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Springer v. Saul

United States District Court, D. South Dakota, Southern Division

October 1, 2019

RICHARD LEE SPRINGER, Plaintiff,
v.
ANDREW SAUL, Commissioner of the Social Security Administration, Defendant.

          MEMORANDUM OPINION AND ORDER

          VERONICA L. DUFFY, UNITED STATES MAGISTRATE JUDGE.

         INTRODUCTION

         Plaintiff, Richard Lee Springer, seeks judicial review of the Commissioner's final decision denying his application for social security disability benefits under Title II of the Social Security Act.[1]

         Mr. Springer has filed a complaint and has requested the court to reverse the Commissioner's final decision denying him disability benefits and to remand the matter to the Social Security Administration for further proceedings.

         This 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. § 636(c).

         FACTS[2]

         A. Statement of the Case

         This action arises from plaintiff Richard Lee Springer's application for Title II disability benefits filed on March 30, 2016, alleging disability since October 5, 2015, due to social anxiety, depression, stress, sleep apnea, dizzy spells, high blood pressure, lack of focus, short and long term memory loss, obesity, and cerebral palsy, including lack of hand-eye coordination, lack of muscle strength and dexterity, slowness and restriction in movement, all more affected on the right side. AR181-190, 221, 257, 261, 285 (citations to the appeal record will be cited by “AR” followed by the page or pages).

         Mr. Springer's claim was denied initially and upon reconsideration. AR143, 149. Mr. Springer then requested an administrative hearing. AR156.

         Mr. Springer's administrative law judge (ALJ) hearing was held on March 15, 2018, by ALJ Jeffrey N. Holappa. AR76-112. Mr. Springer was represented by a non-attorney representative at the hearing, and an unfavorable decision was issued on May 4, 2018. AR8-27, 79.

         At Step One of the evaluation, the ALJ found that Mr. Springer was insured for benefits through September 30, 2020, and that he had not engaged in substantial gainful activity (“SGA”) since October 5, 2015, the alleged onset of disability date. AR13.

         At Step Two, the ALJ found that Mr. Springer had severe impairments of cerebral palsy with right spastic hemiparesis, [3] generalized anxiety disorder, major depressive disorder, personality disorder, panic disorder, and social anxiety disorder, finding that each of those medically determinable impairments significantly limited Mr. Springer's ability to perform basic work activities as required by Social Security Ruling (SSR85-28). AR13.

         The ALJ found that Mr. Springer also had a medically determinable impairment of urinary frequency, but found that it was not severe because the treatment note reflected that Mr. Springer reported, “good bowel and bladder control, ” as of March, 2016, and he has not sought any further evaluation or treatment for this symptom. AR13.

         The ALJ found that Mr. Springer also had medically determinable impairments of sleep apnea, hypersomnia, and a deviated septum. AR14. The ALJ found that Mr. Springer underwent continuous positive airway pressure (CPAP) titration, which determined that proper adaptive servo-ventilation (ASV) therapy would control the majority of Mr. Springer's respiratory events and snoring. AR14. In addition, while Mr. Springer complained of daytime fatigue and sleepiness through March, 2016, these complaints do not reappear in his treatment records from 2017. AR14. Given the brevity of Mr. Springer's complaints of these symptoms to medical providers and the documented efficacy of proposed treatment, the ALJ determined Mr. Springer's sleep apnea, hypersomnia and deviated septum are not severe impairments. AR14.

         The ALJ found that Mr. Springer also had medically determinable impairments of obesity with a BMI ranging from 37.3 to 40.3. AR14. The ALJ found there is no persuasive evidence that Mr. Springer's obesity significantly affects or exacerbates his physical impairment. AR14. The ALJ also found that Mr. Springer had not undergone any special treatment for weight loss and does not make any significant allegations that his weight causes, or contributes to, any degree of functional limitations. AR14. Therefore, the ALJ found Mr. Springer's obesity is non-severe. AR14.

         At Step 3, the ALJ found that Mr. Springer did not have an impairment, or combination of impairments, that met or medically equaled one of the listed impairments in 20 CFR 404, Subpart P, App 1 (hereinafter referred to as the “Listings”). AR14. The ALJ considered the cerebral palsy impairment under Listing 11.07 and found there is no persuasive evidence of disorganization of motor function in two extremities (see 11.00D1) resulting in extreme limitation (see 11.00D2) in the ability to stand up from a seated position, balance while standing or walking, or use the upper extremities. AR14. There is also no persuasive evidence of a marked limitation (see 11.00G2) in understanding, remembering, or applying information; interacting with others; concentrating, persisting, or maintaining pace; or adapting or managing oneself. AR14-15.

