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Caradonna v. Commissioner of Social Security

United States District Court, E.D. Michigan, Northern Division

September 11, 2019

MARY ELIZABETH CARADONNA, Plaintiff,
v.
COMMISSIONER OF SOCIAL SECURITY, Defendant.

          THOMAS L. LUDINGTON DISTRICT JUDGE.

          MAGISTRATE JUDGE'S REPORT AND RECOMMENDATION ON CROSS MOTIONS FOR SUMMARY JUDGMENT (R. 15, 18)

          Patricia T. Morris United States Magistrate Judge.

         I. RECOMMENDATION

         Plaintiff Mary Caradonna challenges Defendant Commissioner of Social Security's final decision denying her claim for Title II Disability Insurance Benefits (DIB). The case was referred to me for review. (R. 3); see 28 U.S.C. § 636(b)(1)(B); E.D. Mich. LR 72.1(b)(3). For the reasons below, I conclude that substantial evidence does not support the Commissioner's decision. Accordingly, I recommend GRANTING Plaintiff's Motion for Summary Judgment, (R. 15), DENYING the Commissioner's Motion, (R. 18), and REMANDING the case under “sentence four” of 42 U.S.C. § 405(g).

         REPORT

         A. Introduction and Procedural History

         Plaintiff filed the present application for DIB on September 11, 2014, [1] alleging that her disability began June 20, 2014. (R. 9, PageID.220.) The Commissioner denied the claim. (Id., PageID.114.) Plaintiff then requested a hearing before an Administrative Law Judge (ALJ), (id., PageID.123), and received two hearings; the first occurred on December 13, 2016, (id., PageID.75-96), and the second on June 1, 2017, (id., PageID.58-74). The ALJ issued a decision on August 1, 2017, finding Plaintiff not disabled during the relevant period. (Id., PageID.42-52.) On August 13, 2018, the Appeals Council denied review, (id., PageID.30-32), and Plaintiff filed for judicial review on October 16, 2018. (R. 1). She moved for summary judgment on March 15, 2019, (R. 15), and the Commissioner countered with its own Motion the following month, (R. 18). Briefing has completed and the case is now ready for resolution.

         B. Standard of Review

         The court has jurisdiction to review the Commissioner's final administrative decision pursuant to 42 U.S.C. § 405(g). The district court's review is restricted solely to determining whether the “Commissioner has failed to apply the correct legal standard or has made findings of fact unsupported by substantial evidence in the record.” Sullivan v. Comm'r of Soc. Sec., 595 F App'x. 502, 506 (6th Cir. 2014) (internal quotation marks omitted). Substantial evidence is “more than a scintilla of evidence but less than a preponderance.” Rogers v. Comm'r of Soc. Sec., 486 F.3d 234, 241 (6th Cir. 2007) (internal quotation marks omitted). “[T]he threshold for such evidentiary sufficiency is not high. . . . It means-and means only-‘such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.'” Biestek v. Berryhill, 139 S.Ct. 1148, 1154 (2019) (citation omitted).

         The Court must examine the administrative record as a whole, and may consider any evidence in the record, regardless of whether it has been cited by the ALJ. See Walker v. Sec'y of Health & Human Servs., 884 F.2d 241, 245 (6th Cir. 1989). The Court will not “try the case de novo, nor resolve conflicts in the evidence, nor decide questions of credibility.” Cutlip v. Sec'y of Health & Human Servs., 25 F.3d 284, 286 (6th Cir. 1994). If the Commissioner's decision is supported by substantial evidence, “it must be affirmed even if the reviewing court would decide the matter differently and even if substantial evidence also supports the opposite conclusion.” Id. at 286 (internal citations omitted).

         C. Framework for Disability Determinations

         Disability benefits are available only to those with a “disability.” Colvin v. Barnhart, 475 F.3d 727, 730 (6th Cir. 2007). “Disability” means the inability

to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than [twelve] months.

