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Laing v. Commissioner of Social Security

United States District Court, S.D. New York

March 9, 2017

ANGELICA LAING, Plaintiff,
v.
COMMISSIONER OF SOCIAL SECURITY, Defendant.

          OPINION AND ORDER

          HENRY PITMAN, United States Magistrate Judge

         I. Introduction

         Plaintiff Angelica Laing brings this action pursuant to Section 205(g) of the Social Security Act (the "Act"), 42 U.S.C. § 405(g), seeking judicial review of a final decision of the Commissioner of Social Security (the "Commissioner") denying her application for supplemental security income ("SSI"). The parties have consented to my exercising plenary jurisdiction pursuant to 28 U.S.C. § 636(c). Plaintiff and the Commissioner have both moved for judgment on the pleadings pursuant to Rule 12(c) of the Federal Rules of Civil Procedure. For the reasons set forth below, plaintiff's motion (Docket Item ("D.I.") 22) is granted and the Commissioner's motion (D.I. 16) is denied.

         II. Facts[1]

         A. Procedural Background

         Plaintiff filed an application for SSI on September 30, 2012, alleging that she had been disabled since February 22, 2011 (Tr. 109-17). Plaintiff completed a "Disability Report" in support of her claim for benefits (Tr. 135-41). Plaintiff claimed that she was disabled due to depression, aggression, a propensity for violence and aural hallucinations, i.e., hearing voices (Tr. 136). Plaintiff reported that she took quetiapine for insomnia (Tr. 138).

         On December 12, 2012, the Social Security Administration (the "SSA") denied plaintiff's application, finding that she was not disabled (Tr. 54-57). Plaintiff timely requested and was granted a hearing before an Administrative Law Judge (an "ALJ") (Tr. 58-60). ALJ Mark Solomon held a hearing on March 18, 2014 (Tr. 24-52). The ALJ reviewed the claim de novo and, in a decision dated May 22, 2014, determined that plaintiff was not disabled within the meaning of the Act from September 30, 2012 to the date of the decision (Tr. 12-20). The ALJ's decision denying benefits became final on August 21, 2015 when the Appeals Council denied plaintiff's request for review (Tr. 1-3). Plaintiff commenced this action on October 1, 2015, seeking review of the Commissioner's decision (Complaint, filed Oct. 1, 2015 (D.I. 2)).

         B. Plaintiff's Social Background

         Plaintiff was born in 1979 and was 34 years old at the time of her hearing before the ALJ (Tr. 109). She was placed into foster care at age nine; her mother was a drug addict and her father was a drug dealer (Tr. 40, 170). She attended special education classes in high school and graduated; she did not attend college (Tr. 29, 137).

         At her hearing before the ALJ, plaintiff testified that she had been receiving public assistance, but it had been terminated without notice (Tr. 29-30). She previously participated in the Work Experience Program (the "WEP") three days a week in order to receive her public assistance grant, and she had been participating in that program since June 2000 (Tr. 30-31). As part of the program, plaintiff mopped floors, emptied trash and set up rooms for different events (Tr. 45). For the other two days of the work week, plaintiff would search for jobs (Tr. 30-31). Plaintiff was discharged from WEP because of excessive absences (Tr. 32, 37, 43). According to plaintiff, she was absent because she had to take care of her children, ages 12 and 15 (32-33, 37).[2] If plaintiff did not have to take care of her children, plaintiff testified that she could have attended the program (Tr. 37-38). Plaintiff's participation in WEP was the only work she ever had (Tr. 45-46, 137).

         C. Plaintiff's Medical Background

         1. Records that Pre-Date the Relevant Time Period

         Dr. Marc Vital-Herne, M.D., treated plaintiff from November 2006 through January 2009 for depression (Tr. 165-70). During that time, plaintiff reported that she heard voices and believed people were talking about her (Tr. 167-69). Dr. Vital-Herne noted that plaintiff did not experience overt delusions (Tr. 166-67). During his treatment of plaintiff, Dr. Vital-Herne prescribed Prozac, Remeron and Haldol (Tr. 165-67).

         2. Records for the Relevant Time Period

         a. Dr. Lisa Turtz, M.D.

