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Parsons v. Berryhill

United States District Court, E.D. Virginia, Norfolk Division

January 22, 2018

RHIANNON V. PARSONS, Plaintiff,
v.
NANCY A. BERRYHILL, Acting Commissioner, Social Security Administration, Defendant.

          REPORT AND RECOMMENDATION

          LAWRENCE R. LEONARD UNITED STATES MAGISTRATE JUDGE

         Plaintiff Rhiannon V. Parsons ("Plaintiff), proceeding pro se, filed a complaint pursuant to 42 U.S.C. § 405(g) seeking judicial review of the final decision of Nancy A. Berryhill, the Acting Commissioner of the Social Security Administration ("the Commissioner"), denying Plaintiffs claim for Supplemental Security Income ("SSI") under the Social Security Act ("the Act"). Plaintiff filed a Motion for Summary Judgment, ECF Nos. 12, 12-1, and a Memorandum of Law in Support, ECF Nos. 13, & 13, attach. I.[1] The Commissioner filed a Cross-Motion for Summary Judgment and Memorandum of Law in Support. ECF Nos. 14-15. Both Motions are now ready for recommended disposition.

         This action was referred to the undersigned United States Magistrate Judge ("the undersigned") pursuant to 28 U.S.C. §§ 636(b)(1)(B)-(C), Federal Rule of Civil Procedure 72(b), Eastern District of Virginia Local Civil Rule 72, and the April 2, 2002 Standing Order on Assignment of Certain Matters to United States Magistrate Judges. After reviewing the Administrative Record and the briefs submitted by the parties, the undersigned makes this recommendation without a hearing pursuant to Federal Rule of Civil Procedure 78(b) and Local Civil Rule 7(J). For the following reasons, the undersigned RECOMMENDS that Plaintiffs Motion for Summary Judgment, ECF No. 12, be DENIED, the Commissioner's Motion for Summary Judgment, ECF No. 14, be GRANTED, the final decision of the Commissioner be AFFIRMED, and that this matter be DISMISSED WITH PREJUDICE.

         I. PROCEDURAL BACKGROUND

         Plaintiff initially filed her application for SSI on May 17, 2012, alleging disability due to anemia, chronic urinary tract infections, bipolar disorder, panic/anxiety disorder, arrhythmia, and chronic pain in her hands, knees, and back, with an alleged onset date of April 20, 2011. R. at 21, 23, 77, 213.[2] Her application was initially denied on October 26, 2012, R. at 112, and denied again upon reconsideration on December 19, 2013, R. at 126. Plaintiff then filed a request for a hearing with an administrative law judge ("the ALJ") on February 3, 2014. R. at 133. The ALJ, Stewart Goldstein, conducted a video hearing on August 12, 2015, at which Plaintiff appeared and testified. R. at 42. Also present were Plaintiffs father, who testified on Plaintiffs behalf, and a vocational expert ("VE"). R. at 43. On October 22, 2015, the ALJ issued a written decision denying Plaintiffs SSI application. R. at 18. On December 21, 2015, Plaintiff then filed a request with the Appeals Council for the Office of Disability and Adjudication ("Appeals Council") to review the ALJ's decision. R. at 16. On October 28, 2016, the Appeals Council denied Plaintiffs request for review on the grounds that the ALJ did not abuse his discretion, there was no error of law, the ALJ's decision was supported by substantial evidence, and the case did not present a policy issue of public interest. R. at 1. Although, the Appeals Council considered the additional evidence submitted by Plaintiff, it determined that the additional information did not provide a basis for changing the ALJ's decision. R. at 2. Therefore, the ALJ's decision became the Commissioner's final decision. R. at 1.

         On January 4, 2017, having exhausted her administrative remedies, Plaintiff, acting pro se, filed the instant Complaint for judicial review of the Commissioner's final decision. ECF No. 3. The Commissioner filed an Answer and the Administrative record, and the matter was referred to the undersigned for recommended disposition. ECF Nos. 8, 10. Plaintiff filed her Motion for Summary Judgment, ECF No. 12, and the Commissioner filed a Cross-Motion for Summary Judgment, a Memorandum in Support, and a Roseboro notice, ECF Nos. 14-16. The matter is now ripe for recommended disposition.

