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Tracy E. v. Saul

United States District Court, E.D. Missouri, Eastern Division

December 30, 2019

TRACY E., Plaintiff,
ANDREW M. SAUL, [1] Commissioner of the Social Security Administration, Defendant.



         This 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).

         I. Procedural History

         On 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).

         Plaintiff 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.

         II. Evidence Before the ALJ

         A. Disability and Function Reports and Hearing Testimony

         Plaintiff 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).

         Plaintiff listed her impairments as bipolar affective disorder, anxiety and panic attacks, major recurrent depression, and arthritis. (Tr. 219). In her November 2015 Function Report[2](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 mood swings.

         In 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).

         Plaintiff 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.[3] (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).

         Plaintiff's 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).

         When 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).

         Vocational 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. 73-75).

         B. Medical Evidence

         Between 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.

         According 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 five beers.

         On 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).

         Plaintiff's 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).

         On 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.

         Kevin 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 psychotherapy.

         On 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.[4] 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 diagnosed ...

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