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Dols v. Berryhill

United States District Court, D. Minnesota

February 27, 2018

Robert Paul Dols, Plaintiff,
v.
Nancy A. Berryhill, [1]Acting Commissioner of Social Security, Defendant.

          James H. Greeman, Greeman Toomey, (for Plaintiff)

          Ann M. Bildtsen, Assistant United States Attorney, (for Defendant).

          ORDER

          Tony N. Leung United States Magistrate Judge

         I. INTRODUCTION

         Plaintiff Robert Paul Dols brings the present case, contesting Defendant Commissioner of Social Security's denial of his application for supplemental security income (“SSI”) under Title XVI of the Social Security Act, 42 U.S.C. § 1381 et seq. The parties have consented to a final judgment from the undersigned United States Magistrate Judge in accordance with 28 U.S.C. § 636(c), Fed.R.Civ.P. 73, and D. Minn. LR 72.1(c).

         This matter is before the Court on the parties' cross-motions for summary judgment. (ECF Nos. 12, 14.) Being duly advised of all the files, records, and proceedings herein, IT IS HEREBY ORDERED that Plaintiff's motion for summary judgment (ECF No. 12) is DENIED and the Commissioner's motion for summary judgment (ECF No. 14) is GRANTED.

         II. PROCEDURAL HISTORY

         Plaintiff applied for SSI in September 2013, asserting that he has been disabled since April 2013 due to, among other things, anxiety, depression, Asperger's syndrome, and a mood disorder.[2] (Tr. 13, 124-25, 140; see Tr. 211-16, 237.) Plaintiff's application was denied initially and again upon reconsideration. (Tr. 135, 137, 139, 152; see Tr. 156-64.) Plaintiff appealed the reconsideration determination by requesting a hearing before an administrative law judge (“ALJ”). (Tr. 13, 165; see Tr. 168-78, 172-78.) The ALJ held a hearing on August 11, 2015. (Tr. 13, 55-101; see Tr. 181-202, 205-10.) After receiving an unfavorable decision from the ALJ, Plaintiff requested review from the Appeals Council, which denied his request for review. (Tr. 1-4, 7-8.) Plaintiff then filed the instant action, challenging the ALJ's decision. (Compl., ECF No. 1.) Plaintiff moved for summary judgment on March 31, 2017 (ECF No. 12), and the Commissioner filed a cross motion for summary judgment on May 15, 2017 (ECF No. 14). This matter is now fully briefed and ready for a determination on the submissions.

         III. RELEVANT MEDICAL HISTORY

         Although Plaintiff sought benefits based on both mental and physical impairments, the instant action relates only to Plaintiff's mental impairments. Accordingly, the Court focuses on the evidence in the record concerning these impairments.

         A. Background

         Plaintiff “lived with his parents until he was almost 50 years old.” (Tr. 311; accord Tr. 324.) When Plaintiff's father passed away in 2004, Plaintiff “stopped working and assumed full-time caretaking of his mother” until “[s]he transitioned into a nursing home in 2006.” (Tr. 311; accord Tr. 324.) Following the passing of his mother, Plaintiff “was able to support himself for a few years through inheritance, ” but “was unable to maintain employment” and eventually became homeless. (Tr. 312; accord Tr. 324.)

         Plaintiff has a history of alcohol and marijuana use since he was a teenager and completed a residential treatment program in 2011. (Tr. 312, 325; see Tr. 375-388, 391-92.) Plaintiff has also been treated for depression for “decades.” (Tr. 312; accord Tr. 325; see Tr. 381, 393, 403.) His diagnoses include a mood disorder and alcohol dependence. (Tr. 312, 325.)

         In 2011, Plaintiff underwent a neuropsychological evaluation. (Tr. 312, 325.) Plaintiff's “intellectual results” and “[n]ew learning and recent memory abilities were low average.” (Tr. 312; accord Tr. 325.) The “[e]xecutive and attentional measures varied from low average to mildly defective.” (Tr. 312; accord Tr. 325.) Plaintiff was diagnosed with “alcohol-induced persisting dementia.” (Tr. 312; accord Tr. 325.)

