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Cassandra S. v. Saul

United States District Court, D. Minnesota

September 24, 2019

Cassandra S., Plaintiff,
v.
Andrew Saul, Commissioner of Social Security, Defendant.

          ORDER

          ELIZABETH COWAN WRIGHT UNITED STATES MAGISTRATE JUDGE

         This matter is before the Court on Plaintiff Cassandra S.’s (“Plaintiff”) Motion for Summary Judgment (Dkt. 18) and Defendant Commissioner of Social Security Andrew Saul’s (“Defendant”) Motion for Summary Judgment (Dkt. 21). Plaintiff filed this case seeking judicial review of a final decision by Defendant denying her application for disability insurance benefits and supplementary security income. For the reasons stated below, Plaintiff’s Motion is DENIED, and Defendant’s Cross-Motion is GRANTED.

         I. BACKGROUND

         Plaintiff filed a Title II application for disability insurance benefits on August 27, 2015. (R. 232.)[1] Plaintiff also filed a Title XVI application for supplemental security income on August 27, 2015. (Id.) In both applications, Plaintiff alleged disability beginning January 1, 1997. (Id.) Plaintiff later amended her alleged disability onset date from January 1, 1997, to November 11, 2014. (R. 10.) Plaintiff’s applications for disability insurance benefits and supplemental security income alleged disability due to adenocarcinoma stage 1, agoraphobia, manic depressive disorder, manic anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder (“PTSD”), pre cancer forming cells, psychosis, schizophrenia, and attention deficit hyperactivity disorder (“ADHD”). (R. 72-73.) Her applications were denied initially (R. 151, 155) and on reconsideration (R. 163, 167). Plaintiff requested a hearing before an administrative law judge (“ALJ”), which was held on September 7, 2017 before ALJ William L. Hogan. (R. 7-25.) The ALJ issued an unfavorable decision on October 31, 2017, finding that Plaintiff was not disabled from the alleged onset date through the date of the ALJ’s decision. (R. 25.)

         Following the five-step sequential evaluation process under 20 C.F.R. § 404.1520(a), [2] the ALJ first determined at step one that Plaintiff had not engaged in substantial gainful activity since November 11, 2014. (R. 12.) At step two, the ALJ determined that Plaintiff had the following severe impairments: depressive disorder; ADHD; post-traumatic stress disorder; generalized anxiety disorder (“GAD”); personality disorder; and substance abuse. (R. 13.) The ALJ determined that Plaintiff had no severe medically determinable physical impairment, as her headaches improved with treatment, she was able to consciously control her seizure activity, and she was effectively treated for traumatic physical injuries and had normal subsequent physical examinations. (Id.)

         At step three, the ALJ determined that Plaintiff did not have an impairment that met or medically equaled the severity of one of the listed impairments in 20 C.F.R. part 404, subpart P, appendix 1. (R. 14.) In making that finding, the ALJ considered whether the “paragraph B” criteria were satisfied and found that they were not, because Plaintiff’s mental impairments did not cause at least two “marked” limitations or one “extreme limitation in any area of functioning. (Id.) The ALJ also considered whether “paragraph C” criteria were present and found that they were not, because there was no evidence that Plaintiff would have minimal capacity to adapt to changes in her environment or to demands that were not already a part of Plaintiff’s daily life. (Id.)

         At step four, after reviewing the entire record, the ALJ concluded that Plaintiff had the following Residual Functional Capacity (“RFC”):

[T]o perform a full range of work at all exertional levels but with the following nonexertional limitations: The claimant can understand, remember, and carryout routine, simple, and repetitive three to four step instructions; can interact appropriately with supervisors on an occasional basis, meaning up to one-third of the workday; can have no interaction with coworkers or the public; can respond appropriately to changes in a work setting involving routine, simple, and repetitive three to four step tasks; and can make judgments on simple work-related decisions.

(R. 15.) In arriving at this RFC, the ALJ found that Plaintiff’s medically determinable impairments could reasonably be expected to cause her alleged symptoms, but that Plaintiff’s statements concerning the intensity, persistence, and limiting effects of her symptoms were not entirely consistent with the medical evidence and other evidence in the record. (Id.)

