United States District Court, E.D. Missouri, Southeastern 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).
8, 2014, plaintiff Gregory Allen I. filed applications for a
period of disability and disability insurance benefits, Title
II, 42 U.S.C. §§ 401 et seq., and
supplemental security income, Title XVI, 42 U.S.C.
§§ 1381 et seq., with an alleged onset
date of June 30, 2006. (Tr. 297-300, 303-09, 363). Plaintiff
subsequently amended the alleged onset date to March 26,
2014. (Tr. 78). After plaintiff's applications were
denied on initial consideration (Tr. 169-73), he requested a
hearing from an Administrative Law Judge (ALJ). (Tr. 178).
Following a hearing on March 17, 2016 (Tr. 82-112), the ALJ
issued an unfavorable decision. (Tr. 143-63). Plaintiff
appealed this decision and, on May 25, 2017, the Appeals
Council remanded the case to the ALJ with
instructions. (Tr. 164-68).
and counsel appeared before the same ALJ for a second hearing
on March 20, 2018. (Tr. 36-81). Plaintiff testified
concerning his disability, daily activities, functional
limitations, and past work. The ALJ also received testimony
from vocational expert Susan Shea, M.A. The ALJ issued a
decision denying plaintiff's applications on May 4, 2018.
(Tr. 12-35). The Appeals Council denied plaintiff's
request for review on August 10, 2018. (Tr. 1-6).
Accordingly, the ALJ's decision stands as the
Commissioner's final decision.
Evidence Before the ALJ
Disability and Function Reports and Hearing
who was born in February 1962, was 52 years old on the
amended alleged onset date. He graduated from high school
after completing a vocational program in electronics. (Tr.
383). Following a brief period in the military, plaintiff
returned to his parents' home. (Tr. 102). After his mother
died in December 2012, plaintiff assumed primary care for his
father until early 2014, when his father died. (Tr. 88-89).
In April 2014, plaintiff moved into a one-bedroom house paid
for by the Department of Mental Health through the Supported
Community Living Program. (Tr. 46, 87). He received mental
health and case management services through the Community
Counseling Center and New Visions. (Tr. 93). He last worked
in late 2014 at a Dollar Tree store and earned a total of
$147 in the final quarter of the year. (Tr. 88, 18).
hearing in March 2016, he testified that he was unable to
keep jobs for very long due to his mental health issues and
that he had had “100 jobs in [his]
lifetime.” (Tr. 89). He had confrontations with
“smart ass young punks” and “bosses that
aren't capable of earning my respect.” He was fired
once after “confronting a known shoplifter too
aggressively, allegedly.” (Tr. 99, 55-56). Several
bosses had given him second and third chances but he
“blew it” and had lost “an awful lot of
good jobs.” (Tr. 97). He had worked as a welder
fabricator, a machinist apprentice, a trailer mechanic, and a
stocker and cashier for a grocery store. (Tr. 103-07, 46-47).
Earnings records from 1980 through 2015 show that he earned
less than $7, 500 during most years. (Tr. 310).
plaintiff applied for disability benefits in 2014, he listed
his impairments as depression; anxiety; borderline
personality disorder; paranoid psychotic; arthritis in the
knees, ankle, and feet; and insomnia. He also became easily
fatigued in the heat. (Tr. 113). In May 2013, his medications
included Ambien, Benadryl, Klonopin, and Restoril for sleep;
Mirapex for restless leg syndrome; Paxil for depression; and
Vistaril for anxiety. He also took meloxicam for arthritis
and a cholesterol medication. (Tr. 385). In August 2015,
plaintiff reported that he was also prescribed trazodone for
depression and insomnia. (Tr. 434).
