Opinion ID: 222918
Heading Depth: 2
Heading Rank: 1

Heading: Medical and Employment History

Text: At the time that she filed applications for Social Security Disability (“SSD”) and Social Security Income (“SSI”), Claimant Christine Monateri was a 47-year old woman, who had a history of semi-skilled sedentary work and was a high school graduate with one year of college and a No. 09-4524 certificate in accounting. Prior to her disability onset date, Monateri worked steadily as a secretary, an accounts receivable clerk and a collections clerk. In February 1999, Monateri had what she describes as a “breakdown” and was hospitalized. After her release, she returned to work at her then-employer Morrison Products, where she remained until November 1999, when she had a second breakdown. At that time, she was terminated from her job at Morrison. In February 2000, Monateri began mental health treatment at Pathways Mental Health Center in Mentor, Ohio. She was initially assessed by psychiatrist Dr. Farid Sabet, whose notes document his impression that Monateri suffered from panic disorder and dysthymia (chronic low-grade depression). It appears from the record that Monateri was already taking Xanax (alprazolam), an anti-anxiety agent, and Prozac (fluoxetine), an anti-depression medication, when she saw Dr. Sabet. He maintained her on the Prozac, but switched her from Xanax to Klonopin (clonazepam). A month later, on March 3, 2000, Monateri’s prescription for Prozac was replaced with one for Paxil (paroxetine), a selective serotonin reuptake inhibitor (SSRI). In June 2000, Dr. Kurt Bertschinger, also a psychiatrist at Pathways, began to treat Monateri for her mental disorders. At that time, Dr. Bertschinger completed a “Mental Functional Capacity Assessment” on Monateri, wherein he found her “moderately limited” in 16 of 20 listed work-related areas. He also offered an assessment that she was “unemployable” and that her limitations were expected to last between nine and eleven months. It appears that Monateri’s condition worsened over the next several months, and by August 2000, Dr. Bertschinger noted the presence of major depressive disorder and generalized anxiety 2 No. 09-4524 disorder. Dr. Bertschinger noted that Monateri’s condition was improved by the medication, but that her “major life stressors” were continuing. Dr. Bertschinger continued to treat Monateri throughout January 2001, during which time he made several adjustments to her medication. In July 2001, Monateri had a “psychological consultive examination” with Pathway’s Dr. Kenneth Felker.1 Dr. Felker diagnosed Monateri with depressive disorder, polysubstance abuse (in remission), and panic disorder without agoraphobia. He concluded that Monateri was impaired in her ability to concentrate, carry out tasks, and relate to others. He also opined that her ability to relate to work peers and supervisors and to tolerate the stress associated with employment was “mildly to moderately” impaired. The condition of Monateri’s mental health, and the severity of her symptoms, fluctuated throughout 2001. At times, Monateri is noted as having decreased tearfulness, brighter affect, and decreased symptoms of depression, anxiety and panic; at other times, she is noted as “doing okay but not great,” suffering from “periods of depression,” and experiencing “hypomanic episodes;” and her response to treatment is noted as ranging from “partial” to “fair.” The record is silent on Monateri’s medical treatment between December 2001 and February 2003, when Pathway’s psychiatrist Dr. Thomas Svete took over Monateri’s care.2 Dr. Svete’s impression was that Monateri suffered from panic disorder and agoraphobia, and post-traumatic stress disorder and alcohol dependence “by history.” Monateri’s condition appears to have worsened 1 Dr. Felker appears to be a psychologist, but the record is unclear. 2 Though Monateri has supplied no medical records for the period between December 2001 and February 2003, it is clear that she was seen by at least one other physician in this intervening time frame, a Dr. Immerman. 3 No. 09-4524 throughout 2003, with Dr. Svete noting that she was “not doing well” and was “severely impaired.” Dr. Svete rated her level of impairment as ranging from a 5 to a 7 (on a scale of 10). Dr. Svete completed an “Assessment of Ability to Do Work-Related Activities (Mental)” created by Monateri’s attorney on June 11, 2003.3 On this form, Dr. Svete indicated that Monateri showed “marked impairment” in her ability to: conduct daily activities; maintain concentration and attention for extended periods; sustain a routine without special supervision; perform activities within a schedule, maintain regular attendance, and be punctual; respond appropriately to co-workers; respond to customary work pressures; and respond appropriately to changes in the work setting. He indicated lesser, but still present, limitations in several other categories, including Monateri’s ability to: relate to people; maintain personal habits; understand, carry out, and remember instructions; respond to supervision; use good judgment; perform complex, repetitive, or varied tasks; and behave in an emotionally stable manner. Dr. Svete further opined that Monateri’s condition would be exacerbated by a stressful work environment, and that she might be absent from work as many as three days per week. On January 7, 2004, Dr. Svete reported that Monateri informed him that she was abusing opiates, and requested admission to a drug detoxification program. On January 10, 2004, Monateri was admitted to Rosary Hall at St. Vincent Charity Hospital for medically supervised opiate and benzodiazepine withdrawal. In addition to abusing her prescribed Xanax, Monateri admitted to abusing Oxycontin, a controlled opiate. Monateri was admitted to Huron Hospital a week later after 3 Dr. Svete reconfirmed this assessment on October 8, 2006. 