Opinion
Civil Action No. 3:14-CV-01967
07-24-2015
Magistrate Judge Juliet Griffin
MEMORANDUM IN SUPPORT OF PLAINTIFF'S MOTION FOR JUDGMENT ON THE ADMINISTRATIVE RECORD
STATEMENT OF THE CASE
On 07/01/11, Plaintiff Gregory Walden filed a claim with SSA for disability insurance benefits (DIB). (AR 178) He asserted that he had become disabled on 02/26/11.
In a decision dated 08/24/11, SSA notified Mr. Walden that his claim had been denied. (AR 121) Mr. Walden requested a reconsideration, but in a notice dated 11/22/11 SSA again denied his DIB claim. (AR 125, 128)
Mr. Walden requested a hearing by administrative law judge (ALJ). (AR 131) ALJ Kerry Morgan held hearings regarding Mr. Walden's DIB claim on 06/25/12 and 01/29/13. (AR 51-118) During the 7 months between the first and second hearing, Mr. Walden's medical impairments improved such that he was able to return to work, and he asked the ALJ to find him disabled for the "closed period" of 02/26/11 to 11/27/12. (AR 100) In an unfavorable decision dated 05/01/13, ALJ Morgan denied Mr. Walden's DIB claim. (AR 13-31)
Mr. Walden requested review by the Appeals Council. (AR 11, 344-382) In a notice dated 08/12/14, the Appeals Council denied Mr. Walden's request for review. (AR 1)
On 10/10/14, Mr. Walden filed the above styled cause of action seeking this Court's review of the final decision of SSA denying his claims for DIB. (Document 1) On 12/22/14 Defendant filed her answer. (Doc. 2) In an Order filed on 01/26/15, this Court set forth the briefing schedule for the parties. (Doc. 8)
STATEMENT OF THE FACTS
I. Mr. Walden's age, education and work experience, i.e. his "vocational factors."
1. AGE: At the time he asserts he became disabled, 02/26/11, Mr. Walden was 32 years old and thus a "younger person."
Mr. Walden was born on 09/24/78. (AR 178) On his alleged onset of disability (AOD) date of 02/26/11, Mr. Walden was 32 years old. Under SSA regulations, and specifically under 20 CFR § 404.1563, entitled "Your age as a vocational factor," a person under the age of 50 is considered to be a "younger person."
2. EDUCATION: Mr. Walden has a high school education.
Mr. Walden completed the 12th grade. (AR 221) Pursuant to 20 CFR § 404.1564 Mr. Walden is considered to have a "high school education."
3. WORK HISTORY: In the 17 year period of 01/01/96 (the first year of reported earnings) to 12/26/12 (the day before he returned to work), Mr. Walden worked for at least 45 different employers; the ALJ found that he could not perform any of his past relevant work.
The "Summary Earnings Query" and "New Hire... Query" prepared by SSA,, establishes his year-by-year earnings from 1996, when he was 17 (he turned 18 on 09/24/96), through 11/26/12 (the day before he returned to work), to be as follows:
Year | Earnings | |
---|---|---|
1996 | 5,280.22 | |
1997 | 7,430.47 | |
1998 | 9,299.15 | |
1999 | 4,817.26 | |
2000 | 12,556.36 | |
2001 | 6,070.31 | |
2002 | 10,541.87 | |
2003 | 9,533.86 | |
2004 | 8,360.71 | |
2005 | 8,914.40 | |
2006 | 10,617.15 | |
2007 | 2,907.00 | |
2008 | 5,882.58 | |
2009 | 6,742.31 | |
2010 | 2,954.37 | |
2011 | ||
2012 | (through 11/26/12) |
(AR 182-218; Mr. Walden made $1,119.09 through StaffMark at the end of 2012, see AR 216-218)
During the 17 year period of 01/01/96 - 11/26/12, Mr. Walden worked for 45 different employers, many of which were "temp agencies" and some of which he worked for more than once:
Employer | Earnings (Year) | |
---|---|---|
1. | Lasko Products, Inc. | 1,506.56 (1996) |
2. | Kroger Company | 373.06 (1996) |
3. | United Parcel Service Inc. | 399.76 (1996)768.15 (2008)6,633.68 (2009)2,566.49 (2010) |
4. | Staffmark Inc. - Nashville | 10,092.00 (1996)163.13 (1998)1,119.09 (2012) |
5. | ERMC LP | 117.00 (1996) |
6. | Syndicated Subscription Services | 106.25 (1996) |
7. | Choices LLC | 70.50 (1996) |
8. | Dillards Inc. | 1,048.07 (1996)686.19 (1997) |
9. | American Golf Corporation | 567.02 (1996) |
10. | RAM III New Corp. | 3,048.34 (1997)1,102.40 (1998) |
11. | DMC Crest Inc. | 3,635.94 (1997) |
12. | Executive Property Services Inc. | 60.00 (1997)52.50 (1998) |
13. | SFN Group Inc. | 90.13 (1998) |
14. | Original Honeybaked Ham Co. | 140.21 (1998) |
15. | Ad-Vance Building Services Inc. | 114.00 (1998) |
16. | Southdown Corporation | 445.86 (1998) |
17. | Greg Brothers Enterprises Inc. | 2,958.42 (1998) |
18. | RemedyTemp Inc. | 4,232.50 (1998)20.00 (2007) |
19. | J C Penny Corp. Inc. | 983.74 (1999) |
20. | FedEx Ground Package System Inc. | 488.30 (1999)3,578.52 (2005)43.50 (2006) |
21. | Randestad Staffing Services Inc. | 1,269.86 (1999)2,414.25 (2000) |
22. | All Star Labor Services Inc. | 56.40 (1999) |
23. | Hibbitt Sporting Goods Inc. | 2,018.96 (1999)2,514.91 (2000) |
24. | Landshire Services Inc. | 1,700.00 (2000) |
25. | Onin Staffing LLC | 5,927.20 (2000)5,987.91 (2001)1,473.30 (2002) |
26. | AmTemps Inc. | 82.40 (2001) |
27. | Ajilon North America LLC | 3,608.77 (2002) |
28. | Mapco Express Inc. | 2,119.39 (2002) |
29. | Wood Personnel Services Inc. | 3,275.91 (2002) |
30. | CPS Inc. | 64.50 (2002) |
31. | Bestway Rental Inc. | 6,371.76 (2003) |
32. | Magnolia Service & Mgmt Inc. | 1,453.38 (2003) |
33. | Adecco USA Inc. | 1,708.72 (2003)80.75 (2004) |
34. | Four Friends Inc. Jock Shop | 7,897.13 (2004)5,335.88 (2005) |
35. | Consolidated Realty Inc. | 382.83 (2004) |
36. | Labor Ready Southwest Inc. | 8,084.62 (2006) |
1,792.00 (2007) | |||
37. | Anytime Labor-Nevada LLC | 1,241.00 (2006) | |
38. | Oasis Outsourcing V Inc. | 1,095.03 (2006) | |
39. | Manpower Inc. of Southern Nevada | 153.00 (2006) | |
40. | SS-Tenn Inc. | 660.00 (2007) | |
41. | RemindAmerica Inc. | 435.00 (2007) | |
42. | United Parcel Service Inc. | 768.15 (2008)6,633.68 (2009)2,566.49 (2010) | |
43. | RGIS Holdings LLC | 5,114.43 (2008) | |
44. | Labor Ready Mid-Atlantic Inc. | 108.63 (2009) | |
45. | Dept. of Commerce Bureau of Census | 387.88 (2010) | (Id.) |
In completing a "Disability Report - Adult" for SSA on 07/19/11, Mr. Walden had this to say about his work history:
I understand that I have a very unstable work history. After learning more about my disability I have found that it is possible that my condition could have contributed to an issues (sic) I may have had while working. (AR 225)
As will be discussed in greater detail below, Mr. Walden has a long history of falling asleep at his jobs. When he finally was evaluated by a sleep specialist in November and December 2011, he was diagnosed with "severe hypersomnia." (AR 544-550)
At the hearing on 06/25/12, VE Tara Watts testified that Mr. Walden's past relevant work consisted of the following 2 jobs:
1. Shipping checker, DOT Code 222.687-030, "SVP of 4, which is semi-skilled. A strength of light."
2. Inventory clerk, DOT Code 222.387-026, "SVP of 4, which is semi-skilled and a strength of medium." (AR 86-87)
At the hearing on 01/29/13, VE Chelsea Brown testified that Mr. Walden's past relevant work consisted of the following 3 jobs:
1. Material handler, DOT Code 929.687-030 "... that's at the heavy exertional level at an SVP of 3."
2. Shipping and receiving clerk, DOT code 222.387-050 "... that's at the medium exertional level at an SVP of 5."
3. Warehouse worker, DOT code is 922.687-058 "... that's at the medium exertional level at an SVP of 2." (AR 112)
The ALJ found that Mr. Walden could not perform any of this past relevant jobs. (AR 24) II. Mr. Walden's medical treatment for his severe impairments of Stage I chronic kidney disease with hematuria ("Sickle cell trait with hemoglobin A2 variant" & "Genitourinary bleeding presumptively from papillary necrosis"), hypersomnia, major depressive disorder and generalized anxiety disorder.
1. Mr. Walden was extensively evaluated for hematuria from 02/26/11 until the fall of 2012, and he became more anxious and depressed as he continued to have blood in his urine but his treatment options were basically limited to drinking a lot of fluids.
A. With no forewarning or discernible cause, Mr. Walden began having copious amounts of blood in his urine in February 2011.
Mr. Walden was seen at the Stonecrest Medical Center ER on 02/26/11 complaining of blood in his urine. (AR 412-416) A CT scan of his abdomen and pelvis did not show any abnormalities. (AR 426) He was diagnosed with hematuria. (Id.)
B. He was diagnosed by his PCP with gross hematuria and referred to a urologist.
On 03/01/11, Debra Drake, M.D. saw him in follow up to the ER visit, and recorded his complaint of "painless hematuria blood in urine every urine since it began." (AR 449-450) She diagnosed "Hematuria, gross" and referred him to a urologist. (Id.)
C. The urologist also diagnosed gross hematuria, and ordered testing which was positive for Sickle Cell disease.
Mr. Walden saw the urologist, Robert Knight, M.D., on 03/28/11. (AR 441-442) The lab test (UA, or urine analysis) showed "3+ blood, positive nitrite, 2+ bacterial, 3 red cells, trace ketones. Urine is grossly red." (Id.) Dr. Knight diagnosed "1. Gross hematuria 2. Urinary tract infection." (Id.) He also ordered Sickle Cell screen, which was positive. (AR 438)
The urinalysis ordered by Dr. Knight when he saw Mr. Walden in follow up on 04/08/11 again documented blood in the urine. (AR 431-432) Dr. Knight also performed a cystoscopy, which showed no evidence of bladder stones or tumors. (Id.) He diagnosed "1. Gross hematuria 2. Sickle cell disease with positive sickle cell screening, and referred Mr. Walden to a nephrologist. (Id.)
D. Mr. Walden was evaluated by a nephrologist, who noted Mr. Walden's continuing hematuria as well as his complaint of fatigue, and recommended referral to a hematologist.
Mr. Walden saw the nephrologist, Keith Watson, M.D., on 04/14/11 and again on 04/20/11. (AR 452-460) On 04/20/11, Mr. Walden reported still having "episodes of hematuria" as well as "episodes of fatigue." (AR 459) Based on tests he had ordered, Dr. Watson concluded that "the only clear risk factor we have to explain patient's hematuria at this time is the possibility of sickle cell disease or sickle cell trait" and recommended referral to a hematologist. (Id.) Dr. Drake actually made the referral after seeing Mr. Walden again on 05/17/11; her diagnosis on that date was "Sickle cell disease." (AR 447-448)
E. The hematologists who evaluated Mr. Walden noted his growing exasperation with his chronic hematuria as well as his complaints of fatigue and anxiety, but recommended only "Aggressive oral hydration" in the way of treatment (they also advised him to "avoid vigorous physical activity").
