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Thompson v. Saul

United States District Court, D. South Carolina

October 31, 2019

Julia Darlene Thompson, 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”) and Supplemental Security Income (“SSI”). 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 the Commissioner's decision be reversed and remanded for further proceedings as set forth herein.

         I. Relevant Background

         A. Procedural History

         On September 24, 2015, Plaintiff protectively filed applications for DIB and SSI in which she alleged her disability began on September 30, 2014. Tr. at 95, 96, 249-55, 256-64. Her applications were denied initially and upon reconsideration. Tr. at 135-38, 139-42, 146-51. On November 30, 2017, Plaintiff had a video hearing before Administrative Law Judge (“ALJ”) Jerry Faust. Tr. at 33-62 (Hr'g Tr.). The ALJ issued an unfavorable decision on February 14, 2018, finding Plaintiff was not disabled within the meaning of the Act. Tr. at 11-32. 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 November 29, 2018. [ECF No. 1].

         B. Plaintiff's Background and Medical History

         1. Background

         Plaintiff was 55 years old at the time of the hearing. Tr. at 36. She obtained a GED. Tr. at 36. Her past relevant work (“PRW”) was as a restaurant server. Tr. at 54. She alleges she has been unable to work since September 30, 2014. Tr. at 249.

         2. Medical History

         Plaintiff presented to the emergency room (“ER”) at Aiken Regional Medical Centers (“ARMC”) on October 9, 2014, complaining of joint pain. Tr. at 461. The attending physician diagnosed chronic generalized pain and prescribed nine Norco 5-325 mg tablets. Tr. at 464.

         Plaintiff was admitted to Aurora Pavillion Behavioral Health Services (“Aurora Pavillion”) on October 23, 2014, with drug-induced delusions and paranoia. Tr. at 438, 440-41. She tested positive for amphetamines, cannabinoids, and opiates. Tr. at 441. She complained of poor sleep, depression, crying spells, and lack of motivation. Tr. at 438. Merry Deleon, M.D. (“Dr. Deleon”), indicated Plaintiff “selectively attended” group sessions, was “seclusive and minimally interactive with staff and peers, ” and “was irritable at times with medication seeking behavior.” Id. Plaintiff was discharged on October 30, 2014, with diagnoses of methamphetamine dependence, drug-induced psychosis, polysubstance abuse, substance-induced mood disorder, and borderline personality disorder trait. Tr. at 440. Dr. Deleon assessed a global assessment of functioning (“GAF”) score[2] of 45[3] upon discharge. Id.

         On November 20, 2014, Plaintiff presented to Aiken Center for a substance abuse assessment. Tr. at 393-407. She reported a history of amphetamine, marijuana, and opiate use. Tr. at 397. She indicated she had initially used methamphetamine two months prior, had spent up to $60 per day to support her habit, and had checked into Aurora Pavillion upon noticing that it was negatively affecting her health. Id. She stated she had first used opioids following the birth of one of her children, had used as many as six pills per day, and would purchase pills off the street if she did not have a prescription. Tr. at 398. She stated she last used methamphetamine on October 22, 2014, cannabis on October 15, 2014, and opioids on September 25, 2014. Tr. at 397, 398. Addiction counselor William Pressley (“Mr. Pressley”), observed Plaintiff to appear adequately groomed; to be cooperative; to have normal speech; to indicate appropriate thought content; to be oriented to person, place, situation, and time; to demonstrate intact memory; to have focused coping ability; and to show affect appropriate to content. Tr. at 399-400. He diagnosed amphetamine dependence, opioid dependence, and cannabis dependence and indicated all to be in remission. Tr. at 405. He assessed mild occupational problems, problems related to the social environment, problems with primary support group, and economic problems and a global assessment of functioning (“GAF”) score of 58.[4] Id. Mr. Pressley recommended Plaintiff participate in intensive outpatient therapy. Tr. at 406. He transferred Plaintiff to another program, but she failed to report and was discharged from services. Tr. at 408, 476-77.

