United States District Court, E.D. Missouri, Eastern Division
MEMORANDUM AND ORDER
M. BODENHAUSEN, UNITED STATES MAGISTRATE JUDGE.
matter is before the Court for review of an adverse ruling by
the Social Security Administration. The parties have
consented to the jurisdiction of the undersigned United
States Magistrate Judge pursuant to 28 U.S.C. § 636(c).
April 2013, plaintiff Valerie Camden filed an application for
disability insurance benefits, Title II, 42 U.S.C.
§§ 401 et seq. (Tr. 200-01), with an
alleged onset date of January 10, 2013. In May 2014, she
filed an application for supplemental security income, Title
XVI, 42 U.S.C. §§ 1381 et seq., with an
alleged onset date of March 1, 2011. (Tr. 236-41). After
plaintiff's application for Title II benefits was denied
on initial consideration (Tr. 115-19), she requested a
hearing from an Administrative Law Judge (ALJ). (Tr. 122-23,
and counsel appeared for a hearing on December 18, 2014. (Tr.
74-100). At plaintiff's request, the ALJ held the record
open and conducted a supplemental hearing on July 17, 2015.
(Tr. 21, 37-72). Plaintiff testified concerning her
disability, daily activities, functional limitations, and
past work. The ALJ also received testimony from medical
expert Janet Telford-Tyler, Ph.D., and vocational expert
Delores Gonzalez, M.Ed. The ALJ issued a decision denying
plaintiff's applications on September 4, 2015. (Tr.
18-36). The Appeals Council denied plaintiff's request
for review on September 1, 2016. (Tr. 1-7). Accordingly, the
ALJ's decision stands as the Commissioner's final
Evidence Before the ALJ
Disability and Function Reports and Hearing
was born on June 16, 1970, and was 42 on the alleged onset
date. She completed the tenth grade. She did not obtain a GED
but did receive vocational training as a medical assistant.
(Tr. 81). She previously worked as an administrative
assistant, a waitress, a receptionist, and a truck
dispatcher. (Tr. 82-88). As a truck dispatcher, plaintiff
supervised, hired and fired drivers, made their schedules,
and ensured they met annual licensing and drug testing
requirements. (Tr. 58, 257). In September 2014, she worked as
a cashier at a gas station for one month; the owner
complained that she had erratic behavior because she would
start to cry and leave her register. In 2015, she worked as a
cashier for 15 to 20 hours a week for about two months, but
she was unable to continue due to panic attacks and crying
spells. (Tr. 52-53). Plaintiff next worked as a “perma
sealer” in a plastics factory and continued to
experience panic attacks. (Tr. 54-57, 60, 221-22).
listed her impairments as depression, anxiety, panic attack,
and tremors. She stopped working due to her short-term
memory, anxiety, panic attacks, and manic
depression.(Tr. 278). She testified that she was
unable to work due to her depression, crying, and
self-isolation. (Tr. 89). Between January 2013 and June 2015
- the time period encompassed by the ALJ's decision -
plaintiff was prescribed a number of medications for the
treatment of anxiety, depression, and insomnia, and to reduce
cravings for alcohol or substances. She took levothyroxine
and Zantac for medical conditions. (Tr. 89-90, 254, 281,
stated in her May 2013 function report (Tr. 230-38) that she
attended group therapy at Community Treatment, Inc.,
(Comtrea) three afternoons a week and AA meetings “6-8
nights a week.” Her husband and daughter prepared
dinner. She stated that she had “lost” her
short-term memory and needed help remembering to take her
medication. She was not able to prepare meals or complete
chores without help due to her distraction and poor memory.
Her medications caused shaking and blurred vision which, in
combination with her poor memory, prevented her from driving.
She was unable to pay bills, count change, or handle bank
accounts. Plaintiff had difficulties with talking, seeing,
memory, completing tasks, concentrating, understanding,
following instructions, and using her hands. The Field Office
interviewer noted that plaintiff's short-term memory
seemed poor, and that she appeared confused and had
difficulty answering questions. (Tr. 242-43).
testified at the December 2014 hearing that she and her
16-year old daughter lived with her parents. (Tr. 91). On
good days, she was able to do her laundry and handle some
household chores. She used to golf and hunt, but no longer
had any interest in doing so. She did not spend time on a
computer and generally did not go anywhere other than to
medical appointments. (Tr. 92-93). Her recent attempt to work
as a cashier failed because she had crying spells and panic
attacks when the store got crowded. (Tr. 94). From 2011 to
2013, she was dependent on alcohol and illegal drugs. She had
been clean since April 5, 2013, when she admitted herself to
Center Pointe Hospital. (Tr. 95). After her release, she
received psychiatric treatment from Dr. Rohatgi at Comtrea
until July 2014, when she asked her primary care physician,
Dr. Kenneth Ross, M.D., to take over her
medications. (Tr. 96-97). Despite ceasing all substance
use, she experienced four or five “bad days” a
week due to her psychiatric symptoms and she and Dr. Ross
were going to discuss electric shock treatment at her next
appointment. (Tr. 98). At the July 17, 2015 hearing (Tr.
