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Jesse Gonzales v. Michael J. Astrue

September 27, 2011

JESSE GONZALES, PLAINTIFF,
v.
MICHAEL J. ASTRUE, COMMISSIONER OF SOCIAL SECURITY, DEFENDANT.



The opinion of the court was delivered by: Sheila K. Oberto United States Magistrate Judge

(Doc. 1)

ORDER REGARDING PLAINTIFF'S SOCIAL SECURITY COMPLAINT

I. BACKGROUND

Plaintiff seeks judicial review of a final decision of the Commissioner of Social Security (the "Commissioner" or "Defendant") denying his application for disability insurance benefits ("DIB") and supplemental security income ("SSI") pursuant to Title II and XVI of the Social Security Act (the "Act"). 42 U.S.C. §§ 405(g), 1383(c)(3). The matter is currently before the Court on the parties' briefs, which were submitted, without oral argument, to the Honorable Sheila K. Oberto, United States Magistrate Judge.*fn1

II. FACTUAL BACKGROUND

Plaintiff was born December 26, 1945, previously worked in maintenance and landscaping for a residential property manager, and has worked in property management. (Administrative Record ("AR") 1125, 1128-31.) Plaintiff has completed the equivalent of two years of college and earned a certificate for completing a real estate course in 2003. (AR 1125-26.) He was on active duty in the United States Army from 1966 to 1972, but never participated in combat. (AR 267, 475, 578, 774, 1133.) He was honorably discharged from service on May 17, 1972. (AR 267, 1133.)

Plaintiff filed the current application for DIB and SSI on September 23, 2005. (AR 25, 79.) Plaintiff alleges disability beginning January 1, 2003, because of post traumatic stress disorder ("PTSD"), anxiety, and depression. (AR 25, 95.) Plaintiff last worked on September 21, 2005. (AR 96, 1126.)

A. Medical Evidence

Plaintiff has received extensive treatment with the Department of Veterans Affairs ("VA"). (AR 150-618, 628-794.) The visits, treatments, and opinions of VA physicians and others relevant to his current application are outlined below.

On October 8, 2003, Plaintiff was seen at the VA Medical Center ("VAMC") in Los Angeles, California, as an outpatient for a Biopsychosocial Assessment and Initial Plan. (AR 168-74.) His chief complaints were "anger, frustration, and stress." (AR 168.) He "expressed persistent homicidal ideation toward his former supervisor . . . [and] indicated that in the past he had devised plans to exact revenge on his supervisor, but has refrained from acting out these plans for fear of going to jail and abandoning his 23 year-old son who lives with him." (AR 169.) "The focus of this treatment was primarily coping with stress." (AR 169.) His GAF score was 68. (AR 173.)

On November 25, 2003, Plaintiff was seen at the VAMC in Los Angeles, California, to determine if he could benefit from psychotropic medication. (AR 166-67.) Ultimately, psychotropic medications were not prescribed, but the staff psychiatrist noted that Plaintiff expressed passive homicidal ideation toward a previous employer who had recently terminated him. (AR 166.)

On March 4, 2004, Plaintiff returned to the VAMC in Los Angeles, California, for depressive symptoms, claiming he was experiencing stress and not sleeping. (AR 163.) He was referred to the mental health clinic there for depression and stress and instructed to do relaxing activities. (AR 164.) On March 15, 2004, Plaintiff saw a social worker and requested housing assistance. (AR 159.) He claimed to be living with family members and was informed of various options for veteran housing in the area. (AR 159.)

On July 13, 2005, Plaintiff met with a VA social worker, Ms. Jami Jensen, in Fresno, California, to discuss housing. (AR 582-83.) Ms. Jensen noted that computer records indicated Plaintiff had a history of homelessness, economic trouble, and PTSD, and she observed that Plaintiff exhibited signs of anxiety and depression. (AR 582.) Ms. Jensen assisted Plaintiff with temporary employment referrals, low cost housing referrals, and information on VA homeless programs. (AR 582-83).

On September 21, 2005, Plaintiff completed an intake form at the Fresno VAMC. (AR 575-81.) He exhibited symptoms of depression and anxiety, he claimed to dream about hurting people, and he was sad when he thought about his life. (AR 576.) The staff psychiatrist escorted him to the main VAMC hospital due to his apparent danger to others, where he was admitted for psychiatric treatment. (AR 573-74.)