42 U.S.C. § 1382c(a)(3)(A). The Commissioner's regulations provide that disability is to be determined through the application of a five-step sequential analysis:

(i) At the first step, we consider your work activity, if any. If you are doing substantial gainful activity, we will find that you are not disabled.
(ii) At the second step, we consider the medical severity of your impairment(s). If you do not have a severe medically determinable physical or mental impairment that meets the duration requirement . . . or a combination of impairments that is severe and meets the duration requirement, we will find that you are not disabled.
(iii) At the third step, we also consider the medical severity of your impairment(s). If you have an impairment(s) that meets or equals one of our listings in appendix 1 of this subpart and meets the duration requirement, we will find that you are disabled.
(iv) At the fourth step, we consider our assessment of your residual functional capacity and your past relevant work. If you can still do your past relevant work, we will find that you are not disabled.
(v) At the fifth and last step, we consider our assessment of your residual functional capacity and your age, education, and work experience to see if you can make an adjustment to other work. If you can make an adjustment to other work, we will find that you are not disabled. If you cannot make an adjustment to other work, we will find that you are disabled.

20 C.F.R. § 404.1520; see also Heston v. Comm'r of Soc. Sec., 245 F.3d 528, 534 (6th Cir. 2001).

         “Through step four, the claimant bears the burden of proving the existence and severity of limitations caused by [his or] her impairments and the fact that [he or] she is precluded from performing [his or] her past relevant work.” Jones v. Comm'r of Soc. Sec., 336 F.3d 469, 474 (6th Cir. 2003). The burden transfers to the Commissioner if the analysis reaches the fifth step without a finding that the claimant is not disabled. Combs v. Comm'r of Soc. Sec., 459 F.3d 640, 643 (6th Cir. 2006). At the fifth step, the Commissioner is required to show that “other jobs in significant numbers exist in the national economy that [the claimant] could perform given [his or] her RFC [residual functional capacity] and considering relevant vocational factors.” Rogers, 486 F.3d at 241 (citing 20 C.F.R. §§ 416.920(a)(4)(v), (g)). The RFC “is the most [the claimant] can still do despite [his or her] limitations, ” and is measured using “all the relevant evidence in [the] case record.” 20 C.F.R. § 404.1545(a)(2).

         D. ALJ Findings

         Following the five-step sequential analysis, the ALJ determined that Plaintiff was not disabled. (R. 9, PageID.42-52.) At step one, the ALJ found that Plaintiff had not engaged in substantial gainful activity since her alleged onset date of June 20, 2014. (Id., PageID.44.) At step two, the ALJ concluded that Plaintiff had the following severe impairments: “bipolar disorder, alcohol abuse, cannabis dependence and opioid use disorder in remission, personality disorder, and schizoaffective disorder.” (Id.) At step three the ALJ decided these impairments did not meet or equal the severity of a listed impairment. (Id., PageID.45-46.)

         Before proceeding to the final steps, the ALJ found that Plaintiff had the residual functional capacity (RFC) to perform

a full range of work at all exertional levels but with the following nonexertional limitations: can never climb ladders, ropes or scaffolds; must avoid all use of hazardous moving machinery; must avoid all exposure to unprotected heights; work is limited to simple, routine and repetitive tasks performed in a work environment free of fast paced production requirements involving only simple work related decision[s] and routine work place changes; only occasional, superficial interaction with the public and co- workers.

(Id., PageID.46.) At step four, the ALJ found Plaintiff unable to perform any past relevant work. (Id., PageID.51.) Finally, at step five, the ALJ determined that Plaintiff could perform a significant number of jobs in the national economy. (Id., PageID.51-52.)

         E. Administrative Record

         1. Medical Evidence

         Sometime in the summer of 2006, Plaintiff was involuntarily hospitalized after a suicide attempt. (Id., PageID.364, 369.) She had brooded on suicide for about a month, brought on in part by threats to her continued employment as a housekeeper. (Id., PageID.368, 370.) The hospital reports recount her history of chronic depression. (Id., PageID.367.) Her first suicide attempt occurred in 1990, and since then she had been receiving psychiatric treatment. (Id.) Her current roster of medications did not provide much help, and her mood vacillated weekly. (Id., PageID.367-68.) At the hospital, Plaintiff complained of generalized weakness and fatigue, but she denied other physical ailments. (Id., PageID.371.) On examination, she was “awake, alert, and oriented times three. She appears in no acute distress; however, she appears somewhat anxious” and “very jittery.” (Id., PageID.371-72.) During a mental-status examination, Dr. Sheldon Siegel observed that Plaintiff was agitated. (Id., PageID.368.) She could not recall the correct date, nor did she remember two of the most recent presidents. (Id., PageID.369.)

