United States District Court, D. Massachusetts
H. HENNESSY, UNITED STATES MAGISTRATE JUDGE
Plaintiff, Jean Conway, seeks reversal of the decision by the
Defendant, the Commissioner of the Social Security
Administration (“the Commissioner”), denying her
Disability Insurance Benefits (“DIB”) and
Supplemental Security Income
(“SSI”). Docket No. 16. The Commissioner seeks an
order affirming the decision. Docket No. 18. Plaintiff has
submitted a response opposing Defendant's motion to
affirm and in further support of her motion for reversal.
Docket. No. 20. In accordance with both 28 U.S.C. §
636(c) and Rule 73(b) of the Federal Rules of Civil
Procedure, the parties consented to have me conduct all
further proceedings in this matter. Docket No. 11. The above
motions are ripe for adjudication.
reasons that follow, this Court GRANTS Plaintiff's motion
for an order reversing the decision of the Commissioner
(Docket No. 16), DENIES Defendant's motion for an order
of affirmance (Docket No. 18), and ORDERS that the case be
remanded for further administrative proceedings.
filed applications for DIB as well as SSI on March 6, 2012
and March 26, 2012, respectively. (Tr. 211-222). In both
applications, Conway alleged disability beginning on October
3, 2008. (Id.). The applications were denied
initially and upon reconsideration. (Tr. 79-132, 150- 155).
Conway requested a hearing on July 8, 2013, (Tr. 156), and a
hearing was held before an ALJ on May 22, 2014, at which
Conway both appeared and testified (Tr. 53-75). Conway waived
her right to representation at the hearing. (Tr. 32, 54). On
August 6, 2014, the ALJ issued a decision finding that Conway
was not disabled. (Tr. 29-45).
19, 2015, the Appeals Council denied Conway's request for
review, making the ALJ's August 6, 2014 decision final
and ripe for judicial review. (Tr. 19-21; see also
42 U.S.C. § 405(g)). After a series of requests for an
extensions of time, the Appeals Council wrote to Conway on
April 17, 2017 to further extend the time within which Conway
could file a civil action challenging the
Administration's decision. (Tr. 1). Having pursued and
exhausted her administrative remedies before the
Commissioner, Conway filed a complaint in this Court on May
8, 2017, pursuant to 42 U.S.C. § 405(g). Docket No. 1.
On September 8, 2017, Conway filed a motion for an order
reversing the decision of the Commissioner (Docket No. 16),
and on October 6, 2017 the Commissioner filed a motion for
affirmance (Docket No. 18). Conway has filed a response to
the Commissioner's motion and in further support of her
own motion. Docket No. 20.
time she claims she became disabled, Conway was 52 years old.
(Tr. 79). Conway is an Army veteran, has obtained a General
Educational Development diploma, and has taken some college
courses. (Tr. 541, 56). She has been living alone in
Massachusetts since June 2012. (Tr. 37, 41). She is able to
cook for herself, drive, food shop, and walk her dog. (Tr.
37, 61-62). For seven years until February 2012, she worked
as a personal care aide for an elderly patient. (Tr. 56, 85).
This job required Conway to work twenty-five to thirty hours
per week. (Tr. 57). In addition, Conway worked for several
months in 2010 as a supervisor for the United States Census
Bureau. (Tr. 58-59). This job required Conway to work twenty
to forty hours per week. (Tr. 59).
November 18, 2010, Conway saw clinical psychiatric pharmacist
Joy R. Miller at the Veterans Administration in Corpus
Christi, Texas (“Corpus Christi VA”). (Tr. 429).
Dr. Miller noted that Conway had been on medication to help
Conway with sleeplessness, depression, anxiety, and pain.
(Tr. 428). Conway reported working part-time at the same job
for five years, an apparent reference to her ongoing
employment as a personal care aide. (Tr. 430). She reported
increased anxiety, and lack of motivation and energy.
(Id.). Conway also reported having no side effects
from current medication, but reported smoking marijuana
daily. (Id.). Dr. Miller diagnosed Conway with
residual depression, and prescribed a new
medication-citalopram-while advising Conway to maintain the
current medication and therapy, and discontinue marijuana
use. (Tr. 431).
April 8, 2011, Conway received mental health treatment at the
Corpus Christi VA from Doris Alvarez, LCSW. (Tr. 418). Conway
had been seeing Ms. Alvarez for counseling since 2009. (Tr.