         B. 2012

         In mid-March 2012, Plaintiff was admitted to a residential treatment program. (Tr. 414-23, 424-67.) Plaintiff was discharged in May after completing the program. (Tr. 419-23, 424-27.) In the discharge summary, it was noted that Plaintiff “appeared quite depressed and described himself as having a negative attitude about his life and prospects for feeling good about himself” upon admission. (Tr. 420; accord Tr. 425; see Tr. 434, 444, 446, 449, 451, 453, 457, 459, 460, 462, 464, 466.) During the course of treatment, it came to light that Plaintiff was in a relationship with another individual who was physically and emotionally abusive to him. (Tr. 420, 425-27, 451, 453, 454, 464, 466, 467; see Tr. 436-37, 447.) At the time of discharge, Plaintiff was feeling much better about himself and it was noted that Plaintiff would not return to the same sober residence as before but rather live in a different sober residence away from this individual. (Tr. 420-21, 425-26, 451, 453, 464, 466.) Plaintiff “agreed, reluctantly[, ] that he would be better off in a place far enough away from [this individual] to reduce the likelihood of continuing that relationship.” (Tr. 420; accord Tr. 425.)

         Between May and July, Plaintiff participated in an outpatient relapse recovery program to address his use of alcohol and marijuana. (Tr. 308.) The relapse recovery program consisted of a number of group sessions. (Tr. 308.) In his discharge summary, it was noted that Plaintiff attended the required number of program hours and “continue[d] to attend a minimum of [two] groups per week for continued support.” (Tr. 308.)

         While it was noted that Plaintiff did “not appear cognitively impaired as previously documented, ” it was also noted that Plaintiff “does not engage in typical or expected personal interaction with others both within the sober living community and within the group dynamic.” (Tr. 308.) Plaintiff was also noted to have “some difficulty establishing relationships and building trust.” (Tr. 308.) Plaintiff “expresse[d] significant frustration about his difficulty stepping away from past relationships where he describes heavy chemical use along with verbal and physical abuse.” (Tr. 310.)

         Specifically addressing Plaintiff's emotional, behavioral, and cognitive abilities, it was noted that Plaintiff reported having depression, but he was taking Prozac[3] to manage his symptoms and his mental health was stable. (Tr. 309.) It was noted, however, that the following behaviors were demonstrated by Plaintiff: “lack of direct eye contact, distinctive and awkward non-verbal communication, speaking forcefully and with a loud voice, mild paranoia regarding peer interactions within him, ruminating thought patterns and a general overall concern with being socially isolated from others.” (Tr. 309.) Plaintiff was scheduled for an “assessment of autism spectrum disorder, specifically Asperger[']s Disorder, ” in April 2013. (Tr. 308; see Tr. 309.)

         In late November, Plaintiff saw Steven J. Carney, M.D., with complaints of depression and anxiety, among other things. (Tr. 343.) Plaintiff reported that he was on Prozac and “fel[t] like he ha[d] good control of the depression.” (Tr. 343.) Plaintiff reported that his anxiety was better with medication but “not under ideal control, ” reporting “a little bit of anxiety” approximately every other day. (Tr. 343.) Plaintiff was wondering if additional medication would help. (Tr. 343.) Dr. Carney refilled Plaintiff's Prozac prescription and prescribed BuSpar[4] for Plaintiff's anxiety. (Tr. 344.) Plaintiff was directed to return as needed. (Tr. 344.)

         C. 2013

         Plaintiff returned to Dr. Carney near the end of February 2013. (Tr. 341.) Plaintiff reported that he had recently started seeing a psychiatrist and was told that he might have Asperger's syndrome. (Tr. 341.) Plaintiff requested neuropsychological testing. (Tr. 341.) Plaintiff reported that BuSpar did not really seem to help his anxiety. (Tr. 341.) Plaintiff's depression remained “under very good control.” (Tr. 341.) Dr. Carney prescribed Zoloft[5] in place of Prozac and BuSpar in an effort to better address Plaintiff's anxiety and ordered neuropsychological testing. (Tr. 341-42.)