         Dr. Siegel assessed bipolar 2 disorder, anxiety disorder, and a Global Assessment of Functioning (GAF) score of 30. (Id.) Bipolar 2 requires at least one major depressive episode and one hypomanic episode, the former lasting at least 2 weeks and the latter at least 4 days. Psychiatric Ass'n, Diagnostic and Statistical Manual of Mental Disorders 135 (5th ed., 2000) (DSM V). The GAF score signified that Plaintiff's “[b]ehavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgment . . . OR inability to function in almost all areas.” Psychiatric Ass'n, Diagnostic and Statistical Manual of Mental Disorders 34 (4th ed., 2000) (DSM-IV).[2]

         Medical records from 2007 and 2008 indicate that she remained on multiple psychotropics, she was properly oriented, her affect was often appropriate but sometimes flat, and she continued to suffer from “major affective disorder.” (Id., PageID.418-22.)

         She was hospitalized again, on a “petition, ” in May 2008. (Id., PageID.394, 400.) The past month, she had lived in a hotel and was experiencing paranoid ideations and irritability. (Id.) The paranoia led her to sleep with a handgun. (Id.) She had not been taking her medications. (Id.) Her initial stay in the hospital was from May 22 to May 27. (Id.) At the time she was discharged, she was cooperative and friendly, but also vague and guarded; her thought content was appropriate and her mood appeared euthymic; she denied hallucinations or delusions but still seemed “mildly paranoid.” (Id.) She remained afraid of her husband and refused to meet with him or any other family members. (Id., PageID.401.) But her medications were helping and she no longer appeared to be a danger. (Id.) Her GAF score was 36, indicating “[s]ome impairment in reality testing or communication . . . OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood.” DSM-IV, supra at 34.

         She left the hospital on May 27 but returned, apparently of her own accord, the following day. (Id., PageID.397, 403.) During her time away, she stopped taking her medications and grew “extremely paranoid and suspicious, ” particularly of her husband, who she thought was having an affair with her stepmother. (Id., PageID.403.) She also believed that a friend had planted listening devices in her room. (Id., PageID.397.) It was noted that her “examination is appropriate to the thought content, ” her mood was “mildly anxious and depressed, ” her speech was brief but coherent and goal directed, she denied suicidal ideations or hallucinations, she was paranoid and suspicious, she was alert and oriented, her memory was fair, she had limited insight, and her judgment was impaired. (Id., PageID.398.) Her GAF score was 22, which was in the same range as her earlier score of 30. DSM-IV, supra at 34.

         She was discharged on June 2, 2008. (Id., PageID.403.) At that time, she was euthymic and her judgment had improved to “average.” (Id.) She felt better, acknowledging her bipolar disorder and the need for medications and to stop drinking. (Id., PageID.404.) Her GAF score stood at 40, (id., PageID.404), which indicated the same basic findings as her earlier score of 36. DSM-IV, supra at 34.

         In November 2008, Plaintiff sought services at Macomb County Community Mental Health. (Id., PageID.444.) The intake paperwork stated that Plaintiff lacked medical insurance and therefore had not being seeing a private psychiatrist. (Id., PageID.444, 447.) At the time she was unemployed and either “looking or on layoff.” (Id., PageID.446.) She slept only five hours a night, her “responses” were slower, she remained paranoid, and she was hearing voices and seeing people, although she later denied hallucinations. (Id., PageID.447.) The notes further stated that records from the past summer indicated a suicide attempt. (Id.) She had attempted suicide three times throughout her life, although she was not currently considering it. (Id., PageID.447-48.) Presently, she was going through a divorce and had begun dating. (Id.) She was not taking psychotropics. (Id., PageID.447.) Plaintiff explained that in May 2008 she began using alcohol to cope with marital stress. (Id.) During this period, she thought people were trying to hurt her, and that her husband was attempting to poison her. (Id.)

