United States District Court, E.D. Missouri, Eastern Division
D. NOCE, UNITED STATES MAGISTRATE JUDGE.
action is before the court for judicial review of the final
decision of the Commissioner of Social Security finding that
plaintiff Paul D. Bindner is not disabled and, thus, not
entitled to Disability Insurance Benefits (“DIB”)
under Title II of the Social Security Act, 42 U.S.C.
§§ 401-434. The parties have consented to the
exercise of plenary authority by the undersigned United
States Magistrate judge pursuant to 28 U.S.C. § 636(c).
For the reasons set forth below, the decision of the
Commissioner is affirmed.
was born on March 14, 1989. (Tr. 65). Plaintiff filed an
application for DIB on November 7, 2015, when he was 26 years
old, alleging an onset date of August II, 2015. (Tr. 129-31,
211). Plaintiff alleges that he suffers from major depressive
disorder with residuals of a traumatic brain injury, sleep
apnea, left shoulder strain, lumbar spine strain, right knee
strain with bursitis and tendonitis, and tinnitus. (Tr. 202).
Plaintiff's application was denied on December 28, 2015,
and he requested a hearing before an administrative law judge
(“ALJ”). (Tr. 78-85). A hearing was held in June
2016, where plaintiff, a vocational expert
(“VE”), and a witness testified. (Tr. 28-64). By
decision dated July 29, 2016, the ALJ found that plaintiff
was not disabled under the Social Security Act. (Tr. 14-23).
The ALJ determined that plaintiff retained the residual
functional capacity (“RFC”) to perform jobs
available in significant numbers in the national economy.
February 15, 2017, the Appeals Council of the Social Security
Administration denied plaintiff's request for review of
the ALJ's decision, making the ALJ's decision the
final decision of the Commissioner to be reviewed in this
case. (Tr. 1-5). Plaintiff argues that the ALJ's decision
is not supported by substantial evidence. (Doc. 18). He asks
that the ALJ's decision be reversed and an award of
benefits entered or that the case be remanded for further
Medical Record and Evidentiary Hearing
to the issues before the court are the following facts.
Plaintiff served on active duty with the United States Air
Force from 2009 through November 2015, when he was medically
discharged. (Tr. 202-03). Plaintiff underwent counseling from
October 2014 through August 2015, at which time the Air Force
placed him on convalescence leave, and then again from
January through June 2016. (Tr. 36, 501, 911, 916, 924, 941,
944). The majority of his treatment records predate his
alleged onset date of August 11, 2015.
October 8, 2014, plaintiff self-referred to an Air Force
medical clinic “for depression associated with high job
dissatisfaction.” (Tr. 951). He met with Joseph C.
Stankus, Ph.D., a licensed clinical psychologist, and stated
he was unhappy at his job in finance and preferred to work
with his hands in “wide-open spaces.” (Tr. 951).
Dr. Stankus observed that plaintiff had a limited affect, but
was otherwise normal with a good prognosis. (Tr. 951-57). Dr.
Stankus diagnosed plaintiff with problems related to
employment and ruled out adjustment disorder with depressed
mood. (Tr. 954). He determined that plaintiff did not need
any alterations to duty status and was fit for continued
military service. (Tr. 957).
subsequent sessions, from October 2014 to March 2015, then
again in July and August 2015, plaintiff repeated his
discouragement at having to do a job “he basically
hates, ” low morale about his job, and his desire to
get out of the Air Force. (Tr. 958, 971, 976, 980, 996, 1007,
1011, 1017, 1026, 1033, 1039, 1064, 1214, 1226).
November 17, 2014, plaintiff informed Wenjing Cao, PMHAPN-BC,
a psychiatric nurse practitioner, that he only took
medication to help him cope with work and he planned to stop
taking it when he went on vacation to visit his farm. (Tr.
992). On December 8, 2014, he reported to Nurse Cao that he
stopped his medications during his two week vacation and
“had a good time during his visit, worked outdoors,
fixed his jeep, cut firewood, shot some targets, did pretty
much the things he planned.” (Tr. 1002). When he
returned, he reported he would try medication again to cope
with his job stressors. (Tr. 1002).
March 2015, plaintiff reported trouble keeping his continuous
positive airway pressure (“CPAP”) mask on, and he
was “strongly urged” to keep trying anyway,
because he could not become accustomed to it unless he wore
it consistently. (Tr. 695).
3, 2015, plaintiff met with Dr. Stankus and reported that
once he left the service, he wanted to spend 6 to 12 months
on his farm doing various repairs on fences, the barn, and
the house. (Tr. 616).
22, 2015, plaintiff reported to Kurt R. Guindon, M.D., that
his Klonopin medication was “spot on, ” leaving
him relatively anxiety-free, centered, and functional. (Tr.