         Plaintiff had a psychotherapy session with Michael Scott around the middle of March. (Tr. 474.) Plaintiff reported that he continued to live in a sober residence. (Tr. 475.) Plaintiff also reported that he was “fearful that a friend of his might try to extort money from him” if he received SSI. (Tr. 475.) Plaintiff was feeling better, however, with Zoloft and Scott noted that Plaintiff was “[l]ess constricted, more verbal, and appropriate.” (Tr. 475.)

         At the same time, Scott noted that Plaintiff's mood was “[d]ysphoric” and he was “[a]ngry, fearful[, c]autious, [and] guarded.” (Tr. 474.) Plaintiff was “[d]isheveled, ” “[m]a[d]e noises, ” displayed “[f]urtive sidelong glances, ” and had “[p]oor eye contact.” (Tr. 474.) Plaintiff also had a “[m]arked lack of insight.” (Tr. 474.) Scott listed Plaintiff's diagnoses as depressive disorder, “[p]robable Asperger's” syndrome, and alcohol and marijuana dependence in remission. (Tr. 475.) Scott noted that he “[m]ay consider a referral to adult protection, ” but it was “[u]nclear if [Plaintiff] is currently a vulnerable adult.” (Tr. 475.)

         In his next session with Scott approximately one month later, Plaintiff's “[a]ffect ha[d] returned to previous baseline.” (Tr. 473.) He was “[d]isheveled, ” “[a]ngry, sullen, [and] hostile.” (Tr. 473; see Tr. 472.) Plaintiff had a “[m]arked lack of insight, ” “[p]oor eye contact, ” and “[p]oor social skills.” (Tr. 473; see Tr. 472.) Plaintiff reported watching television and doing “little else.” (Tr. 473.) Scott “[u]sed problem solving methods for finding some activities that may fill [Plaintiff's] time.” (Tr. 473.) For example, Plaintiff's bike had no brakes, and so they “[l]ooked at [an] upcoming county auction site to see about a possible new bike.” (Tr. 473.) Scott “[e]ncouraged [Plaintiff] to consider activities outside [his sober residence] such as an introduction to computers class, ” but Plaintiff was “not receptive to this.” (Tr. 473.) Scott noted that Plaintiff felt “he ha[d] been unjustly caught up in a ‘sting' on his last DWI, ” and did “not appear to be motivated for sobriety.” (Tr. 473.)

         Plaintiff presented similarly at his next session with Scott in May. (Compare Tr. 470-71 with Tr. 472-73.) Plaintiff continued to “[p]erseverate[] about how he was caught in [a] sting operation and that this is how he got his last DWI.” (Tr. 471.) Plaintiff “[t]end[ed] to ramble about the same issues.” (Tr. 471.) In addition to being disheveled, Scott noted that Plaintiff was “unshaven[ and] belching.” (Tr. 470.)

         In approximately early June, Plaintiff underwent a neuropsychological consultation based on Dr. Carney's referral. (Tr. 311, 324.) Nancy Kaley, BS, LADC, Plaintiff's counselor, accompanied him to the evaluation. (Tr. 311, 324.) Kaley “expressed concern that [Plaintiff] was not progressing in his recovery.” (Tr. 311; accord Tr. 324.) Kaley stated that Plaintiff “does not connect well with other residents at the halfway house”; “appears aloof and disinterested in relationships”; and “frequently avert[s] his eyes during interaction[s].” (Tr. 311; accord Tr. 324.) Plaintiff also “frequently clears his throat, purses his lips, and shows facial ticking.” (Tr. 311 accord Tr. 324.) At times, Plaintiff will “yip[], yell[], and make[] squealing noises.” (Tr. 311; accord Tr. 324.) Plaintiff also “utter[ed] repetitive statements” and engaged in “repetitive arm movements.” (Tr. 311; accord Tr. 324.) Kaley “suspect[ed] that [Plaintiff] has a subtype of pervasive developmental disorder.” (Tr. 311; accord Tr. 324.)