Mr. Walden next saw Linda C. Esuzor, M.D. (apparently in concert with Steven Wolff, M.D.) in the MNGH Hematology/Oncology Clinic on 07/07/11. (AR 462-464) She concluded that she needed to rule out other potential causes (besides the sickle cell disease) for the hematuria, and ordered various tests. (Id.)
Mr. Walden also saw Dr. Keith Watson, the urologist, on 07/07/11. (AR 454) Dr. Watson offered reassurance but also noted that "overtime (sic) papillary necrosis could damage the kidney and result in concentration defects and very rarely loss of renal function." (Id.)
Mr. Walden returned to the MNGH Hematology/Oncology Clinic on 07/21/11 and saw Steven Wolff, M.D. (AR 467-469) Dr. Wolff noted Mr. Walden's growing exasperation with his chronic hematuria as well as his complaints of fatigue and anxiety:
In discussion with the patient today, he is getting more and more exasperated by the chronicity of his GU bleeding, although he is having no life threatening situations. He does have some symptoms of fatigue and anxiety, but he and I both agree this is likely not due to his GU bleeding, but probably his exacerbation of the continuity of his overall situations. (AR 467, emphasis supplied)Dr. Wolff's impression was:
Impression:Regarding treatment, Dr. Wolff noted that "For chronic moderate bleeding, the conservative therapy is to continue hydration and to avoid vigorous physical activity. If the bleeding persists, there is one intervention that could be considered and that is the use of epsilon amino caproic acid - Amicar, which is a fibrinolytic inhibitor and can stop GU bleeding. However, this drug should be used in modest doses and has the risk of causing clotting in the areas that could be quite difficult to manage such as in the ureter, with subsequent renal issues." (AR 468)
1. Sickle cell trait with hemoglobin A2 variant.
2. Genitourinary bleeding presumptively from papillary necrosis.
Mr. Walden saw Dr. Wolff again on 08/04/11. (AR 470-471) Dr. Wolff's treatment note records the "Current Treatment" as "Aggressive oral hydration." (Id.) Dr. Wolff's impression was that "After radiography as well as examination via cystoscopy, it is felt that his chronic hematuria is likely due to chronic papillary necrosis from his sickle cell disease." (Id.) In his "Plan," Dr. Wolff noted that "At this time, it does not seem as though any specific therapy needs to be undertaken..." (Id.)
F. Mr. Walden continued to complain of "chronic fatigue and tiredness," but additional testing only documented his continuing "severe hematuria" while not shedding any further light on its cause.
When Mr. Walden returned to MNGH on 11/17/11, he saw Andrew L. Moore, M.D., not Dr. Wolff. (AR 601-602) Mr. Walden reported continuing chronic hematuria since the 08/04/11 visit. (Id.) He also admitted to "chronic fatigue and tiredness..." (Id.) Dr. Moore's diagnosis was the same as Dr. Wolff's. (Id.)
A CT scan done on 11/29/11 "showed no evidence for renal papillary necrosis," as noted by Dr. Keith Watson in his 12/29/11 treatment note. (AR 607) At that time, Mr. Walden was still reporting "episodes of hematuria with a passage of clots noted 1 month ago." (Id.) Dr. Watson diagnosed chronic kidney disease, Proteinuria, Hematuria unspecified and hypotension. (Id.)
Mr. Walden saw Dr. Watson again on 01/12/12. (AR 609-610) Mr. Walden's complaints remained the same, as did Dr. Watson's diagnoses (though the hypotension was noted to have resolved). (Id.)
On 01/18/12, Mr. Walden was at Baptist Hospital for a CT guided kidney biopsy and also a CT scan of the abdomen and pelvis. (567-568, 592-593) His pre-procedure diagnoses were listed as "599.70 HEMATURIA + Proteinuria and severe hematuria." (AR 567) The "Impression" from the CT scan of the abdomen and pelvis showed "no evidence for renal papillary necrosis. Delayed phase suggest slight papillary blush which may reflect renal tubular ectasia though this is not definite." (See Dr. Watson's 02/09/12 treatment note at AR 613) The kidney biopsy showed "segmental glomerular basement thinning - in this condition the kidney has increased tendency to leak protein and blood, there is no specific treatment, a few patient develope (sic) chronic kidney disease over long periods of time." (Id.) Dr. Watson's "Plan" as noted in his 02/09/12 treatment note was to start Diovan 40mg daily to treat the "proteinuria significant-abnormal ligh (sic) chain ratios, proteinuria secondary to glomerular basement thinning." (Id.)
G. In April 2012, Mr. Watson began taking medication (first Lisinopril, then Diovan) "for renal protection to decrease risk of further kidney disease."
Dr. Watson's 04/05/12 treatment note records Mr. Walden's continuing report of "episodes of hematuria." (AR 615-616) Under "Current Medications," Dr. Watson wrote "on lisinopril after dispute with his insurance company." (Id.)
On 06/05/12 Mr. Walden saw Dr. Drake, who switched him from Lisinopril to Diovan "for renal protection to decrease risk of further kidney disease." (AR 651-652)
H. In September 2012, Mr. Walden's hematuria ended just as inexplicably as it had begun.
On 07/12/12 Mr. Walden told Dr. Watson that his "Urine (was) clearer." (AR 644-645) He expressed concern about his weight loss. (AR 644, see discussion re weight loss below)
On 09/11/12 and at his first visit to Matthew Walker CMC (Aba Hollie, M.D.), Mr. Walden's chronic hematuria is described as "which resolved x 3 weeks ago." (AR 656-659) The MWCMC clinic note for the follow-up visit on 10/09/12 reads, inter alia, "He has Sickle Cell trait and recently chronic hematuria, which has resolved." (AR 670-672)
I. At the 06/25/12 hearing, Mr. Walden testified about the emotional/psychological toll he experienced from the hematuria.
At the 06/25/12 hearing, Mr. Walden was asked "What, when you urinate and see the blood in your urine, what is your emotional or psychological reaction to that?" (AR 73 ) He responded as follows:
Ah, a lot of times I dread going to the restroom due to the fact that it's just never pleasant to see. It's - to me, it's not natural. I sometimes get angry. It's just kind of hard to explain 'cause, like I say, I've really - it's a sick feeling. I've - especially when it first started, I would get kind of nauseous to see it because it's heavy. I've never seen anything like it. (AR 73)Asked "What does the fact that the doctors can't tell you exactly what's wrong, how does that affect you?," Mr. Walden testified "It's, it's stressful. It's irritating because I don't know how, I don't know how serious it is. I don't know what it's doing to my body. So, it's irritating." (AR 73 )
2. Mr. Walden lost greater than 10% of his body mass after his hematuria began, but regained this weight as the hematuria ended.
Mr. Walden testified that his weight "has always been between 148 and 155, somewhere around there." His weight 2 years prior to the onset of the hematuria was 156 lbs., and it was 155 lbs. on the day he first found blood in his urine and went to the ER, 02/26/11. Given his starting weight of 155 lbs. on 02/26/11, and the fact that all of his recorded weights from 05/17/11 to 08/07/12 were 140 lbs. or less, one can see that Mr. Walden's body mass was 10% or more below his baseline for more than a year while he suffered the chronic hematuria. As the hematuria ended, he gained all of this weight back.
The following is an itemization of Mr. Walden's weight as measured by various health care providers:
Date | Weight | AR cite |
---|---|---|
07/28/05 | 147 lbs. | (AR 406) |
03/24/09 | 156 lbs. (71 kg) | (AR 412) |
02/26/11 | 155 lbs. (70.308 kg) | (AR 417) |
03/01/11 | 146 lbs. | (AR 146) |
03/28/11 | 150 lbs. | (AR 442) |
05/17/11 | 144 lbs. | (AR 447) |
07/21/11 | 138 lbs. | (AR 468) |
10/25/11 | 139 lbs. | (AR 489) |
12/16/12 | 140 lbs. | (AR 549) |
12/29/11 | 137 lbs. | (AR 607) |
01/12/12 | 140 lbs. | (AR 610) |
01/18/12 | 137 lbs. | (AR 553) |
06/05/12 | 138 lbs. | (AR 651) |
08/07/12 | 138 lbs. | (AR 653) |
09/11/12 | 148.2 lbs. | (AR 658) |
10/09/12 | 155.4 lbs. | (AR 671) |
11/27/12 | 159.4 lbs. | (AR 679) |
Mr. Walden's nephrologist brought to his attention that his BMI (body mass index) was decreasing, and on 08/07/12 he reported this to his PCP, Dr. Drake. (AR 653) He denied any changes in his appetite, but did say that he did "not have much of an appetite" but was "excessively thirsty." He reported "drinking lots - anything around them" and said his girlfriend "comments on how much he has been drinking." (Id.) He had "just drink and ensure before coming in" to Dr. Drake's office. (Id.) His weight that day was 138 pounds; given his height of 67 inches, his BMI was 21.61. (Id.) Mr. Walden also reported urinating frequently during the night (about 4 times) and in "large volumes." (Id.) Dr. Drake's diagnoses were:
1. Weight loss/Underweight - 783.21 (Primary)
2. Polydipsia - 783.5
3. Polyuria - 788.42
4. Chronic kidney disease, stage I - 585.1 (Id.)
As discussed above, Mr. Walden's hematuria ended in September 2012, and that was the first month that his recorded weight was greater than 140 lbs. since May 2011. By 10/09/12 his weight was back up to where it was on the day the hematuria started, 155 lbs.
When asked at the 06/25/12 hearing about the cause of his weight loss, Mr. Walden testified as follows:
I don't really have an understanding, but I can say that recently I haven't- my appetite is gone because all I've been told by the doctors is you gotta drink lots of water, you gotta drink lots of water, due to the medicine and the blood in my urine. So, it curbs my appetite and I really, I might eat one meal a day and maybe snack a couple of times, but I don't have an appetite 'cause I drink so much water all day. (AR ( )
At the 01/29/13 hearing, Mr. Walden testified that even though his eating habits did not change, once the hematuria ended he started gaining the lost weight back:
Question: When did you start gaining weight again?
Mr. Walden: Uhm, shortly after the blood in the urine stopped. The doctor actually asked me had I changed eating habits or anything like that and I haven't changed anything. I'm - everything that I was doing before, same thing I'm doing now, and, my weight just picked back up. (AR 105)
Mr. Walden noted that when he stopped having blood in his urine and gained the weight back, he felt better and had more energy:
Question: Okay. With the stop - with the, I guess, cessation of the blood in your urine and the weight gain, how have you felt?
Mr. Walden: Ah, I felt better. I've had more energy. Ah, I haven't been as, I guess you could say, depressed or upset. Like I said, I really - I wanted to push myself to see what I could do because I was feeling better. (AR 106)
3. Mr. Walden has suffered with chronic daytime somnolence "for as long as he can remember," and when finally evaluated in October and November of 2011, he was diagnosed after a sleep study with "severe hypersomnia, with an Epworth Sleepiness Scale score of 22 in a patient with what seems to be significant sleep attacks or sleep paralysis."
On 10/25/11, Mr. Walden presented to Dr. Drake seeking referral for a sleep study. (AR 489-490) He related the following history:
He complains of falling asleep easily during the day if he is idle. He says whether he is at home, at his son's baseball game, or Titan's football game- he may doze off for 10-15 min. He says he is difficult to awaken if he has been asleep for several hours and he does not feel well rested even after full night's rest. His fiance says he snores often during the night. He currently is not working and not following a set sleep/ wake cycle, but he says when he was working this was a problem then as well. He was encouraged by his disability atty to have this evaluated. (Id., emphasis supplied)Dr. Drake referred him to a sleep specialist, Oscar Mendez, M.D. (Id.)
Dr. Mendez saw Mr. Walden on 11/16/11, and his treatment records Mr. Walden's history as follows:
... who states that for as long as he can remember, he has had problems with excessive sleepiness. According to the patient, when he was in school, he would start writing and suddenly fall asleep in class. Anytime he has decreased stimulation, he will fall asleep. While he is out of work at this time, even when he was working, when he got a break he would use this time to eat and take a nap. He normally can go to sleep anywhere from 11:00 p.m. to midnight, and sleep 8-10 hours in a row and still feel tired and fatigue. He just has a constant urge to fall asleep. He has had very vivid dreams, and sometimes he acts out his dreams. He does describe experiencing sleep paralysis in the past, with at least three-to-six events over the past three months. He denies any drug abuse.Dr. Mendez conducted a sleep study on Mr. Walden on 12/08/11. His "Impression" reads:
(AR 544-546, emphasis supplied)
Impression: This recording is consistent with objective evidence of hypersomnia. Test is not diagnostic of Narcolepsy. (Id.)
