United States District Court, D. Massachusetts
MEMORANDUM AND ORDER ON PLAINTIFF'S MOTION TO
REVERSE AND DEFENDANT'S MOTION TO AFFIRM THE DECISION OF
Dennis Saylor, IV United States District Judge
an appeal of a final decision of the Acting Commissioner of
the Social Security Administration (“SSA”)
denying plaintiff Andrew Lariviere's application for
Supplemental Security Income (“SSI”) and Child
Insurance Benefits (“CIB”). Lariviere appeals
the denial of his application on the ground that the
administrative law judge (“ALJ”) erred in
discounting the opinions of his treating and consultative
has moved to reverse the decision of the Acting Commissioner,
and defendant has cross-moved to affirm the decision of the
Acting Commissioner. For the reasons stated below, the
decision will be affirmed.
Lariviere was 26 years old at the time of his hearing on
September 16, 2015. (A.R. 35, 38). He graduated from
Bridgewater State University in 2013 with a major in English
and a minor in Secondary Education. (A.R. 39, 44). He has no
work experience and lives with his parents in Massachusetts.
(A.R. 39, 221-22).
Medical Evidence from Examining Physicians
earliest record of treatment of Lariviere dates back to
December 2012, when he reported anxiety to his primary-care
physician, Dr. Felicia Freilich. (A.R. 272-73). At that
appointment, Dr. Freilich noted that the onset of his anxiety
was “many years ago, likely around age 5, ” that
its status was “improving, chronic, ” and that he
denied “anxiety, depressed mood, [and] panic
attacks.” (A.R. 272). At that time, Lariviere was
taking a daily 40 mg dose of Celexa (citalopram hydrobromide)
for anxiety and OCD. (Id.). Dr. Freilich noted that
his anxiety had “[i]mproved significantly on
Celexa” and that his OCD was “much improved on
Celexa.” She noted that his mother reported that
“Celexa has helped Andrew immensely- anxiety is better
OCD-type behaviors are better. He is back to
himself-laughing, joking, etc.” (Id.). In her
general psychological evaluation, she noted that he was
“still with odd, Asperger-type affect, somewhat
flat-HOWEVER, much brighter than before. Made a couple jokes,
more interactive than previous.” (Id.). Dr.
Freilich noted that he was not seeing a therapist, but that
she “[a]gain, offered referral to group therapy for
Asperger's and social interaction, but pt.
continued to see Dr. Freilich for primary care. He had a
physical examination on January 10, 2013, at which Dr.
Freilich noted that he was “[d]oing well overall-much
more functional since he started on the Celexa.” (A.R.
270). As to his OCD, she noted that he was “[d]oing
very well on Celexa-this is probably the most calm I have
ever seen him. Mom very happy with his progress-OCD-type
behaviors are much improved.” (Id.). She also
noted: “odd affect (this is his baseline with the
Aspergers), does seem a lot more calm though, cognitive
function intact, cooperative with exam.” (A.R. 271).
next physical on January 16, 2014, Dr. Freilich noted that
Lariviere's “[m]ain issue is his Aspergers, OCD,
anxiety which is making it very difficult for him to get a
job.” (A.R. 268). She noted that he was “[d]oing
very well on Celexa in terms of his OCD-type behavior,
however, the anxiety and social difficulty typical for
Asperger are still present.” (Id.). She also
noted that he “[f]eels well. Mom wants him to apply for
disability. Pt. says he is doing well on the Celexa in terms
of his anxiety.” (Id.). And she noted
“poor eye contact, affect flat, affect restricted
(baseline for him).” (A.R. 269).
March 14, 2014, Lariviere saw Dr. Timothy Horton for a
psychodiagnostic interview upon referral from the
Massachusetts Rehabilitation Disability Determination
Services. (A.R. 279-81). Lariviere reported that he had a
friend, but that he is lonely, and that he drives regularly.
(A.R. 279-80). Dr. Horton described Lariviere's daily
Able to manage personal care independently, Mr. Lariviere is
also capable of performing all household chores. He knows how
to use both a cell phone and the Internet. Interests/hobbies
are video games and Internet (for information and social
networking). Capacity to focus/concentrate is described as
adequate. During the past two weeks, out-of-home activities
were shopping, visiting friends/relatives, exercising, and
eating at a restaurant.
respect to his mental status, Dr. Horton described him as
“poised and humorless, ” “[m]aintaining
normal eye contact, ” “cooperative, ”
“[a]lert and well oriented, ” and that his
“affect is congruent to thoughts with normal intensity
and limited range.” (A.R. 280-81). Dr. Horton
administered a mini-mental state evaluation, and Lariviere
scored 29/30, “which is above the recommended cutoff
score for identifying cognitive impairment.” (A.R.