         During the evaluation, Plaintiff reported having “interpersonal conflicts and difficulty with others since childhood.” (Tr. 311; accord Tr. 324; see Tr. 312, 325.) Plaintiff “first noticed tic-like symptoms in junior high.” (Tr. 311; accord Tr. 324.) Plaintiff also reported “feeling inferior as well as mistreated and abused since childhood.” (Tr. 311; accord Tr. 324.) Plaintiff reported that these feelings escalated after the death of his parents “and he had to fend for himself.” (Tr. 311; accord Tr. 324.) Plaintiff reported turning to drugs and alcohol for relief. (Tr. 312, 325.)

         Plaintiff reported that he had been unemployed for the past nine years. (Tr. 312, 325.) Plaintiff previously held positions in shipping and receiving, at a warehouse, and with a silkscreen company, but “[r]ecurring interpersonal wrangles and non-attendance from alcoholism contributed to job loss.” (Tr. 312; accord Tr. 325.) Plaintiff never married and has no children. (Tr. 313, 326.) Plaintiff “never dated or had a significant other” and “never cultivated friendships.” (Tr. 313; accord Tr. 326.) Plaintiff's social support and contacts were his parents and a brother. (Tr. 313, 326.) Plaintiff reported that he did not like living at the recovery halfway house, but intends to remain there for the foreseeable future. (Tr. 313, 326.) Kaley noted that Plaintiff “has responded to well to structure and support, despite lack of affiliation with others.” (Tr. 313; accord Tr. 326.) Plaintiff was “compliant with [the halfway house's] rules and active in housekeeping.” (Tr. 313; accord Tr. 326.)

         Plaintiff was “cooperative” and “actively engaged” in the evaluation. (Tr. 313; accord Tr. 326.) Plaintiff's behavior was described as follows:

His alertness was normal. Attention was average, and motivation was average or stronger. Effort was sustained at ample levels for valid assessment. Orientation was intact. Demeanor was well-intentioned yet detached, asocial, unskilled, and immature. Gaze was averted. Countenance was scowling. Rapport was sufficient. Insight into referral issues was satisfactory. Comprehension of test instructions was intact. Spontaneous conversation was minimal. He frequently cleared his throat. He was heard making a high-pitched noise while alone in the testing room. Verbal responses were communicated clearly without appreciable dysnomia or other dysphasia. Perceptual problems were solved carefully for the most part. Figure drawings were adequately organized. Memory retrieval was variable and dysexecutive. Affect was tense and irritable, yet he was generally polite and compliant. Response to success and failure was minimal. Conduct was otherwise not overtly unusual.

(Tr. 313; accord Tr. 326.)

         Plaintiff underwent a series of tests to assess his intellectual, memory, executive, language, and other abilities as well as his personality function and adaptive skills. (Tr. 313-15, 326-28.) With respect to his personality function, Plaintiff's “clinical profile” was “abnormal” and he exhibited “neurotic symptoms.” (Tr. 315; accord Tr. 328.) “Anxious-depressive disorder [wa]s indicated, ” and was noted to be “partly a consequence of developmental disability and its social concomitants.” (Tr. 315; accord Tr. 328.) Plaintiff's “coping [wa]s maladaptive under pressure” and evident in his alcohol abuse. (Tr. 315; accord Tr. 328.)