May 2014 Function Report (Tr. 402-12), plaintiff stated that
he was unable to work due to arthritis which limited the
number of hours he could be on his feet and his inability to
tolerate heat. But, he wrote, his mental health issues made
it impossible for him to maintain employment. He had insomnia
and ate one meal a day. He was indifferent to his appearance
and showered about once a week. He was able to handle his
household chores and took care of his dog. He did not drive
because he did not have a license and relied on a bicycle for
transportation. He shopped in stores as needed. He had no
difficulty managing financial accounts. He stated that he
socialized often but offered no description of his social
activities and stated that he did not go anywhere on a
regular basis. He had difficulty getting along with others,
especially authority figures, and had been fired due to his
anger issues. He needed antianxiety medication to cope with
stress and managed changes in routine only when the change
“improves efficiency.” He had a strong sense of
impending doom and was plagued by almost constant
“hateful violent thoughts.” (Tr. 408). Plaintiff
had difficulties with squatting, standing, walking, kneeling,
climbing stairs, completing tasks, concentrating,
understanding, and getting along with others. He followed
written, but not spoken, instructions well.
described his typical day as walking his dog, running
errands, and then working on projects at home, including
fixing up an old truck and doing yard work. (Tr. 95). He had
a basement shop in which he made models. (Tr. 48). He had
strongly negative feelings about his neighborhood. (Tr.
March 2016 hearing, plaintiff testified that he was kept from
working by arthritis in his lower legs. (Tr. 89). His feet,
which had caused him the most pain, improved after surgery to
remove bone spurs. At the time of the hearing, his primary
physical problem was knee pain, for which he took meloxicam.
Cortisone shots had not provided much relief. He used his
bicycle for transportation and typically rode 20 or 30 miles
a week. (Tr. 89-92). He walked his dog about 45
minutes a day. At the subsequent hearing in March 2018,
plaintiff stated that his arthritis limited how long he could
stand but did not interfere with his ability to do grocery
shopping or manage his household chores. (Tr. 46). He still
walked his dog and relied on his bicycle for transportation.
At his present level of activity his knee pain was managed
with Tylenol and aspirin but he would need to resume taking
meloxicam if he had to spend more time on his feet. (Tr. 47).
stated that his mental health conditions and insomnia are his
primary impairments. (Tr. 95, 97, 59). Following his
father's death in 2014, he became scared by his thoughts
and requested “an in-depth psychological
evaluation.” (Tr. 93, 71-72). He described difficulty
managing his anger in dealing with a neighbor he described as
“crazy” and a “true sociopath.” (Tr.
97, 93). At his hearing in March 2018, he described feeling
“homicidal hate and rage, ” which he attributed
to the conditions in his neighborhood. (Tr. 56-57). Plaintiff
testified that for three years he had been sleeping less than
two hours a night. (Tr. 59). Plaintiff had been sober since
sometime in late 2014. (Tr. 96, 68).
received testimony from vocational experts at both hearings.
In March 2016, Dolores Gonzalez, M.Ed., was asked to testify
about the employment opportunities for a hypothetical person
who was closely approaching advanced age, with a high school
education, with plaintiff's work history who was limited
to medium work, who could occasionally climb ladders, ropes,
and scaffolds and was limited to simple, routine, repetitive
tasks, involving only simple decisions and few workplace
changes in an environment without fast-paced quotas. Ms.
Gonzalez was also asked to assume that the individual was
limited to occasional interaction with co-workers and no
interaction with the general public. (Tr. 108). According to
Ms. Gonzalez, such an individual would not be able to perform
plaintiff's past work as a welder, machinist, trailer
mechanic, stocker, and cashier. (Tr. 104-07, 108). Other work
available in the national economy the individual could
perform included cleaner II, dump-truck driver, and salvage
laborer. The individual would not be able to work as a
dump-truck driver if he were further restricted to only
occasional kneeling and use of foot controls, but he could
work as a cleaner II, salvage laborer, and stubber. All work
would be precluded if the individual consistently missed
three or more work days each month or had a thirty percent
reduction in the ability to maintain socially appropriate
behavior with coworkers and supervisors. (Tr. 108-10).
