United States District Court, N.D. Indiana, Fort Wayne Division
DONNA L. FRAIN, Plaintiff,
COMMISSIONER OF SOCIAL SECURITY, Defendant.
OPINION AND ORDER
PHILIP P. SIMON, Chief District Judge.
Plaintiff Donna L. Frain appeals the Social Security Administration's determination that she is not disabled. In essence, she argues that the ALJ erred in granting the most weight to the opinions of two state agency psychologists, as opposed to a consulting psychologist or her counselor. She also argues that the ALJ erred in discounting her credibility. Because I find that the ALJ relied on substantial evidence in making each of these findings, I AFFIRM his decision.
Readers looking for a more extensive discussion of Frain's medical record are directed to the detailed summaries in the ALJ's decision (R. at 23-30) and in Frain's opening brief (DE 24). Rather than simply reiterating those summaries, I will give a brief overview of the history of Frain's health issues and proceedings before the Social Security Administration.
Although Frain alleged both mental and physical impairments before the ALJ, she challenges only the portion of the decision relating to her mental impairments. Frain claims she has been disabled by post-traumatic stress disorder (PTSD), depression, agoraphobia, and anxiety. (DE 24 at 2) In 2004, Frain was hospitalized for several weeks after attempting suicide. (R. 563) At the time, she was working as a church janitor, but her nervous breakdown left her unable to work. ( Id. at 48) She was awarded Social Security disability benefits at that time. ( Id. at 47) She forfeited those benefits, however, when she was incarcerated from 2009 to 2011 for dealing methamphetamine. ( Id. ; Id. at 26) During her incarceration, Frain showed no signs of mental difficulties upon her intake examination in 2009, nor during multiple examinations by prison doctors. ( Id. at 27; see also e.g. Id. at 483, 489, 502) While incarcerated, Frain was able to complete her GED. (R. 46)
Upon her release from prison, Frain reapplied for benefits and met with Dr. Candace Martin, Psy.D., in July 2011 for a consultative mental status examination as part of her social security disability application. ( Id. at 516) It was the only time she would see Dr. Martin. Dr. Martin found that Frain was exceptionally anxious, depressed, and distraught; reported confusion, poor concentration, and distractability; and displayed nervous shaking, restlessness, and crying during the interview. ( Id. at 518) Frain reported, however, that she tried to present herself in a way that would make others think she's functioning well, such as helping with the vacuuming, laundry, cooking and maintaining her hygiene and grooming appropriately. ( Id. at 518, 520) Dr. Martin observed that Frain was well-oriented to time, place, and person; maintained eye contact adequately; and had adequate attention and concentration during the consultation. ( Id. at 518)
Dr. Martin diagnosed Frain with PTSD, major depressive disorder, generalized anxiety disorder, panic disorder, psychotic disorder NOS, methamphetamine dependence in remission, sleep terrors, amnestic disorder NOS, learning disorder NOS, personality disorder NOS, and probable borderline intellectual functioning. ( Id. at 520-21) She assessed a GAF (Global Assessment of Functioning) score of 18. ( Id. at 520) GAF scores reflect a clinician's judgment about the individual's overall level of functioning. The higher the GAF score, the better the individual's psychological, social, and occupational functioning. A GAF of 18 is alarmingly low; it reflects very serious symptoms indicating "some danger of hurting self or others ( e.g. suicide attempts without clear expectation of death; frequently violent; manic excitement), or occasionally fails to maintain minimal personal hygiene ( e.g. smears feces), or gross impairment in communication ( e.g. largely incoherent or mute)." See Am. Psychiatric Assoc., Diagnostic & Statistical Manual of Mental Disorders 32 (4th ed., Text Rev. 2000). Dr. Martin concluded that Frain was "not likely going to prove to be a reliable or good employee until she is better stabilized medically." (R. 520)
Later in July 2011 and again in October 2011, state agency psychologists Dr. Amy S. Johnson, Ph.D., and Dr. Maura B. Clark, Ph.D., reviewed the evidence in the record, including Dr. Martin's assessment, and provided a Mental Residual Functional Capacity Assessment. They found that Dr. Martin's assessment was extreme and afforded it no weight. ( Id. at 525, 588) The state agency psychologists found Dr. Martin's findings inconsistent with Frain's daily activities and the fact that she demonstrated an intact memory, normal concentration, and normal social interaction during the exam. ( Id. at 526, 588) They found it significant that Frain had demonstrated no symptoms while in prison, because if her symptoms had been as severe as she reported to Dr. Martin, she would not have been able to mask them and would have displayed some symptoms while in prison. ( Id. ) They further found that a sudden onset of severe symptoms after her release from prison was highly unlikely. ( Id. ) For these reasons, they discounted Frain's credibility. ( Id. ) They ultimately concluded that Frain could understand, remember, and carry out at least unskilled tasks, could relate on at least a superficial and ongoing basis with coworkers and supervisors, could attend to task for sufficient periods of time to complete tasks, and could manage the stresses involved with at least unskilled work. ( Id. )
During the time period between the two state agency reviews, in August 2011, Frain began treatment at the Bowen Center. She was referred there by her probation officer for relapse prevention in connection with her previous dependence on methamphetamine. (R. 543) She began individual and group therapy sessions with Jennifer Dyarman, LSW. Frain attended treatment at the Bowen Center about every two weeks for about a year ( see generally d. at 615-663), and it is unclear from the records whether she continued treatment beyond that; the records end in August 2012 ( Id. at 661).
