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Nelson v. Berryhill

United States District Court, D. Connecticut

March 1, 2018



          Hon. Vanessa L. Bryant, United States District Judge

         Plaintiff Pamela Nelson (“Nelson” or “Plaintiff”) challenges the Commissioner of Social Security's final decision to deny Nelson's application for disability benefits pursuant to 42 U.S.C. § 405(g). Nelson moves to reverse and remand the decision and argues Administrative Law Judge Ronald J. Thomas (“ALJ Thomas”) erred in assessing Nelson's residual functional capacity (“RFC”). Defendant Nancy A. Berryhill, Acting Commissioner of Social Security (“Defendant”), moves to affirm the Commissioner's final decision. For the reasons stated below, the Court GRANTS Defendant's motion and DENIES Plaintiff's motion.


         The Court has reviewed the evidence and accepts the facts from the parties' stipulation of undisputed facts, hereby incorporating them into this opinion. See [Dkt. 16-2 (Stipulated Statement of Facts); Dkt. 22-1 (Mot. Affirm) (Defendant's Stipulation)]. Ms. Nelson is a divorced 67-year old woman who has one estranged adult daughter and lives alone. [R. 47-48, 173]. She has a Master's degree in Clinical Chemistry from Quinnipiac University and has worked consistently since 1978. [R. 48-49, 178-79; Dkt. 16-2 at 1]. Ms. Nelson was last employed by Yale University as a research associate. [R. 49]. She started in 2010 on a probationary basis but was laid off within the year on an unknown date. [R. 49; 180]. She currently receives social security retirement and Yale University pension benefits. [R. 48].

         I. Medical History

         Ms. Nelson sought treatment with William Shevin, M.D., DHt. (“Dr. Shevin”), from April to December of 2011 related to issues with her thyroid, iodine, and suspected Lyme disease. [R. 330]. At the first visit, Ms. Nelson reported a history of PTSD, abuse from her ex-husband, and sexual abuse as a child. [R. 330-31]. Dr. Shevin observed that “[h]er manner is disorganized, emotionally volatile, some moments of excitation and some tearfulness.” [R. 331]. Ms. Nelson went to bi-monthly appointments from April through June. [R. 319-33]. In June 2011, Ms. Nelson started to complain of mucus in her sinuses. [R. 323]. In July and August, she switched to monthly appointments, [R. 315-318], but after August she only had one follow-up visit in December of 2011. [R. 312-14].

         At Ms. Nelson's last appointment with Dr. Shevin on December 6, 2011, she reported “pulling worms out of her nose” and stated she cleaned out her nose on an hourly basis. [R. 312]. Dr. Shevin observed she brought “nasal mucus with several irregular with cylindrical, various diameters, perhaps 2 millimeters wide, several cm long, one with a red triangle at the top which she feels is a mouth, but I cannot discern this.” [R. 312]. Dr. Shevin also noted that Ms. Nelson was mildly agitated, and he stated, “She is still doggedly pursuing a course, convinced she has parasites. Maybe she does. I certainly can't be sure because of the specimen she brings in.” [R. 313]. Lastly, he wrote the following: “Since I first saw her, I continue to be concerned regarding her mental stability. She has let go of her medical insurance, is probably eating up her savings, is fixated on parasites and fungus gnats with no real evidence. Note that a CBC done in March 2011 did not show any eosinophilia.” [R. 313]. He referred Ms. Nelson to Thomas A. Moorcroft, D.O. (“Dr. Moorcroft”). [R. 313]. Ms. Nelson had indicated she stopped her health insurance plan because she did not trust standard laboratory tests (like those ordered by Dr. Shevin) except for the lab tests done by Dr. Moorcroft. [R. 313].

         In January 2012, Ms. Nelson began treatment with Dr. Moorcroft upon Dr. Shevin's referral. [R. 348]. Ms. Nelson explained she believed she had parasites in her nose, and Dr. Moorcroft noted “patient feels these are consistent with Linguatula serrata; feels she has seen more of the life stages of this parasite come out of her nose.” [R. 348]. Her parasitology was negative, although Ms. Nelson believed there could be an inaccuracy due to her taking multiple antiparasitic herbs during that time. [R. 348]. Notwithstanding the negative results of the laboratory tests of the specimens Ms. Nelson provided, from January 2012 through April 2013, Dr. Moorcroft treated Ms. Nelson approximately once every two months to manage parasite issues and her thyroid, after which Ms. Nelson sought treatment once every three or four months through July 2015. [R. 486-518].

         Ms. Nelson applied for disability insurance benefits on October 2, 2012. [R. 71]. Later that month on October 30, 2012, Dr. Moorcroft issued a letter to an unidentified recipient, indicating Ms. Nelson was a patient of his who was being treated for chronic illness. He wrote the following: “Her symptoms include muscle weakness, fatigue, poor stamina, and brain fog. Due to these symptoms, patient has a hard time sitting or standing for extended periods of time and has difficulty remembering simple instructions. I feel it unfit for her to be in a workplace setting at this time.” [R. 338].