         Overall, the results of Plaintiff's neuropsychological evaluation were “abnormal” and “compatible with cerebral dysfunction of at least mild magnitude.” (Tr. 315; accord Tr. 328.) His “mental abilities [we]re lower than expected in a few domains.” (Tr. 315; accord Tr. 328.) His “[a]daptive skills [we]re moderately or markedly low, affecting communication and interaction.” (Tr. 315; accord Tr. 328.) Plaintiff's “[e]xecutive/[a]ttentional abilities [we]re mildly or markedly low.” (Tr. 315; accord Tr. 328.) It was noted that “[m]ost” of Plaintiff's neuropsychological abnormality was developmental in nature and “related to an autism-spectrum disorder.” (Tr. 315; accord Tr. 328.) “Some” of his neuropsychological abnormality was “organic” and related to his history of alcohol and drug use. (Tr. 315; accord Tr. 328.)

         Plaintiff was noted to be “susceptible to alienation, indiscretion, distraction, and disorganization.” (Tr. 316; accord Tr. 329.) Plaintiff was “limited in judgment and insight.” (Tr. 316; accord Tr. 317, 329.) Plaintiff also manifested an “inflexibility in modifying maladaptive behavior such as substance over-use.” (Tr. 316; accord Tr. 317, 329.) Continued mental-health and substance-abuse services were recommended. (Tr. 316, 317, 329.) It was also noted that Plaintiff “could be considered for future placement in a semi-independent or shared-living facility with on-site supports.” (Tr. 316; accord Tr. 317, 329.) Lastly, Plaintiff's “prospects for substantial gainful employment” were described as “marginal, ” and he would be “best in positions that do not place much emphasis on social maturity and sustained interaction with others.” (Tr. 316; accord Tr. 317, 329.)

         Plaintiff met with Scott again in June. (Tr. 468-69.) Again, Plaintiff was angry, hostile, fearful, cautious, and guarded. (Tr. 468.) He likewise had poor eye contact and a marked lack of insight. (Tr. 468.) Plaintiff also continued to be disheveled and unshaven, and belched. (Tr. 468.) Plaintiff remained focused on the DWI sting operation. (Tr. 469.) Plaintiff did, however, now have a “functioning bicycle” and Scott encouraged Plaintiff “to get out more to improve his mood.” (Tr. 469.)

         Scott noted:

At the beginning of the session time, [Plaintiff] was still in his outpatient [chemical dependency] group down the hall. When he was let out of the group, [Plaintiff] went to the kitchen and had to [be] retrieved from there for his appointment. When I turned away from him during the session to print out a bike map, (I was telling him what I was doing), he got up and left the office and had to be retrieved again from the kitchen. The sum total of his conversation involved his resentment and anger at being caught in a “sting” operation for his most recent DWI 15 months ago.

(Tr. 469.) Scott further noted that Plaintiff “seems unable to let go of his anger.” (Tr. 469.)

         At the end of July, Plaintiff presented to Teresa A. Tran-Lim, M.D., based on a referral by Dr. Carney to evaluate Plaintiff's mental function. (Tr. 319, 335.) It does not appear that Dr. Tran-Lim had access to the results of the neuropsychological consultation Plaintiff had recently undergone during this appointment. (See Tr. 318-19.) Dr. Tran-Lim noted that Plaintiff was “generally quiet, poor historian, gives short responses to question[s] and had to be prodded for detail.” (Tr. 319; accord Tr. 335.) Dr. Tran-Lim further noted that Plaintiff's depression and anxiety were currently being managed by Dr. Carney and Plaintiff was taking sertraline.[6] (Tr. 319, 335.) Dr. Tran-Lim observed that Plaintiff was well groomed, with a flat affect, and “generally slow cognitively.” (Tr. 321; accord Tr. 337.) Dr. Tran-Lim noted that Plaintiff ‘does have significant psychiatric issues with alcohol dependence and depression/anxiety” and referred Plaintiff for neuropsychological testing, indicating that Dr. Carney had already placed such a referral. (Tr. 322; accord Tr. 338.)

