United States District Court, D. South Dakota, Southern Division
CARLA M. MANCO, Plaintiff,
NANCY A. BERRYHILL, Acting Commissioner of the Social Security Administration, Defendant.
MEMORANDUM OPINION AND ORDER
VERONICA L. DUFFY UNITED STATES MAGISTRATE JUDGE.
Carla M. Manco, seeks judicial review of the
Commissioner's final decision denying her application for
social security disability and supplemental security income
disability benefits under Title II and Title XVI of the
Social Security Act.
Manco has filed a complaint and has requested the court to
reverse the Commissioner's final decision denying her
disability benefits and to enter an order awarding benefits.
Alternatively, Ms. Manco requests the court remand the matter
to the Social Security Administration for further
appeal of the Commissioner's final decision denying
benefits is properly before the court pursuant to 42 U.S.C.
§ 405(g). The parties have consented to this magistrate
judge handling this matter pursuant to 28 U.S.C. §
Statement of the Case
action arises from plaintiff, Carla M. Manco's,
(“Ms. Manco's”), application for SSDI and SSI
filed on June 25, 2015, alleging disability since April 15,
2013, due to a learning disability, dyslexia, anxiety, high
blood pressure, high cholesterol, and depression. AR281, 288,
372 (citations to the appeal record will be cited by
“AR” followed by the page or pages). Ms. Manco
also raised issues of being unable to do well with others,
memory problems, Methicillin-resistant Staphylococcus aureus
(“MRSA”), a cyst on her kidney and neuropathy in
her legs, feet, arms, and hands. AR389, 394-95, 401, 433.
Manco's administrative law judge hearing was held on June
28, 2017, by Jeffrey Holappa (“ALJ”). AR85. Ms.
Manco was represented by other counsel at the hearing, and an
unfavorable decision was issued on August 24, 2017. AR6, 85.
One of the evaluation, the ALJ found that Ms. Manco had not
engaged in substantial gainful activity (“SGA”),
since the date of her alleged onset of disability, April 15,
2013, and that she met the insured status for her SSDI claim
through December, 2021. AR12.
found that Ms. Manco's work at Walgreens in August, 2013,
and at Forum Communications in December, 2016, were both
unsuccessful work attempts. AR12.
Two, the ALJ found that Ms. Manco had severe impairments of
degenerative disc disease of the cervical spine, small fiber
neuropathy, post-traumatic stress disorder
(“PTSD”), borderline intellectual functioning,
attention deficit hyperactivity disorder, dyslexia, anxiety
and depression. AR12.
also found that Ms. Manco had been diagnosed with
hypertension, hyperlipidemia, right carpal tunnel disease,
obesity, right renal cyst, gastroesophageal reflux disease,
and sleep apnea, but determined they were all non-severe.
3, the ALJ found that Ms. Manco did not have an impairment
that met or medically equaled one of the listed impairments
in 20 C.F.R. 404, Subpart P, App 1 (20 C.F.R. §§
416.920(d), 416.925, and 416.926) (hereinafter referred to as
the “Listings”). AR12. The ALJ considered the
mental impairments under Listings 12.02, 12.04 12.06, 12.11,
and 12.15 and found that Ms. Manco had moderate limitations
in understanding, remembering, or applying information;
moderate limitations in interacting with others; moderate
limitations with concentration, persistence or maintaining
pace; and mild limitations in adapting or managing herself,
so did not meet a Listing. AR13-14.
determined that Ms. Manco had the residual functional
capacity (“RFC”) to perform:
less than the full range of medium work as defined in 20 CFR
404.1567(c) and 416.967(c) except: the claimant is limited to
lifting and carrying 50 pounds occasionally and 25 pounds
frequently. The claimant is limited to sitting (with normal
breaks) for about 6 hours out of an 8-hour workday. The
claimant is limited to standing or walking (with normal
breaks) for about 6 hours out of an 8-hour workday. The
claimant is limited to pushing and pulling within the same
weight limitations as lifting and carrying. The claimant is
limited to occasional climbing of ladders, scaffolds or
ropes. The claimant is limited to frequent balancing,
stooping, kneeling, crouching, crawling and climbing ramps or
stairs. The claimant is limited to occasional exposure to
work hazards such as unprotected heights and moving
mechanical parts. Mentally, the claimant is limited to
understanding, remembering and carrying out simple, routine
and repetitive tasks. The claimant is limited to making
simple work-related decisions. The claimant is limited to
occasional interaction with supervisors, coworkers and the
found Ms. Manco's medically determinable impairments
could reasonably be expected to produce the symptoms she
alleged, but her statements concerning the intensity,
persistence, and limiting effects of her symptoms were not
“entirely consistent with the medical evidence and
other evidence in the record for the reasons explained in
this decision.” AR16.