         On August 27, 2012, plaintiff visited University Behavioral Associates of the Montefiore Behavioral Care Integrated Provider Association, where Dr. Lisa Turtz, M.D., completed an Outpatient Clinical Assessment Form (Tr. 180-84). Plaintiff reported to Dr. Turtz that she had been treated for recurrent major depression with psychotic features in 2009 (Tr. 180). She stated that she felt less depressed and did not have hallucinations while taking Prozac, Remeron and Haldol (Tr. 180).

         Plaintiff reported that she had had chronic depression since childhood (Tr. 180). Her symptoms included a depressed mood, anhedonia, [3] feelings of worthlessness/guilt, decreased energy and appetite, insomnia and impaired concentration (Tr. 180). Dr. Turtz noted that plaintiff was talking and moving slowly (Tr. 180).

         Plaintiff also reported that nearly every day over the previous two weeks, she had little interest or pleasure in doing things, felt depressed, had trouble sleeping and eating, felt tired or had little energy and was either lethargic or fidgety (Tr. 189). She also reported that for more than seven of the prior fourteen days, she felt bad about herself, had trouble concentrating on such things as reading the newspaper or watching television and had thoughts of being better off dead or wanting to hurt herself (Tr. 189).

         Dr. Turtz completed a mental status evaluation (Tr. 182-83). She noted that plaintiff was well groomed and cooperative (Tr. 182). Additionally, plaintiff had full range affect that was appropriate to content (Tr. 182). Plaintiff's mood was depressed, her expressive speech/language was coherent, her receptive speech/language revealed age appropriate comprehension of spoken words, her psychomotor activity was normal and her thought process was circumstantial (Tr. 182-83). Plaintiff was alert and oriented to time, place and person (Tr. 183). She had a severe impairment in impulse control; as noted by Dr. Turtz, plaintiff attacked her father with a screwdriver in 2003 (Tr. 183). Plaintiff denied suicidal or homicidal ideation, although she had had thoughts of wanting to die since childhood (Tr. 183).[4] Plaintiff reported that she experienced aural and visual hallucinations four to five times a week (Tr. 183). She also experienced paranoid ideation; plaintiff thought people knew everything about her and could read her mind (Tr. 183). Dr. Turtz diagnosed plaintiff with major depression, recurrent and severe, with psychotic features versus schizoaffective disorder and assessed plaintiff a Global Assessment of Functioning ("GAF") score of 50 (Tr. 183-84).[5] Dr. Turtz prescribed Seroquel (Tr. 183).

         Plaintiff called Dr. Turtz on September 10, 2012 (Tr. 185). She reported that she felt better on Seroquel and did not believe that she needed an increased dosage (Tr. 185). Plaintiff was not having any aural or visual hallucinations (Tr. 185). She also reported that although she continued to experience paranoid ideation, such paranoia bothered her less because of the Seroquel (Tr. 185).

         Plaintiff returned to Dr. Turtz on September 24, 2012 (Tr. 185). Plaintiff reported that she was taking her medication and that she had only one to two episodes of aural hallucinations and one to two episodes of visual hallucinations since her last visit (Tr. 185). Plaintiff also felt "slightly less" paranoid on her medication (Tr. 185). She continued to have thoughts of wanting to die, but they occurred less frequently, which plaintiff attributed to the Seroquel (Tr. 185). Dr. Turtz increased plaintiff's dosage of the medication (Tr. 185).

         On October 15, 2012, plaintiff reported to Dr. Turtz that she felt calmer on the increased dosage of Seroquel (Tr. 185). Plaintiff was experiencing both aural hallucinations and visual hallucinations two to three times a week (Tr. 185-86). Plaintiff described the aural hallucinations as voices calling her name or threatening her and the visual hallucinations as flashes of light and as shadows in the shape of bodies (Tr. 186). Dr. Turtz referred plaintiff to an ophthalmologist for the flashes of light she was seeing (Tr. 186). Plaintiff also reported that she continued to experience paranoia, but felt that Seroquel was more helpful than her previous medications (Tr. 186). Plaintiff also stated that she avoided a physical altercation with another parent at her son's after-school program only because someone intervened (Tr. 186). Dr. Turtz again increased plaintiff's dosage of Seroquel (Tr. 186).