         In August, Plaintiff met with psychiatrist Thomas C. Winegarden, M.D. (Tr. 352, 489-90.) Plaintiff reported a history of Asperger's syndrome, alcohol dependence, and depression. (Tr. 352, 490.) Plaintiff continued to reside at the sober house. (Tr. 352, 490.) Plaintiff reported that he had been taking Zoloft but “it seems to have pooped out.” (Tr. 352; accord Tr. 490.) Dr. Winegarden diagnosed Plaintiff with recurrent depression and Asperger's syndrome, and prescribed a Viibryd[7] titration. (Tr. 352, 490.) Dr. Winegarden also recommended that Plaintiff continue attending AA meetings, stay sober, and be in regular contact with his sponsor and the sober house. (Tr. 352, 490.)

         Plaintiff followed up with Dr. Winegarden approximately one month later. (Tr. 351, 488-89.) Plaintiff was “still ruminating” and “fe[lt] irritable, agitated, chronically dysphoric or unhappy and [a] roller coaster ride of emotions.” (Tr. 351; accord Tr. 488.) Plaintiff reported that he was “staying sober[ and] regularly attending AA meetings, ” but did not yet have a sponsor. (Tr. 351; accord Tr. 488.) Plaintiff “realize[d] he is better off sober.” (Tr. 351; accord Tr. 488.) Plaintiff reported some difficulty sleeping, but attributed it to “an old mattress that is not very comfortable.” (Tr. 351; accord Tr. 488.)

         Dr. Winegarden noted that Plaintiff was “relaxed, casual, cooperative, [and] appropriate.” (Tr. 351; accord Tr. 489.) Plaintiff was oriented, had a full affect, and exhibited “[n]o psychomotor agitation or retardation.” (Tr. 351; accord Tr. 489.) Plaintiff's mood was “euthymic, not depressed, not anxious, and full range.” (Tr. 351; accord Tr. 489.) His speech was normal and his thought process was “[i]ntact, coherent, and organized.” (Tr. 351; accord Tr. 489.) Plaintiff's judgment and insight were both intact. (Tr. 351, 489.) Dr. Winegarden directed Plaintiff to continue with Viibryd and added Seroquel[8] to Plaintiff's regimen. (Tr. 351, 489.)

         When Plaintiff saw Dr. Winegarden the following month, he was having “racing thoughts” and was “quite agitated.” (Tr. 349; accord Tr. 487; see Tr. 350, 488.) Plaintiff reported “[w]aking up kind of happy, ” but still “fe[lt] irritable, agitated, angry, chronically dysphoric or unhappy and [a] roller coaster ride of emotions.” (Tr. 349; accord Tr. 487.) Plaintiff “fe[lt] powerless because his mind is in such a tissy [sic].” (Tr. 349; accord Tr. 487.) Plaintiff also “felt like he was going to have a stroke[, ] light headed and dizzy.” (Tr. 349; accord Tr. 487.) Plaintiff reported that he had previously taken Paxil, [9] which “worked really well, ” but he had stopped taking it because he was not allowed to donate plasma while on this medication. (Tr. 349; accord Tr. 487.)

         While Plaintiff was oriented, Dr. Winegarden noted that he was agitated and irritable. (Tr. 349, 487.) Plaintiff displayed psychomotor agitation and was restless. (Tr. 349, 487.) His thoughts were disorganized and tangential and were positive for “psychosis, paranoia, grandiosity and auditory hallucinations.” (Tr. 349; accord Tr. 487.) Plaintiff's affect was “labile and agitated, ” and his insight and judgment were both impaired. (Tr. 349; accord Tr. 487.) Dr. Winegarden diagnosed Plaintiff with bipolar disorder, directed Plaintiff to taper off Viibryd, and prescribed Paxil and Depakote.[10] (Tr. 349, 488.)

         Plaintiff followed up with Dr. Winegarden towards the end of November. (Tr. 365.) Plaintiff reported that Depakote was helpful and he was a “lot less agitated.” (Tr. 365.) Plaintiff described himself as “mildly depressed.” (Tr. 365.) Dr. Winegarden noted that Plaintiff was “relaxed, casual, cooperative, [and] appropriate.” (Tr. 366.) Plaintiff was oriented and exhibited “[n]o psychomotor agitation or retardation.” (Tr. 366.) Plaintiff's affect had “full range” and his mood was “euthymic, not depressed, not anxious, and full range.” (Tr. 366.) Plaintiff's speech was normal; his thought process was “[i]ntact, coherent, and organized”; and his judgment and insight were intact. (Tr. 366.) Dr. Winegarden increased Plaintiff's Paxil prescription and continued Depakote. (Tr. 366.)

