United States District Court, E.D. Missouri, Eastern Division
ROBIN L. PINILLA, Plaintiff,
NANCY A. BERRYHILL, Acting Commissioner of Social Security, Defendant.
D. NOCE, UNITED STATES MAGISTRATE JUDGE
action is before the Court for judicial review of the final
decision of the defendant Commissioner of Social Security
denying the application of plaintiff Robin L. Pinilla for
disability insurance benefits under Title II of the Social
Security Act, 42 U.S.C. § 401, et seq. The
parties have consented to the exercise of plenary authority
by a United States Magistrate Judge pursuant to 28 U.S.C.
§ 636(c). For the reasons set forth below, the decision
of the Administrative Law Judge (ALJ) is affirmed.
Robin L. Pinilla, born September 3, 1963, applied for Title
II benefits on November 18, 2013. (Tr. 14, 76). She alleged a
disability onset date of January 1, 2010, due to bipolar
disorder, depression, and anxiety. (Tr. 76). Plaintiff's
application was initially denied on February 4, 2014. (Tr.
February 27, 2014, plaintiff requested a hearing before an
ALJ. (Tr. 96-97). On October 1, 2015, the ALJ heard testimony
from plaintiff and Vocational Expert (VE) Teresa McLean. (Tr.
32-75). On March 23, 2016, the ALJ found that plaintiff was
not disabled. (Tr. 11-31). On March 24, 2017, the Appeals
Council denied plaintiff's request for review. (Tr. 1-5).
Thus, the decision of the ALJ stands as the final decision of
following is a summary of plaintiff's medical history
relevant to this appeal. On November 25, 2009, plaintiff was
admitted to Mercy Hospital St. Louis' intensive care unit
for intentional overdose of nortriptyline. Plaintiff
presented with slurred speech, depression, and suicidal
ideation. Plaintiff reported she had swallowed the remainder
of an old prescription of nortriptyline and written a suicide
note before going to bed. Plaintiff reported one prior
suicide attempt by means of Ativan overdose roughly four to
five years prior. Plaintiff reported emotional instability
associated with her recent decision to stop taking medication
for bipolar disorder, including lithium and Lamictal.
Plaintiff mentioned drinking about six cans of beer each
night but denied previous problematic alcohol or drug use.
Treating physician Frederick G. Hicks, M.D., prescribed
Trileptal and recommended plaintiff resume taking lithium and
Seroquel. (Tr. 260-66).
November 27, 2009, plaintiff was transferred to Mercy's
psychiatric division. Discharging physician Steven A. Harvey,
M.D., noted that plaintiff had successfully completed
individual and group therapy while denying suicidal ideation
throughout. Dr. Harvey reported that plaintiff took
appropriate steps to make her home safe, including removing
alcohol and old medications. Dr. Harvey reported that
plaintiff was cooperative and stable on the day of discharge
with no suicidal ideations or evidence of psychosis. Dr.
Harvey changed plaintiff's prescription for lithium to
Lithobid to alleviate gastrointestinal side effects. Dr.
Harvey recommended that plaintiff follow up with her treating
psychiatrist, Dr. Bhat, as soon as possible. (Tr. 288-90).
December 1, 2009, plaintiff saw Savita S. Bhat, M.D., to
treat issues related to plaintiff's suicide attempt. Dr.
Bhat continued prescriptions for lithium and Seroquel and
added a prescription for Depakote. On February 16, 2010, Dr.
Bhat increased the Seroquel dosage but lowered it after two
months. On April 20, 2011, Dr. Bhat again raised the Seroquel
dosage after plaintiff reported spending a week in bed. On
July 26, 2012, Dr. Bhat prescribed clonazepam to help relieve
restless leg syndrome at bedtime. (Tr. 447-59).
August 1, 2012, plaintiff met with Don R. Snodgrass, M.D.,
for a physical exam. Dr. Snodgrass reported that plaintiff
had been managing her bipolar disorder by taking lithium and
Seroquel and that plaintiff had not had a psychotic episode
for several years. Plaintiff reported a recent mixed episode,
during which she experienced extreme distress without any
precipitating event. Yet, Dr. Snodgrass noted that plaintiff
was “doing very well on lithium and Seroquel.”
October 1, 2013, Dr. Bhat diagnosed plaintiff with moderate
bipolar 1 disorder after plaintiff underwent a general
psychiatric examination. Dr. Bhat reported that plaintiff
demonstrated a depressed mood and affect but also a calm and
cooperative attitude, an intact memory, a logical thought
process, and fair judgment. Dr. Bhat prescribed Lamictal and
continued the lithium. Dr. Bhat also recommended cognitive
behavioral therapy (CBT) to address anxiety and avoidance and
encouraged increased physical activity. (Tr. 446).
December 16, 2013, plaintiff reported an ability to
accomplish a number of daily activities, including: cleaning
and doing laundry, playing memory games, taking her
medication, preparing meals, and taking care of her dog.
Plaintiff also reported a limited ability to shop for
groceries, handle money, and go out in public alone. (Tr.
January 18, 2014, plaintiff met with Christi Moore, Ph.D.,
for a consultative psychological evaluation. Plaintiff
reported feeling a varying sense of hopelessness, lack of
interest or pleasure in activities, challenges with sleep,
and feelings of guilt. Plaintiff also reported being more
likely to seek immediate assistance from her psychiatrist for
medication adjustments. Plaintiff reported she does not
require assistance with personal activities of daily living;
however, plaintiff stated she relied on memory aids and that
she needed a caregiver to help with activities outside the
home. Plaintiff reported spending time with family and close
friends but said she does not engage in other social
activities. (Tr. 471-75).
