United States District Court, N.D. Indiana, South Bend Division
OPINION AND ORDER
JON E. DEGUILIO, District Judge.
On July 3, 2013, Plaintiff Tracie Pope Townsend filed her Complaint in this Court seeking review of the final decision of the Defendant Commissioner of Social Security (Commissioner). [DE 1.] The Commissioner filed an Answer on January 31, 2014. [DE 7.] On March 14, 2014, Townsend filed her opening brief [DE 10], to which the Commissioner responded on June 20, 2014. [DE 16.] Townsend did not reply. Accordingly, the matter is now ripe for decision. Jurisdiction is predicated on 42 U.S.C. § 405(g).
I. Procedural History
Townsend filed an application for disability insurance benefits (DIB) on August 23, 2009 and supplemental security income (SSI) on October 6, 2009. (Tr. 154-64.) Her applications were denied initially on May 3, 2010, and again upon reconsideration on December 13, 2010. (Tr. 84-92, 98-103.) On February 24, 2012, a hearing was held before Administrative Law Judge Warnecke Miller (ALJ). (Tr. 47-75.) On March 22, 2012, the ALJ issued a decision denying the claims. (Tr. 16-41.) The Appeals Council denied a request for review on May 8, 2013, making the ALJ's decision the final decision of the Commissioner. (Tr. 1-6.).
Townsend was born on June 1, 1968 and was 43 years old on the date the ALJ rendered his decision. (Tr. 154.) Townsend has completed the eleventh grade, obtained her GED, and earned several college credits. (Tr. 747, 757.) She has worked as an administrative assistant in a veterinarian office and an antique shop, although she essentially had no evidence of work activity from 2000 to 2004, and 2007 to the present. (Tr. 69, 170-172, 747-48.) Townsend grew up in an intact family of seven, but by the time of the hearing, her mother, father, and two of her brothers had passed away, one whom passed away in February 2006 and the other in November 2007. (Tr. 324, 746-47, 893.) In early 2009, she reportedly stopped working to care for her sick mother. (Tr. 768.) After the passing of her mother in April 2009, she lived with her father who was her primary care giver, until he passed away of a sudden heart attack on September 20, 2011. (Tr. 65, 898.) Thereafter, Townsend's sister began caring for Townsend on a daily basis. (Tr. 63-67.)
Townsend has been married twice but has no children. (Tr. 680, 746.) According to her medical report, her functioning started to decline in her early 30's, nearing the end of her second marriage when her drinking significantly increased. (Tr. 750-51, 56.) In this appeal, Townsend alleges a disability onset date of January 1, 2007 for mental impairments involving severe anxiety and depression, panic attacks, and bipolar disorder, while remaining insured through September 30, 2007 for purposes of DIB (Tr. 158, 183-191.)
The evidence establishes that Townsend has suffered from a long-standing history of alcohol abuse with intermittent improvement/relapses until October 2010 when she achieved sobriety but thereafter became incredibly thin. Townsend and her treating physicians believe that Townsend drank as a means of self-medicating for her anxiety and mental health issues. Ultimately, the ALJ opined that absent Townsend's drug addiction and alcoholism (DAA) she could perform limited sedentary work and therefore she was not disabled.
A. Townsend's Alcohol Dependence and Depression/Anxiety
Townsend's joint diagnosis of alcohol dependence and depression/anxiety are noted throughout the record. (Tr. 262, 294, 324, 330, 355, 386, 402, 422, 442, 474, 486, 615, 620, 625, 630, 636, 644, 673, 675, 688, 693, 698, 735, 749, 759, 818, 824, 845, 894, 899.) There are few occurrences in the record where Townsend was not diagnosed with both alcohol dependence and depression/anxiety. (Tr. 255-256, 305, 343, 567.)
Townsend's extensive history of hospitalizations in 2006, 2009, and 2010 are also reflected in the record. (Tr. 255-291, 292-303, 304, 309, 324, 342, 355, 384, 400, 419, 442-43, 486-87, 544, 561, 632, 674, 676.) In 2009 through 2011, she was also under the care of the Center for Behavioral Medicine and Oaklawn Psychiatric Center. (Tr. 612-631, 670-699, 783-824, 827-881, 887, 889, 892-910.)
Dr. Jarvis was extensively involved in Townsend's treatment. In November 2006 and June 2009, Dr. Jarvis noted her various hospitalizations since 2004. (Tr. 324, 332, 324, 360-61.) He also indicated his realization that Townsend had not remained sober as often claimed. Id. In June 2009, Dr. Jarvis wrote a detailed report, noting that Townsend was well known to his practice and had been his patient for five to six years at that point. (Tr. 360-62.) He explained that she has a combination of issues, which consisted of generalized anxiety disorder with limited symptom panic attacks, depressive disorder, bereavement, avoidant personality features, and alcohol dependence which is "episodic" and severe. Dr. Jarvis pointed to a "cascade of losses" that were causing her current presentation, pointing out the death of her mother, brother, pet dog, and the significant evolving illness of her father. (Tr. 360.) Townsend then agreed to transition to Oaklawn Psychiatric Center for rehabilitation which occurred on August 2, 2009. (Tr. 487, 561.)