4 No. 09-4524 her discharge from Rosary Hall, for symptoms related to her mental disorders and because she had relapsed on Xanax. Dr. Svete continued to treat Monateri throughout early 2004 and by May, when Monateri continued to show improvement, had decreased all of her medications. At that time, he reported that Monateri was “doing extremely well,” attending alcoholics anonymous (“AA”) meetings, and had been drug (abuse) free for 60 days. He opined that her conditions were “in early remission” with the exception of her anxiety. By June of 2004, Dr. Svete’s assessment was that Monateri was “mildly ill.” In August of 2004, Monateri was again admitted to Rosary Hall for drug detox, after relapsing on Oxycontin.4 In September 2004, Monateri began working full-time as an accounts receivable/collections clerk at Cintas Corporation. On January 26, 2005, Monateri reported to Dr. Svete that the pressure of the job was causing a recurrence of her mental health symptoms. She reported increased anxiety, and also admitted that she had begun abusing Oxycontin again. In addition to his normal treatment, Dr. Svete suggested at this time that Monateri enter therapy and take only prescribed medications. On March 13, 2005, Monateri was admitted to Laurelwood Hospital for polysubstance detox and symptoms of affective disorder. Hospital records report that Monateri was abusing Oxycontin and Vicodin, in addition to taking her prescribed medications: Zyprexa, Trazodone, and Neurontin. 4 On each occasion that Monateri was admitted to drug detox, she was also treated for her mental disorders. 5 No. 09-4524 Monateri remained at Laurelwood until March 23, 2005. At that time, she was informed by Cintas that she had been terminated from her position. By April 2005, Monateri had begun therapy and was regularly attending AA meetings. Dr. Svete reported that Monateri was addressing her “dishonesty/manipulation regarding drug abuse” in therapy. He referred her for additional treatment to Neighboring Clinical Services Dual Diagnosis Team, which specializes in treating patients with both mental health and substance abuse disorders. Katherine Proehl, Monateri’s treating clinician at Neighboring,5 diagnosed Monateri with drug dependence in partial remission and anxiety disorder. Proehl also noted that Monateri’s external stressors were severe and that she was “moderately” mentally ill. In July 2005, Monateri was again admitted to Laurelwood Hospital for drug detox. Monateri admitted that she “just started using pain pills again, [though she] knew it was wrong.” On August 8, 2005, Laurelwood discharged her, conditioned on “completion of her detoxification and developing motivation addressing her chemical dependency.” On October 4, 2005, Monateri reported to Dr. Svete that she had begun abusing codeine-based cough syrup given to her by a friend. A month later, she reported that she had begun to use Percocet, also provided by a friend. Monateri’s mental health condition continued to vacillate throughout late 2005 and early 2006. At all times she showed symptoms of anxiety and depression, which were exacerbated by the pressure that she reported feeling due to her employment search. In April and May 2006, Proehl noted that Monateri had started taking a computer class at school, but that she was also still abusing Xanax and other medications from friends. Monateri 5 Katherine Proehl is a doctor of nursing. 6 No. 09-4524 reported that she liked school and that she was fine during the mornings, but felt increased anxiety in the afternoons. In June and July, Proehl reported that Monateri was “job hunting” and that she was doing well “with structure and cognitive interactions.” In December, Proehl reported that Monateri had worked for 3 days at a temporary employment agency, and that Monateri admitted to continuing to abuse a friend’s Percocet. In Monateri’s last medical report, dated March 1, 2007, Proehl diagnosed Monateri as suffering from generalized anxiety disorder and drug abuse. At that meeting, Monateri informed Proehl that she had been Xanax-free for one month, but that she was still abusing Percocet. During the period of her disability, Monateri has resided with her mother, one of her two adult children, her brother or various friends. At her hearing before the ALJ, Monateri testified that since the onset of her disability she has had very little social interaction, interest in few hobbies, an inability to sustain interest in activities or mental concentration, and marked anxiety in everyday social interactions. Monateri also conceded during testimony that she did not admit her drug abuse to Dr. Svete or anyone at Pathways until January 2004, although it began sometime before March 1, 2002.6 (R. 544-46: Ex. 22F.)