Opinion ID: 2982946
Heading Depth: 3
Heading Rank: 1

Heading: Mental Health Impairments

Text: Winn reports a long family history of depression, with multiple family members who committed suicide. She testified that she was diagnosed as being manic depressive in her twenties, and that she was more recently diagnosed as bipolar. With respect to her symptoms, Winn reports having erratic mood swings and bouts of depression that cause her to isolate herself from other people and to have difficulty getting out of bed and eating. During these bouts of depression, Winn stays in her apartment all day, avoids contact with other people, and stops maintaining her hygiene (she has gone nearly two weeks without bathing). She testified that she hears voices saying negative statements to her, like that she is going to die. 3 No. 14-3499 Winn’s medical records indicate that she has suffered from symptoms including insomnia, irritability, agitation, paranoia, anxiety, loss of interest in activities, episodic mood swings, difficulty controlling her anger, and occasional suicidal thoughts. Her medical records also indicate that the severity of these symptoms waxes and wanes. At an initial diagnostic assessment performed on July 8, 2009, Winn was diagnosed with depressive disorder and alcohol abuse. She was assigned a Global Assessment of Functioning (“GAF”) score of 55 and was referred for counseling and psychotherapy at Daymont Behavioral Health Services (“Daymont”).1 Following this assessment, Winn attended regularly scheduled appointments with both a psychologist and psychiatrist. She was prescribed psychotropic medication in mid-2009. As of December 14, 2010, Winn was taking three psychotropic medications: Depakote, Lexapro, and Xanax. Treatment notes from Daymont throughout 2009 and 2010 indicate that Winn continued to suffer from depression and anxiety during this time period, despite making progress and experiencing sporadic improvements.
On March 5, 2009, prior to beginning her psychological treatment, Winn was examined by psychologist Mary Ann Jones at the request of the Bureau of Disability Determination. State agency psychologist Kristen Haskins reviewed the record on March 24, 2009 and evaluated Winn’s mental functioning capabilities. 1 The GAF scale rates an individual’s “overall psychological functioning” from 0 to 100 at a given moment in time. This scale is meant to reflect an individual’s “psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness.” Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision at 34. An individual with a score of 51-60 is classified as having “moderate symptoms . . . or moderate difficulty in social, occupational, or school functioning.” Id. 4 No. 14-3499 Dr. Jones determined that Winn suffers from dysthymic disorder, generalized anxiety disorder, and psychological factors affecting her physical condition. She assigned Winn a GAF score of 55 and determined that: Ms. Winn’s mental ability to relate to others, including fellow workers and supervisors, is moderately impaired by her depression, anxiety, and her preoccupation with her medical limitations. She would be unable to relate sufficiently to coworkers and supervisors on any sustained basis (for two or more hours at a time), even to perform simple, repetitive tasks . . . . Ms. Winn’s mental ability to understand, remember, and follow instructions is moderately impaired, and this is more so by her overall psychological condition than any cognitive limitations . . . . Her mental ability to withstand the stress and pressures associated with day-to-day work activity is judged as moderately impaired. Ms. Winn shows moderate mental limitations in the areas of relating and comprehension because of her depression, anxiety, and preoccupation with her medical limitations. (R. 6, Certified Administrative Record, Page ID # 477.) Dr. Haskins reviewed Winn’s record and completed a mental residual functional capacity assessment. Dr. Haskins found that Winn was “markedly limited” in her “ability to interact appropriately with the general public.” (Id. at 500.) She determined that Winn was “moderately limited” in her “ability to complete a normal workday and workweek without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods.” (Id.) She also found Winn to be “moderately limited” in her: (1) “ability to respond appropriately to changes in the work setting,” (2) “ability to understand and remember detailed instructions;” (3) “ability to carry out detailed instructions;” (4) “ability to maintain attention and concentration for extended periods;” and (5) “ability to work in coordination with or proximity to others without being distracted by them.” (Id. at 499500.) 5 No. 14-3499 Following her review of the record, Dr. Haskins concluded that Winn “would be able to perform [simple repetitive tasks and] follow 1-2 step instructions in a static and non-public environment and [without] strict production or time demands.” (Id. at 501.) She also found that “[Winn] would be able to interact [with] others minimally and superficially.” (Id.) On September 15, 2009, state agency psychologist Alice Chambly reviewed the record and affirmed Dr. Haskins’ findings.
Winn began seeing psychiatrist Amparo Wee, M.D. in mid-2010, after her previous psychiatrist retired. In her interrogatories, Dr. Wee concluded that it was not “reasonably probable” that Winn “has been capable of functioning at a high enough level” to: (1) “respond appropriately to supervision, co-workers and customary work pressures;” (2) “withstand the pressure of meeting normal standards of work productivity and work accuracy without significant risk of physical or psychological decompensation or worsening of her physical and mental impairments;” (3) “sustain attention and concentration on her work to meet normal standards of work productivity and work accuracy;” (4) “understand, remember and carry out simple work instructions without requiring very close supervision;” (5) “behave in an emotionally stable manner;” (6) “maintain concentration and attention for extended periods (approximately 2 hour segments);” (7) “respond appropriately to changes in a routine work setting;” (8) “get along with co-workers or peers without unduly distracting them or exhibiting behavior extremes;” (9) “sustain ordinary routine without special supervision;” (10) “work in coordination with, or in proximity to, others without being unduly distracted by them;” or (11) “accept instructions and respond appropriately to criticism from supervisors.” (Id. at 702-06.) 6 No. 14-3499 Additionally, Dr. Wee opined that Winn had marked restriction in the activities of daily living, marked difficulties in maintaining social functioning, and marked “deficiencies of concentration, persistence or pace, resulting in failure to complete tasks in a timely manner (in work settings or elsewhere).” (Id. at 706-707.) According to Dr. Wee, Winn’s ability to “understand, remember and carry out detailed, but not complex, job instructions” was fair and her ability to “understand, remember and carry out simple job instructions” was good. (Id. at 709.)