Dr. Mendez's 12/16/11 treatment note reports that "multiple labs" were "negative for metabolic disorder." (AR 549-550) He diagnosed "Hypersomnia NOS - 780.54 (Primary)" and noted that Mr. Walden "comes in with severe hypersomnia, with an Epworth Sleepiness Scale score of 22 in a patient with what seems to be significant sleep attacks or sleep paralysis." (Id., emphasis supplied) Dr. Mendez reviewed possible treatment with the drugs Modafanil and Adderall, and noted "After extensive review would like to hold. Been tested for kidney disorder." (Id.)
Mr. Walden was asked a number of questions about his fatigue and hypersomnolence at the two hearings, and his responses detail longstanding problems that had affected his work for years:
Mr. Walden: . . .uhm, I'm very fatigued from time to time. If I do something as simple as wipe down the bathroom, then I feel like, you know, I have to sit down, or I have to take a nap because, I mean, I really, I'm tired.
ALJ: Okay. Now, is that fatigue an every-day problem, or does the . . .?
Mr. Walden: The fatigue is an every-day problem.
ALJ: Okay. Would you describe as constant or are there certain times of days or is it with activity that you experience the fatigue?
Mr. Walden: Uhm, it just. It varies. I mean, I really don't know how to explain it. I just, I know, walking to check the mail and coming back in the house. . . . that right there alone, I would have to sit down and, you know, I might doze off just because, you know, I'm tired... It's not just, you know, certain things that make me tired. I'm always tired.
ALJ: Okay. So, what do you do during the day?
Mr. Walden: During the day, I take a lot of naps. I actually try to push myself to see, you know, what I can do. If I can stay awake or what not, but, most of the time, I end up laying around sleeping. I have a hard time doing too much of anything.
ALJ: Okay. How much of the day would you say you spend in bed?
Mr. Walden: On a regular day, I can say more than 10 hours.
ALJ: Do you have any hobbies that you used to do that you're not able to do now?
Mr. Walden: Play with the kids... I used to play basketball. I used to, I mean, I haven't washed my car in I don't know how long. It's a lot that I feel like I used to do, that I just, I try to do now, and I just, once I do it, I go straight to sleep and I'm asleep for hours... I have trouble sitting through my kids' baseball games. I've missed quite a few baseball games due to that.
ALJ: Do any of your doctors feel like the sleep disorder and the kidney disorder are related to each other?
Mr. Walden: Honestly, I haven't gotten a lot of answers from doctors on the kidney issue, so, I wouldn't know. (AR 65 - 66 )
. . .
ALJ: Now, let's see, you last worked in June of 2010. Did you have these problems going on in June 2010?
Mr. Walden: Uhm, the sleep, yes.
ALJ: The sleep problem? Okay.
Mr. Walden: The urine - the blood thing didn't start until February of 2011. (AR 66)
. . .
ALJ: What about walking, how long can you comfortably walk?
Mr. Walden: I don't know. I mean I can walk through this hallway, but, like I say, once I sit down and I'm in a rest position. . . I'm going to sleep. I mean, I don't even necessarily have to be in a rest position. I just know . . .
ALJ: How long would it take you to fall asleep?
Mr. Walden: Not that long.
ALJ: Five minutes? Ten minutes? Twenty minutes?
Mr. Walden: Maybe 5 to 10 minutes, if that long.
ALJ: Okay. Do you have any physical problems with just sitting besides the falling asleep? Does it both you to sit for extended periods?
Mr. Walden: No. Not really.
ALJ: Okay.
Mr. Walden: Now, I could probably fall asleep now.
ALJ: So, when was the last time you just fell asleep in the middle of a conversation with someone, or does it happen like that?
Mr. Walden: It does off and on, but, I don't, it hadn't, like, it's not one of those things like you know, I'm just talking to you every day or, you know... It's not something that would happen every day. I couldn't tell you the last time I just - I've done it quite often with my girlfriend, though, like, you know, because she's around me more than anybody else.
ALJ: Okay. So, Dr. Mendez. How often do you see Dr. Mendez?
Mr. Walden: I won't see him again until the end of this year because he can't run the sleep study again until the end of this year.
ALJ: Okay. So, has he prescribed you any medication or suggested any treatment for you.
Mr. Walden: At that point in time, he didn't prescribe me anything because Dr. Watson was still working on prescribing me some medicine and he didn't want to prescribe me anything that was gonna, I guess, counteract, or, maybe not interact appropriately with the medicine that Dr. Watson was gonna prescribe. (AR 68 - 69)
. . .
Question: What problems, if any, did you have with this sleepiness on the job (as a shipping and receiving manager at the Jock Shop in the mid-2000's)?
Mr. Walden: I would always go to sleep on break. Sometimes during my, during my shift, when I wasn't on break, I would doze off filling out paperwork or typing or something like that. Luckily, I had a boss that, you know, I did a good job, so, she would kind of let me get away with it, but, I would fall asleep quite often. I was known, on the job, for falling asleep.
Question: Where would you take your naps at?
Mr. Walden: I would take them in my car
Question: Where was this job located?
Mr. Walden: In Las Vegas.
Question: So, you would go to your car in the parking lot?
Mr. Walden: Yes sir.
Question: And, what would the temperature be?
Mr. Walden: Ah, summer times in Las Vegas, always triple digits. 107 degrees, you know, that's normal.
Question: And, you would get in your car?
Mr. Walden: And, I would sleep in my car. And people - it should shock people because their thing is how could you sleep in your car and, you know, it's that hot outside. And, it's like, I was sleepy. I mean, I have to take a nap. That's where I spent my breaks.
Question: All right. Did you have any sleeping problems at the Ready- Labor Ready Temp Service you worked for after that?
Mr. Walden: Ah, going to and from the work place, I would fall asleep sometimes. I would more so fall asleep waiting on the jobs to come in, because you get there at maybe 5 o'clock in the morning and they might not send you on a job until 6:30, 7 o'clock, so, in that waiting period, I'm asleep.
Question: What about RGIS, what did you do there?
Mr. Walden: Inventory specialist. I was what they could call a team leader, which is basically a manager position.
Question: And, what about on that job?
Mr. Walden: Ah, as long as I wasn't driving, and I've fallen asleep while I was driving to and from jobs, but if I wasn't driving, it's almost a guarantee I'm falling asleep on the way to the job and most of the time on the way from the job which, in turn, it, that kind of hurt my work performance due to the fact that when I wake up I'm sluggish and I don't, you know, I'm not real talkative and, you know, it would take me a minute to get myself together to where I could perform the way I was supposed to.
Question: Was that a job where you, you and the other people working with you would drive to a site to do inventory?
Mr. Walden: Yeah. We would meet at the office and drive to Hibbitt Sports or Wal-Mart and, like I said, sometimes we worked in Alabama. We worked in Chattanooga. It's, we did quite - we did inventories everywhere.
Question: UPS. What were your sleep habits at the job?
Mr. Walden: Ah, we get maybe 15 to 20 minutes a day for break and most of the time I was found in one of my trucks on my break, instead of going to get water or going to get a snack, I was asleep in my truck trying to build up some energy to the next go-around which ended up, you know, like I said it was a couple of times that there were, my coworkers would have to actually come wake me up out of my truck.
Question: When you saw Dr. Mendez, he diagnosed hypersomnolence.
Mr. Walden: Right.
Question: And, you also said you guys discussed, I believe, what were some medications for that. Does that sound familiar?
Mr. Walden: Yes.
Question: Tell us about what the discussion was and what your decision was.
Mr. Walden: He, ah, he wanted to prescribe a medicine called Provigil, but he wanted to wait until after he saw what Dr. Watson was gonna prescribe me because Dr. Watson hadn't prescribed me anything for the urine yet, and, for the kidneys, I'm sorry, and he also went ahead and set me up for another sleep study to come in at the end of this year 'cause he can only do, I guess, one a year, because he said hypersomnia also can sometimes lead to narcolepsy. So, he wants to check again within a year's time just to see if it's progressed or if it's gotten better or...
Question: Let me, you know, elaborate on this entry in his record on, I believe it's 12/16/2011, it's near the end of it. I'll just quote it. "Review diagnosis idiopathic hypersomnia and potential RDX. (I'm assuming that means prescription options) Review Modafanil and Adderall. After extensive review would like to hold. Been tested for kidney disorder." So, what does that - does that jog your memory at all about the discussion?
Mr. Walden: Yeah. Like I said, he just said he would wait to prescribe me anything because he wanted to see what Dr. Watson was gonna prescribe first. (AR 75 - 78)
. . .
Question: Do you sometimes go and then have these spells of sleepiness come over you?
Mr. Walden: Yes. I will go sleep in the car.
Question: During the game?
Mr. Walden: During the game. (AR 81)
. . .
Question: ... Were you having any of the troubles you've testified to at the first hearing about falling asleep at the job at UPS?
Mr. Walden: Nah, yeah. I fell asleep at the job while on break and, I guess, you know, coming back from that because, at that point in time, I was falling asleep a lot more and, like I said, right before all the, before I got sick. So, I don't know if that, you know, was a symptom of what was to come or what not, but, like I said, I mis-loaded a truck
and I never was told you're fired or, you know, I never quit, I just ended up having to go to a hearing... (AR 108)
4. Terry Edwards, Ed.D., a psychologist with very extensive experience who has performed hundreds of disability evaluations for DDS, treated Mr. Walden's depression and anxiety from September 2011 to October 2012 and provided comprehensive information to DDS/SSA that fully supports his disability clam.
A. Dr. Edwards treated Mr. Walden on 17 occasions from late August 2011 to 10/22/12; consistently found his mood to be anxious and/or depressed, his affect to be labile or mood congruent and his behavior to be agitated and/or withdrawn; and diagnosed him with both anxiety and depressive disorders.
Attached hereto is a "Transcription of the Treatment Notes of Terry L. Edwards, Ed.D." prepared by the undersigned setting forth Dr. Edwards treatment notes in chronological order. This document was submitted to the ALJ and is found in the administrative record at AR 369-382. The attached copy notes the AR cites for Dr. Edwards treatment notes, and was also proofed again and corrected as needed.
Dr. Edwards treated Mr. Walden on 10 dates in 2011 ("late August," September 20, October 1, 8 & 15, November 1 & 20, and December 2, 9 & 16) and on 7 dates in 2012 (June 4, 12 & 19, July 11, August 20, September 24 and October 22). (AR 514, 629-642, 700-703) In her mental status exam findings, Dr. Edwards consistently noted Mr. Walden's mood to be anxious and/or depressed, and sometimes to also be angry and/or tired; his affect to be either labile or "mood congruent"; and his behavior to be agitated and/or withdrawn. (Id.) She initially noted his memory to be "intact" and his judgment to be "fair," but on and after 06/04/12 (and until 10/22/12), she recorded them as both being "poor." (Id.) The "narrative" section of her treatment notes reference Mr. Walden's impulse control issues, behavior cycles, social withdrawal and irritability, feelings of depression and anxiety, difficulty focusing and staying on task, compulsive behaviors, eating of "non food items," poor short-term memory, etc. (Id.)
Dr. Edwards diagnoses on 09/20/11 were depressive disorder NOS/major depressive disorder and anxiety NOS. (AR 620) On 06/04/12 she added "possible intermittent explosive disorder." (AR 638) On 09/24/12 she added bipolar affective disorder NOS. (AR 700)
Dr. Edwards' 10/22/12 treatment note indicates that Mr. Walden was feeling better, notes his behavior to be "appropriate," etc. (AR 702-703)
B. On 10/31/11 Dr. Edwards performed a psychological evaluation pursuant to the DDS evaluation protocol, and noted functional limitations which would clearly sustained work activity.