540). Ms. Alvarez reported Conway's overall mood seemed
more stable and that Conway was working and able to provide
for her financial needs. (Tr. 418). She also reported that
Conway's appetite and sleep had improved. (Id.).
Conway told Ms. Alvarez that she had passive suicidal
thoughts but would never act on them. (Id.). The
session ended prematurely when Conway expressed significant
same day, Conway saw Dr. Miller and reported that the
citalopram medication targeting residual depression was
helping a lot. (Tr. 421). In addition to decreased
depression, Conway reported reduction in anxiety, a healthy
appetite, and adequate sleep. (Id.). Conway also
reported to Dr. Miller that she was still working part-time
at the same job she had for five years and that she recently
“picked up a new client.” (Id.). In
addition, Conway demonstrated increases in motivation and
energy, and was regularly taking her dog to the beach and
park. (Id.). Dr. Miller observed that Conway was
friendly, cooperative, appropriately dressed and groomed, and
had “a much brighter affect” than in previous
appointments. (Tr. 422). Dr. Miller further noted that
Conway's psychiatric condition was significantly
6, 2011, pursuant to a referral from Doris Alvarez, Conway
met with Dr. Melissa Pinson at the Corpus Christi VA. (Tr.
540). Dr. Pinson observed that Conway was alert, oriented,
and defensive, and had a low activity level but appropriate
appearance. (Tr. 543). Conway informed Dr. Pinson that she
was experiencing depression and anxiety since 2008 due to the
end of a thirty-year relationship in 2008. (Id.).
Conway reported first seeking mental health treatment in 2003
following a car accident, and informed Dr. Pinson that her
mother committed suicide in 1978. (Id.). Conway
reported having PTSD symptoms as a result of the car
accident, but that these symptoms were relieved with
counseling and that she “has not been experiencing any
re-experiencing of this event or avoidance related to this
incident.” (Id.). Conway also stated that she
was raped while in the military but that “she is not
bothered by [it] at this time.” (Tr. 542). She reported
that she was employed as a home health aide but that she was
living below the poverty line. (Id.). Dr. Pinson
offered to refer Conway for financial counseling, but Conway
declined. (Id.). Conway reported loss of interest
and enjoyment of activities, and having ongoing legal issues
surrounding the property she shared with her long-term
ex-partner. (Id.). She also reported daily use of
marijuana. (Tr. 543). Dr. Pinson advised Conway to quit
marijuana use because of its negative mood effects, and
Conway told Dr. Pinson that she realized she should quit.
(Id.). Conway denied current suicidal ideation or
intent and her judgment seemed adequate. (Tr. 544). Dr.
Pinson diagnosed major depressive disorder and moderate
anxiety, and assessed a Global Assessment of Functioning
(“GAF”) score of 55. (Id.).
11, 2011, Conway again met with Dr. Pinson. (Tr. 535). Dr.
Pinson noted that Conway was dressed and groomed
appropriately but appeared depressed and irritable.
(Id.). Conway reported that her symptoms of anxiety
and depression were the same as the previous month.
(Id.). She appeared to be “maintaining coping
with symptoms.” (Tr. 536). Conway was concerned about
losing her job if her home health patient passed away and not
being able to find another job in the same field since she
now had a “psychiatric record.” (Tr. 535). Dr.
Pinson helped Conway identify evidence that does not support
these anxious beliefs. (Id.). Conway declined Dr.
Pinson's offer for employment counseling. (Id.).
Dr. Pinson reiterated Conway's diagnoses and GAF score of
55. (Tr. 536). These diagnoses and GAF score were approved by
supervising and cosigning psychologist Dr. Armando Berumen.
August and September 2011, Conway failed to attend scheduled
appointments with Dr. Pinson. (Tr. 530, 533). On October 26,
2011, Conway met for seventy minutes with Dr. Pinson, who
observed that Conway appeared depressed, but oriented,
appropriately dressed and groomed, and without hostility that
Conway exhibited in past meetings. (Tr. 526). Conway reported
that her symptoms of depression and anxiety were “the
same.” (Id.). Dr. Pinson also noted that
Conway brought with her “The Dialectical Behavior
Therapy Workbook, ” which a friend had given her.
(Id.). Conway stated that she has been sleeping
roughly sixteen hours per day to avoid depression, and that
she feels socially isolated. (Id.). In addition,
Conway reported that she sometimes experiences brief suicidal
ideation but that this ideation has not increased in
frequency since 2008. (Tr. 526-27). Dr. Pinson reiterated
Conway's diagnoses and GAF score of 55. (Tr. 527). These
diagnoses and GAF score were approved by supervising and
cosigning psychologist Dr. Jennifer A. Wood. (Tr. 526).
same day, Conway saw Dr. Miller. (Tr. 524). Conway told Dr
.Miller that she has been anxious over the past few months
due to job insecurity, “but this has resolved.”