         II. RELEVANT FACTUAL BACKGROUND

         Plaintiff alleged her disability onset date was April 20, 2011. R. at 21, 77. When Plaintiff filed her application for SSI on May 17, 2012, she was twenty-four (24) years old and had acquired her GED. R. at 31-32, 201-11. Plaintiff does not have consistent prior employment. R. at 201-11. Her work history consists of retail sales positions, all of which seemingly last less than one (1) year, R. at 67, 87, 201, as well as sporadic modeling performances in fashion shows, see, e.g., R. at 475, 683. On August 12, 2015, Plaintiff testified before the ALJ at the administrative hearing and provided additional information. R. at 42-76.

         Plaintiff resides in Hampton, Virginia with her father, whom she contends is severely disabled, R. at 46, 228, and her twin children, then age 5, R. at 46. Her daughter, XXXXX has severe autism, and her son, XXXXX has ADHD and anger issues. R. at 57, 227. Plaintiff stated that both children receive SSI, and both attend regular doctor appointments and therapy sessions. R. at 46, 57-58. She is able, with the help of her father, to dress her children for their appointments and speak with doctors, and relies on both her father and fiance to assist in getting the children to school. R. at 57-58. She attempts to help with housework and chores as much as possible, though she often needs help and encouragement to do so. R. at 24, 229. Plaintiff visits friends once a month, and goes to the movies twice a month at night in order to avoid crowds. R. at 59. She owns a computer, which she uses to access the Internet for websites like Facebook and YouTube. R. at 59. Plaintiff has a driver's license, but does not drive because she experiences panic attacks when doing so. R. at 48, 230. She experiences similar anxiety when in a crowded public place; for instance, when she goes grocery shopping with her fiance. R. at 24, 49, 226.

         At the time of the August 12, 2015 hearing, Plaintiff was prescribed Hydrocodone, Naproxen, and Cyclobenzaprine for pain. R. at 54. She stated that Cyclobenzaprine and Naproxen no longer provided pain relief, and the Hydrocodone was effective approximately twenty-five percent (25%) of the time. R. at 55. Plaintiff also testified that she experiences depression that makes it difficult for her to get out of bed, and periods of mania where she becomes angry and closed off. R. at 62. These manic periods can last between five (5) minutes and three (3) to four (4) hours, and can sometimes cause her to forget to eat. R. at 62-63, 228. Plaintiff claims she experienced a ten (10) pound weight loss due forgetting to eat or drink during manic periods, and "even when [she] thinks about food . . . [she will] get really nauseous and [she will] feel like" she needs to throw up. R. at 63. Plaintiff also stated that during these manic episodes, she can become "really angry, to the point where [she] start[s] throwing things around the house, knocking things over, not wanting to be around anybody, trying to close [herself] off from everybody." R. at 62. Plaintiff also finds that sometimes transitioning from a sitting position to standing causes her to feel faint and black out. R. at 52. These black out episodes can last anywhere between fifteen (15) seconds and one (1) minute, though one time she experienced a black out for two (2) minutes. R. at 53, 714. During these episodes, Plaintiff sometimes falls to the ground or into walls or doors. R. at 54.

         Ronald Parsons ("Mr. Parsons"), Plaintiffs father, also testified at the hearing. R. at 65-68. He testified that Plaintiff has "a false awareness of reality," and that her conditions are worse than she stated. R. at 65. Mr. Parsons indicated that he is taking care of Plaintiffs children, despite a recent heart attack. R. at 65. He stated that he believes Plaintiff is autistic, and shows similar symptoms to Plaintiffs mother, whose medical problems could not be diagnosed and who died at age thirty-eight (38) of a massive heart attack. R. at 66. Mr. Parsons testified that when he is able to procure a job for Plaintiff, "within a month she's calling [him] up freaking out" and he has to pick her up. R. at 67. He then reiterated the opinion of Dr. Mukesh Shah ("Dr. Shah"), Plaintiffs psychiatrist, that Plaintiff is incapable of working. R. at 68.

         After the ALJ's decision, Plaintiff continued treatment at various medical facilities.[3] ECF Nos. 12, 12-1. She was subsequently diagnosed with Hypermobile Ehlers Danlos Syndrome on November 14, 2016, Postural Orthopedic Tachycardia Syndrome on December 27, 2016, and Raynaud's Syndrome on March 20, 2017. ECF No. 13 at 2. She continued to seek treatment from her psychiatrist for anxiety after her August 12, 2015 hearing. R. at 762.