         Plaintiff was hospitalized at Aurora Pavillion on September 21, 2015, after threatening to kill her husband[5] and another person. Tr. at 415-437. Upon presentation to Aurora Pavillion, Plaintiff expressed suicidal ideation and was described as rambling, hyperactive, hyperverbal, disheveled, thin, and demanding. Tr. at 418, 430. She tested positive for methamphetamine, cannabis, opiates, and benzodiazepines. Id. Plaintiff became more cooperative after the methamphetamine wore off, but frequently requested Klonopin and higher doses of medication, which were denied. Id. She reported intermittent swelling in her left hand and was prescribed Ultram. Id. Plaintiff's discharge diagnoses included polysubstance dependence, depression, acute anxiety, amphetamine abuse, anxiety disorder, hypokalemia, and oral pain. Tr. at 415. Dr. Deleon observed the following mental status prior to Plaintiff's discharge on October 5, 2015: appropriate, casual appearance; initiates interaction with staff; oriented to person, place, time, and situation; cooperative, pleasant behavior; anxious mood; no psychomotor abnormalities; affect congruent with mood and thought content; anxious, pleasant affect quality; constricted affect range; linear, goal-directed thought process; coherent thought content; no hallucinations; no delusions; understands need for treatment; intact judgment; capable of reality-based thinking; average intelligence; short attention span; and short-term memory deficits. Tr. at 418.

         Plaintiff presented to Aiken-Barnwell Mental Health Center (“ABMHC”) for an initial clinical assessment update on October 15, 2015. Tr. at 473. She complained of depression, inability to sleep, loss of appetite, increased isolation and irritability, and thoughts of hopelessness and worthlessness. Tr. at 475. Carol J. Ardington, LMSW (“S.W. Ardington”), stated Plaintiff “presented neatly dressed, oriented to person, place and time with motor activity appropriate to situation and tearful affect . . . attitude was cooperative, mood was depressed.” Id. She stated Plaintiff's “[s]peech, thought process and content were normal.” She indicated Plaintiff denied suicidal and homicidal ideation, hallucinations, and delusions. Id. She noted Plaintiff demonstrated poor judgment and insight and good memory and concentration with average fund of knowledge. Id. She recommended Plaintiff participate in individual counseling twice a month to develop coping skills needed to manage depression and substance abuse and address maladaptive cognitive processing. Id.

         Plaintiff followed up with ABMHC for an initial psychiatric medical assessment on October 26, 2015. Tr. at 471. She endorsed anxiety, low self-esteem, and depression. Id. The clinician noted the following findings on psychiatric exam: appearance within normal limits; guarded attitude; calm behavior; normal eye contact; normal speech; intact associations; logical/goal-directed thought processes; denies delusions, suicidal ideation, homicidal ideation, obsessions, and hallucinations; depressed and irritable mood; appropriate affect; alert sensorium; oriented to time, place, and person; mildly-impaired recent and remote memory; mildly impaired concentration; average language; poor judgment and insight; and average fund of knowledge. Tr. at 472. The clinician assessed persistent depressive disorder, severe alcohol use disorder, severe amphetamine-type disorder, and moderate cannabis use disorder. Id. He prescribed Citalopram 20 mg, Risperdal 2 mg, Trazodone 200 mg, Trazodone 25 mg, Remeron 15 mg, and Buspar 15 mg. Id.

         Plaintiff followed up with Wanda Rowland, R.N. (“Nurse Rowland”) at ABMHC for medication monitoring on December 7, 2015. Tr. at 469. She reported symptoms of anxiety, increased appetite, depression, and paranoia, as well as medication-induced side effects of dry mouth and weight gain. Id. She complained of depression, crying spells, and increased anxiety during the day that caused her to rock her body back and forth. Tr. at 470. She requested a prescription for Vistaril and indicated Trazodone was not helping. Id. Nurse Rowland noted Plaintiff appeared neat and clean, demonstrated mildly anxious mood, had clear and organized thoughts, and had gained 22 pounds since October. Id.

         Plaintiff presented to Salli E. Rish, MRC, LPC (“Counselor Rish”), for individual therapy on December 17, 2015. Tr. at 505. Counselor Rish observed Plaintiff to be “struggling with rocking constantly” and scheduled her for an appointment with the nurse to address the rocking. Id. Plaintiff indicated she continued to experience crying spell and anxiety. Id. She agreed to practice one coping skill per day. Id.

