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).
September 25, 2015, plaintiff Tracy E. filed an application
for a period of disability and disability insurance benefits,
Title II, 42 U.S.C. §§ 401 et seq. (Tr.
160-61). On November 4, 2016, she filed an application for
supplemental security income, Title XVI, 42 U.S.C.
§§ 1381 et seq. (Tr. 175-80). In both
applications, she alleged disability beginning on September
23, 2015, which she subsequently amended to April 19, 2015.
(Tr. 162-63). After plaintiff's applications were denied
on initial consideration (Tr. 91-95), she requested a hearing
from an Administrative Law Judge (ALJ). (Tr. 96-97).
and counsel appeared for a video hearing on October 12, 2017.
(Tr. 42-77). Plaintiff testified concerning her disability,
daily activities, functional limitations, and past work. The
ALJ also received testimony from vocational expert Barbara
Myers, M.S. The ALJ issued a decision denying plaintiff's
applications on January 26, 2018. (Tr. 16-29). The Appeals
Council denied plaintiff's request for review on August
7, 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
was born in July 1965 and was 49 years old on the amended
alleged onset date. She lived with her husband and children.
(Tr. 231). She graduated from college. (Tr. 220). In a report
of her work history, she stated that she previously worked as
a consultant to a family business for 14 years, an expeditor
and receiving coordinator for nine months, a college
instructor for five years, and a transportation planner for
three years. She also worked as a material analyst for one
month in August 2015. (Tr. 207).
listed her impairments as bipolar affective disorder, anxiety
and panic attacks, major recurrent depression, and arthritis.
(Tr. 219). In her November 2015 Function Report(Tr. 230-40),
plaintiff stated that she was unable to concentrate or focus
and she felt overwhelmed. She spent her days feeling worried
and anxious while trying to focus on her tasks, such as
getting her children off to school. Before her illnesses, she
used to be able to make decisions, complete tasks, hold down
a job, and enjoy herself. She alternated between sleeping too
much and not enough and was not motivated to bathe or care
for her hair. She needed reminders to take care of her
grooming but not to take her medications. She prepared meals
daily. She enjoyed spending several hours each day on
household projects and gardening but it was hard to complete
any one project because she had too many started at one time.
Her hobbies and interests included animals, reading, music,
and travel. She was able to drive, go out by herself, go
shopping, and manage financial accounts. She helped her
children with homework and interacted with Kevin and her
parents. She did not have trouble getting along with others
unless she was depressed or manic. She followed written and
spoken instructions very well. She could manage stress if she
was medicated but found it hard to “keep changing
routines.” (Tr. 236). When she was manic or depressed
she tended to focus on death and engage in frequent
handwashing and checking. She occasionally used a brace for
her knees. Plaintiff had difficulty with squatting, bending,
standing, walking, sitting, kneeling, talking, climbing
stairs, remembering, completing tasks, concentrating, and
understanding. Her medications caused nausea, headaches, and
September 2015, plaintiff listed her psychotropic medications
as Effexor, Prozac, Seroquel, Sertraline, and Wellbutrin.
(Tr. 222). In November 2016, plaintiff listed her medications
as Vraylar, olanzapine-fluoxetine, and lithium carbonate.
(Tr. 277). In August 2017, she was taking
olanzapine-fluoxetine and lithium carbonate, along with
benztropine to address involuntary movements the
psychotropics caused. (Tr. 283).
testified at the October 2017 hearing that she had had over
50 jobs. She stated that her most recent attempts to work
“kicked in” her mania and caused poor sleep,
reduced eating, and “funny” behavior. (Tr. 56).
At her last job, there was a trash bin fire that caused her
to “freak out.” (Tr. 57). She had been taking
prescribed medications, but they stopped working after a
while. She tried different psychiatrists and medications, but
still experienced poor sleep, daily crying, and poor focus.
(Tr. 58). It took about a year of trying different
medications to “get halfway . . . able to cope.”