second hearing in March 2018, Susan Shea, M.A., testified
that the hypothetical individual, now assumed to be of
advanced age but still able to perform medium work, could not
perform plaintiff's past relevant work as a machinist
apprentice but could work as a laundry worker, machine
feeder, and hand packager. (Tr. 61, 64-65). If limited to
light work and assumed to be approaching advanced age, the
same individual could work as a cleaner or housekeeper, small
product assembler, and light machine tender. (Tr. 65-66). No.
work would be available if the individual were off task 20%
of the day, missed two or more days of work per month due to
mental health issues, was limited to interacting with others
for no more than 10% of the day, or was verbally or
physically inappropriate in the workplace. (Tr. 66-67).
challenges the ALJ's evaluation of medical opinions
regarding limitations caused by his mental impairments.
Accordingly, the following review of the medical evidence
focuses primarily on the treatment plaintiff received for
primary care physician, Mark Kasten, M.D., listed depression,
anxiety, and anger issues among the conditions for which he
was treating plaintiff in 2011. Plaintiff's medications
included Zoloft for depression, buspirone for anxiety,
Invega,  Ambien for insomnia, and Mirapex for
restless leg syndrome. (Tr. 480-82; 478-79). In November
2011, plaintiff told psychiatrist Kishore Khot, M.D., of the
Community Counseling Center (CCC), that he stopped taking
Zoloft and Invega because he did not believe they were
helping. (Tr. 498). Dr. Khot noted that plaintiff's mood
and affect were both anxious. He did not have suicidal or
homicidal ideation or overt psychosis and he was alert and
oriented. His diagnosis was generalized anxiety disorder with
restless legs syndrome as a relevant medical condition. Dr.
Khot reviewed anxiety-management skills with plaintiff and
officially discontinued Invega and Zoloft. A month later,
however, plaintiff called CCC and asked for a prescription
for Zoloft, stating that he had been calling in sick to work
and had suicidal thoughts. (Tr. 495). He had resumed taking
some Zoloft he had on hand. He was given appointments to see
nurse Daniela Kantcheva, APRN, but he did not keep
appointments on December 29, 2011, or January 17, 2012. (Tr.
495). By the time he saw Dr. Khot in March 2012, plaintiff
had changed his mind yet again and did not want to take
Zoloft or other antidepressants because they caused him to
sweat. (Tr. 492). He reported that he had lost his job at a
supermarket because he yelled at a customer who had
April 2012, plaintiff went to the emergency room at Southeast
Missouri Hospital with flank pain that was diagnosed as
kidney stones. (Tr. 623-31). At follow-up with Dr. Kasten
on May 1, 2012, plaintiff reported that he was anxious and
had suicidal thoughts and sleep disturbance. (Tr. 473-75). On
June 25, 2012, Dr. Khot noted that plaintiff was feeling more
anxious. (Tr. 496). Plaintiff reported that he was looking
for work. On mental status examination, plaintiff's mood
and affect were both anxious, he was alert and oriented, with
normal speech, and he did not have suicidal or homicidal
ideation or overt psychosis. Dr. Khot continued
plaintiff's prescriptions for buspirone and Ambien and
added Vistaril as needed for anxiety. Dr. Khot also warned
him not to double up on his Mirapex prescription to treat his
restless legs syndrome.
August 2012, plaintiff told Dr. Kasten that he had stopped
drinking and complained of increasing stomach pain. (Tr.
470-72). A CT scan of the abdomen disclosed tiny
nonobstructive renal calculi and colon diverticulosis. (Tr.
605). Two benign polyps were removed during a colonoscopy in
December 2012. (Tr. 604). In the autumn of 2012, plaintiff
had injections to his knees and feet to treat joint pain.
(Tr. 538-39; 468-69; 466-67).
failed to keep an appointment with Dr. Khot in September
2012. In October, plaintiff continued to present with anxious
mood and affect and was still looking for work. (Tr. 488).
Plaintiff did not return to CCC until early 2014.
had bone spurs removed from his feet in January and February
2013. (Tr. 462-65, 530-31, 535-37, 533-34, 528-39). In
September 2013, Dr. Kasten noted that plaintiff was awakening
5 times a night and had difficulty falling asleep. (Tr.