considered the opinions of the State agency medical
consultants, who found that Ms. Manco did not have a severe
impairment and gave them “only some weight”
because evidence admitted at the hearing level has shown the
claimant was more limited than originally determined with the
development of cervical degenerative disc disease and small
fiber neuropathy. AR19.
considered the opinions of the State agency psychological
consultants and gave them “great weight.” AR19.
considered the medical source statement completed by Ms.
Manco's treating mental health provider, Dr. Fox, who
identified multiple areas of “moderate” and
multiple areas of “marked” limitations, and
accepted the “moderate” limitations. AR19,
810-12. The ALJ rejected all “marked” limitations
asserting they were “inconsistent with the mental
status examination observations in the record as well as the
testing results.” AR19, 810-12 (medical source
statement). The ALJ stated Dr. Fox's opinions were
“afforded some weight to the extent they support the
limitations in the residual functional capacity
assessment” determined by the ALJ. AR19.
gave “some weight” to the statement of the
consultative psychological examiner, Galen Van Kley, Ph.D.,
who stated the claimant's employment opportunities would
be limited by her intellectual deficits, even though she was
capable of learning and retaining new information with
repeated exposure. The ALJ's decision stated, “The
undersigned accepts that the claimant is capable of
performing repetitive tasks and that she is limited, but
noted in the decision that Ms. Manco's treating
physician, Dr. Olegario, limited her to lifting no greater
than 10 pounds “for now” in July, 2014. AR16.
on the RFC determined by the ALJ, the ALJ first found that
Ms. Manco was capable of performing her past relevant work as
a hand packager, a medium exertion unskilled occupation,
stating, “The undersigned accepts the vocational
expert's opinion. Accordingly, the claimant is
unable to perform past relevant work as actually
or generally performed.” AR21. The ALJ stopped the
sequential evaluation at Step 4 and found Ms. Manco not
Appeals Council denied Ms. Manco's request for review
making the ALJ's decision the final decision of the
Plaintiff's Age, Education, and Work Experience.
Manco was born January 31, 1965, and completed the 12th grade
in 1983. She stated that she attended special education
classes. AR121, 373.
identified Ms. Manco's past relevant work as hand
packager, medium exertion unskilled work, DOT# 920.587-018.
Relevant Medical Evidence.
Olegario Medical Clinic Records
Manco was seen on January 22, 2014, to follow-up an emergency
room visit due to right sided wrist pain. AR592. Ms. Manco
reported at the emergency room visit that she had recently
started a new job that required a lot of repetitive activity
with her hands, and following examination, she had been
assessed with overuse syndrome secondary to repetitive motion
and activity with her hands. AR661-62. Examination revealed
right wrist pain in a median nerve distribution, and her
assessment was carpal tunnel syndrome. AR594. Ms. Manco
complained of numbness and tingling as well as pain, and an
EMG was obtained that revealed evidence of right median
neuropathy at the wrist such as seen in carpal tunnel
syndrome. AR547. Karen Garnaas, MD, stated the EMG showed
neuropathy at the right wrist characteristic in carpal tunnel
syndrome which was of “mild electrophysiologic
severity. There is no evidence of a generalized sensorimotor
polyneuropathy, cervical radiculopathy, or ulnar
neuropathy.” AR547. Ms. Manco had right carpal tunnel
surgery on February 27, 2014. AR563, 588.
Manco was seen on July 23, 2014, complaining of low back pain
and pain between her shoulder blades with symptoms she said
were present off and on for years but worsening the past
several days. AR577. Examination revealed mid and low back
tenderness. AR579. Meloxicam and baclofen were prescribed and
she was put on work restrictions with lifting no more than 10
pounds “for now.” The physician stated that there
did not appear to be any worrisome spinal symptoms and her
symptoms were potentially related to musculoskeletal
Manco was seen again on July 29, 2014, with complaints of
lower back pain mainly around her right flank. AR574. She
said she had had significant pain and was observed to be
obviously uncomfortable with, she said, an inability to sit
long periods due to pain. AR574. Ms. Manco also reported
right sided kidney pain, vertigo, and nausea. AR574. A CT
with renal stone protocol was obtained that revealed a
probable right ovarian cyst but no kidney stones. AR607.