         On the basis of this RFC determination, the ALJ concluded that Plaintiff was able to perform past relevant work as an inspector and hand packager, Dictionary of Occupational Titles (DOT) #559.687-074 (light; unskilled, specific vocational preparation (SVP) level 2). (R. 22-23.) The ALJ found that Plaintiff had worked as an inspector and hand packager for two to three months; that this work was substantial gainful activity based on recorded earnings for that period; and that Plaintiff performed this work for a sufficient amount of time to learn the skills required to return to this work. (R. 23.) Accordingly, the ALJ found that Plaintiff’s past work as an inspector and hand packager qualified as past relevant work. (Id.) Subsequently, the ALJ found that Plaintiff was able to perform the physical and mental demands of this past relevant work given her RFC. (Id.) As such, the ALJ concluded that Plaintiff was able to perform past relevant work. (Id.)

         At step five of the sequential analysis, and based on the testimony of the vocational expert (“VE”), the ALJ made the alternative finding that in addition to her past relevant work, Plaintiff was capable of performing other jobs present in substantial numbers in the national economy, including laundry folder, DOT #369.367-018 (light; unskilled) with 20, 000 jobs in the national economy; bench assembler, DOT #706.684- 042 (light; unskilled) with 60, 000 jobs in the national economy; and small products assembler, DOT #706.684-022 (light; unskilled) with 75, 000 jobs in the national economy. (R. 23-25.) The ALJ arrived at this determination after considering the Plaintiff’s age, education, work experience, and RFC and the impact these attributes would have on Plaintiff’s ability to make a successful adjustment to other work. (R. 23.) Accordingly, because Plaintiff was capable of performing both past relevant work and other jobs which existed in significant numbers in the national economy, the ALJ deemed Plaintiff not disabled. (R. 24.)

         Based on the above determinations, the ALJ concluded that Plaintiff had not been under a disability from the alleged onset date of November 11, 2014, to the date of the ALJ’s decisions, October 31, 2017. (R. 25.)

         Plaintiff requested review of the ALJ’s decision. (R. 229.) The Appeals Council denied Plaintiff’s request for review, which made the ALJ’s decision the final decision of the Commissioner. (R. 1-3.) Plaintiff then commenced this action for judicial review. The Court has reviewed the entire administrative record, giving particular attention to the facts and records cited by both parties. The Court will recount the facts of record only to the extent they are helpful for context or necessary for resolution of the specific issues presented in the parties’ motions.

         II. RECORD

         Plaintiff had been experiencing mental health issues since at least late 2014. On November 11 of that year-Plaintiff’s alleged disability onset date-police brought Plaintiff to Benson Hospital’s Emergency Department on reports of self-harm and concerns about her personal safety. (R. 456.) Plaintiff had cut her arm with a kitchen knife after an argument with her fiancé. (Id.) The situation may have been exacerbated by Plaintiff’s having missed several psychiatric appointments and run out of her prescribed medication. (Id.) Plaintiff reported being prescribed clonazepam, amphetamine-dextroamphetamine, and fluoxetine hydrochloride-in addition to other, non-psychiatric medications-at the time of the self-harm incident. (R. 457.) Hospital staff administered Klonopin and Prozac, dressed Plaintiff’s cuts, and allowed Plaintiff to leave in the company of her fiancé after concluding that she did not represent a threat to herself or others. (R. 459.)

         Eight days later, on November 19, 2014, Plaintiff presented to ACMC-Willmar Clinic requesting refills of her psychiatric medications. (R. 454.) Plaintiff reported that she had not been able to see her psychiatrist to have her medications refilled. (Id.) A drug screen was negative for Plaintiff’s prescribed Adderall but positive for methamphetamine. (Id.) Plaintiff’s Prozac and clonazepam were renewed; her prescription for Adderall was not renewed pending scheduled appointments with her regular psychiatric providers. (Id.)

         Plaintiff returned to Benson Hospital’s Emergency Department November 28, 2014, having sustained blows to the right side of her face and the left side of her body, as well as attempted choking, in a domestic altercation with her boyfriend/fiancé. (R. 1033.) Hospital staff noted “extreme emotional distress related to [the] physical and emotional assault, ” and Plaintiff was referred for counseling and allowed to rest in the hospital overnight. (R. 431.)