458-61). On mental status examination, plaintiff was oriented
but had poor judgment and insight. Plaintiff was prescribed
Ambien and Restoril for insomnia. A sleep study in October
2013 disclosed a 69% sleep efficiency, with a 56-minute delay
in sleep onset, 12 awakenings, and 112 arousals.
Plaintiff's sleep pattern was not due to significant
obstructive sleep apnea. (Tr. 597-98). It was recommended
that plaintiff lose weight to reduce snoring and receive
treatment for his restless legs syndrome and insomnia.
February 25, 2014, plaintiff met with Daniela Kantcheva,
APRN, at CCC. (Tr. 487). He reported that he had been off his
medication since 2012. He stated that he wanted psychological
testing and supportive therapy before resuming medication. On
mental status examination, plaintiff had appropriate affect
and mood, logical thought processes, and fair insight and
judgment. He was alert and oriented and denied experiencing
suicidal ideation, homicidal ideation, or
hallucinations. Ms. Kantcheva diagnosed plaintiff with
major depression, recurrent, in partial remission, and
referred him to New Vision Counseling for testing and
Johnson, Psy.D., of New Vision Counseling, completed a
psychological evaluation on March 26, 2014. (Tr. 501-09).
Plaintiff reported that he had never married or had any
long-term intimate relationships. He had a small group of
friends with whom he socialized. He had a history of conflict
with others, especially in work settings. His present
conflict with the next-door neighbor caused him considerable
anguish, including hostile thoughts, hypervigilance, and
paranoid ideation. He had recently reenrolled in outpatient
services at CCC and would receive targeted case management
services. Plaintiff's history of mood and emotional
disturbance began when he was 13, with a period of severe
depression and suicidal thinking in 1994. At present, he was
severely depressed, with frequent episodes of crying,
feelings of hopelessness, low self-esteem, irritability,
suicidal ideation, homicidal thoughts, and agitation with
explosive anger. He also had severe anxiety with panic
attacks. He cried profusely during the evaluation at the
thought of losing his pet. Dr. Johnson noted that plaintiff
“was not reassuring about his risk of self-harm”
in the future and that he experienced homicidal and suicidal
thoughts on a recurring basis. (Tr. 508). On mental status
examination, plaintiff was alert and oriented, with fair eye
contact and blunted affect, and depressed and anxious mood.
He appeared agitated, distraught, and considerably uptight.
He was not overtly psychotic but had paranoid thinking and
persecutory beliefs, some of which might have been
reality-based. He had mild to moderate impairments in both
recent and remote memory. His cognitive functioning was in
the average to high-average range with adequate abstract
reasoning potential. He was responsive, cooperative, and
generally friendly. His judgment was fair. Plaintiff was
presently taking Restoril, Lipitor, and
Klonopin. He was not taking prescribed Synthroid
underwent four hours of psychological testing with Dr.
Johnson, who administered the Personality Assessment
Inventory (PAI), the Minnesota Multiphasic Personality
Inventory (MMPI-2d ed.), and Adult Sentence Completion. (Tr.
510-13). In a report dated April 27, 2014, Dr. Johnson noted
that plaintiff's scores on the PAI indicated clinically
significant and severe ranges of anxiety, depression, and
suicidal ideation, with significant symptoms of reality
impairment and a possible thought disorder, paranoid
interactions, and characteristics that reflected a borderline
personality disorder. Plaintiff's scores on the MMPI
suggested that he was hostile, distrustful, irritable,
self-centered, highly sensitive to criticism from others, and
likely to infer that others were hostile and had negative
intentions. Dr. Johnson diagnosed plaintiff with:
(1) major depressive disorder, recurrent, severe with
psychotic features; rule out bipolar disorder,
schizoaffective disorder, schizophrenia, and delusional
disorder; (2) generalized anxiety disorder with features of
panic disorder; rule out panic ...