         On November 20, 2012, consultative examiner Liese Franklin-Zitzkat, Psy.D. (“Dr. Franklin-Zitzkat”), administered a psychological evaluation on Ms. Nelson. [R. 369]. Dr. Franklin-Zitzkat listed Ms. Nelson's chief complaints as “systemic parasitic disease, chronic malaise/fatigue/rhinitis, nasopharynx parasitic infection, hypothyroidism, autoimmune disease, and adrenal hypofunctioning. [R. 369]. Ms. Nelson expressed depression at a level of 8-10 out of a 10-point scale on most days and that she slept for 1-hour intervals before waking up and cleaning her nose for 2 hours. [R. 369]. Ms. Nelson reported a history of suicidal ideation without any suicide attempts and she denied a history of auditory or visual hallucinations. [R. 369]. Ms. Nelson reported that she spends most of the day cleaning her nose and that she does not go out of the house. [R. 371]. She can prepare simple meals, does not have the energy to clean, can drive, and takes large trips to the grocery store with the goal of going as infrequently as possible. [R. 371]. Ms. Nelson indicated she did not do anything for fun, although she used to enjoy gardening before she lost energy. [R. 371]. Ms. Nelson brought “a jar containing some sort of white tissue suspended in liquid so [Dr. Franklin-Zitzkat] could see what had come out of her nose.” [R. 371]. The record does not reflect whether the specimen was tested to determine if it contained any medical evidence of a parasitic infection.

         Dr. Franklin-Zitzkat observed that Ms. Nelson had unimpaired attention, but her short-term memory appeared slightly impaired. [R. 371]. Ms. Nelson also had difficulty concentrating throughout the interview. [R. 371]. Dr. Franklin-Zitzkat concluded Ms. Nelson had an intellectual functioning in the “average range” and that her insight and judgment appeared to be good. [R. 371]. In light of Dr. Franklin-Zitzkat's observations, she concluded the following with respect to work functioning:

Ms. Nelson should be able to attend to and understand instructions, adapt to changes, and make routine, work-related decisions. She might have mild difficulty remembering instructions. Given her current level of distress, she could be expected to experience moderate to marked difficulty sustaining concentration as well as withstanding the stresses and pressures of a routine work day. Her level of distress could adversely impact interactions with coworkers/supervisors. Her mental health symptoms could interfere with her ability to maintain attendance. Ms. Nelson alleges physical conditions that should also be considered when assessing her capability for work functions.

[R. 371]. Dr. Franklin-Zitzkat also opined that Ms. Nelson could benefit from outpatient mental health treatment. Specifically, she stated, “If, in fact, there is no medical evidence of a parasitic infection, it is possible that her symptoms are related to complex PTSD, OCD, and/or Delusional Disorder.” [R. 372]. Dr. Franklin-Zitzkat also determined Ms. Nelson was generally capable of managing her finances, although it was unlikely that choosing to discontinue health insurance was in her best financial interest. [R. 372].

         In addition to the treating physicians and consultative examiners, two state agency non-treating, non-examining psychological consultants reviewed the record with respect to Ms. Nelson's RFC. The first, Adrian Brown, Ph.D. (“Dr. Brown”), evaluated Ms. Nelson's RFC on November 28, 2012, and determined she had sustained concentration and persistence limitations. [R. 79]. Despite these limitations, he concluded she was “not significantly limited” in her ability to carry out short and simple as well as detailed instructions, to sustain an ordinary routine without special supervision, to work with or near others without distraction, and to make simple work-related decision. [R. 79]. Dr. Brown also concluded Ms. Nelson experienced moderate limitations regarding her ability to maintain attention and concentration for prolonged periods; to perform activities according to a schedule, maintain attendance, and be punctual; and to complete a normal work day and workweek at a reasonable pace without interruptions from psychological symptoms. [R. 79]. With respect to Ms. Nelson's adaptive limitations, Dr. Brown concluded she had reduced stress tolerance that would be sufficient for a routine work setting, but she could not adapt well to “abrupt, frequent, major changes in routine.” [R. 80]. Dr. Brown felt Ms. Nelson was “capable of independent goal directed bx [sic] while completing routine tasks.” [R. 80]. Dr. Brown acknowledged Dr. Moorcraft's descriptions of her restrictions was more limited than his, but he stated, “The opinion relies heavily on the subjective report of symptoms and limitations provided by the individual, and the totality of the evidence does not support the opinion.” [R. 80]. Dr. Brown opined Dr. Moorcroft's position was “without substantial support from other evidence of record, which renders it less persuasive.” [R. 80]. The second psychological consultant, Christopher Leveille, Psy.D. (“Dr. Leveille”), evaluated Ms. Nelson's RFC on reconsideration on March 7, 2013 and arrived at the same conclusions. [R. 97-98].