         The ALJ also considered the mental impairments under Listings 12.04 and 12.06 and considered whether the “paragraph B” criteria are satisfied. AR15. The ALJ found that Mr. Springer had mild limitations in understanding, remembering or applying information because Mr. Springer had an overall mental status exam score of 27/30, which is in the average range. AR15.

         The ALJ found Mr. Springer had moderate limitations in interacting with others because his mental status exams reveal normal dress, behavior, appearance, and speech. AR15. The ALJ noted that Mr. Springer's mental status exams revealed extreme anxiety at times. AR15. The ALJ found Mr. Springer had moderate limitations with concentration, persistence or maintaining pace because although his mental status exams have occasionally shown depressed mood, anxious affect, and agitated presentation, many mental status exams have revealed normal findings, and Mr. Springer was able to accurately perform serial seven calculations. AR15.

         The ALJ found Mr. Springer had mild limitations in adapting or managing oneself because Mr. Springer has not shown evidence of decompensation, despite having undergone major life changes; while Mr. Springer has developed depression while adapting to such changes, there has not been a significant disruption in his ability to adapt to changes; nor is he regularly observed to be malodorous, unkempt, disheveled or otherwise display indicia of an inability to manage oneself. AR15. Therefore, Mr. Springer did not meet a Listing. AR14-15.

         The ALJ determined that Mr. Springer had the residual functional capacity (“RFC”) to perform:

light work as defined in 20 CFR 404.1567(b) except that the claimant can lift and carry up to 20 pounds occasionally and 10 pounds frequently; can sit for six hours in an eight-hour day; can stand for six hours in an eight-hour day; can walk for six hours in an eight-hour day; can occasionally push and pull with the right upper and lower extremity; can occasionally climb ramps and stairs; can never climb ladders or scaffolds; can occasionally balance, stoop, kneel, crouch and crawl; can frequently reach (both overhead and all other directions) with the right upper extremity; and can frequently handle, finger and feel with the right hand. The claimant cannot tolerate exposure to unprotected heights or moving mechanical parts. The claimant would need hourly bathroom breaks lasting five minutes in duration. Finally, the claimant is capable of only simple, routine tasks, with simple work-related decisions, and occasional interactions with supervisors, co-workers and the general public.

AR16.

         The ALJ noted Mr. Springer testified, in part, as follows:

The claimant testified that he was unable to work due to panic, anxiety, depression, fatigue, sleepiness, and difficulty with right hemiparesis and spasticity. The claimant testified that he has problems with right hand dexterity due to cerebral palsy. This has caused problems for him when he worked at Pizza Hut mixing dough. The claimant has sought out work where such dexterity is not required. The claimant has worked at Esurance, but developed anxiety due to the failing health of his mother. The claimant had worked and been successful after transferring. He was able to work [from] home. The claimant then had an out-of-state manager, and he did not get along with this person. The claimant's manager wanted him to cease working at home. The claimant indicated he could not do this because of his social anxiety and depression. . . . The claimant has not taken sertraline for over a year. He does not have health insurance. . . . He does not do a lot of laundry. He can physically perform the light household tasks in his apartment. The claimant goes shopping at night to avoid crowds. He becomes too anxious to effectively shop there during the day. The claimant feeds his cats. The claimant gets anxiety attacks.

AR16-17.

         The ALJ's subjective symptom finding was that Mr. Springer's medically determinable impairments could reasonably be expected to produce the symptoms he alleged, but his statements concerning the intensity, persistence and limiting effects of his symptoms were not “entirely consistent with the medical evidence and other evidence in the record for the reasons explained in this decision.” AR17.

         The ALJ considered a January, 2016, MRI of the brain that revealed findings consistent with cerebral palsy. AR17. The ALJ found that the MRI findings may account for Mr. Springer's right sided symptoms, but the mere presence of objective abnormalities does not, in and of itself, equate to a specific functional limitation, nor does it necessarily indicate the frequency or severity of symptoms caused by the abnormalities. AR17.

         The ALJ also found that Mr. Springer's exam findings do not support the presence of disabling symptoms, noting:

Exams have revealed a boutonniere-type deformity of the right hand; spasticity, weakness and immobility of the right hand; atrophy of the right upper and lower extremities hemi-paretic gait; right spastic hemiparesis; 4-5/right foot strength; and hyperreflexia in the right lower extremity. Exh. 3F, pp. 3, 24; Exh. 6F, pp. 6, 7; Exh. 7F, p. 6. These findings are consistent with some degree of difficulty lifting and carrying heavy objects, engaging in constant postural activity, or engaging in constant activity with the right upper and lower extremity. However, the claimant's exams have also revealed normal strength; stable gait; normal sensation; and normal range of motion. Exh. 1F, p. 3; Exh. 3F, pp. 10, 20; Exh. 7F, p. 3. These findings demonstrate sufficient strength to lift and carry up to 20 pounds occasionally; occasionally push and pull with the right upper and lower extremity; frequently handle, reach, feel, and reach in all direction with the right arm; and occasionally engage in most postural activity.