By August 9, 2009, Townsend started going to two alcoholics anonymous (AA) meetings a week and had a sponsor, although according to Oaklawn's record she began struggling with increased anxiety and weight loss. (Tr. 615.) By August 23, 2009, she had been sober for almost thirty days and increased her AA meetings to three times per week. (Tr. 620.) Although the report stated that her anxiety was still bothersome, she had been able to gain one pound and her sleep improved. (Tr. 620.) By October 15, 2009, Townsend reported that she had finished step two in the AA program. (Tr. 624.) The report still showed that she had increased anxiety, and attributed it to an upcoming court date. (Tr. 624.) On November 12, 2009, she discussed her sobriety, was described as upbeat, and reportedly felt stronger since gaining five pounds. (Tr. 629-31.) On January 7, 2010, Townsend reportedly graduated from Oaklawn's domiciliary intensive outpatient program, completing five months of sobriety. (Tr. 697.)
Unfortunately, one month later, on February 6, 2010, Townsend relapsed nearing the anniversary date of her brother's death. (Tr. 632, 636, 643.) Oaklawn's clinical nurse specialist and medical doctor indicated that "triggers to relapse (trauma), and coping" were discussed. (Tr. 694.) A February 21, 2010 report, made by a medical doctor at Oaklawn, described Townsend's behavior as self-medicating after being depressed about recent family deaths. (Tr. 676.) Both Dr. Jarvis at the Center for Behavioral Medicine and Dr. Matthews at Oaklawn recommended that Townsend be hospitalized for long-term treatment. (Tr. 744-45.) And on March 17, 2010, Townsend was released by Oaklawn and committed to Richmond State Hospital for sustained intensive treatment of her alcohol dependence and mood and anxiety disorders. (Tr. 671-674.) While committed, Townsend was described as a "hopeful, positive person making progress towards recovery." (Tr. 731.) On June 9, 2010, she was transferred from Richmond to the Oaklawn Transitional Group Home. (Tr. 731.)
By June 29, 2010, Townsend was attending AA meetings twice per week, appeared calm, and denied problems with anxiety. (Tr. 802, 805.) At the time, psychiatrist Lois Elaine Duryea, D.O., opined that Townsend was incapable of gainful employment due to her psychiatric illness. (Tr. 783.)
On August 5, 2010, during her treatment at Oaklawn, Townsend reported that she found a small AA group and asked for permission to only attend that group, which met once per week. (Tr. 811.) She reported being anxious in a group of more than five people, but was able to go to the grocery store with family and did not appear anxious in the waiting room of about twenty people. (Tr. 811.) On September 9, 2010, the report states that she was anxious and had trouble relaxing. (Tr. 817.) On October 21, 2010, she was described as pleasant and cooperative, saying that she liked going to her AA meetings and was looking forward to the holidays. (Tr. 823.) On December 16, 2010, she had remained sober and said that she liked going to AA meetings. (Tr. 841, 844.)
B. The State Agents' Assessments
On April 30, 2010, the state consultative examiner William Schirado, Ph.D., completed a psychiatric review technique and indicated that his first assessment was from January 1, 2007 (the onset date) to September 30, 2007 (the date last insured), while his second assessment continued from onset to August 28, 2009. (Tr. 700-727.) Townsend was noted as suffering from "coexisting nonmental impairment(s) that requires referral to another medical specialty." Townsend was not categorized as having any mental disorders until the second assessment which indicated she suffered from substance addiction disorder resulting in induced mood disorder, without which she would not have a medically determinable mental impairment. It appears that Schirado believed Townsend had no functional limitations, but the form was not filled in. On December 8, 2010, reviewing state agent William Shipley, Ph.D, affirmed Schirado's assessment. (Tr. 825.)
On May 3, 2010, state agent Cheryl Bruzewski concluded that physically, Townsend's primary condition was alcoholism, and that the only difficulties she would have were with lifting, squatting, bending, standing, walking, kneeling, and stair climbing, along with difficulties with memory and concentration, but not with instruction. (Tr. 728.) On December 11, 2010, reviewing state agent J. Sands, M.D. affirmed Bruzewski's assessment. (Tr. 826.)
C. Townsend's Malnourishment
As of late October 2010, it appears Townsend stopped drinking, but she began dropping weight. Measuring five feet, eight inches tall (Tr. 683), her reported weight and body mass index (BMI) since September 2010 were as follows:
Date Weight Page Calculated BMI 9/9/10 116 855 17.6 10/21/10 111 823 and 850 16.9 12/16/10 109 844 and 904 16.6 5/12/11 94 903 14.3 8/4/11 87 896, 899, 900 13.2 ...