Opinion ID: 2973424
Heading Depth: 3
Heading Rank: 1

Heading: MPA Group Records

Text: Beginning in April 2000, Kornecky visited social workers, therapists, and case managers at the MPA Group. In April 2000, Kornecky saw social worker Alison Hartman three times, complaining of isolation because she did not have a phone or a car and describing her living -9- No. 04-2171 Kornecky v. Comm’r of Soc. Sec. environment as stressful. She reported that she cooked, read, played solitaire, and helped her mother with yardwork and housework. Hartman observed agitated motor activity and pressured speech and described Kornecky as “suspicious” and “domineering.” Hartman’s summary stated, “She states her belief that she is reliable, responsible, energetic and enthusiastic, but projects most limitations on others. Because of her limited insight and cognitive distortions, short term prognosis is guarded and long-term prognosis is uncertain because it is unclear how entrenched her problems are.” Hartman diagnosed generalized anxiety disorder (“GAD”)4 and could not rule out post- 4 One authoritative definition sets out six criteria for diagnosing GAD: The essential feature of Generalized Anxiety Disorder is excessive anxiety and worry (apprehensive expectation), occurring more days than not for a period of at least 6 months, about a number of events or activities. (Criterion A). The individual finds it difficult to control the worry. (Criterion B). The anxiety and worry are accompanied by at least three additional symptoms from a list that includes restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension, and disturbed sleep . . . (Criterion C). The focus of the anxiety and worry is not confined to features of another Axis I disorder such as . . . Panic Disorder . . . Social Phobia . . . Obsessive-Compulsive Disorder . . . and the anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder (Criterion D). Although individuals with [GAD] may not always identify the worries as “excessive,” they report subjective distress due to constant worry, have difficulty controlling the worry, or experience related impairment in social, occupational, or other important areas of functioning (Criterion E). The disturbance is not due to the direct physiological effects of a substance (i.e., a drug of abuse, a medication, or toxin exposure) or a general medical condition and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder (Criterion F). AM. PSYCHIATRIC ASS’N, DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS 472-73 (4th ed., Text Revision 2000) (“DSM-IV-TR”). - 10 - No. 04-2171 Kornecky v. Comm’r of Soc. Sec. traumatic stress disorder.5 She recommended at least three months of individual therapy to help Kornecky develop self-esteem and autonomy, which would improve her chances of finding a job and a place to live. Kornecky attended eleven therapy sessions from April through July 2000, and social workers opined that she had somewhat improved her self-worth. Kornecky chose to discontinue therapy. About two years later, in July 2002, Kornecky re-established contact with MPA at the request of her guardian ad litem,6 who thought she needed mental-health services to deal with paranoia and confusion. Case manager Tammy Ewald gave Kornecky a Global Assessment of 5 The essential feature of PTSD is the development of: characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criterion A1). The person’s response to the event must involve intense fear, helplessness, or horror . . . (Criterion A2). The characteristic symptoms . . . include persistent reexperiencing of the traumatic event (Criterion B), persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (Criterion C), and persistent symptoms of increased arousal (Criterion D). The full symptom picture must be present for more than 1 month (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). DSM-IV-TR at 463. 6 On March 20, 2002, a Michigan state court for the 18th Judicial Circuit issued a consent order that dismissed an order to show cause that was related to Kornecky’s failure to pay child support. The judge wrote, “The Plaintiff agrees to appointment of a guardian ad litem to assist her in any social security or disability claim.” - 11 - No. 04-2171 Kornecky v. Comm’r of Soc. Sec. Functioning (“GAF”) 7 score of 40-45. Ewald also noted that Kornecky had a “sketchy and erratic history of emotional problems,” tended to isolate herself, blamed others for all her problems, and refused to make changes to improve her situation. Kornecky initially refused mental-health services but later called to schedule an appointment, stating that the judge at her SSI court hearing ordered her to receive mental health treatment. Between September and November 2002, Kornecky visited (1) social worker Ewald, with whom she discussed housing, transportation support, and a therapy referral, and (2) therapist Patricia Straney, with whom she discussed stress related to family and her home environment. Straney stated that Kornecky found her living environment stressful but declined help with moving to her own residence. In January 2003, the MPA Group closed Kornecky’s case after she cancelled an appointment and made no further contact with the group.