diabetes, cholesterol medication, the muscle relaxer Robaxin,
ibuprofen, the antidepressant Zoloft, and Trazadone for
sleep. (Tr. 114).
expert J. Stephen Dolan testified that plaintiff's past
work as a substance abuse service aide was classified as
skilled, light work and her work as a heavy equipment
operator was classified as unskilled, heavy work. (Tr.
119-20). Mr. Dolan was asked to testify about the employment
opportunities for a hypothetical person who was limited to
performing work in the light exertional range, with the
additional limitation of performing only simple routine tasks
that did not involve interaction with the general public. Mr.
Dolan testified that such an individual would not be able to
perform plaintiff's past relevant work. (Tr. 120).
However, other suitable jobs were available in the state and
national economy, including small product assembler,
housekeeping cleaner, or hand packager. (Tr. 121). These jobs
were also suitable if the individual was further limited to
working primarily with objects rather than people and only
occasional contact with co-workers and supervisors. (Tr.
123). However, an individual whose conditions caused her to
be off-task 20 percent of the workday would not be able to
perform the assembler and packager jobs, and the number of
housekeeping cleaner jobs available in the Missouri economy
would decrease from 20, 000 to 5, 000. Limiting the
hypothetical individual to sedentary work narrowed the
available occupations to sedentary unskilled assemblers. (Tr.
124). Employers would not tolerate more than two unexcused
absences in a month or repeated tardiness. (Tr. 122).
response to questioning by plaintiff's counsel, Mr. Dolan
testified that the identified occupations could be performed
with a service animal present to the extent that an employer
permitted it. Imposing additional restrictions on the
hypothetical individual's ability to walk did not reduce
the occupations available; however, a requirement that the
individual elevate her legs to waist level, outside normal
breaks, would eliminate all light and sedentary work. (Tr.
Relevant Medical Records
March 2011, plaintiff was admitted to a hospital in Nevada
with complaints of chest pain, dyspnea, diarrhea, and
dizziness. She reported experiencing three episodes of
nondescript chest pain, with vague shortness of breath. Blood
tests, x-rays and electrocardiogram were all negative and she
was discharged the following day with instructions to follow
up with her primary care physician. (Tr. 329-33). Plaintiff
was being treated for depression with Lexapro at the time of
next medical record dates from October 17, 2011, when
plaintiff presented to the emergency room seeking medication
to treat her depression, which she described as mild. (Tr.
320-27). She was not experiencing appetite loss and she had
no suicidal or homicidal ideation, no hallucinations, and was
not experiencing anxiety, confusion or agitation. On
examination, she was unkempt with dirty clothes and matted
hair. However, her affect was normal, her speech was within
normal limits, and she was not in any apparent distress. She
denied having muscle aches or weakness, back or chest pains,
or difficulty breathing. She had no difficulty with
ambulation and her extremities exhibited normal ranges of
motion. She was stable and had good social support. She
stated that she wanted medication to improve her sleep. She
was provided with 5 Ativan pills and discharged with
instructions to follow up with her primary care physician
before returning to work. The record contains no evidence of
further treatment until May 16, 2012, when she presented to
the emergency room in Nevada with an apparent panic attack.
(Tr. 318). After waiting 90 minutes, she left without being
30, 2013, plaintiff made a visit to a social services office
in Poplar Bluff, Missouri. In a moment of frustration, she
said, “I would be better off if I was suicidal, ' a
statement that she later explained was sarcastic. (Tr. 353).
Later that day, emergency responders came to her home and
transported her to the emergency room, where she was given
Vistaril for severe anxiety/agitation. When interviewed, she
denied suicidal or homicidal ideation, but reported a long
history of depression. She was under a great deal of stress
due to poor finances and conflict with family members and
requested admission to the behavioral health unit. On
examination, she was found to be appropriately groomed, alert
and oriented, with good attention and concentration. Her
affect was anxious and restricted. She described her mood as
“jittery, good, a little agitated.” Her speech
was clear, coherent, loud, and pressured. She had no
hallucinations or paranoid ideations and denied all suicidal
and homicidal thoughts. Her memory was grossly intact; her
insight and judgment were borderline. (Tr. 354). She was
assessed with substance- induced mood disorder with suicidal
ideations and cannabis dependence; PTSD by history, rule out
major depressive disorder; anxiety disorder with panic
attacks; and nicotine dependence. Her current Global
Assessment of Functioning (GAF) was estimated to be 35-40.
Plaintiff was admitted to the behavioral health unit, with