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Bedenbaugh v. Saul

United States District Court, D. South Carolina

September 18, 2019

Kristie Michelle Bedenbaugh, Plaintiff,
v.
Andrew M. Saul, [1]Commissioner of Social Security Administration, Defendant.

          REPORT AND RECOMMENDATION

          Shiva V. Hodges United States Magistrate Judge

         This appeal from a denial of social security benefits is before the court for a Report and Recommendation (“Report”) pursuant to Local Civ. Rule 73.02(B)(2)(a) (D.S.C.). Plaintiff brought this action pursuant to 42 U.S.C. § 405(g) and § 1383(c)(3) to obtain judicial review of the final decision of the Commissioner of Social Security (“Commissioner”) denying her claim for Disability Insurance Benefits (“DIB”). The two issues before the court are whether the Commissioner's findings of fact are supported by substantial evidence and whether he applied the proper legal standards. For the reasons that follow, the undersigned recommends that the Commissioner's decision be reversed and remanded for further proceedings as set forth herein.

         I. Relevant Background

         A. Procedural History

         On January 5, 2015, Plaintiff protectively filed an application for DIB in which she alleged her disability began on December 20, 2013. Tr. at 147- 50. Her application was denied initially and upon reconsideration. Tr. at 93- 96, 101-06. On June 29, 2017, Plaintiff had a hearing before Administrative Law Judge (“ALJ”) Nicholas Walter. Tr. at 29-62 (Hr'g Tr.). The ALJ issued an unfavorable decision on November 17, 2017, finding Plaintiff was not disabled within the meaning of the Act. Tr. at 9-28. Subsequently, the Appeals Council denied Plaintiff's request for review, making the ALJ's decision the final decision of the Commissioner for purposes of judicial review. Tr. at 1-6. Thereafter, Plaintiff brought this action seeking judicial review of the Commissioner's decision in a complaint filed on October 16, 2018. [ECF No. 1].

         B. Plaintiff's Background and Medical History

         1. Background

         Plaintiff was 42 years old at the time of the hearing. Tr. at 35. She completed high school. Tr. at 38. Her past relevant work (“PRW”) was as an accounting clerk, a tax auditor, a court clerk, and a loan clerk. Tr. at 58. She alleges she has been unable to work since December 20, 2013. Tr. at 42.

         2. Medical History

         On January 9, 2014, Plaintiff presented to Joseph Friddle, P.A. (“P.A. Friddle”), for follow up for bipolar I disorder. Tr. at 281. She reported stable mood and good sleep and denied psychosis, suicidal ideation, and homicidal ideation. Id. She complained of stress. Id. P.A. Friddle indicated normal findings on mental status exam, aside from poor judgment. Id. He changed Plaintiff's Lamictal prescription to 100 mg twice a day and continued Prozac and Seroquel. Id.

         On January 14, 2014, Plaintiff reported stiffness lasting three hours, fatigue, weight gain, poor sleep, dry eyes, shortness of breath, and pain in her legs, arms, hands, lower back, and neck. Tr. at 392. She indicated she was unable to afford Lyrica and was taking no medication for pain. Id. She stated she had stopped working because of stress. Id. She indicated she had been walking and stretching. Id. Rheumatologist Mayur Patel, M.D. (“Dr. Patel”), noted he was only able to prescribe limited medications because of Plaintiff's bipolar disorder. Id. He observed Plaintiff to have greater than 12 tender points, but noted no other abnormalities on physical exam. Tr. at 392-93. He stated Plaintiff had experienced cognitive decline. Tr. at 393. He indicated a diagnosis of fibromyalgia, instructed Plaintiff to engage in regular exercise, and prescribed Flexeril 5 mg and Tramadol 50 mg three times daily for pain. Id.