         On December 22, 2014, Plaintiff met with Ralph Johnson, LICSW, LMFT, at Woodland Centers in Willmar. (R. 632.) Plaintiff was alert and oriented, had good hygiene, was cooperative and had an appropriate affect, was sad and anxious, had normal speech, an estimated below average intelligence, and was distractible. (R. 633.) Therapist Ralph Johnson collected relevant medical and mental health histories and administered PHQ-9 and GAD-7 psychological tests-which rely on patient-reported symptoms-that resulted in findings of moderate anxiety and depression. (R. 634-35.) Therapist Ralph Johnson formed the diagnostic impression that Plaintiff suffered from Major Depressive Disorder and Personality Disorder. (R. 636.) As a result, he recommended that Plaintiff engage in individual therapy on a bi-weekly basis for three to six months. (Id.)

         Plaintiff reported to Rice Memorial Hospital’s Emergency Department on January 7, 2015. (R. 560.) Plaintiff presented with concerns about developing suicidal ideation after reportedly being cut off from her medication a week prior. (Id.) However, Plaintiff denied experiencing suicidal ideation on the day she reported to the hospital. (Id.) Plaintiff requested refills of her medications to bridge the gap until her January 26 psychiatric appointment at Woodland Centers. (Id.) Hospital staff administered a single 1mg dose of Ativan, an anti-anxiety medication. (R. 563.) Plaintiff became agitated when hospital staff would not refill her medications and asked to be let out for air. (Id.) Plaintiff was informed that this was against Emergency Department policy, and security staff were eventually required to address the situation. (Id.) Plaintiff was ultimately discharged to Woodland Crisis Center because of self-harm concerns. (Id.)

         At Woodland Crisis Center, Andrew Johnson, LMFT, performed a crisis assessment on Plaintiff, also on January 7, 2015. (R. 638.) Plaintiff informed Therapist Andrew Johnson that she had been without her prescribed psychiatric medications for several weeks, after her previous prescriber had refused to continue treating her due to missed appointments. (Id.) Plaintiff denied currently experiencing suicidal ideations and admitted recently using methamphetamine. (Id.) Therapist Andrew Johnson observed Plaintiff’s mental status to be sad and anxious, with impoverished thought content, below average intelligence, impaired attention and concentration, and poor insight and judgement. (R. 638-39.) Plaintiff claimed delusions in the form of her fiancé burning her with a cigarette and beating her up. (R. 639.) Therapist Andrew Johnson formed the diagnostic impression that Plaintiff suffered from Major Depressive Disorder and Personality Disorder. (Id.) He recommended admission to the crisis center and close observation. (Id.)

         On January 9, 2015, two days after her admission to Woodland Crisis Center, Plaintiff met with Clinical Nurse Specialist Kristel Hart for a psychiatric diagnostic assessment. (R. 641.) Plaintiff reported recently experiencing various symptoms of depression including “decreased interests, energy, concentration, and appetite.” (R. 642.) Plaintiff also reported physical, emotional, and sexual abuse by her father, paternal grandfather, and uncle from the ages of 2 to 10, which continued to cause her nightmares and flashbacks. (Id.) Plaintiff claimed hearing voices that would tell her to harm herself or others. (Id.) CNS Hart observed Plaintiff’s mental status to be hyperfocused- particularly regarding being prescribed ADHD medication and clonazepam-with poor insight, judgement, and motivation. (R. 645.) PHQ-9 and GAD-7 tests resulted in findings of moderate depression and severe anxiety. (R. 646.) CNS Hart formed the diagnostic impression that Plaintiff suffered from Major Depressive Disorder, Generalized Anxiety Disorder, Personality Disorder, and Client-Reported Seizure Disorder. (R. 647.) CNS Hart accordingly referred Plaintiff to the Woodland Crisis Center and Swift County for assistance with medications and housing. (Id.)