         The intake forms also indicated that she independently bathed, dressed, completed housekeeping, prepared food, travelled in the community, maintained appropriate public behavior, used the toilet; she needed reminders, however, to eat, structure her time effectively, find purposeful activities, make reasonable long-term plans, budget and shop, maintain hygiene, and drive or arrange public transportation. (Id., PageID.449-50.) She needed instruction to take her medications, handle money, and pay bills. (Id., PageID.450.) Plaintiff clarified that her hygiene suffered during spells of depression, she relied on her boyfriend for transportation, and she did not have any hobbies. (Id., PageID.451.)

         Therapist Amy Bischof concluded that Plaintiff had proper orientation but flat affect, preoccupied and tangential thought process, limited insight, and dysphoric mood. (Id., PageID.447.) Further, Plaintiff was passive, withdrawn, fearful, anxious, ruminative, apathetic, and dysphonic. (Id., PageID.451.) Her perceptions were marked as normal, yet Bischof also noted Plaintiff had delusions and hallucinations. (Id., PageID.451, 463.) Plaintiff's judgment was poor, as evidenced by her history of suicide attempts, her insight and impulse control were poor, and her sleep and appetite were decreased. (Id., PageID.451-52.) In addition, an alcohol and substance abuse screen “strongly indicate[d] dependence, ” although Plaintiff denied any drinking since the summer 2008 (or, as she later said, October 2008) and any drug use whatsoever. (Id., PageID.452-53, 461.) Overall, Bischof diagnosed bipolar 1 disorder, (id., PageID.453), which is marked by a manic episode preceded or followed by a hypomanic or major depressive episode. DSM-V, supra at 123. Plaintiff's GAF score was 55, suggesting “[m]oderate symptoms . . . OR moderate difficulty in social, occupational, or school functioning.” DSM-IV, supra at 34. Plaintiff was very depressed and qualified for services due to the diagnosis and her “significant functional disability” (including in self-direction, activities of daily living, and social transactions and interpersonal relationships), “certain prior service utilization, ” and the “sufficient duration of the illness.” (Id., PageID.455.)

         On November 26, 2008, Plaintiff saw psychiatrist Sarath Hemachandra, MD, at Macomb County Community Health. (Id., PageID.463.) Plaintiff was tearful, emotionally labile, and moderately depressed, but she denied experiencing hallucinations, paranoia, or delusions, and she also denied using alcohol or having suicidal ideations. (Id., PageID.463- 64.) During the examination, she remained tearful but cooperative, her thoughts were racing, she had average intelligence and no memory impairment, her speech rate and rhythm were decreased, she was properly oriented, her judgment was generally good, and she recognized her own strengths and weaknesses. (Id., PageID.464-65.) Dr. Hemachandra diagnosed bipolar 1. (Id., PageID.465.)

         Plaintiff saw Dr. Hemachandra again in December 2008. (Id., PageID.473.) Her depression continued, at a moderate level, but her sleep had improved and she no longer believed the FBI was monitoring her. (Id.) She had no hallucinations, delusions, suicidal ideations, or paranoia. (Id.) At the examination, Plaintiff's speech was normal, her manner was guarded, her affect was labile and appropriate to her mood (depressed), her thought process was logical, she was properly oriented, her hygiene was appropriate, no blunted affect was observed, she answered promptly, she was mildly irritable or expansive occasionally, there was no evidence of conceptual disorganization or inability to form relationships, her suspiciousness was very mild, and she had no unusual thought content. (Id., PageID.474-77.) Overall, Plaintiff's condition was slowly improving. (Id., PageID.477.)

         At an appointment with Dr. Hemachandra in January 2009, Plaintiff stated, “I am doing allright [sic]. I still feel a little depressed. I am drowsy during [the] daytime, ” although her sleep was noted to be adequate. (Id., PageID.466.) The depression was mild to moderate, as was her anxiety. (Id., PageID.466, 468.) She continued to deny hallucinations, delusions, and paranoia. (Id.) It appeared to Dr. Hemachandra that “[s]ome improvement” had occurred. (Id.) The examination recorded the following: Plaintiff's speech was normal, her manner was guarded, her affect was full and appropriate to her mood, her thought process was logical, her hygiene was appropriate, she responded promptly to questioning, her level of excitement was mild and “of doubtful clinical significance, ” there was no evidence of inability to form relationships, no conceptual disorganization was observed, her suspiciousness was very mild, she had no unusual thought content, and there was no evidence of blunted affect. (Id., PageID.467-68.)

