United States District Court, D. Massachusetts
OPINION AND ORDER
George A. O’Toole, Jr. United States District Judge
The Commissioner of the Social Security Administration denied Jocelyn Santiago’s application for a period of disability and disability insurance benefits. Before the Court are Santiago’s Motion for Judgment on the Pleadings (dkt. no. 9) and the Commissioner’s Motion to Affirm the Commissioner’s Decision (dkt. no. 14).
I. Procedural History
Santiago filed an application for Social Security disability benefits on January 6, 2012, claiming disability since March 2011. (Administrative Tr. 21 [hereinafter R.].) Her application was initially denied on April 12, 2012 and denied upon reconsideration on June 15, 2012. (Id. at 117-22, 125-29.) Santiago requested a hearing, which was held before Administrative Law Judge (“ALJ”) Daniel J. Driscoll on August 13, 2013. (R. at 41-80.) On September 19, 2013, the ALJ issued a decision concluding that Santiago was not disabled under the Social Security Act. (Id. at 18-40.) On October 17, 2013, Santiago requested review of the ALJ’s decision by the Appeals Council. (Id. at 15-17.) However, on December 2, 2014, the Appeals Council denied her request for review, (Id. at 1-6.), rendering the ALJ’s decision the final decision of the Commissioner and making the case ripe for review by this Court under 42 U.S.C. § 405(g).
Santiago was born in 1982. (Id. at 50.) She received an associate degree in business science. (Id. at 54.) During her schooling, she received various accommodations as a special education student. (Id. at 67-68.) Before the alleged onset of her disability, Santiago worked as a telephone operator performing customer service, hand packager, and cashier. (Id. at 55-62, 73-76.) She claims she suffers from various physical and mental impairments that limit her ability to work.
A. Relevant Medical History
i. Holy Family Hospital
On August 10, 2011, Santiago was evaluated in the emergency room at Holy Family Hospital for chest pain which she reported had worsened over a period of months. (Id. at 597.) Santiago complained of shortness of breath, dizziness, nausea, and headache, and reported a history of migraines, diabetes, polycystic ovarian syndrome, hyperlipidemia, asthma, and a cholecystectomy. (Id. at 597, 599, 601.) The examiner formed a clinical impression that Santiago’s chest pain was associated with anxiety and palpitations. (Id. at 602.) Santiago was prescribed Ativan (an anti-anxiety medication) at discharge. (Id. at 610.)
ii. William W. Austin and Roy E. Arroyo
On March 28, 2012, Santiago was evaluated by William W. Austin, Psy.D., and Roy E. Arroyo, Psy.D., at the request of the Social Security Administration. (Id. at 726.) Santiago reported being diagnosed with major depressive order at age 11 and again approximately six months prior to the examination. (Id. at 726.) She described symptoms of frustration, sadness, irritability, concentration problems, economic and health worries, sadness, interpersonal conflicts, need for reminders to perform daily tasks, anxiety attacks triggered by anger outbursts, periods of anhedonia, discomfort in crowded places, racing thoughts, and daily suicidal ideations. (Id. at 726-27.) She reported being able to perform basic acts of self-care independently, including waking up, bathing, dressing, grooming, driving, and managing her own funds. (Id. at 727.) She further reported having difficulty sleeping. (Id.)
According to Drs. Austin and Arroyo, Santiago presented as alert, casually dressed, and adequately groomed with adequate hygiene. (Id.) She was oriented as to person, place, and time, was cooperative, had adequate attention and concentration, and had adequate logical and coherent speech with adequate tone and volume. (Id.) Although no flight of ideas or loose associations were noted and no perceptional disturbances were reported, her mood was depressed with an irritable, flat affect and there was a mild impairment in recent and remote memory. (Id.)