         On December 31, 2015, x-rays of Plaintiff's left hand showed no abnormalities. Tr. at 484. X-rays of her lumbar spine indicated degenerative disc disease characterized by moderate loss of intervertebral disc space and vacuum disc phenomenon at the L5-6 level, as well as mild intervertebral disc space narrowing and disc degeneration at ¶ 4-5. Id. Configuration of the vertebrae and vertebral body height were normal. Id. Pedicles and posterior elements were intact. Id. No malalignment, spinal stenosis, or destructive lesions were detected. Id.

         On January 11, 2016, Counselor Rish observed Plaintiff to appear neat and clean. Tr. at 506. She again observed Plaintiff to be rocking back and forth during the session. Id. Plaintiff complained of feeling tired and lacking motivation. Id. Counselor Rish encouraged her to use coping tools to deal with stress and anxiety. Id.

         On January 13, 2016, Plaintiff complained of erratic sleep, anxiety, occasional panic, poor focus and concentration, low self-esteem, anhedonia, left hand swelling, and rocking back and forth. Tr. at 503. She stated her family did not want her to take medication because the medication made her seem “zombie-like.” Id. Plaintiff indicated she was attending substance abuse meetings. Id. Psychiatrist Khoa Tran, M.D. (“Dr. Tran”), noted the following on mental status exam: appearance within normal limits; cooperative attitude; calm behavior; normal eye contact and speech; intact associations; logical/goal-directed thought process; euthymic mood; constricted affect; alert sensorium; oriented to time, place, person, and circumstance; intact recent and remote memory, attention, and concentration; average language and fund of knowledge; good insight and judgment; and good to excellent knowledge of current events. Tr. at 504. He noted Plaintiff denied hallucinations, delusions, and suicidal and homicidal ideation. Id. He discontinued Risperdal and prescribed Citalopram 20 mg, Trazodone 100 mg, Remeron 15 mg, Buspar 15 mg, Vistaril 50 mg, Buspirone 15 mg, Celexa 40 mg, and Seroquel 100 mg. Tr. at 504.

         Plaintiff presented to Stephen A. Schacher, M.D. (“Dr. Schacher”), for a consultative medical examination on January 15, 2016. Tr. at 487-92. She complained of migraine headaches, left hand nerve damage, back and leg problems, and impaired vision. Tr. at 487. She reported abilities to stand for three minutes, walk 50 yards, and lift 10 pounds. Id. She indicated inability to write, open jars, and use a keyboard with her left hand. Id. She stated she could dress and groom, shop in a grocery store using a “push buggy, ” cook, wash dishes, do laundry, sweep, and mop. Tr. at 488. She indicated she was unable to drive because she did not have a license. Id. She claimed she sometimes became agitated in the store and had to leave. Id. She denied engaging in yard work, using a computer, and vacuuming. Id. She stated she “sits and rocks” for most of the day. Id. Dr. Schacher stated Plaintiff “navigate[d] the exam table normally.” Id. A neurological examination was normal. Id. Dr. Schacher observed Plaintiff to demonstrate weakened left hand grip of 3/5 and decreased range of motion (“ROM”) of the left shoulder. Id. He noted no sensory loss, normal gait and balance, and normal mood and cognition. Id. He stated no diagnosis could be made regarding Plaintiff's weakened left hand grip based on exam alone. Id. Plaintiff demonstrated normal ROM of the cervical spine, lumbar spine, elbows, wrists, knees, hips, and ankles and had normal straight-leg raising. Tr. at 490.

         Plaintiff presented to consultative examiner John B. Bradley, Ph.D. (“Dr. Bradley”), for a mental status examination on January 19, 2016. Tr. at 494-99. She reported pain in her back and left leg resulting from sciatica, as well as left hand swelling. Tr. at 494. She stated she had difficulty standing for long periods and using her left hand. Id. Plaintiff reported a history of depression and prior suicide attempt. Id. She indicated she felt sad on most days, experienced crying spells, found little enjoyment in life, had difficulty sleeping, felt tired all the time, had difficulty concentrating, and had poor self-esteem. Id. She endorsed fleeting suicidal ideation, paranoia, and hallucinations. Id. Plaintiff reported she had not used drugs since her admission to Aurora Pavillion. Tr. at 497. She endorsed abilities to manage self-care, perform a few household chores, occasionally cook, and manage her own money. Id. She stated she was not motivated and did little more than sit and rock during a typical day. Id.