         On November 19, 2012, plaintiff reported that she continued to feel calmer and less paranoid on Seroquel, although she continued to feel that people were talking about her and disrespecting her (Tr. 187). Plaintiff reported that she experienced aural hallucinations twice per week and visual hallucinations four times per week (Tr. 187). Plaintiff had not had any angry outbursts since her last visit (Tr. 187). Dr. Turtz increased plaintiff's dosage of Seroquel (Tr. 187).

         On December 17, 2012, plaintiff reported that she was feeling better on the increased dosage of Seroquel (Tr. 242). Plaintiff no longer had any aural hallucinations (Tr. 242). She continued to see shadows or black dots, but stated that she would see an ophthalmologist (Tr. 242). Plaintiff felt less afraid and less paranoid, and her feeling that people were talking about her was "much milder" (Tr. 242). She no longer felt that people were disrespectful or threatening towards her (Tr. 242). Moreover, she had not had any angry outbursts (Tr. 242).

         On March 11, 2013, plaintiff reported that she continued to feel better on Seroquel (Tr. 243). She had had one or two aural hallucinations since her last visit; during those episodes, the voices she heard were critical of her and talked about hitting her (Tr. 243). Plaintiff also reported that she constantly saw shadows of people and black dots, though she reported that she had an appointment to see an ophthalmologist (Tr. 243). She also continued to feel paranoid and was afraid that people would hurt her (Tr. 243). Although she continued to have episodes of anger, they were milder (Tr. 243). Plaintiff reported that she got angry a week and a half before the appointment because a woman on the bus pushed her son; plaintiff yelled at the woman and felt like physically attacking her, but plaintiff was able to control that impulse (Tr. 243-44). Plaintiff continued to have thoughts of wanting to die four to five times a week (Tr. 244). Dr. Turtz increased plaintiff's dosage of Seroquel yet again (Tr. 244).

         Plaintiff next saw Dr. Turtz on April 15, 2013. Plaintiff felt she was stable on the increased dosage of Seroquel (Tr. 244). Since her last visit, plaintiff had only one aural hallucination (Tr. 244). She continued to see shadows and black dots, though she had an appointment to see an ophthalmologist (Tr. 244). Plaintiff reported that she was calmer and less paranoid, although she did get angry the morning of the appointment because two school girls on the bus had called her names (Tr. 244). Plaintiff reported that she was no longer having thoughts of wanting to die (Tr. 244).

         Dr. Turtz next examined plaintiff on May 20, 2013. Dr. Turtz reported that plaintiff was at a "fairly stable baseline" on the current dosage of Seroquel (Tr. 197). Dr. Turtz noted that plaintiff continued to have visual hallucinations every day, though she was scheduled to see an ophthalmologist (Tr. 194, 201). Plaintiff also had "far fewer" episodes of aural hallucinations (Tr. 194). Dr. Turtz further noted that plaintiff felt less angry and less paranoid as long as she complied with her medication regimen (Tr. 194, 201). Additionally, plaintiff had fewer thoughts of wanting to die (Tr. 194).

         Dr. Turtz found plaintiff to be well-groomed, cooperative and depressed (Tr. 196). Plaintiff's psychomotor and speech were normal and her affect was appropriate (Tr. 196). Plaintiff's thought process was logical and goal-directed (Tr. 196). She had paranoid ideation, visual hallucinations and aural hallucinations (Tr. 196). Plaintiff also had normal cognition and was oriented to time, place, person and situation (Tr. 196). Plaintiff had average intelligence, normal reasoning and intact memory, judgment, insight, attention/concentration, executive functioning and language (Tr. 196). Plaintiff's GAF score was 50, and Dr. Turtz diagnosed plaintiff with schizoaffective disorder (Tr. 197).

         On July 1, 2013, plaintiff returned to Dr. Turtz. Dr. Turtz reported that plaintiff remained stable on Seroquel (Tr. 198). Plaintiff had occasional paranoid thoughts and experienced aural hallucinations twice per week (Tr. 198). Dr. Turtz also noted that plaintiff possibly had floaters, [6] as opposed to visual hallucinations, and that plaintiff planned to see an ophthalmologist (Tr. 198-99). Plaintiff no longer had thoughts of wanting to die (Tr. 199).

         Dr. Turtz's mental status examination of plaintiff yielded the same results as the examination she conducted on May 20, 2013 (Tr. 200). Again, plaintiff's GAF score was 50, and Dr. Turtz diagnosed her with schizoaffective disorder (Tr. 200).