When Frain first began treatment in August 2011, she reported that she was happy, but anxious, and the intake examiner found her to be relaxed and cooperative, with a clean and neat appearance. ( Id. at 543) She was diagnosed with an anxiety disorder with a guarded prognosis. ( Id. at 545-46) In September 2011, when she began treatment with Jennifer Dyarman, Frain was in acute distress with a depressed affect, but she was relaxed and stable. ( Id. at 641) From October 2011 through December 2011, although she experienced some ups and downs, Frain's overall state improved somewhat to moderate distress, an appropriate (not "depressed") affect, and again, she was relaxed and stable. ( Id. at 636-40)
Starting at the end of January 2012, despite reporting more stress, Ms. Dyarman found that Frain's condition improved again to mild distress, appropriate affect, and still relaxed and stable. ( Id. at 630) This is somewhat in tension with the reports of a nurse practitioner who met with Frain that same day, just prior to Ms. Dyarman's meeting. During the meeting with the nurse practitioner, Frain reported increased depressive symptoms, nightmares, excessive worry, and flashbacks. ( Id. at 624) In response, the nurse practitioner prescribed medications to Frain to "improve symptoms." ( Id. at 627-28) It appears this is the first time since her release from prison that Frain had taken psychological medications. During this visit, the nurse practitioner also assigned a GAF score of 30-40 ( id. at 627), which indicates serious symptoms.
It appears that the medications helped because during the time period from February 2012 through August 2012, treatment notes indicate Frain was smiling more, was more relaxed, was displaying a greater range of affect, and that her medication was helping. ( Id. at 615-30, 651-63) That is not to say that she was symptom-free, for she also reported at various times struggling with insomnia, bedwetting, and nightmares. ( Id. ) She also reported some continued difficulty with anxiety and depression. ( Id. )
Ms. Dyarman submitted a letter on Frain's behalf on June 25, 2012, stating that although Frain had experienced some stabilization of symptoms with medication, she would not be able to maintain employment due to the severity of her symptoms. ( Id. at 642) Ms. Dyarman reported that Frain would be off task 25 percent or more of the workday, was markedly limited in her activities of daily living, was markedly or extremely limited in a handful of work areas such as concentration/attention, ability to work with or interact with others, and ability to complete a normal workday without interruption. ( Id. at 645-46) She stated that Frain would need an unknown number of unscheduled breaks throughout the workday and would be absent more than four days a week. ( Id. at 647) She stated that Frain's GAF score at this point was 46. ( Id. at 43)
Social Security Administration Proceedings
Frain applied for disability insurance benefits on June 27, 2011, alleging a disability onset date of June 15, 2004. (R. 21) She was denied on both consideration and reconsideration. ( Id. ) After a hearing before an ALJ in which Frain testified, the ALJ issued a decision denying benefits. ( Id. at18-38) The ALJ employed the standard fivestep analysis. ( Id. ) At step one, the ALJ confirmed that Frain had not engaged in substantial gainful activity since her application date. ( Id. at 23) At step two, the ALJ found Frain suffered severe impairments of amnestic disorder, depression, and anxiety/panic disorder/post-traumatic stress disorder. ( Id. ) At step three the ALJ ...