         Dr. Bradley noted Plaintiff appeared to be minimizing her drug abuse history. Tr. at 497. He observed Plaintiff to be cooperative and polite; to be dressed appropriately and demonstrate good grooming; to have normal gait and posture; to respond to questions and comply with requests; to comprehend and follow simple instructions; to be alert and oriented to time, place, and person; to show a flat affect; to demonstrate a sad facial expression and a depressed mood; to speak in a normal voice and at a normal rate; to discuss appropriate content; to display no evidence of phobias, obsessions, compulsions, or homicidal thinking; to have normal attention and concentration; to demonstrate reasonable memory; to be functioning at a normal level of intelligence; and to have adequate insight and judgment. Tr. at 497-98. Plaintiff obtained a score of 29 on the Folstein Mini-Mental State Examination, which was consistent with no significant cognitive impairment. Tr. at 498. She reported suicidal ideation, but denied suicidal intent. Id.

         Dr. Bradley diagnosed polysubstance dependence in remission by client report and persistent depressive disorder. Id. He noted Plaintiff had reported difficulty standing for long periods and lifting and stated “[s]he appears to be mildly limited in this area.” Id. He stated Plaintiff denied significant problems in social functioning, but found she had moderate limitations in this area. Tr. at 499. Dr. Bradley assessed moderate limitation in Plaintiff's ability to maintain concentration, persistence, or pace. Id.

         On January 20, 2016, state agency medical consultant Ronald Collins, M.D. (“Dr. Collins”), provided the following physical residual functional capacity (“RFC”) assessment: occasionally lift and/or carry 50 pounds; frequently lift and/or carry 25 pounds; stand and/or walk for a total of about six hours in an eight-hour workday; sit for a total of about six hours in an eight-hour workday; frequently balancing, stooping, kneeling, crouching, crawling, and climbing ramps/stairs; and never climbing ladders/ropes/scaffolds. Tr. at 70-72, 84-86. A second state agency medical consultant, Stephen Burge, M.D. (“Dr. Burge”), assessed the same physical RFC on May 16, 2016. Compare Tr. at 70-72, 84-86, with Tr. at 107-08, 124- 25.

         Counselor Rish described Plaintiff as “rock[ing] constantly” during an individual psychotherapy session on January 26, 2016. Tr. at 507. She helped Plaintiff to realize her rocking would cease when she relaxed. Id. Plaintiff reported the rocking helped to soothe her anxiety. Id. She acknowledged her mood improved and anxiety decreased when she reduced her focus on negative thoughts and feelings. Id. She stated coloring helped to reduce her anxiety. Id.

         On January 26, 2016, state agency consultant Janet Boland, Ph.D. (“Dr. Boland”), reviewed the record and completed a psychiatric review technique (“PRT”). Tr. at 68-69, 82-83. She considered Listings 12.04 for affective disorders, 12.06 for anxiety-related disorders, and 12.09 for substance addiction disorders, as well as drug and alcohol abuse. Tr. at 68, 82. In evaluating the paragraph “B” criteria under Listings 12.04 and 12.06, Dr. Boland found no repeated episodes of decompensation and assessed mild restriction of activities of daily living (“ADLs”), moderate difficulties in maintaining social functioning, and moderate difficulties in maintaining concentration, persistence, or pace. Id. She provided a mental RFC assessment, finding Plaintiff was 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; to work in coordination with or proximity to others without being distracted by them; 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; to interact appropriately with the general public; to accept instructions and respond appropriately to criticism from supervisors; to get along with coworkers or peers without distracting them or exhibiting behavioral extremes; to respond appropriately to changes in the work setting; and to set realistic goals or make plans independently of others. Tr. at 72-74, 86-88. She provided the following additional explanation:

Cl[ai]m[an]t should be able to attend to and perform simple unskilled work for reasonable periods of time without supervision. She can attend work regularly, but might miss an occasional day due to her mental illness. She can make work-related decisions, protect herself from work-related safety hazards and travel to and from work independently. She can accept supervision and interact appropriately with co-workers, but might not be suited for work with the general public.

         Tr. at 74, 88.

         On May 12, 2016, a second state agency consultant, Douglas Robbins, Ph.D. (“Dr. Robbins”), considered the same listings as Dr. Boland and assessed the same degree of limitation in the PRT. Compare Tr. at 68-69, 82- 83, with Tr. at 103-05, 120-22. He also assessed the same mental RFC. Compare Tr. at 72-74, 86-88, with Tr. at 108-11, 125-28.