         On May 12, 2014, Plaintiff reported five hours of stiffness, fatigue, weight gain, poor sleep, dry eyes, eye pain, cough, shortness of breath, chest pain, nausea, vomiting, diarrhea, reflux symptoms, scapular muscle tenderness, pain in her legs and feet, stiffness in her elbows, and difficulty rising from a squatting position. Tr. at 395. She indicated she had stopped working because of pain and complained her medications were too expensive. Id. Dr. Patel observed Plaintiff to have greater than 12 tender points, but noted no other abnormalities on physical exam. Tr. at 395-96. He discontinued Flexeril, prescribed Tizanidine 2 mg twice daily, and continued Tramadol. Tr. at 396. He advised Plaintiff to follow up with her primary care physician for dyspnea. Id.

         On July 10, 2014, Plaintiff continued to be pleased with her medications. Tr. at 282. P.A. Friddle indicated normal findings on mental status examination, aside from poor judgment. Id.

         Plaintiff presented to Spartanburg Regional Emergency Center for chest pain on August 24, 2014. Tr. at 285. A chest x-ray and cardiac enzymes were normal. Id.

         On September 11, 2014, Plaintiff reported she had discontinued Tramadol, Lyrica, and Tizanidine because one of the medications was making her sick and causing drowsiness. Tr. at 397. She complained of pain all over. Id. Dr. Patel noted greater than 12 tender points and flat affect, but no other abnormalities on physical exam. Tr. at 397-98. He instructed Plaintiff to stop Flexeril and Tizanidine, hold Tramadol, and take Lyrica 75 mg twice daily. Tr. at 398. He stated he might need to refer Plaintiff to a pain management specialist. Id.

         Plaintiff was transported to Wallace Thomson Hospital on September 29, 2014. Tr. at 339. She admitted that she had overdosed on medication in a suicide attempt. Id. She had two seizures while in the emergency room and was subsequently nonresponsive. Id. The attending physician admitted Plaintiff to the intensive care unit with acute respiratory failure, aspiration pneumonia, septic shock, drug overdose, bipolar disorder with depression, suicidal actions, metabolic and lactic acidosis, multiple seizures, elevated ammonia level, and herpes zoster. Tr. at 333. He discharged Plaintiff to an inpatient psychiatric facility on October 13, 2014, after her conditions stabilized. Tr. at 336.

         Plaintiff was involuntarily committed to Patrick B. Harris Psychiatric Hospital from October 13 through October 28, 2014. Tr. at 382-88. Upon admission, she reported feeling depressed over the prior year. Tr at 382. Psychiatrist Amara Chudhary, M.D. (“Dr. Chudhary”), prescribed Venlafaxine ER 150 mg, Topamax 75 mg, Latuda 20 mg, Lamictal 50 mg, and Protonix 40 mg. Id. Plaintiff reported improvement and denied side effects from medication. Tr. at 382-83. Dr. Chudhary recommended Plaintiff's outpatient psychiatrist continue to titrate Lamictal up to an optimal dose of 200 mg. Tr. at 383. She also instructed Plaintiff's roommate to maintain her medications and dispense them to her at the appropriate times. Id. She diagnosed bipolar disorder, not otherwise specified (“NOS”) and pain disorder associated with both psychological factors and general medical condition. Id. She observed Plaintiff to have no abnormalities on mental status exam and assessed a global assessment of functioning (“GAF”)[2] score of 65[3] at the time of discharge. Id. She noted Plaintiff was court-ordered to follow up with an outpatient mental health provider. Tr. at 384.

         Plaintiff presented to Union Mental Health for an initial clinical assessment on November 4, 2014. Tr. at 406. James W. Platt, M. Div. (“Mr. Platt”), indicated the following abnormal findings on mental status exam: tearful affect; anxious, depressed mood; difficulty with word-finding and organizing thoughts; decreased appetite; and phobias. Tr. at 408-09. He recommended individual treatment with cognitive behavioral therapy (“CBT”) twice a month and indicated Plaintiff should consider group therapy, as well. Tr. at 409.