37-72), there was testimony that plaintiff was hospitalized
in February 2015 following an overdose of Xanax and alcohol.
(Tr. 43-44). A few days before the hearing, she had an
episode of crying and shaking at work and was sent home. She
contemplated admitting herself for inpatient care, but did
not want to miss the hearing. (Tr. 56-57).
2015 hearing, Dr. Telford-Tyler offered her opinion about the
limitations on plaintiff's mental ability to perform
work-related functions, based on interrogatories and a
medical source statement she completed in February 2015
(see Tr. 890-98) and plaintiff's more recent
medical treatment. (Tr. 41-50). Dr. Telford-Tyler found that
plaintiff's medically determinable impairments were major
depressive disorder (Listing 12.04) and alcohol and cocaine
dependence (Listing 12.09). Her opinion is discussed in
greater detail below but, in summary, Dr. Telford-Tyler
opined that plaintiff would have moderate difficulties in
maintaining concentration, persistence, and pace, but was
able to understand and complete simple and detailed work,
with some occasional problems with more complex tasks. She
was likely to miss work one or two times a month.
expert Delores E. Gonzalez was asked to testify about the
employment opportunities for a hypothetical person of
plaintiff's age, education, and work experience who was
able to perform work at all exertional levels but who was
limited to understanding, remembering, and carrying out
simple instructions. (Tr. 67). In addition, the hypothetical
individual was limited to only occasional interaction with
the public, coworkers, and supervisors, and could tolerate
only occasional changes in work location, and could make only
simple work-related decisions. According to Ms. Gonzalez,
such an individual would be able to perform plaintiff's
past work as a sealer. In addition, the individual could
perform other work that was available in the regional and
national economy, including cleaner, lab equipment cleaner,
and marker. (Tr. 67-68). An individual who was absent from
work, late for work or needed to leave work early one to two
times a week would be unable to perform any work in the
national economy. (Tr. 68). For a person working at the
unskilled level, absences of more than one day a month would
preclude employment. (Tr. 69-70).
administrative record in this case includes records of
plaintiff's medical care beginning in May 2010. Plaintiff
confines her discussion of the medical evidence to the
treatment she received beginning in March 2013. The Court
briefly summarizes the earlier records.
Treatment records: 2010 through 2012
May 2010 and September 2012, plaintiff was treated at St.
Anthony's Medical Center on seven occasions after an
overdose of medication or other suicidal gesture made while
intoxicated. (Tr. 369, 388, 401, 417, 442, 457, 455-56). In
February 2012, plaintiff had an initial assessment at
Comtrea, at the urging of a DFS caseworker. (Tr. 617).
Plaintiff reported that she wanted inpatient treatment for
alcohol and cocaine use, and it appears that she entered the
program at Southeast Missouri Behavioral Health. (Tr. 534);
(see also Tr. 442) (noting that plaintiff was allowed to sign
out from St. Anthony's Hyland Center against medical
advice to enter treatment program). In June 2012, plaintiff
reported to psychiatrist Gautam Rohatgi, D.O., at Comtrea
that she had been off all medication and sober for two months
and was attending AA meetings. (Tr. 530-31). She was
diagnosed with major depressive disorder, recurrent;
generalized anxiety disorder; cocaine dependence in early
sustained remission; and alcohol dependence in early
sustained remission. Dr. Rohatgi prescribed the
antidepressant amoxapine, and antipsychotic Haldol. Although
plaintiff reported improvement in her symptoms on July 28,
2012, she was treated in the emergency department on July 29,
2012, and again on September 3, 2012, after being found
unresponsive as a result of mixing alcohol and medication.
(Tr. 528, 455, 457). In October 2012, plaintiff reported that
she had been drinking and requested a support group. (Tr.
579). She was referred to Comtrea's substance treatment
program and, in November 2012, began attending education and
support groups and receiving services from a community
support specialist and a substance abuse counselor. (Tr. 581,
574-75, 576-77, 558-59).
Treatment records: 2013 through 2015
February 2013, plaintiff reported to substance abuse
counselor Peter Ninneman, M.S.W., that “everything is
good.” She was looking for a job and had gone to court
and reported to her community service assignment. She
reported some side effects of medication. (Tr. 556).
Plaintiff resumed medication review with Dr. Rohatgi in
January 2013. (Tr. 524-25). On March 1, 2013, Dr. Rohatgi
noted that plaintiff was sad and depressed and was sleeping
too much. She had multiple psychosocial stressors. On
examination, plaintiff was quite guarded and quiet, with
fair-to-poor eye contact. She had minimal spontaneous speech.