On 10/31/11 Dr. Edwards performed a psychological evaluation pursuant to the protocol for same used by DDS. (AR 491-511) Regarding Mr. Walden's medical history, Dr. Edwards noted "Kidney problems, panic attacks. Blood in urine. Major Depression." (AR 491) Regarding his social history she wrote "Used to have friends and was outgoing. Now has no hobbies, is irritable and withdrawn." (AR 492)
On mental status exam, Dr. Edwards found Mr. Walden's appearance, behavior and speech to be "Articulate, nervous moody stiff posture." (Id.) His thought process was clear with no common thought disorder but "Some mild paranoia." (Id.) His thought content was "Paranoia at times, getting worse." (Id.) She described his mood as "Very depressed sad down anxious irritable. Sometimes feels hopeless. Apathetic at times." (Id.) He had normal judgment, poor insight, poor memory during sessions and poor focus during the therapy sessions. (AR 493) She noted the Mr. Walden's symptoms to include depression anxiety, irritability and paranoia, and the signs of his mental disorders to be "Apathy lack of social activities, irritability poor memory." (AR 494)
Dr. Edwards described Mr. Walden's activities of daily living as follows:
Lives with GF, son, GF's son, GF's daughter, daughter. No pets. Remembers medications. Can cook and clean st. St. avoids chores. Reads mail but doesn't - avoids mail. Avoids paperwork. Poor memory. Poor focus. Fair money manager in past, not now. Trouble with hygiene, avoid daily tasks. Won't shave. Remembers appointments w/help of girlfriend. Drives OK, can take bus by self. Can run errands w/GF, not alone.
On bad day won't show or save. Won't open mail. Will not eat normally. Trouble w/sex drive. Won't interact. Won't socialize. Irritable w/GF. Distance w/kids. Notices boredom, depression anxiety. (AR 495)
Dr. Edwards' diagnoses were "Major depression severe chronic recurrent (and) Moderate generalized anxiety." (Id.)
In the spaces for describing impairment in understanding and remembering, interacting with others and adapting to changes in the work environment, Dr. Edwards wrote:
Immediate memory is good when directly asked w/no interference. However, during sessions, he lacks focus and concentration. He has problems w/recall in conversation. He would have trouble (moderate) focusing and remember at work. He becomes irritated and upset easily. He lacks motivation. He lacks focus over time.
He would have moderate problems w/work change due to irritability.
(AR 495, 497)
Regarding various work-related activities, Dr. Edwards opined that Mr. Walden would not be able to independently, appropriately, and effectively in a full time work setting perform the following:
1. Maintain attention for a two hour segment.
2. Maintain regular attendance and be punctual within customary, usually strict tolerances.
3. Sustain an ordinary routine without special supervision.
4. Work in coordination with or proximity to others without being unduly distracted.
5. Complete a normal workday and workweek without interruptions from psychologically based symptoms.
6. Perform at a consistent pace without an unreasonable number and length of rest periods.
7. Ask simple questions or request assistance.
8. Accept instructions and respond appropriately to criticism from supervisors.
9. Get along with co-workers or peers without unduly distracting them or exhibiting behavioral extremes.
10. Respond appropriately to changes in a routine work setting.
11. Understand and remember detailed instructions.
12. Carry out detailed instructions.
13. Set realistic goals or make plans independently of others.
14. Travel in unfamiliar places. (AR 497-498)
In response to the question "Does the psychiatric condition(s) exacerbate your patient's experience of pain or any other physical symptom?," Dr. Edwards wrote:
He has an unknown medical condition causing the blood in his urine. He is really upset about that. (AR 499)
Regarding work absenteeism, Dr. Edwards opined that Mr. Walden would miss about four days of work per month due to his mental impairments. (Id.)
C. On 11/11/11 Dr. Edwards wrote a letter to provide additional information regarding the nature and severity of Mr. Walden's mental impairments, noting that he "would miss at least one to two days per week" of work, "would lack ability to handle changes in work settings," "would be impatient and easily frustrated with others," and "would have a moderate problem with concentration and focus."
In a letter dated 11/11/11, Dr. Edwards wrote that Mr. Walden was "a self referral to my office in late August of 2011" who "originally presented with anxiety, boredom, and an unknown medical condition." (AR 514-515) She described him as "blank and, at times, apathetic with blocking." (Id.) She noted that he had "always been logical and coherent" and fully oriented, but "with little insight into his own feelings and behaviors." (Id.)
As Mr. Walden opened up to Dr. Edwards over time, he "began to describe anxiety and irritability," social avoidance/isolation, little interest in hobbies, hopelessness, etc. (Id.) Mr. Walden's "apathy seemed to turn to anger" and he "began to have functional problems in his core relationship skills," and problems with his sex life. (Id.) He was not eating regularly and he "felt out of place and fidgety." (Id.) He reported insomnia, and "less patience with neighborhood children and neighbors." (Id.)
Dr. Edwards described Mr. Walden as "profoundly sad during sessions" and "as being very fragile at this time." (Id.) Both Mr. Walden and his girlfriend described him as being "completely different" than his former self. (Id.)
Dr. Edwards opined that Mr. Walden "would miss at least one to two days per week" of work, "would lack ability to handle changes in work settings," "would be impatient and easily frustrated with others," and "would have a moderate problem with concentration and focus." (Id.)
D. In completing a functional assessment form on 06/20/12, Dr. Edwards again provided detailed information about Mr. Walden's mental impairments and again noted limitations which would preclude sustained work activity.
Utilizing the terms "no," "mild", "moderate" and "severe," Dr. Edwards completed a functional assessment form on 06/20/12 in which she noted "severe" impairment in the following two (2) critical work-related activities: maintain attention for a two hour segment and completing a normal workday and workweek without interruptions from psychologically based symptoms. (AR 618-620) She also noted "moderate" and "moderate to severe" limitations in a number of other areas. (Id.)
In the section of the form for a narrative statement, Dr. Edwards wrote as follows:
Mr. Walden is very neat and very clean. He has an excellent short term presentation. He is focused, friendly, and calm for about 15 minutes. After that
time, he has moderate to severe problems w/focus and functional memory. He becomes frustrated and irritated. He cannot complete 3 sentences in a conversation. He becomes angry and upset. He then begins to escalate into a period of extreme frustration after which he "crashes" into a depression. He then is largely dispondent (sic) and sullen. He continues to have problems w/focus. He feels sad and down. He might stare at the walls for hours. He engages in repetitive behaviors. He may spend hours like this before realizing the time has gone. His frustration causes significant problems in social decision making. It is not that he is angry, he seems to have these issues related to his mood. He also has periods of anxiety. He becomes hyper focused with SOB. He cannot shave, shower or complete chores when this happens. This might last ½ a day. His fiancé redirects him at some point.
Mr. Walden displays severe issues in goal setting at times. He sets very small goals and feels frustrated w/himself, becoming unable to complete even these simple goals. He lacks self direction.
Mr. Walden hopes to return to work, however, his depression is worse. He is compliant. His fiancé helps to be sure of this.
Mr. Walden functions on a much lower level than it appears upon greeting. He sends infrequent anxious depressed frustrated and poorly organized messages. He forgets appt times. (Id.)
E. In her 02/25/13 videotaped statement (given when a conflict prevented her from testifying at the supplemental hearing on 01/29/13), Dr. Edwards described mental impairments which profoundly limited Mr. Walden's ability to work during the period 02/26/11 to 11/27/12.
Mr. Walden requested a supplemental hearing with the hope that Dr. Edwards could attend and give live testimony. (AR 284, 102) The ALJ did hold a supplemental hearing, but Dr. Edwards cannot attend due to a death in her family. (AR 102) Consequently, her testimony was obtained via a videotaped statement recorded on 02/25/13. (AR 681-693)
At the time of her 02/25/13 statement, Dr. Edwards had been practicing as a clinical psychologist for 18 years. (AR 681) After obtaining her doctorate, Dr. Edwards completed post-graduate training for prescription privileges but decided not to write prescriptions in Tennessee. (Id.) In addition to seeing a wide range of clients in private practice, Dr. Edwards had worked for and with alcohol and drug agencies and in fact started the first co-occurring treatment center in Nashville. (AR 682) She also does pain management assessments. (Id.) She was a DDS panelist, i.e. she was on the panel of consultants who accepted referrals for evaluation from DDS, for approximately 15 years and performed hundreds of evaluations for DDS. (Id.) In fact, she even supervised two other people who did evaluations for DDS. (Id.) Thus, she was a very familiar with DDS protocol for such evaluations. (AR 682-683)
Dr. Edwards stated that when Mr. Walden first came to see her, he presented with "just kind of mysterious depression, and some anxiety" but he "still was really funny and he was trying to keep his spirits up." (AR 683) Thereafter "he just declined, really to a strange extent and, I mean, he couldn't figure out why he was more and more depressed and despondent and pulling away from his family, and he got - he was very irritable, and he couldn't deal with people. He had no friends, no hobbies. Just - he got worse. And, there were some points that he would get better, but, then, you know, he would get back worse again. And, it was still so mysterious, 'cause he was such a, you know, previously, even when he first came to see me, he was funny and quick. That was one of the things that was weird is that he was, he even told me, because he's a - he was a comedian at one point, that he's very quick and he just lost that. He couldn't focus. It was really dis - one of my, you know, it was just a strange case." (Id.)
Dr. Edwards noted that over time Mr. Walden lost a lot of weight. (Id.) During the sessions, he would "decline dramatically, like, right in front of me." (Id.) She elaborated in this regard as follows:
It was like he couldn't handle the intenseness of a one-hour conversation, and he wouldn't be irritable with me, he would just lose, like his comprehension. I would have to repeat sentences. He wouldn't stay on task. He would start wandering. Then he would get frustrated with himself and then he would get despondent. He would just be like, "I can't function." "This is not me." "This is what I'm like."
"This is what I'm like at home." You know, and he would say that that's how he's like at home. You know, he can, his kids are okay for about 10 minutes, and then he just can't stand to be around any, you know, he just loses his ability to interact or follow instructions or anything. (AR 684)
In response to the question "What were the signs and symptoms that you saw personally of depression and anxiety?," Dr. Edwards stated:
Oh, tearfulness, irritability, poor focus, poor short-term memory, no hobbies, no friends, withdraw from the kids, guilt, feeling ashamed that he wasn't working, inability to make decisions because, you know, a lot of self- doubt. I mean, that would have been some... jittery. (AR 686)
Dr. Edwards noted that Mr. Walden "always had obsessive tendencies" and at one point acting on these tendencies in bizarre ways:
... then he started doing things like he was eating baby powder and, at some point, I think baking - he switched to baking soda, thank goodness, but he was obsessively eating, and he couldn't stop and his girlfriend would get upset and his girlfriend would come in the room and he would literally have baby powder all over his face and he was like he didn't know that he was doing it. Like, when she would call it, he would be like, "Oh, yeah." And he wasn't psychotic, but while he was doing it, he wouldn't realize, I mean, how bizarre, and there's kids, you know, in the house. Just really strange. And he would do other things, but they were more normal. Television - completely fixated and obsessed. Just really strange. Strange thoughts - unusual thoughts. That was pretty consistent. But, the baby powder thing was pretty short-lived and he told his doctor, and he stopped and I think he switched to baking powder, I believe, which is not that unusual. I have seen people that obsessively eat baking powder, or baking soda, but never baby powder. It was bizarre. (AR 687, emphasis supplied)
Mr. Walden was also having a lot of intrusive sexual thoughts that were very upsetting to him. (AR 687-688) Other obsessive thoughts included thoughts about a cousin with whom he had a falling out, a neighbor's cat came into his yard "and he just couldn't let it go," etc. (AR 688) He had "gone off" in his doctor's office on the receptionists. (Id.) And after he "went to some disability thing and it didn't go well, and he came home and tore up a television. He beat it to death. He beat the television to death, and was in a rage and he was completely bewildered by that." (AR 692; Dr. Edwards appears to be referencing Mr. Walden's consultative evaluation by Alice Garland on 07/20/12, see AR 624)
5. Mr. Walden's treatment at Matthew Walker Comprehensive Health Center in September and October of 2012 corroborate Dr. Edwards' opinions.