Plaintiff's admission records indicate that he was held for his "complaints of severe anger toward former co-workers and homicidal ideation," and identified symptoms of homicidal/suicidal ideation, PTSD, and ineffective coping skills. (AR 552, 575-81, 613.) His GAF scale score at admission was 40. (AR 572, 556.) Prior to discharge, he was re-evaluated and assigned a GAF scale score of 45. (AR 574.)

Plaintiff was discharged on September 22, 2005, based on his improved condition. (AR 438.) The discharging psychiatrist noted that "[h]e is mildly hard of hearing, which makes communication difficult[, but his s]peech is [a] normal rate and rhythm, slightly increased in volume but normal in tone. (AR 438-39.) His GAF scale score at the time of his discharge was 55. (AR 436, 441, 556.) Discharge notes indicate that "he emphatically denied that he [had] any desire or plans to harm his previous employer. He is more focused on getting a new job and being able to keep his apartment." (AR 557.) Plaintiff reported that he was in contact with numerous organizations to help with his financial problems, such as Fresno Workforce Connection, California Employment Development Department ("CA EDD"), and the VA. (AR 558.) He also stated he had a case manager who assisted him with "Fair Employment and Housing regarding his employment situation." (AR 558.)

On October 27, 2005, Plaintiff began seeing Dr. L. Darrell Dunkel, a clinical psychologist for VA, for a group-oriented six-week stress- and anger-management class. (AR 790.) Plaintiff attended the initial session with 14 other participants. (AR 790.) Dr. Dunkel noted Plaintiff was cooperative, had a stress level of seven out of 10, and an anger level of eight out of 10. (AR 790.)

On October 31, 2005, Plaintiff called the VA telephone care to report elbow pain, which he described as a six out of 10. (AR 788-90.) He was unable to identify the injury that caused the pain and was referred to the emergency room if it did not get better. (AR 788-90.) Later that day, he presented at the Fresno VAMC for his elbow pain and was told to rest it and take over-the-counter ibuprofen for pain and inflammation. (AR 787-88.) Plaintiff also saw Ms. Jensen, who noted updates on his living situation: he was working with Legal Aid to fight an eviction; he was still unemployed but actively looking for work; and he would be returning for assistance with his pending VA pension claim. (AR 787.)

On November 15, 2005, Plaintiff completed an adult function report. (AR 108-15.) He stated that most of his daily activities involved appointments at the VA, legal issues related to housing and employment, and miscellaneous tasks related to social services, Workforce Connection, and his VA social worker. (AR 108.) He prepared his own meals on a daily basis, although he claimed that his condition reduced his ability to do so. (AR 110.) He continued to do household duties, such as cleaning, laundry, dishwashing, and outside chores, including light-duty yard work, watering the lawn, and sweeping. (AR 110-11.) He was able to walk, drive a car, and take public transportation when he went out. (AR 111.) He shopped on a weekly basis for household products. (AR 111.) His hobbies were watching sports, fishing, billiards, and travel, although he was limited to watching sports due to his lack of income. (AR 112.) He was able to socialize with others, including having phone conversations every two to three days and going to church and the VA hospital on a regular basis. (AR 112.) He listed a problem getting along with employers because they gave him grief and stress, and reported that he lost previous jobs because of unfair labor laws against him. (AR 113.) He stated that his social activities are mainly with VA staff, and he has a short fuse for social activities. (AR 113.)

On November 17 and 23, 2005, Plaintiff attended additional stress- and anger-management group sessions, and Dr. Dunkel noted that Plaintiff was cooperative. (AR 784-85.) On December 8, 2005, Plaintiff participated in a final stress- and anger-management group session. (AR 776-77.) Dr. Dunkel noted Plaintiff was cooperative, and he also had a stress level of seven out of 10, and an anger level of seven out of 10. (AR 777.) Dr. Dunkel also noted that Plaintiff reported having benefitted from the group, and he was invited to a weekly, ongoing stress- and anger- management group. (AR 777.) Following this session, however, Plaintiff reported to Ms. Jensen that he had been evicted the previous day and his son, who had been living with him, left to live in Arizona; he was actively endorsing suicidal ideation. (AR 776.) Ms. Jensen brought him to the VAMC emergency room for a mental health evaluation. (AR 776.)