         On August 5, 2013, Dr. Turtz reported that plaintiff remained stable on Seroquel (Tr. 213). Plaintiff had occasional paranoid thoughts and one to two aural hallucinations since her last visit (Tr. 213). Dr. Turtz also reported that plaintiff had seen an ophthalmologist and had been diagnosed with a cataract in her right eye (Tr. 213). Plaintiff no longer had any thoughts of wanting to die (Tr. 213). Dr. Turtz also noted that plaintiff had started a job training/job search program (Tr. 213).

         Dr. Turtz's August 5, 2013 mental status examination of plaintiff yielded the same results as her previous examinations on May 20, 2013 and July 1, 2013 (Tr. 214). Again, plaintiff's GAF score was 50, and she was diagnosed with schizoaffective disorder (Tr. 214).

         Plaintiff saw Dr. Turtz again on October 28, 2013. Dr. Turtz noted that plaintiff remained stable on Seroquel (Tr. 219). Plaintiff had occasional paranoid thoughts and aural hallucinations one or two times per month (Tr. 219). Plaintiff underwent cataract and laser surgery in September 2013 and no longer saw black dots or otherwise experienced visual hallucinations (Tr. 219). Plaintiff no longer had thoughts of wanting to die (Tr. 219). Dr. Turtz noted that plaintiff was involved in WEP (Tr. 219).

         Dr. Turtz's mental status examination of plaintiff yielded the same results as her previous examinations (Tr. 220). Plaintiff's GAF score was again 50, and Dr. Turtz diagnosed her with schizoaffective disorder (Tr. 221).

         Plaintiff returned to Dr. Turtz on January 13, 2014 and reported that she ran out of Seroquel one or two months beforehand (Tr. 223). While off the medication, plaintiff had paranoid thoughts on a daily basis and experienced aural hallucinations and thoughts of wanting to die (Tr. 223). Plaintiff no longer had visual hallucinations after treatment by the ophthalmologist (Tr. 223). Dr. Turtz noted that plaintiff was participating in WEP (Tr. 223). She also indicated that plaintiff had a tendency to get agitated, angry and irritable if someone was condescending to her at work, although she was less irritable and angry when she was taking her medication (Tr. 223).

         On mental status examination, plaintiff was well-groomed, cooperative and depressed (Tr. 224). Plaintiff's psychomotor and speech were normal and her affect was appropriate (Tr. 224). Plaintiff's thought process was logical and goal-directed (Tr. 224). She was experiencing paranoid ideation and aural hallucinations (Tr. 196). Plaintiff also had normal cognition and was oriented to time, place, person and situation (Tr. 224). Plaintiff had average intelligence, normal reasoning and intact memory, judgment, insight, attention/concentration, executive functioning and language (Tr. 224-25). Dr. Turtz renewed plaintiff's prescription for Seroquel (Tr. 223).

         b. Dr. Arlene Broska, Ph.D.

         At the request of the SSA, Dr. Arlene Broska, Ph.D., performed a consultative examination of plaintiff on November 14, 2012. Dr. Broska noted that plaintiff came to the appointment by herself on public transportation (Tr. 176). Plaintiff reported that she lived with her two children (Tr. 176).

         Plaintiff reported that she had difficulty falling asleep (Tr. 176). Her appetite varied, and she often felt sad (Tr. 176). Plaintiff reported strained family relationships and a difficult childhood (Tr. 176). She stated that she got irritable, angry and anxious and that she smoked cigarettes when stressed (Tr. 176-77). Plaintiff often felt that people did not want to help her and that they only judged and provoked her (Tr. 176). She felt that she could not trust people and that people brought problems to her (Tr. 177). Plaintiff reported that she got into many arguments, which sometimes led to physical altercations (Tr. 176). She also reported that she always worried that something bad would happen to her children (Tr. 177). Plaintiff also stated that she felt as if people were talking about her, though she knew they were just involved in their own conversations (Tr. 177). However, plaintiff would react to this feeling, which led to problems (Tr. 177).

         Plaintiff reported that she was able to dress, bathe and groom herself (Tr. 178). She cooked and prepared food five times a week, cleaned and did laundry once a week, shopped twice a week and traveled independently on public transportation (Tr. 178). Plaintiff did ...


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