Dr. Edwards' diagnoses and RFC assessment are buttressed by the MWCHC treatment notes for 09/11/12 and 10/09/12 of Nicoll Hannaway, LCSW. (AR 660-663, 673-675) In her 09/11/12 note, LCSW Hannaway recorded Mr. Walden's history as follows:
History of Present Illness: 1. depression 2. anxietyLCSW Hannaway's diagnoses were:
Onset: 18 month(s) ago. Date of initial visit for this episode: 09/11/2012. The patient reports it is somewhat difficult to meet home, work, or social obligations. He is experiencing anxious, fearful thoughts, depressed mood, diminished interest or pleasure, fatigue or loss of energy, panic attacks, poor concentration and indecisiveness. Consult received from Dr. Hollie for assessment of pt who presents to the sickle cell clinic to establish care. Pt is a 33 yr old male. PHQ-9, AUDIT, and CRAFT were administered. PHQ-9 reveals that pt suffers from depression. AUDIT and CRAFT reveal that pt does not currently use drugs or alcohol. Pt reports that he currently sees a therapist once per week for talk therapy. Pt reports that he is not on any psychotropic medications at this time, and his mood has not improved despite the talk therapy. Pt reports that he also has anxiety whenever he leaves his home. Encouraged pt to journal his thoughts/ feelings. Discussed role of medication in treatment of depression and anxiety... (AR 660)
1. Agoraphobia with panic disorder (300.21)
2. Depressive disorder, not elsewhere classified (311) (AR 661)
On 10/09/12 Mr. Walden told LCSW Hannaway that here had been no change in his mood or affect since the last visit, and stated his interest in medication to help with his anxiety and depression. Dr. Hollie prescribed Celexa. (AR 673)
On 11/27/12 and at the time when his conditions were improving, Mr. Walden sought and obtained a release to return to work from his medical doctor at MWCHC, Dr. Hollie. (AR 678- 679) Mr. Walden reported to Dr. Hollie that he "has not needed the Celexa" and denied any symptoms of depression at that time. (Id.)
IV. The opinions of the non-examining DDS consultants.
1. DDS non-examining consultants William Downey, M.D. (on 08/23/11) and Carolyn Parrish, M.D. (on 11/18/11) opined that Mr. Walden could perform a full range of "medium" work (lift/carry 50 lbs occasionally, 25 lbs frequently, stand/walk 8 hours, etc.).
See AR 480-487 and 522.
2. On 11/18/11 DDS non-examining psychological consultant Amin Azimi, Ed.D. found Mr. Walden to be credible and that his depression and anxiety "could reasonably produce the stated symptoms and functional limitations," but then inexplicably opined that these "symptoms and impairments would not singly or in combination prevent the CL. from completing work-like activities."
The only Dr. Azimi medical records reviewed and by Dr. Azimi were the 10/31/11 evaluation/assessment and 11/11/11 letter of Dr. Edwards. (AR 535) He also reviewed two (2) disability reports completed by Mr. Walden on 08/02/11 and 10/06/11, respectively. (Id.)
Dr. Azimi found that Mr. Walden's "allegations are credible as the Dx: of MDD, severe, chronic, recurrent and Generalized anxiety D/O could reasonably produce the stated symptoms and functional limitations." (Id.) Dr. Azimi noted that Mr. Walden had been "referred for mental treatment in late August"; "his attorney furnished DDS the initial assessment" of Dr. Edwards (dated 10/31/11); "There was no allegation of mental impairments at the initial claim level"; and Mr. Walden "has no previous MH treatment and currently is not on psych medications." (Id.) Dr. Azimi asserted that "There is a significant discrepancy between the CL.'s ADLs from the initial assessment to recon." (Id.) And without any other comment or rationale, Dr. Azimi opined that Mr. Walden's "symptoms and impairments would not singly or in combination prevent the CL. from completing work-like activities; however, CPP, social and adapt to change are somewhat impacted by the diagnoses and would cause moderate limitations in basic work-like duties." (Id.)
Dr. Azimi's functional capacity assessment reads as follows:
A. The CL. can perform simple and detailed tasks over a full workweek.V. The 07/20/12 consultative psychological evaluation of Alice Garland, MS, LSPE.
B. The CL. can maintain CPP for low-level detailed tasks over a normal workday.
C. The CL. can interact infrequently or 1-1 with general public and meets basic social demands in a work setting.
D. The CL. can adapt to gradual or infrequent changes in the work place. (AR 539)
1. Ms. Garland was not provided with any records to review in evaluating Mr. Walden!
At the request of the ALJ and by referral of DDS, Alice Garland, MS, LPSE performed a consultative psychological evaluation of Mr. Walden on 07/20/12. (AR 621-628) As she notes in her report, she was not provided with any records to review. (AR 624) Her evaluation was limited to interviewing Mr. Walden and performing a mental status exam. (Id.)
2. Ms. Garland only obtained skeletal information from Mr. Walden regarding his present illnesses, family/personal history, symptoms and ADLs, but this skeletal information is completely consistent with his claim of being disabled from 02/26/11 to 11/27/12.
In the four paragraph "Present Illnesses" section of her report, Ms. Garland records Mr. Walden's complaints of anxiety, feeling weak and lightheaded, hematuria, anger, forgetfulness, lack of any clear diagnosis about his kidney problem, hypersomnolence ("he goes to sleep anywhere anytime even in the middle of a conversation" and has "had problems sleeping even as a child"), and his fear of taking "a prescription for depression and anxiety because of his kidney problems." (AR 625)
In the three paragraph "Personal and Family History" section of her report, Ms. Garland records Mr. Walden's report about losing his job at UPS and notes that he "seemed very naïve about problematic work history." (Id.) She also recorded skeletal information about his educational history and current girlfriend and children. (AR 625-626)
In the short, one paragraph "Current Symptoms" section of her report, Ms. Garland records that Mr. Walden "does not enjoy things like he used to but he was not sure why"; he was 150 pounds but is now down to 133 pounds at a height of 5'7"; he wakes up at night with sweats; he feels "worthless and hopeless at times because he is not been able to work and provide for his family"; and "he does not feel suicidal but sometimes wonders what would life be like if he were not around." (AR 626)
The one paragraph "Activities of Daily Living" section of the report notes that Mr. Walden goes to bed around 9 to 10 p.m., gets up at 7 a.m., and "is up and down throughout the night"; "most of the time he does not do much housework, cooking, or laundry" and he "tends to lie around"; he "does not do any shopping on a daily basis" but "may go with his girlfriend occasionally"; he "has not been to church in a while"; and he "visited his father occasionally but does not talk to him on a regular basis." Mr. Walden's girlfriend is a student and "he's young daughter goes to daycare." (Id.) "Recently he has been on the internet trying to find jobs." (Id.)
3. Ms. Garland's mental status exam was limited to making general observations ("his mood seemed irritable") and a few very simple tests ("Name the colors of the American flag").
In the one paragraph "Mental Status" section of her report, Ms. Garland notes that Mr. Walden's dress was neat, his grooming and hygiene good, his motor activity average and eye contact good, and his posture and gait were unremarkable. (AR 626) Other findings were that he was oriented; his speech was "halting, choppy, and spontaneous"; his thought process was organized and there was no indication of a thought disorder; his insight seemed fair to poor; his judgment seemed fair; his affect was appropriate; and his mood seemed irritable. (Id.)
Ms. Garland's "testing" was limited to a few very simple tests. Mr. Walden was asked to spell "world" backward; name some recent presidents; recite a recent news event; name the shape of a basketball, name the colors of the American flag; and count backwards from 100 by 7s. (Id.) He was able to "pass" these very simple tests. He was also given two memory tests, and "he recalled one group of five numbers forward and one group of four backward" but only "recalled one of three objects mentioned previously." (Id.)
4. Ms. Garland diagnosed an affective disorder ("Dysthymia, Rule out Mood Disorder due to medical condition") but she did not diagnose an anxiety disorder.
Ms. Garland's diagnostic impression read as follows:
Axis I: Dysthymia.
Rule out Mood Disorder due to medical condition.
Axis II. Rule out Personality Disorder, NOS.
Axis III: Medical problems have been given in the body of the report.
5. In completing a SSA assessment form, Ms. Garland opined that Mr. Walden was "still able to function satisfactorily" or better in all but one of the areas of functioning listed in the form.
Ms. Garland completed a SSA assessment form in which she opined that Mr. Walden was "still able to function satisfactorily" or better in all of the areas of functioning listed in the form except for the ability to make judgments on complex work-related decisions, in which he noted a "substantial loss in the ability to effectively function." (AR 621-623) More specifically, Ms. Garland noted Mr. Walden's restriction in the various areas of functioning to be "moderate," "mild" or "none" and all but one area of functioning, with the form defining "moderate" to mean that there was "more than a slight limitation... but the individual is still able to function satisfactorily." (Id.)
Ms. Garland's report and assessment were cosigned by Michael C. Hawthorne, Ph.D. (AR 623, 627)
VI. The testimony of the vocational expert Chelsea Brown at the 01/29/13 hearing.
In her unfavorable decision, the ALJ references only the testimony of the vocational expert at the 01/29/13 hearing, Chelsea Brown. (AR 24-25) Accordingly, Mr. Walden will only review Ms. Brown's testimony.
The ALJ instructed VE Brown to consider a hypothetical person of Mr. Walden's age, education and work history with the residual functional capacity for a full range of light work, but with certain additional limitations as follows:
1. Only occasional climbing of ladders, ropes or scaffolds;The ALJ defined infrequently as 5% or less of the workday; occasionally as up to and including a third of the work day; and frequently as up to and including two-thirds of the work day and continuously is anything beyond two-thirds of the work day. (AR 112-113)
2. Only occasional exposure to hazardous machinery and unprotected heights;
3. Can understand and remember simple, as well as more detailed instructions and tasks;
4. Is unable to make executive level decisions;
5. Can maintain attention, concentration, persistence and pace in two-hour segments of time with customary breaks between segments;
6. Can tolerate occasional interaction with the public and with coworkers;
7. Is capable of frequently behaving in an appropriate manner and responding appropriately to criticism from supervisors; and
8. Can tolerate occasional change in the work environment. (AR 113)
The VE testified that such a person could not perform Mr. Walden's past relevant work, but could perform the following other occupations:
1. Housekeeper, DOT code 323.687-014, light & unskilled, 2900 in TN and 300,000 in the U.S.;
2. Electronic assembler, DOT code 720.687-010, light & unskilled, 2000 in TN and 250,000 in the U.S.; and
3. Collator operator, DOT code 208.685-010, light & unskilled, 1600 in TN and 200,000 in the U.S. (AR 114)
In her second hypothetical question, the ALJ instructed the VE to assume an individual with the residual functional capacity for a full range of light work, but with certain additional limitations as follows:
1. Only occasional climbing of ladders, ropes or scaffolds;The VE testified that such an individual could not perform any jobs. (AR 115)
2. Only occasional exposure to hazardous machinery and unprotected heights;
3. Is limited to understanding, remembering, and carrying out simple instructions;
4. Would occasionally have difficulty maintaining regular attendance and be punctual within customary, usual tolerances;
5. Would occasionally have difficulty working in coordination with or in proximity to others without being unduly distracted;
6. Would frequently have difficulty completing a normal workweek without interruptions from psychologically based symptoms; and
7. Would occasionally have difficulty maintaining persistence and pace. (AR 114-115)
On cross-examination, the VE was asked the following questions and gave the following responses:
Q: Ms. Brown, if the hypothetical person in the first hypothetical would miss two or more days of work a month due to psychologically based symptoms, that would preclude the identified jobs, would it not?VII. The ALJ denied Mr. Walden's claim at Step 5 of the sequential evaluation process, and in doing so rejected the opinion of Dr. Edwards in favor of those of the DDS non-examining psychological consultant, Dr. Azimi, and the consulting psychologist, Ms. Garland.
VE: It would, yes.