         A. Relevant Medical Records Regarding Physical Impairments

         1. Primary Care Physician Dr. Linda Schneider

         According to her medical records, Plaintiff was twenty-three (23) years old on April 20, 2011, her alleged disability onset date. R. at 21, 77. On May 17, 2011, about one month later, she sought treatment from Dr. Linda Schneider ("Dr. Schneider"), complaining of anxiety, pain, and allergies. R. at 434. Plaintiff claimed that the onset of her anxiety "was year(s) ago," and that the condition worsens with "stress and [l]oss of sleep." R. at 434. Dr. Schneider noted that Plaintiff relieved her symptoms through medication and counseling, and that Plaintiff was negative for panic attacks or suicidal ideation. R. at 434. Plaintiff described her physical pain as residing in her lower back, and that it was "an ache and sharp." R. at 434. Dr. Schneider's report states that the "symptoms are aggravated by daily activities" and "are relieved by stretching." R. at 434. At the time of the exam, the physician found that Plaintiff had regular heart rate and rhythm, with "no murmurs, gallops or rubs." R. at 435. Dr. Schneider also found that Plaintiffs balance, gait, and coordination were intact, and Plaintiff experienced no sensory loss or motor weakness. R. at 435.

         On September 26, 2011, Plaintiff returned to Dr. Schneider for back pain and fatigue. R. at 431. Dr. Schneider found spinal tenderness and paravertebral muscle spasm, as well as periscapular trigger points. R. at 432. There was also "some audible crepitus" in her neck. R. at 432. However, Dr. Schneider noted that Plaintiff had no joint deformity and normal range of motion for her age, including normal range of motion in her neck. R. at 432.

         On December 12, 2011, Plaintiff returned to Dr. Schneider for back pain. R. at 428. Plaintiff described the pain as "numbness and sharp [, ]" and noted that the symptoms worsened "by changing positions, lifting, sitting and twisting." R. at 428. Pain medication provided some relief, but she had trouble sleeping despite taking her prescribed muscle relaxer, Cyclobenzaprine. R. at 428. During the appointment, Dr. Schneider found decreased lumbar mobility and tenderness, but no spasm. R. at 429. Plaintiffs results were also negative for a straight leg raising test. R. at 429. Dr. Schneider prescribed Ibuprofen and Tylenol. R. at 429.

         On March 28, 2012, Plaintiff visited Dr. Schneider again for back pain, anxiety, and allergies. R. at 424. Dr. Schneider noted that at that time Plaintiff was prescribed Cyclobenzaprine and Ibuprofen as needed for pain. R. at 424. The physical exam showed regular heart rate and rhythm with no murmurs, gallops, or rubs. R. at 424. In a visit on June 5, 2012 for constipation and hemorrhoids, Dr. Schneider noted that Plaintiff was "negative for chest pain, claudication, edema and irregular heartbeat/palpitations . . . negative for anxiety, depression, [and] negative for back pain, joint pain and joint swelling." R. at 658.

         On October 2, 2012, Plaintiff saw Dr. Schneider for hand spasms, back pain, and palpitations. R. at 653. The examination showed spasms along her cervical spine, thoracic spine, and lumbar spine, but full range of motion and no deformity in her elbows and hands. R. at 655. Plaintiff saw Dr. Schneider on November 14, 2012 for a burning sensation in the left side of her face. R. at 649. Her heart rate and rhythm during that examination were regular, with no murmurs, gallops, or rubs. R. at 651. On January 24, 2013, Plaintiff saw Dr. Schneider for cold symptoms and breast tenderness, R. at 645, at which time her heart rate and rhythm were regular, R. at 647.

         On March 18, 2013, Plaintiff sought treatment for Gastroesophageal reflux disease ("GERD"). R. at 642. Another treating physician in Dr. Schneider's practice saw Plaintiff, and noted abdominal tenderness, but no distention. R. at 643. Plaintiff had a regular heart rate and rhythm, with no murmurs, gallops, or rubs. R. at 643. On July 16, 2013, Plaintiff returned to Dr. Schneider for back pain and chest discomfort. R. at 635. Her physical examination showed tenderness in Plaintiffs spine, with no spasm or deformity. R. at 635. Plaintiff continued to have normal range of motion. R. at 635. Plaintiff was tachycardic when sitting, which accelerated with strain and slowed to normal with lying down. R. at 635. Dr. Schneider treated Plaintiff conservatively, instructing her to avoid caffeine and to drink enough fluids to keep urine light in color. R. at 636.