         The following month, however, she told Dr. Hemachandra that she remained moderately depressed. (Id., PageID.503.) Her other claims stayed about the same as in the last session, although she now also cited her “male friend” as a source of emotional support. (Id.) The examination results were similar as well, except this time she was tearful. (Id., PageID.504-07.) Now, Dr. Hemachandra concluded that Plaintiff's condition had deteriorated. (Id., PageID.507.) Later that month, at another appointment, Plaintiff reported “doing ok.” (Id., PageID.496.) Her claims and the examination results remained nearly identical, except her affect was “[f]ull” rather than tearful. (Id., PageID.497-500.) Her status continued “[d]eteriorating, ” Dr. Hemachandra wrote. (Id., PageID.501.)

         In March, Plaintiff reported to Dr. Hemachandra that she was getting married and “feeling better.” (Id., PageID.491.) Her depression was now mild, as confirmed by examination, but her other statements and examination results were otherwise identical to those recorded in the previous visit. (Id., PageID.490-94.) Her condition was improving, the report stated. (Id., PageID.494.) By the following month, she was married and began noticing her anxiety had increased. (Id., PageID.483.) She also denied mood swings or racing thoughts; her statements and the examination results remained the same as last time, although her manner was now guarded and her anxiety was moderate. (Id., PageID.483-87.) She continued to improve, Dr. Hemachandra concluded. (Id., PageID.488.)[3]

         The medical record then jumps to June 2014, when police took her to the hospital after finding her wandering the streets in bunny slippers; when stopped, she “could not recall what she was doing nor could she remember the last five days.” (Id., PageID.575.) She remained in the hospital for over a month, apparently by court order. (Id., PageID.580, 612, 722-23.) At the hospital she reported that since her divorce in 2008, she had not taken her bipolar disorder medications. (Id., PageID.575) Further, she reported having vatic powers. (Id.) Although she failed to report depression, hallucinations, and the like, Plaintiff's paranoia about her husband was evident to the intake interviewer. (Id.)

         On examination, she was labile, she had delusions, her thought process was circumstantial, she did not “fully appreciate [her] clinical condition, ” her judgment was passive as regarded her care, she was fully oriented, and she had no suicidal ideations. (Id., PageID.576.) She was confused and only partially responsive. (Id., PageID.536, 588-89.) On yet another examination, it was noted that her “[c]ognition and memory are not impaired. She exhibits normal recent memory, ” yet she was “[u]nable to recall where she lives.” (Id., PageID.537, 540; see also id., PageID.589 (noting normal memory).) Her thought process was marked by loose associations and she suffered impairments in concentration and executive function. (Id., PageID.589.) However, her perceptions were normal. (Id.)

         Later examination results varied, with many abnormalities noted along with normal results. (Id., PageID.595-96 (cooperative, displayed a relieved and calm mood, had goal-directed thoughts, and had normal speech, affect, thought content, memory, concentration, and executive functioning), 598 (failed to appreciate condition or actively engage with care, her thought processes were marked by loose associations, and she had delusions, illusions, impaired concentration, but normal executive function), 601 (same), 606 (cooperative, displayed a relieved and calm mood, had goal-directed thoughts, and had normal speech, affect, thought content, memory, concentration, and executive functioning), 611 (noting calm but labile mood, circumstantial thought process, impaired visual-spatial functioning, failure to appreciate condition, and passive engagement with care, but otherwise normal), 615 (fast talking, calm but labile mood, failure to appreciate condition or engage with care, circumstantial thought processes, impaired visual-spatial functioning, but otherwise normal), 619 (same), 623 (same), 626 (same), 629-30 (same), 634 (same except mood was elated and affect was congruent with mood), 638 (same), 643 (same and alert with good eye contact), 648 (same), 652 (same except affect had increased intensity, her thought process was tangential, and she had delusions), 656 (same), 659 (cooperative, elated mood, affect had increased intensity, no delusions, appreciated condition, engaged in care, hallucinations), 662-63 (same), 665-66 (same but mood “happy”), 669-70 (same except no hallucinations), 675 (same), 677-78 (uncooperative, calm but intrusive, affect had increased intensity, grandiose delusions, evasive thought processes, normal but poor concentration, impaired executive function and visual spatial function, failure to appreciate condition or engage with care; otherwise normal), 681-82 (same), 684 (same), 686 (same), 690-91 (same), 695 (same but thought process was tangential), 698 (same but not intrusive and “visual spatial” was not assessed), 701 (same), 705 (same but thought process was “loose associations”), 708 (cooperative, goal-directed thought process, and otherwise normal), 717 (alert, labile, delusions, circumstantial thought process, failure to fully appreciate condition or actively engage in care; otherwise normal).)

