United States District Court, E.D. Missouri, Northern Division
D. NOCE K 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 Ashley Couch for
supplemental security income (SSI) benefits under Title XVI
of the Social Security Act, 42 U.S.C. § 1381, 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.
Ashley Couch, born October 4, 1986, applied for SSI benefits
on January 11, 2015. (Tr. 10, 177). She later alleged a
disability onset date of January 28, 2015, due to depression,
anxiety, post-traumatic stress disorder (PTSD),
Wernicke-Korsakoff syndrome,  Wernicke's encephalopathy,
vision related impairments, and vertigo. (Tr. 10, 30, 181).
August 26, 2015, plaintiff requested a hearing before an ALJ.
(Tr. 10). On February 1, 2017, the ALJ heard testimony from
plaintiff and Vocational Expert (VE) Denise Weaver. (Tr.
27-48). On August 23, 2017, the ALJ found that plaintiff was
not disabled. (Tr. 7-20). On April 20, 2018, the Appeals
Council denied plaintiff's request for review. (Tr. 1-4).
Thus, the decision of the ALJ stands as the final decision of
was born on October 4, 1986. (Tr. 177). Plaintiff visited Dr.
Syed Imam of Arthur Center Community Health regularly for
treatment from May 2014 to September 2016, with two to three
month intervals on average between each visit. (Tr. 275-96,
made her first visit to Dr. Imam on May 6, 2014. At the
initial meeting, plaintiff said she was hospitalized for six
days in 2008 for suicidal thoughts, anorexia and bulimia,
severe malnutrition, and related brain damage. She complained
of her anxiousness, especially in a crowd, and her mood
swings. She shared her history of post-partum depression
after her son's birth, nervous breakdowns, and three
years of sexual abuse by her stepfather from the ages of 9 to
12. Dr. Imam diagnosed her with PTSD, anxiety, eating
disorder, and depression. Dr. Imam noted anxious and
depressed mood, anxious affect, fair eye contact, and slurred
speech. (Tr. 297-301).
visited Dr. Imam again on July 8, 2014, with symptoms and
diagnosis mostly similar to the May 6, 2014 initial visit,
except that Dr. Imam recorded, “She has [a] major
[a]nger problem.” Dr. Imam also noted she had an
irritable mood and only fair eye contact, but appropriate
affect, normal speech, logical flow of thought, and concrete
thought content. (Tr. 275-79). Plaintiff's next visit was
on October 14, 2014, and her symptoms and mental status
determinations were identical to those of May 6, 2014. (Tr.
visited Dr. Imam again on January 13, 2015. This visit marked
some changes in plaintiff's symptoms, because plaintiff
described herself as: “[o]verall I am stable.”
While Dr. Imam noted evident irritability and fair eye
contact, plaintiff's affect, speech, and thought were in
the normal range. At the same time, plaintiff complained of
feeling sad, loss of interest, a sense of guilt, choking, and
heart racing. (Tr. 291-96).
March 28, 2015, consultative examiner Kathrina Alexander,
M.D., examined plaintiff. Dr. Alexander observed that
plaintiff was able to sit, stand, walk, and bear light
burdens, and that she was able to touch her toes, squat, rise
from a chair, and mount and dismount the examination table
without assistance. Also, Dr. Alexander observed that
plaintiff had poor balance. (Tr. 315).
April 6, 2015, plaintiff was seen by consultative examiner
Thomas J. Spencer, Psy.D. Dr. Spencer concluded that
plaintiff appeared to be capable of understanding and
remembering simple instructions and engaging in and
persisting with simple tasks. However, he found she was
moderately to markedly impaired in her ability to interact
socially and adapt to the environment. In his opinion,
plaintiff “did not appear capable of managing her
benefits without assistance.” (Tr. 324).
thereafter, plaintiff visited Dr. Imam on April 14, 2015,
stating that overall, she was “not doing good.”
(Tr. 355). She asked for adjustment in her medication. This
time, Dr. Imam diagnosed plaintiff's mood differently
than in previous visits. In addition to anxious mood and fair
eye contact, he found her to have depressed and labile mood,
labile and anxious affect, pushed speech, flow of thought
marked with loose associations, and anxieties and somatic
concerns in thought contents. (Tr. 355, 359-60). Dr.
Imam's notes from plaintiff's visit on July 14, 2015,
are almost identical to those of April 14, 2015. (Tr. 349-54,
October 6, 2015 visit, plaintiff started by saying that
“I got a [sic] bad news.” Her mother was
diagnosed with stage III breast cancer. Dr. Imam noted
plaintiff “was improving and has less anxiety but now
it is rough and emotional” and she was very anxious and
her emotions were “all over the place.” Dr.
Imam's diagnosis of her mental status added
“worthless” to her thought content. (Tr. 343-48).
March 8, 2016, Dr. Imam's description and diagnosis of
plaintiff's symptoms were almost identical to that of the
October 6, 2015 visit. (Tr. 337-42). On June 28, 2016,
plaintiff claimed to be a “support crew” to her
grandfather and her mother, both of whom were suffering from
cancer. Also, she stated her medications mostly help her, but
sometimes she thinks “her body is adjusting or immune
to the doses and it can happen.” (Tr. 331). Her last
visit to Dr. Imam took place on September 13, 2016, when she
said she continued to act as a “support crew” to
her mother and grandfather. (Tr. 325).
addition to Dr. Imam's treatment, plaintiff received
counseling services and training sessions to develop coping
mechanisms, which she initiated on her own on September 30,
2014, at Family Circle Therapeutic Services. She attended 21
sessions from September 30, 2014, to September 23, 2015.
According to the Treating Source Statement from the
institution, she successfully worked through her relationship
issues with her mother, utilized identified strategies to
assist in managing her anxiety attacks, set firmer boundaries
in regard to her son's father, and found herself in a
position of being able to help both her mother and
grandfather in a caregiver role when they were struggling
with cancer. Her affect was good when she was in her sessions
and she denied any ideation of harm to others. Plaintiff
ceased counseling on her own, because she felt that her
anxiety and depression were in a manageable range and that
she had to take care of her mother and grandfather. (Tr.
19, 2017, ten months after plaintiff's last visit with
him, Dr. Imam submitted a medical source statement in a
check-box format. According to the statement, plaintiff is
diagnosed with PTSD, eating disorder, bulimia, obesity, and
Wernicke- Korsakoff syndrome. In Dr. Imam's opinion,
plaintiff would be “off-task” for 25% or more to
perform even simple tasks. He marked that she is more than
mildly limited (either moderately limited, markedly limited,
or extremely limited) on 14 out of the 20 tasks listed,
except for short and simple ones. There were some that were
marked as extremely limited, such as the ability to perform
activities within a schedule, maintain regular attendance,
and be punctual within customary tolerances; the ability to
complete a normal workday and workweek without interruption
from psychologically based symptoms and to perform at a
consistent pace without an unreasonable number and length of
rest periods; the ability to accept instructions and respond
appropriately to criticism from supervisors; and the ability
to travel in unfamiliar places or use public transportation.
Dr. Imam summarily noted his diagnoses and conclusions were
drawn based on medical history, clinical findings, diagnosis,
and treatment. (Tr. 373-74).
ALJ HEARING EVIDENCE