         Plaintiff presented to Austin McElhaney, M.D. (“Dr. McElhaney”), on November 7, 2014. Tr. at 389. Dr. McElhaney noted no abnormalities on physical exam. Tr. at 390. He planned to slowly taper Plaintiff off Topamax because she had no history of seizures prior to her suicide attempt. Tr. at 391. He decreased Topamax from 75 mg to 25 mg twice a day and replaced Protonix with Ranitidine 75 mg twice a day. Tr. at 390. Dr. McElhaney referred Plaintiff to a neurologist. Tr. at 391.

         On January 20, 2015, Plaintiff reported four hours of stiffness, fatigue, poor sleep, shortness of breath, nausea, reflux, and side effects from medications. Tr. at 399. She complained of pain in the left trochanteric bursa and denied performing exercises. Id. Dr. Patel indicated left trochanteric bursitis, flat affect, and greater than 12 tender points on physical exam. Tr. at 400. He administered a Cortisone injection for left trochanteric bursitis and recommended Plaintiff engage in 20 minutes of daily yoga and 10-15 minutes of daily meditation. Id.

         On January 29, 2015, Plaintiff presented to neurologist Carol A. Kooistra, M.D. (“Dr. Kooistra”), for an initial examination. Tr. at 402-03. She indicated her headaches were controlled and she had no history of seizures, aside from the two she experienced while hospitalized for an overdose. Tr. at 402. Dr. Kooistra noted no abnormalities on physical exam. Id. She advised Plaintiff to taper off Topamax by reducing it to one pill a day for two weeks and then discontinuing it. Id.

         In a progress summary dated February 2, 2015, Mr. Platt noted Plaintiff was attending weekly group therapy and monthly individual therapy. Tr. at 405. He requested authorization for Plaintiff to attend twice monthly individual therapy sessions. Id. He stated Plaintiff needed to remain in treatment to reduce panic and increase functioning through CBT and mood mindfulness. Id.

         On March 10, 2015, Plaintiff presented to psychiatrist Eric K. Winter, M.D. (“Dr. Winter”), for an initial psychiatric medical assessment. Tr. at 425- 26. Dr. Winter noted Plaintiff had been ordered by the court to attend treatment and that her partner was administering her medications. Tr. at 425. Plaintiff reported anxiety and difficulty sleeping, but indicated fewer depressive symptoms and no suicidal ideation. Id. A mental status examination was normal, aside from depressed and anxious mood. Tr. at 425. Dr. Winter assessed bipolar I disorder and a GAF score of 55.[4] Tr. at 426. He prescribed Lamictal 100 mg, Venlafaxine XR 150 mg, and Latuda 20 mg. Id.

         State agency consultant Silvie Kendall, Ph.D. (“Dr. Kendall”), reviewed Plaintiff's records and completed a psychiatric review technique (“PRT”) form on March 17, 2015. She considered Listing 12.04 for affective disorders and assessed the following degrees of functional limitation: moderate restriction of activities of daily living (“ADLs”); moderate difficulties in maintaining social functioning; moderate difficulties in maintaining concentration, persistence, or pace; and one or two repeated episodes of decompensation. Tr. at 68. She completed a mental residual functional capacity (“RFC”) assessment and found Plaintiff to be moderately limited with respect to the following abilities: to understand and remember detailed instructions; to carry out detailed instructions; to maintain attention and concentration for extended periods; and to interact appropriately with the general public. Tr. at 71-73. She explained Plaintiff could “understand and remember simple instructions, but may have difficulty with detailed instructions”; could “carry out simple tasks and instructions”; could “maintain concentration and attention for periods of at least 2 hours”; could “carry out simple tasks for 2 hours at a time”; “would perform best in situations that do not require ongoing interaction with the public”; and could “be aware of normal hazards and take appropriate precautions.” Tr. at 73. She stated Plaintiff's impairments “would not preclude the performance of simple, repetitive work tasks” and “would not preclude her from carrying out basic work functions.” Id.