Moore reported that plaintiff displayed the ability to
maintain adequate attention during the exam, appeared to
comprehend questions, and seemed to have good practical
judgment and a good understanding of more complex aspects of
situations. Dr. Moore also opined that plaintiff might
struggle with functioning in social settings or placements
with interpersonal demands due to plaintiff's anxiety and
reported memory challenges. Dr. Moore reported that plaintiff
did not appear capable of managing her own funds, but
concluded that with continued psychiatric and occupational
supports, plaintiff could be expected to function with
improvement. Dr. Moore diagnosed plaintiff with bipolar 1
disorder, panic disorder without agoraphobia, and alcohol
abuse. Dr. Moore assigned a Global Assessment of Functioning
(GAF) score of 46. (Tr. 475).
March 13, 2014, plaintiff met with Leanne Watson-Ficken,
D.O., for a physical exam. Plaintiff stated her bipolar
disorder had been under control, but she also reported
symptoms of depression, anxiety, and sleep disturbances.
Plaintiff reported no confusion or memory loss issues.
Plaintiff reported consuming 4-5 drinks of alcohol once or
twice per week. (Tr. 505-07).
13, 2014, plaintiff reported an increased ability to finish
errands at home but also continued difficulty with driving
and being in public. Plaintiff reported she had quit
consuming alcohol. Plaintiff successfully completed memory
tasks. Dr. Bhat encouraged plaintiff to continue setting
self-care goals. (Tr. 479).
23, 2014, Dr. Watson-Ficken submitted a Physical Residual
Functional Capacity (“RFC”) Assessment. Dr.
Watson-Ficken noted that plaintiff was experiencing chronic
depression, anxiety, and poor sleep due to bipolar disorder.
Dr. Watson-Ficken reported a marked limitation in
plaintiff's ability to deal with work stress, and that
plaintiff's poor coping skills would make it difficult
for her to work full-time on a sustained basis. Dr.
Watson-Ficken expected plaintiff would be off-task more than
20 percent of an eight-hour work day and would require
redirection one to two times per week. Dr. Watson-Ficken also
anticipated plaintiff's impairments would cause about two
absences per month. (Tr. 517-18).
23, 2014, plaintiff reported to Dr. Watson-Ficken that she
was experiencing depression, anxiety, and sleep disturbances.
Plaintiff reported no confusion or memory loss issues. (Tr.
27, 2014, Dr. Bhat submitted a mental RFC assessment. Dr.
Bhat identified the following symptoms: poor memory, sleep
disturbance, mood disturbance, and recurrent panic attacks;
however, Dr. Bhat reported that plaintiff was responding to
medication. Dr. Bhat opined that plaintiff would have
difficulty working a full-time job on a sustained basis. She
expected plaintiff to be off-task during at least 20 percent
of an eight-hour work day and to require redirection one to
two times per day. Dr. Bhat was unable to assess how often
plaintiff would be absent from work. (Tr. 520-21).
Bhat noted the following functional limitations due to
plaintiff's impairments: moderate restriction of daily
living activities; moderate difficulty in maintaining social
functioning; moderate limitation in areas of understanding
and memory; frequent difficulty maintaining concentration and
persistence; seldom repeated episodes of decompensation of
extended duration; and moderate limitation in the ability to
complete a normal work day without interruption. (Tr.
August 4, 2014, plaintiff reported a relatively stable mood
but also that she had trouble staying asleep. Plaintiff
related an inability to leave her home without someone
accompanying her. Plaintiff reported no panic, worrying, or
feelings of hopelessness. Dr. Bhat encouraged plaintiff to
schedule a sleep study. (Tr. 481-82).
separate occasions from August 22, 2014, through July 27,
2015, Dr. Watson-Ficken conducted depression screenings
indicating no need for intervention, finding that plaintiff
expressed interest and pleasure in certain activities and had
no feelings of depression or hopelessness. During each visit,
Dr. Watson also noted that plaintiff appeared alert,
oriented, and in no acute distress. (Tr. 491-501).
August 22, 2014, and October 31, 2014, plaintiff reported
consuming 4-5 drinks of alcohol once or twice per week. (Tr.
November 4, 2014, plaintiff reported that she stopped taking
Depakote because of weight gain and over-sedation, but
plaintiff also stated that she was doing well emotionally.
Plaintiff reported improved sleep, which she attributed to
Relpax for alleviating restless leg syndrome. Dr. Bhat made a
note to check plaintiff's lithium dosage to confirm
therapeutic levels. (Tr. 483-84).
February 17, 2015, plaintiff reported a continued pattern of
avoidance secondary to panic and anxiety, as well as an
increased difficulty with social situations or events
involving crowds. Plaintiff stated she was working with
family to improve her comfort with leaving her home.
Plaintiff further stated a desire to find a clerical job to
get her out of the house; however, she also reported mood
swings and inconsistency in feelings of hope and empowerment
to make changes. Plaintiff reported disrupted sleep with 3-4
hours of uninterrupted sleep each night. Plaintiff stated she
had completely abstained from alcohol for the previous 41
days. (Tr. 485).
Bhat recommended plaintiff use an anxiety workbook after
discussing strategies to overcome avoidance patterns. Dr.
Bhat noted the need to avoid certain medication due to
plaintiff's history of alcohol abuse. Dr. Bhat prescribed
Trileptal to address ...