(Id.). She also reported increased sleep, weight
gain, and increased appetite as a result of one of her
prescribed medications. (Id.). Conway further
reported continued marijuana use but only one-half joint per
day. (Id.). Dr. Miller noted that Conway denied
having any suicidal ideation, intent, or plan, that Conway is
controlled on her current therapy regimen, and that she has
shown decreases in depression and anxiety. (Tr. 525). Dr.
Miller continued Conway on her current medication treatment
plan except for clonazepam, which Dr. Miller discontinued due
to marijuana abuse. (Id.). Dr. Miller told Conway
that she would restart clonazepam if Conway passed a drug
test the following month and continued to pass drug tests
February 1, 2012, Conway met with Dr. Miller. (Tr. 517).
Conway reported additional weight gain, cigarette cessation,
and walking two miles a day with her dog. (Id.). She
also noted that she has not been eating healthy foods because
she has no motivation to cook even though she purchases
healthy foods. (Id.). Conway also reported that
within the year she would like to go home to New England,
where she has friends and family. (Tr. 517). Dr. Miller did
not restart clonazepam treatment due to continued marijuana
abuse, but continued Conway's current medication program.
February 21, 2012, Dr. Pinson and Conway had a telephone
conversation, during which Conway advised Dr. Pinson that the
woman Conway had been caring for had just died. (Tr. 516).
Conway also noted that the decedent's family asked Conway
to continue work caring for decedent's husband.
(Id.). Conway expressed concern with this proposal
and Dr. Pinson discussed reasons with Conway for continuing
to work. (Id.).
February 23, 2012, Conway called Dr. Pinson and expressed
feelings of heightened depression. (Tr. 514). Conway stated
that she was still not sure if she wished to continue to work
for the family of her deceased patient. (Id.).
Conway also reported some suicidal thoughts but stated she
would not carry through with them because of her family.
(Id.). Dr. Pinson provided supportive listening and
addressed possible hospitalization, which Conway declined.
(Id.). On February 27, 2012, Dr. Pinson received
another call from Conway, who advised Dr. Pinson that she was
going to sell her trailer and that she is temporarily living
with a friend. (Tr. 512). Dr. Pinson advised Conway of
services available to homeless veterans for which Conway
expressed interest. (Id.). Dr. Pinson requested that
social worker Rosa Balderas discuss community resources with
March 2, 2012, Conway met with Dr. Pinson. (Tr. 510). Dr.
Pinson noted that Conway's affect appeared depressed but
that she was appropriately dressed and groomed, and oriented.
(Id.). Conway reported that she has been coping much
better lately and that she discontinued marijuana use three
weeks prior. (Id.). She stated that she was feeling
“back together” and planned to move to
Massachusetts to be near family. (Id.). Dr. Pinson
reiterated Conway's diagnoses and assessed a GAF score of
60. (Tr. 511). These diagnoses and GAF score were approved by
supervising and cosigning psychologist Dr. Armando Berumen.
same day, Conway also saw Rosa Balderas, LCSW. (Tr. 508-09).
Conway reported that she no longer had an offer to work for
the family of her former patient. (Tr. 508). Conway expressed
the desire to return to Massachusetts to be near family if
she could not find another job in Texas. (Id.).
Conway was also concerned about having to find a place to
live since she had decided to sell her trailer.
March 6, 2012, Conway reported to Dr. Pinson via telephone
experiencing panic while completing job applications and
noted that she planned to attend her scheduled therapy
session the following week. (Tr. 507). Conway again
telephoned Dr. Pinson on March 12, 2012 to express difficulty
working on her to-do list. (Tr. 506). Dr. Pinson observed
that Conway did not sound distressed and encouraged Conway to
attend her next therapy session. (Id.).
scheduled session on March 16, 2012, Dr. Pinson observed that
Conway appeared depressed but improved from previous
sessions, was appropriately dressed and groomed, oriented,
and polite. (Tr. 504). Conway reported that she did not
believe she could work and wanted to leave Texas soon.
(Id.). Conway also reported that she did not want to
return to Massachusetts because of difficulties with her
sisters. (Id.). She instead noted the desire to
travel to Florida because she had a friend there who offered
to her a condo with low rent. (Id.). Dr. Pinson
reiterated Conway's diagnoses and GAF score of 60. (Tr.