         Also on March 17, 2015, state agency medical consultant Donna Stroud, M.D. (“Dr. Stroud”), reviewed Plaintiff's records and completed a physical RFC assessment. Tr. at 69-71. She indicated the following limitations: occasionally lifting and/or carrying 50 pounds; frequently lifting and/or carrying 25 pounds; standing and/or walking for a total of about six hours in an eight-hour workday; sitting for about six hours in an eight-hour workday; frequently climbing ramps, stairs, ladders, ropes, and scaffolds; unlimited balancing, stooping, kneeling, crouching, and crawling; and avoiding concentrated exposure to hazards. Id.

         On April 25, 2015, Joseph G. Grace, Ph.D. (“Dr. Grace”), provided a psychological evaluation for disability that was based on findings from clinical interviews of Plaintiff and testing administered on April 17 and 25, 2015. Tr. at 411. Plaintiff reported the following symptoms: depressed mood for the entirety of most days; anhedonia; obsessional worry and increased anxiety; initial and terminal sleep disturbances; extreme fatigue with little stamina; loss of motivation for productive and recreational activities; decreased concentration and short-term memory; decreased ability to make routine decisions; increased irritability and decreased frustration tolerance; decreased libido; increased social withdrawal; frequent, intense pain symptoms; recurring and distressing thoughts regarding traumatic experiences; recurring and distressing dreams; persistent, bothersome thoughts, discomfort and awkwardness around others; panic episodes in public places; shortness of breath and dizziness without exertion; and gastrointestinal (“GI”) upset. Tr. at 414-15. She indicated she had withdrawn socially to prevent panic attacks. Tr. at 415. She stated the following symptoms were made less intense by use of prescribed medications: extreme mood and energy fluctuations; pressure of speech; racing thoughts; episodes of poor judgment; fluctuations in quantity and quality of work; feelings of restlessness, agitation, and anger without provocation; extreme problems with attention and concentration; alternating periods of great optimism and pessimism; and moods interfering with productivity and interpersonal relationships. Id. Dr. Grace administered the Minnesota Multiphasic Personality Inventory, second edition (“MMPI-2”) and interpreted Plaintiff's scores to be a valid reflection of her personality dynamics and emotional stability. Id. He stated the clinical scales revealed Plaintiff to be “profoundly depressed, severely anxious and in rather tenuous contact with reality.” Id. He noted Plaintiff was “overwhelmed with problems, guilt-ridden and fe[lt] hopeless, helpless and inadequate.” Id. He observed Plaintiff to be “extremely despondent, slowed in thought and action, lacking in energy, unable to concentrate, very distressed and [to] feel[] miserable.” Id. He stated Plaintiff had “distanced herself physically and emotionally from others to avoid hurt and rejection, ” causing her to be “very withdrawn, alienated, feel[] misunderstood” and to not be “part of her social community.” Id. He indicated Plaintiff was “an obsessional worrier who [was] quite tearful and extremely insecure with numerous phobias.” Tr. at 415-16. He indicated Plaintiff was “emotionally unstable, bitter over her plight in life and prone to exercise poor judgment.” Tr. at 416. He noted from a positive perspective that Plaintiff was empathic, considerate of others, had the propensity to be rather idealistic, and had the capacity to be realistic and responsible. Id. He concluded Plaintiff had “been handicapped psychiatrically, socially, physically and vocationally by her mother's abandonment of her at age 5, her father's untimely death at age 17, and a poor psychiatric and organic genetic endowment.” Id. He assessed panic disorder, agoraphobia, posttraumatic stress disorder (“PTSD”), bipolar II disorder, borderline personality disorder, and schizoid personality disorder features. Tr. at 416-17. He noted a GAF score of 35.[5] Id.

         In a progress summary dated May 3, 2015, Mr. Platt noted Plaintiff had discontinued group therapy, but was attending individual therapy twice a month. Tr. at 424. He indicated Plaintiff was progressing toward goals, but needed to remain in treatment to prevent decompensation. Id. On June 3, 2015, Mr. Platt indicated Plaintiff was attending individual therapy twice a month and making progress toward her goals. Tr. at 452.