Ms. Manco's complaints of mid and low back pain, a lumbar
spine x-ray series was obtained on July 30, 2014, that
revealed very mild convex right thoracolumbar junction
scoliosis and minimal bony spondylosis, but no other abnormal
findings. AR606. In previously taken x-rays from April 2011,
Tamara Wheeler, M.D., noted “slight spinal
curvature” in the left lower thoracic spine and right
upper thoracic spine. AR654. Her impression was
“scoliotic curvature noted.” AR654.
Manco was seen on April 13, 2015, to follow-up on a number of
conditions including depression and refilling her Paxil
medication. AR570. Her psychiatric history included ADD,
anxiety, and depression. AR571. The record showed no barriers
to learning, a readiness to learn and learning preferences
including one-on-one, telephone instruction, verbal
explanation, and written material. AR571. Ms. Manco had
normal mood, affect, speech and thought processes. AR572.
Manco was seen with her mother on June 3, 2015, to discuss
disability. AR566. Ms. Manco was noted to have no learning
barriers. AR567. Her mood was depressed, and she had been
under stress and was feeling more depressed. AR568. Ms. Manco
reported being labeled with a learning disability while
growing up and a possibility of dyslexia, and she said she
had a difficult time maintaining employment despite help from
her mother. AR568. Dr. Olegario stated Ms. Manco had a
depressed mood, normal affect, speech and thought processes.
AR568. Attention deficit disorder was assessed, and Vyvanse
was prescribed. AR569.
AMG Internal Medicine Clinic Records
Manco was seen on March 18, 2016, for complaints of pain in
both feet with achiness and burning in the balls of her feet
into her toes and muscles of her legs. AR837, 840. Ms. Manco
rated her bilateral foot pain as 8 out of 10, and she also
complained of back, joint and muscle pain. AR838-39.
Examination revealed bilateral lower extremity distal
tenderness and bilateral hand pain. AR839.
Manco was seen on April 18, 2016, with complaints of
continued foot and leg pain with pain in the bottom of her
feet radiating up her legs and numbness and tingling below
both feet. AR833, 836. She also complained of anxiety and
stress on the day of the examination. AR833. Examination
revealed depressed mood; normal affect, speech, and thought
processes; and symptoms “consistent with”
neuropathy in both feet, and Lyrica was prescribed. AR836.
Manco was seen on June 8, 2016, for complaints of continued
bilateral leg pain and numbness. AR830. She rated her leg
pain as 7 out of 10. AR831. Ms. Manco complained of a burning
discomfort over her distal bilateral lower extremities and
had similar symptoms over her hands to a milder degree.
AR832. Dr. Olegario noted that back x-rays from the previous
year did not show obvious disc disease. AR832. An MRI had
been ordered but her insurance company denied coverage.
AR832. An EMG was ordered, and gabapentin was prescribed to
replace the Lyrica, which she had not tolerated. AR832.
Neurology Associates Records
Manco was referred to Neurology Associates and seen on July
18, 2016, for complaints of burning foot dysesthesias over
the past year with more recent numbness and tingling in her
hands, sometimes radiating up the arms. AR798, 800.
Examination revealed some lost sensation in the lower
extremities with temperature decreased to lower calves, cool
at upper calves, and in the upper extremities pain was
sharper at mid hands, temperature cooler at mid forearms.
AR803. Ms. Manco was oriented, with intact recent and remote
memory, good attention span and fund of knowledge,
spontaneous speech, and a full range of affect. AR803. Ms.
Manco had normal strength in her wrists, fingers, and hands.
She had intact fine-finger movements and finger-nose-finger
testing “without tremor or ataxia.” AR803. Her
gait was somewhat antalgic but otherwise her heel, toe, and
tandem gaits were normal. AR803. Ms. Manco's
Romberg's sign was normal. AR803. EMG testing showed
minimal evidence of right carpal tunnel syndrome “no
definite radiculopathy or large fiber neuropathy.”