Q: If we take the person described in the first hypothetical and we add to it that the person is subject to being off-task at the work place, randomly, due to falling asleep and let's say that happens at least a few times a week, outside normal breaks. That sort of disruption to the work productivity is gonna also preclude successful performance of the identified jobs, would it not?
VE: Yes, it would.
Q: If we add to the hypothetical, the first hypothetical, that the person would, up to 2 hours or so out of a day, not be capable of behaving in an appropriate manner and responding appropriately to criticism from supervisors, that would preclude those jobs, would it not?
VE: That is correct.
Q: And certainly if to the first hypothetical we just added the limitation that the person's going to at least occasionally have difficulty completing a normal workday and work-week without interruption from psychologically based symptoms, that's also gonna preclude those jobs, would it not?
VE: Yes. (AR 115-116)
1. The ALJ's sequential evaluation findings.
Pursuant to SSA's five step sequential evaluation process (see 20 CFR § 404.1520), the ALJ made the following findings:
Step 1: Mr. Walden did not engage in substantial activity during the period 02/26/11 to 11/27/12.
Step 2. Mr. Walden has the severe impairments of stage I chronic kidney disease, hematuria, hypersomnia, major depressive disorder and generalized anxiety disorder.
Step 3. Mr. Walden does not have an impairment or combination of impairments that meets or medically equals the severity of one of the listed impairments.
Step 4: Mr. Walden cannot perform his past relevant work.
Step 5: Mr. Walden can perform other jobs existing in significant numbers, to wit the three jobs identified by the VE of housekeeper, electronic assembler and collator operator. (AR 17-25)
2. The ALJ's RFC finding matched that contained in her first hypothetical questions to the VE.
The ALJ found Mr. Walden to have the RFC "to perform light work as defined in 20 CFR 4041567(b) except can occasionally climb ladders, ropes, or scaffolds; claimant can tolerate occasional exposure to hazardous machinery and unprotected heights; claimant can understand and remember simple and detailed instructions and tasks; claimant is unable to make executive level decisions; claimant can maintain attention, concentration, persistence, and pace in two hour segments of time with customary breaks between segments; claimant can tolerate occasional interaction with the public and co-workers; claimant can frequently behave in an appropriate manner and responding appropriately to criticism from supervisors; claimant can tolerate occasional change in the work environment." (AR 20)
This is the same RFC as set forth in the ALJ's first hypothetical question to the VE. (AR 112-113)
3. The ALJ rejected the opinion of Dr. Edwards, and instead gave "great weight" to the opinions of Dr. Azimi and Ms. Garland.
See AR 22: "... the undersigned gives Dr. Edwards opinions little weight"; "The undersigned finds this opinion (of Dr. Hawthorne and Ms. Garland) is consistent with the record, specifically with Dr. Edwards treatment notes and gives a great weight"; and "The undersigned finds this opinion (of Dr. Azimi) is consistent with the record and gives it great weight."
ISSUE PRESENTED
Whether the ALJ's finding that Mr. Walden was not disabled during the period 02/26/11-11/27/12 is supported by substantial evidence and comports with applicable law, regulations and rulings.
ARGUMENT
I. The ALJ violated the "treating physician rule" in the weight ("little") she gave to the opinion of treating psychologist Terry Edwards, Ed.D.
1. Treating source opinions must be given controlling weight if is well-supported by medically acceptable clinical and laboratory diagnostic techniques and not inconsistent with the other substantial evidence in the case record.
In Gayheart v. Comm'r of Soc. Sec., 710 F.3d 365 (6th Cir. 2013), the 6 Circuit discussed the "treating physician rule" in great detail in remanding the claimant's (i.e. Mr. Gayheart's) case to SSA because the ALJ violated this rule. The Court noted that "Treating-source opinions must be given "controlling weight" if two conditions are met: (1) the opinion "is well-supported by medically acceptable clinical and laboratory diagnostic techniques"; and (2) the opinion "is not inconsistent with the other substantial evidence in [the] case record." 20 C.F.R. § 404.1527(c)(2)." In regards to whether a treating source's opinion should be given "controlling weight," the Court further observed at pp. 376-377 as follows (bold emphasis has been supplied):
1. The frequency and nature of a claimant's treatment relationship with the treating source, "as well as alleged internal inconsistencies between the doctor's opinions and portions of her reports" are factors which are "properly applied only after the ALJ has determined that a treating-source opinion will not be given controlling weight. See 20 C.F.R. § 404.1527(c)(2) (listing seven specific factors to be applied when a treating-source opinion is not given controlling weight, including the general consistency of the opinion with the record as a whole)."
2. "The failure to provide "good reasons" for not giving Dr. Onady's opinions controlling weight hinders a meaningful review of whether the ALJ properly applied the treating-physician rule that is at the heart of this regulation. See Wilson, 378 F.3d at 544. For example, the conclusion that Dr. Onady's opinions "are not well-supported by any objective findings" is ambiguous. One cannot determine whether the purported problem is that the opinions rely on findings that are not objective (i.e., that are not the result of medically acceptable clinical and laboratory diagnostic techniques, see 20 C.F.R. § 404.1527(c)(2)), or that the findings are sufficiently objective but do not support the content of the opinions.
Similarly, the ALJ does not identify the substantial evidence that is purportedly inconsistent with Dr. Onady's opinions. Surely the conflicting substantial evidence must consist of more than the medical opinions of the nontreating and nonexamining doctors. Otherwise the treating-physician rule would have no practical force because the treating source's opinion would have controlling weight only when the other sources agreed with that opinion. Such a rule would turn on its head the regulation's presumption of giving greater weight to treating sources because the weight of such sources would hinge on their consistency with nontreating, nonexamining sources.
2. Dr. Edwards' opinion should have been given controlling weight.
Pursuant to Gayheart, Dr. Edwards' opinion should have been given controlling weight. As the 6th Circuit notes in Gayheart, the opinion of the non-examining DDS psychologist, Dr. Azimi, cannot and does not comprise substantial evidence that conflicts with Dr. Edwards' opinion in determining whether said opinion is entitled to controlling weight. Likewise, supposed inconsistencies between Dr. Edwards' opinion and her treatment records are not considered. Instead, only two issues are considered: (1) whether Dr. Edwards' opinion is well-supported by medically acceptable clinical and laboratory diagnostic techniques, and (2) whether her opinion is not inconsistent with the other substantial evidence in the case record.
Dr. Edwards' opinion satisfies the two-pronged test for controlling weight, i.e. it is well supported by medically acceptable techniques and it is not inconsistent with the other substantial evidence. As discussed above, Dr. Edwards provided extensive, comprehensive information about Mr. Walden's mental impairments. The ALJ in fact found that Mr. Walden's impairments "could reasonably be expected to cause the alleged symptoms." (AR 21) Secondly, there is no substantial evidence that conflicts with Dr. Edwards' opinion. All of the other treatment records describe an individual who grew progressively more exasperated by his medical conditions and the lack of diagnostic clarity and treatment options. And the report of Ms. Garland certainly does not comprise "substantial" evidence vís-a-vís the voluminous treatment records and supplemental evaluations and statements of Dr. Edwards. Please note that Ms. Garland did not even diagnose an anxiety disorder, much less attribute any limitations to same - while the ALJ found Mr. Walden's anxiety disorder to be severe.
3. If a treating source's opinion is not given controlling weight, "good" reasons must be given for the weight that the opinion is given.
In the decision of Cole v. Astrue, 652 F.3d 653 (6th Cir. 2011) the Court noted that:
The Commissioner has elected to impose certain standards on the treatment of medical source evidence. 20 C.F.R. § 404.1502. Under one such standard, commonly called the treating physician rule, the Commissioner has mandated that the ALJ "will" give a treating source's opinion controlling weight if it "is well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in your case record." 20 C.F.R. § 404.1527(d)(2). If the ALJ declines to give a treating source's opinion controlling weight, he must then balance the following factors to determine what weight to give it: "the length of the treatment relationship and the frequency of examination, the nature and extent of the treatment relationship, supportability of the opinion, consistency of the opinion with the record as aAccord, Wilson v. Commissioner of Social Security, 378 F.3d 541 (6th Cir. 2004), Bowen v. Commissioner of Social Security, 478 F.3d 742 (6th Cir. 2007), Rogers v. Commissioner of Social Security, 486 F.3d 234 (6th Cir. 2004), Hensley v. Astrue, Commissioner of SSA, 573 F.3d 263 (6th Cir. July 21, 2009), Blakley v. Commissioner of SSA, 581 F.3d 399 (6th Cir. 2009). Brooks v. Astrue, No. 09-5924 (6th Cir. 07/15/11, not recommended for full-text publication).
whole, and specialization of the treating source." Wilson v. Comm'r of Soc. Sec., 378 F.3d 541, 544 (6th Cir. 2004) (citing 20 C.F.R. § 404.1527(d)(2)).
Importantly, the Commissioner imposes on its decision makers a clear duty to "always give good reasons in our notice of determination or decision for the weight we give [a] treating source's opinion." 20 C.F.R. § 404.1527(d)(2). Those good reasons must be "supported by the evidence in the case record, and must be sufficiently specific to make clear to any subsequent reviewers the weight the adjudicator gave to the treating source's medical opinion and the reasons for that weight." Soc. Sec. Rul. No. 96-2p, 1996 SSR LEXIS 9, at *12 (Soc. Sec. Admin. July 2, 1996). This requirement is not simply a formality; it is to safeguard the claimant's procedural rights. It is intended "to let claimants understand the disposition of their cases, particularly in situations where a claimant knows that his physician has deemed him disabled and therefore might be especially bewildered when told by an administrative bureaucracy that []he is not." Wilson, 378 F.3d at 544. Significantly, the requirement safeguards a reviewing court's time, as it "permits meaningful" and efficient "review of the ALJ's application of the [treating physician] rule." Id. at 544-45.
4. Even if Dr. Edwards' opinion was not entitled to controlling weight, the ALJ failed to give a single "good reason" for the weight ("little") she gave it.
A. ALJ Reason # 1 for giving no weight to Dr. Edwards' opinion was that Mr. Walden had "no psychiatric treatment for six months of the nineteen month period of alleged disability." This reason is spurious and contrary to SSR 96-7p: Dr. Edwards and Mr. Walden fully explained the gap in treatment.
The ALJ asserts that Mr. Walden had "no psychiatric treatment for six months of the nineteen month period of alleged disability." (AR 22). However and in violation of SSR 96-7p, the ALJ did not consider Mr. Walden's reasons for not receiving care during this time.
SSR 96-7p provides in relevant part as follows (bold emphasis has been supplied):
However, the adjudicator must not draw any inferences about an individual's symptoms and their functional effects from a failure to seek or pursue regular medical treatment without first considering any explanations that the individual may provide, or other information in the case record, that may explain infrequent or irregular medical visits or failure to seek medical treatment. The adjudicator may need to recontact the individual or question the individual at the administrative proceeding in order to determine whether there are good reasons the individual does not seek medical treatment or does not pursue treatment in a consistent manner.
As noted by Dr. Edwards, Mr. Walden's mental conditions impaired his ability to consistently come to appointments - he was simply too depressed to make it to her office, and he also forgot scheduled appointments; transportation was also an issue; (AR 691 - 692): Furthermore, the ALJ specifically asked Mr. Walden at the 06/25/12 hearing about the gap in treatment by Dr. Edwards and he gave her a perfectly acceptable explanation (AR 292; bold emphasis has been supplied):
ALJ: All right. Was there a period in between where you didn't go (to see Dr. Edwards) once a week?
Claimant: She switched offices and I couldn't get in touch with her. I tried to schedule an appointment and, for some reason, it was a scheduling conflict, and I've missed appointments also.
The ALJ's first reason for giving little if any weight to Dr. Edwards' opinion is not a "good" reason.
B. ALJ Reason # 2 for giving no weight to Dr. Edwards' opinion was that her 11/01/11 opinion was "contradictory" of Mr. Walden's statements in the "Function Report" he completed for SSA on 08/02/11. This reason is also spurious, and in fact the ALJ misrepresents Mr. Walden's statements in the Function Report.