AR17-18.

         The ALJ considered Mr. Springer's treatment history and found it inconsistent with the presence of disability impairments. The ALJ found:

While he has sought some treatment for sleep apnea and hypertension, he does not require any treatment to manage his symptoms of cerebral palsy. He does not require any assistive treatment devices. He does not use any braces. Therefore, while the claimant's treatment history is consistent with some degree of limitation, it is not consistent with a disabling degree of limitation.
The claimant has been diagnosed with social anxiety disorder, personality disorder, major depressive disorder, and panic disorder. Exh. 2F. The claimant has been prescribed medications such as Fluoxetine, Wellbutrin, and sertraline. Exh. 6F, p. 3.
This degree of treatment is consistent with some degree of mental limitation. However, the undersigned notes that the claimant has not been psychiatrically hospitalized. Nor has he been seen in the ER for symptoms of a panic or anxiety attack. Although he has been on medications in the past, he reported that he took no medications for depression or anxiety currently. The undersigned also notes that when the claimant presented for a mental health intake in March 2016, he indicated he was hopeful that a psychiatry referral would “assist with his disability claim.” Exh. 3F, p. 5. The claimant was reminded that the purpose of such a referral would be primarily for treatment of his symptoms, that he had reported seeing a psychiatrist in the past, and had reported that he knew that medications would not help. Exh. 3F, p. 5. Despite this, he indicated he wanted another referral to a psychiatrist, whose purpose would only be to diagnose and manage his symptoms though the use of medications. Exh. 3F, p. 5. In addition, the claimant took the MMPI twice, but his results were invalid due to a pattern of atypical and rarely given responses with resulting “grossly over-elevated” clinical scale profiles, and suggesting “possible exaggeration.” Exh. 2F, p. 13. Therefore, while the claimant's treatment history supports some degree of limitation, it is not inconsistent with a disabling degree of limitation.

AR18.

         The ALJ considered Mr. Springer's mental status exam findings of depression and anxiety and found they are not as persistent or limiting as Mr. Springer's allegations might suggest. AR18-19. The ALJ found:

The claimant's mental status exams have revealed depressed and severely anxious mood; flat and labile affect; agitated psychomotor activity; and difficulty expressing himself. Exh. 2F, p. 3.; Exh. 3F, pp. 6, 8, 24, 29; Exh. 6F, p. 7. Formal mental status exam revealed an inability to recall more than three out of five objects on delayed recall, nor an ability to repeat a three-digit sequence in reverse. Exh. 2F, p. 5. These findings are consistent with some degree of limitation in the ability to sustain concentration or interact with others.
However, the claimant's mental status exams have often revealed no abnormalities, and generally reflect appropriate dress, hygiene, and grooming; cooperative demeanor; normal thought processes, content, and associations; appropriate affect and speech. Exh. 1F, p. 1; Exh. 3F, p. 25; Exh 7F, p. 4; Exh. 8F, p. 3. Formal mental status exams finding[s ] have revealed an intact ability to perform serial seven calculations and an overall score of 27/30 on the Montreal Cognitive Assessment (MOCA), which is in the average range. Exh. 2F, p. 5.
These mental status exam findings suggest that the claimant's depression and anxiety are not as persistent or limiting as the claimant's allegations might suggest. The findings of normal speech, behavior, and appearance suggest that the claimant is able to get along appropriately with others on an occasional basis. In terms of his ability to sustain concentration, his depression and anxiety would preclude his ability to perform complex or detailed tasks. However, the relative normalcy of [his] mental status exams, including his overall MOCA score and ability to perform serial seven calculations, demonstrate that he is able to perform simple routine tasks, and make simple work-related decisions.

AR18-19.

         The ALJ considered that Mr. Springer's daily activities were inconsistent with the presence of disabling limitations. AR19. For example, Mr. Springer was able to pay bills, count change, use a checkbook, go shopping alone, drive, and followed spoken instructions fairly well. AR19, 259, 267, 269. The ALJ also noted that Mr. Springer's daily activities were fairly limited. AR19.

         The ALJ considered the opinions of the State agency psychological consultant, Robin Carter-Visscher, Ph.D., who had found there was insufficient evidence in the record to determine if Mr. Springer had a medically determinable severe impairment, and found the opinion was not consistent with the current record and gave it little weight. AR20.

         The ALJ considered the opinions of the State agency psychological consultant, Alison Musso, Ph.D., and gave her opinion partial weight because the opinion used imprecise and vocationally useless terminology in assessing Mr. Springer's ability to perform the mental aspects of work. AR21. The ALJ referred to Dr. Musso's opinion that Mr. Springer could perform “low stress, low social work.” AR21.