AR799. Dr. Olegario would “consider skin biopsy for
small fiber neuropathy.” AR799. He ordered brain and
cervical MRIs and prescribed gabapentin. AR799.
of Ms. Manco's upper extremities was obtained on July 18,
2016, and was minimally abnormal on the right with median
palmar sensory distal latency “just slightly outside of
the normal range” raising the possibility of mild
median neuropathy at the right wrist such as seen in carpal
tunnel syndrome. AR807. Karen Garnaas, M.D., saw no evidence
of a similar process affecting the left upper arm and no
cervical abnormalities affecting either upper limb. AR807.
cervical spine MRI was obtained on July 21, 2016, which
revealed degenerative disc disease with disc protrusions and
bulging at ¶ 4-5, C5-6, and C6-7 without significant
spinal stenosis, cord compression, or demyelinating disease.
and stem MRI was obtained on July 21, 2016, which revealed
three small foci of white matter T2 hyperintensity in the
left frontal lobe, right frontal lobe and right periatrial
white matter, which were nonspecific, although not
inconsistent with demyelinating disease. AR805. The suspicion
of demyelination was low. AR793.
Manco was seen on September 9, 2016, for follow-up and
reported continued tightness of the ankles in the morning
with some tingling and burning, but overall her symptoms were
about 50% improved versus the 8/10 previously reported.
AR794. She reported that her symptoms were worse if she was
on her feet a lot, and her right knee felt unstable and was
randomly giving out. AR794. Ms. Manco also reported her left
hand randomly felt swollen and numb, but her hand symptoms
seemed less severe since starting gabapentin. AR794.
Manco was seen on March 15, 2017, by Becky Emerson, PA-C, to
follow up on her neuropathic symptoms felt to be small fiber
neuropathy, which could not be ruled out. AR788. Small fiber
sensory neuropathy could not be excluded with routine
electrodiagnostic studies. AR789. She reported that she felt
her symptoms were manageable, but her foot symptoms increased
significantly with prolonged standing. AR788. Ms. Manco also
said she had fairly mild tightness, numbness, and tingling of
her hands up to her shoulders intermittently, and her ankles
are always tight with intermittent foot cramps, mild foot to
hip numbness, and tingling that comes and goes, and had
recently fallen when her right leg gave out. AR788. Ms.
Emerson noted that Ms. Manco was pleasant, cooperative, and
in no apparent distress. AR788. Ms. Manco was oriented, had
intact recent and remote memory, good attention span, good
fund of knowledge, and a full range of affect. Ms. Manco had
full motor strength in all extremities. Ms. Manco's heel,
toe, and tandem gait were normal and her sensation was
intact. AR788. Ms. Manco's PHQ-9 score was 3. AR790. She
had no barriers to learning. AR792.
Dakota Counseling Institute Records
Manco was referred for counseling by her primary care
physician and seen on June 10, 2015, by Patricia Fox, Ed.D.,
for depression, anxiety, and PTSD related to a kidnapping and
sexual assault incident. AR611. She complained of symptoms of
flashbacks, depression, anxiety, hypervigilance, exaggerated
startle response, irritability, panic attacks, poor
concentration, low self-esteem, inability to stay focused,
and outbursts of anger. AR611. Ms. Manco reported that she
had lost a job at a nursing home when a resident grabbed her
arm, and she reacted by pushing him away. AR611. Ms.
Manco's attention deficit hyperactivity disorder
(“ADHD”) assessment revealed 12 out of 18
positive answers for ADHD, her Beck Anxiety Inventory showed
moderate anxiety, and her Beck Depression Inventory indicated
severe depression. AR611. Ms. Manco was taking Vyvanse and
Manco reported she had problems learning in school and
attended special education classes through high school.
AR612. She had been diagnosed with dyslexia when she was
eight years old. AR612. Ms. Manco reported being married four
times, physically abused by two of her husbands, and sexually
abused by a neighbor when she was eleven years old. AR612.
Ms. Manco was observed to be in moderate distress and
frequently looked to her daughter, who presented with her, to
answer questions. AR613. She spoke rapidly, had good recall,
normal attention and concentration, appeared to have fair to
poor insight and judgment, and her mood was both anxious and
dysphoric. AR613. She was diagnosed with major depressive
recurrent moderate, generalized anxiety disorder, sexual
abuse of an adult, PTSD, partner relationship problems, and
Cluster B traits with a Global Assessment of Functioning
assessed at 50; she was scheduled for weekly counseling.