         On June 23, 2015, Plaintiff denied significant side effects and indicated her medications had helped to stabilize her mood. Tr. at 451. Dr. Winter noted Plaintiff was mildly anxious and not very forthcoming, but was endorsing improvement. Id. He observed anxious mood and mild impairment to attention and concentration, but indicated no other abnormalities on mental status exam. Id. He assessed a GAF score of 60 and instructed Plaintiff to follow up in four months. Id.

         On July 22, 2015, Plaintiff reported three to four hours of stiffness during the day, constant symptoms, and a pain level of eight. Tr. at 435. She complained of fatigue, weight gain, poor sleep, dry and red eyes, shortness of breath, nausea, diarrhea, constipation, reflux symptoms, and bruising. Id. She indicated she was engaging in yoga and pool exercises. Id. Dr. Patel noted kyphosis of the spine, multiple paraspinal pains, flat affect, and greater than 12 tender points, but stated Plaintiff had normal ROM, strength and tone in her bilateral upper and lower extremities. Tr. at 436. He prescribed Naltrexone 4.5 mg at bedtime and refilled Robaxin 500 mg and Tylenol with Codeine 300-30 mg. Tr. at 436-37.

         On August 11, 2015, a second state agency consultant, Janet Telford-Tyler, Ph.D. (“Dr. Telford-Tyler”), completed a PRT form and mental RFC assessment. Tr. at 83-84, 87-89. She considered Listing 12.04 for affective disorders and assessed the following degrees of functional limitation: mild restriction of ADLs; moderate difficulties in maintaining social functioning; moderate difficulties in maintaining concentration, persistence, or pace; and no episodes of decompensation. Tr. at 84. She indicated on a mental RFC assessment that Plaintiff had moderately-limited abilities to maintain attention and concentration for extended periods; to complete a normal workday and workweek without interruptions from psychologically-based symptoms; to perform at a consistent pace without an unreasonable number and length of rest periods; and to interact appropriately with the general public. Tr. at 87-89. She stated Plaintiff was able to “understand, remember, and carry out simple and detailed instructions and to follow work related procedures with infrequent difficulty on complex tasks possible.” Tr. at 89. She indicated Plaintiff could “maintain attention and perform at an acceptable consistent pace on simple and detailed tasks for 2 hour periods, over 8 hour work days and 40 hour work weeks with normal breaks and without interruption from psychologically based symptoms[, ] but would have occasional difficulty with complex tasks.” Id. She noted Plaintiff would be able to work “under ordinary supervision, ” “make simple work-related decisions, ” and “maintain regular attendance and punctuality.” Id. She stated Plaintiff was “capable of relating appropriately on a casual basis with the general public[, ] but would do better on tasks requiring minimal contact with the general public in order to avoid stress.” Id. She indicated Plaintiff was capable of “accept[ing] direction and criticism from supervisors, ” “relat[ing] appropriately to co-workers without unduly distracting them or exhibiting behavioral extremes, ” “asking simple and detailed questions, ” “making requests for assistance, ” “adapt[ing] to routine changes in the work setting, ” “avoid[ing] normal hazards and tak[ing] appropriate precautions when needed, ” “setting realistic goals, ” and “making plans independently of others.” Id.

         On August 27, 2015, Dr. Winter authorized Plaintiff to attend weekly individual therapy. Tr. at 448.

         On September 11, 2015, a second state agency medical consultant, Sannagai Brown, M.D. (“Dr. Brown”), assessed the following limitations on a physical RFC assessment: occasionally lifting and/or carrying 20 pounds; frequently lifting and/or carrying 10 pounds; standing and/or walking for about six hours in an eight-hour workday; sitting for about six hours in an eight-hour workday; occasionally climbing ramps and stairs; never climbing ladders, ropes, or scaffolds; frequently balancing, stooping, kneeling, crouching, and crawling; and avoiding even moderate exposure to hazards. Tr. at 85-87.