         At his next appointment with Dr. Winegarden in December, Plaintiff reported that he was “doing ok” but was “still depressed.” (Tr. 365; accord Tr. 486.) Plaintiff was, however, “feeling more and more anxious, nervous and worried.” (Tr. 365; accord Tr. 486.) Plaintiff had been unable to increase his Paxil dose because the pharmacy had “not giv[en] him the right # of pills.” (Tr. 365; accord Tr. 486.) This time, Dr. Winegarden noted that Plaintiff was “cooperative, but anxious, depressed and withdrawn.” (Tr. 365; accord Tr. 486.) No adjustments were made to Plaintiff's medications. (Tr. 365, 486.)

         D. 2014

         Plaintiff's next appointment with Dr. Winegarden was in early April 2014. (Tr. 364, 485.) While Plaintiff was less irritable, agitated, and paranoid and more social, he also reported worsening depression. (Tr. 364, 485.) Plaintiff complained of “low energy, poor motivation, and poor concentration.” (Tr. 364; accord Tr. 485.) It was “more difficult [for Plaintiff] to enjoy things.” (Tr. 364; accord Tr. 485.) Plaintiff felt unhappy, “hopeless, helpless and worthless.” (Tr. 364; accord Tr. 485.) Dr. Winegarden increased Plaintiff's Paxil dose and directed him to continue taking Depakote. (Tr. 364, 485.) When Plaintiff saw Dr. Winegarden again approximately one month later, he was doing “about the same, ” but found the increased Paxil dose helpful. (Tr. 363-64; accord Tr. 485.)

         Plaintiff met with Dr. Winegarden again in mid-July. (Tr. 363, 484.) Plaintiff reported that he was “in a better place” and had moved to another sober residence. (Tr. 363; accord Tr. 484.) Plaintiff was “[e]asier to get along with, ” “[m]uch less stressed, ” and “doing well.” (Tr. 363; accord Tr. 484.) Plaintiff was “able to enjoy things and . . . happy.” (Tr. 363; accord Tr. 484.) His energy, motivation, concentration, appetite, and sleep were all within normal limits. (Tr. 363, 484.) Plaintiff “[d]enie[d] any symptoms of depression.” (Tr. 363; accord Tr. 484.)

         Dr. Winegarden observed Plaintiff to be “relaxed, casual, cooperative, [and] appropriate.” (Tr. 363; accord Tr. 484.) He was oriented with “[n]o psychomotor agitation or retardation.” (Tr. 363; accord Tr. 484.) Plaintiff's affect had “full range” and his mood was “euthymic, not depressed, not anxious, and full range.” (Tr. 363; accord Tr. 484.) Plaintiff had normal speech and his though process was “[i]ntact, coherent, and organized.” (Tr. 363; accord Tr. 484.) Plaintiff's judgment and insight were both intact. (Tr. 363, 484.) Dr. Winegarden increased Plaintiff's Paxil prescription again. (Tr. 363, 484.)

         Plaintiff presented similarly at his next appointment with Dr. Winegarden in October. (Compare Tr. 483 with Tr. 363, 484.) Plaintiff reported that he “is doing good” and was “working part-time.” (Tr. 483.) Plaintiff also “continue[d] to stay sober.” (Tr. 483.) Plaintiff's prescriptions were continued without modification. (Tr. 483.)

         E. 2015

         Plaintiff next met with Dr. Winegarden in early January 2015. (Tr. 482.) Plaintiff's presentation was again similar to the July and October 2014 appointments. (Compare Tr. 482 with Tr. 483, 363, 484.) Dr. Winegarden noted that Plaintiff was “doing well” and no changes were made to Plaintiff's medications. (Tr. 482.)

