United States District Court, N.D. Indiana, Fort Wayne Division
OPINION AND ORDER
Collins United States Magistrate Judge
Gina Holsinger appeals to the district court from a final
decision of the Commissioner of Social Security (the
“Commissioner”) denying her application under the
Social Security Act (the “Act”) for Disability
Insurance Benefits (“DIB”). For the following
reasons, the Commissioner's decision will be AFFIRMED.
25, 2014, Holsinger filed her application for DIB, alleging
disability as of August 15, 2008. (DE 5 Administrative Record
(“AR”) 192-93). Holsinger was last insured for
DIB on June 30, 2009 (the “DLI”) (AR 18), and
therefore, she must establish that she was disabled as of
that date. See Stevenson v. Chater, 105 F.3d 1151,
1154 (7th Cir. 1997) (explaining that with respect to a DIB
claim, a claimant must establish that she was disabled as of
his date last insured in order to recover DIB).
claim was denied initially on October 3, 2014, and again on
June 20, 2015. (AR 127-35, 137-43). Holsinger filed a request
for a hearing before an Administrative Law Judge. (AR
146-48). The hearing office staff indicated that
Holsinger's claim was critical need because of her mental
After a review of the evidence, the record indicates that the
claimant has two previous suicide attempts via overdose in
2008 and 2009 (Exhibit 16F, p.3). She also was admitted to
the hospital in April 2014 with feeling of hopelessness and
death wishes (Id.). She added that she was unsure
whether or not she could guarantee her own safety
(Id.). Accordingly, I have found that the record
supports critical need at this time.
(AR 106). On May 12, 2015, Administrative Law Judge Terry
Miller (the “ALJ”) held a hearing, at which
Holsinger, Ann Flaningam, LMFT, LMHC, LSW, and Amy
Kutschbach, a vocational expert (the “VE”),
testified. (AR 36-105). Holsinger was represented by George
Merkle, a non-attorney representative, at the hearing before
the ALJ. (AR 36-37). On May 28, 2015, the ALJ issued an
unfavorable decision, finding that Holsinger was not disabled
because, through the DLI, she was capable of performing a
significant number of jobs in the national economy. (AR
16-29). Holsinger requested that the Appeals Council review
the ALJ's decision (AR 10), and the Appeals Council
denied her request, making the ALJ's decision the final,
appealable decision of the Commissioner (AR 1-5).
January 4, 2016, Holsinger filed a complaint with this Court
seeking relief from the Commissioner's final decision.
(DE 1). In her appeal, Holsinger alleges that the ALJ erred
by: (1) not calling a medical expert to assess her conditions
at step two, step three, and in the residual functional
capacity (the “RFC”) determination; (2)
impermissibly “playing doctor” at step three and
in the RFC determination; (3) not properly considering
evidence of her obesity; and (4) improperly evaluating her
credibility. (DE 12 at 16-22).
time of the ALJ's decision, Holsinger was 47 years old.
(AR 43). She has a high-school education and has taken some
college courses but did not finish any college programs. (AR
46). She has certificates for early childhood development and
for substitute teaching. (AR 47). Holsinger's employment
history includes work as an assistant at a residential
treatment facility, a substitute teacher, arranging flowers,
as a shipping clerk, and at other semi-skilled positions. (AR
Holsinger's Testimony at the Hearing
hearing Holsinger testified as follows: She lives with her
elderly parents in a house that they own. (AR 45, 69). She is
about five feet, four inches tall, and weighs approximately
200 pounds. (AR 43-44). She claims that she weighed 160
pounds in 2009. (AR 44). She divorced her former husband in
2009 and has not remarried. (AR 44). She has two adult
children who do not live with her. (AR 45). Holsinger does
not receive any financial assistance or food stamps. (AR 45).
She has a driver's license and is able to drive. (AR 45).
difficult for Holsinger to relate to others. (AR 64). Her
mood fluctuates and she has strained relationships with her
children. (AR 64). Holsinger also isolates herself two to
three days a week and has trouble leaving her bed or
showering. (AR 65). Two to three days a week Holsinger gets
sidetracked when trying to complete tasks at home because she
wants to retreat. (AR 66-67). Holsinger has one very good
friend who comes over, and usually they stay in and talk. (AR
67-68). On bad days Holsinger does not answer her mobile
phone. (AR 69).
recently held a job from September 2013 to February 2015 at A
Friend's House Ministries, a residential treatment
facility for women, helping prepare meals and providing other
general assistance to residents. (AR 47-48). She stopped
working there because she had difficulty working the hours
that she was scheduled. (AR 48-49). Towards the end of her
time with A Friend's House Ministries, Holsinger missed
days frequently, but she handled the job despite problems
interacting with residents. (AR 65). She was not fired,
however, and left amicably. (AR 65).