576). Dr. Guindon urged him to try his CPAP now that he had
this medication, as it might help him better tolerate the
mask. (Tr. 576). The following day, plaintiff reported to Dr.
Stankus that his sleep had improved and he was getting 6 to 7
hours of sleep a night. (Tr. 574). One week later, plaintiff
stated his sleep had improved but was still fitful. (Tr.
571). Dr. Guindon noted that plaintiff “bucked”
off the CPAP at night, had markedly interrupted sleep, and
did not feel rested during the day. (Tr. 507, 521, 547, 556,
578). He diagnosed plaintiff with sleep onset myoclonus and
insomnia. (Tr. 508, 522, 535, 557, 579).
6, 2015, Dr. Guindon noted that plaintiff had a case of
severe anxiety that he believed met the threshold for
generalized anxiety disorder. (Tr. 554). Dr. Guindon opined
that plaintiff's anxiety disorder would require second
generation antipsychotics and benzodiazepines. (Tr. 554). Dr.
Guindon increased the Klonopin and another drug and
discontinued a third drug. (Tr. 554). Dr. Guindon also opined
that plaintiff had elements of post-traumatic stress
disorder, in that he re-experiences events, has extreme
hypervigilance, has arousal and reactivity, and has anger and
irritability. (Tr. 557).
7, 2015, in response to a medical benefits questionnaire,
plaintiff reported trouble with his CPAP machine. (Tr. 325).
He reported that he had difficulty keeping it in place and
had not had a full night of sleep with it in place, so he
continued to experience some symptoms of daytime sleepiness
associated with his upper airway resistance syndrome/sleep
apnea. (Tr. 334).
9, 2015, plaintiff complained that the Klonopin was now
making him feel drowsy and unable to stay alert. (Tr. 552).
Dr. Guindon reduced the dosage, stating that they were
“struggling to find the window between sedation and
reasonable anxiolysis.” (Tr. 552).
16, 2015, plaintiff reported that his girlfriend had left for
two weeks of temporary duty and that he could not stop crying
at work that day. (Tr. 542). On July 20, 2015, he reported
that he continued to miss his girlfriend, but he was trying
to cope by “keeping busy, ” including cleaning
the house and repairing and detailing his girlfriend's
car. (Tr. 540-42). He reported that he continued to miss his
girlfriend, but his crying spells had reduced to one time per
day. (Tr. 540). He remained quite depressed at night and
sleep remained problematic. (Tr. 540).
28, 2015, plaintiff called Dr. Guindon to report severe
anxiety and that the medication was wearing off in the
afternoon, causing agitation. (Tr. 526). Dr. Guindon made
some adjustments in his medication plan and instructed him to
come in the next day. (Tr. 526).
August 10, 2015, plaintiff reported becoming more irritable
and “rageful” and that he had difficulty going
out in public. (Tr. 514). He stated the only time he felt
reasonably calm was at home. (Tr. 514). Dr. Stankus suggested
the possibility of inpatient hospitalization, but plaintiff
declined because he did not want to be separated from his
girlfriend. (Tr. 514).
his alleged onset date, on August 17, 2015, Dr. Guindon
confirmed diagnoses of generalized anxiety disorder, major
depression, and adjustment disorder with anxiety and
depressed mood, and intended to extend plaintiff's
convalescence leave. (Tr. 511). He noted plaintiff was
experiencing anxiety with profound and detailed worry, panic,
some increase in anger and irritability, obsessive-compulsive
disorder, some disillusionment, PTSD, and demoralization.
(Tr. 507-08). However, Dr. Guindon also opined that Valium
was working much better than Klonopin, and that
plaintiff's anger had considerably improved. (Tr. 505).
Plaintiff reported that he was working from home and
“much less tortured by his anxiety.” (Tr. 505).
Plaintiff reported feeling a bit tired, but functional, and
Dr. Guindon observed that he had a calmer mood with congruent
affect. (Tr. 505).
August 26, 2015, plaintiff reported to Dr. Stankus that he
planned to live on his farm, raise fowl, get an
apprenticeship working on airplanes in exchange for free
flight time at the local airport, and complete his
pilot's license. (Tr. 501). Plaintiff was taking Seroquel
and Valium at the time. (Tr. 501). Dr. Stankus noted that
plaintiff was very anxious, noticeably agitated, and broke
down in tears during the session. (Tr. 502). Plaintiff also
reported he could not tolerate the CPAP machine. (Tr. 502).
cancelled follow-up appointments with Dr. Stankus that were
scheduled in September and October 2015. (Tr. 500). After the
August 26, 2015 appointment, plaintiff did not receive any
additional treatment until January 21, 2016, following his
medical discharge form the ...