Manco was seen on June 24, 2015, to complete her intake that
required more than one appointment due to Ms. Manco answering
most of the intake questions with a story. AR614-15. Her
thoughts were clear and coherent. Ms. Manco had no difficulty
answering questions. AR615. Her intake was completed on June
24, 2015, where Dr. Fox noted she had clear and coherent
thoughts. AR615. In addition, she was scheduled for
counseling in a week; however, the next day Ms. Manco sought
an emergency session and was seen. AR615-16. She presented
with scattered thoughts, restricted affect, and an anxious
and dysphoric mood. AR616. Ms. Manco had a disagreement with
a woman she rented a room from due to some information the
property owner received from Ms. Manco's soon-to-be
ex-husband. The property owner's husband told Ms. Manco
and the property owner that if they could not work things
out, Ms. Manco would have to move. Ms. Manco was concerned
she was going to lose her place to live. AR616. Dr. Fox noted
Ms. Manco was able to ground herself through relaxation
breathing and to develop a plan of action. AR616.
Manco was seen on July 13, 2015, and reported another
altercation with the woman she rented a room from, and this
time it had resulted in a physical altercation with the
sheriff involved. AR726. Ms. Manco reported, “When she
returned Shelly [the property owner] started arguing and then
shoved Carla who shoved her back.” AR726. The sheriff
“went looking” for the property owner, but the
property owner was not charged with anything. AR726. She
began looking for a different place to live and stayed with
her son but reported she had problems sleeping for fear of
the woman. AR726.
Manco was seen on July 16, 2015, for an intake appointment
into the Care program. AR727. She identified needing help
with keeping a job, not being too trusting, and help dealing
with her past trauma. AR728. Ms. Manco told Dr. Fox that she
had never been diagnosed with a developmental disability.
AR729. She reported very few friends, but talked with her
mother and children frequently. AR730. She asserted a
dyslexia diagnosis when she was eight years old and said she
attended special education classes. AR730. Dr. Fox described
Ms. Manco as oriented; with good eye contact, average
intelligence, and circumstantial but coherent thought
process; poor insight and judgment especially in personal
relationships; rapid, loud, and pressured speech, slightly
restricted affect; anxious and dysphoric mood; and a
moderately to severely distressed appearance. AR730.
Manco was seen for counseling on July 31, 2015, and again
reported another confrontation, this time a verbal argument
with a woman who lived next to her husband. Ms. Manco felt
harassed and called the police. AR732.
Manco was seen for a Care appointment on August 7, 2015, and
her affect was slightly restricted, her mood was anxious, and
she reported losing her job at the convenience store because
the owner told her that “others” were not happy
with her work. AR733. Ms. Manco applied for another job at a
grocery store. AR733. She was given information about DBT
therapy group to help her manage her emotions. AR733.
Manco was seen for a Care appointment on August 13, 2015, and
her mood was anxious and slightly dysphoric. She reported
applying for work, but had failed to pass an assessment test
required by Wal-Mart. AR734.
Manco was seen for a Care appointment on August 20, 2015. Her
mood was euphoric, and she reported she had obtained a
part-time job at a liquor store and was scheduled to start
the next Monday, working 22 to 25 hours a week. AR735. Ms.
Manco also reported that she was reconsidering whether to
proceed with her divorce, at the request of her husband, and
she felt much of the responsibility for the separation due to
her irritability and crankiness. AR735. Ms. Manco reported
that negative attitude had changed after she was put on
August 26, 2015, Ms. Manco reported that she and her husband
had gone out to eat several times. AR736. She reported
keeping herself busy, being able to stay out of conflicts
with others, and getting used to life without
Manco was seen for a Care appointment on September 8, 2015,
and she was cheerful and optimistic about the future and
reported that she had applied to become a police officer in
Mitchell. AR737. The record stated:
The focus of today's session was to process her interval
history. Carla reports that she and her husband Don have
applied to become police officers in Mitchell. She took one
test and received a letter inviting her to take a more
extensive test. She also received a notice from disability
services to have a psychological evaluation later this week.
She talked about her concerns regarding the test and we spent
some time discussing testing strategies. She also expressed
concern about her psychological evaluation but was able to
dissipate her concerns before the end of the session. She
will see Brenda Davenport RN, CNP, for a psychiatric
evaluation on 09/11/15. Carla reports that she is getting
along with other coworkers and with those who live in the
same apartment complex. She sees her husband, Don,
frequently. She states that they are communicating well and
there has been no arguing as there was in the past. Carla was
given a bracelet with the saying “thoughts become
things-choose the good ones.” This is to help her stay
out of negativity.
