United States District Court, D. New Hampshire
MEMORANDUM AND ORDER
PAUL BARBADORO, District Judge.
Sarah Lane Brown seeks judicial review of a ruling by the Social Security Administration denying her application for disability insurance benefits ("DIB") and supplemental security income ("SSI"). For the reasons set forth below, I deny Brown's request and affirm the decision of the Commissioner.
Brown applied for DIB and SSI on July 18, 2011. At the time, she was 23 years old and working part-time at The Gap clothing store. Brown alleges a disability onset date of June 12, 2011. On that date, she went to the Portsmouth Regional Hospital Emergency Department because she was experiencing a manic episode. She was diagnosed with bipolar I affective disorder and released from the hospital after seven days. Brown primarily contends that her disability stems from this condition as well as depression and borderline personality disorder.
A. Medical Evidence
1. Barrington Family Practice
On May 25, 2011, Brown went to her primary care provider at Barrington Family Practice, complaining of depression and requesting medication. She reported that she was diagnosed with dysthymia in high school, which worsened in college and has since been intermittent. She was prescribed Celexa.
2. Portsmouth Regional Hospital
On June 12, 2011, Brown went to the Portsmouth Regional Hospital Emergency Department because she was experiencing an episode of mania. It was her first episode of mania and her first psychiatric hospitalization. Her mother and stepfather brought her to the emergency room because she was talking incessantly, unable to sleep, feeling disoriented, and hypersexual. Brown's physician diagnosed her with bipolar I affective disorder and noted that her mania was caused by Celexa. She was prescribed Zyprexa,  Depakote,  and lorazepam.
On June 19, 2011, Brown was discharged from the hospital. Upon discharge, her speech was normal and coherent. Her thought process was logical, she had stopped talking about sex, and her behavior was appropriate. Her affect was appropriate although unusually variable. The physician at the hospital observed that Brown "may still be hypomanic, but overall she was feeling much better and she was discharged in stable condition." Tr. at 360.
2. Nurse Suellen Drake
The record includes notes from five meetings Brown had with Nurse Suellen Drake during the summer and fall of 2011. In June and July 2011, Brown reported to Nurse Drake that her appetite, sleep, and energy had been good. In August, Brown reported that she had "been feeling less depressed" but had some increase in anxiety. In September, Brown said she had "been feeling much better, " had no side effects from medication, and her appetite, sleep, and energy were good. Finally, in November, Brown reported that she had "not been feeling good, " was "feeling depressed again, " and was "working shifts and has questions about that."
3. Psychologist Patricia Salt
On September 8, 2011, Patricia Salt, Ph.D., a non-examining state agency psychologist, reviewed the available evidence of record and completed a mental residual functional capacity ("RFC") assessment. She opined that Brown appeared to meet Listing 12.04 for affective disorders of the Listing of Impairments, 20 C.F.R. pt. 404, subpt. P, app. 1. She noted that Brown's impairment was severe at the time, but that she was new to treatment. Based on Brown's "early pretty good response to medications, " Dr. Salt did not expect Brown's condition to remain severe for twelve months. Tr. at 82-83.
4. Psychiatrist Paul Maguire and Therapist Susan Huebel
On July 19, 2011, therapist Susan Huebel of Community Partners completed an intake assessment of Brown. Ms. Huebel recorded Brown's reported depressive symptoms, including low energy and motivation, insomnia to hypersomnia, lack of focus and concentration, anhedonia,  withdrawal and isolation, suicidal ideation and thoughts of self-harmful behaviors, self-denigrating thoughts, low self-esteem, and anxiety. Ms. Huebel also observed that Brown was freshly showered, well-kept, cooperative, and talkative with "repetitive statements in a circumstantial fashion at times." She noted, however, that Brown's speech was productive and logical, and she was able to sit during the intake assessment and focus on the questions. Ms. Huebel diagnosed Brown as having bipolar disorder and made a provisional diagnosis of borderline personality disorder.
On August 9, 2011, psychiatrist Paul Maguire, M.D., also of Community Partners, evaluated Brown. During the evaluation, Brown reported no difficulty academically, but "subjectively report[ed] poor focus and difficulty with reading." Tr. at 376. She said "she had an outgoing personality and enjoyed being in the theater, " and reported a legal charge for petty theft, which may have occurred "in the setting of hypomania prior to starting Celexa." Tr. at 376. Brown said that her depressed episodes tend to involve seasonal hypersomnolence in the winter, low self-esteem, lack of energy, weight gain, and thoughts of death, but not suicidal behavior.
Dr. Maguire's treatment notes from August 9, 2011 indicate that Brown was stable and not evidencing symptoms of mania. He also observed that she was appropriately dressed and groomed, was calm, and made good eye contact. Her speech had a normal rate, volume, and tone. Her thoughts were goal-directed, sequential, and on-topic. She said that her mood was "[a] little depressed, a little anxious." Tr. at 377. Her affect was controlled. She had good judgment related to her illness, self-care, and personal functioning. Her attention and concentration were adequate for the interview. He diagnosed her with bipolar mood disorder type I, "most recent episode severe, manic, with psychotic features, currently euthymic, " and "[f]eatures of borderline personality disorder by history." Tr. at 377.