         2. Sentara Port Warwick Emergency Department

         On October 14, 2011, Plaintiff went to Sentara Port Warwick Emergency Department ("the Emergency Department") for chest pain and anxiety "that started [that] morning while in court during a very stressful custody hearing." R. at 343, 346. The attending Physician's Assistant ("PA") ordered CK total and CKMB tests, which revealed a friction rub, though Plaintiff had a normal heart rate and rhythm and no gallop or murmur. R. at 348. An echocardiogram ("EKG") showed "normal sinus rhythm, no ectopy." R. at 349. She had normal range of motion, and normal gait and coordination. R. at 348, 351. The Emergency Department prescribed Lorazapem for anxiety, which was later cancelled by a nurse per "patient choice." R. at 351-52.

         On February 8, 2012, Plaintiff returned to the Emergency Department for neck muscle strain, acute upper respiratory infections, and back pain. R. at 358-59. Plaintiff reported worsening neck and back pain over the previous two-week period, and that the pain was "severe and associated with some nausea." R. at 360. She also reported experiencing anemia. R. at 363. During the physical exam, the PA found no lighted-headedness, dizziness, or other complaints that signified the Plaintiff had such a condition. R. at 363. The PA did find that Plaintiff had full range of motion in her neck and back, as well as regular heart rate and rhythm. R. at 361. Plaintiff showed normal affect and thought content. R. at 362. Imaging of Plaintiffs spine showed "some muscle spasm in cspine and osteophytosis of thoracic back, but no concerning osseous abnormalities." R. at 363. The PA prescribed Flexeril and Naprosyn for symptomatic relief. R. at 363.

         On May 23, 2013, Plaintiff returned to the Emergency Department complaining of chest pain. R. at 592. On exam, Plaintiff had a normal heart rate and rhythm with no murmur, and full range of motion in all extremities. R. at 594. A chest x-ray showed "no acute cardiopulmonary process[, ]" while an EKG noted sinus rhythm with ventricular premature complex. R. at 595.

         3. Cardiologist Dr. Eric Chou

         Plaintiff initially sought care from cardiologist Dr. Eric Chou ("Dr. Chou") in 2009. R. at 714. At that time, Dr. Chou did not find any "obvious cardiac etiology" for shortness of breath and irregular pulse. R. at 714. Plaintiff returned to Dr. Chou in 2011, referred by Dr. Schneider, for "ongoing palpitations, chest pain, and recurrent syncopal episodes." R. at 714. Dr. Chou ordered a stress test and a two-week event recorder. R. at 714. At the follow up appointment on July 28, 2012, Dr. Chou reviewed Plaintiffs stress echocardiogram from October 31, 2011, R. at 437, as well as the event recorder, R. at 303. The event recorder showed that Plaintiff experienced "some episodes of sinus tachycardia, but there [were] no prolonged pauses or other significant arrhythmias noted. There were no syncopal episodes." R. at 303. Additionally, "[t]he stress echo was unremarkable." R. at 303. Based on these exam results, Dr. Chou determined that there was no primary cardiac etiology for Plaintiffs symptoms. R. at 303.

         Plaintiff returned to see Dr. Chou on October 31, 2013 for the same symptoms she exhibited in 2011. Dr. Chou performed an EKG, the results of which showed a sinus arrhythmia. R. at 714. He then recommended another two-week event recorder "to evaluate for any significant arrhythmia causing her syncopal episodes." R. at 716. During the physical examination portion of the appointment, Dr. Chou found that Plaintiff had regular heart rate and rhythm. R. at 716. Because of the unremarkable results in cardiac testing, Dr. Chou attributed the cause of Plaintiff s concerns to anxiety and dehydration, and noted that if the repeated event recorder did "not show any significant arrhythmias, [he did] not think [he] would pursue any further cardiac testing" at that time. R. at 717.

         4. Urinary Tract Infections

         Plaintiff claimed in her SSI application that she experiences continuous urinary tract infections ("UTIs"). See, e.g., R. at 319, 331, 383, 396, 417. Plaintiff went to Urgent Care for this problem on April 13, 2011, July 2, 2011, September 30, 2011, November 13, 2011 (at which time she was admitted to the emergency room), and March 20, 2012. See R. at 319, 331, 383, 396, 417. However, Dr. Schneider noted in September 2012 that "it is unclear ... if [Plaintiff] is actually having urinary tract infections" as the only bacterial culture positive for infection on file was taken in August of 2007. R. at 528. Following a renal and urinary bladder ultrasound in 2012 to rule out wider health concerns, Plaintiffs renal functions and bladder were deemed normal. R. at 526-27.

