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Pinsky v. Berryhill

United States District Court, D. Connecticut

June 20, 2018

OLGA PINSKY, Plaintiff,
NANCY A. BERRYHILL, Commissioner of Social Security, Defendant.


          MICHAEL P. SHEA, U.S.D.J.

         Olga Pinsky filed this appeal of the Commissioner of Social Security's decision to deny her application for Title II Disability Insurance Benefits. Under 42 U.S.C. Section 405(g), she asks this Court to reverse the decision of the Commissioner because it was not supported by substantial evidence or, alternatively, to remand for rehearing. (ECF No. 16.) Because I find that Pinsky's legal arguments lack merit and that the Commissioner's decision was based on substantial evidence, I deny Pinsky's motion to reverse or remand and grant the Commissioner's motion to affirm.

         I. Background

         A. Factual Background

         The parties stipulate to the following medical chronology. (ECF No. 16-1.) In 2011, Olga Pinsky was 27 years old and had a history of mental health treatment for anxiety and depression. (Id. at 1.) On January 13, 2011, she had a comprehensive assessment for mental health at Catholic Charities. (Id. at 1.) She had survived the Chernobyl disaster as a child and had experienced difficulties integrating into life in America. (Id.) She reported sleep disturbance, panic attacks, obsessive thoughts, and compulsive behaviors. (Id.) The intake clinician at Catholic Charities reported that Pinsky was cooperative and that she had coherent thoughts and an intact memory. (Id.)

         On April 9, 2012, Pinsky saw Dr. James Sarnelle, a general surgeon, following several weeks of right groin pain. (ECF No. 16-1 at 1.) She stated that the pain had started recently, while she was studying abroad for three weeks in Europe. (Id.) She had a negative computed tomography (CT) scan of her pelvis and abdomen. (Id.) Dr. Sarnelle found that the etiology of Pinsky's pain was unclear. (Id.)

         On October 30, 2012, Pinsky had an MRI of her brain, because she was experiencing dizziness, vertigo, and fever. (ECF No. 16-1 at 1.) The MRI found that there was a single punctate focus of white matter signal abnormality, but no other evidence of abnormality. (Id.) She also had a magnetic resonance angiography (MRA) of her neck, which was normal. (Id.)

         On October 31, 2012, Pinsky had a medical appointment with Dr. Eric Kung, at which she complained of headaches and dizziness. She reported debilitating headaches, one to two times per month, that lasted for 24 hours. (ECF No. 16-1 at 2.) On examination, Pinsky was neurologically intact: she had a full gait, intact reflexes, normal sensation, and full muscle strength throughout. (Id.) Pinsky was pleasant, alert, and fully oriented. (Id.) Dr. Kung diagnosed migraine without aura, without mention of intractable migraine, and without mention of status migrainosus. (Id.) He prescribed Amitriptyline and Tizanidine for Pinsky's headaches. (Id.) Dr. Kung also diagnosed depressive disorder, not elsewhere classified, and Lyme disease. (Id.)

         On November 15, 2012, Pinsky had another appointment with Dr. Eric Kung. She described headaches with intense pressure, throbbing, pulsating, and squeezing pain on the level of 8.5, with radiation to the temporal area, with vertigo, nausea, and low-grade fevers. (ECF No. 16-1 at 2.) Dr. Kung noted that a November 8, 2012 computed tomography angiography (CTA) of Pinsky's head showed sinus disease but was otherwise unremarkable. (Id.) An MRI of Pinsky's cervical region was also normal. (Id.) On examination, Pinsky was neurologically intact. She had a full gait, intact reflexes, normal sensation, and full muscle strength throughout. (Id.) Pinsky was alert and fully oriented. (Id.) Dr. Eric Kung diagnosed migraine without aura, without mention of intractable migraine or of status migrainosus. (Id.) He advised Pinsky to stop Amitriptyline and Tizanidine and recommended a spinal tap for evaluation of chronic fatigue syndrome. (Id.)