         Plaintiff presented to the ER at ARMC with lower back pain and nausea on October 29, 2016. Tr. at 511. Plaintiff's blood pressure was low at 69/39 mm/Hg. Tr. at 513. James Mock, M.D. (“Dr. Mock”), diagnosed hypotension, sciatica, and adrenal insufficiency. Tr. at 516.

         Plaintiff presented to ARMC Medical Center with low back pain and syncopal episode on January 9, 2017. Tr. at 535. Robert Walker, M.D. (“Dr. Walker”), assessed acute kidney injury secondary to dehydration, depression, hypokalemia, sciatic pain, and syncope and collapse. Tr. at 536-37. He ordered fluid resuscitation, potassium repletion, echocardiography with telemetry, bilateral carotid ultrasonography, and venous thromboembolism prophylaxis. Tr. at 537. Plaintiff's lab work showed some abnormalities, but other diagnostic tests, including x-rays of the lumbar spine, were negative. Tr. at 545, 574. Dr. Walker added Lidoderm for Plaintiff's sciatic pain. Id. He discharged Plaintiff on January 12, 2017, with instructions to follow up with her family doctor within five days. Tr. at 540.

         On February 2, 2017, Plaintiff presented to ARMC with a rash on her right buttocks, chest, left upper arm, and lower legs. Tr. at 577. She reported shortness of breath while lying down and facial numbness that had presented earlier in the day. Id. She indicated she self-treated with Benadryl and Morphine 15 mg. Id. Plaintiff denied use of amphetamines, but her drug screen was positive for both opiates and amphetamines. Tr. at 580. Aaron High, M.D., diagnosed contact dermatitis and bronchitis and ordered Tylenol and Atarax. Tr. at 580-81. Plaintiff verbalized frustration and indicated she planned to go to go to another hospital upon discharge. Tr. at 580.

         Plaintiff presented to the ER at Augusta University Medical Center later that day. Tr. at 596. The ER physician diagnosed cutaneous sporotrichosis, impetigo, insect bites, and maculopapular rash. Tr. at 597. He discharged Plaintiff with prescriptions for Acetaminophen 325 mg, Clindamycin 300 mg, Itraconazole 100 mg, and Prednisone 50 mg. Id.

         Plaintiff was again hospitalized at Aurora Pavillion from February 18 to March 1, 2017, after presenting with depression, anxiety, and suicidal ideation with a plan to overdose. Tr. at 586, 590. She reported her mother had recently passed away, one week after being diagnosed with end-stage lung cancer. Tr. at 589. She endorsed worsened mood, insomnia, anhedonia, and difficulty concentrating. Id. Plaintiff's drug screen was positive for cannabinoids and opiates. Tr. at 591. Zachary Zuschlag, D.O. (“Dr. Zuschlag”), observed the following on mental status exam: appears older than stated age; poor hygiene and grooming; calm and cooperative behavior; no psychomotor agitation or retardation; appropriate rate, rhythm, and volume of speech; bad mood; constricted affect; positive suicidal ideation; no auditory or visual hallucinations or other signs of psychosis; linear and coherent thought process; grossly intact memory; fully oriented; and poor judgment and insight. Id. Plaintiff reported her medications included Buspar, Gabapentin, Remeron, and Adderall, but Dr. Zuschlag indicated it did not appear that the medications had been refilled since 2015. Id. Dr. Zuschlag discontinued Buspar and Remeron, increased Plaintiff's dose of Gabapentin, and started Celexa 20 mg and Seroquel 50 mg. Tr. at 592. He stated Plaintiff “spent the majority of her time with me asking for pain meds, benzos and whatever pill she could get.” Tr. at 589. He noted he had informed Plaintiff he “was not going to continue to add more and more pills and that she had to learn to deal with her feelings whether positive or negative.” Id.