         B. Relevant Medical Records Regarding Mental Impairments

         1. Psychiatrist Dr. Mukesh Shah

         On April 20, 2011, Plaintiff had her first appointment with Dr. Mukesh Shah ("Dr. Shah"), Plaintiffs psychiatrist. R. at 501. During that visit, Plaintiff reported that she was diagnosed as bipolar when she was fifteen or sixteen years old, and at the time of diagnosis was prescribed Risperdal. R. at 501. Plaintiff continued use of this medication for approximately two (2) years. R. at 501. She claimed that the medication made her feel "like a zombie ... so she decided to stop taking it ... to see how she did without medications." R. at 501. Additionally, Plaintiff stated in the evaluation that in 2009, she visited her Primary Care Physician ("PCP"), whom this court assumes is Dr. Schneider, for insomnia and anxiety, which reportedly came on "in public places, and sometimes even at her home, where suddenly she would [start to experience] an increase in her heart rate and could not breathe." R. at 501. Plaintiff also reported that she had "given up her job in the past because of her anxiety spells at work[.]" R. at 501. The report states that Plaintiffs PCP prescribed Seroquel and Paxil in 2010 for her anxiety and mood symptoms. R. at 501. Although Plaintiff alleged an onset date of April 20, 2011, during the visit with Dr. Shah on this day Plaintiff denied any physical ailments. R. at 502. During the mental examination that accompanied that evaluation, Plaintiff was alert and oriented, her speech was spontaneous, and her thought process remained mostly goal-directed. R. at 502. She had occasional flight of ideas, and increased psychomotor activity. R. at 502. Her concentration was "okay" and her memory appeared "grossly intact." R. at 502. At the end of the evaluation, Dr. Shah assigned Plaintiff a Global Assessment of Functioning (GAF)[4] score of 55, [5] and increased Plaintiffs dosage of Seroquel. R. at 503.

         Plaintiff sought continued care with Dr. Shah from 2011 to the time of the hearing. R. at 455-97, 504-10, 647-748. On May 18, 2011, Dr. Shah noted that Plaintiff "report[ed] a definite improvement in her mood symptoms." R. at 497. Dr. Shah posited that Plaintiffs improvement might also have related to reduction in stress after winning her custody case. R. at 497. Plaintiff was alert and oriented, and made good eye contact. R. at 497. Her speech was coherent and relevant, her mood unremarkable, and her affect bright. R. at 497. Dr. Shah continued Plaintiffs prescriptions for Seroquel and Paxil. R. at 497.

         On August 8, 2011, Plaintiff reported that her medications might have been too strong, but that "she [was] doing well." R. at 487. Plaintiff was alert and oriented, made good eye contact, and her speech was "spontaneous, coherent and relevant." R. at 487. Her mood was unremarkable, and her affect bright. R. at 487. Dr. Shah reduced her prescriptions for Paxil and Seroquel. R. at 487. On November 17, 2011, Dr. Shah noted that Plaintiff reported was "doing well" but was "not taking Paxil as prescribed due to her having nausea from it." R. at 473. Her mood was stable, and she did not report any panic attacks. R. at 471. Plaintiff was alert, made good eye contact, and her speech was coherent and relevant. R. at 473. Her mood was unremarkable and her affect bright. R. at 471. Plaintiff continued her prescriptions for Paxil and Seroquel. R. at 471.

         On February 9, 2012, Plaintiff attended her appointment with her father and twins. R. at 466. She reported "spells of anxiety, where she gets a significant increase in her heart rate, shortness of breath, and chest pain." R. at 466. Plaintiffs father inquired about the possibility of Plaintiff having Asperger's syndrome. R. at 466. Dr. Shah did not notate his opinion about this assertion. See R. at 466. She reported getting easily overwhelmed when taking care of her children. R. at 466. Plaintiff reportedly continued her medication as prescribed. R. at 466. She was alert and oriented, made good eye contact, and her mood was unremarkable. R. at 466. Dr. Shah removed Paxil from Plaintiffs medications, and introduced Zoloft. R. at 466. Plaintiff continued her use of Seroquel. R. at 466. On March 7, 2012, Dr. Shah noted that Plaintiff "denie[d] any side effects from the current dosage" of Zoloft. R. at 463. On examination, Plaintiff was alert and oriented, made good eye contact, and had relevant and coherent speech. R. at 463. Dr. Shah continued Plaintiffs prescriptions for Zoloft, Xanax, and Seroquel. R. at 463.