From December 8 to 13, 2005, Plaintiff was admitted to the Fresno VAMC for psychiatric treatment due to depression and suicidal ideation. (AR 716-77.) At the time he was admitted, Plaintiff was mainly described as "tearful," and the primary concern noted was his suicidal thoughts. (AR 762, 768, 774, 776.) In regards to his financial and legal problems, the examiner noted that "his accounts are often at odds with the reality as reported by the ex employer . . . . " (AR 774.) During intake questioning, he mentioned that he did not participate in combat during his service in the Army, but had witnessed the death of fellow soldiers during military training and "expresse[d] feelings of guilt over not being able to prevent those deaths." (AR 774.) He claimed to have "occasional flashbacks[, but had] not been formally assessed for PTSD." (AR 774.) His GAF scale score at admission was 40. (AR 774.) He was reassessed approximately seven hours later, and his GAF scale score was 35. (AR 768.) A staff psychiatrist noted that he was "at risk for suicide if released due to recent homelessness." (AR 768.)

During his inpatient treatment, Plaintiff was "found in [the] TV room watching Platoon" and had to be reminded that "war movies may be difficult [for] other patients to see or hear." (AR 744.) He was diagnosed with major depression on December 10, 2005. (AR 749, 743.) He was discharged and identified as "stable for outpatient management" on December 13, 2005. (AR 718, 723.) His GAF scale score at the time of his discharge was 70. (AR 649, 727.)

On January 12, 2006, Dr. Dunkel completed a form reporting that he had been treating Plaintiff from October 27, 2005, through January 6, 2006, "as needed" and diagnosed Plaintiff with Major Depressive Disorder ("MDD"). (AR 1094.) Dr. Dunkel observed that Plaintiff's symptoms included "dysphoria, anhedonia, impaired concentration, excessive guilt, suicidal thoughts [and posited that h]is symptoms prevent him from effectively attending to job-related tasks." (AR 1094.) Dr. Dunkel further claimed that Plaintiff was incapable of performing his regular work since October 27, 2005, but anticipated that he could return to work on July 12, 2006. (AR 1094.)

On February 15, 2006, Plaintiff attended a previously scheduled appointment with Dr. Neil Smith, a psychiatry resident at the Fresno VAMC.*fn2 (AR 706-09.) Plaintiff claimed to have nightmares and flashbacks. (AR 707.) Dr. Smith's notes indicate that he ruled out PTSD as a disorder, citing Plaintiff's financial situation, unemployment, and recurring nightmares as indicia of an adjustment disorder with depressed mood. (AR 708.) Plaintiff was assigned a GAF scale score of 65. (AR 708.)

On April 7, 2006, Dr. Cal VanderPlate, a non-examining state agency psychiatrist, completed a Mental Residual Functional Capacity ("RFC") Assessment of Plaintiff.*fn3 (AR 621-627.) Dr. VanderPlate found that Plaintiff was capable of understanding and remembering at least simple directions, capable of carrying out simple tasks, limited in pace and concentration but could maintain his attention for a two-hour period during an eight-hour workday and complete a normal workweek, somewhat restricted in dealing with others because of his history of depression and anger issues, capable of relating appropriately to others in social situations, able to accept supervision and deal appropriately with criticism, and had no problems with adaptive skills. (AR 623.) Dr. VanderPlate concluded that Plaintiff's claimed limitations for stress, anxiety, and depression were only partially credible because they were not supported by medical evidence. (AR 627.)

On May 8, 2006, Plaintiff was seen by Dr. Smith for a follow-up appointment. (AR 703-05.) Plaintiff claimed to have recurring dreams with blurry faces that he did not recognize. (AR 704.) He was drinking more, purportedly in social situations, and had the need to "feel part of the group." (AR 704.) Dr. Smith added to his previous disorder identifications that Plaintiff may have an alcohol abuse problem or a dependency. (AR 704.) Dr. Smith again noted that PTSD had been ruled out as a diagnosis. (AR 704.) Plaintiff was given a GAF scale score of 70. (AR 705.)

On June 5, 2006, Dr. Smith saw Plaintiff for a scheduled follow-up appointment. (AR 692-96.) During this appointment, Plaintiff claimed to have "graduated from Fresno State with a dual major (one in Spanish) and has had many good jobs in the past." (AR 693.) Additionally, Plaintiff claimed to have "occasional nightmares but [did] not . . . elaborate on their content." (AR 693.) A loan discharge application form was discussed, and Plaintiff claimed that Dr. Dunkel "mentioned in the past that he was permanently disabled." (AR 693.) Plaintiff was given a GAF scale score of 64. (AR 695.)