         On May 22, 2013, Dr. Moorcroft wrote another letter regarding her treatment for chronic illness. [R. 375]. As he did in the previous letter from October 30, 2012, Dr. Moorcroft indicated Ms. Nelson's symptoms included “muscle weakness, fatigue, poor stamina, . . . and brain fog, ” adding that she also experienced insomnia. [R. 375]. Dr. Moorcroft then stated the following:

Due to these symptoms, Pamlea [sic] has a hard time sitting or standing for extended periods of time, has difficulty remembering simple instructions, as well as staying on a particular task for more than a few minutes due to fatigue and weakness. Her anxiety also makes it difficult for her to handle every day pressures of a workplace setting. I feel it unfit for her to be in a workplace setting at this time.

[R. 375]. Like the previous letter, there is no indication who is the intended recipient.

         In June 2015, Dr. Moorcroft completed a “Medical Opinion Questionnaire: Mental Impairments Independent of Alcoholism and Drug Addiction” form on behalf of Ms. Nelson. [R. 416]. The form contains a chart listing tasks pertaining to the “mental abilities and aptitude needed to do any job.” [R. 416-17]. Dr. Moorcroft classified Ms. Nelson's ability to “maintain socially appropriate behavior” and “adhere to basic standards of neatness and cleanliness” as “poor or none.” [R.416]. She scored either “fair” or “good” for all other tasks, except her ability to “carry out very short and simple instructions” was “unlimited or very good.” [R. 417].

         II. ALJ Decision

         Ms. Nelson applied for disability insurance benefits on October 2, 2012 with an onset date of June 11, 2012. [R. 71]. Her claim was initially denied on November 29, 2012 and on reconsideration on May 28, 2013. [R. 110, 116]. She thereafter requested a hearing, which was dismissed by ALJ Thomas as untimely on September 27, 2013. [R. 102]. Ms. Nelson appealed and her request for a hearing was reinstated on April 25, 2014. [R. 107-08]. ALJ Thomas then held a hearing on July 16, 2015. [R. 44]. After receiving additional evidence per the matters discussed during the hearing, ALJ Thomas rendered his decision on October 22, 2015, denying Ms. Nelson's request for disability insurance benefits. [R. 35]. ALJ Thomas's conclusions are as follows.

         ALJ Thomas found that Ms. Nelson had not engaged in substantial gainful activity since her onset date of June 11, 2011. [R. 26]. He determined she suffered from the “severe impairment” of “chronic sinusitis and rhinitis, secondary to parasitic infection, thyroiditis, post-traumatic stress disorder, and adjustment disorder with depression.” [R. 26]. ALJ Thomas also concluded that Ms. Nelson's “severe impairments” did not individually or collectively meet or medically equal the severity of a listed impairment under 20 C.F.R. Part 404, Subpart P, Appendix 1. [R. 26]. Ms. Nelson does not challenge any of these findings.

         ALJ Thomas then determined Ms. Nelson has a RFC to perform medium work as defined under 20 C.F.R. 404.1527(c) with the exception that Ms. Nelson is limited (1) “to only occasional interaction with the public, co-workers, and supervisors” and (2) “to simple, routine, repetitious work, with one or two-step instructions.” [R. 28]. In making this evaluation, ALJ Thomas granted in relevant part “significant weight” to non-treating, non-examining psychological consultants, Dr. Brown and Dr. Leveille; “some weight” to the evaluation and opinion of consultative examiner Dr. Franklin-Zitzkat, but “little weight” to her GAF score; and “little weight” to Ms. Nelson's treating physician, Dr. Moorcroft. [R. 31-32].

         ALJ Thomas also evaluated Ms. Nelson's credibility. She reported difficulty with focusing, physical weakness, nose drainage that interferes with her sleep, fatigue and malaise during the day as a result of her failure to sleep at night, and the need for nasal spray and swabs every five to 15 minutes. [R. 29]. He also noted Ms. Nelson reported she can only walk for five minutes before needing to rest for 15 minutes to one hour and that she becomes incapacitated for two weeks after attempting to complete a task. [R. 29]. ALJ Thomas considered her testimony and determined her impairments could reasonably cause the alleged symptoms but did not find “entirely credible” her statements about the intensity, persistence, and limiting effects. [R. 29]. In short, ALJ Thomas concluded there existed certain inconsistencies in the record as to Ms. Nelson's degree of symptoms and functional limitations. [R. 31]. The reasons for these opinions are: Dr. Brown's and Dr. Leveille's evaluations were “internally consistent and well supported by a reasonable explanation of the available evidence”; Dr. Franklin-Zitzkat's opinions were consistent with her findings and Ms. ...

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