         In Dr. Shah's May 2, 2012 medication evaluation, Plaintiff reported that she was "definitely doing better" and only had to use Xanax one time in two months. R. at 459. She maintained a stable mood and experienced adequate sleep. R. at 459. Plaintiff reported that "she remain[ed] busy taking care of her twins." R. at 459. Dr. Shah continued Plaintiff on her medications. R. at 459. In his July 11, 2012 quarterly medication evaluation, Dr. Shah reported that Plaintiff maintained stability and used Xanax only one time in three months. R. at 455, 675. She denied any sleep disturbance and side effects from her medications. R. at 455, 675. Her mood was unremarkable and her affect was bright. R. at 455, 675. Plaintiffs speech was coherent, she had fair eye contact, and her judgment appeared intact. R. at 455, 675. Dr. Shah reported continued use of her medications (Seroquel, Zoloft, and Xanax), as well as individual counseling. R. at 455.

         On October 1, 2012, Dr. Shah noted that Plaintiff "maintained stability during [that] review period. She denie[d] any side effects from her medications." R. at 671. Plaintiff was alert and oriented, made good eye contact, and had a "friendly" mood and bright affect. R. at 671. She continued her prescriptions of Zoloft and Seroquel. R. at 671. On November 19, 2012, Plaintiff reported increased stress due to having to find a new place to live and taking care of her father. R. at 688. Plaintiff was alert and oriented, with coherent and relevant speech. R. at 688. Her mood was unremarkable, "however, she did talk about some of her anxiety and sadness due to increased stress." R. at 688.

         On February 15, 2013, Dr. Shah's progress notes show that Plaintiff was doing "reasonably well," and that she required minimal use of Xanax over the prior three-month period. R. at 696. Plaintiffs mood was unremarkable, her speech coherent and spontaneous, and she showed fair judgment. R. at 696. In an appointment with another physician in Dr. Shah's office on May 17, 2013, Plaintiffs mood was "stressed," but she spoke spontaneously and had good eye contact. R. at 704. She reported trouble sleeping, and more frequent use of her Xanax. R. at 704. She continued Seroquel, Zoloft, and Xanax. R. at 705. On July 17, 2013, Plaintiff reported she was "doing reasonably well at [that] time." R. at 712. She was alert and oriented, made good eye contact, and had coherent and relevant speech. R. at 712. Her mood was unremarkable and her affect bright. R. at 712. Plaintiff continued her medications. R. at 712.

         On January 17, 2014, Plaintiff attended her appointment with her father and daughter. R. at 746. She stated that she was "not doing well at all" without her medication. R. at 746. Dr. Shah noted that Plaintiffs father asked him to write a letter attesting to Plaintiffs ability to work, and Dr. Shah opined in his patient notes that Plaintiff could not "return to work at [that] time or in the next twelve (12) months." R. at 746. Plaintiff was alert and oriented, but seemed overwhelmed. R. at 746. She allowed her father to take care of her daughter when she became disruptive, and Plaintiff did not intervene with her father's discipline. R. at 746. Plaintiffs speech was coherent and relevant, though her mood was "dysphoric" and affect "tense to a degree." R. at 746. Plaintiff agreed to retry a higher dose of Zyprexa (though the record is unclear when Plaintiff was prescribed Zyprexa prior to this appointment), as well as Xanax. R. at 747. She received a GAF score of 45. R. at 747. On January 23, 2014, Dr. Shah wrote a letter stating that Plaintiffs bipolar diagnosis would not allow her to work for the next twelve (12) months.[6] R. at 719.

         On February 21, 2014, Plaintiff reported that she was "doing reasonably well." R. at 743. She was alert and oriented, made some eye contact, and had coherent and relevant speech. R. at 743. Her mood was unremarkable and affect appropriate. R. at 743. She continued her medication, and had a GAF score of 51. R. at 743. During her May 15, 2014 visit, Plaintiff reported she was "not doing well." R. at 740. She experienced increased stress due to the behavioral issues of her children. R. at 740. She was alert and oriented, had coherent and relevant speech, and interacted appropriately with her son, who attended the appointment ...


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