         On February 27, 2013, Dr. Irene Nasaduke, Pinsky's treating physician, wrote a letter requesting a neurological consultation for Pinsky. (ECF No. 16-1 at 2, R. at 447-48.) Nasaduke stated as follows: She wrote that Pinsky first developed depression at the beginning of high school after being bullied. (Id.) She had taken Wellbutrin daily since 2009, but medication had had no effect of her chronic fatigue. (Id.) In February 2010, Pinsky had complained of becoming short of breath after climbing one flight of stairs. (Id.) In June 2011, Pinsky had complained of severe nonstop headaches, which she would have for three or four days at a time and which were not alleviated by Excedrin. (Id.) Pinsky had had blood tests for CBC, ESR, SMA-15, HgA1c, TSH, free T4, vitamin 12, folate, and rapid plasma regain (RPR). (Id.) As of February 2013, Pinsky was less fatigued and able to walk one flight of stairs without shortness of breath. (Id. at 2-3.) In 2011, she had developed onset of chronic low-grade fever accompanied by fatigue. (Id. at 3.)

         On March 4, 2013, Pinsky had an evaluation for chronic fatigue at Yale Department of Neurology. (ECF No. 16-1 at 3.) Her neurological exam at this time was normal, and she had a normal gait, intact reflexes, and full strength throughout, but it was noted that she may have true Epstein-Barr virus-related chronic fatigue syndrome and that she did appear to have comorbid sleep disorder, anxiety, and depression. (Id.) Pinsky was alert and fully oriented with a normal fund of knowledge. (Id.) Pinsky reported an onset of symptoms around 2007, beginning with extreme fatigue. (Id.) Since that time, she had had good periods and bad periods. (Id.) Since the summer of 2012, she had been having a bad period. (Id.) She would wake up from eight hours sleep without feeling rested. (Id.) She had some insomnia. (ECF No. 16-1 at 3.) Her fatigue interfered with her ability to function. (Id.) She had difficulty going to class and doing school work due to fatigue. (Id.) At times, she would stay in bed for most of the day due to fatigue. (Id.) She had loss of energy, as well as daytime sleepiness, although those were two separate issues. (Id.) She had some difficulty with words when she was anxious. (Id.) She had vertigo, especially when changing positions, as well as a bilateral hand tremor. (ECF No. 16-1 at 3.) On physical examination, she was positive for photophobia, malaise and fatigue, shortness of breath, nausea, and dizziness, weakness, speech changes, depression, and environmental allergies. (Id., R. at 353.)

         On April 10, 2013, Pinsky underwent a sleep study to determine the cause of her daytime fatigue. (ECF No. 16-1 at 3.) Her sleep efficiency was decreased to 79.4%, but the rest of her sleep study was essentially normal, and there was no evidence of clinically significant sleep disordered breathing. (Id., R. at 377.)

         Between May 22, 2013, and August 27, 2013, Pinsky engaged in intensive outpatient therapy at St. Vincent's Hallbrook. (ECF No. 16-1 at 3.) She was diagnosed with generalized anxiety disorder and described a long history of significant anxiety, which had been most recently triggered by school-related stress. (Id.) She reported that her anxiety was preventing her from running errands and decreasing her level of focus and concentration, which in turn was having a negative effect, and, as a result, she was becoming increasingly overwhelmed by her school workload. (Id.) Pinsky had good participation in groups, but her attendance was sporadic, and she missed multiple scheduled treatment days. (Id. at 3-4.) She reported that she had symptoms of chronic fatigue syndrome and said that she was struggling to function and could not make the program consistently. (Id. at 4, R. at 368.) Dr. Mikhail Magid, Pinsky's psychiatrist, assigned a global assessment of function (GAF) score of 51.[1] (ECF No. 16-1 at 4.) Dr. Magid reported that Pinsky was cooperative, alert, and fully oriented and that she related adequately. (Id., R. at 368.) He also reported that Pinsky denied any hallucinations, violent thoughts, or suicidal/homicidal ideations. (ECF No. 16-1 at 4.) He stated that she had fair insight and good judgment. (Id.) Dr. Magid advised Pinsky to continue her individual therapy with Lisa Gardner, Ph.D. (Id.)

