United States District Court, D. Rhode Island
RONNYANN M. MOREAU, Plaintiff,
CAROLYN W. COLVIN, ACTING COMMISSIONER OF SOCIAL SECURITY, Defendant.
Ronnyann Moreau, Plaintiff, represented by Morris Greenberg,
Green and Greenberg.
Carolyn W. Colvin, Defendant, represented by Susan D. Beller,
Social Security Administration.
REPORT AND RECOMMENDATION
PATRICIA A. SULLIVAN, Magistrate Judge.
matter is before the Court on Plaintiff's motion for
reversal of the decision of the Commissioner of Social
Security (the "Commissioner"), denying Disability
Insurance Benefits ("DIB") and Supplemental
Security Income ("SSI") under Â§Â§ 205(g) and
1631(c)(3) of the Social Security Act, 42 U.S.C. Â§Â§ 405(g),
1383(c)(3) (the "Act"). Plaintiff contends that the
Administrative Law Judge ("ALJ") erred in his
evaluation of Plaintiff's credibility and that the
ALJ's mental residual functional capacity
("RFC") findings were not supported by
substantial evidence. Defendant Carolyn W. Colvin
("Defendant") has filed a motion for an order
affirming the Commissioner's decision.
matter has been referred to me for preliminary review,
findings and recommended disposition pursuant to 28 U.S.C. Â§
636(b)(1)(B). Having reviewed the entire record, I find no
material legal error and that the ALJ's findings are well
supported by substantial evidence. Accordingly, I recommend
that Plaintiff's Motion to Reverse the Decision of the
Commissioner (ECF No. 10) be DENIED and Defendant's
Motion for an Order Affirming the Decision of the
Commissioner (ECF No. 11) be GRANTED.
alleged disability onset date (March 1, 2012), Plaintiff was
forty years old. Tr. 183. She had earned her GED and worked
fairly consistently until the alleged onset of disability as
a cashier, a leasing specialist, and a customer order clerk.
Tr. 211. Her SSI and DIB applications were filed on June 26,
2012, claiming disability based both on physical impairments
arising from migraines and arm, knee, back, wrist and elbow
pain, and on mental impairments due to "bipolar, fear of
death, depression, anxiety, impulsive
behavior/outbursts." Tr. 210. Her claim of physical
disability was rejected by the ALJ, who found that her
physical impairments were non-severe and that her statements
and testimony to the contrary lacked credibility. Plaintiff
does not challenge these findings; her allegations regarding
physical impairments will not be discussed further in this
report and recommendation.
the period of alleged disability, Plaintiff lived at times
with some, at times with all, of her four children, a
grandchild and unspecified pets. She was the primary
caretaker for the younger children, including participating
in the care of her grandchild. Tr. 279, 354. According to the
medical record and her statements, she engaged in a wide
range of activities, including light chores and laundry,
driving, using public transportation, shopping, reading,
attending her son's graduation and sports events, taking
a vacation, texting friends and socializing with her mother.
See, e.g., Tr. 22-23, 354. Also throughout the period of
disability, in addition to her physical complaints, Plaintiff
was treated for depression and anxiety, primarily by a nurse
working with her primary care physician and by a licensed
mental health counselor, as well as, for a six-month stretch,
by a psychiatrist and once by the staff at Rhode Island
Hospital's ("RIH") partial hospitalization
program ("PHP"). These treating records are replete
with her descriptions of her difficulties with depression and
anger and the challenge of controlling her temper when she is
around other people. See, e.g., Tr. 264, 371, 510, 518.
Notwithstanding these concerns, the record reflects only one
brush with the law - a disorderly conduct charge from an
unspecified time in the past (not during the period of
alleged disability) that resulted either in no incarceration
or an overnight in jail and was expunged. Tr. 354, 368, 375.
Over the course of the relevant period, Plaintiff's
Global Assessment of Functioning ("GAF") score was
assessed by various providers; these scores,
particularly following treatment, generally fell into range
for moderate to mild symptoms or difficulties. Despite her
claims of anger and irritability directed towards other
people, including anger with other patients when she received
treatment in a group setting, the record does not reflect
that Plaintiff engaged in violent or inappropriate behavior
directed towards treatment providers. See, e.g., Tr. 273
(Plaintiff assessed by RIH staff as having cooperative manner
and unremarkable speech); Tr. 369 (Dr. Rashid notes that
speech, language and appearance normal); Tr. 451 (Plaintiff
described by physical therapy provider as "pleasant,
polite, anxious, motivated, cooperative"). Nevertheless,
the mental status examinations reflected in the treating
notes consistently record that her mood and affect are sad,
depressed, anxious, angry, irritable or tearful. See, e.g.,
Tr. 274, 369; see Tr. 294 (Nurse Pio does not do full mental
status examination but does review depression guidelines and
finds Plaintiff meets criteria).
Mental Health History
to onset, Plaintiff was treated in the RIH PHP from March 3
to March 13, 2011, for family stress, depression, social
isolation, tearfulness, and anger outbursts, resulting in her
fear that she would act out on her anger impulses. Tr. 264.
At discharge, staff noted an improvement of her mood and a
reduction of the symptoms of depression, anxiety and anger.