         On November 17, 2015, Plaintiff indicated her symptoms had improved on medication. Tr. at 443. She expressed concern over drug interactions, and Dr. Winter found possible negative interactions between Latuda and her other medications. Id. Dr. Winter noted no abnormalities on mental status examination. Id.

         On January 20, 2016, Plaintiff endorsed constant symptoms of polyarthritis with limited improvement in response to medical therapy. Tr. at 432. She indicated she was using medication and rest to improve her symptoms. Id. She reported her pain as an eight on a 10-point scale and complained of stiffness. Id. She endorsed the following additional symptoms: fatigue, poor sleep, dry eyes, cough, shortness of breath, chest pain, nausea, vomiting, diarrhea, and reflux symptoms. Tr. at 433. Plaintiff reported some relief with Tylenol with Codeine and Robaxin, but complained that Naltrexone caused nausea. Id. She endorsed pain in her left hip and right radial thumb following a recent fall. Id. Dr. Patel noted greater than 12 tender points, kyphosis in the spine, and multiple pains in the paraspinal region, but also observed Plaintiff to have normal range of motion (“ROM”), strength, and tone in the bilateral upper and lower extremities. Id. He administered Lidocaine and Methyl Prednisolone SR injections to treat left trochanteric bursitis and right DeQuervain's tenosynovitis. Id. He recommended Plaintiff engage in regular exercise and continued her prescriptions for Robaxin and Tylenol with Codeine. Tr. at 434.

         On January 25, 2016, Plaintiff presented to gastroenterologist Peter J. Kobes, M.D. (“Dr. Kobes”), for fecal incontinence, left lower quadrant pain, nausea, vomiting, diarrhea, constipation, and rectal pain. Tr. at 459. She reported up to six episodes of frequency diarrhea per day on four days per week, often followed by several days of constipation. Id. Dr. Kobes recommended a high fiber diet and full colonic evaluation. Tr. at 461. He prescribed Levsin 0.125 mg. Tr. at 462.

         On January 26, 2016, Plaintiff reported anxiety, depression, irritability, and sleep disturbance. Tr. at 440. She complained of more frequent and severe depressive episodes. Tr. at 441. She stated she was experiencing nightmares and was only sleeping for two hours in a 24-hour period. Id. Kristal T. Tribble, R.N. (“Nurse Tribble”), notified Dr. Winter and reminded Plaintiff that she had an upcoming visit scheduled with him. Id.

         In a progress summary dated February 2, 2016, Mr. Platt indicated Plaintiff was scheduled for weekly group therapy and twice monthly individual therapy. Tr. at 439. He stated Plaintiff was participating actively in group therapy sessions, but considered coping mechanisms to be minimally effective. Id.

         On March 8, 2016, Plaintiff complained that Latuda caused increased anxiety. Tr. at 438. Dr. Winter observed Plaintiff to demonstrate akathisia, fidgetiness, and anxiety. Id. He noted the following findings on mental status examination: cooperative attitude; calm behavior; intact associations; logical/goal-directed thought process; no suicidal or homicidal ideation; depressed and anxious mood; appropriate affect; mildly impaired attention and concentration; and fair insight and judgment. Id. Dr. Winter discontinued Latuda and increased Lamictal to 250 mg daily. Id.

         Plaintiff participated and interacted well with others during group therapy sessions on April 7 and 21, 2016. Tr. at 529-30.

         On May 4, 2016, Plaintiff complained of abdominal pain and cramping, nausea, vomiting, diarrhea, and occasional bowel incontinence. Tr. at 549. She reported weight gain, frequent urination, and excessive thirst and requested that her blood sugar be checked. Id. Tiffany Nobles, FNP-BC (“N.P. Nobles”), noted tenderness to palpation of Plaintiff's abdomen, but indicated no other abnormalities on physical exam. Tr at 549-50. She encouraged Plaintiff to follow up with her GI specialist for irritable bowel syndrome (“IBS”) with diarrhea, referred her for lab work, counseled her on diet and exercise, and advised her to lose weight and to take a daily multivitamin. Tr. at 550.