         The ALJ considered the opinions of Thomas Price, Ph.D., and stated he gave his opinion little weight. AR20. The ALJ gave Dr. Price's opinion little weight because the opinion was rendered after a single examination of Mr. Springer, the opinion only addressed Mr. Springer's ability to perform one of his past jobs, the opinion did not suggest he would be unable to perform other types of work and the opinion that a claimant cannot work is an issue reserved for the Commissioner. AR20.

         The ALJ considered the opinions of the State agency medical consultants, and gave them partial weight because the ALJ found that Mr. Springer's ongoing exam abnormalities regarding his right upper extremity supported a greater degree of limitation on the use of that arm than envisioned by the medical consultants. AR21.

         The ALJ considered the opinion of treating physician Jeffrey Meyer, M.D., who the ALJ indicated had opined that Mr. Springer should work at home, and gave the opinion little weight. AR19. The ALJ found that Dr. Meyer's opinion was inconsistent with Mr. Springer's mental status exam findings and treatment history, Mr. Springer's current job at the time of the opinion rendered significant interaction with the public, and the opinion did not address whether Mr. Springer could perform other types of work. AR19.

         The ALJ considered the opinion of treating physician Jonathan Bannwarth, M.D., who the ALJ indicated had completed housing disability paperwork indicating Mr. Springer was unable to work. AR20. The ALJ gave Dr. Bannwarth's opinion little weight because the opinion was not explained in any detail, did not include function-by-function limitations, was not consistent with mental status exams, treatment history, or activities of daily living, and the issue of disability is reserved to the Commissioner. AR20.

         The ALJ considered the opinion of treating physician Bradley Kamstra, M.D., who the ALJ indicated completed a disability parking permit indicating Mr. Springer was disabled and would be unable to work until further notice. AR21. The ALJ gave Dr. Kamstra's opinions little weight because they were not explained in any detail, did not include function-by-function limitations, was not consistent with mental status exams, treatment history, or activities of daily living, and the issue of disability is reserved to the Commissioner. AR21.

         Based on the RFC determined by the ALJ, the ALJ found that Mr. Springer was not capable of performing his past relevant work. AR21-22.

         At Step 5, the ALJ found Mr. Springer capable of adjusting to other work that existed in significant numbers such as a copy machine operator, DOT# 207.685-014; mail clerk, DOT# 209.687-026; and clerical checker, DOT# 222.687-010, relying on testimony from the vocational expert regarding the number of jobs available for each occupation nationally and denied the claim. AR22-23.

         Mr. Springer timely requested review by the Appeals Council and submitted additional evidence related to his cerebral palsy, an article or excerpts from a website, as well as a personal statement. AR33-75, 310-313. The Appeals Council denied Mr. Springer's request for review, making the ALJ's decision the final decision of the Commissioner. AR1-7. When denying Mr. Springer's request for review, the Appeals Council considered the personal statement Mr. Springer submitted. AR1-7.

         B. Plaintiff's Age, Education and Work Experience

         Mr. Springer was born in April of 1975 and completed the 12th grade in 1993. AR222.

         The ALJ found that Mr. Springer had past relevant work as a telephone customer clerk and a statistical report clerk. AR21.

         C. Relevant Medical Evidence (chronological sequence)

         Mr. Springer saw Dr. Meyer at Sanford Family Medicine on October 5, 2015, to follow up on depressive symptoms including depressed mood, anhedonia, anxiety, diminished interest in activities, diminished concentration, fatigue, feelings of worthlessness, feelings of inappropriate guilt, hopelessness, and insomnia. AR382. Mr. Springer had been seen approximately one year earlier with symptoms gradually getting worse. AR382. Mr. Springer reported that he liked his work, but would like to work from home, as he was having trouble keeping up and was worried he might lose his job or be forced into the office to work. AR382. He reported that the social anxiety at the office was more than he could stand. AR382. Mr. Springer was alert, oriented to time, person and place, and his thought content, speech, affect, mood and dress were normal. AR382. Zoloft and Ambien were prescribed, counseling recommended, and he was put off work for three weeks. AR382.

         Mr. Springer saw Dr. Meyer at Sanford Family Medicine on November 16, 2015, to follow up on his anxiety, depression, and insomnia and reported he continued to struggle with anxiety and was not sleeping well. AR376. He reported he would like to continue to work from home because he felt the office environment was too stressful. AR376. Dr. Meyer noted Mr. Springer's anxiety was improving. AR376. Dr. Meyer stated he was willing to recommend that he work from home. AR377.

         On November 18, 2015, Mr. Springer contacted Dr. Meyer's office complaining of sweats, which he felt were due to his medications, but Dr. Meyer stated he had discussed this with Mr. Springer before and felt that the sweats were due to his anxiety, not his medications. AR376.