         The same was true when Plaintiff met with Dr. Winegarden in early April. (Compare Tr. 481-82 with Tr. 482, 483, 363, 484.) Plaintiff reported that he was working at a warehouse. (Tr. 481.) Although Plaintiff was “tired, ” he continued to “[d]en[y] any symptoms of depression.” (Tr. 481.) Dr. Winegarden again described Plaintiff as “doing well” and made no adjustments to Plaintiff's medications. (Tr. 481-82.)

         At the end of May, however, Plaintiff “stopped into [Dr. Winegarden's] office stating he is in a crisis situation.” (Tr. 481.) Plaintiff no longer had health insurance because he was “making too much [money], ” but subsequently lost his job. (Tr. 481.) Plaintiff was in the process of obtaining health insurance, but was not presently able to afford his Paxil prescription. (Tr. 481.) Plaintiff “became agitated when [staff] asked if he c[ould] purchase some Paxil until [his] ins[urance] coverage” resumed. (Tr. 481.) Plaintiff's Paxil prescription was switched to Brintellix[11] for the time being and he was directed to continue taking Depakote. (Tr. 481.)

         When Plaintiff next saw Dr. Winegarden towards the middle of July, he was “doing better” and “got his insurance back.” (Tr. 493.) Plaintiff reported feeling anxious in the morning. (Tr. 493.) Plaintiff was “relaxed, casual, cooperative, [and] appropriate.” (Tr. 493.) He was oriented and showed “[n]o psychomotor agitation or retardation.” (Tr. 493.) He had a full affect and his mood was “euthymic, not depressed, not anxious, and [had] full range.” (Tr. 493.) Plaintiff's speech was normal and his thought process was “intact, coherent, and organized.” (Tr. 493.) His judgment and insight were likewise intact. (Tr. 493.) Dr. Winegarden increased Plaintiff's Depakote prescription. (Tr. 493.)

         Plaintiff reported “the ‘usual'” at his next appointment with Dr. Winegarden in early October. (Tr. 494.) Plaintiff presented in the same manner as he had in July. (Compare Tr. 494 with Tr. 493.)

         IV. LEINONEN CONSULTATIVE EXAMINATION

         In February 2014, Plaintiff participated in a consultative examination with Carol Leinonen, Psy. D. (Tr. 354-57.) Plaintiff reported that “he has ‘depression and anxiety, a mood disorder and I'm an alcoholic I guess.'” (Tr. 354.) Plaintiff reported having depression for a long time and currently rated his depression as “mild” but also stated that he was irritated by his living situation at the sober house. (Tr. 354.) Plaintiff also reported “irritability and restlessness” at not being able to go outside due to the cold weather. (Tr. 354.) Plaintiff “denied fatigue, lack of motivation or decreased interest/pleasure in daily activities.” (Tr. 354.) Plaintiff “did report difficulties with interpersonal relationships.” (Tr. 354.) Plaintiff generally spent time on his own and had ‘trouble being in larger groups of people.” (Tr. 354.) With respect to his anxiety, Plaintiff described worrying about the future, racing thoughts, and difficulty sleeping. (Tr. 354.) Plaintiff reported “that he often feels tense and has difficulties relaxing.” (Tr. 354.) Plaintiff also reported worrying about germs. (Tr. 355.)

         Plaintiff described his typical day as getting up around 8:30 a.m., dressing and performing his personal care, watching the news, and eating breakfast. (Tr. 355.) Plaintiff prepared his own lunch and napped when tired. (Tr. 355.) In the evening, Plaintiff made his own dinner and watched more television. (Tr. 355.) Plaintiff attended “groups and after-care on certain days, ” including AA meetings. (Tr. 355.) Plaintiff rode his bike to meetings in good weather, and “prefer[red] to be outside or riding his bike.” (Tr. 355.) Plaintiff stayed at home if he did not have a meeting. (Tr. 355.) Plaintiff also ...


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