         On May 6, 2016, Plaintiff reported to Mr. Platt that her visit with N.P. Nobles had been unpleasant because N.P. Nobles was hateful and did not spend adequate time with her. Tr. at 526. Mr. Platt affirmed Plaintiff's feelings and noted her accomplishment in not reacting drastically to N.P. Nobles. Id.

         On June 7, 2016, Plaintiff complained of poor sleep, pain, stomach problems, and headache. Tr. at 524. She discussed conflict in her relationship. Id. Mr. Platt encouraged Plaintiff to avoid conflict. Id.

         On June 9, 2016, Jessica McCraw, MA, LMPT (“Ms. McCraw”), observed Plaintiff to be engaged and to laugh with others during group therapy. Tr. at 523. She stated Plaintiff continued to “be dealing with a lot of pain and health p[roblems].” Id. She indicated Plaintiff's depression might improve if her health problems were better managed. Id.

         On June 21, 2016, Plaintiff complained of insecurities regarding her relationship. Tr. at 522. Mr. Platt observed Plaintiff to be a little less worried than during the prior visit. Id.

         On June 23, 2016, Ms. McCraw observed Plaintiff to be engaged in the group and to laugh during the session. Tr. at 521. Plaintiff reported going out to dinner and a movie. Id. She endorsed problems with pain, but no major mental health problems. Id.

         On June 29, 2016, Plaintiff followed up with Dr. Kobes for abdominal pain and diarrhea. Tr. at 455. She reported frequent pain in her left upper quadrant, occasional pain in her lower abdomen, and watery diarrhea occurring between three and six times per day. Id. She stated Levsin had provided no benefit. Id. Dr. Kobes assessed chronic diarrhea with probable IBS and prescribed Bentyl. Tr. at 457.

         Ms. McCraw observed Plaintiff to be engaged and to appear well during a group therapy session on June 30, 2016. Tr. at 520. Plaintiff discussed a negative encounter with her mother and processed her reaction with members of the group. Id.

         On July 5, 2016, Plaintiff complained of sleep disturbance, nightmares, and weird dreams. Tr. at 519. Mr. Platt noted Plaintiff was reflecting on prior choices and losses and felt confused and unable to focus on reading and math. Id.

         On July 7, 2016, Ms. McCraw noted Plaintiff had some difficulty completing the painting assignment “because of her hands.” Tr. at 518. She instructed Plaintiff on a relaxation technique to address her reports of sleep disturbance. Id.

         On July 13, 2016, Plaintiff reported relief from the injections Dr. Patel administered during the prior visit. Tr. at 468. She complained of left hip pain, migraines, and pain and stiffness in her neck that was exacerbated by turning her head. Id. She endorsed symptoms that included fatigue, red and dry eyes, shortness of breath, constipation, diarrhea, nausea, vomiting, arthralgias, myalgias, sleep disturbance, and three hours of morning stiffness. Tr. at 468-69. Dr. Patel noted the following abnormalities on physical exam: pain and stiffness in the cervical spine, paraspinal pain and tenderness, pain in the left trochanteric bursa, and greater than 12 tender points. Tr. at 469. He continued Plaintiff's prescriptions for Robaxin and Tylenol with Codeine and administered a Depo-Medrol injection to her left trochanteric bursa. Tr. at 470.

         On July 14, 2016, Ms. McCraw noted Plaintiff participated less and was more quiet than she had been during prior group sessions. Tr. at 517. A medication monitoring form reflects symptoms of anxiety, decreased appetite, depression, flight of ideas, hyperactivity/inattention, irritability, paranoia, thought disorganization, sleep disturbance, and being hyperverbal. Tr. at 516. Plaintiff denied side effects from medications. Id.

         On July 22, 2016, Mr. Platt indicated Plaintiff was “making a little progress overall.” Tr. at 515. Plaintiff reported benefits from ...


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