         Unspecified medical notes from August 17, 2013, state that Pinsky suffered from chronic fatigue disorder, Lyme disease, dizziness, migraine headaches, chronic head pressure, photophobia, memory deficits, arthralgias, and dyspnea on exertion. (ECF No. 16-1 at 4, R. at 460.) At that time, Pinsky said she had an inability at times to hold things in her hands, with a recent worsening of this condition. (Id.)

         On October 1, 2013, Pinsky had a neurological consultation for chronic fatigue, Lyme disease, and headaches. (ECF No. 16-1 at 4, R. at 422.) At this time, Pinsky complained of severe exhaustion, insomnia, photophobia, headaches, bilateral hand tremors, short-term memory loss, and difficulty concentrating. (Id.) She reported migraines, blurred vision, and some slurring speech when she spoke rapidly. She experienced some vertigo when she got up quickly and stated that her balance had been off for the past year. (Id.) Dr. Evangelos Xistris, the neurologist, reported that Pinsky was neurologically intact. (ECF No. 16-1 at 4, R. at 423). Pinsky had a normal gait, full muscle strength throughout, normal sensation, and intact reflexes. (Id.)

         On October 3, 2013, Dr. Nasaduke completed a medical source statement. (ECF No. 16-1 at 4, R. at 373-76.) She had been treating Pinsky since February 4, 2010. (Id.) She reported that Pinsky's chronic fatigue disorder had worsened. (Id.) She said that Pinsky was fully oriented but that her memory and concentration were impaired. (Id.) She could not enunciate words when fatigued, and her judgment and insight were more labored than they were previously. (Id.) For the following statements, Dr. Nasaduke checked the corresponding boxes on a form:

• Pinsky had a very serious problem asking questions or requesting assistance and performing work activity on a sustained basis, eight hours per day, five days per week. (ECF No. 16-1 at 5, R. at 374-75.)
• Pinsky had a serious problem using appropriate coping skills to meet the ordinary demands of a work environment, carrying out multi-step instructions, focusing long enough to finish assigned simple activities or tasks, changing from one simple task to another, and performing basic work activities at a reasonable pace and finishing on time. (ECF No. 16-1 at 4-5, R. at 374-75.)
• Pinsky had an obvious problem handling frustration appropriately and interacting appropriately with others in a work environment. (ECF No. 16-1 at 5, R. at 374-75.)
• Pinsky had no problem taking care of personal hygiene, caring for her physical needs, using good judgment, respecting/responding appropriately to others in authority, and getting along with others without distracting them or exhibiting behavioral extremes. (ECF No. 16-1 at 5, R. at 374-5.)
• Pinsky had a slight problem carrying out single-step instructions. (ECF No. 16-1 at 5, R. at 375.)

         On October 9, 2013, Dr. Michael Bohnert, a state agency medical consultant reviewed the evidence and opined that Pinsky had a moderate restriction in activities of daily living, moderate difficulties in maintaining social functioning, moderate difficulties in maintaining concentration, persistence, or pace, and no repeated episodes of decompensation. (ECF No. 16-1 at 5.) Dr. Bohnert opined that Pinsky retained the mental capacity to understand and remember simple instructions and could understand, but could not remember, moderately complex/detailed instructions. (Id.) He also said that Pinsky could sustain the mental demands associated with carrying out simple tasks over the course of a routine workday/workweek within acceptable attention, persistence, and pace tolerances and was unable to sustain the mental demand for moderately complex/detailed tasks requiring sustained concentration. (Id.) Dr. Bohnert also opined that Pinsky could relate adequately with supervisors and co-workers, but could not sustain these same demands in working routinely with the general public, and that she could adapt to routine workplace changes as they relate to simple tasks and could remain aware of environmental hazards (Id.)