         Mr. Springer saw Dr. Meyer at Sanford Family Medicine on November 25, 2015, for his anxiety and Mr. Springer reported he was really struggling. AR375. He was having chest pain, sweats, and sleeping problems. AR375. Mr. Springer felt he would be able to return to work on December 8 if things worked out. AR375. Mr. Springer also reported some neuropathy in his right fourth and fifth fingers, which Dr. Meyer noted was the extremity that Mr. Springer had his disability from cerebral palsy, and Mr. Springer was wondering about getting botox shots for spasticity. AR375.

         Examination revealed that Mr. Springer was “extremely anxious as usual, ” and it was difficult to hold a conversation with him because of his interruptions. AR375. Examination of his right arm revealed chronic spasticity from cerebral palsy and some numbness in the ulnar nerve distribution. AR375. Seroquel was added to his medications to help with mood and sleep. AR375. Mr. Springer had been seeing a counselor, and Dr. Meyer recommended continued counseling. AR375. Dr. Meyer stated he would be happy to fill out paperwork to put him back to work on December 8 if possible. AR375.

         Mr. Springer was seen on December 1, 2015, at Midwest Ear, Nose and Throat for evaluation of possible sleep apnea. AR318. Mr. Springer reported excessive daytime sleepiness with decreased concentration and frequent memory problems. AR318. Objective findings show Mr. Springer was in no apparent acute or chronic distress; had normal ability to communicate; had normal and appropriate mood and affect; and had normal gait. AR319-20. Following examination, the assessments were deviated nasal septum, hypertrophy of nasal turbines, and hypersomnia, and a polysomnogram was recommended. AR320.

         Mr. Springer saw Dr. Meyer at Sanford Family Medicine on December 10, 2015, for anxiety and insomnia and continued to report being exhausted during the day and sleeping poorly at night. AR374. He continued to be unable to work. AR374. Dr. Meyer noted that it was very unusual for someone to miss work due to sleep apnea, but noted Mr. Springer was an extremely anxious individual, and Dr. Meyer felt he would have great difficulty working and excused him from working until the end of the year. AR374.

         Mr. Springer underwent a sleep study on December 22, 2015, at the Sleep Center of the Midwest which revealed moderate obstructive sleep apnea, and severe treatment emergent central apnea, which was resistant to CPAP and BIPAP therapy. AR321. A titration study with ASV therapy was presented as an option. AR321.

         Mr. Springer saw Dr. Meyer on January 4, 2016, to discuss his sleep study. AR366. Dr. Meyer noted he would start an echocardiogram, urine drug test, and an MRI of the brain for workup of Mr. Springer's central apnea. AR367. In an addendum dated January 15, 2016, Dr. Meyer noted Mr. Springer's MRI showed his cerebral palsy but nothing acute; his echocardiogram had normal ejection fraction; and his urine drug screen was negative. AR367. Dr. Meyer noted Mr. Springer was anticipated to return to work by February 1. AR367.

         Mr. Springer had the follow-up full night, titration sleep study on January 18, 2016, at the Sleep Center. AR327. ASV pressures were gradually increased, and the majority of respiratory events and snoring were controlled. AR327. The impression was complex sleep apnea with past CPAP failure, snoring controlled with positive pressure therapy, and follow-up was recommended for ASV therapy. AR327.

         Mr. Springer saw Dr. Meyer at Sanford Family Medicine on January 29, 2016, for anxiety and sleep issues. AR363. Dr. Meyer noted that based on sleep studies, a brain MRI and an echocardiogram, he had been diagnosed with central sleep apnea and determined to be a candidate for an ASV, a specialized CPAP for his type of sleep apnea. AR363. Mr. Springer was waiting for insurance approval to obtain the machine and remained exhausted, and his chronic anxiety had been much worse due to this problem. AR363. Dr. Meyer continued to keep him off work while waiting for the ASV machine. AR363.

         On February 3, 2016, Mr. Springer contacted Dr. Meyer's office stating his short-term disability company was not finding any abnormal findings on his recent exams to explain why he was still not working. AR363. Dr. Meyer stated there would never be abnormal physical exam findings for his condition, but they could get a psych assessment for his anxiety. AR363.

         Mr. Springer saw Dr. Meyer on February 24, 2016, on follow-up for his anxiety, depression and sleep apnea. AR359. Dr. Meyer noted Mr. Springer started CPAP and hoped it worked and helped his sleep and anxiety. AR359. Dr. Meyer had also doubled Mr. Springer's medication dose for his mood and for his hypertension since his last visit. AR359.