         In short updates about her progress in therapy sessions, various observations were made: Plaintiff did not attend many therapeutic activities early in her stay; she was cooperative and pleasant on occasion, but also quiet and withdrawn; she could “engage in productive activity, ” but she also was “restless and easily distracted”; her mood was labile; and she made bizarre or paranoid comments. (Id., PageID.535; see also id., PageID.616 (noting impulsivity and distraction, but cooperativeness), 617 (noting difficulty remaining on task and poor personal boundaries), 621 (noting Plaintiff was withdrawn but became engaged with prompting, and was polite and calm), 627 (noting that she participated when prompted, and demonstrated appropriate social skills), 631 (noting she was cooperative and polite), 641 (easily distracted), 650 (noting distraction, impaired concentration, impaired socialization, bizarre statements), 657 (calm and pleasant), 661 (actively participated), 664 (active participation but constricted affect and confusion), 667 (active participation but tearful), 668 (active participation), 672 (sad affect that improved, logical interactions with others), 672 (“profane, refuses to participate, interruptive, irritable”), 680 (“easily distracted, impaired social skills, ” anxious, illogical, but engaged with prompting), 683 (alert and attentive), 687 (“impaired concentration, anxious, impaired social, isolating”), 688 (“[l]imited coping skills, ” but logical, calm, and goal-directed), 689 (impaired social skills and concentration but polite and cooperative), 692 (“initially resistive, scattered”), 696 (“impaired concentration, impaired socialization”), 720 (irritable, intrusive, inappropriate, sexually preoccupied with male peer), 723 (appropriate, pleasant, agreeable), 724 (easily distracted, bizarre or paranoid comments), 727 (pressured, repetitive speech, cooperative), 728 (rude, labile), 729-31 (making delusional statements, irritable, confused, intrusive, angry, loud, hypomanic), 733 (pleasant but manic, intrusive, aggravating, attempting to incite riots, mean, sarcastic, impulsive), 735 (delusional), 737 (cooperative and pleasant, but earlier she was agitated and belligerent), 738-40 (anxious but cooperative), 745-46 (cooperative, completed daily activities), 747 (“uncooperative, agitated, loud, paranoid, delusional, grandiose”), 911 (isolating, confused, poor activities of daily living, but behavior controlled).)

         The notes stated that she was defiant during a large portion of her stay, refusing to take medications. (Id., PageID.580; see also id., PageID.594-95 (noting her refusal to take medications).) During this period-which lasted sometime into July, near her discharge- her behavior was inappropriate, her mood vacillated, and she displayed signs of mania and psychosis, with moderate but constant symptoms; she could not function outside the hospital. See, e.g., (Id., PageID.594-95, 601, 605, 610, 614, 629, 637, 708.) Plaintiff expressed guilt for not wanting to work anymore, and she mentioned her plans to apply for disability; the therapist discussed how she might be able to resume working in the future if she made her mental health a priority first. (Id., PageID.624.)