In her decision, the ALJ asserts that:
On November 11, 2011, Dr. Edwards opined the claimant would miss one to two days per week; he lacked the ability to handle changes in work settings; he would be impatient and easily frustrated with others; and he would have a moderate problem with concentration and focus (AR 514 - 515). This is contradictory of theThe ALJ has simply misrepresented what Mr. Walden wrote in completing the Function Report (AR 228 - 235). Mr. Walden's statements on this form include the following:
claimant's own statements from three months prior, wherein he was able to do a myriad of household chores without encouragement, to care for his personal needs, and to get along with others including authority figures (AR 228 - 235).
5. How do you illnesses, injuries or conditions limit your ability to work?
"Makes things difficult do to the fact that I have urinate blood & have to stay hydrated. I often feel fatigued."
"I often find myself sleeping more."
"I can do just about anything. I just don't have the stamina."
(Cleaning, laundry, cooking take) "longer than normal. Do a little every day so that it doesn't get out of control."
(I go outside) "not often."
(I) "love playing sports but haven't been playing because of fatigue."
(Places I go on a regular basis) "not much of anywhere."
"Not social at all."
(Lifting, walking, etc.) "I can do most of the things listed, it just feels like my thought process is not the same and I can't do things for long periods of time."
h. How well do you get along with authority figures?
"I respect who respects me."
l. Have you noticed any unusual behavior or fears?
As one can see, the ALJ has not accurately characterized Mr. Walden's functioning as he described it in the Function Report. His description is very consistent with Dr. Edwards' assessment: he is not an invalid and does take care of some of the household chores, but his fatigue and lack of stamina have severely impaired his activities of daily living."I have mood swings. Thats unusual to me." (Id.)
The ALJ's Reason # 2 for giving no weight to Dr. Edwards' opinion is spurious and rests on a misrepresentation of Mr. Walden's Function Report.
C. ALJ Reason # 3 for giving no weight to Dr. Edwards' opinion is just silly: the ALJ treats a figure of speech in Dr. Edwards' 11/11/11 narrative statement as a statement of fact, and then cites this as evidence that Dr. Edwards' assessment is unreliable.
The ALJ's Reason # 3 for giving no weight to Dr. Edwards' opinion reads as follows (ALJ decision, p. 7):
In her narrative she noted the claimant could not complete three sentences in a conversation (Ex. 20F). The undersigned notes the claimant actively participated in two significant hearings, where he was able to communicate clearly with the undersigned as well as his representative.
The ALJ has taken literally what Dr. Edwards only meant figuratively. In her 06/20/12 MSS, Dr. Edwards wrote in relevant part as follows:
Mr. Walden is very neat and very clean. He has an excellent short term presentation. He is focused, friendly, and calm for about 15 minutes. After that time, he has moderate to severe problems w/focus and functional memory. He becomes frustrated and irritated. He cannot complete 3 sentences in a conversation. He becomes angry and upset. He then begins to escalate into a period of extreme frustration after which he "crashes" into a depression. (AR 618-619)If one reads the 06/20/12 MSS in its entirety, one can readily see that Dr. Edwards does not literally mean that Mr. Walden can never "complete 3 sentences in a conversation." She is instead using a figure of speech to describe Mr. Walden's difficulty conversing when his frustration, anger, irritability and depression "crash" down on him. To take the statement "He cannot complete 3 sentences in a conversation" literally and then use it in an attempt to discredit Dr. Edwards' assessment is just silly.
D. ALJ Reason # 4 for giving no weight to Dr. Edwards' opinion is, like the other reasons, both contrary to the evidence and nonsensical.
The ALJ's 4 and final reason for giving no weight to Dr. Edwards' opinion reads as follows:
On February 25, 2013, Dr. Edwards participated in a deposition approximately four months after her last session with the claimant and three months after the claimant had begun working again. She noted the claimant had periods of improvement, but he would get worse again (AR 683). In fact, Dr. Edward's final treatment notes show the claimant's anxiety and depression were better with the only noted complaints regarding money (AR 700).
The undersigned finds these opinions are not consistent with the longitudinal record, specifically with Dr. Edwards's treatment notes and observations from other medical professionals. Therefore, the undersigned gives Dr. Edwards's opinions little weight. (AR 22-23, emphasis supplied)
The ALJ again misrepresents what is in the record: Dr. Edwards' "final treatment notes" DO NOT "show the claimant's anxiety and depression were better with the only noted complaints regarding money." Dr. Edwards' last 4 treatment notes contain the following description of Mr. Walden's mental conditions and symptoms (emphasis has been supplied):
07/11/12 Narrative: ... Withdrawn. Irritable and cross. Doing ok at home this week with less compulsion this week. Worried and feels unsure of what to do. We discussed dds process again. He is really worried that he cannot work due to depression and poor focus. He does seem to veer off task very soon with me. I have to redirect him. He quickly loses ability to have a discussion of anything for more than a few sentences. He becomes upset and then irritable. He has a poor ability to focus on his emotional issues. It is easy to see he is cross at home and I think this adds to his depression and anxiety. He described poor sleep habits but is still always tired. (AR 640 - 641)As one can see, it was only in the very last session on 10/22/12 that Mr. Walden's depression and anxiety seem to be abating - and shortly after that he returned to work through a temporary agency. (Id.)
08/20/12 Narrative: ... New compulsive behaviors noted. Now is thinking about eating non food items again. Describes feeling hopeless and sad. Discouraged and upset. ... I believe he would have marked impairment in overall functioning at work at this time due to his inability to have a
conversation in session. He veers a lot and has poor focus and impaired short term memory which seems to be related to his depression. He would struggle with co workers. I think he will find a job because of his initial presenation (sic) but he will struggle to hold on to it. (AR 641 - 642)
09/24/12 Narrative: ... Reported depression and some anxiety but not as bad. Irritability discussed. He became unable to focus half way through session and trailed off. Somewhat tangential. Eye contact trailed off toward end of session. Still reports that he is feeling better but is more isolated. Worries about money. (AR 700)
10/22/12 Narrative: Neat clean oriented. Not suicidal or homicidal. Feeling still a bit better discussed a family issue and a financial issue. Discussed stress at home with him not working. He feels his depression and anxiety are better but he is stressed about money and work. (AR 703 - 703)
Dr. Edwards' opinions, as expressed in great detail in several medical source statements, letters and even in a deposition, are very consistent with her treatment records. The ALJ's assertion to the contrary is without any basis in fact.
5. The opinion of Dr. Azimi is entitled to no weight, and certainly does not constitute substantial evidence in support of the ALJ's decision.
As discussed above, Dr. Azimi did not examine Mr. Walden, and the only medical records which he reviewed with those of Dr. Edwards which fully support Mr. Walden's disability claim. Dr. Azimi opined that Mr. Walden's allegations were credible, and is impairments "could reasonably produce the stated symptoms and functional limitations" (which included such limitations as missing at least 1 to 2 days of work per week). (AR 535, 515) His analysis of the evidence which he did review is thus at complete odds with his own RFC assessment.
Dr. Azimi's internally and externally inconsistent RFC opinion is entitled to no weight.
6. The opinion of Ms. Garland is entitled to no weight, and certainly does not constitute substantial evidence in support of the ALJ's decision.
The opinion of Ms. Garland is not substantial evidence if for no reason other than the fact that she did not even diagnose, much less attribute any functional limitations to, one of Mr. Walden's severe impairments, his anxiety disorder. Other glaring deficiencies regarding Ms. Garland's report include the fact that she did not consider any of Mr. Walden's voluminous treatment records; she obtained only the most skeletal information from him; and her mental status exam had very little substance to it (her testing was limited to inquiring about the color the flag and shape of a basketball and the like; notably did not discuss Mr. Walden's poor performance on the memory test where he only remembered one of three objects). (AR 621-628) Furthermore, if the ALJ had actually given "great weight" to Ms. Garland's RFC assessment, the only area in which Mr. Walden would have been found unable to perform at a satisfactory or better level would have been making judgments on complex work-related decisions. (AR 621-623)
Ms. Garland's evaluation does not support the ALJ's decision but in fact contradicts it. This evaluation was not based upon a review of the record or any meaningful testing of Mr. Walden, and should be given no weight.
II. The ALJ's evaluation of Mr. Walden's claim was neither supported by substantial evidence nor in accordance with applicable rules and regulations.
In Cynthia Winn v. Comm. of SSA, Case No. 14-3499 (6th Cir. 06/15/15) the 6th Circuit found that the ALJ violated the treating physician rule and accordingly remanded the case to SSA. The court found that in denying Ms. Winn's claim, the ALJ had relied up on "half-sentences and phrases" to "paint a misleading picture of Winn's mental health." Winn pp. 10-11. The court further wrote that:
The ALJ's skewed depiction improperly disregards significant portions of the specific medical notes from which these phrases were excerpted. Viewed in their entirety, these notes clearly indicate that Winn continued to suffer from mental ailments. Winn p. 11
Citing prior 6th Circuit precedent, the Court emphasized that "Substantiality of the evidence must be based upon the record taken as a whole" and "Failure to consider the record as a whole undermines the Secretary's conclusion." (Id.) The court then went on to detail the other information contained in the treatment notes from which the ALJ had cherry picked the "half-sentences and phrases" used to justify denying Ms. Winn's claim. (Id.)
The Court's decision also stands for the following additional propositions:
1. ALJs should not "focus exclusively" on instances in which a disability claimant appeared to be doing relatively well;
2. An ALJ is not free to set his own expertise against that of a physician who presents competent evidence;
3. Participation in social activities such as church attendance does not constitute substantial evidence that a claimant can participate in work activities;
4. Activities such as driving, cleaning and apartment, caring for pets, reading, exercising, and watching the news "are not comparable to typical work activities"; and
5. What matters for the purposes of a disability claimant's functional limitation determination is that claimant's overall state, not the mere fact that treatment might be proving to be helpful.
The ALJ's flawed evaluation of Ms. Winn's claim is very similar to the approach taken by the ALJ in denying Mr. Walden's claim. The ALJ's focus in reviewing Mr. Walden's treatment records was exclusively on those parts of the records which could arguably support a denial. For example, the ALJ's cites to the Function Report completed by Mr. Walden on 08/02/11 as painting a very rosy picture of his ADLs, when reading that report in the context of the entire record, especially all the additional information about his deteriorating mental condition and progressively more limited ADLs, establishes ADLs completely consistent with being unable to work a full time job. (AR 18, 255-262, see discussion above). Another example is the ALJ's citation to Mr. Walden's looking for jobs on the internet at the time he saw Ms. Garland in July 2012 as somehow proving he could have worked at that time, while ignoring Dr. Edwards' detailed description in her videotaped statement of how profoundly, indeed bizarrely, his mental impairments were affecting him - to the point that he was compulsively eating baby powder, and at times not even realizing he was doing it. (AR 20, 687) Likewise, the ALJ does not discuss Mr. Walden's destruction of a TV after going to an appointment for SSA (presumably the July 2012 appointment with Ms. Garland). (AR 689) The end result was that the ALJ painted a very misleading picture of Mr. Walden's treatment history and the vast support contained in the records for his description of his symptom experience. Furthermore, the ALJ clearly "set her own expertise" against that of Dr. Edwards.
Taking Mr. Walden's "overall state" and his actual daily activities (as established by the entire record and not just a cherry-picked Function Report from early in the disability process) into consideration, he is clearly not capable of full-time work. He fully deserves to be found disabled, the substantial evidence in the record fully supports such a finding, and the ALJ has failed to cite any substantial evidence to the contrary.
III. The ALJ denied Mr. Walden the opportunity to cross-examine the consulting psychologist upon whose report the ALJ relied in denying the claim.
The ALJ's denial of Mr. Walden's request to cross-examine consulting psychologist Alice Garland, SPE regarding her report (AR 621-623) is reversible error. (See AR 284, 285-286).
IV. The self-contradictory testimony of the VE does not comprise substantial evidence that Mr. Walden can perform other jobs existing in significant numbers.