         Mr. Springer was seen on March 4, 2016, at Sanford Family Medicine by Nicole Vlegersdyk, LPC-MH, for an initial assessment of his mental health symptoms. AR355-56. Ms. Vlegersdyk noted Mr. Springer was seeking short-term disability and was hopeful that the psychiatry referral would assist with his disability. AR356. Ms. Vlegersdyk explained to Mr. Springer that a psychiatry referral was to help with symptoms presented/diagnosis and that short-term disability was secondary. AR356. Ms. Vlegersdyk noted Mr. Springer saw a psychiatrist one time at Falls Community Health and went to two therapy sessions in November, 2015, and he reported, “they just wouldn't throw medication at the problem and I know that wouldn't help.” AR356. Ms. Vlegersdyk documented that Mr. Springer still wanted to go through with the referral for a psychiatric evaluation. AR356. Examination revealed Mr. Springer was agitated, anxious, had excessive worry, and he reported panic attacks and memory problems. AR357. He was given a psychiatric referral. AR358.

         On March 15, 2016, Mr. Springer contacted his primary care clinic regarding a psychiatric exam, scheduled with Dr. Price, that Mr. Springer's disability company had requested. AR355. Dr. Meyer referred Mr. Springer to Thomas Price, Ph.D., for additional information on Mr. Springer's short-term disability through his employer, related to Mr. Springer's anxiety, depression, and insomnia. AR335.

         On March 23, 2016, Dr. Price conducted a psychological evaluation at Dr. Meyer's referral. AR335. Dr. Price's psychological evaluation consisted of records review, behavioral observations, sleep-related screening, functional impairment ratings, Barkley Deficits in Executive Functioning Scale, mental status exam, Montreal Cognitive Assessment, vocational history review, Occupational Stress Inventory and personality testing (administered twice). AR335-350. Dr. Price noted that Mr. Springer reported he has cerebral palsy on his right side, but his left side is normal, and his cerebral palsy has not affected his cognitive functioning. AR343. Mr. Springer denied going to the emergency department for mental health problems and reported never receiving inpatient or residential mental health care, other than very limited counseling at the Sanford Clinic. AR344.

         Dr. Price observed that Mr. Springer was alert throughout the evaluation, but did appear a bit sleepy at several points. AR336. Examination revealed very flat affect, depressed mood, emotionally labile, easily agitated and tense at times. AR336. Mr. Springer became more easily distracted as the evaluation proceeded. AR336. Mr. Springer was given the Montreal Cognitive Assessment (MOCA) which indicated he had mild attention and memory-related difficulties. AR342. Mr. Springer was given the Occupational Stress Inventory, which revealed significant problems in the workplace. AR346. Mr. Springer was twice given the Minnesota Multiphasic Personality Inventory - Revised (MMPI-2), which showed excessive number of atypical and rarely given responses to the inventory. AR347. Based on the MMPI-2 results, Dr. Price noted Mr. Springer's clinical scale profile could be grossly over-elevated because of the severity of his psychopathology, an extreme plea for help or deliberate malingering. AR347. Dr. Price concluded that Mr. Springer's overstatements and possible exaggeration were too extreme for further interpretation and his MMPI-2 profile were not considered. AR347.

         Mr. Springer also completed the Million Clinic Multiaxial Inventory - Third Edition (MCMI-III), designed to assess both clinical syndromes as well as personality patterns. AR347. Mr. Springer's MCMI-III response tendency scores indicated that he magnified the level of experienced illness or characterlogical inclination to be self-pitying, and his Clinical Syndromes scale may be somewhat exaggerated, but standard scale modifications were utilized to account for his response style. AR347. The MCMI-III indicated Mr. Springer was experiencing major depression. AR347.

         Following the tests, Dr. Price diagnosed Mr. Springer with major depressive disorder, recurrent, severe, without psychotic features; generalized anxiety disorder; panic disorder with agoraphobia; personality disorder with avoidant and depressive personality traits; and complex sleep apnea. AR349. Dr. Price concluded that Mr. Springer met the definition of disability given by his employer because his mental illness prevented him from performing one or more of the essential duties of his occupation. AR349. Dr. Price noted that Mr. Springer's mental disorder had adversely impacted his ability to function in occupational and social settings, and that he was experiencing lethargy, significant fatigue, daytime sleepiness, impatience, irritability, low tolerance for frustration, poor motivation, problems focusing his attention, difficulties with vigilance, problems processing information, problems remembering, lack of self-discipline, agitation and anxiety towards others, and challenges to remain in social settings or interact with others. AR349.

         Dr. Price also stated Mr. Springer was inclined to perceive others' comments or reactions in a negative way; he predicts that he will not be treated well and has a tendency to react abruptly and in an irrational manner; he is easily annoyed; his mood shifts quickly; and when away from home he becomes tense and panicky. AR350. Dr. Price concluded that Mr. Springer's worry, panicking, low mood, moodiness, and social apprehension prevent him from performing his current job. AR350.