280). Dr. Horton noted that his “[c]ognitive ability is
estimated to be above average, ” that his
“[l]ong-term memory is intact, ” that his
“[s]peech is rapid but otherwise normal, ” and
his “[e]xpressive language skills are
well-developed.” (Id.). As to his anxiety, Dr.
Horton noted: “Obsessive content and compulsive
tendencies are reported. Mood is described as apprehensive
(anxiety in some types of social settings, e.g., student
teaching, public speaking).” (Id.).
Horton diagnosed “Social Phobia (300.23); rule-out
other Anxiety Disorders, ” obesity, and
“occupational and economic problems.” (A.R. 281).
He assessed a global assessment of functioning
(“GAF”) score of 60. (A.R. 281). He concluded as
With regard to employment, Mr. Lariviere is capable of asking
questions, requesting assistance, understanding and recalling
work procedures, and meeting hygiene standards. Symptom
(social anxiety in specific types of settings) interference
may negatively impact attendance, work/rate persistence,
tolerance for change/stress, and capacity to sustain working
relationships with coworkers and supervisors.
18, 2014, Dr. Freilich submitted a DDS questionnaire in which
she noted that “Andrew has Asperger's syndrome and
OCD-both of which make it very difficult to function
socially in a work environment.” (A.R. 295). In
response to a prompt requesting information as to whether his
condition had worsened or changed, she stated: “Andrew
continues to exhibit classic Asperger-type
behavior-difficulty reading social cues, difficulty
interacting with others. He also has significant anxiety and
OCD, which is treated with medication. While the medication
does help with the anxiety and OCD, Andrew would have a very
hard time functioning in a work environment.” (A.R.
February 6, 2015 annual physical examination, Lariviere
reported to Dr. Freilich that his “[m]ain concern is
worsening OCD-doesn't think the Celexa is working
anymore.” (A.R. 308). She also noted “odd affect,
poor eye contact, mood depressed, anxious-appearing, alert,
oriented, cognitive function intact, cooperative with
exam.” (A.R. 310). As to his OCD, Dr. Freilich wrote:
Pt has finally agreed to see psychiatry (I have tried to
refer him several times over the years), so I have given him
a list of psychiatrists to call and schedule an appt. I think
that pt would benefit from Abilify or another atypical
antipsychotic, but would prefer for pt to be following by
psychiatry. Pt admittedly has only agreed to see psychiatry
since he was denied SSI.
saw Dr. Gabriela Velcea, a psychiatrist, for an evaluation on
June 19, 2015. He reported to her that “his emotional
struggles have been increasingly more severe in the past year
or so, to the point of rarely leaving the house, ” and
that the Celexa “was initially helpful, but lately
doesn't seem to help as much.” (A.R. 335-36). She
diagnosed PTSD, OCD, and Asperger's disorder and assessed
a GAF of 55. (A.R. 339). She increased his dose of Celexa to
60 mg. and “recommended individualized therapy
ASAP.” (Id.). It appears, however, that
Lariviere did not want therapy, because she also made a note
to follow up with “therapist referral if pt. decides to
accept it.” (Id.).
saw Dr. Velcea two more times. On July 6, 2015, she noted
that his condition had “[i]mproved, ” and that
she had explained to him and his mother the “need for
cognitive restructuring, basic CBT principles.” (A.R.
340). On August 17, 2015, she again noted that his condition
was “[i]mproved” and that he “reports he
has been doing better, anxiety diminished, able to function
better, although he is not doing too much outside the
house.” (A.R. 341). In addition to the 60 mg. dose of
Celexa, she prescribed Ativan “for anxiety before known
Lariviere and his mother submitted reports on his functioning
and activities in connection with his initial application for
benefits. (AR. 227, 234). His mother indicated that he
“eat[s], cook[s], plays video games, enjoys his cats,
watches TV, does some chores, sleeps at various times no set
sleep pattern, ” and that his hobbies include
“creating a computer game” and
“drawing.” (A.R. 227, 231). She noted that he
feeds, grooms, and cleans the litter box for his cats. (A.R.
228). She indicated that he is capable of his own personal
care, but that he is “not very concerned about his
hygiene” and “has to be constantly reminded &
pushed to bathe & change clothes.” (Id.).
With respect to chores, she wrote that he does cleaning and
laundry but needs “constant reminder[s]” and it