Drs. Austin and Arroyo opined that Santiago’s social functioning and functional abilities were limited based on her reports. (Id. at 727.) They diagnosed major depressive order (recurrent, moderate), anxiety disorder, and cannabis abuse in sustained remission. (Id.) They noted occupational problems and problems related to the social environment and gave her Global Assessment Functioning (“GAF”) score of 53. (Id. at 728.)
iii. Erin Nuttall of Northeast Behavioral Health
On January 15, 2013, Santiago began treatment with therapist Erin Nuttall, M.A. (Id. at 874.) Santiago reported that she had been going through a difficult time since she became pregnant approximately five months prior to her appointment and subsequently lost her job after missing too many days while on bed rest. (Id.) Santiago also reported that she “over-worr[ied] about a lot of things” and felt sad or tearful every day. (Id.) She previously took Cymbalta and Wellbutrin, but was not on any medications at the time of the appointment. (Id. at 877.)
At that time, Santiago reported two arrests: one for armed robbery and one for assault and battery. (Id. at 875.) She also reported that she attended Katherine Gibbs College to become an administrative assistant and had studied psychology at Hesser College. (Id.) When asked if she wanted to work, Santiago stated “no.” (Id. at 876.)
Nuttall found that Santiago’s appearance was neat and appropriate and that her eye contact, build, posture, body movement, clothing, speech, emotional state-mood, emotional state-affect, facial expression, perception, thought content and process, intellectual functioning, orientation, memory, insight, and judgment were all within normal limits. (Id. at 878.) She described her behavior as relaxed and cooperative. (Id.) Santiago did not report any delusions or thoughts that were self-abusive, suicidal, or aggressive. (Id.) She did report difficulty controlling her anger, struggling with depression, and feeling stress because of family issues. (Id. at 879-80.)
Nuttall found no suicidal or homicidal ideation or self-destructive or aggressive thoughts or behavior and did not complete a safety plan with Santiago. (Id. at 869-70.) She noted that Santiago had a depressed affect and that Santiago denied current suicidal or homicidal ideations. (Id. at 873.) Nuttall diagnosed major depressive disorder and generalized anxiety disorder with a GAF of 45. (Id. at 872, 882.) She noted that Santiago needed help managing her depression, anxiety, and anger. (Id. at 883.) She noted that Santiago would benefit from individual therapy as well as exploring psychopharmacology options for pregnant women. (Id. at 882-83.) She also suggested medication management treatment post-pregnancy. (Id.)
On January 25, 2013, Nuttall documented that Santiago reported feeling overwhelmed by demands her family placed on her, wanted to move out of her parents’ house, and stated that her relationship with her boyfriend was turbulent, leading Nuttall to record her mental status as “appeared tired (emotionally and physically), sad, engaging.” (Id. at 886.)
On February 11, 2013, Nuttall’s notes state that Santiago had decided to move out of her parents’ house and was living in her car because of home-related stress. (Id. at 887.) Nuttall described Santiago’s mental status as “flat affect, appeared tired, engaging.” (Id.) She noted that Santiago was not taking any medication. (Id.)
On February 12, 2013, Nuttall’s notes state that Santiago’s strengths included her intelligence, her ability to be proactive, and her regular attendance at appointments. (Id. at 884.) She reported that Santiago stated that she wanted to feel less depressed, feel good about herself, and decrease stress. (Id.) At that time, stated potential barriers to reaching her goals of managing stress and her depressed mood included being homeless, unemployed, and unable to take medication because of her pregnancy, as well as her lack of support from others. (Id.)
On February 19, 2013, Nuttall’s treatment notes state that Santiago reported anxiety about a housing application and having had a difficult week because she discovered her boyfriend soliciting other women through social media, argued with her mother, and tried to go to a shelter but found it “disgusting.” (Id. at 888.) Nuttall described Santiago’s mental status as “frustrated, disappointed, engaging.” (Id.)
On February 26, 2013, Nuttall documented that Santiago reported she was sleeping at her boyfriend’s house and discovered additional evidence of his infidelity. (Id. at 889.) Nuttall described Santiago’s mental status as “appeared tired, frustrated, discouraged.” (Id.)
On March 5, 2013, Santiago reported some issues with her family, but she also noted that her relationship with her boyfriend had improved. (Id. at 890.) Nuttall described Santiago’s mental status as “positive affect, engaging, ” and wrote that Santiago was considering moving to ...