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Paula Christensen v. Michael J. Astrue

May 30, 2012


The opinion of the court was delivered by: Sandra M. Snyder United States Magistrate Judge


Plaintiff Paula Christensen, by her attorneys, Law Offices of Jeffrey Milam, seeks judicial review of a final decision of the Commissioner of Social Security ("Commissioner") denying her application for disability insurance benefits (DIB) under Title II and for supplemental security income ("SSI") pursuant to Title XVI of the Social Security Act (42 U.S.C. § 301 et seq.) (the "Act"). The matter is currently before the Court on the parties' cross-briefs, which were submitted, without oral argument, to the Honorable Sandra M. Snyder, United States Magistrate Judge. Following a review of the complete record and applicable law, the undersigned recommends that the Court remand this matter, pursuant to Sentence 6 of 42 U.S.C. § 405(g), for the limited purpose of determining, through additional testimony of the vocational expert, whether the Plaintiff has the residual functional capacity to perform any other work, in light of all her functional limitations.

I. Administrative Record

A. Procedural History*fn1

Plaintiff was insured under the Act through December 31, 2010. On November 6, 2006, Plaintiff applied for disability benefits pursuant to Title II of the Act. On November 21, 2006, Plaintiff filed a second application for supplemental security income ("SSI") under Title XVI. In both cases, Plaintiff alleged disability beginning October 12, 2005. Her claims were initially denied on May 4, 2007, and upon reconsideration, on October 2, 2007. On December 1, 2007, Plaintiff filed a timely request for a hearing. Plaintiff appeared and testified at a hearing on April 13, 2008. On January 5, 2009, Administrative Law Judge Stephen W. Webster denied Plaintiff's applications. The Appeals Council denied review on September 24, 2010. On November 24, 2010, Plaintiff filed a complaint seeking this Court's review.

B. Factual Record

Plaintiff's testimony. Plaintiff (born November 8, 1960) completed a GED and a secretarial course. Although she had a driver's license, because she rarely left the house, she rarely drove. She had previously worked as an office assistant.

Plaintiff was able to perform her own personal care but was unable to perform household chores such as laundry, cooking, and cleaning. She rarely cooked other than warming food in the microwave. She also did light housework when she felt good.

Because of her panic attacks and the pain in her back, Plaintiff watched television, "maybe too much." She no longer read, and did not go to movies or church.

Plaintiff had agoraphobia and "pain from head to toe." Her back pain was constant, and although pain medication helped, the amount she could take was limited. Her psychiatrist, Dr. Giesbrecht handled her medications; Dr. Russom treated her pain. Dr. Russom prescribed a narcotic pain reliever, Percoset, which helped Plaintiff's pain, but "not enough."

Plaintiff explained that she began seeing Dr. Russom after her husband no longer had a job that provided medical insurance. Her former physician, Dr. Kalamkarian would not renew her prescriptions without seeing her in the office, but charged $100 for an office visit.

Plaintiff had never used illegal drugs. She had stopped drinking when she began taking narcotic pain medication.

Plaintiff could sit about fifteen minutes and stand from fifteen to twenty minutes--just long enough to finish the dishes. She could not finish cleaning the kitchen before she needed to lie down. She got panic attacks four or five times weekly. She treated the panic attacks by doubling her medication and lying down, often falling asleep. According to Plaintiff, the panic attacks were exhausting, "kind of like a seizure," in that during an attack she was conscious but cloudy. Plaintiff could not identify what triggered her panic attacks.

Husband's testimony. Plaintiff's husband, Gary Christensen, worked a part-time job that provided full-time hours to ensure the flexibility to leave the job site to care for his wife. He described Plaintiff as having, over the course of a few years, gone from a "very independent, very self-supporting, very strong woman" to one who was frequently terrified and had panic attacks. Christensen cooked most meals and did the housework to "try to help her out."

According to Christensen, Plaintiff's panic attacks were severe and frequent, occurring three to five times weekly, on average, and as many as eight or nine times weekly. They were sometimes triggered by men's voices that were similarly pitched to her ex-husband's voice, screaming, or pain, but often occurred for no apparent reason. When Plaintiff experienced an attack, she removed any constricting clothing, retreated to her bed, curled into a ball, and trembled. Ultimately, she fell asleep for several hours. After an attack, Plaintiff had no energy and was "really out of it," like she was "about three-fourths dr[u]nk."

Plaintiff's application for benefits. Plaintiff worked as an office assistant from January 2000 to October 2005. Her job responsibilities included answering the telephone, dispatching, requisitions, computer work, filing, and running errands. Except for an occasional box of computer paper, the heaviest weight Plaintiff lifted was ten pounds.