At the time of the hearing, she stated, she was still unable
to concentrate. When she experienced mania, she started
multiple projects that she did not finish before moving on to
another one. She described herself as more depressed at the
time of the hearing, which also caused difficulty with focus
and memory. (Tr. 59-60). She testified that there was a year
in which she “didn't hardly go anywhere” and
“pretty much stayed in bed most of the time, ”
unable “to cope with life.” At the time of the
hearing, she was able to go to the grocery store but still
did not feel well enough to work on any projects. She stated
that it was “too hard to do things” and that she
would rather just go back to bed. When asked to explain what
was “too hard, ” she responded that she could not
focus on anything and was unable to finish any projects she
started. As an example, she stated that her family had
recently moved and she found it overwhelming to unpack boxes
and put the contents away. (Tr. 60-61). When asked about her
psychiatrist's observations that she had improved,
plaintiff agreed that she had improved in that she was not
suicidal, no longer had the shakes, and could go to the
grocery store. (Tr. 62). Nonetheless, she did not believe she
was able to return to work because she was “too
scatterbrained.” (Tr. 62-63).
typical day consisted of driving her daughter and son, ages
16 and 9, to their schools and then trying to do some light
chores. (Tr. 63). Usually, however, she was too tired and
went back to bed and listened to the radio or slept until
11:00 or noon. She left the house at 2:30 to pick up her
children and helped with their homework if needed. Kevin
usually cooked dinner because she was not a good cook. She
swept sometimes but had not done laundry in months. (Tr. 64).
She was not motivated to do chores and typically spent eight
hours a day in bed. (Tr. 65). She started something and then
experienced frustration and walked away. She no longer felt
motivated to garden and lacked the focus to read. (Tr. 67).
She estimated that she could focus on an assigned task for
about 15 minutes. (Tr. 68). She stated that, even with menial
tasks, like putting stickers on items, she would start to
worry that she had missed some and lose focus. She did not
bathe or change her clothes every day. (Tr. 66).
asked by the ALJ why she had not stopped drinking alcohol as
her doctors directed her to do, she denied knowing that she
had been told to do so. At the same time, she stated that she
had cut down. (Tr. 69).
expert Barbara Myers was asked to testify about the
employment opportunities for a hypothetical person of
plaintiff's age, education, and work experience who had
no exertional limitations but was limited to simple, routine
tasks, with only minimal changes in job setting and duties;
who could not have contact with the general public or handle
customer complaints; could occasionally have contact with
supervisors and coworkers; and could not perform fast-paced
production work. (Tr. 71). According to Ms. Myers, such an
individual would be unable to perform plaintiff's past
work as a rate clerk, billing checker, invoice control clerk,
and administrative clerk. Other jobs were available in the
national economy, such as salvage laborer, merchandise
marker, and cleaner housekeeper. (Tr. 71-72). These jobs
would be precluded if the individual were unable to maintain
attention and concentration for two-hour segments, remember
simple routine instructions for two-hour segments, complete
simple tasks, or missed work more than one day a month. (Tr.
May 2014, when the medical records in this matter begin, and
December 7, 2015, plaintiff received treatment for her
psychiatric disorders from Adam J. Sky, M.D., and Theresa
Kormos, AP/MHCN. She also had two brief psychiatric
hospitalizations during this period. In January 2016, she
transferred her care to Luis Giuffra, M.D., Ph. D.
to treatment records from Dr. Sky and Ms. Kormos, plaintiff
was generally stable between May 2014 and early August 2015.
(Tr. 347, 345, 344, 343). She was diagnosed with bipolar
affective disorder, stable, and history of alcohol abuse.
Minor modifications were made to her prescriptions in
response to her insurance or ability to pay. She was
regularly advised to reduce her daily consumption of four or
August 10, 2015, plaintiff called Dr. Sky and said she felt
“manic again” and admitted that she had not been
taking her medications reliably. Id. She was advised
to take her prescriptions as directed. On August 19th,
plaintiff's mother called and reported that plaintiff was
manic, angry, and unable to carry on a conversation. Dr. Sky
directed plaintiff to take one dose of Seroquel right then
and a second dose in the evening and to recontact him in the
morning. Id. The following day, Kevin reported that
plaintiff seemed worse and was asking who he was, whether her
parents were dead, and uttering random words. (Tr. 342).
Noting that plaintiff had a manic episode in 2011, Dr. Sky
directed plaintiff's family to take her to the emergency
room. She was admitted to St. Mary's Hospital for two
days. (Tr. 297-337).
mother told hospital staff that plaintiff had trouble
remembering when she had taken her medications and had been
noncompliant with her medications over the prior two weeks.
(Tr. 316). She had taken an extra dose of Seroquel the day
before, as instructed by Dr. Sky, but it was unclear how much
additional Seroquel she actually took or whether she had
taken any other medication. At admission, plaintiff blurted
out random words and phrases and laughed inappropriately. She
had reduced appetite, slept only three hours a night, and was
anxious. (Tr. 297-98, 313). She was described as very
pleasant with poor concentration and poor insight and
difficulty staying focused during conversation. (Tr. 301,
316). It was noted that she became agitated when her parents
were in the room and repeatedly shouted “get away from
me, Dad, ” in her sleep. (Tr. 300). On August 21, 2015,
psychiatrist Sabina Morga, M.D., noted that plaintiff denied
having any desire to harm herself or others. (Tr. 323-24).