Her insight and judgment were fair to poor. She was diagnosed
with major depressive disorder, recurrent, mild to moderate;
generalized anxiety disorder; and cocaine dependence and
alcohol dependence in early sustained remission. Dr. Rohatgi
made changes to plaintiff's antidepressant medications.
On March 7, 2013, plaintiff told Mr. Ninneman that her mood
had improved with the medication changes and that she wanted
to taper off Xanax. She admitted to drinking small quantities
of alcohol. (Tr. 547-48). On March 30, 2013, plaintiff was
taken to St. Anthony's Medical Center in police custody
after an overdose of alcohol and Xanax, which she denied was
a suicide attempt. (Tr. 479-80, 482-84, 520). She was
variously described as combative, agitated, and labile, and
ultimately required physical and chemical restraint. Once
sober, she was anxious and worried but not suicidal. She was
discharged to continue in outpatient treatment. (Tr. 485). On
April 1, 2013, plaintiff told Dr. Rohatgi that she had
difficulty controlling the urge to drink. (Tr. 520-21). She
denied feeling depressed and, on examination was cooperative,
with good eye contact, linear thought processes, and
frustrated mood. Her insight and judgment were poor. Dr.
Rohatgi directed plaintiff to speak with her primary care
physician about discontinuing Xanax and starting gabapentin.
He prescribed ReVia. On April 2, 2013, plaintiff told Mr.
Ninneman that she was having difficulty handling stress. She
was unhappy with the total abstinence requirement and
reported that her husband was abusive and enabled her
continued drinking. (Tr. 544-45). Mr. Ninneman gave plaintiff
referrals for medical detoxification programs at her request.
was admitted to Center Pointe Hospital's inpatient
chemical dependency unit on April 5, 2013. (Tr. 502-06). She
reported that she had been drinking a fifth of vodka a day
for about three months and using methamphetamine
periodically. A physical examination was unremarkable, with
the exception of elevated thyroid stimulating hormone levels.
She was started on Synthroid. (Tr. 507-09). At discharge on
April 19th, it was noted that plaintiff actively participated
in all phases of the rehabilitation program. (Tr. 501). She
was described as making good progress and motivated to
continue a recovery program. She wished to move with her
teenaged daughter to her parents' home. At discharge, her
diagnoses were polysubstance dependence, rule out bipolar
disorder NOS; alcohol dependence; and hypothyroidism. Her
discharge medications included Cogentin to address
extrapyramidal symptoms, Tegretol as a mood stabilizer,
trazadone for insomnia, Vistaril for anxiety, Neurontin,
Prilosec, and Synthroid. She was directed, pursuant to a
court order, to follow-up with Comtrea. (Tr. 501-02).
attended regular group meetings at Comtrea. (Tr. 780-89). She
met with Dr. Rohatgi for medication management every three or
four weeks. In May 2013, she reported that she had detoxed
from Xanax while at Center Pointe. (Tr. 796-97). She denied
any depression or loss of interest, but was uncomfortable due
to medication side effects, including sedation, tiredness,
confusion, and fatigue. On examination, she was cooperative,
with good eye contact, linear thought processes, and fluent,
clear speech. Her affect was “worried due to the side
effects of these medications.” Her insight and judgment
were fair. Dr. Rohatgi made changes to plaintiff's
medication and directed her to contact the clinic if she
noticed any deterioration in her mood or behavior. In June
2013, the side effects had dissipated, but she complained of
mood swings, frustration, anger, anxiety, and difficulty with
short-term memory. She reported that her medications were
effective in curbing her desire for alcohol and drugs. On
examination, she was cooperative and had good eye contact,
linear thought processes, and fluent, clear speech. Her mood
was tired and anxious, and her affect was worried. Her
insight and judgment were fair. Her diagnoses were major
depressive disorder, recurrent; generalized anxiety disorder;
and alcohol dependence and cocaine dependence in sustained
early remission. Dr. Rohatgi again made medication changes.
(Tr. 825-26). In July 2013, plaintiff reported that the mood
swings, anger, and irritability had abated and she was
maintaining sobriety. Dr. Rohatgi determined that her
depression was in full remission and made no changes to her
medication. (Tr. 823-24).
in August 2013, plaintiff experienced multiple stressors: her
husband was drinking heavily, her daughter was assaulted by a
neighbor, and she and her daughter moved into her
parents' home. She used alcohol at least once in August.
(Tr. 783). On August 29, 2013, she told Dr. Rohatgi that she
had been without medication for two weeks. He declined her
request for Valium and Xanax, explaining that they were not
in her best interest, and restarted her medications. On
examination, she was cooperative, with good eye contact and
linear thought processes, and fluid, clear speech. Her affect
was angry, upset, and sad. Her insight and judgment were
fair. (Tr. 819-20). In September 2013, Dr. Rohatgi noted that
plaintiff improved once she resumed her medications. (Tr.
