United States District Court, D. Rhode Island
MEMORANDUM AND ORDER
JOHN J. McCONNELL, Jr., District Judge.
Plaintiff Susan Cookson brings this action for judicial review of the Social Security Commissioner's ("the Commissioner") final decision, as issued in accordance with the ruling of an Administrative Law Judge ("ALJ"), denying her claim for Disability Income Benefits ("DIB") and Supplemental Security Income ("SSI") benefits under Titles II and XVI of the Social Security Act. Ms. Cookson seeks reversal without or, alternatively, with a remand of the determination that she is not entitled to Social Security (ECF No. 5), while the Commissioner seeks an affirmance of the ALJ's decision. (ECF No. 8). After a thorough review, this Court finds that substantial evidence supports the Commissioner's finding that Ms. Cookson was not disabled during the relevant time period.
Ms. Cookson is a high school educated woman who has previously worked as an inventory clerk and a nanny. (Tr. at 71-75). She currently packs prescription medication into bottles at home for her partner's pharmacy business approximately five hours per week in order to remain covered by his insurance policy. ( Id. at 72).
Ms. Cookson's medical issues are rooted in an April 2001 laparoscopic cholecystectomy that was complicated by an abdominal aortic bleed. ( Id. at 371). This surgery sent her on a path of continual pain management for the next decade. She saw Dr. Pradeep Chopra in October 2007 for abdominal and muscle spasms. ( Id. at 418-23). From 2002 through 2010, Dr. John Phillip, a laparoscopic surgeon, prescribed Vicodin and OxyContin for her abdominal and flank pain. ( Id. at 793-806). In May 2009, he said he would no longer do so and referred her to doctors in Boston for pain management. ( Id. at 801). In November 2010, Dr. Phillip performed a laparoscopy and lysis of adhesions along with a Tru-Cut liver biopsy. ( Id. at 795-96). Post-operation, Ms. Cookson presented with a soft, flat, and non-tender abdomen. ( Id. at 794).
Another doctor that she saw for pain during the 2008 through 2010 time period was Dr. Kameel Garas, a pain specialist at Lahey Clinic. ( Id. at 523-45). In 2008, he advised Ms. Cookson to stay active and to consult with a behavioral medical specialist to explore the possibility of using non-pharmaceutical methods for treating her chronic pain. ( Id. at 534). He also gave her nerve blocks, managed her medications, and on four occasions in 2008 and 2009 pulsed radio frequency ablation. Dr. Garas's notes indicate that Ms. Cookson reported fairly good relief after these treatments, but that her symptoms of anxiety and depression were exacerbating her perception of pain. ( Id. at 534).
Ms. Cookson saw Dr. Chopra again in 2011 for left flank and right groin pain. ( Id. at 935-940). She denied depression and indicated that the opioid medications she was taking relieved her pain only when she was inactive. ( Id. at 935). Dr. Chopra concluded that she was disabled because no conservative measures were effective at relieving her pain. ( Id. at 940).
Ms. Cookson also saw Dr. Albert Marano, a neurologist, for her pain. Dr. Marano managed Ms. Cookson's use of narcotics during that time period. In July of 2011, he concluded that she was not able to work, despite the fact that he had not examined Ms. Cookson since 2007. ( Id. at 811). When he saw her again in 2013, Dr. Marano's notes indicate she walked daily on a trip to Florida in March, but that she reported more pain when she was more active. ( Id. at 934). She is quoted in his notes as saying that Fentanyl "saved her life." ( Id. ) In June 2013, Ms. Cookson told Dr. Marano that she suffered depression and anxiety due to stress in her relationship. ( Id. at 933). Dr. Marano prescribed two blocks for left groin pain. ( Id. at 934).
In August 2013, Ms. Cookson saw Dr. Stephen D'Amato who told her to continue taking Fentanyl, Ativan, and Xanax for pain. ( Id. at 950). His records from that visit do not contain any details of physical examinations, but he advised her to apply for total disability. ( Id. at 952). Dr. D'Amato indicated in a supplemental questionnaire as to her residual functional capacity that her psychological symptoms would cause moderately severe limits in dealing with work. ( Id. at 954).