Manco was seen by Brenda Davenport, RN, CNP, for a
psychiatric evaluation on September 11, 2015, and reported
she had been working with Dr. Fox for a few months to address
mood and anxiety symptoms, but provided a very long and
confusing history going into a significant discussion of her
history of abuse. AR738. Ms. Manco reported she continues to
have nightmares and that her abuser “John” is
getting out of prison and “he always finds me.”
AR738. Ms. Manco said she enjoyed activities like spending
time with her children and fishing with her husband. She had
feelings of hopelessness in the past but “not much
now.” AR738. Ms. Manco reported improved self-esteem
and her energy level was better with the use of Vyvanse, and
she said the Vyvanse helps to reduce her mind racing
symptoms. AR738. Ms. Manco endorsed some level of psychomotor
agitation and vague and passive history of suicidal thinking
with no plan or intent. AR738. Her Beck Depression Inventory
endorsed severe symptomatology, her Mood Disorder
Questionnaire indicated a moderate problem, a bipolar
diagnostic scale showed the upper end of low probability, and
she had 4 of 10 affirmative criteria for borderline
personality disorder. AR739. Ms. Davenport said Ms. Manco did
not demonstrate manic symptomatology but seemed influenced by
an overly dramatic or emotional family. AR739. The mental
status exam revealed no prominent deficits, but her
differential diagnoses included major depressive disorder,
recurrent, moderate with anxious distress; generalized
anxiety disorder per history; probable lower level of
intellectual functioning; and she was found to meet the
criteria for SMI services. AR742-43. Ms. Davenport observed
that Ms. Manco had good eye contact, appropriate grooming,
and friendly mannerisms. AR742. Ms. Manco was attentive, had
a normal gait, clear speech, and a fairly euthymic mood.
AR742. She had logical thought process, average intellect,
and appropriate judgment and insight. AR742.
saw Ms. Manco for a Care appointment on September 22, 2015,
and her mood was slightly anxious but overall optimistic.
AR744. She reported going to the emergency room because of
boils on her abdomen, but was upset that the ER doctor did
not think they needed treatment. AR744. Ms. Manco thought
they could extend to her brain, so she was going to see her
primary care doctor. AR744. Dr. Fox described her thoughts as
clear and coherent and noted she was “doing very well
both in her relationships and at work.” AR744.
Manco was seen for a Care appointment on November 9, 2015,
and her affect was restricted and her mood was very anxious.
AR745. She had seen her primary care doctor who did not think
she had MRSA. AR745. Ms. Manco reported numerous worries and
obsessing over the one-night affair her husband had while
they were separated. AR745.
saw Ms. Manco for a Care appointment on March 4, 2016, and
her thoughts were scattered, speech rapid, and mood anxious.
AR748. Dr. Fox noted that she was able to calm down by the
end of the session. Ms. Manco had not seen Dr. Fox since
November, 2015, and Ms. Manco did not offer a reason why she
had not done so. AR748. She reported the anniversary of her
kidnapping and rape was coming up and she was having
nightmares and flashbacks. AR748. Ms. Manco reported being
under a lot of stress at work because they were remodeling,
and she could not find things. AR748. She reported that the
woman her husband had an affair with while they were
separated continued to harass them, and they filed a
complaint with the police. AR748.
Manco saw Ms. Davenport for a psychiatric appointment on
March 29, 2016, and her Paxil dosage was increased, however,
Ms. Manco never took the increased dosage due to other
medical problems. AR750-51. Ms. Manco had also missed
appointments in November and December. AR749. Ms. Manco
reported having a lot more anxiety and nightmares. AR749. Ms.
Manco reported having a lot more flashback symptoms in the
day and being able to reduce her symptoms “very
quickly” with a tapping series or technique. AR749. Ms.
Manco reported having a lot of pain in her feet and some pain
in her hands as well. AR749. Ms. Manco reported working two
jobs: one at a grocery store for 22-25 hours every two weeks
and one in securities where she was paid “under the
table” three days a week. AR749. Ms. Davenport
described Ms. Manco as alert and oriented, with clear speech,
logical and goal-oriented thought processes, and appropriate
insight and judgment. AR750. Her energy level was fair to
2016, Ms. Manco told Ms. Davenport that she rarely went to
Florida, which she found stressful. She still engaged in her
usual fun activities, went fishing with her husband, and had
been bonding with her daughter. AR751. Ms. Davenport
described Ms. Manco as pleasant, with fairly logical,
goal-oriented thought processes and appropriate insight and
judgment. AR751. Her energy level was “awesome.”