821-22). She reported that her anxiety had decreased by
20-30%, but her sleep was disturbed. She continued to
experience a number of stressors but was coping as best as
could be expected and meeting her responsibilities, despite
feeling sad, angry, and frustrated over recent events. She
denied all alcohol and drug use. On examination, her affect
was calm and appropriate, her mood was frustrated and upset,
and her insight and judgment were fair. Dr. Rohatgi made some
alterations to her medications and set a follow-up
appointment in two weeks.
October 4, 2013, plaintiff reported that she was having
difficulty sleeping and so had changed her gabapentin dosage
and was taking Nyquil. (Tr. 817-18). In addition, she had
taken Valium, which was detected in a drug screen
administered to her after a car accident. She stated that she
was not having mood swings or irritability, but continued to
feel sad, angry, and frustrated. She was performing her
activities of daily living. Dr. Rohatgi prescribed doxepin
for insomnia. On October 31st, plaintiff reported that she
still experienced disturbed sleep. (Tr. 815-16). She was
otherwise doing well in that her agitation and irritability
had decreased and her mood was more calm and relaxed. She did
not experience mood swings, mania, depression, loss of
interest, or cravings for alcohol or drugs. She was planning
to start working in a relative's cleaning business. Dr.
Rohatgi diagnosed her with major depressive disorder,
recurrent, improved; generalized anxiety disorder; and
alcohol dependence and cocaine dependence in sustained early
engagement with services at Comtrea dropped off between
November 2013 and January 2014, and she faced dismissal from
the program. (Tr. 766-80). During a phone call in December,
she told Mr. Ninneman that she was moving and had enough
medication to last until January. He agreed to send her
referrals for treatment providers in her new area. (Tr. 775).
In late January 2014, plaintiff called Mr. Ninneman and
reported that she was still living with her parents and was
home schooling her daughter. She agreed to make an
appointment at Comtrea. (Tr. 766).
February 4, 2014, plaintiff told Dr. Rohatgi that she was
doing well and coping appropriately with various stressors,
although she had trouble sleeping. (Tr. 813-16). He made some
changes to her medication. He described her as quite guarded
and diagnosed her with major depressive disorder, recurrent,
in full remission; generalized anxiety disorder; and alcohol
dependence and cocaine dependence in sustained early
remission. On February 28, 2014, plaintiff reported that she
was still struggling with depression, and rated her anxiety
level at 10 on a 10-point scale. She continued to struggle
with sleep and stated that she had racing thoughts. She was
helping her mother take care of her father, who was now
disabled. She was informed that she needed to remain alcohol
free and have consistent attendance in order to graduate from
the substance abuse program. (Tr. 875-76). On March 24, 2014,
plaintiff told Mr. Ninneman that she was working and had
gotten a car. (Tr. 864-65). She reported that there were days
when she did not want to get out of bed and she had used
alcohol on two occasions. Her goal was to drink in
moderation, rather than “shoot for abstinence.”
She understood that abstinence was required to complete the
program, however, and stated that she would avoid
“happy hour for ten weeks.” In April 2014, she
reported that she was working and had a better relationship
with her daughter. She said she was maintaining sobriety,
even though she was tempted to drink. (Tr. 860-61). She had
stopped taking her thorazine “to see if it would make a
difference, ” because going off her medications was
“the only thing that gives excitement to my
life.” (Tr. 861). She agreed not to make any more
medication changes without consulting with Dr. Rohatgi first.
Plaintiff's urine screens came back positive for alcohol
and benzodiazepines on April 17, and May 6, 2014. (Tr. 862,
855). She admitted to taking two sips of wine and taking a
prescription cough medicine, but denied taking
benzodiazepines. She worried about the impact of the positive
test on her probation status. (Tr. 856).
10, 2014, plaintiff reported to Mr. Ninneman that she was
attending AA, staying sober, and enjoying work as a school
bus driver. (Tr. 847-48). She was finding it much easier to
stay sober “because she is doing the kind of work she
wants to.” Unfortunately, her job was terminated a few
days later based on her past drug offense. (Tr. 841). By late
June, she was working in the family cleaning business again.
(Tr. 838). Dr. Rohatgi noted that plaintiff's mood was
euthymic as long as she was taking Cymbalta and Haldol. (Tr.
809-10). She agreed to accept a referral to a sleep
specialist to address her continuing insomnia.
Plaintiff's diagnoses were major depressive disorder,
recurrent, in full remission; generalized anxiety disorder;
and alcohol dependence and cocaine dependence in sustained
early remission. In July 2014, she was preparing for
discharge from Comtrea. (Tr. 834-35). She had spoken with the
pastor of her church about forming a support group. On August
6, 2014, she successfully completed the alcohol and ...