On a typical day, Plaintiff had difficulty waking up and moving around because of her pain. She began the day by having coffee and her medications. If she was very depressed and in pain, she did not dress, although she was physically able to dress herself. On her most stressful and painful days, she did little more than watch television and prepare very simple meals. Because she did not sleep well at night, she often slept during the day.

Plaintiff was able to perform light housework and laundry but no work such as ironing, repairs, or outside work. Her anxiety and pain kept her from leaving the house. She sometimes shopped with her husband for thirty to forty-five minutes, but had difficulty with crowds and pain. She was frequently impatient and often preferred to be alone. Nonetheless, she did socialize with her daughters and grandchildren.

In response to the agency's pain questionnaire, Plaintiff reported that she had experienced progressively worsening arthritis pain for many years. The worst pain, which was in her upper back, was never relieved. She quit work in October 2005 when the pain became too bad. A auto accident in February 2006 greatly increased her pain. Any type of movement aggravated the pain, which Plaintiff described as a severe ache with shooting pains throughout her entire back. The pain also spread to her shoulders, upper arms, and legs. It was so intense that it nauseated her and made her dizzy.

Plaintiff's medications included Fentanyl and Oxycodone for pain, and Fuoxetine, Imipramine, and Clonazapam for her anxiety attacks and agoraphobia. She experienced side effects including nausea, drowsiness, constipation, and irritability. Fentanyl, which is morphine-based, caused physical dependency. Plaintiff also used a TENS unit, but reported that it provided little pain relief. Despite taking strong pain relievers, Plaintiff's pain was rarely less than seven to eight on a scale of ten.

Plaintiff was fully capable of handling her own finances. She could read and follow instructions.

Dr. Von Kaenel. On October 28, and December 15, 2005, William Von Kaenel, M.D., administered intralaminar epidural steroid injections to Plaintiff for cervical disc displacement, cervical radiculopathy, and cervical spine pain. According to Plaintiff, the injections "didn't help much, I still have pain." AR 237.

In a January 2, 2006 letter to Plaintiff's primary care physician, Jeffrey T. Gardner, M.D., Dr. Von Kaenel reported that Plaintiff experienced no overall benefit from the steroid injections. Von Kaenel's diagnosed:

Ms. Christensen has had neck and upper extremity pain. The epidural steroid injections have not been helpful. She has a small disc protrusion at C4-C5 and C5-C6 suggestive of the source of axial or upper extremity of pain, but not causing nerve compression.

AR 265.

Explaining that epidural steroid treatments are not helpful for discogenic pain, Von Kaenel suggested a surgical referral to explore potential treatment for the discs with protrusions.

In January 2006, Dr. Gardner noted that Plaintiff told him that the second injection caused severe neck pain.

Dr. Bernstein. In a March 8, 2006 letter to Dr. Gardner, clinical psychologist Robert M. Bernstein, Ph.D., prepared a report of his psychological assessment of Plaintiff following an automobile accident on February 16, 2006. The accident occurred when a truck rear-ended Plaintiff's car, which was stalled at an intersection. Plaintiff reported flashbacks of the accident, memory loss, nightmares, and increased fear and anxiety.

Plaintiff had a fifteen-year history of treatment of anxiety, agoraphobia, panic attacks, and depression, which had been treated with medication. In January 2000, she returned to the work force. After a new supervisor was hired in August 2005, Plaintiff experienced severe stress and was placed on disability in October 2005. "Notwithstanding, [Plaintiff] reported that she did not have panic attacks at the time of the auto accident." AR 274. Bernstein diagnosed:

Axis I 309.24 Adjustment disorder with anxiety

(309.81 Posttraumatic stress disorder, acute--this diagnosis was applicable with the exception of the time period, which required one month following the accident. It was anticipated that she would meet the criteria for this diagnosis if seen in one additional week.)

Axis II V71.09 None

Axis III Pain in back and neck and dull ache in legs

Axis IV Car accident

Axis V current GAF, 50 highest GAF in past year, 60 AR 274-275.*fn2 Dr. Bernstein concluded: [Plaintiff] manifested a vulnerability for anxiety disorders, including panic attacks, which had been largely controlled by medication and occurred infrequently prior to the car accident. As a result of the car accident, [Plaintiff] experienced a pronounced increase in anxiety and panic attacks, as well as fearfulness in a car.

She would benefit from cognitive-behavioral therapy to enhance ...

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