Id . The RIH staff made an intake assessment
reflective of major impairment (GAF 40), but increased their
assessment to moderate symptoms (GAF 55) when she was
discharged ten days later. Tr. 264-74. Shortly after onset,
in May 2012, Plaintiff was admitted again to RIH PHP, but
attended for only five days before being discharged on May 7,
2012, for excessive absences. Tr. 371.
the period of alleged disability, Plaintiff's primary
mental health treating source was Nurse Katelyn Pio, who
worked in the office of Plaintiff's primary care
physician, Dr. Joyce Coppola. Tr. 276-317, 510-58. Nurse
Pio's notes record Plaintiff's subjective complaints
of mood swings, irritability, violent outbursts, and
increased depression and anxiety. Tr. 459, 462, 479. However,
apart from somewhat consistently making clinical inquiry into
the diagnostic criteria for depression, e.g., Tr. 300, 303,
these notes do not reflect that a mental status examination
or other objective testing or clinical methods were ever
deployed, except that Nurse Pio occasionally recorded a GAF
assessment. Tr. 297, 300, 531, 536, 553, 557. These GAF
scores range from GAF 51 (moderate symptoms) to GAF 75
(slight symptoms). Id . Nurse Pio prescribed
medication and referred Plaintiff to counseling. By mid-2012
and thereafter, Nurse Pio's notes mostly reflect that
Plaintiff was doing well, although at some appointments she
reported difficulties. Tr. 306 ("she feels like she has
better control of her emotions"); Tr. 315 ("feeling
well"); Tr. 510 ("two episodes of destructive
behavior... throwing objects, punching walls"); Tr. 515
("feeling well"); Tr. 539 ("feeling not well,
" son in jail, daughter's house foreclosed,
grandchild molested); Tr. 556 ("depression more
during the period of alleged disability, Plaintiff apparently
met regularly for therapy with a licensed mental health
counselor, Mr. Phillip Lowry. Tr. 318-19, 562-65. Apart from
his two opinions, which were submitted in August 2012 and May
2014, it is impossible to know what clinical observations and
findings he might have made or how frequently he saw
Plaintiff because none of his treating notes were
submitted. On January 29, 2013, Plaintiff started
treatment with an RIH psychiatrist, Dr. Wasim Rashid. Tr.
368-70. At intake, Dr. Rashid diagnosed major depressive
disorder, recurrent, moderate, estimated her GAF at 50 and
prescribed Remeron; after he began treatment, her GAF score
was increased to and sustained at 52 (moderate symptoms). Tr.
358-65. Except for his observations of angry mood and thought
content reflective of worthlessness and guilt, Dr.
Rashid's findings on mental status examinations were
generally within normal limits. Tr. 358-70. For reasons not
disclosed in the record, the treating relationship with Dr.
Rashid ended on July 2, 2013. Tr. 358.
August 6, 2012, the counselor, Mr. Lowry, submitted a letter
in support of Plaintiff's disability claim in which he
reported diagnoses of major depressive disorder, recurrent,
moderate, generalized anxiety disorder, parent-child
relational problem, and personality disorder not otherwise
specified, together with a GAF score of 51 (moderate
symptoms). Based on her "enduring pattern of very poor
interpersonal functioning and impulse control, " he
opined that "these behaviors will impact her ability to
work by: not being able to get along with co-workers, being
unable to accept instructions and criticisms from any
supervisor, and being unable to interact appropriately with
the general public" and that "[h]er ability to
follow simple instructions when angered would be poor."
September 21, 2012, Nurse Pio completed a one-page form
opining that Plaintiff was "significantly limited"
(the worst category on the form) in every mental health
function listed on the form. Tr. 381. These findings resulted
in her conclusion that Plaintiff could not engage in any
employment, education, or skills training on a daily or
weekly basis. Tr. 381. Nurse Pio's contemporaneous
treatment note is completely inconsistent: on September 17,
2012, she wrote that "[Plaintiff] is feeling well... is
independent in all ADL's... is tolerating all medications
well... [and] has no acute complaints at this time." Tr.
February 7, 2013, Plaintiff was examined by SSA consultative
psychiatrist Dr. Ghulam Mustafa Surti. Tr. 353-56. Plaintiff
told Dr. Surti that her depressive symptoms were a 9 on a
scale of 1 to 10. Tr. 353. On mental status examination,
Plaintiff was able to perform serial 3s from 100 to 79 with
no mistakes; memory registration was three out of three, but
recall was one out of three. Tr. 354. Her affect was sad and
tearful and her mood was depressed; her speech and thought
process were linear and goal-directed. Tr. 354. Dr. Surti
diagnosed major depression, recurrent, severe, and estimated
her GAF at 45 to 50. Tr. 355.
October 29, 2013, State agency consultant psychologist
Clifford Gordon, Ed.D., reviewed Plaintiff's records as
of that date and determined that she was suffering various
severe mental impairments: affective, anxiety, and
personality disorders. Tr. 105, 117. His RFC opinion
concludes that Plaintiff's memory and concentration
limitations would limit her to "simple instructions
only, " but that she "retains ability to complete a
normal eight-hour work day and normal work week, "
although her moodiness and violent outbursts would restrict
her to "work in [a] situation where she is more involved
with production/objects and less involved in social[ly]
demanding situation." Tr. 108, 120.
24, 2014, Mr. Lowry submitted a second letter, this time with
two RFC forms. Tr. 562-65. In the first, he found that most
of Plaintiff's limitations were moderate, but that she
has marked limitations in her abilities to deal with detailed
instructions or to work with others, including the general
public, supervisors or co-workers. Tr. 559-60. In the other
RFC, he made similar findings, in addition to the conclusion
that she has a moderate restriction of daily activities. Tr.
563-64. As the source for these opinions, he mentions his
missing progress notes, but also noted that he did not rely
on any psychological evaluation because none had been
obtained. Tr. ...