On June 7, 2006, Dr. Smith indicated on a loan discharge form that Plaintiff was unable to work due to his depression. (AR 1093.) According to Dr. Smith, Plaintiff's "major depression disorder" prevented him from "work[ing] or earn[ing] income in any capacity." (AR 1093.) Dr. Smith noted that it was not known at that time if Plaintiff's disability was permanent. (AR 1093.)

On July 21, 2006, Dr. Dunkel indicated that he was still treating Plaintiff, with the last date of treatment on June 5, 2005. (AR 1092.) Dr. Dunkel noted Plaintiff's diagnosis as MDD and stated that his present condition prevented him from returning to work because "[i]t prevents him from adequately focusing on and [sic] performing work-related tasks." (AR 1092.) The only factor Dr. Dunkel listed as causing the extended disability was unemployment and estimated that Plaintiff should be able to return to work on January 21, 2007. (AR 1092.)

On August 14, 2006, Plaintiff saw Dr. Smith for a scheduled appointment. (AR 685-88.)

Plaintiff brought his significant other to the appointment. (AR 687.) Plaintiff complained of having more "ups and downs" in his moods and continued anxiety, and he continued to experience insomnia and reported seeing "silhouettes," claiming that one was a person he knew who recently passed away, but was unable to elaborate further. (AR 686.) His significant other stated Plaintiff was experiencing tremendous amounts of anger, sometimes directed at her, and often seemed on edge. (AR686.) He expressed frustration that he was not understood. (AR 686.) Plaintiff admitted to withdrawing or avoiding things that made his symptoms worse. (AR 686.) Dr. Smith gave him a GAF scale score of 58 and again ruled out PTSD as a potential diagnosis. (AR 687.) Dr. Smith added "current discord with significant other" to his Axis IV assessment. (AR 687.)

On September 6, 2006, Plaintiff saw Dr. Smith for a scheduled appointment. (AR 674-77.) Plaintiff did not bring his significant other to this appointment, but mentioned that he thought she was overwhelming and controlling. (AR 675.) Plaintiff presented a note from his significant other requesting he be taken off some of his current medications. (AR 675.) He stated that he first wanted to work on his PTSD symptoms in group therapy before considering any other treatment. (AR 675.) He continued to report seeing "silhouettes" at night and was able to identify most of them as people he worked with and who had passed away, but did not understand what it meant. (AR 675.) He also complained of chronic anxiety. (AR 675.) Dr. Smith gave him a GAF scale score of 54 and again ruled out PTSD as a potential diagnosis. (AR 676.)

On September 25, 2006, Dr. Smith completed a Department of Education form regarding Plaintiff's previous application for loan forgiveness. (AR 670-71, 1093.) Dr. Smith noted that the Department of Education was under the impression Plaintiff was permanently disabled, which Dr. Smith denied and clarified that the extent or length of Plaintiff's disability was not known. (AR 671.)

On September 28, 2006, Plaintiff returned to the Fresno VAMC to obtain a signature to complete a form required to apply for general relief. (AR 670.) Plaintiff claimed that two items on the form had not been checked and social services would not allow him to submit the application. (AR 670.) During the discussion with VA staff, Plaintiff claimed to be "unable to hold a job because of mental health issues, not physical [sic] issues." (AR 670.) He also stated that "he gets angry and short tempered, can't stand 'stupid people' and was fired for 'mouthing off' in June 2002. He [stated he] has not been able to tolerate a work environment since that time." (AR 670.) He further claimed to have "enemy images that intrude on his thoughts and his sleep is disturbed by them. He has guilt and aggressive thoughts about enemy soldiers." (AR 670.) He expressed interest in attending a PTSD treatment program if he was diagnosed with that problem. (AR 670.)

On November 15, 2006, Plaintiff saw Dr. Smith and reported having ongoing problems with his significant other and that she was a source of stress. (AR 865.) He was having a lot of ups and downs, depending on the situation, but overall remained stable. (AR 865.) He claimed to have insomnia, nightmares, depressed moods, and chronic anxiety. (AR 865.) Dr. Smith again ruled out PTSD as a diagnosis and gave Plaintiff a GAF scale score of 54. (AR 866.) Dr. Smith considered MDD, adjustment disorder with depressed mood, alcohol abuse or dependency, and dyssomnia as potential diagnoses. (AR 866.) Dr. Smith further noted, however, that he was considering prescribing Prazosin*fn4 for high blood pressure, which could also help with PTSD. (AR 866.)