She admitted that she might have mixed her medications with
alcohol and marijuana. She had a “fairly reactive
affect” and did not appear depressed. She denied
feeling hopeless, helpless, worthless, or useless. She did
have difficulty concentrating and became tearful when
speaking of a brother who died at age 5 of leukemia. Her
behavior was appropriate. She was discharged on August 21st,
with recommendations that she apply for disability and
Medicaid. (Tr. 302).
August 24, 2015, plaintiff told Dr. Sky that she had been
without Seroquel for three or four days. (Tr. 341). She
reported that she could not sleep, had decreased appetite,
and was experiencing panic attacks. Her affect was sad and
crying. She was restarted on 400 mg. of Seroquel XR. On
September 1, plaintiff reported that she was a lot better,
but that Kevin had been in and out of the emergency room for
the past week and was now in the hospital. (Tr. 340). Her
appetite had improved and she had not had any panic attacks,
although she was anxious. It was observed that she was alert
and oriented and that her affect was bright. She was more on
task, but had “some disorganization with papers she was
carrying.” Her dosage of Seroquel was reduced to 300
mg. Two weeks later, plaintiff was described as
“better, ” with decreased anxiety and less stress
since Kevin was no longer in the hospital. (Tr. 339). She
reported that she was shopping impulsively but was not in
danger of going into debt because she was shopping at the
dollar store. She was alert and oriented, with bright affect
and normal speech. She seemed slightly better organized. She
was drinking two to three beers a night and was told to
reduce her alcohol consumption. She continued on 300 mg. of
Seroquel and 200 mg. of Zoloft.
accompanied plaintiff to Dr. Sky's office on October 13,
2015. (Tr. 358). Plaintiff was paranoid and thought her
credit card was tracking her. She was not sleeping and got
agitated and verbally abusive. She was drinking three beers
at a time and wanted to reduce her Seroquel dosage. On mental
status examination, she was alert and oriented, with labile
affect and reduced insight. She spoke in short sentences. She
was diagnosed with bipolar affective disorder with psychosis
and alcohol abuse. Her Seroquel dosage was increased to 400
mg. Later that day, she was found lying in the grass at home
and stating that she had bugs and tracking devices in her
uterus. (Tr. 370). She had suicidal and homicidal ideation.
She was given an injection of the antipsychotic Geodon and
transferred to St. Mary's Hospital for admission. (Tr.
367-78). She reported having visual and auditory
hallucinations along with the sensation of something moving
in her abdomen that she described as a bug or tracking
device. (Tr. 370). She had been experiencing these symptoms
for a week or so but had become frightened by something on
this particular day. She denied experiencing manic symptoms,
depression, or anxiety. On mental status examination,
plaintiff was alert and oriented, pleasant and cooperative,
and in acute distress. (Tr. 373). She was neatly dressed and
well groomed and made good eye contact. Her mood was fearful
and her affect labile. Her insight and judgment were
impaired. She acknowledged intermittent use of alcohol and
marijuana. Drug screens were negative for tested substances
with the exception of marijuana. (Tr. 375). The day after her
admission, she denied having hallucinations or delusions and
was able to contract for safety, so she was discharged
against medical advice. (Tr. 377-78). Her insight and
judgment remained impaired, however, and her thought
processes were circumstantial, and her affect was reactive.
Her prognosis appeared “questionable” and
depended on community support, medication management, and
October 16, 2015, Dr. Sky noted that plaintiff was still
psychotic. (Tr. 357). She thought she had a tracking device
in her forehead and was being tracked by her credit cards and
still felt movement in her lower abdomen. On mental status
examination, she was alert and oriented, with a brighter
affect, and was able to respond to joking, but she
“still really believe[d]” the
delusions. She was diagnosed with bipolar affective
disorder with psychosis and history of alcohol abuse. She was
provided with samples of 400 mg. of Seroquel XR. Dr. Sky
noted “no improvement” on October 23rd. (Tr.
356). Kevin reported that plaintiff had not slept the night
before and had had three beers. She had been walking around
outside at night and rearranging the house without actually
completing it. She spoke less about her delusions but still
felt she had an electromagnetic tracker. On mental status
examination, she was alert and oriented, with somewhat labile
affect. She was irritable and talked over Kevin. She was