The VE gave directly contradictory testimony which cannot constitute substantial evidence. More specifically, the ALJ asked the VE what jobs could be performed by someone who could "behave and respond appropriately" 2/3rds of the day, which implies that the other 1/3rd of the day the person would not necessarily be able to do so. (AR 112-116, see discussion above) The VE testified that such a person could perform work and gave 3 DOT job titles as examples. Counsel for Mr. Walden asked the VE to assume that the very same hypothetical individual could not "behave and respond appropriately" for " 2 hours or so out of a day" (i.e. for about 1/3rd of the day), and the VE contradicted her earlier testimony and stated that such a person could not work. (Id.) In other words, counsel posed the same hypothetical question that the ALJ did, simply approaching the limitation regarding "behave and respond appropriately" from a different angle, and got a different and indeed directly contradictory answer.
The self-contradictory testimony of the VE does not comprise substantial evidence that Mr. Walden could perform other jobs existing in significant numbers.
V. Conclusion
The Plaintiff's Motion for Judgment on the Administrative Record should be granted, Mr. Walden found to be disabled for the "closed period" of 02/26/11 to 11/27/12, and his claim be approved. In the alternative, his claim should be remanded for a new hearing and new decision.
Respectfully submitted,
/s/ Michael P. Williamson
Michael P. Williamson, #9700
Attorney for Plaintiff
201 4 Ave. N., Ste. 1490
Nashville, TN 37219
(615) 726-0808
CERTIFICATE OF SERVICE
I hereby certify that a true and correct copy of this Motion has been forwarded to Mercedes Maynor-Faulcon, Assistant U.S. Attorney, 110 9th Avenue South, Ste. A-961, Nashville, TN 37203, via U.S.D.C. electronic notification system, this 23 day of July, 2015.
/s/ Michael P. Williamson
Michael P. Williamson
TRANSCRIPTION OF THE TREATMENT NOTES OF TERRY L. EDWARDS, Ed.D. Prepared by Michael P. Williamson, attorney 09/20/2011
Treatment Note Terry L. Edwards, EdD (AR 629)
Diagnostic Interview/Intake
Axis I Diagnoses:
Dep. NOS
311 Dep NOS
300.00 Anx. NOS . . .
296.21 Major Dep D/O
Other: Marital Issues
Mental Status | |
---|---|
Appearance | Appropriate |
Speech | Normal |
Mood | Anxious |
Affect | Labile |
Thought Form | Coherent |
Thought Content | Normal |
Orientation | Full |
Memory | Intact |
Insight | Fair |
Judgment | Fair |
Behavior | Agitated |
Treatment Note Terry L. Edwards, EdD (AR 630)
Diagnostic Interview/Intake
Axis I Diagnoses:
311 Dep NOS
300.00 Anx. NOS . . .
296.21 Major Dep D/O
Other: Marital Issues
Mental Status | |
---|---|
Appearance | Appropriate |
Speech | Normal |
Mood | Anxious |
Affect | Labile |
Thought Form | Coherent |
Thought Content | Normal |
Orientation | Full |
Memory | Intact |
Insight | Fair |
Judgment | Fair |
Behavior | Agitated |
Treatment Note Terry L. Edwards, EdD (AR 631)
Diagnostic Interview/Intake
Axis I Diagnoses:
311 Dep. NOS
300.00 Anx. NOS . . .
296.21 Major Dep D/O
Other: Marital Issues
Mental Status | |
---|---|
Appearance | Appropriate |
Speech | Normal |
Mood | Anxious |
Affect | Labile |
Thought Form | Coherent |
Thought Content | Normal |
Orientation | Full |
Memory | Intact |
Insight | Fair |
Judgment | Fair |
Behavior | Agitated |
Treatment Note Terry L. Edwards, EdD (AR 632)
Diagnostic Interview/Intake
Axis I Diagnoses:
311 Dep. NOS
300.00 Anx. NOS . . .
296.21 Major Dep D/O
Other: Marital Issues
Mental Status | |
---|---|
Appearance | Appropriate |
Speech | Normal |
Mood | Anxious |
Affect | Labile |
Thought Form | Coherent |
Thought Content | Normal |
Orientation | Full |
Memory | Intact |
Insight | Fair |
Judgment | Fair |
Behavior | Agitated |
Treatment Note Terry L. Edwards, EdD (AR 633)
Individual 45-50 minutes Axis I Diagnoses:
311 Dep. NOS
300.00 Anx. NOS . . .
296.21 Major Dep D/O
Other: Marital Issues
Mental Status | |
---|---|
Appearance | Appropriate |
Speech | Normal |
Mood | Anxious |
Affect | Labile |
Thought Form | Coherent |
Thought Content | Normal |
Orientation | Full |
Memory | Intact |
Insight | Fair |
Judgment | Fair |
Behavior | Agitated Withdrawn |
Treatment Note Terry L. Edwards, EdD (AR 634)
Individual 45-50 minutes Axis I Diagnoses:
311 Dep. NOS
300.00 Anx. NOS . . .
296.21 Major Dep D/O
Other: Marital Issues
Mental Status | |
---|---|
Appearance | Appropriate |
Speech | Normal |
Mood | Anxious |
Affect | Labile |
Thought Form | Coherent |
Thought Content | Normal |
Orientation | Full |
Memory | Intact |
Insight | Fair |
Judgment | Fair |
Behavior | Agitated Withdrawn |
Treatment Note Terry L. Edwards, EdD (AR 635)
Individual 45-50 minutes Axis I Diagnoses:
311 Dep. NOS
300.00 Anx. NOS . . .
296.21 Major Dep D/O
Other: Marital Issues
Mental Status | |
---|---|
Appearance | Appropriate |
Speech | Normal |
Mood | Anxious |
Affect | Labile |
Thought Form | Coherent |
Thought Content | Normal |
Orientation | Full |
Memory | Intact |
Insight | Fair |
Judgment | Fair |
Behavior | Agitated Withdrawn |
Treatment Note Terry L. Edwards, EdD (AR 636)
Individual 45-50 minutes Axis I Diagnoses:
311 Dep. NOS
300.00 Anx. NOS
. . .
296.21 Major Dep D/O
Other: Marital Issues
Mental Status | |
---|---|
Appearance | Appropriate |
Speech | Normal |
Mood | Anxious |
Affect | Labile |
Thought Form | Coherent |
Thought Content | Normal |
Orientation | Full |
Memory | Intact |
Insight | Fair |
Judgment | Fair |
Behavior | Agitated Withdrawn |
Treatment Note Terry L. Edwards, EdD (AR 637)
Individual 45-50 minutes Axis I Diagnoses:
311 Dep. NOS
300.00 Anx. NOS . . .
296.21 Major Dep D/O
Other: Marital Issues
Mental Status | |
---|---|
Appearance | Appropriate |
Speech | Normal |
Mood | Anxious |
Affect | Labile |
Thought Form | Coherent |
Thought Content | Normal |
Orientation | Full |
Memory | Intact |
Insight | Fair |
Judgment | Fair |
Behavior | Agitated Withdrawn |
Treatment Note Terry L. Edwards, EdD (AR 638)
Individual 45-50 Minutes Axis I Diagnoses:
300.00 Anx. NOS . . .
296.21 Major Dep D/O
Other: major depression anxiety disorder possible intermittent explosive disorder
Mental Status | |
---|---|
Appearance | Appropriate |
Speech | Normal |
Mood | Depressed Anxious Angry Tired |
Affect | Mood Congruent |
Thought Form | Coherent |
Thought Content | Normal |
Orientation | Full |
Memory (Immediate) | Poor |
Insight | Fair |
Judgment | Poor |
Behavior | Agitated |
Treatment Note Terry L. Edwards, EdD (AR 638 - 639)
Individual 45-50 Minutes Axis I Diagnoses:
300.00 Anx. NOS . . .
296.21 Major Dep D/O
Other: major depression anxiety disorder possible intermittent explosive disorder
Mental Status | |
---|---|
Appearance | Appropriate, Irritable |
Speech | Normal |
Mood | Depressed Anxious Angry Tired |
Affect | Mood Congruent |
Thought Form | Coherent |
Thought Content | Normal |
Orientation | Full |
Memory (Immediate) | Poor |
Insight | Fair |
Judgment | Poor |
Behavior | Agitated |
Treatment Note Terry L. Edwards, EdD (AR 639 - 640)
Individual 45-50 Minutes Axis I Diagnoses:
300.00 Anx. NOS . . .
296.21 Major Dep D/O
Other: major depression anxiety disorder possible intermittent explosive disorder
Mental Status | |
---|---|
Appearance | Appropriate, Irritable |
Speech | Normal |
Mood | Depressed, Tired |
Affect | Mood Congruent |
Thought Form | Coherent, Circumstantial |
Thought Content | Normal |
Orientation | Full |
Memory (Immediate) | Poor |
Insight | Fair |
Judgment | Poor |
Behavior | Agitated |
Treatment Note Terry L. Edwards, EdD (AR 640 - 641)
Individual 45-50 Minutes Axis I Diagnoses:
300.00 Anx. NOS . . .
296.21 Major Dep D/O
Other: major depression anxiety disorder possible intermittent explosive disorder
Mental Status | |
---|---|
Appearance | Appropriate, Irritable |
Speech | Normal |
Mood | Depressed Anxious Angry Tired |
Affect | Mood Congruent |
Thought Form | Coherent |
Thought Content | Normal |
Orientation | Full Memory (Immediate) Poor |
Insight | Fair |
Judgment | Poor |
Behavior | Agitated |
Treatment Note Terry L. Edwards, EdD (AR 641 - 642)
Individual 45-50 Minutes Axis I Diagnoses:
300.00 Anx. NOS . . .
296.21 Major Dep D/O
Other: major depression anxiety disorder possible intermittent explosive disorder
Mental Status | |
---|---|
Appearance | Appropriate, Irritable |
Speech | Normal |
Mood | Depressed Anxious Angry Tired |
Affect | Mood Congruent |
Thought Form | Coherent |
Thought Content | Normal |
Orientation | Full |
Memory (Immediate) | Poor |
Insight | Fair |
Judgment | Poor |
Behavior | Agitated |
Treatment Note Terry L. Edwards, EdD (AR 700)
Individual 45-50 minutes
Axis I Diagnoses:
. . .
300.00 Anx. NOS . . .
296.21 Major Dep D/O
296.80 BPAD, NOS
Mental Status | |
---|---|
Appearance | Appropriate |
Speech | Expressive |
Mood | |
Affect | |
Thought Form | |
Thought Content | |
Orientation | Full |
Memory | Immediate Recent Remote |
Insight | Good |
Judgment | |
Behavior |
Treatment Note Terry L. Edwards, EdD (AR 700 - 701)
Individual 45-50 minutes
Axis I Diagnoses:
. . .
300.00 Anx. NOS . . .
296.21 Major Dep D/O
296.80 BPAD, NOS
Mental Status | |
---|---|
Appearance | Appropriate |
Speech | Expressive |
. . .Orientation | Full |
Memory | Immediate |
Recent | |
Remote | |
Insight | Fair |
Treatment Note Terry L. Edwards, EdD (AR 701 - 702)
Individual 45-50 minutes
Axis I Diagnoses:
. . .
300.00 Anx. NOS . . .
296.21 Major Dep D/O . . .
296.80 BPAD, NOS
Narrative: Patient no show Followup: [×] 2 weeks 10/22/2012
Treatment Note Terry L. Edwards, EdD (AR 703 - 703)
Individual 45-50 minutes
Axis I Diagnoses:
. . .
300.00 Anx. NOS . . .
296.21 Major Dep D/O . . .
296.80 BPAD, NOS
Mental Status | |
---|---|
Appearance | Appropriate |
Speech | Expressive |
Mood | |
Affect | |
Thought Form | |
Thought Content | |
Orientation | Full |
Memory | Immediate Recent Remote |
Insight | Good |
Judgment | Good |
Behavior | Appropriate |
Treatment Note Terry L. Edwards, EdD (AR 703 - 704)
Individual 45-50 minutes
Axis I Diagnoses:
. . .
300.00 Anx. NOS . . .
296.21 Major Dep D/O . . .
296.80 BPAD, NOS
Mental Status
. . .
Orientation Full
. . . Narrative: No Show Followup: [×] 2 weeks