between 2008 and 2010, Holsinger held positions as a
substitute teacher and arranging flowers, among other
semi-skilled positions. (AR 50-52). She left those positions
due to stress or other difficulties caused by depression or
anxiety. (AR 48-52, 77).
estimates that she can lift five to 10 pounds, walk two or
three blocks, and has trouble sitting. (AR 57). She claims
she was diagnosed with post-traumatic stress disorder
(“PTSD”), a major depressive disorder with
psychotic features, a borderline personality disorder with
bipolar features, a generalized anxiety disorder, and
agoraphobic tendencies. (AR 58). Due to her PTSD, she
experiences night terrors three or four times a week. (AR
causes Holsinger to have trouble leaving the house and to put
things off. (AR 60). When Holsinger leaves the house, hears
certain sounds, or smells certain scents, she begins to feel
anxious, causing her hands to sweat. (AR 61). She sometimes
has long periods of crying and has difficulty sleeping. (AR
61). Holsinger's night terrors wake her up frequently
during the night, and she has to sleep during the day. (AR
72). When Holsinger naps or goes to bed, she usually sleeps
for about four hours. (AR 73).
takes Trazodone and Minipress to aide with sleep. (AR 61).
Holsinger has seen a therapist, Ms. Flaningam, for
psychological counseling once or twice a month since 2008,
and finds it helpful. (AR 62). She takes Wellbutrin, a generic
form of Remeron and Clonazepam, and a generic form of Zoloft.
(AR 63). In 2008, Holsinger was taking Prozac and Xanax,
which sometimes helped with anxiety. (AR 63-64).
does the dishes, the laundry, occasionally “swiffers,
” but no yardwork or gardening. (AR 71-72). She does
not go to church or any type of religious service. (AR 72).
Holsinger likes to scrapbook but does not do that any longer
because it is hard for her to focus. (AR 72).
November 2008, Holsinger attempted suicide by overdosing on
Trazodone. (AR 80). She did this after seeing her therapist
and describing painful memories. (AR 80). In April 2014,
Holsinger had suicidal thoughts but did not act on them. (AR
80). Since 2008, Holsinger has felt depressed about five to
six days a week. (AR 74-75). She has difficulty working
because she does not know if she is going to have a good day
or a bad day. (AR 75-76). Even if she had a job where she
could sit alone she would have a hard time concentrating. (AR
Ms. Flaningam's Testimony at the Hearing
Flaningam testified as follows: She began seeing Holsinger in
September 2008 and saw her extensively in 2009. (AR 82).
However, Holsinger only saw Ms. Flaningam a little bit in
2010 and then did not see her again regularly until 2014. (AR
82). Ms. Flaningam does not believe that Holsinger saw
another therapist in that time. (AR 82). Ms. Flaningam
believes that Holsinger stopped therapy because “of the
disorders that she was having.” (AR 82). Generally,
Holsinger was not always compliant with treatment and Ms.
Flaningam suspects this was due to Holsinger's symptoms
and financial issues caused by overspending. (AR 82).
Flaningam opined that Holsinger's depression and anxiety
started around 2000 when her former husband, who Holsinger
alleged was abusive, put stress on Holsinger and exacerbated
her mental health issues. (AR 83-84). Holsinger reported to
Ms. Flaningam that between 2004 and 2008 she was extremely
depressed with anhedonia. (AR 85).
Holsinger began seeing Ms. Flaningam, she was “very
anxious, she couldn't go places, she had not been
sleeping, and would maybe only sleep for about an hour at a
time . . . .” (AR 85-86). Holsinger reported that she
had lost about 60 pounds towards the end of her marriage and
felt helpless. (AR 86). Holsinger told Ms. Flaningam that she
had suicidal ideation, and had made a plan. (AR 86). Ms.
Flaningam opined that Holsinger was exhibiting symptoms
typical of major depression, an anxiety disorder, and PTSD,
despite taking Prozac, Cymbalta, and Klonopin. (AR 86).
months after Holsinger began seeing Ms. Flaningam in November
2008, she overdosed on Trazodone and Klonopin, and contacted
Ms. Flaningam. (AR 86). Ms. Flaningam insisted that Holsinger
go to the emergency room, and Holsinger complied. (AR 86).