         On March 28, 2016, Mr. Springer went to Eugenio B. Matos, M.D., a neurologist with Sanford Health, regarding his sleep apnea. AR354. Dr. Matos noted Mr. Springer had a history of cerebral palsy with right spastic hemiparesis, which had been stable. AR354. Dr. Matos conducted a physical examination and noted Mr. Springer was in no distress; was alert and oriented; and had normal speech and normal memory. AR354. Mr. Springer's cranial nerves were normal, and he had no facial asymmetry or weakness. AR354. Due to cerebral palsy, Mr. Springer had right spastic hemiparesis, overall 5-5 exempt for right foot dorsiflexion, which is 4-/5, stable as per Mr. Springer, and he had no involuntary movements. AR354. Mr. Springer's sensory was normal bilaterally; his finger-nose-finger was normal; and his gait was right hemiparetic but stable. AR354. Dr. Matos' impression was central sleep apnea with complex sleep apnea seen after treatment of obstructive sleep apnea, spastic cerebral palsy, and arterial hypertension. AR354. Dr. Matos' plan was to obtain report of CPAP and ordered laboratory testing. AR354.

         A brain MRI obtained on January 6, 2016, showed a loss of white matter in the left frontoparietal region with ex vacuo dilatation of the left lateral ventricle, suggestive of chronic changes possibly due to an old ischemic insult in that region. AR354, 393, 408. “The MRI of the brain otherwise appear[ed] unremarkable. An acute process [was] not identified.” AR393. Mr. Springer was complaining of daytime sleepiness and a polysomnogram obtained on December 22, 2015, had found moderate obstructive sleep apnea. AR354. A second polysomnogram on January 18, 2016, showed “complex sleep apnea with failure of CPAP (in the past) with snoring controlled by positive pressure of therapy.” AR354. Mr. Springer was currently using a CPAP or ASV therapy, but was still feeling tired and sleepy during the day despite being compliant with the CPAP treatment. AR354.

         Mr. Springer's significant tiredness and sleepiness was causing him to be off work. AR354. Dr. Matos examined Mr. Springer and noted he was in no distress; was alert, oriented; had normal speech and normal memory; his weight was stable at 233 pounds, with a BMI of 37.63; his cranial nerves II through XII and visual fields were normal; and he had no facial asymmetry or weakness. AR354. A motor exam showed right spastic hemiparesis, overall 5/5 except for right foot dorsiflexion, which is 4-/5, stable as per Mr. Springer due to cerebral palsy. AR354. Mr. Springer had no involuntary movements; had normal sensory bilaterally; and his gait was right hemiparetic but stable. AR354. Dr. Matos' impression was central sleep apnea with complex sleep apnea seen after obstructive sleep apnea and during polysomnogram, and spastic cerebral palsy, and Dr. Matos stated Mr. Springer might need cognitive behavioral therapy for insomnia. AR354-55.

         On June 9, 2017, Mr. Springer was seen by Jonathan Bannwarth, M.D., a physician at Falls Community Health, to establish care since losing his insurance and to request that a work function form be filled out. AR432. Examination revealed atrophy on the right upper and lower extremities secondary to cerebral palsy, with reduced strength on the entire right side compared to the left side, and depressed mood. AR433.

         On June 9, 2017, Dr. Bannwarth completed a “Work Ability Form” for the county's rental assistance program. AR426. In the form, Dr. Bannwarth stated Mr. Springer suffered from panic disorder, anxiety disorder, depressive disorder, complex sleep apnea, and avoidant and dependent personality traits. AR426. Dr. Bannwarth stated Mr. Springer was not able to work because his mental illness adversely impacted his ability to function in a job setting. AR426. Dr. Bannwarth also stated Mr. Springer was unable to attend training programs and/or search for employment. AR426.

         On November 6, 2017, Mr. Springer saw Dr. Kamstra of Falls Community Health, who noted Mr. Springer was applying for disability due to cerebral palsy that was diagnosed when he was two years old. AR431. Dr. Kamstra noted Mr. Springer was there asking for forms to be filled out. AR431. Dr. Kamstra noted Mr. Springer had a history of cerebral palsy, and his biggest deficit is most of his right arm. AR431. Dr. Kamstra stated, “I think the physical disability in addition to his psychological issues certainly have been compounded, and I do not foresee any changes that are going to happen, especially with the cerebral palsy. I think he will start getting more weakness and maybe some spasticity.” AR431. Examination noted that Mr. Springer's arm “is kind of held at his side. He has boutonierre [sic] type deformity of his hand and certainly a weakness and immobility of that area. It is not completely flaccid. He can move it some, but he doesn't have the strength as compared to his left arm.” AR431. Dr. Kamstra also noted Mr. Springer's mental issues will be an ongoing. AR431. Dr. Kamstra wrote a “To whom it may concern” note, stating that Mr. Springer was unable to work until further notice, and authorized Mr. Springer for a companion animal due to his mental health symptoms. AR436-37.

