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Therrien v. Berryhill

United States District Court, D. New Hampshire

April 21, 2017

Marie Therrien
Nancy A. Berryhill, Acting Commissioner of Social Security[1] Opinion No. 2017 DNH 079


          Landya McCafferty United States District Judge.

         Marie Therrien seeks judicial review, pursuant to 42 U.S.C. § 405(g), of the decision of the Acting Commissioner of Social Security, denying her application for disability insurance benefits under Title II and supplemental security income under Title XVI of the Social Security Act, 42 U.S.C. § 423 and § 1382. In support, Therrien contends that the Administrative Law Judge (“ALJ”) erred at Step Two of the sequential analysis, failed to properly weigh the medical opinion evidence, and improperly assessed her subjective complaints of pain. The Acting Commissioner moves to affirm.

         Standard of Review

         In reviewing the decision of the Acting Commissioner in a social security case, the court “is limited to determining whether the ALJ deployed the proper legal standards and found facts upon the proper quantum of evidence.” Nguyen v. Chater, 172 F.3d 31, 35 (1st Cir. 1999); accord Seavey v. Barnhart, 276 F.3d 1, 9 (1st Cir. 2001). The court defers to the ALJ's factual findings as long as they are supported by substantial evidence. § 405(g); see also Fischer v. Colvin, 831 F.3d 31, 34 (1st Cir. 2016).

         “Substantial evidence is more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Castillo Condo. Ass'n v. U.S. Dep't of Housing & Urban Dev., 821 F.3d 92, 97 (1st Cir. 2016) (internal quotation marks omitted). The court will uphold the ALJ's findings, even if the record could support another conclusion, as long as “a reasonable mind, reviewing the evidence in the record as a whole, could accept it as adequate to support his conclusion.” Irlinda Ortiz v. Sec'y of Health & Human Servs., 955 F.2d 765, 769 (1st Cir. 1991).


         Marie Therrien filed for social security benefits in May 2013, when she was 33 years old. She has a high school education and previously worked in a fast food restaurant and as a parking lot cashier. She lives with her children, as a single parent.

         Her medical records begin in December 2012 when she was admitted for in-patient mental health treatment because of depression and suicidal thoughts. On admission, Dr. David M. Ledner recorded that Therrien's physical examination was “essentially unremarkable.” Therrien received medication and group therapy. She was discharged a week later with a diagnosis of “major depressive disorder, recurrent, severe.”

         In February 2013, Therrien's carpal tunnel syndrome was treated with a decompression procedure. Therrien had a normal mood and affect during an appointment with Peter Barr, Physician's Assistant, in March 2013.

         Therrien saw her treating physician, Dr. David Kehas, in May 2013, because of right neck and shoulder pain that Therrien said had been intermittent over the past few years. On examination, Dr. Kehas found that Therrien was alert, cooperative, and in no distress. He found her cranial nerves were intact, decreased sensation to touch and temperature in her right arm and fingers, her right arm reflexes were brisk, and her strength was four out of five due to pain.

         A few days later, Dr. Kehas filled out a “Physical Capacities” section of a document titled “Physician/Clinician Statement of Capabilities.” He noted Therrien's diagnoses for cervical radiculopathy, plantar fasciitis, carpal tunnel syndrome, and low back pain. In Dr. Kehas's opinion, Therrien could do work at the sedentary and light physical levels, with some limitations on postural activities and a need to avoid heights and hard floors. He found that she could occasionally do manipulative activities and pushing and pulling. Dr. Kehas also found that Therrien could do work activities for only 20 to 25 hours per week.

         Therrien had her annual examination with Dr. Kehas on May 14, 2013. She reported back pain without help from medication. Dr. Kehas noted that Therrien had a body mass index (“BMI”) of 53.75, which correlates to obesity. On examination, Dr. Kehas found that Therrien was in no acute distress and her gait, sensation, reflexes, cranial nerves, and motor strength were all normal. Dr. Kehas told Therrien to come back in a year.

         The same day, Leslie Clukay, A.P.R.N., completed the “Psychological Capacities” part of the “Physician/Clinician Statement of Capabilities.” Clukay stated that Therrien's psychological condition began in August 2008. Despite her condition, Clukay indicated that Therrien had no deficits and was not limited in her ability to perform a list of activities, including socially acceptable behavior, remembering work procedures, and driving. In some other areas, Clukay responded “unknown.” She wrote that other medical issues had exacerbated Therrien's psychiatric symptoms. Clukay then stated that Therrien was unable to work.

         Therrien had an MRI of her cervical spine, also done in May 2013. Because she moved during the study, the results were limited. The reviewing doctor reported no significant disc desiccation or disc height loss, a disc protrusion, and mild bulging and narrowing at ¶ 6-C7. Therrien had an MRI of her right shoulder in June 2013. The reviewing doctor reported mild to moderate tendinosis and narrowing.

         Dr. Hugh Fairley, a state agency physician, reviewed Therrien's records on July 19, 2013. He found that Therrien had severe impairments due to obesity; a skin disease, hidradenitis suppurativa (“HS”); disorders of muscle, ligament, and fascia; and carpel tunnel syndrome. Despite those impairments, Dr. Fairley found that Therrien could frequently lift up to 10 pounds, could stand or walk for two hours in an eight-hour work day, could sit for six hours, had an unlimited ability to push or pull up to 10 pounds, and could occasionally climb ramps or stairs. She could not do some postural activities but could occasionally do others. Her ability to do manipulative activities was not limited.

         Therrien had a consultative mental health evaluation on August 14, 2013, with Juliana Read, Ph.D. Dr. Read found that Therrien could communicate effectively and interact appropriately with others, could understand and remember all instructions and procedures, and could maintain attention and concentration. Dr. Read also found that Therrien could make simple decisions and tolerate stress in the work setting.

         Michael Schneider, Psy.D., a state agency psychologist, reviewed Therrien's records on August 15, 2013. Dr. Schneider found that Therrien had a severe anxiety disorder and a nonsevere affective disorder. Because of those issues, Therrien had mild restrictions in her daily activities and maintaining concentration, persistence, or pace, and moderate difficulties in maintaining social functioning. In assessing Therrien's specific functions, Dr. Schneider found no limitations or no significant limitations in most functions and moderate limitation in her ability to interact appropriately with the general public. Dr. Schneider's opinion was that Therrien would be able to work without problems from psychological symptoms except that she should not work directly with the public.

         Because of complaints of back, knee, and hip pain, Dr. Brian Klagges ordered an MRI for Therrien in December 2013. The results were completely normal. Dr. Klagges wrote that he had no explanation for Therrien's complaints of pain.

         Therrien had gastric bypass surgery on December 23, 2013. In February 2014, Therrien saw Dr. Klagges because of debilitating back pain and pain radiating to her right knee. Dr. Klagges noted Therrien's described pain and that the pain had not been controlled by other treatment. ...

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