         On November 1, 2013, Pinsky saw Dr. Evangelos Xistris, a neurologist, for complaints of chronic fatigue, Lyme disease, and headaches. (ECF No. 16-1 at 5). On examination, Pinsky was neurologically intact, and she had an intact gait, full muscle strength throughout, and intact reflexes. (Id.)

         On November 12, 2013, Pinsky underwent an x-ray of her lumbar spine with a lumbar puncture with no significant findings. (ECF No. 16-1 at 6.)

         On November 25, 2013, Pinsky complained to Dr. Samit Mahotra, a sleep specialist and neurologist, of trouble falling asleep. (ECF No. 16-1 at 6.) She reported that she would lie in bed and stare at the ceiling for hours. (Id.) She also reported that, although she had finished her Master's degree program the previous June, her sleep problems had worsened. (Id.) She further reported that she was depressed because she did not have “a job or a life.” (Id.) She stated that she was in bed most of the time and that she did not get out of bed, although she was awake, because of severe exhaustion. (Id.) Dr. Mahotra reported that Pinsky was alert and fully oriented. (Id.) At this visit, Pinsky had a normal gait, full range of motion throughout, and was neurologically intact (Id.) Dr. Mahotra said that Pinsky had a normal mood and affect. (Id.) Dr. Mahotra diagnosed poor sleep hygiene and commented that Pinsky did not have a social life or job that forced her to wake up in the morning. (Id.) He also diagnosed delayed sleep phase syndrome and said that she did not have insomnia. (Id.) He advised her not to take daytime naps, unless she was about to drive, and recommended another sleep study if the symptoms continued. (Id.)

         On December 5, 2013, Pinsky completed a behavioral health treatment plan. (ECF No. 16-1 at 6.) She described herself as depressed due to chronic fatigue syndrome, reported psychomotor retardation, and stated that she had problems going to sleep. (Id.) She said that her major problem was a lack of energy and that she had poor concentration and was indecisive. (Id.) She did not feel energized enough to socialize. (Id.) The intake clinician assigned Pinsky a GAF score of 55. (Id.) On December 12, 2013, clinician Terry Ann Gillin, LCSW, reported that Pinsky did not look sick. (Id.) Gillin said that Pinsky's energy level was high as she described her activities. (Id.) The therapist also said that Pinsky was somewhat cavalier as she described that her mother researched and contacted all her therapists, psychiatrists, and doctors. (Id.) Pinsky said that she was putting her Ph.D. on hold as she thought it was too much trouble to figure out how to transfer credits. (Id.) A week later on December 19, 2013, Gillin reported that Pinsky was energized at her session. (Id.) Pinsky told Gillin that she had been out to dinner with family and had talked to her friends. (Id.) Pinsky also said that she had written a book of poetry that was published and sold 80 copies. (Id. at 6-7.) She also said that she had written 400 or 500 new poems, which she hoped to publish, and that she enjoyed photographing nature. (Id. at 7.) Pinsky's mother left a message for Gillin on December 27, 2013, which stated that Pinsky would not be attending therapy any longer. (Id.) Gillin discharged Pinsky from treatment after her voluntary withdrawal. (Id.)

         On December 26, 2013, Lisa Gardner, another therapist, assessed Pinsky. (ECF No. 16-1 at 7.) Pinsky told Gardner that she crashed after getting her MBA. (Id.) Pinsky also said that she was always tired, that she had “brain freeze, ” and that her depression was getting worse. (Id., R. at 731.) Gardner reported that Pinsky was cooperative and fully oriented. (ECF No. 16-1 at 7, R. at 732.) She observed that Pinsky was somewhat physically lethargic but also talkative and spontaneous. (ECF No. 16-1 at 7.) Pinsky had normal and clear speech. (Id.) ...

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