         D. State Agency Assessments

         On July 21, 2016, Gregory Erickson, M.D., State agency physician consultant at the initial level, stated that Mr. Springer had severe cerebral palsy and could occasionally lift 25 pounds and frequently lift 20 pounds, and that Mr. Springer had no manipulative limitations. AR120-21. Dr. Erickson did state that Mr. Springer was limited to occasional pushing or pulling with the right upper and lower extremities due to his history of cerebral palsy with right spastic hemiparesis. AR120. Dr. Erickson also stated that due to cerebral palsy and spastic right hemiparesis, Mr. Springer had postural limitations and was limited to frequent balancing, kneeling, crouching, and crawling; to occasional climbing of ramps, stairs, ladders, ropes and scaffolds; and to avoid even moderate exposure to hazards, such as machinery and heights. AR120-21. Dr. Erickson noted that no ADL's were available for review when he issued his opinion, and that he gave heavy weight to the neurology exam from March 28, 2016, when he completed his opinion of Mr. Springer's physical residual functional capacity (PRFC). AR121. Dr. Erickson also found that Mr. Springer's sleep apnea and high blood pressure were considered non-severe impairments with medical compliance. AR121.

         Gregory Stevens, M.D., State agency physician consultant at the reconsideration level, issued identical PRFC findings on September 27, 2016. AR133, 135-37. Dr. Stevens also stated that Mr. Springer had a history of cerebral palsy “although he is only noted to have a tremor at a couple of exams, otherwise is [sic] remains unnoticed….” AR132.

         The state agency psychological consultant concluded:

Mental - [Mr. Springer] alleges significant social anxiety and depression. He does appear to have some limitations due to his mental allegations, but he is still able to go out alone, maintain romantic relationships, and grocery shop. He appears to have some difficulty taking instructions from supervisors. He is noted in evaluations to exaggerate symptoms, and the possibility of deliberate malingering was even mentioned. [W]hile he complains of increased anxiety in his appeal form, he does not seek mental health treatment. He is independent in his daily activities, and has no periods of inpatient hospitalizations. He is only noted to seek treatment when requesting letters or statements from providers in order to remain on short-term disability, otherwise he states he is uninterested in medications or therapy. He was noted to be capable of performing in his work at home[.] [I]t was when he was told to come into 5 days of training at the office that he stopped working…. [Mr. Springer] appears capable of low social unskilled work.

AR132.

         On July 23, 2016, Robin Carter-Visscher, Ph.D., State agency psychological consultant at the initial level, stated that Mr. Springer had severe medically determinable impairments due to cerebral palsy and anxiety disorder. AR117. Dr. Carter-Visscher also seemed to indicate that she looked at whether the evidence supported the existence of an impairment due to an affective disorder and personality disorder, but indicated there was insufficient evidence in the file to evaluate the “B” and “C” criteria. AR117-19.

         On September 28, 2016, Alison Musso, Ph.D., State agency psychological consultant at the reconsideration level, found that Mr. Springer had mild restrictions in ADLs, moderate difficulties in maintaining social functioning, and moderate difficulties in maintaining concentration, persistence or pace (the “B” criteria), and also found the evidence did not establish the presence of the “C” criteria. AR133. Dr. Musso stated Mr. Springer was capable of “low social, low stress environment” unskilled work AR132, 139.

         E. Testimony at the ALJ Hearing

         1. Mr. Springer's Testimony

         Mr. Springer testified he lived alone in an “income-based” apartment, and received SNAP benefits. AR81-82. Mr. Springer testified that he drives AR82. Mr. Springer testified that he is 5'6” tall and weighs 235 pounds. AR82. Mr. Springer testified that he was lefthanded as long as he could remember because he had cerebral palsy on the right side. AR82.

         Mr. Springer testified that he has some college education, majoring in computer science, but it did not work out because he was working a full-time job. AR82. Mr. Springer testified that he last worked at Esurance in January or February, 2016, but went on short-term disability. AR83-84. Mr. Springer also testified that he tried to go back to work at Esurance a couple of times, but it did not work so he went back on short-term disability. AR83-84. He testified that both the Esurance job and his prior jobs at Wells Fargo and Cigna were incoming calls, customer service desk jobs that did not require much lifting. AR85-86.

         Mr. Springer testified that he tried to get call center jobs with more talking due to his disability from his cerebral palsy. AR86. He explained the first he tried was at Pizza Hut, but he did not have the needed hand dexterity to perform that type of work. AR86. Mr. Springer testified that he had recent additional symptoms from his ...


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