         Plaintiff was subsequently informed on January 9, 2015, that she would not be able to leave Woodland Crisis Center to return home because she was unable to care for herself. (R. 565.) Plaintiff then began having a seizure-like shaking episode and was transferred to Rice Memorial Hospital. (Id.) At the hospital, Dr. Okerlund informed Plaintiff he would have to cut her sweatshirt, at which point she stopped shaking and said, “please don’t cut my clothes.” (Id.) Plaintiff was administered a single 1mg dose of Ativan and diagnosed by Dr. Okerlund as suffering from depression and anxiety. (R. 567, 569.) Plaintiff was anxious, her affect was angry and inappropriate, her speech was pressured, and her cognition and memory were impaired. (R. 568.) Hospital staff then returned Plaintiff to Woodland Crisis Center. (R. 569.)

         On January 11, 2015, Plaintiff was again transported from Woodland Crisis Center to the Rice Memorial Hospital Emergency Department by EMS after a recurrence of her seizure-like spells. (R. 448.) EMS felt Plaintiff was having pseudoseizures and advised her to stop or they would have to drop in a nasal airway; Plaintiff then stopped shaking and started talking with EMS staff. (Id.) At Rice Memorial, Dr. Egal concluded that Plaintiff’s symptoms were “consistent with psychogenic nonepileptic pseudoseizures.” (R. 574.) Hospital staff administered a sodium chloride IV and diagnosed Plaintiff with a behavioral disorder. (R. 450.) Subsequently, Woodland Crisis Center refused to take Plaintiff back, stating she required care beyond what they could provide. (Id.)

         Over the next four weeks, Plaintiff missed several Swift County Adult Mental Health case management meetings. (R. 1122-25.) She also missed several psychiatric meetings at Woodland Centers with Nurse Practitioner Barbara Little (“NP Little”), and instead sought out a Primary Care Physician, Dr. Stephen Hietala, for a medication refill on February 16, 2015. (R. 523.) Dr. Hietala diagnosed Plaintiff as suffering from ADHD and a mixed Anxiety and Depressive Disorder. (Id.) He accordingly refilled Plaintiff’s Klonopin, fluoxetine, and Adderall. (Id.) Plaintiff met with Dr. Hietala again on March 13, 2015 for another medication refill, stating at that time that she felt “her mood [wa]s doing fine, ” and that “she [wa]s doing well on the [medication] regimen.” (R. 521.)

         Plaintiff eventually met with NP Little at Woodland Centers for a psychiatric diagnostic assessment on April 20, 2015. (R. 653.) At that time, Plaintiff reported experiencing severe anxiety, a recent suicide attempt, and a history of seizures, but denied recent illicit drug or alcohol use. (R. 653, 1128.) Plaintiff also informed NP Little that she was currently prescribed clonazepam and Adderall by a Primary Care Physician in Wadena but had no local provider. (R. 653.) Further, Plaintiff stated that she thought future suicide attempts were unlikely, but asserted that she would be “better off dead.” (R. 1128.) Plaintiff was oriented, had normal grooming, an appropriate affect, normal speech, an average intelligence, was distractible, and had a normal memory. (R. 1132.)

         NP Little observed Plaintiff’s mental status to be dysphoric, anxious, and distractible, with poor insight. (R. 657.) NP Little formed the diagnostic impression that Plaintiff suffered from Major Depressive Disorder, ADHD, GAD, PTSD, and Histrionic Personality Disorder, and noted a client-reported Seizure Disorder. (R. 659.) NP Little also observed that Plaintiff had poor coping skills, minimal self-reliance skills, a history of severe abuse, and a tendency towards “histrionic responses to crisis situations, ” and reported that Plaintiff needed “help with community interaction and supportive services.” (R. 1134-35.) NP Little further opined that Plaintiff had symptoms of mental illness that impaired her ability to secure or maintain employment. (R. 1135.) NP Little accordingly recommended continuing Plaintiff’s medication with minor adjustments and referred Plaintiff to a neurologist for a consultation regarding her “seizure disorder.” (R. 1135.)

         Plaintiff was booked into Wadena County Jail on June 2, 2015 on fraud and forgery charges. (R. 432, 852.) After several days in jail, Plaintiff was transported to Tri-County Healthcare’s Emergency Room in Wadena, after she had been “flailing on the floor” of the jail. (R. 439.) Hospital staff observed “[n]o evidence of seizure” and noted that the spells “appear[ed] to be a panic attack.” (R. 442, 1140.) Plaintiff noted to jail staff that Geodon, an anti-psychotic drug, had been administered in the past for similar spells to beneficial effect. (R. 856.) Hospital staff administered Valium and discontinued Plaintiff’s stimulant prescription because of her observed anxiety levels. (R. 1140.)

