Opinion ID: 854868
Heading Depth: 3
Heading Rank: 1

Heading: Treatment history

Text: After working as an assistant manager in an auto parts store for more than 20 years, Gayheart quit in September 2005 because he was suffering daily panic attacks in the workplace that lasted up to 15 minutes at a time. He had been taking prescription medication to treat depression, anxiety, and panic attacks since 2000. Sweating, shaking, dizziness, shortness of breath, and an accelerated heart rate accompanied the panic attacks, and Gayheart’s supervisor had to drive him home on several occasions after Gayheart suffered such attacks. Gayheart also regularly drank several “beers,” varying from as many as six to as few as two, every night since he was 22 years old. Soon after quitting work, Gayheart sought treatment from Jackie Thompson, a psychological therapist. Gayheart reported daily panic attacks, headaches, nervousness, decreased sex drive, social anxiety, and sleeping difficulties to Thompson, who diagnosed him as having a generalized anxiety disorder and a panic disorder without agoraphobia (a fear of public places), with a differential diagnosis of bipolar disorder. Thompson assigned Gayheart a Global Assessment Functioning (GAF) score of 42, No. 12-3553 Gayheart v Commissioner of Social Security Page 3 indicating that Gayheart’s overall physiological functioning reflected severe symptoms or serious impairment in social or occupational functioning. See White v. Comm’r of Soc. Sec., 572 F.3d 272, 276 (6th Cir. 2009) (explaining the import of GAF scores); American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Text Revision 34 (4th ed. 2000) (noting that GAF scores between 41 and 50 indicate serious symptoms). Gayheart had seven therapy sessions with Thompson from October 2005 to February 2006, at which point Thompson’s practice no longer accepted the medical insurance of Gayheart’s wife. Thompson reported in January 2006 to the Social Security Administration’s Bureau of Disability Determination that Gayheart suffered from bipolar disorder and a generalized anxiety disorder, that his tolerance for stress was extremely low, and that his depression, mood swings, verbal aggression, frustration, and anxiety “interfere with [his] ability to function effectively.” Her report also described Gayheart’s poor concentration, slowness in processing information, and inability to be in public places or socialize in large crowds. Gayheart first saw psychiatrist Alice Onady in mid-November 2005 and continued seeing her through the point of the ALJ’s final hearing in February 2009. Dr. Onady diagnosed Gayheart’s condition as a panic disorder, with bipolar II as a differential diagnosis. She also noted antisocial traits and assigned Gayheart a GAF score of 50, which is in the range of serious symptoms or impairments. Dr. Onady was aware of Gayheart’s beer consumption and instructed him not to drink alcohol with any of the antidepressant and anti-anxiety medication that she prescribed. Her diagnoses reflected clinical observations of depression, anxiety, isolation, and socially phobic behavior. Like Thompson, Dr. Onady completed a report for the Bureau of Disability Determination. Her diagnoses in that report, dated May 2006, were panic disorder, bipolar disorder, and mixed personality disorder (paranoid). She noted Gayheart’s poor concentration and memory, his decreased cognitive function, and his anxious, nervous, and edgy affect. Also noted were his poor abilities to handle simple and routine tasks No. 12-3553 Gayheart v Commissioner of Social Security Page 4 in a work setting, to interact socially, and to adapt to change. Six months later, Dr. Onady added diagnoses of pain disorder and “alcohol abuse in partial remission” in her interrogatory responses to the Social Security Administration’s Office of Hearings and Appeals. She rated Gayheart’s functional limitations as “marked” in the following three areas: (1) daily living, (2) social functioning, and (3) concentration, persistence, or pace. Dr. Onady also noted three episodes of decompensation (temporary exacerbations in the symptoms of an illness or disorder). Dr. Onady’s treatment notes continued to document diagnoses of panic disorder and bipolar II throughout her treatment of Gayheart, and she regularly modified his prescriptions of psychotropic medications. From November 2007 to February 2008, she diagnosed alcohol abuse and dependency, but this diagnosis does not appear in the notes from April through October of 2008. She added major depression to her diagnoses starting in April 2008. Gayheart noted that his visits to Dr. Onady were limited to approximately ten per year because that was the maximum number of visits his wife’s insurance policy would cover. Finally, Gayheart started treatment with Jennifer Fenske-Doyle, a psychological therapist in Dr. Onady’s medical-practice center, in September 2006 and continued treatment with her through October 2007. Fenske-Doyle’s initial diagnoses were bipolar II and panic disorder with agoraphobia. She assigned Gayheart a GAF score of 49. Her notes from 13 months of treating Gayheart provide considerable detail about the severity of the symptoms that Gayheart suffered and how they impacted his daily life. They reflect Gayheart’s description of the anxiety that he suffers from simply having to drive himself to and from his therapy sessions. The notes also reflect his avoidance of social situations, a loss of interest in hobbies, paranoid thinking, feelings of hopelessness, difficulties concentrating, and passive thoughts of suicide. At the end of her treatment sessions with Gayheart, Fenske-Doyle noted a recent increase in his alcohol consumption of upwards to six “beers” per day. Her last diagnoses were bipolar II and panic disorder with agoraphobia. She recorded that Gayheart’s current GAF score was 45 and that the highest it had been in the past year No. 12-3553 Gayheart v Commissioner of Social Security Page 5 was 49. According to Fenske-Doyle’s final assessment, Gayheart’s severe anxiety and panic disorder had not improved over the course of treatment.