United States District Court, D. Connecticut
MEMORANDUM OF DECISION
Vanessa L. Bryant, United States District Judge
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
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.
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].
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].
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].
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].
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.
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
[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].
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].
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.
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].
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.
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.
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].
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.