505). These diagnoses and GAF score were approved by
supervising and cosigning psychologist Dr. Armando Berumen.
a March 22, 2012 session, Dr. Pinson noted that Conway
appeared depressed, that her affect had improved, and that
she was appropriately dressed and groomed. (Tr. 498). Conway
informed Dr. Pinson that she had sold her trailer and planned
to move either to Florida or Massachusetts, or apply for
housing in Texas. (Id.). She expressed feeling
manic, and having difficulty making life-changing decisions.
(Id.). Conway stated that since 2008 she has had
daily thoughts of harming herself. (Id.) Dr. Pinson
further explored this statement because it was inconsistent
with Conway's prior reports of the frequency of suicidal
ideation. (Id.). Conway strongly denied intent or
plan, and declined hospitalization. (Id.). Dr.
Pinson reiterated Conway's diagnoses and GAF score of 60.
(Tr. 499). These diagnoses and GAF score were approved by
supervising and cosigning psychologist Dr. Armando Berumen.
(Tr. 500). Five days later, Conway called Dr. Pinson to
explain that she moved to Florida and would establish
treatment services at the local VA. (Tr. 496).
March 29, 2012, Conway visited the VA in West Palm Beach,
Florida (“Florida VA”). (Tr. 633). She reported
that she was on her way to Massachusetts when she ran out of
money in Florida. (Id.). Conway reported non-service
related PTSD and requested placement, clothing, food, mental
and medical health services, a referral to vocational
rehabilitation, and information about benefits.
(Id.). Conway recounted a detailed plan to harm
herself while in Texas. (Id.). She appeared to have
a bipolar disorder. (Id.).
April 26, 2012, Conway met with psychiatrist Elsa Zayas, M.D.
at the Florida VA. (Tr. 621-26). Conway discussed her
mother's death, the car accident in 2004, and her
long-term relationship that ended in 2008. (Tr. 622-23). She
stated that she experienced chronic depression. (Tr. 622).
Dr. Zayas diagnosed Conway with PTSD and depression, and
assessed a GAF score of 45. (Tr. 624). Dr. Zayas placed
Conway on a fourteen-day prescription plan discontinuing one
medication, adding one, and otherwise continuing Conway's
former regimen. (Tr. 624).
early May, Conway presented to Dr. Linda Welkovitch at the
Florida VA. (Tr. 613). Dr. Welkovitch observed that Conway
was alert, oriented, and cooperative. (Tr. 614). Conway
reported that she was feeling more balanced than usual.
(Id.). Dr. Welkovitch noted that Conway's mood
was depressed and anxious. (Id.). She assessed a GAF
score of 45. (Tr. 615).
15, 2012, Janis Hoewing, LCSW, met with Conway at the Florida
VA. (Tr. 600). Conway reported having moved into an
apartment. (Id.). She stated she was a “lot
less depressed” and “not having any real highs or
lows.” (Id.). Ms. Hoewing reported that Conway
seemed mildly depressed and anxious. (Id.). That
same day, Conway called her assigned social worker and told
her that she was enjoying her new apartment, and had been
making friends. (Id.). She reported reconnecting
with a childhood acquaintance and socializing.
days later, Conway informed Ms. Hoewing that she felt
depressed and anxious because of sexual advances by two men.
(Tr. 595). Ms. Hoewing noted that Conway exhibited a high
level of anxiety, and decreased concentration and focus. (Tr.
596). Conway's GAF score of 45 was reaffirmed.
22, 2012, Ms. Hoewing observed that Conway still seemed
dysphoric and anxious with low energy and fatigue. (Tr. 561).
Conway also presented to the mental health crisis clinic on
the same day, requesting an evaluation for depression and
anxiety. (Tr. 556). She was observed as casually dressed and
groomed, but tearful, anxious, and verbose. (Tr. 557).
traveled to Massachusetts, where she began to receive housing
and other social services from the Boston VA. (Tr. 645-75).
Clinical psychologist David Chick, Ph.D. of the Central
Western Massachusetts VA conducted an initial mental health
evaluation. (Tr. 731). Dr. Chick noted that Conway was mildly
depressed and anxious to return to self-sufficiency.
(Id.). He assessed major depression, PTSD, and a GAF
score of 50. (Id.). One week later, Conway reported
feeling better and more stable. (Tr. 730). She reported that
she was approved for a housing voucher looked forward to
establishing residency. (Tr. ...