A psychological undercurrent runs through Ms. Cookson's medical records, but those symptoms were largely unaddressed. Her primary care physician, Dr. Robert Cohen, treated her between March 2008 and 2011. During that period, he managed her medications for Generalized Affective Disorder and Attention Deficit Disorder. ( Id. at 769-75). She denied depression or anxiety and her mental status and memory exams were normal. ( Id. at 769). Dr. Cohen prescribed her Ativan in March 2011 for a trip to Florida. ( Id. ) She treated with Tina Plaszek, a Licensed Mental Health Counselor, between January and June of 2011 who diagnosed her with an adjustment disorder with mixed anxiety and depressed mood. ( Id. at 738-49). Ms. Cookson had a GAF of 55-63 and her initial assessment of moderate difficulties was reduced to mild difficulties upon discharge by Ms. Plaszek. ( Id. ) In March 2012, Ms. Cookson had inpatient treatment after a suicide attempt. ( Id. at 866-77). Her GAF at discharge was 50. ( Id. at 868). In May of 2012, Dr. Kristin Stone, a psychologist, gave Ms. Cookson a psychological evaluation. ( Id. at 886-97). Ms. Stone diagnosed her with a pain disorder with psychological factors. ( Id. ) Ms. Cookson had one follow-up visit, but the records for that visit contain no details of diagnosis or treatment. ( Id. at 879).
Pursuant to her August 24, 2009 disability application, Ms. Cookson was examined by Dr. Parsons, a psychologist. ( Id. at 612). During that exam in 2010, she denied depression and anxiety, but said she is upset about her pain. ( Id. at 617). Her responses pattern to testing was indicative of only mild problems with depression. ( Id. at 616). Dr. Parsons diagnosed her with adjustment disorder with depression and a GAF of 60. ( Id. at 619). He recommended referral to a pain clinic and outpatient psychotherapy. ( Id. ).
After being denied initially and at the rehearing stage, she requested a hearing before an Administrative Law Judge ("ALJ"). ( Id. at 169). The hearing was held and she was found not disabled at Step Five on September 21, 2012. ( Id. at 132). In his decision, the ALJ focused on three severe impairments - neuropathic pain syndrome, asthma, and adjustment disorder. ( Id. at 138). Ms. Cookson requested a review by the Appeals Council, who directed the ALJ to obtain additional evidence and medical and vocational opinions relating to Ms. Cookson's depression and anxiety disorders based on its finding that "[t]he claimant has also alleged severe chronic pain with depression, and her symptoms have been observed by Social Security staff." ( Id. at 156).
Pursuant to this remand, Ms. Cookson saw Dr. Francis Sparadeo for a psychological evaluation to assess her emotional status relative to chronic pain. ( Id. at 941-49). He performed a battery of tests and determined that she had clinically significant depression and anxiety relative to her pain with a GAF of 45-55. ( Id. at 947). He concluded that she was totally disabled and unable to work. ( Id. )
The ALJ held a hearing on October 18, 2013. ( Id. at 92). He engaged a medical expert, Dr. John Ruggiano, who testified at the hearing. The substance of Dr. Ruggiano's testimony was that Ms. Cookson had no clear diagnosis of a mental disorder so no clear secondary functional limitations relative to a mental health impairment. ( Id. at 104-06). He also did not find functional limitations because she had almost no psychological treatment record on which to base a diagnosis or Residual Functional Capacity ("RFC"). ( Id. ) Dr. Pella also testified as a medical expert on remand. ( Id. at 99). He found, based on the complete medical record, minimal objective findings to substantiate her complaints of pain. The only objective findings were scar tenderness and decreased range of motion related to her pain. ( Id. at 101-02). Dr. Pella opined that any functional limitations other than those related to the two objective findings would be based on subjective complaints and would come down to the ALJ's assessment of Ms. Cookson's credibility. ( Id. )
After the hearing and based on the additional evidence and testimony from medical experts and a vocational expert, the ALJ denied Ms. Cookson's application again, finding that her only severe impairment was asthma. ( Id. at 31-54). Ms. Cookson submitted additional evidence - January 2014 records related at an MRI - to the Appeals Council in support of her appeal. ( Id. at 16-27). The Appeals Council considered those records, but denied Ms. Cookson's request for review so, on ...