There, Dr. Brown and Ms. Flaningam initiated a 72-hour period
of detention to keep Holsinger in the hospital, and she was
treated by a psychiatrist and prescribed antipsychotic
medication. (AR 86-87).
continued to see Ms. Flaningam after the emergency room
visit, and she exhibited mood instability, sleep disturbance,
anger, and lethargy, began to cut herself, and sometimes
binged and purged. (AR 87). Holsinger was suspicious and
anxious to the point of being psychotic and paranoid. (AR
87). Holsinger had a couple of dating relationships with men,
but they were superficial and made Holsinger anxious. (AR
88). Generally, Holsinger had difficulty forming
relationships with other people. (AR 87-88). During the
period where Holsinger did not see Ms. Flaningam, Holsinger
dated a man, and Ms. Flaningam believed that this may have
made Holsinger happy. (AR 91-92).
was hospitalized once in 2011 and twice in 2014. (AR 88). The
second hospitalization in 2014 was the result of Holsinger
being depressed, cutting herself, experiencing flashbacks,
hallucinating, and being suicidal. (AR 88). Holsinger
continued to see Ms. Flaningam in 2014, but found it
difficult to be compliant with therapy. (AR 89). Holsinger
also exhibited difficulty paying bills due to overspending,
and she acted out sexually with men on a superficial level.
moved in with her parents in 2014. (AR 90). Ms. Flaningam
explained that Holsinger lives with her elderly parents, not
because they need physical care, but so that she is around in
case of an emergency. (AR 90). Ms. Flaningam also believes
that Holsinger's financial need prompted her to move in
with her parents. (AR 92). Holsinger lives on the second
floor of her parents' house, which allows her to isolate
herself from others. (AR 90). Prior to living with her
parents, Holsinger lived alone in an apartment. (AR 92).
Flaningam opined that Holsinger's anxiety and extreme
dysfunction make it difficult for her to interact with
society or develop “good relationships” with
other people. (AR 94). Ms. Flaningam reasons that
Holsinger's symptoms would likely cause her difficulty
traveling to and from work, given that she has trouble
getting to Ms. Flaningam's office. (AR 94-95). In Ms.
Flaningam's opinion, the severity of Holsinger's
symptoms from 2008 to the present makes it impossible for her
to work. (AR 95).
Relevant Medical Evidence
Prior to the DLI
September 1, 2008, Holsinger went the emergency room at
Bluffton Regional Medical Center, and presented with anxiety
and depression. (AR 302-04). Holsinger was in the midst of
divorcing her husband at the time, and reported suicidal
ideation but had no plan. (AR 303). Holsinger reported that
she was not sleeping or eating, but she had no self-inflicted
injuries or hallucinations. (AR 303). Although she had
prescriptions for Xanax and Cymbalta, she had not taken
either in a few days. (AR 303). Holsinger reported weighing
190 pounds. (AR 305). Steven Price, M.D., diagnosed her with
depression and hypokalemia; instructed her to stay with
family until she was better; recommended that she follow up
with David Brown, D.O.; and prescribed Xanax and Cymbalta.
September 18, 2008, Holsinger began seeing Ms. Flaningam,
having been referred by Dr. Brown. (AR 736). Holsinger
presented with daily depression, insomnia, weight loss, and
suicidal ideation with intent. (AR 736). Ms. Flaningam
reported that Holsinger felt that she could not face tomorrow
and was “thinking of wrecking her car.” (AR 736).
At the time Holsinger was taking Xanax, Cymbalta, and
Klonopin. (AR 737). Ms. Flaningam's report indicates that
Holsinger had no auditory or visual hallucinations. (AR 740).
Ms. Flaningam diagnosed Holsinger with depressive and anxiety
disorders, rule out panic disorder, and rule out major
depression. (AR 741). Ms. Flaningam assigned Holsinger a
Global Assessment of Functioning (“GAF”) score of
and noted that her highest GAF score in the past year was 65.
(AR 741). Ms. Flaningam developed a treatment plan for
Holsinger including continued therapy, medication, a suicide
prevention plan, and divorce care. (AR 741).
November 13, 2008, Holsinger went to the emergency room and
later was admitted to the intensive care unit at Bluffton
Regional Medical Center for overdosing on Trazodone; she had
intentionally ingested nine Trazodone pills at once. (AR
285-302). Holsinger reported that, just prior to taking the
Trazadone pills, her then-husband told her he was going to
leave for a long weekend with his mistress, prompting
Holsinger to file for divorce. (AR 289). Holsinger's
stress had been increasing up until then due to emails and
text messages involving her children. (AR 289). Holsinger
reported that she had lost “60 pounds in this whole
event.” (AR 289). Holsinger was tearful and