         Later in the day on June 8, 2015, Nancy Bernstetter, LICSW, of Northern Pines Mental Health prepared an intervention report at the request of jail staff. (R. 432.) Plaintiff had been reporting auditory and visual hallucinations to jail staff, stating that “[t]he demons are back. The voices are back.” (Id.) Clinical Social Worker Bernstetter noted that Plaintiff’s mental health was complex, given that she “knows what to say to get what she wants, which seems to be release from jail at this current time.” (Id.) CSW Bernstetter also noted that Plaintiff “[t]alks clearly and logically at times, when she is trying to be convincing about her story.” (Id.) Further, CSW Bernstetter observed that Plaintiff “lacks healthy, appropriate coping skills, [but] is able to get what she needs.” (R. 433.) CSW Bernstetter recommended that Plaintiff remain incarcerated and finish her time. (Id.)

         Plaintiff was again transported from Wadena County Jail to the TCHC Emergency Room on June 26, 2015 due to seizure-like activity. (R. 476.) An officer noted that Plaintiff was awake and talking, “shaking both arms and legs during the episode and complaining that she was having another seizure.” (Id.) At the hospital, Dr. Faith opined that Plaintiff’s episodes were “not consistent with seizure activity as she [wa]s able to talk and converse with generalized symptoms.” (R. 478.) Dr. Faith further opined that he suspected the spells were psychogenic episodes and discharged Plaintiff back to jail. (Id.) Plaintiff was negative for hallucinations, confusion, self-injury and agitation. (R. 477.) Plaintiff was nervous, but she was not hyperactive. (Id.)

         Plaintiff was once again brought to the TCHC Emergency Room from Wadena County Jail on June 30, 2015, again after experiencing “seizure type activity.” (R. 470.) On this occasion, Plaintiff was observed to adapt her seizures to her surroundings, “mov[ing] her seizure over after an item was set near her.” (R. 472.) Dr. Duchene opined that Plaintiff’s movements were “likely behavioral, ” as Plaintiff was in jail. (Id.) Plaintiff exhibited normal but slow speech, she was oriented, her cognition and memory were normal, and she exhibited a depressed mood. (Id.) Dr. Duchene accordingly did not administer benzodiazepines and instead encouraged Plaintiff to follow up with a psychiatrist, discharging her back to jail. (Id.)

         On July 13, 2015, Plaintiff met with NP Little for a psychiatric medication management meeting at Woodland Centers. (R. 668.) NP Little observed Plaintiff’s mental status to be generally normal but with poor judgment, fair to poor insight and fair to poor motivation. (R. 669.) NP Little affirmed her earlier diagnoses and continued Plaintiff’s medications generally as prescribed but with an increase of Plaintiff’s clonazepam dosage and the addition of an Ambien trial. (R. 670.) NP Little also instructed Plaintiff to continue attending individual therapy with her therapist. (Id.)

         On August 2, 2015, Plaintiff was evaluated in Rice Memorial Hospital’s Emergency Room due to increased visual and auditory hallucinations and recurrent headaches. (R. 486.) Dr. Scott observed Plaintiff’s mental status to be generally normal outside of her self-reported hallucinations. (R. 487-88.) A drug test came back positive for methamphetamine which Plaintiff explained by noting she had been working cleaning out an old meth lab recently. (R. 486.) However, Plaintiff’s boyfriend stated that she had been using meth the week prior and Dr. Scott noted that “Patient though has been labeled a ‘liar’ according to some old records as well.” (R. 486, 493.) Plaintiff was alert and oriented, her memory was intact (except for a slightly diminished recent memory), her concentration was diminished, she had little difficulty with math, and her speech was normal with no flight of ideas noted. (R. 487-88.) Zyprexa proved helpful in diminishing Plaintiff’s hallucinations, and Dr. Scott eventually arrived at a final diagnosis of Major Depression, Recurrent Type, with a rule out diagnosis of Bipolar Disorder NOS with additional PTSD. (R. 487-89.) Plaintiff discharged from Rice Institute Inpatient care on August 11. (R. 499.)