On August 29, 2011, Dr. Maguire completed a mental impairment questionnaire based on his August 9, 2011 examination. He observed that she was seated, calm, and cooperative; her speech had a normal rate, volume, and tone; her mood was a "little depressed, a little anxious"; her affect was controlled without lability; her content of thought had no abnormalities; and her sensory functions were "grossly intact." Tr. at 386. Dr. Maguire opined that Brown had marked limitations in her task performance, stating that she had "poor ability to attend and concentrate." Tr. at 387. He also opined that she had moderate limitations regarding her reaction to stress, stating that she was easily overwhelmed and over-reactive. He noted, however, that she was new to treatment. Dr. Maguire also opined that Brown would be able to manage her own benefits. Dr. Maguire again listed his diagnostic impressions as bipolar mood disorder type I, "most recent episode manic, severe with psychotic features" and "[d]epressed, features of Borderline Personality by history." Tr. at 387.
On December 29, 2011, Brown began seeing Susan Huebel for individual therapy approximately once a week. Over the course of the first month of therapy, Brown reported that she had been terminated from work for shoplifting and that she was struggling to appeal a denial of Social Security benefits. She was struggling from anxiety and relied on her mother for help with keeping her Social Security paperwork organized. On one occasion, she discussed looking for work and engaging in healthy activities. She also reported disagreement with her roommate.
On January 31, 2012, Dr. Maguire completed an RFC assessment of Brown. He opined that Brown was moderately limited in understanding and memory activities, including the ability to understand and remember simple or detailed instructions. He opined that she was markedly limited in most sustained concentration activities, such as maintaining a routine without special supervision and completing a workweek without psychological symptom disruption. Similarly, he opined that she was markedly limited in most social interaction activities. Finally, for adaptation activities, he opined that her ability was mixed between moderate and marked limitation.
From February through June 2011, Brown met regularly with Ms. Huebel and occasionally with Dr. Maguire. Throughout February, she reported depressive symptoms including low motivation and energy. By April, however, Brown stated that she had "been doing very well" and "did not have distressing symptoms related to her illness." Tr. at 581. Over the spring and summer, Brown continued to report a generally stable mood, but she also occasionally expressed anxiety and low motivation.
On June 28, 2012, Brown reported to Ms. Huebel that she had recently been sexually assaulted. She described having tension in her chest, feeling numb, and occasionally dissociating. Brown also reported increased anxiety and extreme fatigue. Ms. Huebel worked with Brown on various relaxation skills and Brown stated that she was comfortable with her current support system.
On July 6, 2012, Brown reported to Ms. Huebel that she had been "keeping busy with going out with her boyfriend to various places" and had been exercising. Tr. at 592. She had some mild illness-related symptoms such as interrupted sleep, some racing thoughts, nightmares on occasion, anxiety, negative thoughts, increased late night binge eating, and some irritability. She was not interested in discussing the events of the sexual assault.
Three days later, on July 9, 2012, Brown's mother called Ms. Huebel to express concerns about Brown's behavior. She stated that Brown had not been functioning as well as she could and had not been attending to her activities of daily living as well as she had in the recent past. She told Ms. Huebel she noticed a decline in Brown's functioning since her "reported rape a few weeks ago" including "not answering her phone, not cleaning up after herself, isolating and withdrawing, and... exercising possible poor judgment."
On July 11, 2012, Brown saw Dr. Maguire. Dr. Maguire noted that Brown was exercising regularly, including going to the gym and walking every day, and she was interested in obtaining a volunteer position. He observed that she was seated, calm, cooperative, polite, and made good eye contact. Her speech was spontaneous, with normal rate, volume, and tone. Describing her mood, she said, "I feel really good." Tr. at 633.
On July 12, 2012, Brown saw Ms. Huebel and reported feeling numb and struggling with her mood since her assault. Ms. Huebel noted that her affect was blunt and she appeared to be depressed. A week later, Brown again met with Ms. Huebel and stated she was experiencing depressive symptoms with a lack of desire or energy to engage in pleasant events. She reported that having a schedule and staying active helped and she noted that she was having her boyfriend and his friends over in the afternoon.
On July 26, 2012, Brown saw Ms. Huebel and discussed her plans to go hiking and camping with her boyfriend. She declined to engage in trauma-related work, saying that she was "fine with this for now." Tr. at 640. She said she had been "sliding back a little bit" with her illness and lost some of her motivation to exercise, but she was looking forward to having a pleasant time with her boyfriend. Ms. Huebel indicated that Brown had made some progress, noting that she "appears to be coming to terms with her illness." Tr. at 640.
On August 2, 2012, Brown saw Ms. Huebel and reported that she was "doing well" and had an audition for a theater troupe. She reported feeling "kind of down today" but said she had been enjoying her time with her boyfriend. She was keeping a vegan diet and blogging about her progress for motivation. Ms. Huebel also informed ...