Manco was seen for a Care appointment on May 20, 2016, and
her affect was slightly restricted and her mood dysphoric.
AR753. Ms. Manco reported visiting her sister in Florida for
her nephew's graduation, but staying with her sister did
not go well. She regretted going. AR753.
Manco saw Dr. Fox for a Care appointment on June 6, 2016, and
her affect was restricted and her mood anxious and dysphoric.
AR754. She reported losing her job due to an altercation with
a coworker, but blamed her coworker who said she was very
angry with her and shouted at her in front of customers, so
she walked off the job. Despite calling her boss to explain
why she was upset, he fired Ms. Manco the next day. AR754.
Ms. Manco reported that she had lost other jobs in the past
because of similar problems. AR754.
Manco was seen for a Care appointment on June 20, 2016, and
her mood was slightly anxious, but also optimistic about the
future. AR755. She had found a job as a taxi driver. AR755.
Manco saw Kari Rickel, CSW-PIP, for a Care intake appointment
on August 1, 2016, and reported working at the American
Legion as a bartender and waitress. AR757. She was observed
to speak fast with elaborate answers and had some difficulty
with focus and concentration, and it took her a half hour to
fill out the questionnaire. AR759. Ms. Rickel also noted she
appeared to be a good historian. AR759. Ms. Manco was found
to continue to qualify for SMI services with a severe mental
disability, markedly limited job skills and poor work
history, and inability to procure appropriate support
services without assistance. AR759.
Manco was seen for a Care appointment on August 3, 2016, and
her thoughts were scattered and she was quite agitated with
restricted affect and extremely anxious mood. AR761. She did
not have money to pay for her medications because she lost
her insurance because she had not paid her premiums, and she
requested samples. AR761. She complained of not being able to
concentrate and was not going to be able to do her job
because of that. AR761. She was quite agitated and had called
her doctor at home, but the doctor's wife would not let
her speak to him. AR761.
saw Ms. Manco for a Care appointment on August 8, 2016, and
her thoughts were somewhat scattered, speech rapid, affect
restricted and mood anxious and agitated. AR762. She received
assistance applying for the Medical Assistance for Workers
with Disabilities program. AR762.
Manco saw Ms. Davenport for a psychiatric appointment on
August 10, 2016, and reported being out of Vyvanse for three
days. AR763. She reported it had been causing her to be
argumentative and agitated, and her husband had told her she
was psychotic and had issues. AR763. She was working
part-time at the American Legion. She reported losing her job
at Coborn's because a co-worker got in her face and made
her angry. AR763. Her manager witnessed the altercation and
also got in her face. AR763. Ms. Davenport stated that Ms.
Manco had fairly logical and goal oriented thought processes
and fairly appropriate judgment and insight. Her energy level
was fair to good and her gait was within normal limits.
AR764. Ms. Davenport's plan for Ms. Manco included
helping Ms. Manco understand her medical concerns “as
she is lower functioning than she appears and is really
struggling to understand her own medical needs at this
Manco was seen for a Care appointment on August 24, 2016, and
reported being scolded by her boss for failing to serve
drinks to her customers. She was angry about the criticism.
AR765. Ms. Manco was able to process her thoughts with a
guided imagery exercise. AR765.
Manco saw Ms. Davenport for a psychiatric appointment on
September 22, 2016, and reported she had been able to obtain
Vyvanse through an assistance program. She stated her mood
and focus were much better, but she continued to be somewhat
lower functioning. AR766. Ms. Davenport reported Ms. Manco
had logical and goal oriented thought processes and fairly
appropriate judgment and insight. AR767.
saw Ms. Manco for a Care appointment on October 13, 2016, and
her affect was slightly restricted. Her mood was anxious and
dysphoric. AR769. She reported her manager fired her from her
job at the American Legion. AR769. Her manager had many
complaints about her, but she felt he treated her poorly.
AR769. Ms. Manco acknowledged that she had lost a number of
jobs in the past year and a half, and she blamed her managers
rather than looking at her own behavior. AR769. Ms. Manco
reported she continued to help her husband deliver newspapers
and had a security job where she took money to the ...