         Plaintiff was next in the Emergency Room on August 19, 2015, this time in Willmar, Minnesota. (R. 463.) Plaintiff reported to Emergency Room ER complaining of an acute right-sided headache, blurry vision, and sensitivity to light. (Id.) She requested Dilaudid, an opioid pain medication, stating that that was typically effective in controlling her headache. (R. 465.) A physical examination was normal. (Id.) Plaintiff did receive a 1mg dose of Dilaudid along with instructions to follow up with her physician if the headache worsened. (Id.)

         Plaintiff was transported to Benson Hospital’s Emergency Room via ambulance on August 23, 2015, having called emergency services after experiencing further seizurelike episodes. (R. 514.) EMS found Plaintiff’s vitals to be normal but observed generalized shaking in both arms and to some extent both legs; they also found Plaintiff to be initially unresponsive. (Id.) Upon arrival at the ER, hospital staff observed further spells lasting 45-60 seconds and consisting mostly of “generalized shaking of the upper extremities, mainly of [plaintiff’s] hands.” (Id.) Plaintiff was, however, able to communicate effectively after each event. (R. 512.) Plaintiff was administered a total of 17mg of Valium as well as a loading dose of Dilantin, a seizure medication, to no effect. (Id.) Hospital staff noted that the spells “appeared to have no significant effect on her.” (R. 907.) Dr. Richard Horecka told Plaintiff that “none of the characteristics of her seizure activity was consistent with legitimate epilepsy, ” and that he believed the episodes “were being caused volitionally by herself, ” likely to get doses of drugs. (R. 512.) Plaintiff “had little to say after [Dr. Horecka] challenged her on the situation.” (Id.) Dr. Horecka eventually arrived at a diagnosis of Pseudoseizures and Chronic Mental Illness, and Plaintiff was discharged the following morning. (R. 909.)

         On September 14, 2015, Plaintiff met with Mental Health Practitioner Tiffany Miller at Woodland Centers for a Functional Assessment. (R. 650.) Plaintiff reported experiencing depression and anxiety on a regular basis along with a desire to die but no active suicidal ideation. (Id.) Plaintiff further reported being able to keep up with her required mental health treatment even when experiencing symptoms. (Id.) MHP Miller noted that Plaintiff’s “symptoms impact her ability to seek and maintain employment, [to] seek housing, [and] to develop and maintain relationships.” (Id.) MHP Miller also noted that Plaintiff had a history of drug-seeking behavior and that her “mental health symptoms and history leave [her] susceptible to drug abuse and inaccurate reporting regarding drug use and abuse.” (Id.)

         Plaintiff again reported to Rice Memorial Hospital’s Emergency Room on September 28, 2015, complaining of migraine, vomiting, and nausea. (R. 742.) Plaintiff was at that time scheduled to see Dr. Nelson in one week for a neurological consultation related to her seizure-like spells. (Id.) Plaintiff was alert, she had a normal mood and affect and her behavior was normal. (R. 745.) Plaintiff was administered Dilaudid and Benadryl and instructed to continue taking Benadryl as needed for nausea and pain. (R. 745.)

         Plaintiff returned to Rice Memorial Hospital’s Emergency Room the following day, September 29, 2015, reporting auditory hallucinations commanding her to kill herself. (R. 594, 921.) Plaintiff reported experiencing similar hallucinations dating to the age of five and stated that she did not want to act on the commands, but that they became louder if she tried to ignore them. (Id.) Plaintiff was “begging for Geodon” to address the hallucinations and was administered 10mg of Geodon via intramuscular injection. (R. 609.)

         That same day, Plaintiff also described actively experiencing severe depression, manic symptoms, anxiety, panic attacks, PTSD related to her childhood abuse, and dissociative episodes. (R. 594.) Dr. Scott observed Plaintiff’s mental status to be generally normal outside of her self-reported hallucinations and anxious affect. (R. 595.) Dr. Scott also noted that Plaintiff “appear[ed] to try her best to talk physicians into more medicine than what she really needs, ” and that she “was already showing significant improvement at the time of discharge.” (R. 596.) He arrived at a final diagnosis of Major ...


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