         Plaintiff returned to ABMHC for a new clinical assessment on March 21, 2017. Tr. at 603. She reported difficulty coping with the death of her mother and obtaining medications. Id. She complained of difficulty eating and sleeping. Id. She endorsed suicidal thoughts, but denied suicidal ideation. Id. Counselor Rish indicated the following observations on mental status exam: disheveled appearance and hygiene; appropriate motor activity; cooperative attitude; appropriate affect; depressed, angry, and hopeless mood; normal rate and tone of speech; normal, appropriate, coherent, and relevant thought process; ideas of hopelessness and worthlessness and suicidal thoughts; auditory and visual hallucinations; no evidence of delusions; alert and oriented to person, place, time, and situation; usually able to make sound decisions; acknowledges and understands problems; intact memory; easily distracted concentration and calculations; and average fund of knowledge. Tr. at 605-06. She diagnosed amphetamine abuse in sustained remission, mild cannabis abuse, and depressive disorder, not otherwise specified. Tr. at 606. She stated Plaintiff was struggling with depression, low motivation, and grief and had reported panic attacks while in public and in large crowds. Id.

         On May 15, 2017, Plaintiff complained of feeling depressed and suicidal. Tr. at 600. Dr. Tran noted Plaintiff had returned, after missing appointments since January 2016. Id. Plaintiff stated she was angry with her mother, who had passed away eight months prior, because she had not raised her. Id. She indicated she was having difficulty raising her 11-year-old grandson. Id. She stated a friend was allowing her to live with her in exchange for maintaining the household chores. Id. She reported being depressed and anxious, but denied outward agitation. Id. She endorsed fluctuations in mood, hopelessness, helplessness, low self-esteem, guilt, low motivation, social anxiety, crying spells three to four times per week, panic attacks two to three times per week, fluctuating sleep, poor energy, fair appetite, low memory and concentration, and nightmares/flashbacks. Id. Plaintiff indicated good response to Risperdal, over-sedation from Seroquel, poor response to Buspirone, insomnia from Trazodone, and ineffective treatment with Prazosin. Id.

         Dr. Tran observed the following on mental status exam: appearance within normal limits; cooperative attitude; calm behavior; normal speech and eye contact; intact associations; logical/goal-directed thought process; persecutory delusions; homicidal ideation present without plan; obsessions; auditory hallucinations; euthymic mood; appropriate affect; alert sensorium; oriented to time, place, person, and circumstance; intact recent and remote memory, attention, and concentration; average language; fair insight; good judgment; good fund of knowledge; and poor to no knowledge of current events. Tr. at 601. He prescribed Latuda 40 mg, Vistaril 25 mg, Wellbutrin SR 100 mg, and Amitriptyline 25 mg. Id. He also noted Plaintiff's prescriptions for Gabapentin 400 mg and Tramadol 50 mg for neuropathy and sciatica. Tr. at 601-02.

         On May 16, 2017, Dr. Tran completed a medical opinion RFC form. Tr. at 593-94.

         Plaintiff continued to endorse depression related to her mother's death on August 16, 2017. Tr. at 599. Dr. Tran indicated he had increased Plaintiff's doses of Risperdal, Wellbutrin, and Amitriptyline, after she reported no response to Latuda. Tr. at 599. Plaintiff reported compliance with medication and denied side effects. Id. She indicated her cousin was providing her money for medications in exchange for cleaning her house and noted she was doing housework for a friend while the friend worked. Id. She reported increased crying spells caused by the anniversary of her mother's death. Id. She stated her anxiety was high, but she stayed busy to cope with it. Id. She indicated she had experienced panic attacks in public. Id. She endorsed more good than bad days. Id. She indicated she was no longer babysitting her grandson as often, as he had returned to school. Id. She stated her anger lessened with the increase in medication. Id. She reported sleeping roughly four hours per night, but endorsed good energy and appetite. Id. She indicated her memory and concentration were poor. Id. She was unhappy with her counselor. Id. Dr. Tran observed the following on mental status exam: appearance within normal limits; cooperative attitude; calm behavior; eye contact within normal limits; normal speech; intact associations; logical/goal-directed thought process; persecutory delusions; suicidal ideation without plan; euthymic mood; appropriate affect; alert sensorium; oriented to time, place, person, and circumstance; intact recent and remote memory, attention, and concentration; average language; fair judgment; good insight; and average fund of knowledge with good to excellent knowledge of current events. Id.

         On November 3, 2017, Dr. Tran provided an additional opinion statement. Tr. at 607.

         C. The Administrative Proceedings

         1. The ...


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