On December 1, 2006, Dr. Glenn Ikawa, a non-examining state agency psychiatrist, reviewed Dr. VanderPlate's mental RFC assessment, and completed a Psychiatric Review Technique Form (see 20 C.F.R. § 404.1520a). (AR 795-810.) Dr. Ikawa affirmed the findings of Dr. VanderPlate and specifically stated that he agreed that Plaintiff was able to complete simple, repetitive tasks with limited public contact. (AR 795, 810.)

On December 18, 2006, Plaintiff saw Dr. Smith for a scheduled appointment. (AR 851-54.) Plaintiff remained depressed and indicated his disability claim denial had a negative affect on him. (AR 852.) He claimed to have some dizziness and stated that it was due to previous head traumas; he requested a Magnetic Resonance Imaging ("MRI") to determine if there was anything wrong with his brain. (AR 852.) He mentioned his upcoming appointment with Dr. Lynn Nile and "hope[d] he [could] wait that long." (AR 852.) Dr. Smith again ruled out PTSD as a potential diagnosis and gave Plaintiff a GAF scale score of 52. (AR 853.) While Dr. Smith had not come to a conclusion on Plaintiff's diagnosis, he did note again that Prazosin, which would be used for his blood pressure, may help with PTSD. (AR 853.) Dr. Smith discussed with Plaintiff that he would be leaving the clinic in January and encouraged him to meet with Dr. Nile for a follow-up appointment on January 22, 2007. (AR 853.) On December 20, 2006, Plaintiff underwent a Computed Topography ("CT") scan, which revealed no significant intracranial or extracranial pathology for a person his age. (AR 832.)

On January 22, 2007, Plaintiff met with Dr. Nile, a treating attending psychiatrist at the Fresno VAMC. (AR 846-48.) Plaintiff reported nightmares three to four times a week and intrusive, traumatic memories occurring daily. (AR 847.) She noted that Plaintiff's depression was an eight out of 10 and that he was angry about being prematurely and wrongfully terminated. (AR 847.) Dr. Nile described Plaintiff as engaged with good eye contact and cooperative, but irritable, depressed, slightly agitated, anxious and stressed. (AR 847.) Dr. Nile also noted that Plaintiff was struggling financially, anxious, stressed, isolative, experiencing increased irritation, anger, frustration, and resentment, was hyper vigilant, had an exaggerated startle response, and decreased concentration. (AR 847.) Dr. Nile recorded PTSD as an active problem for Plaintiff. (AR 977.)

On March 19, 2007, Plaintiff saw Dr. Nile for a follow-up appointment to discuss his symptoms. (AR 1075.) He claimed to be angry and irritated at the world, more isolated, had intrusive traumatic thoughts daily, had passive thoughts of death or dying, fleeting thoughts of suicidal ideation, and nightmares four to five times per week. (AR 1075.) Dr. Nile reported that Plaintiff's additional symptoms included sleeping three to four hours per night, exaggerated startle response, hyper vigilance, and decreased concentration. (AR 1075.) Dr. Nile noted Plaintiff's PTSD as severe and MDD as recurrent, chronic, and moderate-to-severe, but she also indicated that his medications helped with his PTSD and depression. (AR 1075.)

On April 29, 2007, Plaintiff called the VA's after-hours medical advice and emergency phone number but refused to answer any triage questions. (AR 1058-60.) Plaintiff stated that the VA was not doing anything for veterans and he had been sensible and reasonable with them. (AR 1058.) He was told to go to the Fresno VAMC emergency room to speak with a psychiatrist. (AR 1058.) He stated he did not need to talk and hung up. (AR 1059.) The record reflects Dr. Nile reviewed this incident on April 30, 2007. (AR 1059.)

On May 3, 2007, Plaintiff went to the Fresno VAMC, but left before discussing any issues with anyone. A note states that Plaintiff had missed two appointments and was not returning phone calls in regard to PTSD treatment and therapy. (AR 1058.) On May 8, 2007, Plaintiff completed assessments for a PTSD treatment program, his results were reviewed by the treatment team, and he was recommended to begin treatment in Dr. Jack Papazian's psycho-educational group. (AR 1057.)