         Other notes, including from just a few days before discharge, reported Plaintiff's hyperverbal and pressured speech, her intrusiveness and irritability, the continued lack of insight into her condition, the persistent thought disorganization, and her overall cooperative nature. See, e.g., (Id., PageID.605, 609-10 (same), 614 (same), 676-77 (thought disorganization, mood instability, psychosis), 680-81 (thought disorganization, psychosis, anxiety, mood instability (all moderate to severe)), 683 (same), 690 (same), 694 (same), 697 (same).) At times, she reported that medication and group therapy helped her symptoms. See, e.g., (Id., PageID.614, 618, 622, 668.) She also, on occasion, experienced insomnia. (Id., PageID.614, 643, 655, 677, 694, 700; see also id., PageID.727 (noting that Plaintiff “[a]ppears [to have] . . . difficulty falling asleep and staying asleep”), 739 (noting that sleep was a problem but that she slept well the previous evening); but see id., PageID.665 (noting a restful night sleep).)

         According to the discharge notes, once she started taking her medication, she “quickly changed and improved.” (Id., PageID.580.) On discharge, Plaintiff's condition was “fair.” (Id.) She denied suicidal ideations, her personal care had improved, she attended groups and activities, her sleep and appetite were normal, she was not experiencing hallucinations or delusions, her thinking became “more reality based, ” and she “agreed to pursue . . . Social Security Benefits since she is not able to work.” (Id.) She was cooperative, displayed a relieved and calm mood, and had goal-directed thoughts with normal speech, affect, thought content, memory, concentration, and executive functioning. (Id., PageID.581.) The end diagnosis was “[b]ipolar disorder with severe mania.” (Id.)

         A few days she after discharge, she returned to Macomb County Community Mental Health. (Id., PageID.917.) In new intake paperwork, it was noted that Plaintiff had claimed crying spells, sleep troubles, lack of motivation and energy, attention issues, mood swings, impulsive behavior, memory issues, and decreased appetite. (Id., PageID.924.) Further, Plaintiff's recent hospitalization was explained as resulting from the discontinuance of her medications because she could no longer afford them. (Id., PageID.941.) She “presented as a poor historian due to [the] severity of [her] reported memory problems.” (Id., PageID.924.) She was not currently suicidal. (Id., PageID.926.) On examination, she was cooperative, her communication was unremarkable, her perceptions were normal, she had delusions, she was anxious, she had poor judgment, her impulse control was poor, her insight was fair, and her sleep was normal. (Id., PageID.926-27.) Her GAF score of 43 indicated “[s]erious symptoms . . . OR moderate difficulty in social, occupational, or school functioning.” DSM-IV, supra at 34.

         At a follow-up with Dr. N.B. Murthi a few days later, on July 31, 2014, Plaintiff's examination results were as follows: her speech was normal; her mood was stable; her affect was euthymic; her thoughts were logical; she denied hallucinations and delusions; she had no memory impairment; she was properly oriented; her judgment was “[g]enerally good”; and she had limited understanding of her condition. (Id., PageID.942-43.) Plaintiff stated that she had improved while taking her current medications. (Id., PageID.943.)

         The following month, Plaintiff returned to see Dr. Murthi. (Id., PageID.946, 954.) Sleep had been difficult recently, she noted; she was diagnosed with insomnia. (Id., PageID.954, 959.) More generally, she stated that she enjoyed reading, coloring, and art projects; she could get to appointments-her boyfriend took her around-but could not work; she could cook, take care of her cat, do household chores, do crafts, listen to the radio, and talk to her boyfriend on the phone; she hoped to travel once she got better. (Id., PageID.946.) Dr. Murthi observed Plaintiff's good grooming and hygiene, logical thought processes, normal affect, very mild depression, very mild excitement (“of doubtful clinical significance”), very mild anxiety, euthymic mood, and cooperative behavior, and that she had contact with reality, her speech was coherent and goal-directed, her affect was equable, and there were “no signs of an active thought disorder or psychosis.” (Id., PageID.954-57.) Plaintiff denied delusions, hallucinations, and suspiciousness. (Id., PageID.955, 958-59.) There was no evidence that Plaintiff lacked the ability to form relationships, had unusual thought content, or had conceptual disorganization. (Id., PageID.958.) Dr. Murthi concluded that Plaintiff was improving. (Id., PageID.959.)

         The record from Plaintiff's visit with Dr. Murthi in September 2014 is nearly identical to the August record, except Plaintiff's affect was labile, she was mildly irritable or expansive, and she denied anxiety. (Id., PageID.964-69.) But it was clear to Dr. Murthi that that ...


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