On May 15, 2007, Plaintiff attended the first session of the PTSD psycho-educational group treatment program, led by Dr. Papazian. (AR 1052-53.) Dr. Papazian noted that Plaintiff was interested and actively involved in group discussions, and his diagnostic impression of Plaintiff was PTSD. (AR 1052-53.)

On May 22, 2007, Plaintiff attended the second session of the PTSD group led by Dr. Papazian. (AR 1045-46.) Dr. Papazian noted that Plaintiff was interested, actively involved in groups discussions, and his diagnostic impression was PTSD. (AR 1045-46.) Dr. Papazian reported his observations on May 29, 2007, when Plaintiff attended the third session. (AR 1038.)

On June 1, 2007, Plaintiff met with Dr. Nile for a follow-up appointment. (AR 1037.) Plaintiff discussed his PTSD group therapy and described it as helpful. (AR 1037.) Plaintiff claimed that his son was in legal trouble, which increased his own stress and anxiety. AR 1037.) He had nightmares a few times a week, had flashbacks 15-20 times per week, had daily intrusive and traumatic thoughts, and was experiencing an increase in his irritation and anger levels. (AR 1037.) Dr. Nile noted Plaintiff's PTSD as severe and his MDD as recurrent, chronic, and moderate. (AR 1037.) She also noted that the medications helped with Plaintiff's depression and anxiety. (AR 1037.)

On June 12, 19, and 26, and July 10, 2007, Plaintiff attended the PTSD group lead by Dr. Papazian, who again noted that Plaintiff appeared interested, was actively involved in group discussions, and his diagnostic impression was PTSD. (AR 1017-18, 1034-35.) After his final group session, Dr. Papazian referred Plaintiff to Dr. Dunkel's PTSD/Anxiety Management group. (AR 828.)

On July 10, 2007, Plaintiff was fitted with hearing aids and provided an examination to determine his functional gain and speech audiometry. (AR 1016.) He was instructed on how to manipulate the volume and program controls of the hearing aids, as well as general use and care for the devices. (AR 1016.) His functional gain was not significant, but his speech audiometry was beneficial because his speech discrimination improved from 68% at 70 dB to 92% at 55 dB. (AR 1016.)

On September 7, 2007, Dr. Nile prepared a Mental RFC Assessment for Plaintiff, and she indicated that Plaintiff had marked limitations in interacting socially and in sustaining concentration and persistence. (AR 1096-97.) Dr. Nile's diagnosis was severe PTSD and recurrent, moderate MDD, based on a psychiatric diagnostic interview and psychotherapeutic interventions. (AR 1097, 1098.) Dr. Nile opined that Plaintiff's disorders "cause[] him to have marked limitations socially, personally, emotionally and occupationally." (AR 1098.) She opined that these restrictions existed since his first mental health visit to the Fresno VAMC on November, 29, 1999. (AR 1097.)

On September 20, 2007, Plaintiff met with Dr. Nile for a follow-up appointment. Plaintiff claimed to be frustrated, irritated, "losing hope" about getting benefits for PTSD, depressed, and angry. (AR 1099.) Dr. Nile noted specifically that Plaintiff "[c]ontinues to exhibit severe PTSD symptoms, including daily intrusive, traumatic memories, flashbacks 15-20 times per week [sic], nightmares few times per week [sic], inc[reased] irrit/anger, dec[reased] STM/conc., hypervigilant, exag. startle, broken sleep (3-4 hrs.)." (AR 1099.) Dr. Nile opined that Plaintiff's PTSD was severe and disabling, rendering him permanently disabled and unemployable. (AR 1099.) Additionally, she noted his MDD to be recurrent, chronic, and moderately severe. (AR 1099.) She also noted that Plaintiff was engaged during appointments, made good eye contact, and cooperative. (AR 1099.)

On October 5, 2007, Dr. Nile stated that Plaintiff's PTSD permanently reduced his ability to engage in work, but the onset date was unknown. (AR 1108-09.) Her diagnosis was PTSD and recurring, moderately severe MDD. (AR 1109.)*fn5

B. Third Party Lay Statements

In a letter dated November 16, 2006, Robert Kovar, Plaintiff's friend of approximately 15 years, wrote that he watched Plaintiff "go from a mild tempered person very quiet in demeanor to a person who is on edge and short tempered." (AR 139.) Mr. Kovar stated that he had to watch what he said to Plaintiff because anything can upset him. (AR 139.) He stated that Plaintiff's continuous references to military service were evidence of some deep scars left on his ...


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